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NBME 18 Answers

nbme18/Block 2/Question#47 (reveal difficulty score)
A 2 month old boy is brought to the physician ...
ventricular septal defect ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: cardio repeat heart_sounds

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submitted by โˆ—cheesetouch(249)
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2 months old w/ holosystolic LLSB murmur -- ONLY holosystolic murmurs are mitral regurg, Tricuspid regurg, VSD PDA - continuous machine like murmur

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isaacyo94  But this was described as a BLOWING murmur. When I hear the buzzword BLOWING murmur, I think regurg. +1
djeffs1  can someone remind me what the functional murmur would look like? +
ih8payingfordis  Don't get distracted by "blowing" Holosystolic is the key here and from there you can get VSD because that's the most common congenital heart defect +1

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submitted by โˆ—an1(114)
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Holosystolic: MR, TR, or VSD

Lower left sternal border (the left border is Erb's point, beneath that is the Tricuspid area) --> TR or VSD

Whats more common? VSD (by far!!)

If they had mentioned the mum having BPD or taking pills for a psych disorder, then TR could be a big contender.

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submitted by โˆ—step7777(7)
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The location is what helped me out. Left lower sternal border is LV. Mitral regurg would be at apex, PDA would be machine like, coarctation would have weak distal extremity impulses, and patent foramen ovale would be upper sternal border. The only time I've ever heard of Tricuspid regurgitation is with IVDA, which I doubt is going on with the 2 month old boy unless the mom has the propensity to shoot him up and in that case he'd probably present with a fever anyways.

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