question: Q:A 2-year-old girl is brought to the physician by her mother for a well-child examination. Cardiac auscultation is shown. When she clenches her fist forcefully for a sustained time, the intensity of the murmur increases. Which of the following is the most likely cause of this patient's auscultation findings?? 
  {'A': 'Prolapse of the mitral valve', 'B': 'Fusion of the right and left coronary leaflets', 'C': 'Defect in the atrial septum', 'D': 'Defect in the ventricular septum', 'E': 'Failure of the ductus arteriosus to close'},