NBME 21 Aortic (NBME Answers)

NBME 21 Answers

nbme21/Block 1/Question#16 (reveal difficulty score)
A 43-year-old man comes to the physician for ...
Aortic 🔍 / 📺 / 🌳 / 📖
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+38 upvote downvote
submitted by ∗mcl(670)

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Labeled CXR showing position of different valves.

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hyperfukus this link is great! they're still kind of close together :( its so hard to tell for me w/o reference of the others +

mannywillsee So the way to differentiate Aortic valve from the others is by checking the lateral view, AV will be more medial than both tricuspid and mitral; tricuspid will be more anterior and mitral will be posterior while Pulmonary is doing its own thing +3

sunnyside A surgeon told me once that there is no "left" and "right" heart - only anterior and posterior - referring to how the heart sits in vivo. Helps me think through imaging and these weird anatomy questions +1

sunnyside Just to finish out that thought... Right side = anterior. Left side = posterior. +

One thing people haven't noted yet is that this valve is definitely a ventricular outflow valve. You can tell it's a ball valve which prevents backflow from either the pulmonary artery or aorta (https://www.researchgate.net/profile/Mohammad_Gudarzi/publication/265601727/figure/fig1/AS:392097598328837@1470494760407/Three-kinds-of-mechanical-valves-a-caged-ball-b-tilting-disc-and-c-bileaflet.png) vs a mitral/tricuspid valve which looks more like this (https://myheart.net/wp-content/uploads/2015/11/replacement-mitral-valves.jpg)

+5/- ibestalkinyo(60)

+19 upvote downvote
submitted by ∗step1soon(51)

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https://radiologykey.com/valvular-heart-disease/

Look at where the cusps are pointing → upwards therefore aortic. if cusps were downward → then mitral valve would be the right answer

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misterdoctor69 mitral valve would only have 2 cusps even if it were replaced though right?... +

bbr After staring at this for awhile, I wanted to elaborate on this to make it even clearer. The 3 areas that meet at a point would be the 3 cusps. These 3 flaps are going to get blown open. Means flow is from down to up. +5

+4 upvote downvote
submitted by ∗kentuckyfan(47)

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another link I found helpful

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+3 upvote downvote
submitted by ∗suckitnbme(239)

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I was stuck between mitral and aortic and went with aortic because the L ventricle looks enlarged, possibly hinting that the patient had aortic stenosis.

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drzed I went with aortic because it looks like the valve has three cusps, while the mitral valve should only have two. Incorrect logic? +4

an1 I was stuck between aortic and mitral. Thought he looked like he might have kyphosis, assumed it was trying to make us think Marfan and went for mitral valve :( +

+0 upvote downvote
submitted by ∗nbaumgarten(0)

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This may be wrong, but it also looks like he may have had aortic regurgitation before. You can see that his has Left Ventricular enlargement.

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ali_hassan honestly i just thought that he had an early valvular lesion (had surgery when he was 43) without any history of some sort of endocarditis etc.. could be he had bicuspid valve which needed replacing +

ali_hassan 33* +

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