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CRRAB 1 week 2 > Severson CV Development Vignettes > Flashcards

Severson CV Development Vignettes Flashcards

1
Q 
What is the most common type of defect associated with the cardiac septa?
A.	Membranous type VSD
B.	Muscular type VSD
C.	Patent foramen ovale
D.	Primary type ASD
E.	Secondary type ASD
A

A

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2
Q

What structures fuse to close the primary foramen?
A. Membranous and muscular parts of the interventricular septum.
B. Membranous part of the interventricular septum and the endocardial cushions.
C. Primary septum and the endocardial cushions.
D. Primary septum and the septum secundum.
E. Secondary septum and the endocardial cushions.

A

C

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3
Q

Which of the following statements regarding transposition of the great arteries (TGA) is CORRECT?
A. This abnormality is more common in female than male infants.
B. Most infants with this abnormality survive for several months without intervention; surgical repair is done when they are about five years old.
C. This abnormality is not amenable to surgical correction.
D. This abnormality is caused by unequal partitioning of the bulbus cordis and truncus arteriosus coupled with an incomplete interventricular septum.
E. This abnormality is due to failure of the aorticopulmonary septum to develop a spiral course.

A

E

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4
Q

The tetralogy of Fallot is an association of anomalies that arises through a pathogenetic cascade of malformations in the heart. Which of the following anomalies would be considered to be the final defect in this pathogenetic cascade?
A. Constricted subpulmonary orifice
B. Enlarged right ventricle
C. Pulmonary stenosis
D. Rightward displacement of the aorta (overriding aorta)
E. Ventricular septal defect

A

B

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5
Q 
In humans, the left fourth aortic arch gives rise to a portion of which of the following structures?
A.	Arch of the aorta
B.	Ductus arteriosus
C.	Left common carotid artery
D.	Left external carotid artery
E.	Left subclavian artery
A

A

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6
Q 
In a particular newborn infant, a substantial volume of blood takes the following route from the left ventricle to the lower limbs: ascending aorta > brachiocephalic artery > right subclavian artery > right internal thoracic artery > right anterior intercostal arteries > right posterior intercostal arteries > descending aorta.  What diagnosis is probably likely for this newborn infant?
A.	Coarctation of the aorta
B.	Double aortic arch
C.	Patent ductus arteriosus
D.	Patent foramen ovale
E.	Tetralogy of Fallot
A

A

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7
Q

Transposition of the great arteries was diagnosed in a male infant with obvious cyanosis and mild tachypnea (rapid breathing). This condition results from which of the following?
A. Abnormal resorption of the primary septum
B. Abnormal transformation of the sixth aortic arches
C. Failure of the endocardial cushions to fuse
D. Faulty partitioning of the bulbus cordis and truncus arteriosus
E. Involution of the ductus arteriosus

A

D

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8
Q 
What is the most common congenital anomaly of the heart and great vessels associated with the congenital rubella syndrome?
A.	Atrial septal defect
B.	Coarctation of the aorta
C.	Patent ductus arteriosus
D.	Tetralogy of Fallot
E.	Ventricular septal defect
A

C

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9
Q 
Which of the following is NOT associated with the tetralogy of Fallot?
A.	Hypertrophy of the right ventricle
B.	Interventricular septal defect
C.	Overriding aorta
D.	Patent foramen ovale
E.	Pulmonary stenosis
A

D

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10
Q 
What developmental structure contributes to the formation of the membranous part of the interventricular septum and fuses with the aorticopulmonary septum?
A.	Crista terminalis
B.	Endocardial cushions
C.	Interatrial septum II
D.	Ligamentum arteriosum
E.	Transverse sinus
A

B

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11
Q

Which aortic arch gives rise to the proximal part of the right pulmonary artery?
A. Left sixth aortic arch (proximal portion)
B. Left sixth aortic arch (distal portion)
C. Right third aortic arch (proximal portion)
D. Right fourth aortic arch (entire arch)
E. Right sixth aortic arch (proximal portion)

A

E

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12
Q

Which vessel(s) in the fetal circulation carries blood with the highest oxygen content?
A. Arteries to the head and upper extremities
B. Dorsal aorta
C. Ductus arteriosus
D. Pulmonary veins
E. Umbilical vein

A

E

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13
Q 
Which veins drain the yolk sac?
A.	Azygos veins
B.	Cardinal veins
C.	Intercostal veins
D.	Umbilical veins
E.	Vitelline veins
A

E

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14
Q 
Where do the vitelline veins, umbilical veins and cardinal veins directly drain?
A.	Aortic arches
B.	Bulbus cordis
C.	Primitive atrium
D.	Sinus venosus
E.	Ventricle
A

D

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15
Q 
The embryonic umbilical vein develops into what structure during development of the postnatal circulation?
A.	Ductus arteriosum
B.	Ligamentum arteriosum
C.	Ligamentum teres
D.	Ligamentum venosum
E.	Superior vesical artery
A

C

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16
Q

The cardinal veins in the fetus:
A. are formed from splanchnic mesoderm.
B. completely disappear by the time of birth.
C. contribute to the superior and inferior vena cava.
D. drain the developing intestinal tract.
E. travel through the umbilical cord in conjunction with the umbilical artery.

A

C

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17
Q 
What structure is formed by the right horn of the sinus venosus?
A.	Aorta
B.	Coronary atrium
C.	Left atrium
D.	Pulmonary trunk
E.	Right atrium
A

E

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18
Q

Which of the following are responsible for formation of the truncobulbar ridges?
A. Endocardial cushions
B. Interatrial and interventricular septa
C. Neural crest mesenchyme
D. Somatic mesoderm
E. Yolk sac mesoderm

A

C

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19
Q

The endocardial cushions contribute to the formation of what structure?
A. Aorticopulmonary septum
B. Interatrial septum II
C. Membranous part of interventricular septum
D. Muscular part of interventricular septum
E. Urorectal septum

A

C

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20
Q

The ductus venosus shunts blood from the:
A. inferior vena cava to the umbilical arteries.
B. left umbilical vein to the inferior vena cava.
C. left umbilical vein to the pulmonary artery.
D. left umbilical vein to the pulmonary trunk.
E. pulmonary trunk to the aorta.

A

B

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21
Q 
Which of the following vessels is NOT derived from the cardinal veins?
A.	Azygos veins
B.	Common iliac vein
C.	Renal veins
D.	Superior mesenteric vein
E.	Superior vena cava
A

D

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22
Q

What term is used to refer to abnormal heart development in which the aorta arises from the right ventricle and the pulmonary trunk arises from the left ventricle?
A. Dextrocardia
B. Persistent truncus arteriosus
C. Pulmonary infundibular stenosis (narrowing)
D. Transposition of the great vessels (TGA)
E. Ventricular septal defect

A

D

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23
Q

Which of the following would NOT be responsible for development of an atrial (interatrial) septal defect?
A. An incompetent foramen ovale
B. Excessive resorption of the tissue around the secondary foramen
C. Failure of resorption of the dorsal mesocardium
D. Failure of the endocardial cushions to form
E. Failure of the primary septum to fuse with the endocardial cushions

A

C

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24
Q

The foramen ovale and the valve of the foramen ovale are derived, respectively, from:
A. endocardial cushions, membranous interventricular septum.
B. interatrial septum I, interatrial septum II.
C. interatrial septum II, interatrial septum I.
D. membranous interventricular septum, endocardial cushions.
E. membranous interventricular septum, muscular interventricular septum

A

C

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25
Q

A secondary ASD was detected in a young child. This congenital defect:
A. includes defects of the fused endocardial cushions.
B. is located near the superior vena cava.
C. occurs more frequently in males than in females.
D. usually results from abnormal resorption of the primary septum.
E. usually causes death in early childhood.

A

D

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26
Q

Incomplete fusion of the endocardial cushions usually is associated with which of the following types of atrial septal defect?
A. Common atrium
B. Primary-type atrial septal defect
C. Probe patent atrial septal defect
D. Secondary-type atrial septal defect
E. Sinus venosus-type atrial septal defect

A

B

27
Q

A female infant with congestive heart failure and continuous systolic and diastolic murmurs was diagnosed as having a patent ductus arteriosus. Which of the following statements is CORRECT?
A. The ductus arteriosus is a remnant of the left fourth aortic arch.
B. The ductus arteriosus closes during fetal development.
C. The ductus arteriosus shunts blood from the umbilical vein to the inferior vena cava.
D. The ductus arteriosus closes just before birth.
E. In the fetus, most of the blood from the pulmonary trunk flows into the aorta.

A

E

28
Q

On routine examination a loud murmur was detected at the lower left sternal border of an infant who has failed to thrive and has low weight. A diagnosis of VSD was made, and subsequently, the absence of the membranous part of the interventricular septum was confirmed by two-dimensional echocardiography. Which of the following statements best describes a membranous VSD defect?
A. It is the result of failure of subendocardial tissue of endocardial cushions to fuse with the aorticopulmonary septum and the muscular part of the interventricular septum.
B. It results from excessive resorption of myocardial tissue during the embryonic period.
C. It causes shunting of blood from the right ventricle into the left ventricle.
D. It is found only in association with an ASD.
E. It is the less common type of VSD.

A

A

29
Q

Transposition of the great arteries was diagnosed in a male infant with obvious cyanosis and mild tachypnea. What developmental defect is responsible for this condition?
A. Abnormal resorption of the primary septum
B. Abnormal transformation of the sixth aortic arches
C. Failure of the endocardial cushions to fuse
D. Faulty partitioning of the bulbus cordis and truncus arteriosus
E. Involution of the ductus arteriosus

A

D

30
Q 
1. A 2-day-old cyanotic newborn is diagnosed with transposition of the great arteries (TGA).  Which of the following structures is responsible for the division of the truncus arteriosus into the great arteries?
A.	Aorticopulmonary septum
B.	Endocardial cushions
C. 	Membranous interventricular septum
D.	Primary interatrial septum
E. 	Secondary interatrial septum
A

A

31
Q 
2.	A 2-year-old child is seen by their family physician who hears a 4/6 systolic murmur and suspects a congenital heart condition.  Which of the following conditions occurs most often?
A. 	Membranous ventricular septal defect
B. 	Muscular ventricular septal defect
C. 	Patent ductus arteriosus
D. 	Primary foramen (ostium) defect
E. 	Secondary foramen (ostium) defect
A

A

32
Q 
3.	A 2-day-old cyanotic newborn is diagnosed with transposition of the great arteries (TGA).  This condition is fatal if left untreated for more than 4 months.  Which of the following structures must remain patent so that the infant can survive until surgical correction of the malformation?
A. 	Ductus arteriosus
B. 	Ductus venosus
C. 	Foramen ovale
D. 	Umbilical artery
E. 	Umbilical vein
A

A

33
Q 
4.	An echocardiogram is ordered of a 3-day-old slightly cyanotic newborn female.  An ultrasound reveals pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy.  What clinical condition is best characterized by these signs?
A. 	Atrial septal defect
B. 	Pulmonary atresia
C. 	Tetralogy of Fallot
D. 	Transposition of the great vessels
E. 	Ventricular septal defect
A

C

34
Q 
5.	A 2-day-old slightly cyanotic newborn male is diagnosed with pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy.  Which of the following embryological processes is most likely responsible for the development of these developmental anomalies?
A. 	Abnormal rotation of the heart
B. 	Anomalous pulmonary veins
C. 	Aorticopulmonary septum defect
D. 	Atrioventricular canal malformation
E. 	Endocardial cushion defect
A

C

35
Q 
6.	A 2-year-old boy is brought in to establish care and have a well child exam with a new family physician. His vital signs show tachypnea, as well as an O2 saturation slightly lower than expected. Auscultation of the heart reveals a  grade 3/6 systolic murmur heard best over the right and left 2nd intercostal spaces, as well as a wide, fixed spit S2. What is the most likely diagnosis?
A.  Aortic stenosis
B.  Atrial septal defect
C.  Tetralogy of Fallot
D.  Transposition of the great arteries
E.  Ventricular septal defect
A

B

36
Q
  1. A 4-month-old infant is diagnosed with trisomy 21 (Down syndrome). An EKG shows evidence of cardiac arrhythmias. What underlying pathology would most likely be seen on echo examination of this patient?
    A. Coarctation of the aorta
    B. Atrial septal and ventricular septal defects
    C. Transposition of the great arteries
    D. Tetralogy of Fallot
    E. Truncus arteriosus
A

B

37
Q
  1. A 2-month-old infant is diagnosed with a deletion at the 22q11 chromosome (DiGeorge syndrome). A routine cardiovascular examination reveals severe congenital cardiac abnormalities. Which of the following malformations will most likely be associated with 22q11 syndrome?
    A. Aortic stenosis
    B. Atrial septal and ventricular septal defects
    C. Coarctation of the aorta
    D. Tetralogy of Fallot and truncus arteriosus
    E. Transposition of the great arteries
A

D

38
Q 
9.	A 2-month-old infant is diagnosed with a deletion at the 22q11 chromosome (DiGeorge syndrome).  A routine cardiovascular examination reveals severe congenital cardiac abnormalities.  Which of the following cells is responsible for the cardiac abnormalities?
A. 	Gonadal germ cells
B. 	Mesenchymal cells
C. 	Myoblasts
D. 	Neural crest cells
E. 	Undifferentiated epithelial cells
A

D

39
Q
  1. A 26-year-old G1P0 woman in her first trimester of pregnancy visits a family physician. Physical examination reveals that she has diabetes mellitus. Which of the following cardiac malformation is most likely to affect the fetus when the mother has diabetes?
    A. Atrial septal and ventricular septal defects
    B. Coarctation of the aorta
    C. Transposition of the great arteries
    D. Tetralogy of Fallot
    E. Truncus arteriosus
A

C

40
Q 
11.	When performing a cardiac catheterization of a 5-year-old boy, the radiologist observed that the contrast medium released into the arch of the aorta immediately became visible in the left pulmonary artery.  What is the most likely diagnosis?
A. 	Patent ductus arteriosus
B. 	Patent ductus venosus
C. 	Patent foramen ovale
D. 	Tricuspid stenosis
E. 	Ventricular septal defect
A

A

41
Q 
12.	An 8-year-old boy is seen by his family physician because while playing sports his mother noticed that he was easily fatigued and often removed himself from the game in order to catch his breath.  His S1 heart sound is slightly exaggerated and the S2 heart sound is widely split.  Chest x-rays show mild cardiomegaly and increased pulmonary vascularity.  Which of the following embryological defects is responsible for this condition?
A. 	Atrial septal defect
B. 	Patent ductus arteriosus
C. 	Patent ductus venosus
D. 	Pulmonary stenosis
E. 	Ventricular septal defect
A

A

42
Q 
13.	A prenatal ultrasound on a 30-year-old woman in her 24th week of gestation revealed an abnormal image of the fetal heart.  Instead of a four-chambered view produced by the typical “cross”, a portion just below the crosspiece was missing. What congenital malformation has probably occurred in this infant?
A. 	Atrial septal defect
B. 	Coarctation of the aorta
C. 	Patent ductus arteriosus
D. 	Tetralogy of Fallot
E. 	Ventricular septal defect
A

E

43
Q 
14.	An 18-year-old woman has an uneventful prenatal labor and vaginal delivery.  She delivers a 5 lb, 8 oz female with severe craniofacial defects.  Severe cyanosis developed shortly after birth.  What congenital malformation has probably occurred in this infant?
A. 	Atrial septal defect
B. 	Dextrocardia
C. 	Patent ductus arteriosus
D. 	Truncus arteriosus (persistent)
E. 	Ventricular septal defect
A

D

44
Q 
15.	An 18-year-old woman delivers vaginally a newborn child, but the child has severe craniofacial defects.  Severe cyanosis developed shortly after birth.  What cell population might play a role in both abnormalities?
A. 	Gonadal germ cells
B. 	Mesenchymal cells	
C. 	Myoblasts
D. 	Neural crest cells
E. 	Undifferentiated epithelial cells
A

D

45
Q 
16.	An 18-year-old woman delivers vaginally a newborn child, but the child has severe craniofacial defects.  Severe cyanosis developed shortly after birth.   What potent teratogen may be involved in both abnormalities?
A. 	Cocaine
B. 	Diethylstilbestrol 
C. 	Retinoic acid
D. 	Tetracycline
E	Thalidomide
A

C

46
Q 
17.	A 21-year-old man who has not seen a physician since childhood visits the clinic complaining of fatigue.  Physical examination of the patient reveals cyanosis of the lower body.  Auscultation of the heart revealed a “machine-like” murmur.  What congenital malformation occurred in this individual?
A. 	Atrial septal defect
B. 	Coarctation of the aorta
C. 	Patent ductus arteriosus
D. 	Transposition of the great vessels
E. 	Ventricular septal defect
A

C

47
Q 
18.	A 12-year-old girl visited her family physician for a physical examination.  The physician was unable initially to detect a heart beat, but with further examination detected the heart beat on the right side.  What congenital anomaly of the heart would account for failure to detect a heart beat on the left side of the chest but be detected on the right?
A. 	Atrial septal defect
B. 	Coarctation of the aorta
C. 	Dextrocardia
D. 	Transposition of the great vessels
E.	Ventricular septal defect
A

C

48
Q
  1. A 45-year-old woman was playing tennis and suddenly fell, complaining of severe pain in her chest and down the left arm. Her playing partner rushed her to the hospital. What nerves are responsible for conveying pain to the left arm?
    A. Somatic afferents from the upper extremity
    B. Somatic efferents to the upper extremity
    C. Visceral efferents accompanying the cardiac nerves
    D. Visceral afferents accompanying the sympathetic nerves
    E. Visceral afferents accompanying the vagus nerve
A

D

49
Q 
20.	A 62-year-old man consulted his physician about difficulty in breathing.  During the physical examination the physician palpated the man’s trachea in the jugular notch.  During cardiac systole the trachea moved abnormally.  What disease process may radiographic studies reveal?
A. 	Aneurysm
B. 	Coarctation of the aorta
C. 	Dextrocardia
D. 	Esophageal reflex
E. 	Mediastinal tumor
A

A

50
Q
  1. A 48-year-old business woman during a heated discussion experienced a sudden, crashing pain in her chest that radiated along the medial aspect of her left arm. She said that when the pain struck she had a feeling of weakness and nausea. An arrhythmia was detected on auscultation, and the ECG showed ST elevation in leads V2-V5. What coronary vessel was most likely involved in this patient?
    A. Anterior interventricular artery (left anterior descending artery)
    B. Circumflex artery
    C. Ductus arteriosus
    D. Marginal artery
    E. Posterior interventricular artery (posterior descending artery)
A

A

51
Q 
22.	A 42-year-old man complained about recent difficulties in breathing during exercise and extreme fatigue.  Physical examination revealed a prominent right ventricular cardiac impulse.  A moderately loud midsystolic murmur was heard over the 2nd and 3rd intercostal spaces along the inferior left sternal border.  Radiographs revealed enlargement of the right side of the heart, especially of the right outflow tract, a small aortic knob, dilation of the pulmonary artery and its major branches, and increased pulmonary vascular markings.  Serial samples of blood for determination of oxygen saturation revealed increased oxygen saturation of the right atrial blood compared with blood in the inferior vena cava.  What diagnosis is likely to be made in this individual? 
A. 	Atrial septal defect
B. 	Patent ductus arteriosus
C. 	Tetralogy of Fallot
D. 	Transposition of the great vessels
E. 	Ventricular septal defect
A

A

52
Q 
23.	A 3-week-old female was born normally after a pregnancy complicated by a rubella infection during week 7 of pregnancy.  Physical examination revealed cataracts, deafness and congenital heart disease.  A radiograph of the infant’s chest at 3 weeks showed generalized cardiac enlargement with some increase in pulmonary vascularity.  What congenital cardiovascular anomaly is commonly associated with material rubella during early pregnancy?
A. 	Atrial septal defect
B. 	Coarctation of the aorta
C. 	Dextrocardia 
D. 	Patent ductus arteriosus
E. 	Tetralogy of Fallot
A

D

53
Q
  1. A 3-week-old female, who was born normally after a pregnancy complicated by a rubella infection during the first trimester of pregnancy, had congenital cataracts, deafness and congenital heart disease. Radiograph of the infant’s chest at 3 weeks showed generalized cardiac enlargement with some increase in pulmonary vascularity. What congenital cardiovascular anomaly is commonly associated with material rubella during early pregnancy?
    A. Left to right blood flow through the ductus arteriosus
    B. Left to right blood flow through the foremen ovale
    C. Left to right blood flow through the membranous portion of the interventricular septum
    D. Pulmonary stenosis
    E. Transposition of the great arteries
A

A

54
Q 
25.	A 3-week-old female, who was born normally after a pregnancy complicated by a rubella infection during the first trimester of pregnancy, had congenital cataracts, deafness and congenital heart disease.  Radiograph of the infant’s chest at 3 weeks showed generalized cardiac enlargement with some increase in pulmonary vascularity.  What pharmacological treatment may be used to correct the cardiac anomaly?
A. 	Ampicillin
B. 	Bacitracin
C. 	Cocaine
D. 	Indomethacin
E. 	Methotrexate
A

D

55
Q 
26.	A newborn male infant was delivered after a full-term normal pregnancy.  Severe generalized cyanosis was observed on the first day.  A chest X-ray revealed a slightly enlarged heart with a narrow base and increased pulmonary vascularity.  What clinical diagnosis would you anticipate?
A. 	Atrial septal defect
B. 	Patent ductus arteriosus
C. 	Tetralogy of Fallot
D. 	Transposition of the great arteries
E. 	Truncus arteriosus (persistent)
A

D

56
Q 
27.	A newborn male infant was delivered after a full-term normal pregnancy.  Severe generalized cyanosis was observed on the first day.  A chest film revealed a slightly enlarged heart with a narrow base and increased pulmonary vascularity.  How was the infant able to survive after birth with this congenital anomaly?
A. 	Patent foramen ovale
B. 	Patent interventricular septum
C. 	Patent ductus arterious
D. 	Patent umbilical vein
E. 	Patent coronary sinus
A

C

57
Q 
28.	A 36-year-old male presents with progressive shortness of breath on exertion and palpitations.  Physical examination revealed an irregular pulse.  A chest film demonstrated dilated proximal pulmonary arteries, increased pulmonary vascularity, enlarged right atrium and right ventricle.  Echocardiography demonstrated paradoxical septal movement and left-to-right flow.  What is the most likely responsible for the clinical symptoms?
A. 	Atrial septal defect
B. 	Coarctation of the aorta
C. 	Pulmonary stenosis
D. 	Tetralogy of Fallot
E. 	Ventricular septal defect
A

A

58
Q 
29.	An 18-year-old male is found to have high blood pressure.  Blood pressure in the upper extremity was significantly greater than blood pressure in the lower extremity (BP right arm 180/110, left arm 190/110; BP in legs 110/70).  Femoral pulses were diminished and delayed, and a harsh systolic ejection murmur was heard between the shoulder blades.  ECG demonstrated a left ventricular hypertrophy.  Chest x-ray demonstrated rib notching.  What is the most likely diagnosis?
A.	Atrial septal defect
B.	Coarctation of the aorta
C.	Pulmonary stenosis
D.	Tetralogy of Fallot
E.	Ventricular septal defect
A

B

59
Q 
30.	An 8-year-old female with a history of recurrent pneumonia and low exercise tolerance is seen by her family physician for evaluation.  The child was born prematurely and has a history of recurrent respiratory tract infection.  Her mother had rubella during the early weeks of pregnancy.  Physical examination revealed a continuous “machine-like” murmur with systolic accentuation and thrill at the second intercostal space at the left parasternal border.  The ECG showed a left axis deviation.  Chest x-ray showed an enlarged cardiac shadow with increased pulmonary blood flow.  What clinical condition is most likely present in this girl?  
A. 	Atrial septal defect
B. 	Dextrocardia
C. 	Patent ductus arteriosus
D. 	Tetralogy of Fallot
E. 	Transposition of the great arteries
A

C

60
Q 
31.	An 8-year-old female with a history of recurrent pneumonia and low exercise tolerance is seen by her family physician for evaluation.  The child was born prematurely and has a history of recurrent respiratory tract infection.  Her mother had rubella during the early weeks of pregnancy.  Physical examination revealed a continuous “machine-like” murmur with systolic accentuation and thrill at the second intercostal space at the left parasternal border.  The ECG showed a left axis deviation.  Chest x-ray showed an enlarged cardiac shadow with increased pulmonary blood flow.  What aortic arch remained patent in this girl and is responsible for her clinical condition?
A. 	Left third aortic arch
B. 	Left fourth aortic arch
C. 	Right fourth aortic arch
D. 	Left sixth aortic arch
E. 	Right sixth aortic arch
A

D

61
Q 
32.	An 8-year-old boy is brought to his family physician with a complaint of excessive fatigue and uncomfortable legs when walking or running.  On physical examination the physician noted a reduced dorsalis pedis pulse and some signs of cyanosis of the toes.  The boy’s hands showed no signs of cyanosis.  Blood pressure in the upper extremity was significantly greater than blood pressure in the lower extremity.  Based on the physical examination, what is the most likely cause of this boy’s symptoms?
A. 	Atrial septal defect
B. 	Coarctation of the aorta
C. 	Patent ductus arteriosus
D. 	Tetralogy of Fallot
E. 	Ventricular septal defect
A

B

62
Q 
33.	A 2-month-old female presents with dyspnea, feeding difficulties, poor growth, and profuse perspiration.  Physical examination revealed no edema, cyanosis, or clubbing.  A palpable parasternal heavy, apical thrust and systolic thrill were present.  A chest x-ray demonstrated cardiomegaly with increased pulmonary vascularity.  Doppler showed a left-to-right shunt.  What is the most likely diagnosis?
A.	 Atrial septal defect
B. 	Dextrocardia
C. 	Patent ductus arteriosus
D. 	Transposition of the great arteries
E. 	Ventricular septal defect
A

E

63
Q 
34.	A 2-month-old female presents with dyspnea, feeding difficulties, poor growth, and profuse perspiration.  Physical examination revealed no edema, cyanosis, or clubbing.  A palpable parasternal heavy, apical thrust and systolic thrill were present.  A chest x-ray demonstrated cardiomegaly with increased pulmonary vascularity.  Doppler showed a left-to-right shunt.  What is the most likely site of the defect?
A. 	Foramen ovale
B. 	Foramen primum (primary)
C. 	Ductus arteriosus
D. 	Membranous interventricular septum
E. 	Muscular interventricular septum
A

D

CRRAB 1 week 2 (15 decks)

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