USMLE Step 2 - Question 11

A 82 year old male with a history of recent aortic valve replacement, hypertension, and diabetes presents to the emergency department with fevers for 5 days. No chest pains or shortness of breath are present. His medications include lisinopril, hydrochlorothiazide, aspirin, and coumadin. His temperature is 38.4 C, blood pressure is 160/60, heart rate 100, respirations 20, and oxygen saturation 99% on room air. Physical examination reveals normal lung sounds, a II/IV early diastolic decrescendo murmur, and a very soft 1st heart sound.  Laboratory studies reveal a white blood cell count of 15 thousand and an ESR of 110. A portion of his ECG is below. Which of the following is causing his abnormal finding on his ECG?

Step2-Q11-PIC1

A. Aortic valve endocarditis

B. Aortic valve regurgitation

C. Aortic valve annular abscess

D. Aortic valve stenosis

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