NBME Step 2 CK Form 6 Pulmonary artery pressure (NBME Answers)

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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 1/Question#8 (reveal difficulty score)
A 37-year-old woman comes to the physician ...
Pulmonary artery pressure 🔍 / 📺 / 🌳 / 📖
tags: cardio pulm inc

+4 upvote downvote
submitted by sasoo8888(4)

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I was confused why diastolic filling time wouldn't be correct. Hx of Mitral stenosis should mean that it takes longer for her left ventricle to fill up, right, so increased diastolic filling time?

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tinylilron you have a good point +2

ronabobonafofona I also thought this. But I knew for sure that Pulmonary artery pressure would go up, so I just went with what I was sure of. +1

lubdub HR's fast. 100 bpm.. No time for filling there! The lack of filling time contributes to the pathology. +2

jlbae If I had the power to, I would dub lubdub the resident cardiologist of this forum. +4

+3 upvote downvote
submitted by ∗step_prep7(71)

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Classic presentation of mitral stenosis on NBME exams (rheumatic heart disease, worse with pregnancy, murmur description with diastolic snap-murmur)
Over time, mitral stenosis will lead to increased pressures in the left atrium which will back up into the lungs and the right side of the heart, eventually leading to right-sided heart failure; this knowledge coupled with the right ventricular lift (which occurs because the RV experiences hypertrophy secondary to increased pulmonary artery pressure) points to elevated pulmonary artery pressure
Diastolic filling time decreased (takes longer for mitral valve to open) and LV end-diastolic pressure also decreased/normal because of less blood flow from LA to LV

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-1 upvote downvote
submitted by ∗sugaplum(487)

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She is the classic demographic for pulmonary arterial hypertension. Slowly progressive disease. The PE findings support it

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medicalmike This patient's mitral opening snap and diastolic murmur are due to her mitral stenosis. Long-standing MS leads to elevated left atrial pressures which transmit to the pulmonary artery -> secondary pulmonary hypertension (not primary idiopathic PAH) +10

ronabobonafofona No worries @sugaplum. You've been right on for 99% of the other qs. +2

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