USMLE PRACTICE QUESTION OF THE WEEK
Question for November 21, 2025
A 66-year-old man is evaluated during a routine visit. He reports exertional fatigue but no chest pain or syncope. He has long-standing hypertension and hyperlipidemia. Temperature is 36.8°C (98.2°F), blood pressure 142/58 mm Hg, pulse 72/min. Cardiac exam reveals a high-pitched, blowing, early diastolic decrescendo murmur best heard along the left sternal border with the patient sitting up, leaning forward, and holding breath in end-expiration. There is bounding carotid pulse and a wide pulse pressure.
Which of the following valvular abnormalities is most likely present?
Which of the following valvular abnormalities is most likely present?
Correct Answer:
C. Aortic regurgitation
Correct Answer Explanation:
Aortic regurgitation causes a high-pitched, early diastolic decrescendo murmur at the left sternal border that increases with leaning forward and expiration. Physical findings include wide pulse pressure and bounding pulses. Aortic stenosis produces a crescendo–decrescendo systolic murmur at the right upper sternal border. Mitral stenosis yields a low-pitched diastolic rumble at the apex. Mitral regurgitation is holosystolic at the apex radiating to the axilla. Pulmonic regurgitation is best at the left upper sternal border and often softer.
Further Insight:
- Chronic AR may cause LV dilation and systolic dysfunction; afterload reduction can help symptoms.