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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor=Mahmoud Sakr M.D.
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Cardiovascular
|Prompt=43 y/o female presents to her primary care physician for routine health examination.  She denies any complaints and walks 2 miles 3 times a week.  Initial evaluation reveals a Blood pressure is 127/77 mm Hg, Pulse is 82 /min, RR 14, oxygen saturation of 99% on room air.  Physical examination is unremarkable except for a midsystolic click on cardiac auscultation. Which of the following mechanisms is likely responsible for this physical finding;
|Prompt=43 y/o female presents to her primary care physician for routine health examination.  She denies any complaints and walks 2 miles 3 times a week.  Initial evaluation reveals a Blood pressure is 127/77 mm Hg, Pulse is 82 /min, RR 14, oxygen saturation of 99% on room air.  Physical examination is unremarkable except for a midsystolic click on cardiac auscultation. Which of the following mechanisms is likely responsible for this physical finding;
|Explanation=Mitral valve prolapse (aka primary form of myxomatous degeneration of the mitral valve aka floppy mitral valve syndrome) is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. Upon auscultation of an individual with mitral valve prolapse, a mid-systolic click, followed by a late systolic murmur heard best at the apex is common.  Echocardiography is the most useful method of diagnosing a prolapsed mitral valve. Two- and three-dimensional echocardiography are particularly valuable as they allow visualization of the mitral leaflets relative to the mitral annulus. This allows measurement of the leaflet thickness and their displacement relative to the annulus. Thickening of the mitral leaflets >5 mm and leaflet displacement >2 mm indicates classic mitral valve prolapse.
|Explanation=Mitral valve prolapse (aka primary form of myxomatous degeneration of the mitral valve aka floppy mitral valve syndrome) is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. Upon auscultation of an individual with mitral valve prolapse, a mid-systolic click, followed by a late systolic murmur heard best at the apex is common.  Echocardiography is the most useful method of diagnosing a prolapsed mitral valve. Two- and three-dimensional echocardiography are particularly valuable as they allow visualization of the mitral leaflets relative to the mitral annulus. This allows measurement of the leaflet thickness and their displacement relative to the annulus. Thickening of the mitral leaflets >5 mm and leaflet displacement >2 mm indicates classic mitral valve prolapse.
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|AnswerBExp=Correct answer.  Mitral valve prolapse is due to  of myxomatous degeneration of the mitral valve leading to a  floppy mitral valve.
|AnswerBExp=Correct answer.  Mitral valve prolapse is due to  of myxomatous degeneration of the mitral valve leading to a  floppy mitral valve.
|AnswerC=Congenital bicuspid anomaly of valvular leaflets
|AnswerC=Congenital bicuspid anomaly of valvular leaflets
|AnswerCExp=usually an abnormality of the aortic valve.
|AnswerCExp=usually an abnormality of the aortic valve.
|AnswerD=Lipid deposition and plaque formation in the arterial walls
|AnswerD=Lipid deposition and plaque formation in the arterial walls
|AnswerDExp=This answer relates to an atherosclerotic process
|AnswerDExp=This answer relates to an atherosclerotic process
|AnswerE=Rheumatic heart disease  
|AnswerE=Rheumatic heart disease
|AnswerEExp=Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as streptococcal pharyngitis. Chronic rheumatic heart disease (RHD) is characterized by repeated inflammation with fibrinous resolution. It presents with polyarthritis, Carditis, subcutaneous nodules, erythema marginatum, fever, leukocytosis, ECG may show features of heart block, such as a prolonged PR interval.
|AnswerEExp=Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as streptococcal pharyngitis. Chronic rheumatic heart disease (RHD) is characterized by repeated inflammation with fibrinous resolution. It presents with polyarthritis, Carditis, subcutaneous nodules, erythema marginatum, fever, leukocytosis, ECG may show features of heart block, such as a prolonged PR interval.
|RightAnswer=B
|RightAnswer=B
|Approved=Yes
|Approved=Yes
}}
}}

Revision as of 13:55, 9 September 2013

 
Author PageAuthor::Mahmoud Sakr M.D.
Exam Type ExamType::USMLE Step 2 CK
Main Category MainCategory::Internal medicine
Sub Category SubCategory::Cardiovascular
Prompt [[Prompt::43 y/o female presents to her primary care physician for routine health examination. She denies any complaints and walks 2 miles 3 times a week. Initial evaluation reveals a Blood pressure is 127/77 mm Hg, Pulse is 82 /min, RR 14, oxygen saturation of 99% on room air. Physical examination is unremarkable except for a midsystolic click on cardiac auscultation. Which of the following mechanisms is likely responsible for this physical finding;]]
Answer A AnswerA::Rupture of a papillary muscle due to an ischemic event
Answer A Explanation AnswerAExp::This answer would relate an ischemic event.
Answer B AnswerB::Myxomatous degeneration of a heart valve
Answer B Explanation AnswerBExp::Correct answer. Mitral valve prolapse is due to of myxomatous degeneration of the mitral valve leading to a floppy mitral valve.
Answer C AnswerC::Congenital bicuspid anomaly of valvular leaflets
Answer C Explanation AnswerCExp::usually an abnormality of the aortic valve.
Answer D AnswerD::Lipid deposition and plaque formation in the arterial walls
Answer D Explanation AnswerDExp::This answer relates to an atherosclerotic process
Answer E AnswerE::Rheumatic heart disease
Answer E Explanation [[AnswerEExp::Rheumatic fever is an inflammatory disease that occurs following a Streptococcus pyogenes infection, such as streptococcal pharyngitis. Chronic rheumatic heart disease (RHD) is characterized by repeated inflammation with fibrinous resolution. It presents with polyarthritis, Carditis, subcutaneous nodules, erythema marginatum, fever, leukocytosis, ECG may show features of heart block, such as a prolonged PR interval.]]
Right Answer RightAnswer::B
Explanation [[Explanation::Mitral valve prolapse (aka primary form of myxomatous degeneration of the mitral valve aka floppy mitral valve syndrome) is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. Upon auscultation of an individual with mitral valve prolapse, a mid-systolic click, followed by a late systolic murmur heard best at the apex is common. Echocardiography is the most useful method of diagnosing a prolapsed mitral valve. Two- and three-dimensional echocardiography are particularly valuable as they allow visualization of the mitral leaflets relative to the mitral annulus. This allows measurement of the leaflet thickness and their displacement relative to the annulus. Thickening of the mitral leaflets >5 mm and leaflet displacement >2 mm indicates classic mitral valve prolapse.

Educational Objective:
References: ]]

Approved Approved::Yes
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