Valvular Heart Disease: ABFM practice questions

5 board-style questions on valvular heart disease in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 79-year-old man presents with a 3-month history of progressive exertional dyspnea. He also reports a syncopal episode last week while climbing stairs. Physical exam reveals a harsh, late-peaking crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids, with a diminished and delayed carotid upstroke (pulsus parvus et tardus). Echocardiogram shows an aortic valve area of 0.7 cm2, a mean transvalvular gradient of 52 mmHg, a peak velocity of 4.5 m/s, and an EF of 50%. What is the most appropriate next step?

  1. Refer for aortic valve replacement (surgical AVR or transcatheter TAVR)
  2. Optimize medical management with a diuretic and schedule repeat echocardiography in 6 months
  3. Perform an exercise stress test to assess symptom threshold and hemodynamic response
  4. Start an ACE inhibitor to reduce afterload and improve symptoms

Sample question 2

A 54-year-old woman is found to have a grade 3/6 holosystolic murmur at the apex radiating to the left axilla during a routine physical examination. She is completely asymptomatic and exercises without limitations. Echocardiography reveals moderate mitral regurgitation due to mitral valve prolapse. Her left ventricular ejection fraction is 62%, LV end-systolic diameter is 38 mm, left atrial volume index is 30 mL/m2, and estimated pulmonary artery systolic pressure is 28 mmHg. What is the most appropriate management?

  1. Immediate referral for mitral valve repair surgery
  2. Cardiac catheterization to assess hemodynamic severity
  3. Start an ACE inhibitor to reduce regurgitant volume
  4. Clinical and echocardiographic surveillance every 1-2 years

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