CVS Week 8 Quiz Flashcards
(13 cards)
A 28-year-old woman in her second trimester of pregnancy attends her routine prenatal check-up. The physician explains the cardiovascular changes occurring during pregnancy. Which of the following best encapsulates why these changes occur and what they entail?
Question 1Answer
a.
Pre-eclampsia is characterized by reduced cardiac output and plasma volume, necessitating reduced physical activity during pregnancy
b.
Right axis shift on ECG and decreased cardiac output as adaptive mechanisms to increased intra-abdominal pressure
c.
Decreased plasma volume and increased red cell mass to prepare the body for potential blood loss during delivery
d.
Increased cardiac output and plasma volume due to hormonal influences that accommodate fetal growth and placental demands
e.
Vasodilation and decreased heart rate to reduce the risk of developing pre-eclampsia
d. Increased cardiac output and plasma volume due to hormonal influences that accommodate fetal growth and placental demands
During pregnancy, hormonal changes (particularly increases in progesterone) lead to vasodilation, which, along with the demands of the growing fetus and placenta, necessitates an increase in cardiac output and plasma volume. This adaptation ensures adequate blood supply to the uterus and supports fetal development
Which portion of the fetal heart tube, listed below, has the greatest contribution to the adult right atrium?
Question 2Answer
a.
Primitive ventricle
b.
Outflow tract
c.
Bulbus cordis
d.
Sinus venosus
e.
Truncus arteriosus
d.
Sinus venosus
The sinus venosus forms the smooth venous part of the right atrial wall
The fetus relies entirely on the maternal circulation for nutrients and oxygen. Which of the following statements about the fate of most of the blood entering the fetal circulation from the placenta is true?
Question 3Answer
a.
It passes through the pulmonary arteries
b.
It enters the fetus via the umbilical arteries
c.
It passes through the left ventricle
d.
It passes through the right atrium
e.
It enters the pulmonary circulation via the ductus arteriosus
d.
It passes through the right atrium
Blood flows directly through the ductus venosus into the inferior vena cava, bypassing the liver then enters the right atrium
Blood may be shunted between the pulmonary and systemic circulations in some congenital heart defects. These are classified as cyanotic or acyanotic depending on the direction of the shunt. What is a cyanotic congenital heart defect?
Question 4Answer
a.
Atrial septal defect (ASD)
b.
Patent ductus arteriosus (PDA)
c.
Transposition of great vessels
d.
Ventricular septal defect (VSD)
e.
Coarctation of the aorta
c.
Transposition of great vessels
Transposition of great vessels in which the aorta and pulmonary artery are transposed and the output from the left and right ventricles are reversed, leading to cyanosis
A 32-year-old woman with an ostium secundum ASD presents for follow-up after a 4-year absence from your clinic. You previously advised her to undergo catheter-based closure of her ASD, but she declined because she was feeling well. She has not been seen by a physician since her last office visit with you. Over the past year she has experienced a significant functional decline with progressive weakness, dizziness, and shortness of breath. She also reports headaches, blurry vision, and epistaxis.
Her vital signs are as follows: blood pressure 90/68 mmHg, pulse 110 bpm, respirations 22 per minute, and room air oximetry 78%. She has perioral cyanosis. Examination reveals a loud and palpable second heart sound with III/VI holosystolic murmur at the left sternal border. Her lungs are clear, and her extremities are cool with marked digital clubbing.
Laboratory data include a normal basic metabolic panel, hemoglobin 21 g/dL, and hematocrit 65%. Her echocardiogram reveals marked right-sided chamber enlargement with severe right ventricular systolic dysfunction with severe tricuspid regurgitation and an estimated right ventricular systolic pressure of 120 mmHg. There is a large secundum ASD with laminar flow from right to left. She agrees to hospitalization for additional diagnostic testing and management. Which of the following treatment choices is not appropriate for this patient?
Question 5
a.
Phlebotomy
b.
Oral contraceptive therapy
c.
Right-heart catheterization with trial of pulmonary vasodilator therapy
d.
Percutaneous ASD closure
e.
Advanced heart failure consultation to discuss eligibility for heart and lung transplantation
d.
Percutaneous ASD closure
All of the following untreated congenital heart defects are associated with a risk for Eisenmenger syndrome except _____
Question 6Answer
a.
Tetralogy of Fallot
b.
VSD
c.
PDA
d.
ASD
e.
Bicuspid aortic valve
e.
Bicuspid aortic valve
Bicuspid aortic valve is an isolated valvular abnormality that is not associated with left-to-right shunting. All of the remaining diagnoses have shunting as a key hemodynamic feature and may result in Eisenmenger syndrome
A 2-year-old child presents with failure to thrive and breathlessness. On examination there is a continuous machine-like murmur. Which of the following conditions is most likely present in this patient?
Question 7Answer
a.
Patent ductus arteriosus
b.
Patent foramen ovale
c.
Ventricular septal defect (VSD)
d.
Tetralogy of Fallot
e.
Cardiomyopathy
a.
Patent ductus arteriosus
Left-to-right shunt with blood passing back from the aorta down the patent ductus to the pulmonary artery. At age 2–3 years old patients develop harsh blowing machinery murmur in the region of the pulmonary artery
The fetus has a different circulatory pattern from the newborn. Of the following statements about the fate of most of the deoxygenated blood returning from the head and neck of the fetus in the fetal circulation, which is correct?
Question 8Answer
a.
It enters the right atrium via the inferior vena cava
b.
It is returned to the placenta via the umbilical veins
c.
It passes through the left ventricle
d.
It passes through the pulmonary circulation
e.
It passes through the right ventricle
e.
It passes through the right ventricle
Blood enters the right ventricle via the tricuspid valve
Which of the following is not a feature of tetralogy of Fallot (ToF)?
Question 9Answer
a.
Right ventricular hypertrophy
b.
Aortic dilatation
c.
Pulmonic stenosis
d.
Rightward displacement of the aorta
e.
Ventricular septal defect
b.
Aortic dilatation
Aortic dilatation is not a feature of tetraolgy of Fallot, all the other answers are a feature
A newborn undergoes significant physiological changes immediately after birth. Which of the following best describes an anatomical change in the fetal cardiovascular system that occurs at birth, why it happens, and the outcome of this change?
Question 10Answer
a.
The pulmonary artery dilates significantly to increase systemic blood flow and maintain higher blood pressure
b.
Constriction of the ductus arteriosus triggered by increased oxygen levels, redirecting blood away from the lungs
c.
The aorta constricts at the site of the ductus arteriosus to maintain higher pressure in the upper body
d.
Persistence of the umbilical vein to supplement nutrition until breastfeeding is established
e.
Closure of the foramen ovale due to pressure changes in the atria, preventing blood mixing and ensuring lung passage
e.
Closure of the foramen ovale due to pressure changes in the atria, preventing blood mixing and ensuring lung passage
After birth, increased left atrial pressure from lung function initiation closes the foramen ovale, stopping the direct atrial blood flow and directing blood through the lungs for oxygenation
A 4-year-old child presents with a murmur found on routine examination. The mother notes that the child is otherwise fit and well but did have difficulty in feeding as a baby. On examination there is a pansystolic murmur, a parasternal heave and a laterally displaced apex beat. Which of the following conditions is most likely affecting this patient?
Question 11
a.
Tetralogy of Fallot
b.
Ventricular septal defect (VSD)
c.
Coarctation of the aorta
d.
Cardiomyopathy
e.
Patent ductus arteriosus
b.
Ventricular septal defect (VSD)
VSDs have a pansystolic murmur with thrills and heaves. May be associated with other cardiac and valve defects
A 9-year-old girl has recently been diagnosed with Turner syndrome. Her mother is concerned as the child has episodes of dizziness and shortness of breath. On examination all observations are normal, however on palpation of the radial pulses they are found to be asynchronous. On palpation of the right radial and the femoral pulse, there is also a radio-femoral delay present. Which of the following conditions is most likely present in this patient?
Question 13Answer
a.
Coarctation of the aorta
b.
Tetralogy of Fallot
c.
Patent ductus arteriosus
d.
Ventricular septal defect (VSD)
e.
Cardiomyopathy
a.
Coarctation of the aorta
Narrowing of the aorta after birth which causes overload of the left ventricle and heart failure; femoral pulses are weak. Radio-femoral delay will be seen due to narrowing of aorta after the branching of the arteries supplying the upper limbs. Often associated with Turner syndrome in females
A 2-year-old child has been brought in by his mother. She is concerned as he can ‘go blue’ whilst running and playing which is improved when the child crouches down and squats. She was told that he had a murmur when he was a baby. On examination: The child is small for his age, observations all normal, clubbing of the fingers, pansystolic murmur. Investigations: CXR – ‘boot-shaped heart’ with large right ventricle and small pulmonary artery.
Given the history, examination and investigation findings what is the most likely diagnosis in this patient?
Question 12
a.
Tetralogy of Fallot
b.
Eisenmenger’s syndrome
c.
Transposition of the great arteries
d.
Patent ductus arteriosus
e.
Coarctation of the aorta
a.
Tetralogy of Fallot
This is the most common congenital cause of blue baby; a right-to-left shunt is present
