Cardiology: mechanism of Austin Flint murmur: 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: mechanism of Austin Flint murmur

Sample item

A 50-year-old man with severe chronic aortic regurgitation has a soft, low-pitched mid-to-late diastolic rumble at the apex. There is no opening snap and the first heart sound is not loud. What is the mechanism of this rumble?

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

The answer and the reasoning

C. Aortic jet striking and partly closing the anterior mitral leaflet

In severe aortic regurgitation the regurgitant jet hits the anterior mitral leaflet and impedes its opening, producing a functional mitral rumble. Unlike true mitral stenosis there is no opening snap or loud first sound, and the murmur settles when the regurgitation is treated.

Option by option

  • A. Pulmonary regurgitation across a dilated pulmonary valve ring

    Pulmonary regurgitation produces a murmur along the left sternal edge and is not an apical murmur.

  • B. Coexisting rheumatic mitral stenosis with thickened leaflets

    True rheumatic mitral stenosis would give an opening snap and a loud first sound, which are absent.

  • C. Aortic jet striking and partly closing the anterior mitral leaflet (correct)

    Correct. The regurgitant jet impedes the anterior mitral leaflet and creates functional mitral narrowing.

  • D. Rapid early filling through a dilated left atrium and mitral ring

    Increased early flow across the mitral valve causes a flow murmur in mitral regurgitation, not this late rumble.

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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Aortic jet striking and partly closing the anterior mitral leaflet. In severe aortic regurgitation the regurgitant jet hits the anterior mitral leaflet and impedes its opening, producing a functional mitral rumble.

Why is "Pulmonary regurgitation across a dilated pulmonary valve ring" not the answer?

Pulmonary regurgitation produces a murmur along the left sternal edge and is not an apical murmur.

Why is "Coexisting rheumatic mitral stenosis with thickened leaflets" not the answer?

True rheumatic mitral stenosis would give an opening snap and a loud first sound, which are absent.

Why is "Rapid early filling through a dilated left atrium and mitral ring" not the answer?

Increased early flow across the mitral valve causes a flow murmur in mitral regurgitation, not this late rumble.

What concept does this question test?

It tests Cardiology: mechanism of Austin Flint murmur in General Medicine. Unlike true mitral stenosis there is no opening snap or loud first sound, and the murmur settles when the regurgitation is treated.

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: mechanism of Austin Flint murmur?

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.