USMLE Step 2 - Question 38

A 65 year old female with no prior past medical history presents to her primary care physician with increasing dyspnea on exertion, lower extremity edema, and a 20 pound weight loss in the past 3 months. She denies any chest pains. Her physical examination includes normal breath sounds, an early diastolic sound followed by a II/IV early diastolic murmur, and 1+ lower extremity edema. ECG shows left atrial enlargement. Which of the following is the most likely diagnosis?

A. Mitral valve stenosis

B. Aortic valve regurgitation

C. Left atrial myxoma

D. Tricuspid valve stenosis

This patient has a left atrial myxoma based on her symptoms and murmur consistent with mitral valve stenosis in the presence of weight loss. Also, she has a classic “tumor plop” on examination which occurs when the tumor moves in and out of the mitral valve inflow tract. Symptoms may include platypnea. Treatment is surgical excision.