LE2 (CARDIO) 2026 Flashcards by

This structure in the anterior mediastinum recedes during puberty and is mostly replaced by adipose tissue in adulthood.
a. Fat
b. Lymph nodes
c. Lymphatics
d. Thymus

d. Thymus

The thymus is located in the anterior mediastinum and undergoes involution after puberty, gradually being replaced by adipose tissue.

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This is the anterior boundary of the prevascular compartment of the mediastinum.
a. Posterior surface of the sternum
b. Anterior pericardium
c. Thoracic inlet
d. Diaphragm

a. Posterior surface of the sternum

The prevascular compartment (anterior mediastinum) is bounded anteriorly by the posterior surface of the sternum and posteriorly by the pericardium.

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The most common acute emergency condition of the aorta, often with a fatal outcome.
a. Intramural hematoma
b. Penetrating atherosclerotic ulcer (PAU)
c. Aortic aneurysm
d. Aortic dissection

d. Aortic dissection

Aortic dissection is the most common life-threatening aortic emergency, characterized by an intimal tear that allows blood to enter the medial layer, creating a false lumen.

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Classification of aortic dissection wherein the lesion involves the THORACIC AORTA distal to the left subclavian artery.
a. Stanford type A
b. Stanford type B
c. Stanford type C
d. None of the above

b. Stanford type B

Stanford type B dissections involve the thoracic aorta distal to the left subclavian artery, whereas type A involves the ascending aorta.

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This structure separates the true from the false lumen in an aortic dissection.
a. Intimal flap
b. Cobweb sign
c. Beak sign
d. Thrombosis

a. Intimal flap

The intimal flap is the thin layer of tissue that separates the true and false lumens in an aortic dissection.

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A secondary finding in aortic dissection.
a. Circumferential dissection of the intimal layer
b. Intimo-intimal intussusception
c. Internal displacement of intimal calcification
d. Visible false lumen

c. Internal displacement of intimal calcification

This sign indicates the presence of an intimal tear, as calcium deposits are displaced inward toward the false lumen.

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A middle-aged female presents with dysphagia and progressive dyspnea. A routine chest radiograph shows an ill-defined right paratracheal opacity with tracheal deviation to the left. What imaging modality should be requested to determine the mediastinal location and characteristics of this lesion?
a. Thyroid ultrasound
b. Chest CT scan
c. Radioiodine scan
d. MRI

b. Chest CT scan

A CT scan provides detailed cross-sectional imaging to determine the mediastinal location, density, and characteristics of the lesion.

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A 45-year-old male presents with a chest PA radiograph showing a lobulated mass in the left hilar area at the origin of the pulmonary vessels. The most cost-effective imaging modality to determine the location of the lesion is:
a. Lateral chest radiograph
b. Chest CT scan with contrast
c. Chest ultrasound
d. Plain chest CT scan

a. Lateral chest radiograph

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Subsequent imaging of the above case shows a solid anterior mediastinal mass with heterogeneous enhancement and areas of necrosis near the origin of the great vessels on the left. Mediastinal node metastasis is identified. The most likely diagnosis is:
a. Seminoma
b. Thymic cyst
c. Thymoma
d. Teratoma

c. Thymoma

Thymomas are common solid anterior mediastinal tumors with heterogeneous enhancement and potential metastasis to mediastinal lymph nodes.

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A posterior mediastinal mass arising from paraganglionic cells is most likely:
a. Schwannoma
b. Ganglioneuroblastoma
c. Pheochromocytoma
d. Sarcoidosis

c. Pheochromocytoma

A posterior mediastinal mass from paraganglionic cells suggests a paraganglioma, also known as an extra-adrenal pheochromocytoma.

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The most accurate imaging modality for the initial diagnosis, differentiation, and staging of acute aortic syndrome (AAS) is:
a. Chest X-ray
b. CT scan
c. MRI
d. Ultrasonography

b. CT scan
CT angiography is the preferred initial imaging modality for diagnosing and staging acute aortic syndrome due to its high sensitivity and rapid acquisition.

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A sign that indicates dissection of the aortic segment due to a secondary dissection within one of the channels is:
a. Cobweb sign
b. Beak sign
c. Mercedes-Benz sign
d. Windsock sign

c. Mercedes-Benz sign

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A 7-year-old boy presents with increasing respiratory distress. A CT scan shows a complex mass centered in the anterior mediastinum with fluid, fat, and calcifications. What is the most likely diagnosis?
a. Primary Koch’s infection
b. Thymoma
c. Lymphadenopathy due to lymphoma
d. Teratoma

d. Teratoma
A teratoma is an anterior mediastinal germ cell tumor containing elements of different germ layers, including fat, fluid, and calcifications.

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Which Stanford classification of aortic dissection typically requires urgent surgical intervention to prevent extension into the aortic root, pericardium, and coronary arteries?
a. Stanford type A
b. Stanford type B
c. Stanford type C
d. Stanford type D

a. Stanford type A

Stanford type A aortic dissections involve the ascending aorta and require urgent surgical intervention to prevent complications such as aortic root extension, pericardial tamponade, and coronary artery involvement.

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Content/s of the middle mediastinum
a. Vagus nerve
b. Esophagus
c. Origin of the great vessels
d. Lymphatics

c. Origin of the great vessels

The middle mediastinum contains the heart, pericardium, great vessels (aorta, pulmonary arteries, and veins), trachea, and mainstem bronchi.

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A nuclear myocardial perfusion scan is the ideal imaging modality for diagnosing:
a. Aortic dissection
b. Myocardial infarction
c. Shunt anomaly
d. Ventricular wall motion abnormalities

b. Myocardial infarction

A nuclear myocardial perfusion scan evaluates myocardial blood flow, detecting ischemia or infarction by showing perfusion defects.

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Coronary angiography is the preferred examination for evaluating which cardiac pathology?
a. Anatomic cause of angina
b. Cardiomyopathies
c. Congenital heart disease
d. Valvular stenosis or insufficiency

a. Anatomic cause of angina

Coronary angiography is the gold standard for evaluating coronary artery disease and identifying the anatomical cause of angina.

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CT coronary calcium screening is primarily used for:
a. Evaluating post-coronary artery bypass graft for stenosis or occlusion
b. Identifying the presence of central pulmonary emboli
c. Predicting the risk of future acute coronary events
d. Ruling out significant coronary stenosis

D. Ruling out significant coronary stenosis
/or coronary calcification as an indicator of coronary stenosis

Rationale:
CT coronary calcium screening detects coronary artery calcification, which is a marker of underlying atherosclerosis. While it does not directly assess luminal stenosis, a high calcium score suggests an increased likelihood of significant coronary artery disease (CAD). Conversely, a zero calcium score has a high negative predictive value, effectively ruling out significant coronary stenosis in many cases.

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Mild enlargement of which cardiac chamber will NOT CAUSE bulging of the lateral cardiac silhouette on a PA chest X-ray?
a. Right atrium
b. Right ventricle
c. Left atrium
d. Left ventricle

b. Right ventricle

Explanation:

On a PA chest X-ray, the right ventricle (RV) is positioned anteriorly, meaning that mild enlargement of the right ventricle does not significantly contribute to the lateral cardiac silhouette. Instead, it tends to enlarge anteriorly and inferiorly, which is better appreciated on a lateral chest X-ray, rather than on a PA view.

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In a 35-year-old female with diagnosed rheumatic heart disease and valvular involvement, the first cardiac chamber to enlarge will manifest on chest X-ray as:
a. Bulging of the apex
b. Straightening of the cardiac waistline
c. Normal cardiac silhouette
d. Prominent right cardiac border

b. Straightening of the cardiac waistline

In rheumatic heart disease, mitral stenosis leads to left atrial enlargement, causing the left heart border to straighten on a chest X-ray.

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A finding of myocardial infarction on a nuclear myocardial perfusion scan warrants which of the following interventions?
a. Aortic graft surgery
b. Coronary bypass surgery
c. No invasive intervention
d. Percutaneous coronary intervention

c. No invasive intervention

Why?

A nuclear myocardial perfusion scan (MPS) assesses myocardial blood flow, identifies infarcted (dead) myocardium, and detects ischemia (reversible perfusion defects). If the scan only shows myocardial infarction (scarred tissue) without ongoing ischemia, no invasive intervention is required

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In chest X-ray findings of mitral stenosis, there is straightening of the left heart border due to:
a. Cephalization of blood flow
b. Left atrial enlargement
c. Pulmonary arterial hypertension
d. Right ventricular enlargement

b. Left atrial enlargement

Mitral stenosis leads to increased left atrial pressure and enlargement, which causes the straightening of the left heart border on a chest X-ray.

While rheumatic heart disease was previously the most common cause of mitral regurgitation, it is now more commonly associated with:
a. Autosomal dominant trait
b. Cor pulmonale
c. Papillary muscle dysfunction
d. Preexisting atrial septal defect

c. Papillary muscle dysfunction

Mitral regurgitation is now more commonly caused by ischemic heart disease leading to papillary muscle dysfunction, rather than rheumatic heart disease.

In patients with aortic valve stenosis, instead of a diminutive aorta, aortic dilatation often develops due to:
a. Bicuspid aortic valve
b. Jet phenomenon turbulence
c. Coexisting mitral valve disease
d. Rheumatic heart disease

b. Jet phenomenon turbulence

Aortic stenosis leads to high-velocity turbulent flow, causing post-stenotic dilatation of the ascending aorta.

35. Secondary aortic valve insufficiency is commonly associated with: a. Barlow’s syndrome b. Lutembacher syndrome c. Marfan’s syndrome d. Tetralogy of Fallot

c. Marfan’s syndrome Marfan syndrome is associated with connective tissue defects that can cause secondary aortic valve insufficiency due to aortic root dilatation.

36. In mitral regurgitation, the predominant cardiac chamber that becomes enlarged is the: a. Right atrium b. Right ventricle c. Left atrium d. Left ventricle

c. Left atrium Mitral regurgitation (MR) occurs when the mitral valve does not close properly, causing blood to flow backward from the left ventricle (LV) into the left atrium (LA) during systole. Over time, this volume overload leads to left atrial enlargement due to the following reasons: Increased Volume Load: During systole, some of the blood that should be pumped into the aorta is instead regurgitated into the left atrium. This extra volume stretches the left atrium, leading to chronic dilation. Increased Left Atrial Pressure: The regurgitant flow increases left atrial pressure, which can eventually lead to left atrial hypertrophy and dilation. This can predispose to atrial fibrillation, further worsening MR. Adaptation to Chronic MR: The left atrium dilates to accommodate the excess blood volume. This compensatory dilation helps reduce left atrial pressure, delaying symptoms.

A 57-year-old male patient, smoker, diabetic, with hyperlipidemia, and working as a manager in a services company, presents to the emergency room with severe substernal squeezing chest pain radiating to the shoulder after his morning jog. 37. In the frontal PA chest radiograph, which is the most likely finding? a. Haziness of the lower chest with a curved meniscus border b. Hazy opacities with cavities in both upper lobes c. Hyperlucency of the left hemithorax with contralateral mediastinal shift d. Prominence of the hilar markings

d. Prominence of the hilar markings Prominent hilar markings on a PA chest radiograph may suggest pulmonary venous congestion, which is seen in coronary artery disease (CAD) and acute coronary syndromes. The other choices suggest unrelated pathologies (pleural effusion, tuberculosis, pneumothorax).

A 57-year-old male patient, smoker, diabetic, with hyperlipidemia, and working as a manager in a services company, presents to the emergency room with severe substernal squeezing chest pain radiating to the shoulder after his morning jog. 38. A nuclear myocardial perfusion scan will likely reveal: a. Identical stress and rest images b. Hypoperfusion on rest images that fills in on stress images c. Hypoperfusion on stress images but fills in on rest images d. Hypoperfusion in both stress and rest images

c. Hypoperfusion on stress images but fills in on rest images

A 57-year-old male patient, smoker, diabetic, with hyperlipidemia, and working as a manager in a services company, presents to the emergency room with severe substernal squeezing chest pain radiating to the shoulder after his morning jog. 39. On nuclear myocardial perfusion scan, hypoperfusion involving the anterior wall and cardiac apex is most likely due to involvement of: a. Left anterior descending coronary artery b. Left circumflex coronary artery c. Main coronary artery d. Right coronary artery

a. Left anterior descending coronary artery The LAD supplies the anterior wall and cardiac apex. An infarct or ischemia in this territory is consistent with LAD involvement.

A 57-year-old male patient, smoker, diabetic, with hyperlipidemia, and working as a manager in a services company, presents to the emergency room with severe substernal squeezing chest pain radiating to the shoulder after his morning jog. 40. On cardiac CT, the patient’s calcium score is 630, which indicates: a. High risk for future cardiac events b. Moderate non-obstructive coronary artery disease (CAD) c. Minimal coronary artery stenosis d. Moderately high-risk patient

a. High risk for future cardiac events A calcium score of 630 is considered severe coronary artery calcification, indicating a high risk for major adverse cardiac events (MACE).

A 57-year-old male patient, smoker, diabetic, with hyperlipidemia, and working as a manager in a services company, presents to the emergency room with severe substernal squeezing chest pain radiating to the shoulder after his morning jog. 41. Coronary angiography is indicated in this patient if there is: a. Contraindication to perform cardiac CT b. Hypoperfusion on MPI images in both stress and rest phases c. Marked cardiomegaly (>50%) on chest X-ray d. Refractory ventricular arrhythmias

d. Refractory ventricular arrhythmias Why? Coronary angiography is the gold standard for diagnosing coronary artery disease (CAD) and is indicated in patients with high-risk features or complications of myocardial ischemia, such as refractory ventricular arrhythmias.

A 35-year-old female with a history of viral flu-like symptoms progressively developed chest pain, fatigue, shortness of breath, and swelling of the lower extremities. The condition later worsened, leading to the inability to sleep flat in bed (requiring at least two pillows) and engorgement of her neck veins. 42. The main indication for requesting a PA chest X-ray in this patient is to: a. Assess pulmonary vascularity b. Compute for ejection fraction c. Evaluate for valvular stenosis d. Rule out myocardial ischemia

a. Assess pulmonary vascularity PA chest X-ray is useful to evaluate pulmonary congestion and cardiomegaly, which help assess the degree of heart failure.

A 35-year-old female with a history of viral flu-like symptoms progressively developed chest pain, fatigue, shortness of breath, and swelling of the lower extremities. The condition later worsened, leading to the inability to sleep flat in bed (requiring at least two pillows) and engorgement of her neck veins. 43. On echocardiography, the most likely finding would be: a. Coronary calcification b. Global hypokinesia c. Right atrial enlargement d. Thickening of the left ventricular wall

b. Global hypokinesia Global hypokinesia (reduced myocardial contractility throughout the heart) is a classic echocardiographic finding in dilated cardiomyopathy (DCM).

A 35-year-old female with a history of viral flu-like symptoms progressively developed chest pain, fatigue, shortness of breath, and swelling of the lower extremities. The condition later worsened, leading to the inability to sleep flat in bed (requiring at least two pillows) and engorgement of her neck veins. 44. If the patient later reveals a history of chemotherapy with doxorubicin, the most likely diagnosis is: a. Dilated cardiomyopathy b. Restrictive cardiomyopathy c. Hypertrophic cardiomyopathy d. Right ventricular cardiomyopathy

a. Dilated cardiomyopathy Doxorubicin (anthracycline) toxicity is a known cause of dilated cardiomyopathy, leading to systolic dysfunction and heart failure.

A 35-year-old female with a history of viral flu-like symptoms progressively developed chest pain, fatigue, shortness of breath, and swelling of the lower extremities. The condition later worsened, leading to the inability to sleep flat in bed (requiring at least two pillows) and engorgement of her neck veins. 45. The optimal imaging examination to evaluate the ejection fraction in this case is: a. 2D Echocardiography b. Chest X-ray PA and lateral views c. Cardiac MRI d. Nuclear myocardial perfusion scan

a. 2D Echocardiography Echocardiography is the gold standard for assessing ejection fraction (EF) in patients with suspected heart failure.

A 35-year-old female with a history of viral flu-like symptoms progressively developed chest pain, fatigue, shortness of breath, and swelling of the lower extremities. The condition later worsened, leading to the inability to sleep flat in bed (requiring at least two pillows) and engorgement of her neck veins. 46. In left-to-right shunt cardiac anomalies, the pulmonary arterial vascularity is usually: a. Increased b. Decreased c. Not affected at all d. Not a reliable sign

a. Increased In left-to-right shunt anomalies (e.g., ASD, VSD, PDA), excessive pulmonary blood flow leads to increased pulmonary vascularity on imaging.

A 35-year-old female with a history of viral flu-like symptoms progressively developed chest pain, fatigue, shortness of breath, and swelling of the lower extremities. The condition later worsened, leading to the inability to sleep flat in bed (requiring at least two pillows) and engorgement of her neck veins. 47. In right-to-left shunt cardiac anomalies, the pulmonary arterial vascularity is usually: a. Increased b. Decreased c. Not affected at all d. Not a reliable sign

c. Not affected at all

38. On the lateral view, which cardiac chamber is markedly enlarged? a. Right atrium (RA) b. Right ventricle (RV) c. Left atrium (LA) d. Left ventricle (LV)

b. Right ventricle (RV) In Tetralogy of Fallot (TOF), the right ventricle undergoes hypertrophy due to right ventricular outflow obstruction and pressure overload, leading to marked RV enlargement on lateral view.

39. Describe the pulmonary arterial vascularity. a. Increased b. Decreased c. Normal d. Unaffected

b. Decreased TOF is a right-to-left shunt anomaly, causing decreased pulmonary arterial vascularity due to reduced blood flow to the lungs.

40. What is the likely cause of this chamber enlargement and pulmonary vascularity? a. Overriding aorta b. Pulmonic stenosis c. Ventricular septal defect (VSD) d. Atrial septal defect (ASD)

b. Pulmonic stenosis Pulmonary stenosis is a hallmark of TOF, contributing to RV hypertrophy and decreased pulmonary circulation. The other choices (VSD, ASD, overriding aorta) are also components of TOF but do not directly explain the decreased pulmonary vascularity.

41. The cardiac contour manifests as: a. Box-shaped heart b. Boot-shaped heart c. Egg-on-its-side heart d. Snowman configuration

b. Boot-shaped heart The boot-shaped heart (coeur en sabot) is characteristic of TOF, resulting from RV hypertrophy, an upturned cardiac apex, and concave pulmonary outflow tract.

What is the diagnosis?

Tetralogy of Fallot TOF is a cyanotic congenital heart defect with four main features: Pulmonary stenosis Right ventricular hypertrophy Overriding aorta Ventricular septal defect (VSD)

42. The radiograph of a cyanotic neonate shows a narrowed vascular pedicle. What is the underlying pathology? a. Persistent ductus arteriosus b. Singular channel of ventricular outlet through the truncus arteriosus c. Inappropriate ventricular origin of the aorta and pulmonary artery d. Anomalous pulmonary venous return into an infracardiac systemic vein

c. Inappropriate ventricular origin of the aorta and pulmonary artery Transposition of the Great Arteries (TGA) occurs due to an abnormal ventriculoarterial connection, where the aorta arises from the right ventricle (RV) and the pulmonary artery arises from the left ventricle (LV). This results in parallel circulation, leading to severe cyanosis.

43. The cardiac contour manifests as: a. Box-shaped heart b. Boot-shaped heart c. Egg-on-its-side heart d. Snowman configuration

c. Egg-on-its-side heart The “egg-on-its-side” cardiac contour on chest X-ray is characteristic of TGA due to: A narrow mediastinum (vascular pedicle) from malpositioned great vessels Enlarged right atrium and left ventricle, creating a globular heart shape resembling an egg.

What is the diagnosis?

Transposition of the Great Arteries (TGA) A cyanotic congenital heart disease, where the pulmonary and systemic circulations run in parallel, requiring immediate medical or surgical intervention (e.g., atrial septostomy or arterial switch procedure).

44. The yellow arrow points to which chamber? a. Right atrium (RA) b. Right ventricle (RV) c. Left atrium (LA) d. Left ventricle (LV)

a. Right atrium (RA) In Ebstein’s anomaly, the tricuspid valve is dysplastic and displaced apically, causing atrialization of the right ventricle and massive right atrial enlargement. The right atrium is the most affected chamber and is significantly enlarged.

45. Is the said chamber enlarged? a. Yes, it is enlarged. b. No, it is not enlarged. c. Normal d. Not affected

a. Yes, it is enlarged. The right atrium becomes massively dilated due to tricuspid regurgitation and impaired right ventricular function. This leads to a markedly enlarged right heart silhouette on imaging.

46. The cardiac contour manifests as: a. Box-shaped heart b. Boot-shaped heart c. Egg-on-its-side heart d. Snowman configuration

a. Box-shaped heart The box-shaped heart (or “wall-to-wall heart”) is a classic radiographic finding in Ebstein’s anomaly, caused by severe right atrial enlargement and an elongated right ventricle.

What is the diagnosis?

Ebstein’s Anomaly Congenital malformation of the tricuspid valve, characterized by: Apical displacement of the tricuspid valve Right atrial enlargement Severely enlarged right heart on X-ray (box-shaped heart) Cyanosis and heart failure in severe cases

Radiograph of a non-cyanotic child with a pansystolic murmur. 47. Describe the pulmonary arterial vascularity. a. Increased b. Decreased c. Normal d. Unaffected

a. Increased A pansystolic murmur in a non-cyanotic child suggests a left-to-right shunt anomaly (e.g., ventricular septal defect [VSD]), leading to increased pulmonary arterial vascularity due to excessive pulmonary blood flow.

Radiograph of a non-cyanotic child with a pansystolic murmur. 48. Estimate the cardiothoracic ratio. a. 0.40 b. 0.50 c. 0.60 d. Indeterminate

c. 0.60 A cardiothoracic ratio (CTR) greater than 0.50 suggests cardiomegaly. In large left-to-right shunt lesions, increased volume overload leads to chamber enlargement, particularly of the left atrium and left ventricle, which increases the CTR to around 0.60.

Radiograph of a non-cyanotic child with a pansystolic murmur. 49. What is the likely cause of the radiographic appearance? a. Shunt anomaly b. Trisomy 21 c. Pulmonary edema d. Pulmonic stenosis

a. Shunt anomaly Ventricular septal defect (VSD) is the most common congenital cause of a pansystolic murmur and is associated with left-to-right shunting, increased pulmonary vascularity, and cardiomegaly on radiographs. Other left-to-right shunts (e.g., atrial septal defect, patent ductus arteriosus) can present similarly.

50. What is the radiographic impression/diagnosis? a. Pulmonary embolism b. Pulmonary congestion c. Coarctation of the aorta d. Essentially normal

d. Essentially normal