Examination Vivas

Question 1

Aortic stenosis

Presentation
Differentials (3)
Investigations
Management (CMS)

Answer 1

Presentation/
Relevant +ves:
- ESM loudest in the aortic region, radiating to the carotids
Relevant -ves:
- No signs of decompensation
- No peripheral stigmata of endocarditis

Differentials/
MR
Aortic sclerosis
HOCM

Investigations/
Bedside:
ECG - LVH
Urine dip - proteinuria (IE)

Bloods:
Cultures + CRP (IE)

Imaging:
CXR - LVH + oedema
Echo

Management/ 
Refer to cardiology 
Conservative: 
- Health promotion 
Medical: 
- BP control 
- Statins 
Surgical: 
- Valve replacement

Question 2

Mitral regurgitation

Presentation
Differentials (3)
Investigations
Management (CMS)

Answer 2

Presentation/
Relevant +ves:
- Pansystolic murmur heard loudest over mitral region
- Radiates to axilla
Relevant -ves:
- No signs of decompensation
- No peripheral stigmata of endocarditis

Differentials/

• AS
• Septal defect
• IE

Ix/ 
Investigations/
Bedside:
ECG - LVH 
Urine dip - proteinuria (IE) 

Bloods:
Cultures + CRP (IE)

Imaging:
CXR - LVH + oedema
Echo

Management/ 
Conservative
- Health promotion
- Avoid intense physical activity but encourage mild to moderate exercise
Medical
- Managing HTN
Surgical
- Valve replacement if they are symptomatic or asymptomatic with a reduced ejection fraction