Today we will discuss another Q74 Cardiology PLAB 1/ UKMLA exam question. This is a common topic that has appeared in the past PLAB 1 exam.

A 68-year-old woman with a history of hypertension and hyperlipidemia presents to the clinic with increasing fatigue and reduced exercise tolerance over the past six months. She denies chest pain, shortness of breath, and syncope. On physical examination, her blood pressure is 145/90 mmHg, heart rate is 70 beats per minute, and respiratory rate is 16 breaths per minute. Auscultation of the heart reveals a late peaking ejection systolic murmur with a harsh quality, heard loudest at the second right intercostal space and radiating to the carotid arteries. The murmur becomes softer when the patient performs a Valsalva manoeuvre. Which of the following is the SINGLE most likely diagnosis for this patient?

A. Aortic regurgitation

B. Aortic stenosis

C. Mitral regurgitation

D. Mitral stenosis

E. Tricuspid regurgitation

The correct answer is B.

Aortic stenosis is a common valvular heart disease in older patients and is often associated with reduced exercise tolerance, fatigue, and in severe cases, chest pain, shortness of breath, and syncope. This patient's age, history of hypertension, and hyperlipidemia put her at risk for developing aortic stenosis. 

A. Aortic regurgitation typically presents with an early diastolic murmur, heard best at the left sternal border, and is not consistent with this patient's presentation.

B. Aortic stenosis is characterized by a late peaking ejection systolic murmur with a harsh quality, loudest at the second right intercostal space, and radiating to the carotid arteries. The murmur becoming softer with the Valsalva maneuver further supports this diagnosis.

C. Mitral regurgitation presents with a holosystolic murmur, heard best at the apex and radiating to the left axilla, which is not consistent with this patient's presentation.

D. Mitral stenosis presents with a low-pitched, rumbling, mid-diastolic murmur, heard best at the apex in the left lateral decubitus position, which is not consistent with this patient's presentation.

E. Tricuspid regurgitation presents with a holosystolic murmur, heard best at the left lower sternal border and increasing with inspiration, which is not consistent with this patient's presentation.

Further reading: Patient.info

Checkout: Q75 Neurology PLAB 1 question

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