nbme 2 block 1 q 39 - zbest

[ArchivalUser]

A 72 year old woman has an episode of acute substrenal chest pain while running to catch a bus...she has basilar crackes at both lung bases..S1 is normal while S 2 is dec..systolic murmur at upper rt sternal border radiates to the neck
LV volume
BP EDV ESV HR
control 130/70 140 50 85
exercise 160/80 165 58 120


while exercise pt has shortness of breath w/o substernal chest pain..what is the cause


1. dec CO during exercise
2 dec pulm blood flow
3 inc Aortic pressure
4 inc end diastolic pressure of LV during exercise
5.. tachycardia



right answer is 4

can plz somebody explain why?
thanks

[ArchivalUser]

pt hs systolic murmur...so hving AS.....SUBSTERNAL CHEST pain z dt AS...so decr aortic-> carotid blood supply-> angina...
nw during ex ...coz sympathetic stimulation....vaso constr......incr pre load....n so EDV.....INCR sv...co

[ArchivalUser]

zbest where can i get the answers to the tests

[ArchivalUser]

histocell i downloaded nbme forms from this forum they are w/ answers