USMLE Forums banner
1 - 1 of 5 Posts

· Registered
3,200 Posts
Pathophysiology and memorizing that table

I don't think that table is really important for the CK exam. Exam cases are usually differentiated on the basis of other more important characteristics and patient's history rather than merely the effects of these maneuvers.

However, here's some help with table.

First of all swipe off the middle column "Squatting". The lateral four columns are just opposite each other. Valsalva is the opposite of leg raising and that makes sense because Valsalva decreases venous return while leg raising increases venous return. Phenylphrine is the opposite of Amyl Nitrite that makes sense because the first is a constrictor while the other is a dilator.

Take phenylphrine in AS. You'll see that the murmur decreases this is because you constricted the arterioles and so you increased the preload and so less flow across the aortic valve (therefore more flow in the other channels like flowing back through MR or through VSD increasing the intensity of their respective murmurs). Once you memorize this then everything else is a game of oppisites. 2nd column opposite of 4th and 1st column opposite of 5th column. Likewise, AS/HOCM opposites of VSD/MR. The only exception to this rule is HOCM in Valsalva and Leg raising.

Hope this helps a little.

But as I told you don't spend time trying to memorize. It's not going to benefit you on the exam.
1 - 1 of 5 Posts
This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.