The answer is: D
Respiratory syncytial virus (RSV) is the most important cause of pneumonia and bronchiolitis in infants. The infection is localized to the respiratory tract. The virus can be detected rapidly by immunofluorescence on smears of respiratory epithelium. In older children, the infection resembles the common cold. Aerosolized ribavirin is recommended for severely ill hospitalized infants.
Tags: MCQ, Microbiology, RSV, Syncitial Virus

The answer is: D
Kuru and Creutzfeldt-Jakob disease (CJD) are similar but not identical diseases with very different epidemiology. Kuru is prevalent among certain tribes in New Guinea who practiced ritual cannibalism by eating the brains of the departed. CJD is found worldwide and has been transmitted by corneal transplants and in pituitary hormone preparations. There is some association between CJD and Mad Cow Disease in England. Prions are unconventional selfreplicating proteins, sometimes called amyloid. It is now thought that CJD, Kuru, and animal diseases such as scrapie, visna, and bovine spongiform encephalopathy (Mad Cow Disease) are caused by prions.

The answer is: D
Aseptic meningitis is characterized by a pleocytosis of mononuclear cells in the cerebrospinal fluid; polymorphonuclear cells predominate during the first 24 h, but a shift to lymphocytes occurs thereafter. The cerebrospinal fluid of affected persons is free of culturable bacteria and contains normal glucose and slightly elevated protein levels. Peripheral white blood cell counts usually are normal. Although viruses are the most common cause of aseptic meningitis, spirochetes, chlamydiae, and other microorganisms also can produce the disease.

The answer is: B
Human papillomavirus (HPV) is the cause of genital warts. It is one of the most pervasive of all the sexually transmitted diseases. There is no specific cure or vaccine. There are multiple serotypes of papillomavirus and some serotypes are linked to cervical cancer. New techniques for molecular diagnosis of HPV show promise for rapid and sensitive detection and perhaps more aggressive treatment.
Tags: MCQ, Microbiology, Papilloma virus

ExplanationCoagulative necrosis occurs five to six hours after the infarction occurs.
Collagen synthesis (choice a) occurs at the site of the infarction three to six weeks after a myocardial infarction.Contraction (choice b) of the scar tissue occurs four to six weeks after the myocardial infarction.Influx of eosinophils, lymphocytes and plasma cells (choice d) occurs approximately two weeks after an infarction.New capillaries at the site of infarction (choice e) occurs after about a week. Tags: MCQS, Pathology, Necrosis

The correct answer is C Explanation
The lesion described are called telangiectasia. Hereditary hemorrhagic telangiectasia is also called Osler-Rendu-Weber. It is autosomal dominant, which explains why her father had it as well.
Sturge-Weber syndrome (choice a) is associated with port-wine stain on the face. The cutaneous manifestations of Von Recklinghausen disease (choice b) are cafe au lait spots and neurofibromatosis, not telangiectasias. The lesions of Kaposi sarcoma (choice d) are dark blue-red papules and nodules. Although the lesions of Peutz-Jeghers syndrome (choice e) affect the oral mucosa, and it also is inherited by an autosomal dominant mechanisms, the lesions are tan-brown and do not result in bleeding Tags: MCQS, Genetics, Osler-Rendu-Weber

The correct answer is A Explanation
In the diagnostic evaluation of the woman with withdrawal bleeding , an LH and FSH level may be helpful. If the LH is high (above about 10 MIU/ml) and the LH/FSH ratio is above 2:1, this supports the clinical diagnosis of polycystic ovarian disease
Tags: MCQS, Gynecology, Polycystic Ovary

The correct answer is D Explanation
A vaginal lubricant would be appropriate since although most of the estrogen acts locally, some of it is rapidly absorbed into the systemic circulation
Tags: MCQS, Gynecology, Vaginal Lubricant

Answer: D
This patient has many potential causes for a hypercoagulable state including bedrest, possible HIT from heparin flushes in his central venous catheter, carcinoma, and a possible inherited predisposition to thrombosis as suggested by his previous DVT. In terms of tests that should be done at this time, the genetic tests can be accurately interpreted, but should be done on a tissue sample different from the usual peripheral blood leukocyte sample due to the circulating white cells from the transplant donor.

Answer: E
Patients with CLL may have aberrant immune responses that include the development of antibodies to coagulation factors. In this case, the patient had a low factor VIII ( and, on further testing, low VWF) due to an acquired antibody to VWF leading to clearance and decreased levels of VWF and factor VIII. A lupus anticoagulant or a decreased factor XII would not be expected to lead to bleeding, which the patient reports. Although decreased factor IX or factor XI levels could lead to bleeding, there is no past history or family history of bleeding, and acquired antibodies to these factors are exceedingly rare.

Answer: B
An alpha2 antiplasmin deficiency will cause bleeding, particularly after an invasive procedure when the fibrinolytic system is activated, and (as seen in this case) it will not cause abnormalities in the screening coagulation studies. The normal screening coagulation studies in the patient make it very unlikely that coagulation screening of the mother, a factor XI level, or a d-Dimer will be helpful in this evaluation. Electron microscopic study of the patient’s platelets is not indicated in the face of the normal platelet studies that have been reported.

The correct answer is A Explanation
Vitamin B9, also called folic acid or folate, is one of eight water-soluble B vitamins. All B vitamins help the body to convert carbohydrates into glucose (sugar), which is "burned" to produce energy.
These B vitamins, often referred to as B complex vitamins, are essential in the breakdown of fats and protein.
B complex vitamins also play an important role in maintaining muscle tone along the lining of the digestive tract and promoting the health of the nervous system, skin, hair, eyes, mouth, and liver. Folic acid is crucial for proper brain function and plays an important role in mental and emotional health. It aids in the production of DNA and RNA, the body's genetic material, and is especially important during periods of high growth, such as infancy, adolescence and pregnancy.

The correct answer is D
Explanation
Manifestations of Vitamin K deficiency include hypoprothrombinemia ,hemorrhaagic diathesis, an increased tendency to bleeding and a prolonged coagulation time. Vitamin K is required for gamma-carboxylation of glutamic acid residues of the procoagulant Factors II (prothrombin), VII, IX, and X and the anticoagulant factors protein C and protein S Severe vitamin K deficiency can lead to a hemorrhagic diathesis that is characterized by prolongations of the PT and sometimes also the aPTT.

Explanation Trimetaphan appears to work by competitive block of ACh receptors. Mecamylamine is also a blocker of neuronal nicotinic receptors, initially developed as an antihypertensive ganglionic blocker, abandoned because of postural hypotension, and now of interest because its noncompetitive voltage-dependent interference with nicotinic receptors makes it significant in the study of addiction
Tags: MCQS, Pharmacology, Mechanism of action

Explanation class Ib
- shorten action potential
- limited effect on rate of rise of phase 0
- shorten repolarization
- shorten QT
- raise fibrillation threshold
- mild-moderate sodium channel blockade
- little effect on refractoriness since there is essentially no blockade of potassium channels
- eg lignocaine, mexilitine, phenytoin, propafenone
Tags: MCQS, Pharmacology, Anti-Arrythmics

The correct answer is B
Explanation
class Ib
- shorten action potential
- limited effect on rate of rise of phase 0
- shorten repolarization
- shorten QT
- raise fibrillation threshold
- mild-moderate sodium channel blockade
- little effect on refractoriness since there is essentially no blockade of potassium channels
- eg lignocaine, mexilitine, phenytoin, propafenone
Tags: MCQS, Pharmacology, Anti-Arrythmics

The correct answer is D
Explanation
Class II
- decrease potential for arrhythmias to develop in response to catecholamines
- eg bretylium: blocks release of sympathetic transmitters
- beta blockers: competitive antagonists and also block possible arrhythmogenic effect of cAMP
- indirect blockade of Ca channel opening by attenuating adrenergic activation
Tags: MCQS, Pharmacology, Arrythmia

PThe correct answer is D
Explanation
Class III
- K channel blockers: prolong duration of action potential with resulting prolongation of effective refractory period
- eg amiodarone, sotalol, disopyramide, bretylium
Tags: MCQS, Pharmacology, Anti-Arrythmics

The correct answer is C
Explanation
Zollinger-Ellison syndrome is caused by excessive gastrin production and is usually due to a gastrinoma (90%)of the pancreas.The diagnosis should be suspected in the case of peptic ulcers failing to respond to drug therapy and repeated episodes of diarrhea and steathorrea (as in this case) Antral G cell hyperplasia is present in 10%. The commonest location is the duodenal bulb, followed by the stomach and then the postbulbar dusodenum. Gastro-esophageal reflux (as in this case)is a complication rather than a cause and is present in most of these patients and often complicated by esophagitis.

The correct answer is D
Explanation
Valproic acid is a drug of choice for:
Generalized epilepsy of unknown cause that produces more than one type of seizure. Absence seizures.
Ethosuximide is the other drug of choice.
If a person has absence seizures as well as other types of seizures, however, valproic acid usually works better because it can control several types of seizures.
Myoclonic seizures, such as those caused by juvenile myoclonic epilepsy.

The correct answer is E
Explanation
Beta-1 selective blockers
These include atenolol and metoprolol (as well as betaxolol, bevantolol, and perhaps esmolol).
Metoprolol
This beta blocker lacks ISA and MSA; one can deduce its metabolism and short half-life from its lipophilicity. Some slow-release formulations of metoprolol have peculiar doses.
Atenolol
Examination candidates should probably know this agent fairly well. Important topics to discuss would be its water solubility, metabolism, ß-1 selectivity, and recent studies showing improved post-operative survival even after very short-term use in the peri-operative period.

The correct answer is B
Explanation
Parathion is a commonly used insecticide which belongs to organophosphorous group of chemicals. Poisoning due to parathion occurs usually in farming areas where it is used as an insecticidal agent. Parathion acts by irreversible inhibition of the enzyme acetylcholine esterase which is responsible for the breakdown of acetylcholine. Normally acetylcholine binds to the esteratic site of the enzyme resulting in acetylation of the enzyme. The acetylated enzyme reacts with water resulting in breakdown of acetylcholine and release of free enzyme.

The correct answer is A
Explanation
Spironolactone is effective in lowering the systolic and diastolic blood pressure in patients with primary hyperaldosteronism. It is also effective in most cases of essential hypertension, despite the fact that aldosterone secretion may be within normal limits in benign essential hypertension.
Through its action in antagonizing the effect of aldosterone, spironolactone inhibits the exchange of sodium for potassium in the distal renal tubule and helps to prevent potassium loss.
Hyperkalemia: Hyperkalemia may occur in patients treated with spironolactone if the potassium intake is excessive. This can cause cardiac irregularities, some of which may be fatal. Hyperkalemia may also occur even in the absence of potassium supplementation, particularly in patients with impaired renal function, elderly patients, or patients with diabetes. Consequently, no potassium supplementation should ordinarily be given with spironolactone. Hyperkalemia can be treated promptly by rapid i.v. administration of glucose (20 to 50%) and regular insulin, using 0.25 to 0.5 units of insulin/g of glucose. This is a temporary measure to be repeated if required. Spironolactone should be discontinued and potassium intake (including dietary potassium) restricted.

The correct answer is D
Explanation
Recognised complications of Quinidine.
Hypotension and a reflex increase in heart rate. Due to peripheral vasodilation.
Depresses vagal tone. Due to an antimuscarinic action (works against direct effect on SA and AV nodes).
Torsades de pointes. A potentially life-threatening proarrhythmia.
Cinchonism. A syndrome characterized by nausea, vomiting, diarrhea, tinnitus, headache, auditory and visual disturbances and vertigo.
Hypersensitivity reactions (rashes, fever, angioneurotic edema hepatitis) and reversible thrombocytopenia.
Tags: MCQS, Pharmacology, Drug Toxicity

The correct answer is E
Explanation
Phenytoin is approximately 90 per cent bound to serum albumin. Therefore, in an initial total plasma phenytoin concentration of 20ìg/ml represents the sum of the protein bound drug (90 per cent of 20 = 18ìg/ml) and the unbound drug (10 per cent of 20 = 2ìg/ml). The unbound drug is available for distribution to the site of therapeutic effect (ie, the brain), peripheral tissues, and the site of elimination (the liver). The bound drug is confined to the bloodstream.
Tags: MCQS, Pharmacology, Pharmacokinetics

The correct answer is B
Explanation
Primary treatment of gastroparesis includes dietary manipulation and administration of antiemetic and prokinetic agents.Dietary recommendations include eating frequent smaller-size meals and replacing solid food with liquids, such as soups. Foods should be low in fat and fiber content.
Antiemetic agents are administered for nausea and vomiting. The principal classes of antiemetic drugs are antidopaminergics, antihistamines, anticholinergics, and more recently serotonin receptor antagonists. The antiemetic action of phenothiazine compounds is primarily due to a central antidopaminergic mechanism in the area postrema of the brain. Commonly used agents include prochlorperazine, trimethobenzamide, and promethazine.

Answer: D
Although the history initially suggests ITP, further questioning indicates that the patient has a life-long bleeding history and that her father may have a bleeding disorder. Additionally, the patient did not respond to treatment with prednisone.
Although the results of the VWF activity and antigen were within the normal reference range, they should be increased above normal (approximately twice normal) at this point in the patient’s pregnancy.
Type 2B VWD can cause this clinical picture with worsening thrombocytopenia during pregnancy; this is due to the increased synthesis of VWF that normally occurs in later pregnancy, leading to a higher level of the abnormal VWF in the circulation that binds to platelets and causes small aggregate formation and clearance of the platelets.

The answer is: B
HSV meningitis or encephalitis is difficult to diagnose by laboratory tests as there is a low titer of virus present in the CSF. Neonatal HSV infects the child during the birth process. While culture, Tzanck smear, and even antibody tests may be useful in adults, particularly those with HSV-rich lesions, they are not useful for CSF testing. Only PCR is sensitive enough to detect HSV DNA in the CSF. Once diagnosed rapidly, HSV encephalitis or meningitis can be treated with acyclovir.

ExplanationThe incidence of hyponatremia associated with Chlorpropamide is about 7 percent. The majority of patients are mildly hyponatremic with serum sodium concentrations between 130 and 134 mmol/L. The incidence of Chlorpropamide-induced syndrome of inappropriate antidiuretic hormone is 2 percent. Concurrent angiotensin-converting enzyme (ACE) inhibitor is identified as a risk factor; thiazide diuretic use is not.
Tags: MCQS, Pharmacology, Diuretics

The answer is: B
Rubella virus does not produce cytopathic effects (CPEs) in tissue-culture cells. Moreover, rubella-infected cells challenged with a picornavirus are resistant to subsequent infection and thus would not exhibit CPEs. Monkey kidney cells infected only with picornavirus would show CPEs.
Tags: MCQ, Microbiology, Virus

The correct answer is B
Explanation
Primary treatment of gastroparesis includes dietary manipulation and administration of antiemetic and prokinetic agents.
Dietary recommendations include eating frequent smaller-size meals and replacing solid food with liquids, such as soups. Foods should be low in fat and fiber content.
Antiemetic agents are administered for nausea and vomiting. The principal classes of antiemetic drugs are antidopaminergics, antihistamines, anticholinergics, and more recently serotonin receptor antagonists. The antiemetic action of phenothiazine compounds is primarily due to a central antidopaminergic mechanism in the area postrema of the brain. Commonly used agents include prochlorperazine, trimethobenzamide, and promethazine.

Answer: C
In this case where there have been several past cardiac surgical procedures, the chances are high that the patient was exposed to “fibrin glue” which contains bovine thrombin (and bovine factor V in this semi-purified preparation). Inhibitors to bovine thrombin and factor V commonly develop, and although the antibody to bovine thrombin usually does not cross react with human thrombin, the antibody to factor V frequently cross reacts with human factor V and can cause serious bleeding. A factor V test showing a decreased level should be followed by a factor V inhibitor assay to confirm this; a thrombin time performed with human thrombin as the reagent would be normal. DIC is not likely in the presence of a normal platelet count and this degree of abnormality in the coagulation tests. A hereditary dysfibrinogenemia could cause prolonged assays in all 3 tests noted above, but it is not likely to cause bleeding, and it was not detected on the previous testing. A lupus anticoagulant would not cause a prolonged thrombin time. Heparin would not be expected to cause this prolongation of the prothrombin time, and thrombin time would be greater than 2 minutes if the aPTT is increased to 51 seconds by heparin.

Answer: E
The history suggests a possible autoimmune disease (such as Systemic Lupus Erythematosis) as well as a lymphoma. The prolonged aPTT that only partially corrects with a 1:1 mixing study indicates an inhibitor, while the total correction of the prothrombin time on 1:1 mix suggests a deficiency. A lupus anticoagulant with an associated factor II (prothrombin) deficiency due to an antibody that complexes with prothrombin (affecting clearance but not affecting the active site of thrombin) will cause this pattern of laboratory results. von Willebrand disease would cause only a prolonged aPTT, and a factor V deficiency or inhibitor would not be expected to give this pattern of correction in the 1:1 mixing studies (either both assays would be corrected or both would not be corrected). DIC is unlikely because the aPTT is prolonged out of proportion to the prothrombin time and degree of thrombocytopenia, and the patient has no bleeding symptoms. Platelet antibodies, while they might be positive in this setting, would not account for the abnormal coagulation parameters.

The answer is: E
The advent of triple therapy or a therapeutic "cocktail" has had a marked effect on AIDS patients. The combination of drugs work together as reverse transcriptive inhibitors and a protease inhibitor. Patients improve rapidly, their CD4 lymphocyte counts increase, and their HIV viral load is drastically reduced, often to <50>
On the other hand, an untreated HIV-positive patient with a low CD4 and a high viral load

Answer: B
Weir, E.G., Borowitz, M.J. Flow cytometry in the diagnosis of acute leukemia. Seminars in Hematology. 2001, 38:124-128.
Tags: MCQ, Hematology, Leukemia

Answer: B
Primary mediastinal large B cell lymphomas demonstrate a diffuse large cell proliferation. Sclerosis is present in most cases. The neoplastic cells have a large transformed cell appearance. This type of lymphoma is most common in females and has a proclivity for local invasion and superior vena cava obstruction. The neoplastic cells are CD19, CD20, CD22 positive, they are negative for CD5, CD10, CD30, CD15 and in general do not express surface immunoglobulin. Non-Burkitt small transformed cell lymphomas are positive for CD45, CD19, CD20, CD10 and surface immunoglobulins. B lymphoblastic lymphomas express CD19, CD20, CD10 and do not express surface immunoglobulins. Reed-Sternberg cells are typically CD45-, CD30+ and CD15+.

Answer: C
The autoimmune lymphoproliferative syndrome (ALPS) arises in early childhood in patients who inherit mutations in genes that mediate apoptosis. ALPS is inherited in an autosomal dominat fashion. The syndrome is defined as chronic, non-malignant lymphoproliferation associated with an elevated percentage (>1%) of double negative T lymphocytes (CD3+, CD4-, CD8-) and defective lymphocyte apoptosis. Autoimmune syndromes are commonly associated with ALPS. The most common autoimmune diseases are hemolytic anemia and ITP. Most cases of ALPS are associated with specific Fas mutations; mutations in other apoptosis genes are thought to underlie cases in patients with normal Fas. Peripheral blood or tissues, show no evidence of clonality or chromosome abnormalities.

Answer : 1 Lower esophageal sphincter tone is decreased by:
- Pregnancy
- Obesity
- Smoking, Alcohol
- Fatty foods, large meals, chocolate
- Diseases such as diabetes
The lower esophageal sphincter (LES) is a ring of muscle that forms a valve at the lower end of the esophagus, where it joins the stomach.

Answer: D
Mast cell disease is associated with irregular and patchy marrow infiltration. The majority of mast cells are the fusiform type and contain a variable number of granules. Fibrosis accompanies mast cell infiltrates. Abundant numbers of eosinophils and foci of reactive lymphocytes are present near the mast cell foci. Uninvolved marrow is usually normal.
Giemsa, toluidine blue, aldehyde-fuschin, astra blue, chloroacetate esterase and tryptase stains are strongly positive in mast cells.

Answer: D
( MDS: myelodysplastic syndrome, AML: acute myeloid leukemia, LGL: Large granular lymphocyte )
Hairy cell leukemia (HCL) is most often associated with cytopenias. Anti-CD20 is a highly sensitive immunohistochemical stain for B cells and, thus, is more sensitive for diagnosing HCL than TRAP, but the TRAP stain is more specific. The bone marrow in HCL is very often hypocellular, dysplastic changes are usually not present. Aplastic anemia, myelodysplastic syndrome , hypocellular AML and LGL syndrome are part of the differential diagnosis in a cytopenic patient with mild splenomegaly and an hypocellular marrow; large aggregates of CD20 positive lymphocytes are not seen in these disorders.

ExplanationThe optochin test is a presumptive test that is used to identify strains of Streptococcus pneumoniae.Optochin (ethyl hydrocupreine) disks are placed on inoculated blood agar plates. Because S. pneumoniae is not optochin resistant, a zone of inhibition will develop around the disk where the bacteria have been lysed. This zone is typically 14mm from the disk or greater.Streptococcus pneumoniae is a gram-positive coccus that in clinical specimens often appears in pairs with tapered ends (lancet shaped), although it grows in short chains on nutrient broth media. It is a relatively fastidious facultative anaerobe and requires increased carbon dioxide for optimum recovery from clinical specimens .

The correct answer is E Explanation
 
The earliest ECG evidence of hyperkalemia usually appears in the T waves The variety of changes include: Increased amplitude and peaking of the T wave PR interval prolongation QRS interval prolongation Flattening of the P wave. A plasma potassium of >6.5mmol/l should be treated urgently unless it is an artefact.

The correct answer is C Explanation
In severe aortic stenosis , the left ventricle functions at the steep portion of the pressure-volume curve. In aortic stenosis, there is pressure overload leading to concentric hypertrophy of the left ventricle. This causes increased contractility and decreased compliance of the chamber. More pressure is thus exerted to eject the same volume of blood. The pressure–volume curve therefore shifts to the left. In aortic and mitral regurgitation, volume overload occurs leading to a dilated left ventricle. This causes decreased contractility and increased compliance and shifts the pressure–volume curve to the right.

The correct answer is E.
Most RNA viruses (eg, poliovirus) replicate in the cytoplasm and therefore can replicate in enucleated cells. Poliovirus belongs to the family Picornaviridae. These viruses are nonenveloped and have an icosahedral nucleocapsid that contains positive-sense RNA.
The exception to the rule regarding RNA viruses is the family Orthomyxoviridae, the influenza viruses (choice C). Orthomyxoviruses undergo transcription and RNA replication in the nucleus of the host cell because they need to cannibalize the capped 5' termini of cellular RNAs for use as primers for viral mRNA transcription.

Answer: E
Review:
Stetler-Stevenson, M., Braylan, R.C. Flow cytometric analysis of lymphomas and lymphoproliferative disorders. Seminars in hematology. 2001, 38:11-123
Tags: MCQS, Hematology, Lymphomas

The correct answer is C
Explanation
Kallmann's syndrome which is an isolated gonadotropin (LH and FSH) deficiency occurs in both a sporadic and familial form and although uncommon i.e. 1 in 10,000 men, it is second to Klinefelter's syndrome as a cause of hypogonadism. The syndrome is often associated with anosmia, congenital deafness, hair lip, cleft palate, craniofacial asymmetry, renal abnormalities, color blindness. The hypothalamic hormone GnRH appears to be absent.

The correct answer is E
Explanation
Craniopharyngioma is the most common brain neoplasm of nonglial origin and the most common brain tumor associated with hypothalamic-pituitary dysfunction and sexual infantilism.
Clinical manifestations include headache, visual disturbances, short stature, symptoms of diabetes insipidus, and weakness of one or more limbs. Physical findings include visual defects (including bilateral temporal field deficits), optic atrophy or papilledema, and signs of GH deficiency, delayed puberty, and hypothyroidism. Although only a few patients seek evaluation because of short stature, most are below the mean in height and height velocity at the time of diagnosis.

The correct answer is C
Explanation
Medullary thyroid cancer is a malignancy of the thyroid parafollicular cells. Thyroid parafollicular cells normally produce the hormone calcitonin. A malignancy of these cells, therefore, can also produce calcitonin. Assay of calcitonin is a very good diagnostic test for medullary carcinoma of the thyroid. Thyroid stimulating hormone (choice a) is an anterior pituitary hormone and is not produced by the thyroid gland at all.

The correct answer is D
Tags: MCQS, Physiology, Homeotasis

The correct answer is D Explanation
Wenckebach phenomenon is a form of incomplete atrio-ventricular heart block in which there is progressive lengthening of conduction time in cardiac tissue with P-R interval increasing until there is not a ventricular response.
This is followed by a conducted beat with a short P-R interval, and then the cycle repeats itself. This occurs frequently after an inferior myocardial infarction and tends to be self-limiting.
Tags: MCQ, Cardiology, Heart Block

The correct answer is B Explanation
With aortic stenosis there is a systolic ejection murmur that is heard loudest at the second right intercostal space (the aortic area). A systolic ejection murmur is also seen with pulmonic stenosis, however this is best heard in the second left intercostal space.
Atrial fibrillation is common in mitral stenosis. It is also seen in mitral regurgitation, however, less commonly than with mitral stenosis.