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NBME 27 Answers

nbme27/Block 3/Question#50 (reveal difficulty score)
A 52-year-old man comes to the emergency ...
Congenital bicuspid valve ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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submitted by โˆ—shak360(14)

Got this wrong because age matters in differentiating between age-related calcification and a bicuspid aortic valve for aortic stenosis.

Aortic stenosis is a

  • Crescendo-decrescendo systolic ejection murmur and soft S2 (ejection click may be present).
  • LV >> aortic pressure during systole.
  • Loudest at heart base; radiates to carotids.
  • โ€œPulsus parvus et tardusโ€โ€”pulses are weak with a delayed peak.

Can lead to Syncope, Angina, and Dyspnea on exertion (SAD). Most commonly due to age-related calcification in older patients (> 60 years old) or in younger patients with early-onset calcification of bicuspid aortic valve.

The patient in this question was 52 so it's more likely a congenital bicuspid valve.

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