WBR0842

Author	PageAuthor::Neeraja Danda M.B.B.S
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::A 24 year old female in her 12th week of gestation came to the office complaining difficulty in swallowing. She has noticed a change in her voice as well. Auscultation at the apex reveals an opening snap followed by a diastolic murmur. Which one of the following is true regarding patient’s condition?]]
Answer A	AnswerA::Transesophageal echocardiogram is the best initial test.
Answer A Explanation	AnswerAExp::'''Incorrect''' Transesophageal echocardiogram is the most accurate but the best initial test is transthoracic echocardiogram
Answer B	AnswerB::Valve replacement is must in all cases
Answer B Explanation	AnswerBExp::'''Incorrect''' Valve replacement is not the choice of treatment in this case of mitral stenosis. The indication for invasive treatment with either a mitral valve replacement or valvuloplasty is NYHA functional class III or IV symptoms.
Answer C	AnswerC::Pregnancy is a contraindication to surgical intervention
Answer C Explanation	AnswerCExp::'''Incorrect''' Pregnancy is not a contraindication for valvuloplasty.
Answer D	AnswerD::Hoarseness of voice is due to compression of superior laryngeal nerve
Answer D Explanation	AnswerDExp::'''Incorrect''' Hoarseness of voice is due to compression of recurrent laryngeal nerve by the enlarged left atrium.
Answer E	AnswerE::Murmur increases in intensity on squatting
Answer E Explanation	AnswerEExp::The murmur of mitral stenosis does increase on Squatting and leg rising.
Right Answer	RightAnswer::E
Explanation	[[Explanation::The murmur of mitral stenosis increases in intensity on squatting as the venous return increases and the blood flow through the valve increases. It also increases on leg rising for the same reason. Mitral stenosis is most often caused by rheumatic fever. Pregnancy can precipitate symptoms of mitral stenosis in otherwise asymptomatic patients. Educational objective: The murmur of mitral stenosis increases on Squatting and leg rising. References: Page 59, 65 Master the boards Step 3 2009, Page 86, 87, 88 Master the boards step 2 CK second edition Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::mitral stenosis
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::