Valvular Heart Disease

Question 1

S1 Intensity increase in (2)

Answer 1

Early stages of rheumatic MS

Hyperkinetic States

Question 2

S1 becomes SOFTER in (2)

Answer 2

Late stages of MS

Contractile Dysfunction

Question 3

A2-P2 Interval unusually narrow

Answer 3

Pulmonary Hypertension

Question 4

A2-P2 Interval widened

Answer 4

Severe MR

Question 5

Fixed Splitting A2-P2 interval

Answer 5

ASD

Question 6

Reverse or Paradoxical Splitting of A2-P2 interval

Answer 6

Severe AS, HOCM, MI

Question 7

A2-P2 Interval INCREASES during

Answer 7

INSPIRATION

narrows with expiration

Question 8

Opening Snap

Answer 8

Mitral Stenosis

Question 9

Tumor plop

Answer 9

Atrial Myxoma

Question 10

Pericardial Knock

Answer 10

Constrictive Pericarditis

Question 11

Crescendo Mid-systolic Murmur

Answer 11

Aortic Stenosis

Question 12

Holosystolic Murmur

Answer 12

Mitral/Tricuspid Regurgitation

Question 13

Murmur of VSD

Answer 13

Holosystolic murmur at Left Lower Sternal Border (Tricuspid)

Question 14

Murmur of ASD

Answer 14

Systolic Ejection Murmur at 2nd ICS Left of Sternum (Pulmonic)

Question 15

All other murmurs diminishes with standing and valsalva maneuver except?

Answer 15

HOCM, MVP

Question 16

All other murmurs are louder when squatting except?

Answer 16

HOCM, MVP

Question 17

70/M with chest pain on exertion, SOB for 2 months. 1 episode of syncope. 3/6 midsystolic murmur at the 2nd ICS right sternal border. With weak and delayed pulse.

DIAGNOSIS?

Answer 17

Aortic Stenosis

Question 18

Cardinal Symptoms of AS

Answer 18

SYNCOPE
ANGINA
DYSPNEA

Question 19

Best initial test for AS/AR

Answer 19

Transthoracic Echocardiogram

Question 20

Treatment of choice for AS

Answer 20

AV valve replacement surgery

Question 21

3 Principal Causes of AS

Answer 21

1 Congenital Bicuspid Valve with superimposed calcification
2 Calcification of normal trileaflet valve
3 Rheumatic Disease

Question 22

Term for murmur transmitted downward confusing AS with MR

Answer 22

Galliverdin Effect

Question 23

Average rate of hemodynamic progression in AS

Answer 23

decrease in aortic valve area of 0.12cm2/yr

Question 24

62/M with HTN complains of fatigue and SOB. With high pitched, blowing, diastolic murmur on the left sternal border and widened pulse pressure. With murmur heard on femoral artery. DIAGNOSIS?

Answer 24

Aortic Regurgitation

Question 25

Murmur heard over femoral artery is known as

Answer 25

DUROZIEZ SIGN

Question 26

Etiology AR

Answer 26

Primary Valve disease and/or aortic root disease

Question 27

Rumbling sound heard in severe AR

Answer 27

Austin Flint murmur

Question 28

Jarring of the entire body and bobbing motion of the head in AR

Answer 28

De Musset Sign

Question 29

Bounding ans forceful pulse, rapidly increasing and subsequently collapsing in AR

Answer 29

Water-Hammer or Corrigan's pulse

Question 30

Capillary pulsation at the root of the nail

Answer 30

Quincke's pulse

Question 31

Booming "pistol shot" sound over femoral arteries

Answer 31

Traube sign

Question 32

Management for Acute AR

Answer 32

Diuretics, Vasodilators Surgery within 24hrs NO TO X BETA BLOCKERS

Question 33

Management for Chronic AR

Answer 33

ACEi or ARBs Diuretics DHP CCB/BB Surgery

Question 34

30/F with hx of rheumatic fever presents with dyspnea and palpitation. Opening Snap heard followed by low pitched, tumbling, diastolic murmur at apex. DIAGNOSIS?

Answer 34

MITRAL STENOSIS

Question 35

Most common cause of MS

Answer 35

Rheumatic Fever

Question 36

Earliest CXR finding in MS

Answer 36

straightening of the upper left border of the cardiac silhoutte

Question 37

Treatment of choic for MS

Answer 37

Percutaneous Transmitral Commissurotomy

Question 38

Hemodynamic hallmark of MS

Answer 38

Abnormally elevated AV pressure gradient on 2D Echo or hemodynamic studies

Question 39

2D Echo showed symmetric fusion of commissures, resulting in DOMING of leaflets in diastole (Hockey Stick Sign) DIAGNOSIS?

Answer 39

MS

Question 40

Normal Mitral valvular area

Answer 40

4 - 6 cm2 Mitral Stenosis Mild - >1.5cm Moderate - 1-1.5cm Severe - <1.5cm

Question 41

MS management

Answer 41

Diuretics for pulmonary congestion Slow down HR - BB, Digoxin, NDHP CCB Warfarin if with AF Percutaneous Mitral Balloon valvotomy (most effective tx) Valve replacement surgery Penicillin prophylaxis for Group A B-hemolytic strep (rheumatic fever)