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Opening (30 s)
"Mitral Stenosis — give a one-line definition and the single most important immediate risk."
Model: Mitral stenosis (MS) is a narrowing of the mitral valve orifice that obstructs flow from the left atrium to the left ventricle during diastole. The normal mitral valve area (MVA) is 4 to 6 cm squared; MVA at or below 1.5 cm squared is severe (clinically significant) and at or below 1.0 cm squared very severe. The leading cause worldwide is rheumatic heart disease (RHD) — commissural fusion, leaflet thickening and subvalvular chordal shortening giving the fish-mouth valve. The single most important immediate risk is acute pulmonary oedema provoked by any tachycardia, classically new fast atrial fibrillation, which shortens diastole and spikes the transmitral gradient; the immediate answer is rate control and careful diuresis, never a first-line vasodilator.
Station 1 — Pathophysiology (2 min)
Explain the mechanism chain from cause to clinical features and one major complication.
Station 2 — Clinical diagnosis (2 min)
Classic presentation, atypical groups, named bedside signs, and what you examine for red flags.
Red flag cue: Acute pulmonary oedema with new fast atrial fibrillation in a young pregnant woman — suspect previously silent rheumatic MS; rate-control, diuresis, urgent echo
Station 3 — Investigations (2 min)
First-line tests, definitive tests, and any named score with exact components.
Station 4 — Emergency management (3 min)
ABC priorities, first drugs with dose and route, procedures, and when to escalate to ICU/theatre.
Station 5 — Definitive / long-term care (2 min)
Stepwise definitive therapy, monitoring, complications of treatment, follow-up.
Station 6 — Special populations (2 min)
Child / pregnancy / elderly / immunocompromised / renal impairment — what changes.
Station 7 — Evidence & pitfalls (2 min)
Landmark trial or guideline name if standard; three classic exam traps.
Station 8 — Rapid-fire pearls (1 min)
Five high-yield facts a candidate must not forget under time pressure.
Examiner pass criteria
- Speaks in mechanisms and numbers, not vague lists
- Gives at least one exact dose or threshold
- Names escalation criteria
- Avoids dangerous delays (imaging when unstable, etc.)