USMLE Step 2 - Question 43

A 45 year old prostitute presents to the emergency department with increased shortness of breath and lower extremity edema slowly worsening over a few months. Her temperature is 37.2, blood pressure 140/60, heart rate 100, and respirations 20. Physical examination reveals a II/IV short early diastolic murmur at the right upper sternal border loudest in end-expiration while having her lean forward. Laboratory studies are normal. Which of the following is the most likely diagnosis?

A. Bicuspid aortic valve

B. Aortic valve endocarditis

C. Aortic dissection

D. Syphilitic aortitis