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"Mitral Valve Prolapse — give a one-line definition and the single most important immediate risk."
Model: Mitral valve prolapse (MVP) is the systolic billowing of one or both mitral leaflets above the mitral annulus into the left atrium, defined echocardiographically as leaflet displacement of more than 2 mm beyond the mitral annular plane in the parasternal long-axis view during systole. The underlying pathology is myxomatous degeneration of the leaflet (proteoglycan-rich matrix, fragmented collagen) with chordal elongation, often with annular dilatation or mitral annular disjunction. The single most important immediate risk is the arrhythmic phenotype — bileaflet prolapse with mitral annular disjunction, inferior repolarisation abnormalities, complex ventricular ectopy and papillary-muscle or inferobasal fibrosis — because it causes polymorphic VT, ventricular fibrillation and sudden cardiac death in young patients with only mild or moderate mitral regurgitation, and it is the one presentation that must never be reassured away.
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: Sudden syncope, cardiac arrest or polymorphic VT/VF in a young patient with MVP and MAD - arrhythmic MVP; secondary prevention, ICD, treat MAD/MR
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.)