[khanar]

I've seen a question where it described a child with grad 2/6 left sternal murmur and he was suffering from anemia also.
In the options there were innocent murmur and systolic flow murmur and so I picked innocent murmur.
It turns out to be wrong and I should have picked the systolic flow murmur.
What are your thoughts about this

 

[rasheed]

There's no difference

When answering USMLE questions put yourself in the question maker's shoes and see how he/she thinking.
When they hinted you about the anemia they surely wanted to pick the systolic flow murmur.
Nevertheless, I don't like this question and I don't think you'll see it in USMLE unless it was an experimental one. Because pathophysiologically speaking there's no difference between systolic flow murmur seen in anemia and the innocent murmurs seen in infection, anxiety, exercise, stress, and fever. In all of them the cause is merely a hyperdynamic circulation causing increased blood flow through normal vessels and channels.

However, do pay attention to venous hums and pulmonary flow murmurs as they are clinically different from the aforementioned.