The Daily PANCE and PANRE Question 79

During a sports 'screening physical' examination, a 15 year-old male is noted to have a murmur. You perform bedside maneuvers in an attempt to delineate which type of murmur you are auscultating. Which of the following would be the finding associated with the highest risk of sudden death for this patient? A. the intensity of the murmur increases during a valsalva maneuver B. the intensity of the murmur decreases during standing C. the murmur does not change while the patient squat D. the intensity of the murmur decreases during exercise E. elevation of the legs while the patient is supine increases the intensity of the murmur Answer:A Hypertrophic cardiomyopathy (most common cause of sudden cardiac death in this age individual) would have a systolic ejection murmur which would INCREASE with valsalva (decreased preload causing a smaller LV volume and an increase in the obstruction) The murmur would DECREASE with squat or elevating the legs (increase preload, make the LV volume larger and decrease the obstruction) Help Support The Physician Assistant Life for FREE! This is provided as an opportunity for anyone who appreciates this email series to help support it painlessly. If you are going to be purchasing anything from Amazon.com (books, school supplies, etc.) simply start your next Amazon.com purchase byclicking here... it's a free way for you to help support the cause! Justclick over to Amazon. Then, when you make your purchase, Amazon will send a portion of the proceeds to The Physician Assistant Life. The money goes toward paying for one-time and ongoing costs (like equipment, hosting, backup services, etc.). Thank you for supporting the site and keeping this content free! If you are studying for the PANCE or the PANRE I recommend theseReview Books.