Examkin

Question

Difficulty: EasyPhysical Examination Findings

A 75-year-old retired teacher comes to the primary care clinic reporting an episode of lightheadedness that resulted in a brief loss of consciousness while climbing stairs at his home. He reports no chest pain, palpitations, or shortness of breath at rest. His vital signs are within normal limits. Cardiac auscultation reveals a harsh, late-peaking systolic crescendo-decrescendo murmur at the right second intercostal space that radiates to the carotid arteries. Based on the most likely underlying diagnosis, which of the following peripheral pulse abnormalities is characteristically found on physical examination of this patient?

  1. Pulsus parvus et tardusAnswer
  2. B
    Pulsus paradoxus
  3. C
    Water-hammer pulse
  4. D
    Pulsus alternans
  5. E
    Bisferiens pulse

Answer

Pulsus parvus et tardus
The correct answer is pulsus parvus et tardus. The patient's clinical presentation of exertional syncope combined with a harsh, late-peaking systolic crescendo-decrescendo murmur that radiates to the carotids is the classic presentation of severe aortic stenosis. Due to the fixed obstruction at the aortic valve, the stroke volume is reduced and the ejection of blood is prolonged. This translates to the peripheral arteries as a pulse with a low amplitude (parvus, or weak) and a delayed peak (tardus, or late).

Step-by-Step Solution

1
Identify the patient's clinical syndrome and murmur.
The patient has exertional syncope and a harsh, late-peaking systolic murmur radiating to the carotids, which is highly indicative of severe aortic stenosis.
Recognizing the classic triad of aortic stenosis (syncope, angina, dyspnea) and its distinct murmur is the first step in diagnosis.
2
Determine the physical examination finding associated with this condition.
Severe aortic stenosis obstructs left ventricular outflow, resulting in a peripheral arterial pulse that has a decreased amplitude and a delayed peak.
Understanding the hemodynamic consequences of the valvular lesion allows for the deduction of peripheral physical signs.
3
Match the hemodynamic finding to the correct medical terminology.
A weak and delayed pulse is known clinically as pulsus parvus et tardus.
Standard medical terminology must be used to correctly answer the question.

Key Concept

The classic physical examination finding of the peripheral pulse in severe aortic stenosis is pulsus parvus et tardus (a weak and delayed upstroke).
Rate this question

Topics

Physical Examination Findings

More questions from this topic