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Retired NBME 16 Answers

nbme16/Block 4/Question#11 (reveal difficulty score)
A 78-year-old man comes to the physician ...
Bacterial endocarditis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—maxillarythirdmolar(45)
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You should be thinking of something like Enterococcus. They had a GU procedure and subsequent cardiac issues.

When I hear soft S1, i think that the patient must have had a issue with the closing of either the mitral or tricuspid valves. Playing odds, this should be the mitral valve. You also here an early diastolic murmur, so you might be thinking volume overload (S3).

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baja_blast  You're almost certainly right that it's mitral valve endocarditis. The murmur is accentuated by Expiration, consistent with lEft-sided murmurs. On the other hand, rIght-sided murmurs are accentuated by Inspiration. Note the capital letters for a handy trick. God Bless Dr. Jason Ryan. +9
rahmanu  But the murmur is auscultated at the 2nd left intercostal space, isn't that aortic regurgitation (vulvular)? still a left sided murmur yes. +1
mkayman  @rahmanu aortic valve regurgitation would be heard on the 2nd RIGHT intercostal space. +
chaosawaits  Actually, an AR is best heard at the third intercostal space on the left side. Be mindful when they want to get tricky! +



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