Transcript THE CARDIOVASCULAR SYSTEM

THE CARDIOVASCULAR
SYSTEM
JAMEEL AL-ATA, M.D.
Assistant Professor & Consultant
Pediatric Cardiologist
King Abdulaziz University Hospital
1. The finding of substernal thrust on palpation
of the precordium is most likely to be
associated with which one of the following?
a. Left ventricular hypertrophy
b. Right ventricular hypertrophy
c. An ejection click
d. Systemic hypertension
e. Pericardial effusion
2. A still murmur is
a. An early diastolic murmur signifying
mitral stenosis
b. An innocent murmur that disappears
on jugular pressure
c. An innocent, musical, vibratory ejection
murmur heard best when the patient is
in the recumbent position
d. An innocent, blowing, early systolic
murmur that increases in intensity on
expiration
e. A blowing diastolic murmur most
frequently heard in the newborn period
3. Electrocardiograms are useful in the
diagnosis of each of the following EXCEPT
a.
b.
c.
d.
e.
Congenital heart disease
Rheumatic heart disease
Electrolyte disorders
Endocrine and metabolic disease
Prematurity
4. Each of the following is a critical congenital
heart disease of the neonate EXCEPT
a.
b.
c.
d.
e.
Transposition of the great vessels
Hypoplastic left heart syndrome
Right ventricular outflow obstruction
Coarctation of the aorta
Endocardial fibroelastosis
5. Congenital rubella syndrome is associated
with which of the following?
a. Patent ductus arteriosus (PDA) and
branch pulmonary artrery stenosis
b. Ventricular septal defect (VSD) and
PDA
c. Atrial septal defect (ASD) and PDA
d. VSD and ASD
e. VSD and pulmonary artery stenosis
6. Which of the following is the most common
congenital heart defect in infants and
children (excluding the neonatal period)?
a. ASD
b. VSD
c. PDA
d. Coarctation of the aorta
e. Tetralogy of Fallot
7. Tetralogy of Fallot consists of each of the
following cardiac malformations EXCEPT
a. Pulmonary stenosis
b. VSD
c. ASD
d. Dextroposition of the aorta
e. Right ventricular hypertrophy
8. Each of the following statements about
transposition of the great arteries is true
EXCEPT
a. It is the primary cause of death from
cyanotic congenital heart disease in
the first year of life
b. Congestive heart failure occurs by 4
months of age when a VSD is present
c. A VSD, PDA, and/or an ASD must be
present for the newborn to survive
d. The electrocardiogram is often normal
initially in the newborn period
e. More females than males are affected
9. In recent years the development of which of
the following has improved the survival rate
of infants with transposition of the great
arteries?
a. Rashkind procedure (balloon atrial
septostomy)
b. Echocardiography
c. Blalock-Taussig procedure (subclavian
pulmonary anastomosis)
d. Brock procedure (infundibular resection)
e. Home oxygen availability
10. Which one of the following is NOT present in
tricuspid atresia?
a. Left axis deviation on electrocardiogram
b. Patent foramen ovale
c. Right ventricular hypoplasia
d. Split second heart sound
e. Diminished pulmonary vascularity on
plain anteroposterior chest film
11. Which of the following statements regarding
ventricular septal defect is correct?
a. It is most easily diagnosed at birth
b. Congestive heart failure usually develops
within the first month of life
c. The defect is usually small and closes
spontaneously
d. Surgery should usually be performed
within the first six months to prevent
subacute bacterial endocarditis
e. Pulmonary hypertension will develop
rapidly if the defect is not treated
surgically
12. Which one of the following statements about
atrial septal defect is true?
a. The murmur is caused by rapid flow
from the left atrium to the right atrium
b. The second heart sound is variably
split
c. High flow through the pulmonary artery
causes a palpable thrill at the upper left
sternal border
d. The defect is a patent foramen ovale
e. It causes heart failure in 50% of infants
with the defect
13. Which of the following is the most serious
atrial septal defect?
a. Ostium primum defect
b. Ostium secundum defect
c. Endocardial cushion defect with
common atrioventricular canal
d. Patent foramen ovale
14. A diastolic as well as a systolic murmur in a
child with a patent ductus arteriosus
generally indicates which one of the
following?
a. Normal or only slightly elevated
pulmonary arterial pressure
b. Pulmonary hypertension
c. Systemic hypotension
d. Mitral stenosis
e. Tricuspid stenosis
15. The majority of coarctations of the aorta
occur
a. Between the origin of the right
subclavian artery and the right carotid
artery
b. Between the right and left carotid
arteries
c. Between the left carotid artery and the
left subclavian artery
d. Below the left subclavian artery
e. At the level of the diaphragm
16. In total anomalous pulmonary venous
return, the anomalous vein most often
enters the
a. Coronary sinus
b. Left superior vena cava
c. Right superior vena cava
d. Portal vein
e. Ductus venosus
17. The syndrome of idiopathic hypercalcemia,
hypertelorism, and mental retardation is
associated with which one of the following?
a. Supravalvular aortic stenosis
b. Valvular aortic stenosis
c. Subvalvular aortic stenosis
d. Aortic insufficiency
e. Patent ductus arteriosus
QUESTIONS 18-19
A teenage girl comes to the clinic
complaining that her “heart beats fast
sometimes”. She is otherwise well, healthy,
and doing well in school. She denies taking
any drugs, and she does not smoke
cigarettes.
Physical examination is
unremarkable. Pulse rate is 80 per minute.
You decide to do an electrocardiogram.
18. Below are five electrocardiograms. Which is most
likely to be from this patient? (If you were to have a
tracing when she is symptomatic).
19. Reversion of this patient’s electrocardiogram
to normal will occur most readily with which of
the following?
a. Vagal stimulation
b. Digoxin
c. Quinidine
d. D-C cardioversion
e. Phenytoin-(Dilantin)
20. The most common underlying factor in
children who develop acute bacterial
endocarditis is which of the following?
a. Congenital heart disease
b. Dental surgery
c. Streptococcal pharyngitis
d. Acute rheumatic fever
e. Tonsillectomy
21. Which of the following is the most important
procedure in the diagnosis of subacute
bacterial endocarditis?
a. Complete blood count
b. Urinalysis (microscopic)
c. Erythrocyte sedimentation rate
d. Blood cultures
e. Electrocardiogram
22. Which of the following is the most common
immediate valvular lesion resulting from
acute rheumatic fever?
a. Mitral insufficiency
b. Mitral stenosis
c. Aortic insufficiency
d. Aortic stenosis
e. Tricuspid insufficiency
23. Evidence that digitalis has had an effect in
an infant with congestive heart failure would
include each of the following EXCEPT
a. Diminished venous pressure
b. Decreased liver size
c. Decreased
P-R
interval
on
electrocardiogram
d. Decreased heart rate
e. Increased urinary output
24. Pulsus paradoxus is associated with
a.
b.
c.
d.
e.
pericarditis
endocarditis
Rheumatic fever
myocarditis
Postperfusion syndrome
25. The combination of tachycardia, enlarged
liver, a cardiac gallop without murmurs, and
a cranial bruit is most likely
a. Congestive heart failure from viral
myocarditis
b. Congestive
heart
failure
from
mucocutaneous lymph node syndrome
c. Congestive heart failure from an
intracranial hemangioma
d. Thyrotoxicosis
e. Aneurysm of the circle
(intracranial aneurysm)
of
Willis
26. Potentially curable forms of hypertension in
children include each of the following
EXCEPT
a. Neuroblastoma
b. Pheochromocytoma
c. Medullary cystic disease
d. Renal artery stenosis
e. Ingestion of excessive amounts of
licorice
27. Each of the following statements about
hyperlipidemia in children is true EXCEPT
a. Screening programs have not been
shown to be cost beneficial
b. Cholesterol is the major blood lipid
implicated in the pathogenesis of
arteriosclerotic heart disease
c. Dietary regulation is the most important
treatment modality
d. Colestipol
is
the
most
effective
cholesterol-lowering agent available
e. Surgical therapy (portocaval shunts)
has shown promising results
QUESTIONS 28-29
A 16-year old girl comes to your office
because of dizziness and throbbing
heartaches occurring two or three times a
day. She has no other complaints and is
otherwise in good health. There is no family
history of hypertension.
28. Important other history would include which
of the following? (Choose as many as are
appropriate).
a. Renal trauma
b. Immunizations
c. Drug use
d. Smoking
e. Visual problems
f. Nocturnal cough
g. Personality change
h. Excessive sweating
29. There is no history of renal trauma. Immunizations
are up to date. She neither smokes nor drinks, but
does take oral contraceptives. Her vision is fine,
and she has no cough at all. There has been no
personality change or excessive sweating. On
physical examination you find that blood pressure is
140/100 mm Hg; pulse is 90 per minute; height and
weight are in the 25th percentile. The remainder of
the physical examination including funduscopic
examination and complete neurologic examination,
is normal. There are no abdominal bruits, and her
thyroid gland is normal. Which one of the following
would be indicated at this point?
Con’t. (29)
a. Repeat blood pressure measurements
at least twice over the next few weeks
b. Order complete blood count, urinalysis,
urine culture, and intravenous urogram
c. Measure urinary catecholamines, 17hydroxysteroids, and 7-ketosteroids
d. Tell her to discontinue oral contraceptives
e. Begin antihypertensive therapy
30. Each of the following is true about hypertension in
children EXCEPT
a. Essential hypertension is the most common
form
b. Most newborns with hypertension
have
hyperthyroidism
c. Renal disease if the most likely etiology in
childhood if hypertension is secondary
d. A discrepancy in renin secretion of greater than
1.5:1 indicates renal involvement on the side with
the higher level
e. The natural history of essential hypertension
is not known
31. The most common cardiac
childhood is
a. Rhabdomyosarcoma
b. Mesothelioma
c. Papilloma
d. Lipoma
e. Myxoma
tumor
in