nbme - akshaya007

[ArchivalUser]

A healthy 4-year-old girl is brought for a well-child examination. A grade 2/6 systolic ejection murmur is heard along the upper left sternal border. S2 is widely split and does not vary with respiration. A soft mid-diastolic murmur is heard along the lower left sternal border. xamination shows no other abnormalities. Which of the following is the most likely diagnosis?

A) Aortic stenosis

B) Atrial septal defect

C) Coarctation of the aorta

D) Mitral valve prolapse

E) Patent ductus arteriosus

F) Pulmonary stenosis

G) Tetralogy of Fallot

H) Transposition of the great arteries

I) Ventricular septal defect

J) Normal heart

[ArchivalUser]

B?

[ArchivalUser]

Yeah B, typical s2 plus "functional TS"

[ArchivalUser]

spartanike--ty! what what do you mean by 'functional TS'? sorry not sure.

[ArchivalUser]

Hi Jazpreet2000, sorry for late response

Functional Trivuspid stenosis: recall that mid diastolic rumble is a murmur of AV valve stenosis e.g. MS or TS

When the volume of blood passing through these valves is more than usually, then it simulates a stenosed valve For instance, in the case of ASD, shutting from LA increases amount of blood in the RA, thus more than normal amount of blood trying to go through normal tricuspid valve producing a murmur similar to tricuspid stenosis hence a functional stenosis as opposed to structural stenosis

[ArchivalUser]

that was beautifully explained! Thank you very much!!!!

[ArchivalUser]

uwc jazpreet2000 (sorry for the typos)