question: Q:A 52-year-old woman comes to the physician because of a 3-month history of worsening chest pain and breathlessness during exercise. She has no history of serious illness and takes no medications. Vital signs are within normal limits. Auscultation of the chest shows a murmur in the 2nd right intercostal space. A phonocardiogram of the murmur is shown. Which of the following is the most likely underlying cause of this patient's symptoms?? 
  {'A': 'Metastatic valvular calcification', 'B': 'Congenital leaflet fusion', 'C': 'Cystic medial necrosis', 'D': 'Sterile platelet thrombi formation', 'E': 'Viridans group streptococci infection'},