A 32-Year-Old Paramedic Comes to the Office for a Routine

A 32-year-old paramedic comes to the office for a routine health maintenance examination.  He has had headaches for the past several months as well as episodes of nosebleeds.  He has no other medical problems.  The patient does not use tobacco or illicit drugs but drinks 1 or 2 cans of beer daily.  He has no family history of heart failure or sudden death.
Temperature is 36.1 C (97 F) ; blood pressure is 188/96 mm Hg in the right arm, 184/94 mm Hg in the left arm, and 114/76 mm Hg in the right leg; pulse is 68/min, and respirations are 14/min.  Height is 180 cm (5 ft 11 in) .  Examination reveals no audible carotid bruits.  There is a 2/6 mid-systolic murmur heard at the left sternal border as well as a continuous "rumbling" sound heard in the back over the interscapular area.
Diagnostic testing is most likely to demonstrate which of the following findings?

A) Atrial septal defect
B) Bicuspid aortic valve
C) Pulmonic stenosis
D) Right ventricular dysplasia
E) Wolff-Parkinson-White syndrome

Correct Answer:

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