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A six year old girl comes to your office for her annual check up. On physical examination, you note a normal S1 and S2 as well as a soft systolic murmur with a vibratory character, heard best over the right upper sternal border. You suspect an innocent murmur, but her mother asks if she should be referred to a cardiologist.

Each of the following findings would support the diagnosis of a pathological murmur EXCEPT:

A. the murmur occurs in diastole
B. the murmur is associated with a thrill
C. the murmur is louder in the supine position and softer when the child sits upright
D. the child has mild finger clubbing
E. there is a loud P2 component of the second heart sound

????
 

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Excellent question - I know nothing about innocent murmurs - can someone explain the reasoning - ie: what happens to blood flow etc etc...
 
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