Cardiovascular: bedside manoeuvres in hypertrophic cardiomyopathy: practice question

A Physiology 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.

Try it

Physiology · Cardiovascular: bedside manoeuvres in hypertrophic cardiomyopathy

Sample item

A 22-year-old athlete has a systolic ejection murmur from dynamic left ventricular outflow obstruction. Which manoeuvre would reduce the intensity of the murmur?

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

The answer and the reasoning

D. Squatting from the standing position

Dynamic outflow obstruction worsens when the left ventricle is smaller or the afterload is lower, because the septum and anterior mitral leaflet come closer. Squatting increases venous return and systemic resistance, enlarging the cavity and reducing the murmur. Standing, Valsalva strain and amyl nitrite lower preload or afterload, so they intensify the murmur.

Option by option

  • A. Inhalation of amyl nitrite

    Amyl nitrite lowers afterload, which increases the gradient and murmur.

  • B. Standing up quickly from squatting

    Standing reduces venous return and ventricular size, intensifying the murmur.

  • C. The strain phase of the Valsalva manoeuvre

    Valsalva strain lowers venous return and ventricular volume, increasing the murmur.

  • D. Squatting from the standing position (correct)

    Correct. Squatting enlarges the ventricular cavity and raises afterload, relieving obstruction.

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 Physiology questions

Questions about this Physiology question

What is the answer to this Physiology question?

The best answer is D, Squatting from the standing position. Dynamic outflow obstruction worsens when the left ventricle is smaller or the afterload is lower, because the septum and anterior mitral leaflet come closer.

Why is "Inhalation of amyl nitrite" not the answer?

Amyl nitrite lowers afterload, which increases the gradient and murmur.

Why is "Standing up quickly from squatting" not the answer?

Standing reduces venous return and ventricular size, intensifying the murmur.

Why is "The strain phase of the Valsalva manoeuvre" not the answer?

Valsalva strain lowers venous return and ventricular volume, increasing the murmur.

What concept does this question test?

It tests Cardiovascular: bedside manoeuvres in hypertrophic cardiomyopathy in Physiology. Squatting increases venous return and systemic resistance, enlarging the cavity and reducing the murmur. Standing, Valsalva strain and amyl nitrite lower preload or afterload, so they intensify the murmur.

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 Cardiovascular: bedside manoeuvres in hypertrophic cardiomyopathy?

For each system, sketch the key graph (pressure–volume loop, oxygen dissociation curve, nephron handling) and explain it aloud. Then use the flashcards and the other Physiology 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.