NMS Q&A Family Medicine

46 NMS Q&A Family Medicinesquats, as a result of an increase in venous return thatallows greater diastolic filling in this condition in whichdiastolic dysfunction is a part of the pathophysiology.28. Mitral valve prolapse: The answer is D. Midsystolic,late systolic, or pansystolic click are produced. If there isaccompanying mitral insufficiency, then there is the additionalmurmur thereof, as described in the answer toQuestion 27.29. Aortic regurgitation: The answer is B. This lesioncauses a high-pitched soft diastolic decrescendo murmurthat “crashes” off the second aortic sound and rapidly fallsoff in a decrescendo.MATCHING THE LETTERED EFFECTS WITHTHE NUMBERED MANEUVERS THAT MAYINFLUENCE MURMURS30. Inspiration, squatting: The answer is C. This maneuverincreases venous return and thus increases mitralregurgitation when present (see Question 28).31. Expiration, standing: The answer is A. Expirationand standing erect decrease venous return and effect anincrease in the prominence of a mitral click.32. Valsalva phase 3: The answer is D. This is the releasephase and produces a rapid decline in arterial BP.33. Valsalva phase 4: The answer is E. This is the reboundphase after Valsalva and it produces a rise in arterial BPand bradycardia.34. Handgrip: The answer is B. This produces a rise inSVR, heart rate, and cardiac output.ReferencesBradley JG , David KA . Orthostatic hypotension . Am Fam Physician. 2003 ; 68 : 2393 – 2398 .Eaton CB , Cannistra AJ . Common cardiac problems in familypractice . In: Rudy DR , Kurowski K , eds. Family Medicine:House Officer Series . Baltimore : Williams & Wilkins ; 1997 :71 – 96 .Family Medicine Board Review 2009 . May 3 – 9 , 2009.Gutierrez C , Blanchard D . Diastolic heart failure: Challenges ofdiagnosis and treatment . Am Fam Physician . 2004 ; 69 : 2609 –2616 .Maisel AS , Zoorob R . B type natriuretic peptide in congestiveheart failure . CME Bull (Am Acad Fam Physician) . 2004 ; 3 :1–4.Wiviott SD , Braunwald E . Unstable angina and non-ST-segmentelevation myocardial infarction: Part I. Initial evaluation andmanagement and hospital care . Am Fam Physician . 2004 ;70 : 525 – 532 .