This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Unknown
Which of the following is not a clinical sign associated with mitral stenosis? 
Select and explain. 
A. Malar flush, B. Atrial fibrillation, C. Pan-systolic murmur which radiates to axilla, D. Tapping, undisplaced apex beat
C: Pan-systolic murmur which radiates to axilla
Answer: C: Pan-systolic murmur which radiates to axilla 
Explanation: Malar flush, atrial fibrillation, and a tapping apex beat which occurs secondary to pulmonary hypertension, are all clinical signs associated with mitral stenosis. On auscultation of the precordium, a mid-
diastolic murmur (±opening snap, representing a mobile valve) is heard rather than a pan-systolic murmur which is
usually heard in mitral regurgitation, tricuspid regurgitation and ventricular septal defects.