Cardiology: mitral stenosis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: mitral stenosis

Sample item

A 34-year-old woman with a history of rheumatic fever has exertional breathlessness. She has a loud first heart sound, an opening snap and a mid-diastolic rumble at the apex. Echocardiography shows a mitral valve area of 0.9 cm2 with pliable, mobile leaflets, minimal subvalvular fusion, mild mitral regurgitation and no left atrial thrombus. What is the most appropriate intervention?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Percutaneous balloon mitral valvotomy

Symptomatic severe mitral stenosis (valve area 1.5 cm2 or less) needs relief of the mechanical obstruction. When the leaflets are pliable, there is little calcification or subvalvular disease, regurgitation is no more than mild and the left atrium is free of thrombus, percutaneous balloon valvotomy gives excellent results. Replacement is reserved for unfavourable anatomy.

Option by option

  • A. Percutaneous balloon mitral valvotomy (correct)

    Balloon valvotomy splits the fused commissures and is the preferred first procedure in this favourable valve morphology.

  • B. Open surgical mitral commissurotomy after a trial of ACE inhibitors

    ACE inhibitors do not relieve a fixed mechanical obstruction, and surgical commissurotomy is only chosen when balloon valvotomy is unsuitable.

  • C. Mitral valve replacement with a mechanical prosthesis

    Valve replacement carries operative risk and lifelong anticoagulation, and is reserved for calcified, rigid valves or significant regurgitation.

  • D. Lifelong diuretics and digoxin without intervention

    Drugs control heart rate and congestion but leave the fixed obstruction untouched, so symptoms and pulmonary hypertension progress.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Percutaneous balloon mitral valvotomy. Symptomatic severe mitral stenosis (valve area 1.

Why is "Open surgical mitral commissurotomy after a trial of ACE inhibitors" not the answer?

ACE inhibitors do not relieve a fixed mechanical obstruction, and surgical commissurotomy is only chosen when balloon valvotomy is unsuitable.

Why is "Mitral valve replacement with a mechanical prosthesis" not the answer?

Valve replacement carries operative risk and lifelong anticoagulation, and is reserved for calcified, rigid valves or significant regurgitation.

Why is "Lifelong diuretics and digoxin without intervention" not the answer?

Drugs control heart rate and congestion but leave the fixed obstruction untouched, so symptoms and pulmonary hypertension progress.

What concept does this question test?

It tests Cardiology: mitral stenosis in General Medicine. 5 cm2 or less) needs relief of the mechanical obstruction. When the leaflets are pliable, there is little calcification or subvalvular disease, regurgitation is no more than mild and the left atrium is free of thrombus, percutaneous balloon valvotomy gives excellent results. Replacement is reserved for unfavourable anatomy.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: mitral stenosis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.