[MCQ] Valvular Heart Disease- Part 1

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Valvular Heart Disease- Part 1

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Congratulations - you have completed Valvular Heart Disease- Part 1. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Which of the following is not a cause of obstruction to left atrial outflow ?

A	Systemic lupus erythematosus
B	Rheumatoid arthritis
C	Wegeners granulomatosis
D	Cor triatriatum

Question 1 Explanation:

Rheumatic fever is the leading cause of mitral stenosis (MS). Other less common etiologies of obstruction to left atrial outflow include congenital mitral valve stenosis, cor triatriatum, mitral annular calcification with extension onto the leaflets, systemic lupus erythematosus, rheumatoid arthritis, left atrial myxoma, and infective endocarditis with large vegetations

Question 2

What proportion of all patients with rheumatic heart disease & a history of rheumatic fever have pure or predominant MS ?

A	10 %
B	20 %
C	30 %
D	40 %

Question 2 Explanation:

Pure or predominant MS occurs in ~40% of all patients with rheumatic heart disease and a history of rheumatic fever.

Question 3

In patients of MS with atrial fibrillation (AF), thrombi arise more frequently from ?

A	Mitral valve leaflets
B	Chordae tendineae
C	Left atrial appendage
D	Mitral commissures

Question 3 Explanation:

Thrombus formation & arterial embolization may arise from calcific valve itself, but in patients with atrial fibrillation (AF), thrombi arise more frequently from the dilated left atrium (LA), particularly from within the left atrial appendage.

Question 4

In normal adults, which of the following parameter of the mitral valve orifice is 4-6 cm2 ?

A	Diameter
B	Circumference
C	Area
D	Radius

Question 4 Explanation:

In normal adults, the area of the mitral valve orifice is 4-6 cm2.

Question 5

Significant obstruction of mitral valve orifice is considered when the orifice is less than approximately ?

A	1 cm2
B	2 cm2
C	3 cm2
D	4 cm2

Question 5 Explanation:

Mitral valve orifice area of < ~2 cm2 is considered “significant obstruction” because blood can flow from LA to LV only if propelled by an abnormally elevated left atrioventricular pressure gradient.

Question 6

Mitral stenosis is called “moderate”, when the mitral valve orifice is ?

A	1.0 cm2 - 1.5 cm2
B	1.5 cm2 - 2.0 cm2
C	2.0 cm2 - 2.5 cm2
D	2.5 cm2 - 3.0 cm2

Question 6 Explanation:

Mitral stenosis is called “moderate”, when the mitral valve orifice is 1.0 cm2 - 1.5 cm2.

Question 7

Mitral stenosis is called “severe”, when the mitral valve opening is reduced to ?

A	< 1.5 cm2
B	< 1 cm2
C	< 0.5 cm2
D	< 0.2 cm2

Question 7 Explanation:

When the mitral valve opening is reduced to < 1 cm2 it is referred to as “severe” MS.

Question 8

In severe MS, LA pressure required to maintain a normal cardiac output is ?

A	~ 10 mm Hg
B	~ 15 mm Hg
C	~ 20 mm Hg
D	~ 25 mm Hg

Question 8 Explanation:

In severe MS, LA pressure of ~25 mmHg is required to maintain a normal cardiac output

Question 9

Pulmonary hypertension is considered severe if the pulmonary artery systolic pressure (PASP) is more than ?

A	20 mm Hg
B	40 mm Hg
C	60 mm Hg
D	80 mm Hg

Question 10

Hemodynamic variable of importance in Mitral Stenosis is ?

A	Transvalvular pressure gradient
B	Cardiac output
C	Heart rate
D	All of the above

Question 10 Explanation:

Hemodynamic severity of MS depends on transvalvular pressure gradient and the flow rate which depends on the cardiac output and heart rate.

Question 11

Clinical and hemodynamic features of MS are influenced importantly by ?

A	Cardiac output
B	Heart rate
C	Transvalvular pressure gradient
D	Pulmonary arterial pressure (PAP)

Question 11 Explanation:

The clinical and hemodynamic features of MS are influenced importantly by the level of the PAP

Question 12

“Second stenosis” refers to which of the following ?

A	Passive backward transmission of elevated LA pressure
B	Pulmonary arteriolar constriction
C	Interstitial edema in walls of small pulmonary vessels
D	Organic obliterative changes in pulmonary vascular bed

Question 12 Explanation:

Pulmonary hypertension results from passive backward transmission of elevated LA pressure; pulmonary arteriolar constriction (“second stenosis”), interstitial edema in walls of small pulmonary vessels and organic obliterative changes in pulmonary vascular bed.

Question 13

Severe pulmonary hypertension results in ?

A	RV enlargement
B	Secondary tricuspid regurgitation (TR)
C	Pulmonic regurgitation (PR)
D	All of the above

Question 13 Explanation:

Severe pulmonary hypertension results in RV enlargement, secondary tricuspid regurgitation (TR) and pulmonic regurgitation (PR), as well as right-sided heart failure

Question 14

What proportion of all patients with mitral stenosis are female ?

A	One-fourth
B	One-third
C	Two-third
D	Three-fourth

Question 15

Which of the following about mitral stenosis is false ?

A	Latent period between initial attack of rheumatic carditis &development of symptoms due to MS is ~ 2 decades
B	Infective endocarditis is rare in isolated MS
C	Hemoptysis is rarely fatal
D	None of the above

Question 16

In MS, hemoptysis results from rupture of ?

A	Alveolar capillaries
B	Pulmonary arterioles
C	Bronchial arterioles
D	Pulmonary-bronchial venous connections

Question 16 Explanation:

Hemoptysis results from rupture of pulmonary-bronchial venous connections secondary to pulmonary venous hypertension in patients who have elevated LA pressures without markedly elevated pulmonary vascular resistances and is rarely fatal.

Question 17

In MS, hemoptysis results from ?

A	Pulmonary-bronchial venous connections
B	Recurrent pulmonary emboli
C	Pulmonary infections
D	All of the above

Question 18

Which of the following PFT variable is reduced in MS ?

A	Vital capacity
B	Total lung capacity
C	Maximal breathing capacity
D	All of the above

Question 18 Explanation:

In addition to interstitial edema in walls of small pulmonary vessels and organic obliterative changes in pulmonary vascular bed, fibrous thickening of walls of alveoli & pulmonary capillaries occurs commonly in MS. Vital capacity, total lung capacity, maximal breathing capacity, and oxygen uptake per unit of ventilation are reduced

Question 19

In MS, systemic embolization occurs more frequently in ?

A	Patients with AF
B	In older patients
C	In those with a reduced CO
D	All of the above

Question 19 Explanation:

Thrombi form in left atria, particularly in enlarged atrial appendages of patients with MS. Systemic embolization, incidence of which is 10–20%, occurs more frequently in patients with AF, in older patients (>65 years), and in those with a reduced CO.

Question 20

Which of the following is false in auscultation in MS ?

A	S1 is accentuated and delayed
B	OS follows A2 by 0.05 - 0.12 seconds
C	A2 - OS interval varies directly with severity of MS
D	None of the above

Question 20 Explanation:

A2 - OS time interval varies inversely with the severity of the MS

Question 21

Which of the following correlates with the severity of mitral stenosis ?

A	Loudness of opening snap
B	Duration of mid-diastolic murmur
C	Duration of presystolic accentuation
D	All of the above

Question 21 Explanation:

Duration of low-pitched, rumbling, diastolic murmur correlates with the severity of the stenosis in patients with preserved CO.

Question 22

In patients with MS with RV failure, pleural effusion is on which side ?

A	Right
B	Left
C	Bilateral
D	All of the above

Question 22 Explanation:

All of the above

Question 23

In MS, which of the following findings can be found along left sternal border ?

A	RV tap
B	High-pitched, diastolic, decrescendo blowing murmur
C	Soft, grade I or II/VI systolic murmurs
D	All of the above

Question 23 Explanation:

RV tap along the left sternal border signifies an enlarged RV. With severe pulmonary hypertension, a pansystolic murmur, louder during inspiration, produced by functional TR may be audible along the left sternal border. Graham Steell murmur of PR, a high-pitched, diastolic, decrescendo blowing murmur along the left sternal border, results from dilation of pulmonary valve ring due to severe pulmonary hypertension. Soft, grade I or II/VI systolic murmurs are commonly heard at the apex or along the left sternal border in patients with pure MS and do not necessarily signify the presence of MR

Question 24

Which of the following echocardiographic technique is most useful in evaluating a patient of MS ?

A	M-mode Echocardiography
B	2D Echocardiography with Colour Doppler studies
C	Transthoracic echocardiography (TTE) with color flow and spectral Doppler imaging
D	All of the above

Question 24 Explanation:

All of the above

Question 25

In MS, Kerley B lines on X-Ray chest are apparent when the resting mean LA pressure exceeds approximately ?

A	10 mmHg
B	15 mmHg
C	20 mmHg
D	25 mmHg

Question 25 Explanation:

Kerley B lines are fine, dense, opaque, horizontal lines most prominent in the lower and midlung fields resulting from distention of interlobular septae and lymphatics with edema when resting mean LA pressure > ~20 mmHg.

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See all quizzes of the Valvular Heart Disease- Part at here:

II. Preview all questions below:

1.Which of the following is not a cause of obstruction to left atrial outflow ?
A. Systemic lupus erythematosus
B. Rheumatoid arthritis
C. Wegeners granulomatosis
D. Cor triatriatum

2. What proportion of all patients with rheumatic heart disease & a history of rheumatic fever have pure or predominant MS ?

A. 10 %
B. 20 %
C. 30 %
D. 40 %

3. In patients of MS with atrial fibrillation (AF), thrombi arise more frequently from ?
A. Mitral valve leaflets
B. Chordae tendineae
C. Left atrial appendage
D. Mitral commissures

4. In normal adults, which of the following parameter of the mitral valve orifice is 4-6 cm2 ?
A. Diameter
B. Circumference
C. Area
D. Radius

5. Significant obstruction of mitral valve orifice is considered when the orifice is less than approximately ?
A. 1 cm2
B. 2 cm2
C. 3 cm2
D. 4 cm2

6. Mitral stenosis is called “moderate”, when the mitral valve orifice is ?
A. 1.0 cm2 – 1.5 cm2
B. 1.5 cm2 – 2.0 cm2
C. 2.0 cm2 – 2.5 cm2
D. 2.5 cm2 – 3.0 cm2

7. Mitral stenosis is called “severe”, when the mitral valve opening is reduced to ?
A. < 1.5 cm2
B. < 1 cm2
C. < 0.5 cm2
D. < 0.2 cm2

8. In severe MS, LA pressure required to maintain a normal cardiac output is ?
A. ~ 10 mm Hg
B. ~ 15 mm Hg
C. ~ 20 mm Hg
D. ~ 25 mm Hg

9. Pulmonary hypertension is considered severe if the pulmonary artery systolic pressure (PASP) is more than ?
A. 20 mm Hg
B. 40 mm Hg
C. 60 mm Hg
D. 80 mm Hg
10. Hemodynamic variable of importance in Mitral Stenosis is ?
A. Transvalvular pressure gradient
B. Cardiac output
C. Heart rate
D. All of the above

11. Clinical and hemodynamic features of MS are influenced importantly by ?
A. Cardiac output
B. Heart rate
C. Transvalvular pressure gradient
D. Pulmonary arterial pressure (PAP)

12. “Second stenosis” refers to which of the following ?
A. Passive backward transmission of elevated LA pressure
B. Pulmonary arteriolar constriction
C. Interstitial edema in walls of small pulmonary vessels
D. Organic obliterative changes in pulmonary vascular bed

13. Severe pulmonary hypertension results in ?
A. RV enlargement
B. Secondary tricuspid regurgitation (TR)
C. Pulmonic regurgitation (PR)
D. All of the above

14. What proportion of all patients with mitral stenosis are female ?
A. One-fourth

B. One-third
C. Two-third
D. Three-fourth
15. Which of the following about mitral stenosis is false ?
A. Latent period between initial attack of rheumatic carditis &
development of symptoms due to MS is ~ 2 decades
B. Infective endocarditis is rare in isolated MS
C. Hemoptysis is rarely fatal
D. None of the above
16. In MS, hemoptysis results from rupture of ?
A. Alveolar capillaries
B. Pulmonary arterioles
C. Bronchial arterioles
D. Pulmonary-bronchial venous connections

17. In MS, hemoptysis results from ?
A. Pulmonary-bronchial venous connections
B. Recurrent pulmonary emboli
C. Pulmonary infections
D. All of the above
18. Which of the following PFT variable is reduced in MS ?
A. Vital capacity
B. Total lung capacity
C. Maximal breathing capacity
D. All of the above

19. In MS, systemic embolization occurs more frequently in ?
A. Patients with AF
B. In older patients
C. In those with a reduced CO
D. All of the above

20. Which of the following is false in auscultation in MS ?
A. S1 is accentuated and delayed
B. OS follows A2 by 0.05 – 0.12 seconds
C. A2 – OS interval varies directly with severity of MS
D. None of the above

21. Which of the following correlates with the severity of mitral stenosis ?
A. Loudness of opening snap
B. Duration of mid-diastolic murmur
C. Duration of presystolic accentuation
D. All of the above

22. In patients with MS with RV failure, pleural effusion is on which side ?
A. Right
B. Left
C. Bilateral
D. All of the above

23. In MS, which of the following findings can be found along left sternal border ?
A. RV tap
B. High-pitched, diastolic, decrescendo blowing murmur
C. Soft, grade I or II/VI systolic murmurs
D. All of the above

24. Which of the following echocardiographic technique is most useful in evaluating a patient of MS ?
A. M-mode Echocardiography
B. 2D Echocardiography with Colour Doppler studies
C. Transthoracic echocardiography (TTE) with color flow and spectral Doppler imaging
D. All of the above

25. In MS, Kerley B lines on X-Ray chest are apparent when the resting mean LA pressure exceeds approximately ?
A. 10 mmHg
B. 15 mmHg
C. 20 mmHg
D. 25 mmHg

Valvular Heart Disease

[MCQ] Valvular Heart Disease- Part 1

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Valvular Heart Disease- Part 1

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