need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (โ€œpredict me!โ€)

Retired 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

 Login (or register) to see more


 +2  upvote downvote
submitted by โˆ—cheesetouch(250)
get full access to all contentpick a username

2 months old w/ holosystolic LLSB murmur -- ONLY holosystolic murmurs are mitral regurg, Tricuspid regurg, VSD PDA - continuous machine like murmur

get full access to all contentpick a username
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



 +2  upvote downvote
submitted by โˆ—an1(114)
get full access to all contentpick a username

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.

get full access to all contentpick a username



 +1  upvote downvote
submitted by โˆ—step7777(7)
get full access to all contentpick a username

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.

get full access to all contentpick a username



Must-See Comments from nbme18

feliperamirez on He is medically qualified to drive
anechakfspb on Tubular atrophy
aneurysmclip on Endothelial nitric oxide synthase production
azibird on 24,25-Dihydroxycholecalciferol
famylife on Increased transcription of HMG-CoA reductase
match95 on Plasmid loss
apurva on Antineoplastic
cbreland on Basement Membranes
match95 on Proximal tubule: isotonic; Macula densa: ...
sugaplum on Abnormal migration of endoderm from the ...
amirmullick3 on Myelofibrosis
merpaperple on Primary spermatocyte
wishmewell on Alpha-synuclein
namira on Greening reaction on blood agar

search for anything NEW!