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Repeated USMLE Questions Step 1- 314

A 58-year-old man presents to the clinic with sudden weakness of his right arm. He also complains of progressive difficulty breathing on exertion, palpitations and a low grade fever during the last month. Examination reveals elevated jugular venous pressure, a loud S1 and mid-diastolic rumbling murmur hard on fifth intercostal space. Transesophageal echocardiography (TEE) confirms the diagnosis.

What is the most likely diagnosis?

A-Atrial thrombus

B-Atrial myxoma

C-Left ventricular wall aneurysm

D-Vegetative valvular lesions

Answer



This is most likely a case of atrial myxoma which causes a mid-diastolic murmur heard at the apex. Tumor causes low grade fever and neurologic deficits due to emboli. TEE is diagnostic. Atrial thrombus causes sudden dyspnea and palpitation and more progressive. Other options lead to different presentations.

The correct answer is B


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