A 17-year-old male is presenting for evaluation of a systolic mitral murmur found by the school nurse during a routine visit. The patient is not complaining of any symptoms. The accompanying mother refers that the patient has hypermobility of the joints, “just like his father”.

Indeed, on physical examination, you are able to apposition the thumb to the flexor aspect of the forearm and to hyperextend the elbow more than 10° (see Figures).

You are also able to stretch the skin more than 4 cm on the dorsum of the forearm.

His cardiac examination reveals an ejection click followed by a systolic murmur suggestive of mitral regurgitation.

Answer Options:

Marfan syndrome

Loeys-Deitz syndrome

Ehlers-Danlos syndrome

Normal adolescent

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