@weidereviews: USMLE Step 1 Cardio/ USMLE USMLE Step 1 Cardio/ USMLE Step 2 IM Q 104 🫀 Correct answer: A. Aortic stenosis This patient has the classic findings of severe aortic stenosis: Harsh systolic murmur at the right upper sternal border Diminished carotid pulse = pulsus parvus et tardus Exertional chest pain + presyncope/light-headedness Aortic stenosis creates a fixed obstruction to LV outflow. During exercise, the heart cannot sufficiently increase cardiac output → decreased cerebral perfusion → light-headedness/syncope. The increased LV workload also causes hypertrophy and increased myocardial O₂ demand → exertional angina. Think: Aortic stenosis = SAD Syncope Angina Dyspnea ❌ B. Carotid sinus hypersensitivity: Syncope is usually triggered by neck pressure, shaving, tight collars, or turning the head. ❌ C. Coronary atherosclerosis: Can cause exertional angina, but does not explain the characteristic murmur and diminished carotid pulse. ❌ D. Orthostatic hypotension: Symptoms after standing make this tempting, but the major clues are exertional symptoms + classic aortic stenosis exam findings. ❌ E. Paroxysmal arrhythmia: Usually causes sudden episodic palpitations/syncope and would not explain the murmur or abnormal carotid pulse. High yield: elderly patient + RUSB systolic murmur + slow/weak carotid pulse = aortic stenosis.🫀 Correct answer: A. Aortic stenosis This patient has the classic findings of severe aortic stenosis: Harsh systolic murmur at the right upper sternal border Diminished carotid pulse = pulsus parvus et tardus Exertional chest pain + presyncope/light-headedness Aortic stenosis creates a fixed obstruction to LV outflow. During exercise, the heart cannot sufficiently increase cardiac output → decreased cerebral perfusion → light-headedness/syncope. The increased LV workload also causes hypertrophy and increased myocardial O₂ demand → exertional angina. Think: Aortic stenosis = SAD Syncope Angina Dyspnea ❌ B. Carotid sinus hypersensitivity: Syncope is usually triggered by neck pressure, shaving, tight collars, or turning the head. ❌ C. Coronary atherosclerosis: Can cause exertional angina, but does not explain the characteristic murmur and diminished carotid pulse. ❌ D. Orthostatic hypotension: Symptoms after standing make this tempting, but the major clues are exertional symptoms + classic aortic stenosis exam findings. ❌ E. Paroxysmal arrhythmia: Usually causes sudden episodic palpitations/syncope and would not explain the murmur or abnormal carotid pulse. High yield: elderly patient + RUSB systolic murmur + slow/weak carotid pulse = aortic stenosis.

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Thursday 20 August 2026 20:33:43 GMT