BOTH Am I crazy or is this Kaplan explanation WRONG...

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7+ Year Member
Aug 18, 2014
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I don't think I've ever seen an attempt to claim ankle edema is a hallmark of left heart failure without right heart failure...
I'd just like to know if this is a thing, or if this is a Kaplan goof.
Thank you :)

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I agree this doesn't make sense - since they mentioned bilat. ankle edema. However, question was about increase - so the first thing to increase will be left atrial pressure - as it's first thing behind mitral valve where pressure increases primarily. Right side will be affected eventually, but it's somewhere down the line. Well, not all questions are perfect - that's why you need to be able to reason and recognize most likely answer - even if there are 2 or 3 acceptable ones. If it was easy and straightforward - then wouldn't be hard and physicians salary would be at minimum wage if everyone can do it.
Guarantee the audio clip is a textbook mitral stenosis murmur. Don't overthink it.
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Mitral stenosis murmur means that left atrium is affected first. The right side of the heart is also affected, hence the ankle edema. However, because the left atrium is affected first, by the time the right side is affected and you see ankle edema, the left atrium has been affected for even longer.

The left atrium is the most theoretically affected and therefore it is "most likely" to have increased pressure. I agree though that it is poorly written. It should read "Which of the following will most likely have the greatest proportional change from baseline pressure?"
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Hx of rheumatic heart disease always means stenosis of either the mitral valve or the aortic valve. Audio clip will def tell you whether it's stenosis of the mitral valve or aortic valve.
I agree this question sucks. Because the ankle edema points to RHF. But think about it, if RAP was the correct answer, then wouldn't choice E (systemic venous pressure) also be correct? But history of rheumatic heart disease + the audio clip would probably indicate MS, which in that case their answer would be the *most* accurate, anyways that's a weird question lol

edit: but since she has peripheral pitting edema, then wouldn't that mean RAP must be elevated? like wtf
you can also get ankle edema with venous insufficiency. It alone isn't a hallmark of right heart failure. But a mitral stenosis like that ensures the left atrial pressure is high. It is actually a fair question
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Audio clip + "rheumatic heart disease" -> mitral stenosis -> pick increased left atrial pressure and move on.
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Overthinking is a pain in the ass.. I agree with the what you are saying to a certain extent.. But what i have found while going from mid - 230s to mid - 260s on NBMEs is that..
You have to be in SYNC with the examiner's psyche.. that is like super important.. they arent trying to hone in on RA pressure increase by saying RHD and MS..

Dont make life tougher.. Most of the other posters on here i agree with..
Who else haven't commented yet about same old lol? I think OP got the point you wankers.
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