What directly produces the first heart sound?

A) Atrial wall stretch

B) AV valve closure vibrations

C) Semilunar valve opening

D) Rapid ventricular filling

B. AV valve closure vibrations

The first heart sound is heard at the:

A) Start of diastole

B) End of diastole

C) Mid diastole

D) Beginning of systole

D. Beginning of systole

Why does S1 contain audible vibrations?

A) Attempted backflow after contraction

B) Coronary flow entering ventricles

C) Passive atrial emptying only

D) Septal depolarization alone

A. Attempted backflow after contraction

The second heart sound is most directly associated with:

A) AV valve opening

B) Atrial contraction

C) Semilunar valve closure

D) Rapid ventricular filling

C. Semilunar valve closure

The second heart sound occurs at the:

A) End of systole

B) Middle of systole

C) Beginning of diastole

D) End of atrial systole

A. End of systole

In S2, the semilunar valves mainly move by:

A) Opening into arteries

B) Flattening into atria

C) Swinging toward aorta

D) Bulging toward ventricles

D. Bulging toward ventricles

Which sound is longer in duration normally?

A) Equal durations

B) S1

C) S2

D) Neither is audible

B. S1

Why is S2 higher frequency than S1?

A) AV valves are tauter

B) Ventricles are more elastic

C) Semilunars and arteries are tauter

D) Atria vibrate more strongly

C. Semilunars and arteries are tauter

A third heart sound is usually heard during the:

A) End of systole

B) End of diastole

C) Atrial kick only

D) Beginning of mid diastole

D. Beginning of mid diastole

What is the best proposed mechanism of S3?

A) Blood oscillation between chambers

B) Valve leaflet calcification

C) Papillary muscle tension

D) Arterial recoil alone

A. Blood oscillation between chambers

Why is S3 not heard earlier in diastole?

A) Atria have not depolarized

B) Semilunars stay closed

C) Ventricles are not full enough

D) AV valves are too taut

C. Ventricles are not full enough

In whom can S3 be a normal finding?

A) Older adults with CAD

B) Children and young adults

C) Patients with aortic stenosis

D) Patients with LV hypertrophy

B. Children and young adults

In an older adult, a new S3 most strongly suggests:

A) Systolic heart failure

B) Mitral stenosis

C) Normal aging

D) Acute pericarditis

A. Systolic heart failure

A fourth heart sound occurs when the:

A) Semilunars close

B) Ventricles eject

C) AV valves close

D) Atria contract

D. Atria contract

Why is S4 often not heard by routine auscultation?

A) It occurs only in systole

B) It has very low frequency

C) It is masked by S1

D) It requires tachycardia

B. It has very low frequency

S4 is most expected in patients with:

A) High-output failure

B) Severe bradycardia alone

C) Increased ventricular compliance

D) Decreased ventricular compliance

D. Decreased ventricular compliance

Best auscultation point for the tricuspid valve?

A) Left sternal border, 5th ICS

B) Right sternal border, 2nd ICS

C) Left sternal border, 2nd ICS

D) Left midclavicular, 5th ICS

A. Left sternal border, 5th ICS

Best auscultation point for the mitral valve?

A) Left sternal border, 5th ICS

B) Right sternal border, 2nd ICS

C) Left sternal border, 2nd ICS

D) Left midclavicular, 5th ICS

D. Left midclavicular, 5th ICS

Best auscultation point for the pulmonic valve?

A) Right sternal border, 2nd ICS

B) Left midclavicular, 5th ICS

C) Left sternal border, 2nd ICS

D) Left sternal border, 5th ICS

C. Left sternal border, 2nd ICS

Best auscultation point for the aortic valve?

A) Left sternal border, 2nd ICS

B) Right sternal border, 2nd ICS

C) Left sternal border, 5th ICS

D) Left midclavicular, 5th ICS

B. Right sternal border, 2nd ICS

The tricuspid area is heard mainly over the:

A) Left atrium

B) Right atrium

C) Left ventricle

D) Right ventricle

D. Right ventricle

The mitral area is heard mainly over the:

A) Apex of left ventricle

B) Base of right ventricle

C) Left atrial appendage

D) Pulmonic outflow tract

A. Apex of left ventricle

Which stenotic lesion usually gives the loudest murmur?

A) Pulmonic stenosis

B) Aortic stenosis

C) Tricuspid stenosis

D) Mitral stenosis

B. Aortic stenosis

Which stenotic lesion usually gives the weakest murmur?

A) Aortic stenosis

B) Pulmonic stenosis

C) Mitral stenosis

D) Tricuspid stenosis

C. Mitral stenosis

Which lesion pair causes murmurs heard only during systole?

A) Aortic stenosis and mitral regurgitation

B) Mitral stenosis and aortic regurgitation

C) Patent ductus and aortic stenosis

D) Mitral regurgitation and PDA

A. Aortic stenosis and mitral regurgitation

Which lesion pair causes murmurs heard only during diastole?

A) Aortic stenosis and mitral regurgitation

B) PDA and mitral stenosis

C) Pulmonic stenosis and MR

D) Aortic regurgitation and mitral stenosis

D. Aortic regurgitation and mitral stenosis

A murmur from patent ductus arteriosus is heard during:

A) Systole

B) Systole and diastole

C) Middle Diastole

D) Early diastole

B. Systole and diastole

Which structures mainly transmit the second heart sound vibrations?

A) Atria

B) Great arteries

C) Ventricles

D) Pericardium

B. Great arteries

Why is S1 longer than S2?

A) AV valves are tauter

B) Semilunars vibrate longer

C) Semilunars are tauter, shorter

D) Atria add extra resonance

C. Semilunars are tauter, shorter

Besides the valves themselves, what also vibrates in S1?

A) Adjacent walls and vessels

B) Coronary sinus

C) Purkinje network

D) Pericardial fat pad

A. Adjacent walls and vessels

What autoimmune disease causes the greatest number of valvular lesions?

A) Infective endocarditis

B) Rheumatic fever

C) Marfan syndrome

D) Libman-Sacks endocarditis

B. Rheumatic fever

What best explains autoimmune valvular injury in rheumatic fever?

A) Viral invasion of leaflets

B) Antibody cross-reaction after strep

C) Calcium emboli on cusps

D) Direct toxin digestion

B. Antibody cross-reaction after strep

Which prior infection classically precedes rheumatic valvular disease?

A) Staphylococcal cellulitis

B) Streptococcal throat infection

C) Viral myocarditis

D) Fungal pneumonia

B. Streptococcal throat infection

In rheumatic valvular disease, severity of valve damage correlates best with:

A) Heart rate at infection and persistence

B) Age at infection and antibody concentration

C) Antibody concentration and persistence

D) Serum calcium level and antibody concentration

C. Antibody concentration and persistence

Which valve undergoes the greatest turbulent trauma?

A) Tricuspid valve

B) Pulmonic valve

C) Aortic valve

D) Mitral valve

D. Mitral valve

Which valve undergoes the second greatest turbulent trauma?

A) Aortic valve

B) Tricuspid valve

C) Pulmonic valve

D) Mitral valve

A. Aortic valve

Valvular scarring most directly causes the leaflets to:

A) Thin and lengthen

B) Fuse and stiffen

C) Detach from annulus

D) Calcify without fusion

B. Fuse and stiffen

Rheumatic scarring predisposes valves to which two functional problems?

A) Shunting and rupture

B) Regurgitation and stenosis

C) Thrombosis and embolism

D) Hypertrophy and dilation

B. Regurgitation and stenosis

Aortic stenosis classically produces a murmur during:

A) Systole

B) Diastole

C) Early diastole only

D) Atrial systole

A. Systole

Why is the murmur of aortic stenosis systolic?

A) Blood falls into LV

B) LA empties turbulently

C) LV ejects through narrowed valve

D) Coronaries recoil into aorta

C. LV ejects through narrowed valve

In aortic stenosis, pressure is typically:

A) Low in LV and aorta

B) High in aorta only

C) Equal in LV and aorta

D) High in LV, normal aorta

D. High in LV, normal aorta

What directly produces the loud murmur of aortic stenosis?

A) Venous backflow to atrium

B) High-velocity aortic turbulence

C) Mitral leaflet prolapse

D) Pulmonary artery recoil

B. High-velocity aortic turbulence

A palpable upper chest or lower neck vibration in severe aortic stenosis is called:

A) Heave

B) Lift

C) Thrill

D) Knock

C. Thrill

Aortic regurgitation classically causes a murmur during:

A) Systole

B) Isovolumic contraction

C) Diastole

D) Atrial contraction

C. Diastole

Why is aortic regurgitation heard in diastole?

A) LV ejects through tight valve

B) Blood jets backward into LV

C) LA contracts against resistance

D) RV fills from vena cava

B. Blood jets backward into LV

Mitral regurgitation classically causes a murmur during:

A) Early diastole

B) Mid diastole

C) Systole

D) Late diastole

C. Systole

The typical quality of mitral regurgitation is:

A) Harsh scraping murmur

B) High-frequency blowing murmur

C) Low rumbling opening snap

D) Musical midsystolic click

B. High-frequency blowing murmur

Mitral stenosis classically causes a murmur during:

A) Systole

B) Diastole

C) End systole only

D) Isovolumic relaxation

B. Diastole

In mitral stenosis, left atrial pressure is usually:

A) Decreased

B) Unchanged

C) Increased

D) Equal to LV

C. Increased

Why is no murmur usually heard in the first part of diastole in mitral stenosis?

A) Valve is fully open

B) There is little LV blood

C) Atrial systole is absent

D) Aortic recoil masks it

B. There is little LV blood

As the ventricle partially fills in mitral stenosis, the murmur appears because:

A) Ventricular stretch permits reverberation

B) Coronary flow suddenly ceases

C) Semilunar valves become taut

D) Papillary muscles contract

A. Ventricular stretch permits reverberation

What happens to net stroke volume in aortic stenosis?

A) Increases

B) Stays normal

C) Decreases

D) Becomes zero

C. Decreases

Why does aortic stenosis decrease net stroke volume?

A) LV empties inadequately

B) RV preload falls

C) LA cannot contract

D) Coronary sinus obstructs flow

A. LV empties inadequately

What happens to net stroke volume in aortic regurgitation?

A) Increases

B) Decreases

C) Is unchanged

D) Alternates beat to beat

B. Decreases

Why does aortic regurgitation reduce net stroke volume?

A) Blood shunts to lungs

B) Blood returns to LA

C) Blood refluxes into LV

D) RV cannot fill

C. Blood refluxes into LV

How do chronic aortic stenosis and aortic regurgitation affect blood volume?

A) Decrease blood volume

B) No volume change

C) Increase blood volume

D) Cause plasma loss

C. Increase blood volume

Why does blood volume increase in chronic aortic valve disease?

A) To reduce afterload

B) To offset reduced stroke volume

C) To lower LA pressure

D) To improve valve elasticity

B. To offset reduced stroke volume

Why can aortic stenosis cause ischemia of the myocardium?

A) LV work rises without more coronaries

B) RV hypertrophy compresses LAD

C) Coronary sinus pressure collapses

D) Aortic pressure always falls to zero

A. LV work rises without more coronaries

In compensated aortic stenosis or regurgitation, the left ventricle initially adapts mainly by:

A) Fibrosing rapidly

B) Reducing blood volume

C) Increasing pump effort

D) Shunting to right heart

C. Increasing pump effort

Once compensation fails in severe aortic valve disease, the left ventricle first tends to:

A) Become restrictive only

B) Dilate and weaken

C) Shrink concentrically

D) Empty completely

B. Dilate and weaken

When decompensation occurs in severe aortic stenosis or regurgitation, cardiac output typically:

A) Rises markedly

B) Becomes fixed normal

C) Begins to fall

D) Affects only RV

C. Begins to fall

As left ventricular failure progresses in severe aortic valve disease, pressure backs up into the:

A) Right atrium and vena cava

B) Left atrium then lungs

C) Coronary sinus only

D) Aorta then carotids

B. Left atrium then lungs

The major pulmonary consequence of decompensated aortic stenosis or regurgitation is:

A) Pneumothorax

B) Pulmonary edema

C) Pleural fibrosis

D) Lobar infarction

B. Pulmonary edema

Which valvular lesion most directly raises left atrial pressure?

A) Aortic stenosis

B) Pulmonic stenosis

C) Mitral stenosis

D) Aortic regurgitation

C. Mitral stenosis

Mitral stenosis or regurgitation most directly causes which triad?

A) Pulmonary edema, LA enlargement, increased blood volume

B) RV hypertrophy, ascites, decreased blood volume

C) Systemic edema, RA shrinkage, low preload

D) Pulmonary stenosis, LV collapse, hemoconcentration

A. Pulmonary edema, LA enlargement, increased blood volume

In mitral valve disease, pulmonary edema develops mainly because pressure backs up into the:

A) Right ventricle

B) Pulmonary veins

C) Coronary sinus

D) Aorta

B. Pulmonary veins

Left atrial enlargement in mitral stenosis or regurgitation is primarily caused by:

A) Coronary thrombosis

B) Pressure buildup

C) Myocardial rupture

D) Reduced venous tone

B. Pressure buildup

In chronic mitral stenosis or regurgitation, blood volume tends to:

A) Decrease markedly

B) Stay unchanged

C) Increase

D) Become zero

C. Increase

In chronic mitral stenosis or regurgitation, the heart pumps less effectively.

So the body senses reduced effective forward flow and activates:

RAAS + sympathetic system

That causes:

↑ sodium retention → ↑ water retention → ↑ blood volume

Why does left atrial enlargement predispose to atrial fibrillation?

A) Shortens atrial pathways

B) Increases impulse travel distance

C) Blocks AV node directly

D) Eliminates reentry circuits

B. Increases impulse travel distance

The arrhythmia most classically promoted by chronic left atrial enlargement is:

A) Ventricular tachycardia

B) Junctional rhythm

C) Atrial fibrillation

D) Complete heart block

C. Atrial fibrillation

In mitral valve disease, enlarged atrial size promotes atrial fibrillation mainly by favoring:

A) SA nodal arrest

B) Circus movement reentry

C) Purkinje fibrosis

D) Ventricular escape beats

B. Circus movement reentry

Which everyday activity can greatly worsen dynamic abnormalities from valvular disease?

A) Sleeping

B) Exercise

C) Sitting upright

D) Quiet breathing

B. Exercise

Coarctation of the aorta usually causes arterial pressure that is:

A) Lower above than below

B) Equal above and below

C) Higher above than below

D) Higher only in legs

C. Higher above than below

In coarctation of the aorta, blood often reaches the lower body through:

A) Coronary arteries

B) Collateral arteries

C) Lymphatic channels

D) Pulmonary veins

B. Collateral arteries

Patent ductus arteriosus is classically what type of shunt after birth?

A) Right-to-left

B) Bidirectional only

C) Left-to-right

D) No true shunt

C. Left-to-right

During fetal life, pulmonary arterial pressure is normally:

A) Very low

B) Moderately low

C) High

D) Zero

C. High

During fetal life, aortic pressure relative to pulmonary pressure is:

A) Higher

B) Lower

C) Equal

D) Unrelated

B. Lower

Why is fetal pulmonary vascular resistance high?

A) Lungs are overexpanded

B) Alveoli are collapsed

C) Placenta drains lungs

D) Aortic valve is closed

B. Alveoli are collapsed

In the fetus, most pulmonary arterial blood flows through the ductus arteriosus into the:

A) Left atrium

B) Right ventricle

C) Pulmonary veins

D) Aorta

D. Aorta

The direction of fetal ductus arteriosus flow is mainly determined by:

A) Low pulmonary, high aortic pressure

B) Equal great-vessel pressures

C) High pulmonary, low aortic pressure

D) Coronary sinus pressure gradient

C. High pulmonary, low aortic pressure

After birth, pulmonary arterial pressure normally:

A) Rises sharply

B) Falls markedly

C) Stays fetal level

D) Becomes higher than aortic

B. Falls markedly

After birth, pulmonary arterial pressure falls mainly because:

A) Ductus closes first

B) Lungs inflate and resistance drops

C) Placenta keeps flowing

D) RV output stops

B. Lungs inflate and resistance drops

After birth, aortic pressure rises mainly because:

A) Coronary flow stops

B) Pulmonary veins constrict

C) Placental runoff stops

D) Ductus enlarges

C. Placental runoff stops

After birth, normal forward flow through the ductus arteriosus ceases because:

A) Pulmonary pressure rises above aortic

B) Pulmonary falls and aortic rises

C) Both pressures become zero

D) LV stops ejecting

B. Pulmonary falls and aortic rises

Once postnatal pressures reverse, blood through a persistent ductus arteriosus flows from the:

A) Pulmonary artery to aorta

B) RV to left atrium

C) Aorta to pulmonary artery

D) SVC to pulmonary trunk

C. Aorta to pulmonary artery

Failure of ductus arteriosus closure after birth results in:

A) Tetralogy of Fallot

B) Patent ductus arteriosus

C) Tricuspid atresia

D) Coarctation only

B. Patent ductus arteriosus

Tetralogy of Fallot is classically what kind of shunt?

A) Left-to-right

B) Right-to-left

C) No shunt

D) Atrial-only shunt

B. Right-to-left

The most common cause of a “blue baby” is:

A) Coarctation of aorta

B) Patent ductus arteriosus

C) Tetralogy of Fallot

D) Mitral stenosis

C. Tetralogy of Fallot

In Tetralogy of Fallot, the aorta characteristically:

A) Arises only from LV

B) Overrides the septal defect

C) Originates from left atrium

D) Drains into pulmonary trunk

B. Overrides the septal defect

Which lesion in Tetralogy of Fallot most directly reduces blood flow to the lungs?

A) Mitral regurgitation

B) Pulmonary stenosis

C) Aortic coarctation

D) Tricuspid prolapse

B. Pulmonary stenosis

The septal defect in Tetralogy of Fallot allows blood to move between the:

A) Atrial veins

B) Great arteries

C) Ventricles

D) Pulmonary veins

C. Ventricles

The right ventricle enlarges in Tetralogy of Fallot mainly because of:

A) High pressure load

B) Mitral inflow obstruction

C) Low venous return

D) Reduced afterload

A. High pressure load

The main physiologic problem in Tetralogy of Fallot is that a lot of venous blood:

A) Is fully oxygenated twice

B) Bypasses lungs into aorta

C) Returns only to left atrium

D) Pools in pulmonary veins

B. Bypasses lungs into aorta

Which congenital lesion most strongly creates higher upper-body than lower-body pressure?

A) Tetralogy of Fallot

B) Coarctation of aorta

C) Patent ductus arteriosus

D) Mitral stenosis

B. Coarctation of aorta

Which postnatal change normally favors ductus arteriosus closure?

A) Higher pulmonary than aortic pressure

B) Lower systemic resistance

C) Lower pulmonary and higher aortic pressure

D) Increased fetal lung compression

C. Lower pulmonary and higher aortic pressure

Other than hereditary defects, what is a recognized cause of congenital heart anomalies?

A) Maternal diabetes late pregnancy

B) Maternal viral infection first trimester

C) Paternal smoking before conception

D) Neonatal cyanosis after birth

B. Maternal viral infection first trimester

Cardiac valves normally produce audible heart sounds when they:

A) Open rapidly

B) Begin calcifying

C) Close

D) Prolapse

C. Close

Why are normal valve opening events usually silent?

A) Opening creates no turbulence

B) Opening does not create audible vibrations

C) Arteries absorb all sound

D) Atria contract simultaneously

B. Opening does not create audible vibrations

A fourth heart sound is also associated with:

A) Increased resistance to filling

B) Reduced atrial contraction

C) Increased coronary flow

D) Decreased afterload

A. Increased resistance to filling

Heart sounds can be amplified and recorded with a:

A) Sphygmomanometer

B) Capnograph

C) Phonocardiogram

D) Spirometer

C. Phonocardiogram

In rheumatic fever, heart valves are likely to be:

A) Dilated or hypertrophied

B) Damaged or destroyed

C) Only calcified

D) Shortened or duplicated

B. Damaged or destroyed

In rheumatic fever, characteristic valvular lesions are typically:

A) Hemorrhagic and fibrinous

B) Calcified and avascular

C) Fibrotic and smooth

D) Purulent and caseating

A. Hemorrhagic and fibrinous

The classic rheumatic valvular lesions grow along the:

A) Chordae tendineae

B) Ventricular septum

C) Inflamed valve edges

D) Papillary muscle tips

C. Inflamed valve edges

Rheumatic valvular lesions are also described as:

A) Flat and translucent

B) Bulbous

C) Pedunculated

D) Contractile

B. Bulbous

A valve whose leaflets adhere so extensively that blood cannot flow normally is called:

A) Regurgitant

B) Stenosed

C) Prolapsed

D) Insufficient

B. Stenosed

A valve with scarred edges that cannot close during ventricular contraction produces:

A) Stenosis

B) Thrill

C) Regurgitation

D) Cyanosis

C. Regurgitation

In aortic stenosis, blood exiting through the narrowed valve forms a:

A) Low-pressure pool

B) Nozzling jet

C) Venous shunt

D) Laminar wave

B. Nozzling jet

The nozzling effect of aortic stenosis causes blood to leave at tremendous:

A) Compliance

B) Resistance

C) Velocity

D) Viscosity

C. Velocity

The immediate flow abnormality produced by aortic stenosis is:

A) Severe turbulence

B) Coronary steal

C) Reverse shunting

D) Venous damping

A. Severe turbulence

The loud murmur of aortic stenosis is produced when turbulent blood strikes the:

A) Left atrium

B) Aortic walls

C) Pulmonary veins

D) Mitral chordae

B. Aortic walls

The murmur of mitral stenosis is typically:

A) Harsh and high-pitched

B) Weak and low-frequency

C) Loud and blowing

D) Musical and sharp

B. Weak and low-frequency

In both aortic stenosis and aortic regurgitation, the left ventricle typically:

A) Atrophies

B) Fibroses first

C) Hypertrophies

D) Collapses

C. Hypertrophies

During exercise, large quantities of what blood are returned to the heart from the periphery?

A) Arterial

B) Capillary

C) Venous

D) Coronary

C. Venous

Even in mild to moderate valvular disease, what declines in proportion to lesion severity?

A) Pulmonary reserve

B) Renal clearance

C) Cardiac reserve

D) Coronary sinus flow

C. Cardiac reserve

A patient with mild valvular disease becomes symptomatic mainly during exertion because exercise increases:

A) Venous return

B) Aortic elasticity

C) Valve area

D) Diastolic filling time

A. Venous return

Which statement best explains why valvular disease worsens during exercise?

A) Less blood returns to heart

B) More blood returns to heart

C) Arterial oxygen falls to zero

D) Coronary flow stops entirely

B. More blood returns to heart

Exercise increases cardiac workload, so a damaged valve struggles more.

Stenotic valve → harder to push extra blood through
Regurgitant valve → more blood can leak backward

Which is a major category of congenital cardiovascular anomaly?

A) Right-to-right shunt

B) Left-to-left shunt

C) Stenosis of blood channel

D) Coronary thrombosis

C. Stenosis of blood channel

A left-to-right shunt primarily means blood fails to pass normally through the:

A) Lungs

B) Coronary sinus

C) Systemic circulation

D) Right atrium

C. Systemic circulation

So instead of going normally to the body: Left heart → systemic circulation

some blood goes: Left heart → right heart → lungs again

A right-to-left shunt primarily means blood fails to pass normally through the:

A) Systemic veins

B) Lungs

C) Aorta

D) Left ventricle

B. Lungs

Which set lists the three major congenital anomaly categories correctly?

A) Stenosis, left-to-right shunt, right-to-left shunt

B) Regurgitation, stenosis, aneurysm

C) Septal rupture, tamponade, coarctation

D) Cyanosis, edema, hypertrophy

A. Stenosis, left-to-right shunt, right-to-left shunt

Which lesion combination is matched correctly?

A) Aortic stenosis-diastolic murmur

B) Mitral stenosis-high-frequency loud murmur

C) Mitral regurgitation-systolic backflow

D) Aortic regurgitation-systolic jet

C. Mitral regurgitation-systolic backflow

Which lesion is most associated with a weak, low-frequency murmur?

A) Aortic stenosis

B) Mitral stenosis

C) Mitral regurgitation

D) Aortic regurgitation

B. Mitral stenosis

Which consequence follows increased left atrial pressure from mitral valve disease?

A) Pulmonary edema

B) Aortic aneurysm

C) Right-to-left shunt

D) Cardiac tamponade

A. Pulmonary edema

A congenital narrowing of the aorta, often near the level of the diaphragm, is called:

A) Patent ductus arteriosus

B) Coarctation of the aorta

C) Tetralogy of Fallot

D) Truncus arteriosus

B. Coarctation of the aorta

The fetal vessel connecting the pulmonary artery to the aorta is the:

A) Foramen ovale

B) Ductus venosus

C) Coronary sinus

D) Ductus arteriosus

D. Ductus arteriosus

At birth, forward blood flow through the ductus arteriosus normally:

A) Increases sharply

B) Ceases suddenly

C) Reverses permanently first

D) Becomes turbulent only

B. Ceases suddenly

Patients with patent ductus arteriosus usually do not become cyanotic until later in life, when the heart fails or the lungs become:

A) Fibrotic

B) Congested

C) Hyperinflated

D) Embolized

B. Congested

The major physiologic reserves reduced in patent ductus arteriosus are:

A) Renal and hepatic

B) Cardiac and respiratory

C) Cerebral and coronary

D) Venous and lymphatic

B. Cardiac and respiratory

The murmur of patent ductus arteriosus is most intense during:

A) Diastole

B) Atrial systole

C) Systole

D) Isovolumic relaxation

C. Systole

The murmur of patent ductus arteriosus becomes less intense during:

A) Diastole

B) Systole

C) Atrial contraction

D) Rapid ejection

A. Diastole

The waxing and waning murmur of patent ductus arteriosus is classically called a:

A) Blowing murmur

B) Machinery murmur

C) Opening snap

D) Pericardial knock

B. Machinery murmur

The standard surgical treatment of patent ductus arteriosus is to:

A) Stent the pulmonary artery

B) Ligate or divide the ductus

C) Replace the aortic valve

D) Create an atrial septal shunt

B. Ligate or divide the ductus

After dividing a patent ductus arteriosus surgically, the surgeon then:

A) Reopens both ends

B) Closes both ends

C) Inserts a stent

D) Narrows the aorta

B. Closes both ends

Because much blood bypasses the lungs in Tetralogy of Fallot, the aortic blood is predominantly:

A) Oxygen-rich arterial blood

B) Unoxygenated venous blood

C) Lymphatic fluid

D) Coronary venous blood

B. Unoxygenated venous blood

Which of the following is part of Tetralogy of Fallot?

A) Aorta arises from right ventricle

B) Mitral stenosis

C) Left atrial rupture

D) Coarctation

A. Aorta arises from right ventricle

A major lesion in Tetralogy of Fallot that decreases pulmonary blood flow is:

A) Aortic regurgitation

B) Pulmonary artery stenosis

C) Tricuspid prolapse

D) Patent foramen venosum

B. Pulmonary artery stenosis

In Tetralogy of Fallot, blood from the left ventricle may pass through a septal defect into the:

A) Left atrium

B) Pulmonary vein

C) Right ventricle

D) Coronary sinus

C. Right ventricle

The aorta in Tetralogy of Fallot often overrides a:

A) Mitral annulus

B) Ventricular septal defect

C) Patent ductus

D) Pulmonary vein

B. Ventricular septal defect

The fourth classic abnormality in Tetralogy of Fallot is an:

A) Enlarged right ventricle

B) Enlarged left atrium

C) Enlarged aortic root

D) Enlarged left ventricle

A. Enlarged right ventricle

An enlarged right ventricle in Tetralogy of Fallot can be identified by:

A) EEG

B) Angiograms

C) Colonoscopy

D) Sputum culture

B. Angiograms

Definitive repair of Tetralogy of Fallot includes opening the pulmonary stenosis and:

A) Ligating the coronary sinus

B) Closing the septal defect

C) Enlarging the left atrium

D) Closing the ductus only

B. Closing the septal defect

Tetralogy of Fallot surgery also aims to:

A) Reconstruct the outflow pathway

B) Close the mitral valve

C) Lower venous return

D) Narrow the aorta

A. Reconstruct the outflow pathway

One of the most important mechanisms by which the heart adapts to increased workload is:

A) Atrophy

B) Hypertrophy

C) Fibrillation

D) Embolization

B. Hypertrophy

The most common cause of cardiac hypertrophy is:

A) Viral myocarditis

B) Hypertension

C) Mitral prolapse

D) Anemia

B. Hypertension

Physiological cardiac hypertrophy is best viewed as a:

A) Degenerative lesion

B) Compensatory response

C) Congenital shunt

D) Fibrotic scar

B. Compensatory response