LearnWithTest

1 A 55-year-old man with long-standing rheumatic mitral stenosis presents with ascites, pedal edema, and a pansystolic murmur that increases on inspiration. JVP shows prominent v waves. What is the most likely mechanism of tricuspid regurgitation?

Primary rheumatic involvement of tricuspid valve Papillary muscle ischemia Functional regurgitation due to right ventricular dilation Congenital leaflet malformation

2 An IV drug user presents with fever, septic pulmonary emboli, and a new systolic murmur at the left lower sternal border. Which pathological change most likely explains the murmur?

Annular calcification Leaflet fibrosis Vegetation-induced leaflet destruction Right ventricular hypertrophy

3 A patient with carcinoid syndrome develops progressive right heart failure. Echocardiography reveals severe tricuspid regurgitation. What is the underlying pathology?

Valve calcification Chordal rupture Plaque-like fibrous thickening of valve leaflets Pure annular dilation

4 A 70-year-old woman with permanent atrial fibrillation develops severe tricuspid regurgitation despite normal pulmonary pressures. The most likely mechanism is:

Primary leaflet degeneration Atrial functional tricuspid regurgitation due to annular dilation Rheumatic involvement Infective endocarditis

5 A patient with severe tricuspid regurgitation has a relatively soft murmur despite marked symptoms. What best explains this finding?

Short systolic duration Low right ventricular systolic pressure Calcified valve leaflets Reduced venous return

6 A patient undergoes mitral valve replacement. Intraoperative assessment shows moderate tricuspid regurgitation with annular diameter of 42 mm. Best management?

No intervention on tricuspid valve Medical therapy only Concomitant tricuspid valve repair Tricuspid valve replacement

7 A patient with a permanent pacemaker develops worsening right heart failure. Echocardiography shows the lead crossing the tricuspid valve. Mechanism of regurgitation is:

Annular fibrosis Mechanical leaflet impingement Pulmonary hypertension Leaflet calcification

8 In severe tricuspid regurgitation, which Doppler finding best confirms severity?

Mild central jet Late systolic jet Dense, early-peaking triangular CW Doppler signal Small vena contracta

9 A patient with severe tricuspid regurgitation develops marked ascites and hepatomegaly. The primary pathophysiological mechanism is:

Pulmonary venous congestion Reduced left ventricular output Systemic venous hypertension Renal artery hypoperfusion

10 Which clinical sign best differentiates tricuspid regurgitation from mitral regurgitation on examination?

Radiation to axilla Holosystolic murmur Increase in murmur intensity with inspiration Presence of S3

11 A patient with severe tricuspid regurgitation is planned for surgery. Which option is generally preferred?

Mechanical valve replacement Bioprosthetic valve replacement only Valve repair with annuloplasty No surgery due to high risk

12 Which factor most strongly predicts poor prognosis in patients with severe tricuspid regurgitation?

Murmur grade Right atrial size Right ventricular dysfunction Patient age

13 A patient with chronic lung disease develops tricuspid regurgitation. The primary precipitating factor is:

Direct leaflet damage Pulmonary hypertension causing RV dilation Left ventricular failure Rheumatic inflammation

14 In severe tricuspid regurgitation, hepatic vein Doppler typically shows:

Normal systolic forward flow Reduced diastolic flow Systolic flow reversal Absent venous flow

15 Which scenario most strongly supports primary rather than functional tricuspid regurgitation?

Pulmonary hypertension with RV dilation Atrial fibrillation with annular dilation Carcinoid syndrome with fibrotic valves Left-sided heart failure