NBME 23 Atrial septal defect (NBME Answers)

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NBME 23 Answers

nbme23/Block 3/Question#27 (reveal difficulty score)
A 30-year-old man reports increasing fatigue ...
Atrial septal defect 🔍 / 📺 / 🌳 / 📖
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+16 upvote downvote
submitted by ∗sympathetikey(1600)

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Any time you see fixed wide splitting of S2, smash ASD.

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someduck3 I'm not 100% about this so take it with a grain of salt. But i was confused about why there would be a systolic murmur. I think its b/c prolonged ASD would eventually cause pulmonic stenosis which would present as a systolic murmur. But besides that I super agree with @sympathetikey +

need_answers https://www.youtube.com/watch?v=7hzabZ7YBr0 -smash, smash, smuh-ash +3

usmlecharserssss with airpods in 2012 +

paulkarr Low key was hoping for someone to try and argue this one... +

an1 I was stuck between Aortic insufficiency or ASD. I opted for ASD because Aortic insufficiency is usually referred to when there's aneurysm or something, leading to the valve being insufficient to close and causing regurgitation (which is a diastolic murmur). I've seen this word used mostly with regurgitation, just a thought +

+3 upvote downvote
submitted by ∗adong(144)

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If you're confused by the systolic murmur look at FA2019 p.288. ASD can cause systolic ejection murmurs in the pulmonic location (can think of it as increase turbulent flow).

Of course the more important thing is fixed splitting so SMASH away.

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+0 upvote downvote
submitted by ∗usmile1(154)

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Fixed wide split S2 is Atrial septal defect obvi.... But also ASD is associated with an early systolic ejection murmur heard at the Left Upper Sternal border (pulmonic area) the systolic murmur is not due to pulmonic stenosis

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