NBME 18 Answers ↦
(13.5 difficulty score)
68 yo man, 3 days of increasingly severe deep ...
Adding on, hoarseness + difficulty swallowing means something is pushing on the recurrent laryngeal.
Murmur in the second right intercostal space = AR, AS, or Pulm regurg --> AR associated with thoracic aortic aneurysm, or at minimum, you can infer it's a cardiac etiology
The dyspnea, dysphagia, stridor, and cough are pretty indicative of a mediastinal mass. So expansion of the aorta can cause compression of the esophagus, trachea, recurrent laryngeal nerve, etc. depending on the severity of it.
You would not see a "viable pulsation above the manubrium, which you should not confuse with a "brisk carotid upstroke" associated with aortic stenosis.
"brisk carotid upstroke" is the description of a normal carotid pulse. Aortic stenosis has a slowly rising/late peaking upstroke since the stenosis impedes flow out of the LV.