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 Best of Five 219

 

   

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BOF: 219

A 24-year-old male presents with fatigue, poor exercise tolerance and loss of weight.  On examination he looks underweight, pulse rate of 120 beats per minute regular. The pulse volume decreases during inspiration.  His JVP is elevated 5 cms and the level increases during inspiration. On auscultation of the heart sounds an early diastolic sound is audible at the left sternal edge. On examination of the abdomen there is 4 fingerbreadths of hepatomegaly and ascites.

In this patient the early diastolic added sound is due to:

a)      Opening of a thickened atrioventricular valve

b)      Tumour plop

c)      Rapid ventricular filling

d)      Arrest of ventricular filling

e)      Pericardial crunch

 

 

 

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