October 24, 2010

USMLE 2 Question 16

26 year old female experiences chest pain. She also complains of paplitations. An ECHO is done and shows that she has mitral valve prolapse. Her physical findings are classic for mitral valve prolapse.

Which of the following is associated with mitral valve prolapse:

a) large v wave in the jugular pulse
b) diastolic rumbling murmur
c) increased pulse pressure
d) large a wave in the jugular pulse
e) mid systolic click with a systolic murmur








ANSWER
The correct answer is E



Explanation
A mid systolick click with a systolic murmur is heard with mitral valve proplapse. Mitral valve prolapse is also called 'click murmur syndrome'.

A large v wave in the jugular pulse (choice a) is seen with tricuspid insufficiency. A diastolic rumbling murmur (choice b) is heard with mitral stenosis, not with mitral valve proplapse. The pulse pressure is the difference between systolic and diastolic pressure. An increased pulse pressure (choice c) is seen with aortic regurgitation. A large a wave in the jugular pulse (choice d) is seen with tricuspid stenosis.

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