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 Best of Five 108

 

   

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BOF: 108

A 14-year-old male, a recent immigrant to the country is been investigated for a murmur.

On examination he is in sinus rhythm, he has a loud pan systolic murmur best heard at the left sternal edge and a mid-diastolic murmur best heard at the apex. The first heart sound is not loud; there is no opening snap and no pre-systolic accentuation of the diastolic murmur.

Cardiac catheterisation results are as follows:

 

Chamber

Pressure (mm Hg)

% Oxygen saturation

Superior vena cava

 

66

Inferior vena cava

 

68

Right atrium

3.5

67

Right ventricle

35/0

80

Pulmonary artery

35/10

81

Left ventricle

100/0

96

 

In this patient the mid-diastolic murmur is due to:

a)      Increased flow across the mitral valve

b)      Increased flow across the tricuspid valve

c)      Mitral stenosis

d)      Tricuspid stenosis

e)      Lutembacherís syndrome

 

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