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NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 1/Question#17 (reveal difficulty score)
A 28-year-old woman at 28 weeks' gestation ...
Mitral stenosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: cardio DDX murmur

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submitted by โˆ—sugaplum(487)
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They are taking my buzz words away.......:(

Opening SNAP plus a diastolic rumble.. this is mitral stenosis

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ronabobonafofona  Also, the only diastolic murmurs here are mitral stenosis and aortic regurgitation. From there, you just have to look at what area we're auscultating, which is the apex -- aka, the area for the mitral valve. +4



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submitted by โˆ—step_prep7(71)
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  • Diastolic murmur = Aortic regurgitation or mitral stenosis (assuming left-side of heart)
  • AR murmur = Early, diastolic, decrescendo murmur heard best at upper sternal border
  • MS murmur = Diastolic snap (โ€œsharp sound after S2โ€) followed by a late diastolic murmur heard best at the apex that can sometimes be described as increasing in intensity before S1 (due to atrial kick pushing increased blood across valve right before valve closes)
  • Key idea: In setting of pregnant woman with new-onset dyspnea, always consider mitral stenosis (increased cardiac output due to plasma expansion in pregnancy can cause previously asymptomatic valvular defect to become symptomatic) and pulmonary embolism (pregnancy is a hypercoagulable state)
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