Cardiac

Question 1

annuloaortic ectasia

(dilatation of annulus and sinuses of Valsalva with effacement of the sinotubular junction; “tulip bulb” configuration of the aortic root)

Answer 1

1. connective tissue disorder (Marfan, Ehlers-Danlos, Loetz-Dietz [SMAD3 mutation causes cystic medial necrosis])
2. congenital bicuspid valve (fibrillin-1 deficiency)
3. idiopathic cystic medial necrosis
4. tertiary syphilis
5. homocysteinuria

Question 2

dilated cardiomyopathy

Answer 2

1. ischemia
2. infection (viral myocarditis)
3. alcohol
4. idiopathic

Question 3

pericardial calcifications

Answer 3

• infection (TB)
• iatrogenic: surgery, radiation
• hemorrhage
• uremia
• neoplasm
• autoimmune

Question 4

isolated left atrial enlargement (think obstruction)

Answer 4

1. MV stenosis (rheumatic fever)
2. LA myxoma
3. cor triatriatum (0.1% congenital cardiac anomalies)

Question 5

RV and RA enlargement

Answer 5

• valvular disease: tricuspid insufficiency
• left to right shunt (ASD or PAPVR)
• cardiomyopathy (ARVC)
• Ebstein anomaly: apical displacement of tricuspid leaflet, w atrialization of RV

Question 6

ascending aortic aneurysm causes

Answer 6

post stenotic dilatation from aortic stenosis
atherosclerosis/hypertension
previous aortic dissection
aortitis: Takayasu, giant cell, RA, seroneg SpA
congenital heart dz, PDA, coarctation
mycotic pseudoaneurysm: staph, salmonella, TB, HIV
tertiary syphilis

Question 7

descending aortic aneurysm causes

Answer 7

atherosclerosis/hypertension
previous dissection/PAU
previous trauma w missed rupture (saccular pseudoaneurysm at isthmus)
mycotic pseudoaneurysm
Kommerell diverticulum (saccular bulge at origin of aberrant subclavian a)

Question 8

isolated sinus of Valsalva aneurysm

Answer 8

mycotic (infective endocarditis of aortic valve)

congenital

Question 9

pediatric cardiomegaly with pulmonary venous hypertension, interstitial edema (AIRP)

Answer 9

left sided obstruction (e.g. aortic stenosis, coarctation)
large L to R shunts
valvular regurgitation 
cardiomyopathy
conduction abnormality
tumour

Question 10

pediatric heart murmur +/- exercise intolerance with enlarged RV on echo

Answer 10

ASD
PAPVR
ASD + PAPVR

Question 11

aortic pseudoaneurysm - causes

Answer 11

penetrating atherosclerotic ulcer
trauma
infection