Path 12a Flashcards

A patient with heart failure has atrial stretch, arterial vasodilation, natriuresis, and diuresis. Which hormone best explains this response?

A) BNP

B) Aldosterone

C) ANP

D) ADH

Which embryologic heart field expresses Hand1 and primarily gives rise to the left ventricle?

A) First heart field

B) Second heart field

C) Neural crest

D) Proepicardium

Which embryologic population expresses Hand2 and FGF-10 and contributes to the outflow tract, right ventricle, and most atria?

A) First heart field

B) Second heart field

C) Endocardial cushions

D) Cardiac jelly

By about which day of development do the ventricles, atria, and AV valves form a four-chambered heart?

A) Day 28

B) Day 35

C) Day 42

D) Day 50

The most common genetic cause of congenital heart disease is:

A) Trisomy 13

B) Turner syndrome

C) Trisomy 21

D) DiGeorge syndrome

Congenital heart disease in trisomy 21 most often affects which structure derived largely from the second heart field?

A) Aortic arch

B) AV septum

C) Pulmonary valve

D) Left ventricle

A patient with a congenital bicuspid aortic valve is most likely to have a mutation in:

A) NOTCH1

B) JAG1

C) NKX2-5

D) TBX5

Mutations in NOTCH2 and JAG1 are classically associated with:

A) Coarctation

B) PDA

C) Tetralogy of Fallot

D) ASD

The force generated by cardiac muscle depends most directly on the:

A) Number of nuclei

B) Distance each sarcomere contracts

C) Calcium stores per atrium

D) Valve recoil speed

Excessive ventricular dilation reduces actin-myosin overlap, sharply lowering contractile force and predisposing to:

A) Bradycardia

B) Heart failure

C) Pericarditis

D) Cyanosis

Compared with ventricular myocytes, atrial myocytes are more haphazardly arranged and generate:

A) Stronger forces

B) Weaker forces

C) Equal forces

D) No force

The coordinated beating of cardiac myocytes depends primarily on:

A) Purkinje fat pads

B) Intercalated discs

C) Chordae tendineae

D) Fibrous trigones

Abnormal spatial distribution of cardiac gap junctions most directly predisposes to:

A) Valve calcification

B) Arrhythmia and heart failure

C) Aortic coarctation

D) Pericardial tamponade

Cardiac valves are lined by:

A) Mesothelium

B) Endothelium

C) Epithelium

D) Myocardium

Valvular interstitial cells are chiefly responsible for synthesizing:

A) Troponin filaments

B) Extracellular matrix

C) Action potentials

D) Coronary endothelium

In addition to producing matrix, valvular interstitial cells also express matrix-____ enzymes.

A) building

B) stiffening

C) degrading

D) sealing

Competence of the atrioventricular valves depends on proper function of the leaflets, tendinous cords, and:

A) Coronary sinus

B) Papillary muscles

C) AV node

D) Trabeculae carneae

Which pathologic valvular change most directly weakens leaflets by disrupting structural support?

A) Nodular calcification

B) Fibrotic thickening

C) Collagen damage

D) Endothelial hyperplasia

Which of the following is a classic pathologic change of cardiac valves?

A) Nodular calcification

B) Purkinje hypertrophy

C) Coronary thrombosis

D) Septal rupture

Cardiac myocytes rely almost exclusively on which pathway for energy production?

A) Anaerobic glycolysis

B) Oxidative phosphorylation

C) Pentose pathway

D) Beta oxidation only

Coronary arteries running on the external surface of the heart are called:

A) Intramural coronaries

B) Endocardial coronaries

C) Epicardial coronaries

D) Thebesian coronaries

Once coronary arteries penetrate the myocardium, they are termed:

A) Intramural arteries

B) Marginal arteries

C) Septal veins

D) Endocardial sinuses

The major named branches of the left anterior descending artery are the:

A) Marginal branches

B) Diagonal branches

C) Septal veins

D) Circumflex branches

The major named branches of the left circumflex artery are the:

A) Diagonal branches

B) Marginal branches

C) Infundibular branches

D) Anastomotic branches

Most blood flow to the myocardium occurs during:

A) Atrial systole

B) Ventricular systole

C) Ventricular diastole

D) Isovolumic contraction

Cardiac stem cells proliferate at a very ____ rate, with the greatest activity in neonates.

A) rapid

B) variable

C) slow

D) absent

Bulging of the basal ventricular septum into the LV outflow tract is termed:

A) Muscular ridge

B) Sigmoid septum

C) Septal aneurysm

D) Dynamic shelf

Congestive heart failure is present when the heart cannot meet tissue ____ or can do so only at elevated filling pressure.

A) oxygen saturation

B) metabolic demands

C) venous tone

D) coronary reserve

Systolic heart failure results from progressive deterioration of myocardial ____ function.

A) contractile

B) endocrine

C) conductive

D) valvular

Diastolic heart failure is recognized as an inability of the heart chamber to expand and fill sufficiently during:

A) systole

B) repolarization

C) diastole

D) ejection

Cardiac hypertrophy requires increased protein synthesis mainly to assemble additional:

A) capillaries

B) sarcomeres

C) valves

D) fibroblasts

The main structural result of volume-overload hypertrophy is:

A) ventricular dilation

B) septal thinning only

C) valve calcification

D) atrial standstill

In dilated hearts, the best measure of hypertrophy is:

A) wall thickness

B) ejection fraction

C) heart weight

D) chamber pressure

Myocyte hypertrophy is not accompanied by a proportional increase in:

A) capillary numbers

B) mitochondria

C) protein synthesis

D) myofilaments

Oxygen consumption by the hypertrophied heart is typically:

A) Decreased

B) Elevated

C) Unchanged

D) Intermittent

At autopsy, hearts from patients with chronic congestive heart failure are generally:

A) Small and rigid

B) Heavy and dilated

C) Light and thick-walled

D) Small and hyperdynamic

In CHF, the ventricular walls at autopsy may appear relatively:

A) Calcified

B) Thin-walled

C) Nodular

D) Septated

Aerobic exercise is most associated with what cardiac adaptation?

A) Pressure-load hypertrophy

B) Volume-load hypertrophy

C) Fibrotic atrophy

D) Septal calcification

Compared with static exercise, aerobic exercise is more likely to increase:

A) Valve thickness

B) Capillary density

C) Resting blood pressure

D) Resting heart rate

Regular aerobic training is often associated with decreased resting:

A) HR and BP

B) EF and preload

C) SV and CO

D) RV and LV mass

Static exercise such as weight lifting is most associated with:

A) Volume hypertrophy

B) Pressure hypertrophy

C) Atrial dilation only

D) Valve prolapse

Forward failure in CHF is best defined by:

A) Venous pooling and perfusion

B) Decreased CO and perfusion

C) Pulmonary fibrosis and perfusion

D) AV valve calcification and perfusion

Backward failure in CHF is characterized primarily by:

A) Arterial vasospasm

B) Venous blood pooling

C) Coronary thrombosis

D) Conduction block

Backward failure can produce which edema pattern?

A) Pulmonary or peripheral edema

B) Cerebral edema or peripheral edema

C) Myxedema or peripheral edema

D) Lymphatic edema or peripheral edema

The most common cause of right-sided heart failure is:

A) Primary RV infarction

B) Left-sided heart failure

C) Pulmonary embolism

D) Tricuspid stenosis

Generalized massive edema is termed:

A) Anasarca

B) Ascites

C) Hydrothorax

D) Lymphedema

Which two organs are prominently affected in right-sided heart failure?

A) Spleen and pancreas

B) Kidney and brain

C) Thyroid and thymus

D) Adrenals and colon

Which condition is the most common cause of left-sided heart failure?

A) Hyperthyroidism

B) Ischemic heart disease

C) Tetralogy of Fallot

D) Pulmonary fibrosis

A common major cause of left-sided CHF besides ischemic disease is:

A) Hypertension

B) Renal agenesis

C) Pericarditis

D) Atrial septal defect

Left-sided CHF may also result from disease of which valves?

A) Tricuspid and pulmonic

B) Aortic and mitral

C) Mitral and tricuspid

D) Aortic and pulmonic

Hemosiderin-laden macrophages in the lung are classic markers of prior:

A) Pleuritis

B) Pulmonary edema

C) Asthma

D) Sarcoidosis

Hemosiderin-laden macrophages found in CHF are commonly called:

A) Aschoff cells

B) Heart failure cells

C) Foam cells

D) Anitschkow cells

As CHF worsens, progressive pulmonary edema commonly causes:

A) Hemoptysis and stridor

B) Orthopnea and PND

C) Cyanosis and clubbing

D) Bradycardia and syncope

Atrial fibrillation is best described as what type of atrial activity?

A) Slow coordinated contraction

B) Uncoordinated chaotic contraction

C) Fixed mechanical standstill

D) Hyperdynamic ejection

A reduced ejection fraction decreases perfusion to which organ, thereby activating RAAS?

A) Liver

B) Kidney

C) Brain

D) Spleen

Mutations in which transcription factors are associated with atrial and ventricular septal defects?

A) GATA4, TBX5, NKX2-5

B) MYOD, PAX6, WT1

C) FBN1, ELN, CFTR

D) RET, KIT, APC

Mutations in which signaling pathway are associated with congenital heart defects such as bicuspid aortic valve and tetralogy?

A) Hedgehog

B) Wnt

C) Notch

D) TGF-beta

Deletion 22q11.2 occurs in up to half of patients with:

A) Turner syndrome

B) DiGeorge syndrome

C) Marfan syndrome

D) Noonan syndrome

In DiGeorge syndrome, abnormal development involves the fourth branchial arch and derivatives of which pouches?

A) First and second

B) Second and third

C) Third and fourth

D) Fourth and fifth

The mnemonic CATCH-22 in DiGeorge syndrome includes all except:

A) Cardiac abnormality

B) Thymic aplasia

C) Cleft palate

D) Hyperkalemia

Which transcription factor gene is deleted in many cases of DiGeorge syndrome?

A) TBX1

B) GATA4

C) NKX2-5

D) NOTCH1

TBX1 is important for neural crest migration and expansion of progenitors in which heart field?

A) First heart field

B) Second heart field

C) Proepicardium

D) Septum secundum

Important chromosomal aneuploidies associated with congenital heart disease include Turner syndrome and trisomies:

A) 8, 9, and 10

B) 11, 12, and 13

C) 13, 18, and 21

D) 15, 16, and 17

Most structural congenital heart defects can be grouped into which three categories?

A) Stenosis, rupture, hypertrophy

B) Left-to-right, right-to-left, obstruction

C) Cyanotic, acyanotic, valvular

D) Septal, valvular, conduction

A shunt in congenital heart disease is an abnormal:

A) Valve thickening

B) Chamber enlargement

C) Communication

D) Pressure gradient

Once irreversible pulmonary hypertension develops in a left-to-right shunt, the defect is generally considered:

A) Benign

B) Reversible

C) Irreparable

D) Compensated

Obstructive congenital heart disease results from abnormal:

A) Narrowing

B) Dilation

C) Fibrosis

D) Cyanosis

A complete congenital obstruction is called:

A) Stenosis

B) Atresia

C) Coarctation

D) Hypoplasia

The most common overall category of congenital heart disease is:

A) Right-to-left shunts

B) Obstructive lesions

C) Left-to-right shunts

D) Valve atresias

Most atrial septal defects are usually asymptomatic until:

A) Infancy

B) Childhood

C) Adolescence

D) Adulthood

The septum primum is best described as a crescent-shaped membranous ingrowth between the:

A) Ventricles

B) Atria

C) Great arteries

D) AV valves

During fetal development, the ostium primum allows blood flow from the:

A) Left atrium to right

B) Right atrium to left

C) Right ventricle to left

D) Pulmonary artery to aorta

Before the septum primum fully closes the ostium primum, it develops a second opening called the:

A) Foramen ovale

B) Septum secundum

C) Ostium secundum

D) Ductus venosus

As the septum secundum grows, it leaves a small opening called the:

A) Ostium primum

B) Foramen ovale

C) Sinus venosus

D) AV canal

The flap of the foramen ovale opens when pressure is greater in the:

A) Left atrium

B) Right atrium

C) Left ventricle

D) Pulmonary vein

At birth, lung expansion lowers pulmonary vascular pressure, causing right atrial pressure to fall below left atrial pressure and the foramen ovale to:

A) Widen

B) Calcify

C) Close

D) Shunt rightward

The most common type of ASD is:

A) Primum ASD

B) Sinus venosus ASD

C) Secundum ASD

D) Coronary sinus ASD

A murmur in ASD is usually due to excessive flow through the pulmonary valve and/or:

A) Aortic root

B) The ASD itself

C) Mitral valve

D) Coronary sinus

Mortality is generally low in:

A) VSDs

B) Tetralogy

C) ASDs

D) Truncus arteriosus

The most common form of congenital heart disease overall is:

A) ASD

B) PDA

C) Coarctation

D) VSD

VSDs are incomplete closures of the ventricular septum that allow blood communication between the:

A) Atria

B) Ventricles

C) Aorta and PA

D) Veins

VSDs are classified mainly by their:

A) Size and location

B) Murmur pitch

C) Oxygen saturation

D) Age at diagnosis

A membranous VSD is located in the:

A) Pulmonary trunk

B) Atrial septum

C) Intraventricular septum

D) Mitral annulus

An infundibular VSD is found within the muscular septum or just below the:

A) Aortic valve

B) Pulmonary valve

C) Tricuspid valve

D) Mitral valve

Pediatric VSDs that become clinically apparent are often associated with other anomalies such as:

A) Mitral prolapse

B) Tetralogy of Fallot

C) ASD secundum

D) Coarctation

Large unclosed VSDs almost universally lead over time to irreversible:

A) Aortic stenosis

B) Pulmonary vascular disease

C) Tricuspid atresia

D) Myocarditis

The long-term result of severe pulmonary vascular disease from an unclosed VSD is often shunt reversal, cyanosis, and:

A) Recovery

B) Death

C) Bradycardia

D) Valve closure

The ductus arteriosus arises from the:

A) Aorta

B) Pulmonary artery

C) Left ventricle

D) SVC

Which change promotes ductus arteriosus closure after birth?

A) Lower oxygenation

B) Increased prostaglandin E2

C) Increased oxygenation

D) Higher pulmonary resistance

A second factor promoting ductus arteriosus closure is decreased:

A) Systemic vascular resistance

B) Pulmonary vascular resistance

C) Left atrial pressure

D) Heart rate

A third factor promoting ductus arteriosus closure is declining local levels of:

A) Prostaglandin E2

B) Nitric oxide

C) Endothelin

D) Angiotensin II

After complete closure, the ductus arteriosus becomes the:

A) Ligamentum venosum

B) Ligamentum arteriosum

C) Coronary ligament

D) Annulus fibrosus

PDA classically produces what type of murmur?

A) Opening snap

B) Machinery-like murmur

C) Late systolic click

D) Low diastolic rumble

Which lesion most commonly increases pulmonary outflow volume without greatly increasing pulmonary pressure early on?

A) ASD

B) VSD

C) PDA

D) Tetralogy

Which pair typically increases both pulmonary blood flow and pulmonary pressure?

A) ASD and PFO

B) VSD and PDA

C) ASD and VSD

D) PDA and coarctation

Which septal structure develops first as a crescent-shaped ingrowth between the atria?

A) Septum secundum

B) Septum primum

C) Endocardial cushion

D) Foramen ovale

Which opening is continuous with the ostium secundum?

A) Ductus arteriosus

B) Coronary sinus

C) Foramen ovale

D) Ostium primum

Which congenital category best describes ASD, VSD, and PDA before pulmonary hypertension becomes irreversible?

A) Right-to-left shunts

B) Left-to-right shunts

C) Obstructive lesions

D) Cyanotic lesions

A cyanotic infant with Tetralogy of Fallot classically has a heart that is:

A) Small and globular

B) Enlarged and boot-shaped

C) Narrow and elongated

D) Calcified and rigid

The clinical severity of Tetralogy of Fallot depends mainly on the severity of:

A) Aortic override

B) RV hypertrophy

C) Subpulmonary stenosis

D) Atrial septal defect

Why does subpulmonary stenosis largely determine Tetralogy physiology?

A) It sets blood-flow direction

B) It closes the ductus

C) It fixes atrial pressure

D) It blocks coronaries

Transposition of the great arteries produces which anatomic relationship?

A) Atrioventricular concordance

B) Ventriculoarterial discordance

C) AV septal deficiency

D) Left-to-right shunting

Tricuspid atresia is best defined as complete occlusion of the:

A) Mitral annulus

B) Pulmonic outflow

C) Tricuspid valve orifice

D) Coronary sinus ostium

Embryologically, tricuspid atresia most directly results from unequal division of the:

A) Truncus arteriosus

B) AV canal

C) Septum secundum

D) Aortic sac

The infantile form of coarctation usually features tubular hypoplasia of the arch:

A) Distal to a PDA

B) Proximal to a PDA

C) Distal to subclavian

D) At the aortic root

_____-type coarctation is classically a discrete, ridgelike narrowing of the aorta near the insertion of the ligamentum arteriosum, which is the remnant of the closed ductus arteriosus.

Coarctation of the aorta associated with a PDA usually presents:

A) Late in adulthood

B) Early in life

C) Only during pregnancy

D) Only after exercise

Subaortic stenosis is usually associated with a prominent systolic:

A) Click

B) Murmur

C) Rub

D) Snap

A palpable vibration may accompany subaortic stenosis as a:

A) Heave

B) Thrill

C) Knock

D) Gallop

Subaortic stenosis is usually caused by dense fibrous tissue located:

A) Above the cusps

B) Below the cusps

C) Within the atrium

D) At the apex

Compared with the RV, myocardial fibers are more circumferentially organized in a spiral pattern in the:

A) LV

B) RA

C) RV

D) LA

Which valves have leaflets?

A) Semilunar valves

B) AV valves

Which valves are described as having cusps?

A) AV valves

B) Semilunar valves

The most abundant cell type in cardiac valves is the valvular ____ cell.

A) endothelial

B) interstitial

C) nodal

D) mesothelial

Which valvular structures are supported by chordae tendineae?

A) Semilunar cusps

B) AV leaflets

C) Aortic cusps

D) Pulmonic cusps

Cardiac stem cells make up a greater proportion of normal cellularity in the:

A) ventricles

B) atria

C) septum

D) valves

With aging, epicardial fat generally:

A) decreases

B) increases

C) calcifies only

D) disappears

With aging, cardiac valves commonly develop:

A) fatty atrophy

B) fibrous thickening

C) myocyte hyperplasia

D) vascular proliferation

Mitral valve prolapse most directly increases pressure in the:

A) LV

B) LA

C) RV

D) aorta

Age-related basophilic degeneration in myocytes reflects accumulation of a gray-blue byproduct of:

A) collagen synthesis

B) glycogen metabolism

C) fatty acid oxidation

D) calcium transport

A pathologist examines hypertrophic cardiac myocytes. How do their nuclei typically appear?

A) Small and pyknotic

B) Enlarged

C) Fragmented

D) Binucleated only

In pressure-overload hypertrophy, new sarcomeres are added in:

A) Series

B) Parallel

C) Spirals

D) Clusters

In volume-overload hypertrophy, new sarcomeres are added in:

A) Parallel

B) Rings

C) Series

D) Sheets

Pressure-overload hypertrophy most characteristically produces:

A) Ventricular dilation

B) Thinner walls

C) Wall thickening

D) Atrial collapse

Volume-overload hypertrophy most characteristically produces:

A) Concentric thickening

B) Ventricular dilation

C) Septal calcification

D) Valve stenosis

A patient with left-sided heart failure is at increased risk for atrial fibrillation mainly because LV dysfunction causes:

A) RV infarction

B) LA dilation

C) SA node fibrosis

D) PDA reopening

In left-sided heart failure, thrombus formation is especially likely in the:

A) Coronary sinus

B) Left atrial appendage

C) Right ventricle

D) Aortic root

Far-advanced CHF may cause irritability, poor attention, and eventual coma from cerebral hypoperfusion. This is called:

A) Hepatic encephalopathy

B) Hypoxic encephalopathy

C) Uremic encephalopathy

D) Septic encephalopathy

A hallmark hemodynamic finding in left-sided heart failure is increased:

A) RV systolic pressure only

B) LV end-diastolic pressure

C) Pulmonary valve area

D) Coronary sinus flow

In left-sided heart failure, reduced ejection fraction is the key finding in which type?

A) Diastolic failure

B) Systolic failure

C) Restrictive failure

D) High-output failure

What is the main problem in diastolic left-sided heart failure?

A) Hyperdynamic ventricle

B) Stiff LV with impaired filling

C) Severe RV dilation

D) Reduced coronary flow only

What is the ejection fraction in classic diastolic left-sided heart failure?

A) Elevated

B) Reduced

C) Normal

D) Absent

What is the most common underlying abnormality in diastolic left-sided heart failure?

A) COPD

B) Hypertension

C) Aortic dissection

D) Viral myocarditis

Low-flow symptoms such as cool extremities, cachexia, and confusion are more typical of:

A) Diastolic left HF

B) Systolic left HF

C) Isolated right HF

D) High-output HF

A patient with left-sided heart failure and pulmonary edema will most likely have which lung finding on auscultation?

A) Wheezes only

B) Rhonchi only

C) Crackles or rales

D) Pleural rub

Which heart sound is more associated with high left atrial pressure?

A) S1

B) S2

C) S3

D) S4

Which heart sound is more associated with a stiff left ventricle?

A) S1

B) S2

C) S3

D) S4

In which type of left-sided heart failure is an S4 most expected?

A) Systolic HF

B) Diastolic HF

C) High-output HF

D) Right-sided HF

Cor pulmonale refers to isolated right-sided heart failure caused by:

A) Aortic stenosis

B) Lung disease or pulmonary hypertension

C) Mitral regurgitation

D) Coronary thrombosis

Compared with left-sided heart failure, right-sided heart failure generally causes:

A) Marked pulmonary edema with little systemic congestion

B) Minimal pulmonary congestion with marked systemic congestion

C) No edema at all

D) Only cerebral edema

Chronic passive hepatic congestion from right-sided heart failure produces the classic gross appearance called:

A) Fatty liver

B) Cirrhotic liver

C) Nutmeg liver

D) Blue liver

Long-standing severe right-sided heart failure with marked hepatic congestion can eventually produce cardiac:

A) Adenoma

B) Cirrhosis

C) Hemochromatosis

D) Necrosis

Which edema pattern is a hallmark of right-sided heart failure?

A) Periorbital and sacral only

B) Pedal and pretibial edema

C) Pulmonary alveolar edema only

D) Upper extremity lymphedema

Most congenital heart disease arises from faulty embryogenesis during which gestational period?

A) Weeks 1-2

B) Weeks 3-8

C) Weeks 9-16

D) Weeks 20-28

Cardiac precursor cells originate from which germ layer?

A) Endoderm

B) Neural crest

C) Lateral mesoderm

D) Paraxial mesoderm

During early cardiac development, cardiac precursors migrate to the midline in two waves to form a crescent of first and second heart field cells by about:

A) Day 8

B) Day 12

C) Day 15

D) Day 20

By about day 20, the early cardiac crescent develops into a:

A) Four-chambered heart

B) Beating tube

C) Septated atrium

D) Mature ventricle

During early cardiac development, which cells migrate into the outflow tract to help separate it and form the aortic arches?

A) Endodermal cells

B) Neural crest cells

C) Mesothelial cells

D) Epicardial cells

The swellings that enlarge from interstitial connective tissue and contribute to the future AV canal and outflow tract are called:

A) Trabeculae carneae

B) Endocardial cushions

C) Septum primum

D) Sinus horns

By about which day does cardiac development produce a four-chambered heart with separated ventricles, atria, and AV valves?

A) Day 30

B) Day 40

C) Day 50

D) Day 60

The major known causes of congenital heart disease are predominantly:

A) Familial abnormalities

B) Sporadic genetic abnormalities

C) Viral infections only

D) Nutritional deficiencies

Which type of shunt is associated with cyanosis from the start?

A) Left-to-right

B) Right-to-left

C) Bidirectional

D) Aortic-to-pulmonary

The most common ASD is usually associated with other congenital anomalies:

A) Always

B) Usually

C) Rarely

D) Never

Which ASD subtype occurs adjacent to the AV valves and is often associated with AV valve abnormalities or VSDs?

A) Sinus venosus defect

B) Ostium primum ASD

C) Ostium secundum ASD

D) PFO

Which ASD subtype is commonly associated with Down syndrome?

A) Ostium secundum ASD

B) Sinus venosus defect

C) Ostium primum ASD

D) Coronary sinus defect

The splitting of S2 in a significant ASD is mainly due to delayed closure of the:

A) Aortic valve

B) Mitral valve

C) Tricuspid valve

D) Pulmonic valve

What specific subtype accounts for about 90% of ventricular septal defects?

A) Muscular VSD

B) Infundibular VSD

C) Membranous VSD

D) Inlet VSD

Most VSDs are isolated findings:

A) True

B) False

VSDs are classically associated with which maternally caused syndrome?

A) DiGeorge syndrome

B) Fetal alcohol syndrome

C) Turner syndrome

D) Noonan syndrome

An adult with an unrepaired childhood VSD now has RV hypertrophy, hypoxemia, polycythemia, and clubbing. What is the best diagnosis?

A) Cor pulmonale

B) Tetralogy of Fallot

C) Eisenmenger syndrome

D) Coarctation

A patent ductus arteriosus is what type of shunt?

A) Right-to-left

B) Left-to-right

C) Bidirectional only

D) Atrial-to-ventricular

Most PDAs are:

A) Associated with many anomalies

B) Part of TOF

C) Isolated defects

D) Caused by VSDs

The ductus arteriosus connects the pulmonary artery to the:

A) Left atrium

B) Superior vena cava

C) Aorta

D) Left ventricle

PDA is classically associated with which congenital maternal viral infection?

A) CMV

B) Rubella

C) Parvovirus B19

D) Coxsackievirus

A neonate with aortic valve atresia needs ductus arteriosus patency to survive. Which therapy helps keep the ductus open?

A) Indomethacin

B) Propranolol

C) PGE2

D) Digoxin

Which drug is commonly used to close a patent ductus arteriosus?

A) Alprostadil

B) Indomethacin

C) Furosemide

D) Dopamine

The cardinal features of Tetralogy of Fallot result embryologically from:

A) Failure of septum primum

B) Anterosuperior infundibular septum displacement

C) Absent endocardial cushions

D) Persistent truncus arteriosus

In transposition of the great vessels, a patient surviving beyond infancy typically develops what ventricular pattern?

A) RV atrophy, LV hypertrophy

B) RV hypertrophy, LV atrophy

C) Biventricular hypertrophy

D) Biventricular atrophy

Why does the right ventricle hypertrophy in long-surviving transposition of the great arteries?

A) It supports pulmonary flow

B) It becomes the systemic ventricle

C) It ejects into left atrium

D) It receives coronary overflow

Why does the left ventricle become thin-walled in long-surviving transposition of the great arteries?

A) It pumps systemic blood

B) It supports low-resistance pulmonary flow

C) It loses all preload

D) It becomes fibrotic

About half of adult-form coarctation cases are associated with which valvular defect?

A) Mitral valve prolapse

B) Bicuspid aortic valve

C) Tricuspid atresia

D) Pulmonic stenosis

Why is early cyanosis more likely in infantile coarctation?

A) Excess pulmonary flow

B) Poor collateral circulation

C) LV hyperplasia

D) Aortic regurgitation

Why do patients with adult-type coarctation often remain asymptomatic until adulthood?

A) Lower heart rate

B) Better collateral circulation

C) PDA remains open

D) Lower systemic pressure

Which form of coarctation is more common?

A) Infantile form

B) Adult form

C) Preductal arch form

D) Valvular form

Initial treatment of severe congenital aortic stenosis or atresia often aims to:

A) Close the PDA

B) Preserve PDA patency

C) Reduce coronary flow

D) Block prostaglandins

In mild congenital aortic stenosis, prophylaxis may be given to prevent:

A) Rheumatic fever

B) Endocarditis

C) Atrial fibrillation

D) Pulmonary edema

Which produces the louder murmur: a small VSD or a large VSD?

Why is the murmur of a small VSD often louder than that of a large VSD?

A) Greater total flow

B) More turbulent flow

C) More cyanosis

D) Higher pulmonary resistance