American Board of Internal Medicine (ABIM) Certification Practice Exam

What could a continuous murmur in the posterior interscapular area indicate?

1. Aortic dissection

2. Coarctation of the aorta

3. Pulmonary hypertension

4. Aortic stenosis

The correct answer is: Coarctation of the aorta

A continuous murmur in the posterior interscapular area is most commonly associated with coarctation of the aorta. This condition typically involves a narrowing of the aorta, usually occurring just distal to the left subclavian artery. When blood flow is impacted by this narrowing, collateral circulation can develop, leading to an increase in blood flow through these collateral vessels, which often manifests as a continuous murmur. This murmur is classically heard in the posterior interscapular area due to the engagement of vascular structures that arise from the aorta and supply blood to the back. In contrast, the other options involve different pathophysiological mechanisms or locations for murmurs. Aortic dissection may present with a variety of sounds depending on the involvement of the aortic structure, but a continuous murmur in the interscapular area is not typically a hallmark of this condition. Pulmonary hypertension might create heart sounds or right-sided murmurs, but would not specifically result in a continuous murmur in this region. Aortic stenosis, while it does produce heart murmurs, typically results in a systolic ejection murmur rather than a continuous one and is usually best heard at the second right intercostal space or in