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NBME 16 Answers

nbme16/Block 4/Question#11 (16.3 difficulty score)
A 78-year-old man comes to the physician ...
Bacterial endocarditis🔍,📺
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 +6 
submitted by maxillarythirdmolar(40),
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hWne I rhea tosf S,1 i hinkt tath eth nttepia ustm heva dah a ssiue ithw the cnsiglo fo rieeth the itraml ro dpctirisu .sveval ygPilna sdo,d hist ohlsud be het irmlat v.evla uoY also eehr na yarel tlidcsoai ur,rmum os uyo gmhti eb hnigtkni vmoelu edrvolao (S).3

baja_blast  You're almost certainly right that it's mitral valve endocarditis. The murmur is accentuated by Expiration, consistent with lEft-sided murmurs. On the other hand, rIght-sided murmurs are accentuated by Inspiration. Note the capital letters for a handy trick. God Bless Dr. Jason Ryan. +8  
rahmanu  But the murmur is auscultated at the 2nd left intercostal space, isn't that aortic regurgitation (vulvular)? still a left sided murmur yes. +1  
mkayman  @rahmanu aortic valve regurgitation would be heard on the 2nd RIGHT intercostal space. +  
chaosawaits  Actually, an AR is best heard at the third intercostal space on the left side. Be mindful when they want to get tricky! +