2022 Cardio Residents exam

Question 1

Most common type of valve dysfunction in adults. (Requisites 281)

Answer 1

Mitral Regurgitation

Question 2

Most common cause of constrictive pericarditis?

Answer 2

Post pericardiotomy

Question 3

Most common abnormality of the pericardium

Answer 3

Pericardial effusion

BRANT: Pericardial effusion is the most common abnormality of the pericardium. The normal pericardial stripe is 2 to 3 mm on chest radiograph and CT and less than 4 mm on MR. Plain films show thickening of the pericardial stripe or differential density sign in up to 63% of patients with pericardial effu- sions. The water-bottle configuration is seen in chronic effu- sions. Fluoroscopy shows decreased cardiac pulsations. The normal pericardium contains approximately 20 mL of fluid, whereas it takes approximately 200 mL to be detectable by plain film. Echocardiography detects very small quantities (50 mL) of pericardial fluid, usually as a posterior sonolu- cent collection (Fig. 22.45). Small effusions (100 mL) will appear as anterior and posterior sonolucent regions. Moderate-sized effusions (100 to 500 mL) demonstrate a sonolucent zone around the entire ventricle. Very large effu- sions (500 mL) extend beyond the field of view and may be associated with the “swinging heart” inside the pericardium.

Question 4

Most common type of cardiomyopathy

Answer 4

Dilated CM

Brant

Question 5

What is the most common form of single ventricle?

Answer 5

Underdeveloped right ventricle

Question 6

Most common cause of congestive heart failure in the first day of
life?

Answer 6

Hypoplastic left heart syndrome

Swischuck

Question 7

Type 2 endoleak is the most common complication encountered in
the endovascular repair aneurysms. The classic finding noted in this type
of endoleak is ___. (Requisites p. 314)

Answer 7

Collateral vessels supplying the aneurysmal sac

Journal: Type II is the most common, making up 10–25% of all endoleaks (10). They occur from retrograde collateral blood flow into the aneurysm sac, typically from a lumbar artery or the inferior mesenteric artery (IMA).

Question 8

What is the most common type of thoracic aortic aneurysm?
(Requisites p. 325)

Answer 8

Fusiform

Question 9

The most common site of an infected aneurysm is the _____.
(Requisites p. 332)

Answer 9

Femoral artery

Question 10

Acute ischemia of the lower extremity, in the absence of occlusion of
a bypass graft, is most often the result of ____. (Brant p. 634)

Answer 10

Embolism

Question 11

What is the most common site of atherosclerotic involvement in the
upper extremity? (Brant p. 633)

Answer 11

Subclavian artery

Question 12

Dilated cardiomyopathy accounts for 90% of all cardiomyopathies.
What is its most common cause? (Brant 4th ed., p. 603)

Answer 12

Chronic infarction

Question 13

Dilated cardiomyopathy accounts for 90% of all cardiomyopathies.
What is its most common cause? (Brant 4th ed., p. 603)

Answer 13

Ischemic cardiomyopathy

Question 14

Which is TRUE about restrictive cardiomyopathy? (Brant 4th ed., p.
604)

A. The primary differential diagnosis is hypertrophic cardiomyopathy.
B. It is the most common form of cardiomyopathy.
C. Early in the disease, ventricular systolic function is severely impaired.
D. Etiologies include in lnfiltrative disorders such as amyloid, glycogen storage
disease, hemochromatosis, sarcoidosis.

Answer 14

D

It is in fact the least common, primary Ddx is constrictive CM, diastollic impaired early in disease

Question 15

What is the MOST COMMON course abnormality of the coronary
arteries? (Webb 3rd ed., p. 2820)

Answer 15

Myocardial Bridge

Question 16

. Most common congenital heart abnormality? (Brant 4th Ed p. 1164)

Answer 16

BIcuspid aortic valve

Bicuspid aortic valve is most common in males and is present in 25% to 50% of patients with aortic coarctation. Of patients with a bicuspid aortic valve, 60% of those older than 24 years of age have calcification within the bicuspid valve

Coarctation of the aorta is a primary abnormality of the media with eccentric narrowing of the aortic lumen due to infolding of the aortic wall (Fig. 23.3A). Approximately 70% are associated with congenital cardiac anomalies, the most common being bicuspid aortic valve.

Question 17

What is the most common type of valvular stenosis seen in Tetralogy
of Fallot? (Brant 4th Ed p. 1172)

Answer 17

Subvalvular (infundibular)pulmonary stenosis

Question 18

Which statement refers to the second most common dextroposition?
(Swischuk p. 295-297)

a. Situs inversus always present
b. Associated congenital heart disease is common
c. Complete inversion of cardiac chambers
d. Normal anteroposterior chamber relationships

Answer 18

Associated congenital heart disease is common

On the other hand… The most common type of dextrocardia is so-called “mirror image dextrocardia.” In these cases, the cardiac apex points to the right, and there is complete inversion of the cardiac chambers. In other words, the left atrium and ventricle become right sided, and the right atrium and ventricle become left sided (Fig. 3.106A). Normal anteroposterior chamber relationships, however, are preserved. Situs inversus is always present, bur generally, there is no increased incidence of congenital heart disease

Question 19

What is the most common congenital pericardial defect? (Swischuk
p.317)

Answer 19

Complete absence of the left pericardium

Pericardial defects are much more common on the left than on the right, and of those occurring on the left, complete absence
of the left pericardium is the most common (1). Fortunately, this particular anomaly is relatively benign and requires no specific treatment.

Question 20

1. What is the target heart rate for cardiac CT? (Requisites p. 144, Brant p.589)

Answer 20

60-70 bpm

Question 21

Regarding ECG-gated CT acquisition. Which DOES NOT describe
prospective gating? (Requisities, p. 201)

Answer 21

Has the advantage of lower radiation dose compared to retrospective gating

X Complete datasets in any phase of the cardiac cycle is acquired

The scanner will usually acquire images during late diastole when the heart is most quiescent
The scanner will only acquire x-ray projections in a prespeci ed phase of the
cardiac cycle

Retrospective gating allows acquiring unlimited complete datasets in any phase of the cardiac cycle. This approach uses a spiral CT acquisition, in which the x-ray current remains turned on during the entire scan. The user may then in retrospect define what phase of the cardiac cycle to reconstruct. The major advan- tage of this approach is that the interpreter may decide to try a different phase of the cardiac cycle if the initial reconstruction demonstrates motion artifact. Another advantage is the ability to “edit” the ECG.

Question 22

Answer 22

A calcium score of 11-100 indicates minimal plaque burden and signi cant
coronary artery disease is very unlikely. *

One method of scoring utilizes the Agatston method where coronary calcification is defined as an area with greater than 130 HU and larger than 2 mm2.

Question 23

Stenoses greater than __% are considered hemodynamically
significant. (Brant p. 588). Narrowing of the coronary artery diameter by
__ % roughly predicts cross-sectional area reduction by approximately
75%. This is the physiologic point at which flow is restricted enough to
result in ischemia under stress conditions. (Brant p. 598)

Answer 23

stenoses >50%

Question 24

The patient’s heart is right-dominant if the right coronary artery
supplies what? (Brant p. 583)

Answer 24

The posterior descending artery and the posterior and inferior surface of the
myocardium

Question 25

. This is an inflammatory condition of the coronary arteries, probably from a prior viral syndrome, which results in coronary stenosis and coronary aneurysms. (Brant p. 585)

Answer 25

Kawasaki Syndrome

Question 26

Which is a contraindication to cardiac MRI? (Brant p. 589) ## Footnote Prosthetic valve Cardiac pacemaker Myocardial ischemia High calcium score

Answer 26

Cardiac pacemaker

Question 27

Which MRI sequence will you check for the best anatomic depiction of the heart in which the moving blood produces a signal void or "black blood" appearance? (Brant p. 589)

Answer 27

Question 28

The following conditions preclude adequate coronary CT angiography EXCEPT? (Requisites, p.210) ## Footnote atrial brillation small coronary arteries severe calci cation high heart rates None of the above

Answer 28

none of the above

Question 29

What is the modality of choice for patients with low to intermediate pretest probability of significant coronary artery disease? (Requisites p. 205)

Answer 29

CT angiography

Question 30

Which of the following statements DOES NOT describe the morphologic right atrium? (Requisites, p. 170) ## Footnote A Cardiac chamber receiving hepatic venous drainage B. Receives blood from the inferior vena cava and coronary sinus C. possesses the crista terminalis D. Has a fingerlike atrial appendage

Answer 30

D

Question 31

Which of the following DOES NOT describe the right ventricle? (Requisites p. 173) ## Footnote A. tricuspid valve papillary muscles originate from both the interventricular septum and the free wall of the right ventricle B. most reliably differentiated from the left ventricle by presence of the infundibulum C. has thicker and straighter muscular trabeculations D. has smoother endocardial surface than the left ventricle

Answer 31

C

Question 32

TRUE OR FALSE: Bicuspid aortic valve is the second most common congenital cardiovascular congenital anomaly. (Requisites 269)

Answer 32

FALSE | most common

Question 33

Predominant cause of mitral stenosis. (Requisites 280)

Answer 33

Rheumatic fever

Question 34

Type of pulmonary stenosis in Tetralogy of Fallot. (Brant 610) *

Answer 34

Subvalvular

Question 35

16. Findings in mild mitral stenosis EXCEPT (Brant 607) * ## Footnote A.Valve area <1.5 cm2 B.Left atrial enlargement C.Normal chest radiograph D. Elevated left atrial pressure during exercise

Answer 35

B

Question 36

60% to 70% of mitral regurgitation is caused by (Requisites 281) *

Answer 36

Degenerative mitral valve disease

Question 37

Radiographic features of severe mitral regurgitation EXCEPT: (Brant 608) ## Footnote Left atrial enlargement Pulmonary venous hypertension Left ventricular enlargement Right ventricular enlargement

Answer 37

D

Question 38

19. Most common type of valve dysfunction in adults. (Requisites 281) *

Answer 38

Mitral Reurgitation

Question 39

20. Leaflets of the pulmonic valve EXCEPT: (Requisites 283) * ## Footnote Posterior Anterior Left Right

Answer 39

except posterior for pulmonic valve

Question 40

Which radiologic finding distinguishes mitral insufficiency/regurgitation from mitral stenosis?

Answer 40

left ventricular enlargement

Question 41

Stages of progression of mitral stenosis. Which is incorrect? (Brant 607) ## Footnote Stage 1: Pulmonary venous hypertension with hilar angle loss Stage 2: Interstitial edema with Kerley lines Stage 3: Recurrent congestive failure None of the above

Answer 41

Stage 3 is incorrect because it should be alveolar edema

Question 42

Type of acquired pulmonary stenosis associated with Behcet's disease.

Answer 42

Supravalvular stenosis

Question 43

Chest film hallmark/s in chronic and severe aortic regurgitation (Requisites 275)

Answer 43

LV enlargement & aortic dilatation

Question 44

26. MR features of aortic regurgitation EXCEPT: * ## Footnote Decreased LV stoke volume Diastolic signal void starting at closed aortic valve on cine MRI Increased LV end-diastolic and end-systolic volume All of the above

Answer 44

Except Decreased LV stroke volume

Question 45

Severe aortic stenosis is defined as (Requisites 271) *

Answer 45

Valvular systolic ori ce area less than 1.0 cm2 | from brant ## Footnote Aortic stenosis is any abnormality of the aortic valve in which the leaflets restrict the lumen of the outflow tract. The three cardinal features of aortic stenosis are (1) leaflet thickening, deformity, and calcification; (2) decreased mobility or doming of the leaflets, or both; and (3) an absolute decrease in size of the valve orifice resulting from reduced cusp separation It results in concentric LV hypertrophy

Question 46

This is defined as right ventricular failure secondary to a pulmonary parenchyma or pulmonary arterial disease

Answer 46

Cor pulmonale

Question 47

Type of cardiomyopathy that would present with thick LV wall, normal to decreased LV cavity, increased contractility, and decreased compliance

Answer 47

Hypertrophic

Question 48

Chamber affected in Uhl anomaly *

Answer 48

Right Ventricle

Question 49

True of pericardial cysts

Answer 49

They occasionally communicate with the pericardial space

Question 50

True of pericardial effusion?

Answer 50

Most common abnormality of the pericardium ## Footnote BRANT:20 mL WEBB: 50 mL The water-bottle configuration is seen in chronic effu- sions. Fluoroscopy shows decreased cardiac pulsations. The normal pericardium contains approximately 20 mL of fluid, whereas it takes approximately 200 mL to be detectable by plain film. Echocardiography detects very small quantities (50 mL) of pericardial fluid, usually as a posterior sonolu- cent collection (Fig. 22.45). Small effusions (100 mL) will appear as anterior and posterior sonolucent regions. Moderate-sized effusions (100 to 500 mL) demonstrate a sonolucent zone around the entire ventricle. Very large effu- sions (500 mL) extend beyond the field of view and may be associated with the “swinging heart” inside the pericardium

Question 51

In cor triatriatum, an extra chamber is seen adjacent to which chamber?

Answer 51

LA

Question 52

Answer 52

In partial defect, the LA appendage usually herniates

Question 53

Blunt trauma is the most common traumatic injury to the thoracic aorta. What part of the aorta is most commonly injured in these cases? (Requisites p. 320)

Answer 53

Aortic isthmus

Question 54

Which of the following is NOT a DIRECT SIGN of aortic injury? (Brant p. 622) ## Footnote Change in caliber of the aorta Periaortic hematoma Contrast extravasation Intimal ap

Answer 54

Periaortic hematoma is not a direct sign of aortic injury

Question 55

An aortic dissection with the intimal flap beginning in the right aspect of the sinotubular junction and ending in the descending thoracic aorta can be classified as _______. (Brant p. 627; Requisites p. 304)

Answer 55

DeBakey 1, Stanford A

Question 56

. Which of the following imaging characteristics differentiates diabetic vascular disease from typical atherosclerosis? (Brant pp. 632-633)

Answer 56

Involves more distal vessels, often sparing large proximal vessels ## Footnote dramatic vascular calcification involving arteries of all sizes is also another key findings in diabetic vascular dse

Question 57

An aneurysm of the ascending thoracic aorta is defined when the diameter is greater than ____. (Requisites p. 302; p. 323)

Answer 57

> 5 cm for ascending aortic aneurysm

Question 58

# 1. Which of the following disease entities is NOT included in the three pathologic processes comprising the “acute aortic syndrome?” (Requisites p. 302) ## Footnote Aortic dissection Penetrating aortic ulcer Aortic intramural hematoma Aortic aneurysm

Answer 58

Aortic aneurysm is not included

Question 59

Which of the following imaging findings is the hallmark of aortic dissection? (Requisites p. 311)

Answer 59

Intimal flap

Question 60

What is the radiologic hallmark of cardiovascular syphilis? (Requisites p. 338)

Answer 60

Aortitis ## Footnote The lesions of cardiovascular syphilis include aortitis and aortic aneurysms, aortic valvular insufficiency, and narrowing of the coronary ostia. Disease starts about 5–10 years after infection, but symptoms of cardiovascular syphilis may not be clinically evident for more than 20 years.

Question 61

What is the earliest angiographic change in Takayasu arteritis? (Requisites p. 336)

Answer 61

Irregularity/Narrowing of the lumen with no pressure gradient

Question 62

Acute ischemia of the lower extremity, in the absence of occlusion of a bypass graft, is most often the result of ____. (Brant p. 634)

Answer 62

Infection

Question 63

In coronary calcium scoring, what range corresponds to MILD plaque burden? (Brant 4th ed., p. 596)

Answer 63

11-100

Question 64

Which of the following is NOT one of the three basic features of cardiomyopathies? (Brant 4th ed., p. 602) ## Footnote failure of the heart to maintain its contractility failure of the heart to maintain cardiac output failure of the heart to maintain normal electrical activity failure of the heart to maintain its architecture

Answer 64

failure of the heart to maintain its **contractility** is not a basic feature

Question 65

What is the imaging finding in the first week after myocardial infarction? (Webb 3rd ed., p. 2774)

Answer 65

High signal of T2-weight images

Question 66

Which is NOT an accepted indication for coronary CT angiography? (Webb 3rd ed., p. 2786) ## Footnote Lung or liver transplant Patients with low risk for CAD who present with angina Major vascular surgery None of the above. All are accepted indications.

Answer 66

None of the above

Question 67

Patients with a heart rate lower than ____ bpm have significantly better image quality and less motion artifact compared to patients with higher heart rates. (Webb 3rd ed., p. 2789)

Answer 67

60

Question 68

Following the Agatston score protocol, any pixel within the coronary arterial tree with a density higher than ____ is considered as containing calcium. (Webb 3rd ed., p. 2792)

Answer 68

130

Question 69

Which is NOT a finding in hypertrophic cardiomyopathy? (Brant 4th ed., p. 604) ## Footnote systolic anterior motion of the mitral valve with mitral regurgitation narrowing of the left ventricular out ow tract during systole hypokinetic left ventricular function hypertrophy of the interventricular septum (>12 to 13 mm)

Answer 69

hypokinetic left ventricular function - is not a finding in HCM

Question 70

Which is TRUE about restrictive cardiomyopathy? (Brant 4th ed., p. 604) ## Footnote The primary differential diagnosis is hypertrophic cardiomyopathy. It is the most common form of cardiomyopathy. Early in the disease, ventricular systolic function is severely impaired. Etiologies include in lnfiltrative disorders such as amyloid, glycogen storage disease, hemochromatosis, sarcoidosis.

Answer 70

Etiologies include in infiltrative disorders such as amyloid, glycogen storage disease, hemochromatosis, sarcoidosis.

Question 71

What is the MOST COMMON pitfall in coronary imaging? (Webb 3rd ed., p. 2848)

Answer 71

Motion Artifacts

Question 72

Which of the following disease processes does not present with unequal pulmonary blood flow? (Swischuk p.235) ## Footnote Pulmonary valve stenosis Persistent truncus arteriosus Ebstein’s anomaly Tetralogy of Fallot

Answer 72

Ebstein’s anomaly

Question 73

Which congenital cardiac abnormality presents classically with “gooseneck” deformity on left ventricular angiography? (Swischuk p. 243- 244/Brant 4th ed p.1165)

Answer 73

Endocardial cushion defect ## Footnote The ostium primum type of ASD (endocardial cushion defect) is caused by abnormal development of the primi- tive endocardial cushions that form the interatrial and interventricular septa and atrioventricular valves. This condi- tion commonly occurs in trisomy 21. The specific malforma- tion ranges from two separate atrioventricular valves with a low ASD and a VSD to the complete form, with a common atrioventricular ring and a five-leaflet valve. The mitral valve B is clefted and abnormally positioned, resulting in elongation of the left ventricular outflow tract, which creates a “gooseneck” appearance on angiography (Fig. 50.69B).

Question 74

On chest x-ray, this non-cyanotic patient has increased vascularity, small aorta, large pulmonary artery, large left atrium, and biventricular cardiomegaly. What does the patient have? (Brant 4th Ed p. 1164)

Answer 74

VSD

Question 75

On chest x-ray, this cyanotic patient has decreased vascularity, large aorta, concave pulmonary artery, and right ventricular enlargement. What does the patient have? (Brant 4th Ed p. 1169)

Answer 75

Tetralogy of Fallot

Question 76

Which congenital anomaly has a functional left-to-right shunt with obligatory right-to-left shunt? (Swischuk p. 250)

Answer 76

Total anomalous pulmonary venous return ## Footnote In the type III anomaly, the same functional left-to-right and obligatory right-to-left shunts are present, but marked pulmonary venous obstruction complicates the picture. As a result, the left-to-right shunt is attenuated for it is believed [hat [here is impedance of blood flow through the long, thin anomalous common pulmonary vein inserting into the pOrtal vein.

Question 77

Which structure causes the “boxed” appearance of the heart in Ebstein’s anomaly? (Swischuk p. 276)

Answer 77

Elevated right ventricle ## Footnote In longstanding cases, a bulge resulting from the elevated "residual" right ventricle is seen along the upper left cardiac border. This bulge has resulted in the so-called "squared" or "boxed" cardiac appearance demonstrated in Fig. 3 . 80C.

Question 78

Which of the following statements about coarctation of the aorta is correct? (Swischuk p. 283-287) a. Rib notching of the posterior fourth to eighth ribs can regress after surgical correction b. In juxtaductal type, there is cyanosis of the lower half of the body c. A and B only d. In preductal type, the area of narrowing is usually short and discrete e. All of the above

Answer 78

a. Rib notching of the posterior fourth to eighth ribs can regress after surgical correction ## Footnote a. True b. In the juxtaductal type, there is cynosis of the lower half of the body (PREDUCTAL type) c. In preductal type, the area of narrowing is usually LONG (short and discrete for juxtaductal type) ----- There are two types of coarctation of the aorta, but the most frequently encountered type is the juxtaductal variety. In this type, previously known as the adult type, the area of coarctation is located at, or just distal to, the left subclavian artery and ductus arteriosus and usually is short and discrete. In the rarer second type, the area of narrowing lies proximal to the ductus arteriosus, somewhere between it and the left subclavian artery. This type is referred to as "preductal," "isthmic," or "infantile coarctation" and, in contrast to the juxtaductal variety, usually consists of a long segment of narrowing. In addition, a ventricular septal defect often is present, and a patent ductus arteriosus always is present. In addition, a ventricular septal defect often is present, and a patent ductus arteriosus always is present. In the preductal or isthmic type, the hemodynamics are somewhat different. Left ventricular systolic overloading is still a prominent feature, but since a ventricular septal defect often also is present, an associated left-to-right shunt. develops and, together with the obstructing coarctation, leads to marked overloading of the heart and cardiomegaly along with congestion. A collateral circulation is not so critical in these patients, since blood is delivered to the descending aorta through the patent ductus arteriosus.However, since this blood is unoxygenated, the lower half of the b ody is cyanotic.

Question 79

Which of the following presents asymptomatically? (Swischuk p. 303) a. Double aortic arch b. Aberrant left pulmonary artery c. Right aortic arch, right descending aorta, anomalous left subclavian artery d. Left aortic arch, left descending aorta, anomalous right subclavian artery, ductus ligamentum

Answer 79

c. Right aortic arch, right descending aorta, anomalous left subclavian artery

Question 80

Which of the following findings is pathognomonic for vascular sling? (Swischuk p.315) a. Oblique posterior esophageal indentation from lower left to upper right b. Oblique posterior esophageal indentation from lower right to upper left c. Reverse S-shaped indentation of the esophagus d. Posterior tracheal indentation just above the carina and indentation of the anterior wall of the esophagus

Answer 80

d. Posterior tracheal indentation just above the carina and indentation of the anterior wall of the esophagus ## Footnote After the aberrant left pulmonary artery hooks around the carina, it crosses the mediastinum between the esophagus. In so doing, it produces a characteristic indentation of the posterior aspect of the trachea just above the carina and a corresponding indentation of the anterior wall of the barium-filled esophagus (Figs. 3.130B and 3.131 B). Aberrant left pulmonary artery is the only vascular anomaly to produce this configuration, but it is not necessarily clearly demonstrated in all patients. However, once seen, it is pathognomonic, and one should proceed with further imaging.

Question 81

Diagnosis?

Answer 81

Cor Triatriatum

Question 82

Answer 82

WATER BOTTLE SIGN

Question 83

Answer 83

CONSTRICTIVE PERICARDITIS

Question 84

# 1.

Answer 84

CORONARY ARTERY DISEASE

Question 85

Answer 85

LEFT ANTERIOR DESCENDING ARTERY

Question 86

Answer 86

MITRAL REGURGITATION

Question 87

Answer 87

TETRALOGY OF FALLOT

Question 88

Answer 88

MITRAL VALVE

Question 89

Answer 89

MITRAL STENOSIS

Question 90

Answer 90

MITRAL REGURGITATION

Question 91

Answer 91

LEFT VENTRICULAR ANEURYSM

Question 92

Answer 92

LEFT VENTRICULAR THROMBUS LEFT VENTRICLE THROMBUS LEFT VENTRICULAR APICAL THROMBUS

Question 93

Answer 93

MICROVASCULAR OBSTRUCTION OR ACUTE MICROVASCULAR OBSTRUCTION

Question 94

Answer 94

COR TRIATRIATUM

Question 95

Answer 95

ABERRANT LEFT PULMONARY ARTERY PULMONARY SLING VASCULAR ARTERY SLING

Question 96

Answer 96

SNOWMAN SIGN

Question 97

Answer 97

HOLT-ORAM SYNDROME

Question 98

Answer 98

PSEUDOANEURYSM ## Footnote ARTERIAL PSEUDOANEURYSM RIGHT FEMORAL ARTERY PSEUDOANEURYSM FEMORAL ARTERY PSEUDOANEURYSM

Question 99

Answer 99

BUERGER DISEASE THROMBANGIITIS OBLITERANS

Question 100

Answer 100

TYPE III