nbme 1 - marphes101

[ArchivalUser]

6. A 37-year-old woman comes to the physician because of progressive shortness of breath over the past 5 years; she now has fatigue and shortness of breath with mild exertion. She has a history of mitral stenosis secondary to rheumatic fever at the age of 15 years. She was asymptomatic until 5 years ago when she developed severe shortness of breath during pregnancy. She was treated with diuretics, low-sodium diet, and bed rest, and she was able to deliver the baby at term. Her only medication is hydrochlorothiazide. Her temperature is 37 C (98.6 F), blood pressure is 110/80 mm Hg, pulse is 100/min and regular, and respirations are 26/min. Cardiac examination shows an obvious opening snap in S2. A grade 3/6, late diastolic murmur is heard at the apex. A right ventricular lift is palpated along the left sternal border. Which of the following is most likely increased in this patient?

A
) Blood flow to the lower lung fields

B
) Diastolic filling time

C
) Left-to-right shunt of blood

D
) Left ventricular end-diastolic pressure

E
) Pulmonary artery pressure

[ArchivalUser]

E pulmonary artery pressure .... ot has shortness of breath with rt parasternal heave .... mitral stenosis ... lt atrial hypertrpphy back flow of blood into the pulmonary circulation and finally rt heart strain leading to hypertrohpy ... therefore E