Archive Of Standardized Exam Questions: Mitral Stenosis

OVERVIEW

This page is dedicated to organizing various examples of standardized exam questions whose answer is mitral stenosis. While this may seem a odd practice, it is useful to see multiple examples of how mitral stenosis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.

KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)

When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for mitral stenosis

  • Heart murmur is auscultated: 
    • Opening snap heard right after S2 (can be a “sharp sound”) 
    • Diastolic murmur: can starts at S2 and continues to S1. If mitral valve opens later murmur can start later a bit after S2.  
      • Can increase in intensity before S1: S1 can be LOUD
      • Rumbling or mid rumbling murmur 
    • Heard best at apex 
  • Altered pressures within the heart: 
    • Increased left atrial pressure: a pulmonary cap wedge pressure might read as elevated. 
    • Decreased left ventricular end-diastolic pressure is a result of the valve’s stenosis 
    • Normal left ventricular peak systolic pressure 
QUESTION EXAMPLES

Question # 1

Explanation # 1

Question # 2

Explanation # 2

TESTABLE FACTS ABOUT THIS CONDITION (BEYOND ITS IDENTIFICATION)

Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clincial implications that are commonly asked. Some of these are listed below:

  • Causes of this condition:
  • Consequences of murmur: increased pulmonary artery pressure (greater pressure is needed to open stenotic valve)
  • Complications: over time will cause left atrial dilation and many patients develop atrial fibrillation because of this condition 
  • How to assess degree of mitral stenosis:
    • On auscultation: on auscultation the best indicator of mitral stenosis severity is the length of time between S2 (specifically A2) and the opening snap. As mitral stenosis worsens this interval decreases due to increased atrial pressures.
    • Gold standard: doppler echo is used to more accurately evaluate the severity of mitral stenosis. 
Page Updated: 04.02.2017