4 Months Of Progressive in Medicine / Internal Medicine — 55yo Woman | Cardiology | SMLE Q#11057
SMLE Question #11057
Medicine / Internal Medicine
Cardiology
Objective: OBJ-163
Last updated: February 2026
A 55-year-old woman with a 5-year history of interstitial lung disease presents with 4 months of progressive exertional dyspnea, bilateral leg swelling, and abdominal fullness. She is breathless after walking one block. Examination shows elevated jugular venous pressure, bilateral pitting edema, and tender hepatomegaly. Cardiac examination reveals a left parasternal heave and a loud pulmonary component of S2. Lungs have bibasilar fine inspiratory crackles. Which of the following is the most expected additional finding on heart auscultation?
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