QuestionSBA
QuestionChoice
This does not explain the murmur and is unlikely in a young patient.
10015650
e
Atherosclerosis
QuestionChoice
An ASD would cause a soft ejection systolic murmur, but this is unlikely to radiate to the carotids.
10015647
b
Atrial septal defect
QuestionChoice
The murmur described is likely aortic stenosis. The most common cause of aortic stenosis in a young patient is a bicuspid aortic valve. The fever is likely related to the URTI with the murmur being an incidental finding.
10015646
a
Congenitally bicuspid valve
QuestionChoice
Rheumatic fever is a less common cause of aortic stenosis in the UK. Rheumatic fever is classically associated with mitral stenosis.
10015649
d
Rheumatic fever
QuestionChoice
This is a more likely cause of aortic stenosis in an older patient.
10015648
c
Valvular calcification
QuestionComment
Mean question
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Derek
QuestionComment
For these questions just keep eliminating, and you are eventually able to get rid of all the other options. Literally whats getting me thru cardio atp
57025
QuestionComment
how do u eliminate rheumatic fever if they have a fever 
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Acute Kinin
QuestionComment
Cause of Mitral Stenosis and less common in Western populations
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Humerus H
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TheSecretSayer
QuestionComment
how do you find this on the BNF?
59370
QuestionComment
this is not a PSA mock hun
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Defibrillator Dominant
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Stasis Flutter
Concept
Chapter
# Summary

An ejection systolic murmur  (ESM)is described as a high-pitched, crescendo-decrescendo (*diamond shaped*), midsystolic murmur. The most common cause of an ESM is aortic stenosis. 

# Differentials for ejection systolic murmurs

* Aortic stenosis - loudest in aortic region and on expiration, radiates to the carotids. 
* Aortic sclerosis - loudest in aortic region and on expiration, no radiation. 
* Pulmonary stenosis - loudest in pulmonary region and on inspiration. 
* Flow murmur (anaemia, pregnancy, thyrotoxicosis)
* Hypertrophic obstructive cardiomyopathy
* Pulmonary stenosis
* Supravalvular aortic stenosis (Williams syndrome) 
625
656
Differentials of ejection systolic murmur
Topic
35
Cardiology
Video
Concept
656
Differentials of ejection systolic murmur
380
Uc4eAMD
images/videos/paediatrics.png
Tetralogy of Fallot
Condition
55
Aortic valve disease
UkmlaTopic
4
Cardiovascular
Condition
56
Aortic valve disease
UkmlaTopic
21
Perioperative medicine and anaesthesia
Condition
57
Aortic valve disease
UkmlaTopic
25
Surgery
15673
In young adults, an ejection systolic murmur radiating to the carotids is most commonly caused by a bicuspid aortic valve resulting in aortic stenosis.
Presentation
312
Heart murmurs
UkmlaTopic
4
Cardiovascular
A 24-year-old woman comes to the GP practice with a productive cough and fever. On examination, the GP hears an ejection systolic murmur which radiates to the carotids.

Given the diagnosis, what is the most likely aetiology?
a