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Chronic mitral regurgitation — USMLE Step 2 CK MCQ

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ModerateInternal MedicineChronic mitral regurgitationUSMLE Step 2 CK

A 45-year-old Middle Eastern man comes to the emergency department because of chest discomfort or shortness of breath. History and focused examination are notable for holosystolic apical murmur radiating to the axilla with dyspnea. Temperature is 99.1°F (37.3°C), blood pressure is 118/74 mmHg, pulse is 116/min, respirations are 26/min, and oxygen saturation is 89% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most appropriate initial diagnostic study?

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Correct answer: A — Transthoracic echocardiography

The vignette describes Chronic mitral regurgitation, supported by holosystolic apical murmur radiating to the axilla with dyspnea. Transthoracic echocardiography is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: ACC/AHA 2020 Valvular Heart Disease Guideline