American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is NOT a feature of severe aortic stenosis?

1. Echo every 6-12 months

2. Normal mean gradient

3. clinical eval yearly

4. AVA ≤1.0 cm2

The correct answer is: Normal mean gradient

In assessing the features of severe aortic stenosis, it is important to recognize what characterizes this condition. A normal mean gradient is not consistent with severe aortic stenosis, where one would typically expect to see a significantly elevated gradient. Severe cases are usually associated with a mean gradient of greater than 40 mm Hg. The presence of severe aortic stenosis can be inferred from other key indicators. The aortic valve area (AVA) is often ≤1.0 cm², which is a clear sign of significant obstruction. The frequency of echocardiograms is also a regular part of the management for patients at this severity, often occurring every 6-12 months, as close monitoring is essential. Furthermore, clinical evaluations are typically performed annually to evaluate symptom progression and overall cardiac function. Thus, a normal mean gradient would not be expected in patients with severe aortic stenosis, making it the correct choice in identifying a feature that does not align with the condition's clinical presentation.