DID ANYONE GET AUDIO-VIDEO Qs IN THE EXAM

[net4545]

ANYONE WHO HAS TAKEN THE EXAM RECENTLY GOT AUDIO-VIDEO Qs
MY EXAM IS IN ANOTHER 10 DAYS

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[Treg]

I wrote it today, and did not have any. HOWEVER, the testing center lady said they were supposed to have the new version and it had been mailed to the wrong address. So i would assume that you will have it. I am in Canada and I am guessing the mail is slower here.

 

[hockeymaniac101]

I took my test yesterday and had 1. pt with bounding pulse and you had to listen to the heart. obvious aortic insufficiency.

 

[Lee580]

So you were able to hear an obvious diastolic murmur?

By the way, this is a great thread. It should be a sticky. I hope everyone will continue to share their experiences with these question types.

 

[hockeymaniac101]

So you were able to hear an obvious diastolic murmur?

By the way, this is a great thread. It should be a sticky. I hope everyone will continue to share their experiences with these question types.

You almost didnt even need to listen to it, they showed u the bounding pulse, so it was classic for aortic insufficiency, but I was able to hear the diastolic murmur. Problem was they asked what is the most likely cause of this murmur. The patient was 23 and with no other symptoms or past medical problems so I was between bicuspid aortic valve or rheumatic fever. I picked bicupsid but idk.

 

[DrFraud]

A bicuspid aortic valve produces a systolic murmur. Acute rheumatic fever could cause either aortic or mitral regurg. and since there was a bounding pulse during diastole I would go with rheumatic fever.

 

[medstu2006]

A bicuspid aortic valve produces a systolic murmur. Acute rheumatic fever could cause either aortic or mitral regurg. and since there was a bounding pulse during diastole I would go with rheumatic fever.

I thought Rheumatic Fever resulted in aortic stenosis which would result in a systolic murmur. I think a bicuspid valve could lead to a systolic and/or a diastolic murmur. What were the other ans choices?

 

[RxnMan]

A bicuspid aortic valve produces a systolic murmur. Acute rheumatic fever could cause either aortic or mitral regurg. and since there was a bounding pulse during diastole I would go with rheumatic fever.

A bicuspid aortic valve can cause either aortic insufficiency (bounding pulses + diastolic murmur) or stenosis (systolic snap). The aortic valves close in diastole, and if they leaked, they would produce a murmur at that time.

Bounding pulses only occur during diastole and arise from an effective loss of cardiac output.

Given a young pt without a PMHx (they would give you something like "recurrent coughs/colds as a child" for rheumatic fever), hockey did the right thing.

 

[jbuck824]

A bicuspid aortic valve produces a systolic murmur. Acute rheumatic fever could cause either aortic or mitral regurg. and since there was a bounding pulse during diastole I would go with rheumatic fever.

i concur...from what i hear theres only at most 1 or 2 of these interactive questions on each exam...and you can figure it out without listening..

 

[DrFraud]

I thought Rheumatic Fever resulted in aortic stenosis which would result in a systolic murmur. I think a bicuspid valve could lead to a systolic and/or a diastolic murmur. What were the other ans choices?

Chronic RF leads to stenosis. Acute RF leads to regurgitation.

 

[DrFraud]

A bicuspid aortic valve can cause either aortic insufficiency (bounding pulses + diastolic murmur) or stenosis (systolic snap). The aortic valves close in diastole, and if they leaked, they would produce a murmur at that time.

Bounding pulses only occur during diastole and arise from an effective loss of cardiac output.

Given a young pt without a PMHx (they would give you something like "recurrent coughs/colds as a child" for rheumatic fever), hockey did the right thing.

I have always read and made the association of a bicuspid aortic valve with stenosis.

 

[wmc24]

doesnt a bicuspid valve take longer to calcify and become stenosed than a 23 year old??? i would put aortic regurg in a 23 yr old with bicuspid valve

 

[DrFraud]

doesnt a bicuspid valve take longer to calcify and become stenosed than a 23 year old??? i would put aortic regurg in a 23 yr old with bicuspid valve

The quesiton is not asking what type of murmur you would hear with a bicuspid valve. It is asking ( I believe) for the most likely cause of aortic regurg in a 23 y.o. Even though the stem did not mention any s + s of infection which in this case would be a give-away, I would go with infection b-4 congenital causes.

 

[RxnMan]

OK. But rheumatic still requires some PMHx. Maybe there was another, better choice (Marfan's?)

BTW, I meant bounding pulses occur in systole, not diastole.

Also - If they have video, I will put down money that somebody had a Gower maneuver question.

 

[R_C_Hutchinson]

I always understood it as follows:

MCC aortic insufficiency in old person: dilation of the aortic root
MCC aortic insufficiency in young person: bicuspid valve
MCC aortic stenosis in old person: calcification of bicuspid valve

All these apply to the North America/Western Europe etc.

 

[DrFraud]

I always understood it as follows:

MCC aortic insufficiency in old person: dilation of the aortic root
MCC aortic insufficiency in young person: bicuspid valve
MCC aortic stenosis in old person: calcification of bicuspid valve

All these apply to the North America/Western Europe etc.

I believe that endocarditis is the MCC of aortic insufficiency/regurg in a young person. (Disclaimer - I am saying this as an MS II w/o much clinical experience)

 

[dsprague12]

FWIW, wikipedia has it as a dead heat between bicuspid valve and RF.

"In about 15% the cause is innate bicuspidal aortic valve, while another 15% cases are due to retraction of the cusps as part of postinflammatory processes of endocarditis in rheumatic fever and various collagen vascular diseases."

 

[doctorFred]

FWIW, wikipedia has it as...

one of the epidemiologists at our school told us that the frequency with which we reference wikipedia as the source of our hypotheses keeps him up at night.

 

[SeventhSon]

one of the epidemiologists at our school told us that the frequency with which we reference wikipedia as the source of our hypotheses keeps him up at night.

it shouldn't, wikipedia is probably more accurate than any of our syllabi

 

[thewildleo]

Hi,

Did you find much of a difference in the overall format of questions with this format compared to previous experiences? Is it still similar to UW ?
Heard the q's are longer and tougher than NBME 2-4 with the 336 format

 

[DwyaneWade]

The quesiton is not asking what type of murmur you would hear with a bicuspid valve. It is asking ( I believe) for the most likely cause of aortic regurg in a 23 y.o. Even though the stem did not mention any s + s of infection which in this case would be a give-away, I would go with infection b-4 congenital causes.

It is asking the most likely cause of Aortic Regurg in an otherwise asymptomatic 23 year old. It's not asking for just any 23 year old. So I think infection is less likely.

 

[hockeymaniac101]

From what I remember, there were no other better choices ie marfans but i could be mistaken. I dont know if i am remembering this right or if it matters at all but they may have mentioned that the patient runs a couple miles a day. I may be mixing this up with another question though. I knew rheumatic fever causes aortic insufficiency acutely, and I knew bicuspid can have both, with stenosis most likely later in life, so i picked bicuspid and moved on.


I spoke to 2 other students from NJMS who also took the exam this week, and they said they also had 1 question on the exam. They were both heart murmur questions. For some reason, for all 3 of us, it was question number 48 in one of the sections. pretty odd...

Overall, I thought the exam was really tough, but many people feel that way afterwards. on the other hand, alot of the questions were straight forward. I seemed to always have 10 questions per section that I was unsure of.

 

[hockeymaniac101]

thanks for all those who are giving me hope that my answer might be right lol. why do i feel that these audio/video questions are going to be experimental questions for now?

 

[Mediculous]

thanks for all those who are giving me hope that my answer might be right lol. why do i feel that these audio/video questions are going to be experimental questions for now?

That's probably why they were #48---so they wouldn't unfairly take your time from other questions. The NBME may have a heart, after all...

 

[SaturdayDwarf]

Don't know if anyone cares anymore, but Lilly's Pathophys of Heart Disease list these causes of Aortic Regurg. I think they are in order of most common:

Abnormalities of Valve Leaflets
1. Congenital (bicuspid valve)
2. Endocarditis
3. Rheumatic

Dilation of aortic root
1. Aortic aneurysm
2. Aortic Dissection
3. Annuloaortic ectasia
4. Syphilis

Let's hope it was an experimental question, though.

 

[DrFraud]

Let's hope it was an experimental question, though.

I agree. I can only imagine what most students pick in 1-2 minutes when we have all day to discuss this. I looked this up too, but I could not find an age breakdown for the MCC. If anyone has a source, please post.

 

[ROBINHO]

I just did the UWorld Self Assessment Exams.
And there was this diagram crescendo decrescendo classic of Stenosis. and the question was...what was the cause?
I chose bicuspid---calcification and that turned out to be right.
There was no RF in the choice but in the explanation they said that WORLDWIDE RF is the MCC of Stenosos whiles in the USA it would be bicuspid.

cheers

 

[Minion677]

You almost didnt even need to listen to it, they showed u the bounding pulse, so it was classic for aortic insufficiency, but I was able to hear the diastolic murmur. Problem was they asked what is the most likely cause of this murmur. The patient was 23 and with no other symptoms or past medical problems so I was between bicuspid aortic valve or rheumatic fever. I picked bicupsid but idk.

23yo I'm thinking bacterial endocarditis or acute rheumatic fever but if he has no other symptoms then probably not because youd also have a fever among other things. bicuspid aortic valve usually presents later in life. marfan or ehlers danlos would be a good answer but if they werent there then idk.

 

[DrFraud]

23yo I'm thinking bacterial endocarditis or acute rheumatic fever but if he has no other symptoms then probably not because youd also have a fever among other things. bicuspid aortic valve usually presents later in life. marfan or ehlers danlos would be a good answer but if they werent there then idk.

I cant help but wonder if there was some type of discrete hint in the q. that would some how guide us...

 

[jwsmiths]

I just took the exam a few hours ago - I've forgotten most of what I saw.

Did horribly IMHO - but who knows, I may be second guessing myself.

I hope that last section wasn't the 'experimental' one - I knew 40 of them immediately, and the other 8 weren't that hard to develop an educated guess about either. One of the middle sections was my worst, I barely had any time left over when I was done answering them and I had to re-read a lot of them 2-3 times before I could decide on an answer.

Anyways, if I remember correctly my A/V question was the last question of the exam and was an elderly person brought in following a syncopal episode, I went with Aortic Stenosis.