Symptoms and Clinical Findings of Heart Disease in Pregnancy

Question 1

Which symptom in a pregnant woman is most suggestive of underlying heart disease rather than normal pregnancy changes?
A. Fatigue and exercise intolerance
B. Progressive dyspnea and orthopnea
C. Increased respiratory effort
D. Mild lower extremity edema

Answer 1

1. B. Progressive dyspnea and orthopnea
   
   • Rationale: While mild dyspnea is common in normal pregnancy due to increased oxygen demands, progressive dyspnea and orthopnea indicate pulmonary congestion or left-sided heart failure. These are hallmark signs of cardiac dysfunction, particularly mitral stenosis or left ventricular failure.
   • Buzz Words: Pulmonary congestion, heart failure, orthopnea, progressive dyspnea.

Question 2

A nocturnal cough in pregnancy is most likely indicative of:
A. Physiological changes of pregnancy
B. Pulmonary congestion or heart failure
C. Gastroesophageal reflux disease (GERD)
D. Asthma exacerbation

Answer 2

1. B. Pulmonary congestion or heart failure
   
   • Rationale: A nocturnal cough is a classic symptom of pulmonary edema or left ventricular dysfunction, distinguishing it from physiological dyspnea in pregnancy. This symptom reflects worsening pulmonary congestion during recumbency.
   • Buzz Words: Pulmonary edema, left ventricular dysfunction, nocturnal cough.

Question 3

Hemoptysis in pregnancy is most commonly associated with which of the following conditions?
A. Anemia
B. Pulmonary hypertension or mitral stenosis
C. Hyperemesis gravidarum
D. Lower respiratory tract infection

Answer 3

1. B. Pulmonary hypertension or mitral stenosis
   
   • Rationale: Hemoptysis is a red flag in pregnancy, often pointing to severe pulmonary hypertension, mitral stenosis, or pulmonary embolism. It requires immediate evaluation due to its life-threatening implications.
   • Buzz Words: Pulmonary hypertension, mitral stenosis, hemoptysis, emergency evaluation.

Question 4

A pregnant woman with syncope should be evaluated for:
A. Physiological anemia
B. Arrhythmias or severe stenosis
C. Orthostatic hypotension
D. Dehydration

Answer 4

1. B. Arrhythmias or severe stenosis
   
   • Rationale: Syncope associated with exertion in pregnancy suggests arrhythmias, aortic stenosis, or cardiomyopathy. Simple vasovagal syncope is more benign and not exertion-related.
   • Buzz Words: Syncope, arrhythmias, aortic stenosis, cardiomyopathy, exertion.

Question 5

Chest pain in pregnancy that raises concern for ischemia or aortic dissection is often associated with which of the following findings?
A. Physiological systolic murmur
B. Persistent tachycardia
C. Grade 3/6 systolic murmur or greater
D. Diastolic murmur

Answer 5

1. D. Diastolic murmur
   
   • Rationale: A diastolic murmur is always pathological, often linked to mitral stenosis or aortic insufficiency. When paired with chest pain, ischemia or aortic dissection must be ruled out, particularly in high-risk conditions like Marfan syndrome.
   • Buzz Words: Diastolic murmur, mitral stenosis, aortic dissection, chest pain.

Question 6

Cyanosis in a pregnant woman is most indicative of:
A. Chronic anemia
B. Congenital heart disease causing hypoxia
C. Pulmonary embolism
D. Physiological changes in oxygenation

Answer 6

1. B. Congenital heart disease causing hypoxia
   
   • Rationale: Cyanosis indicates systemic hypoxia, commonly due to right-to-left cardiac shunting in cyanotic congenital heart diseases like Tetralogy of Fallot. This is a pathological finding requiring evaluation.
   • Buzz Words: Cyanosis, congenital heart disease, right-to-left shunt, hypoxia.

Question 7

Clubbing of the fingers in pregnancy is most often associated with:
A. Long-term hypoxia from congenital heart disease
B. Gestational diabetes
C. Physiological changes of pregnancy
D. Nutritional deficiencies

Answer 7

1. A. Long-term hypoxia from congenital heart disease
   
   • Rationale: Clubbing reflects chronic hypoxia, often caused by cyanotic congenital heart disease. It is not a physiological finding in pregnancy.
   • Buzz Words: Clubbing, chronic hypoxia, congenital heart disease.

Question 8

Persistent neck vein distention in pregnancy is suggestive of:
A. Pulmonary edema
B. Right-sided heart failure
C. Physiological venous engorgement
D. Superior vena cava syndrome

Answer 8

1. B. Right-sided heart failure
   
   • Rationale: Persistent neck vein distention suggests right-sided heart failure or elevated central venous pressure (CVP). It may also be a sign of constrictive pericarditis or tricuspid regurgitation.
   • Buzz Words: Neck vein distention, right-sided heart failure, elevated CVP.

Question 9

Which murmur in pregnancy always warrants further evaluation?
A. Functional systolic murmur
B. Diastolic murmur
C. Grade 1/6 systolic murmur
D. Soft systolic murmur in late pregnancy

Answer 9

1. B. Diastolic murmur
   
   • Rationale: A diastolic murmur in pregnancy is always pathological and frequently indicates mitral stenosis or aortic insufficiency. This contrasts with functional systolic murmurs, which are benign.
   • Buzz Words: Diastolic murmur, pathological, mitral stenosis.

Question 10

Cardiomegaly in pregnancy is best detected using which diagnostic tool?
A. Electrocardiography (ECG)
B. Chest radiography
C. Cardiac MRI
D. Echocardiography

Answer 10

1. D. Echocardiography
   * Rationale: Echocardiography is the preferred diagnostic tool for detecting cardiomegaly, as it provides detailed imaging of ventricular enlargement, valve abnormalities, or pericardial effusion without radiation exposure.
   * Buzz Words: Cardiomegaly, echocardiography, ventricular enlargement.

Question 11

Which heart sound in pregnancy is most concerning for underlying heart disease?
A. Third heart sound (S3)
B. Fourth heart sound (S4)
C. Persistent split S2
D. Ejection click

Answer 11

1. B. Fourth heart sound (S4)
   * Rationale: A fourth heart sound (S4) is pathological and indicates reduced ventricular compliance, often seen in hypertensive heart disease or aortic stenosis. It is a concerning finding in pregnancy.
   * Buzz Words: S4, ventricular compliance, aortic stenosis.

Question 12

Which finding is most consistent with pulmonary hypertension in pregnancy?
A. Cyanosis
B. Persistent tachycardia
C. Elevated pulmonary artery pressures
D. Functional systolic murmur

Answer 12

1. C. Elevated pulmonary artery pressures
   * Rationale: Pulmonary hypertension in pregnancy is diagnosed when the pulmonary arterial pressure exceeds 25 mmHg at rest. This condition is commonly seen in congenital heart defects or mitral valve disease.
   * Buzz Words: Pulmonary hypertension, elevated pressure >25 mmHg, congenital heart disease.

Question 13

Which of the following is a misleading finding that can mimic heart disease in pregnancy?
A. Functional systolic murmur
B. Diastolic murmur
C. Cyanosis
D. Persistent tachycardia

Answer 13

1. A. Functional systolic murmur
   * Rationale: Functional systolic murmurs are common and benign in pregnancy due to increased cardiac output. They should not be confused with pathological murmurs, such as diastolic murmurs or loud systolic murmurs (≥3/6).
   * Buzz Words: Functional systolic murmur, benign, increased cardiac output.

Question 14

Lower extremity edema in pregnancy is typically:
A. Always pathological and suggests heart failure
B. A physiological finding unless accompanied by other symptoms of heart disease
C. Diagnostic of right-sided heart failure
D. Indicative of gestational hypertension

Answer 14

1. B. A physiological finding unless accompanied by other symptoms of heart disease
   * Rationale: Mild lower extremity edema is common in normal pregnancy due to venous stasis and compression by the gravid uterus. Generalized or severe edema may suggest heart failure.
   * Buzz Words: Edema, venous stasis, physiological vs. pathological.

Question 15

Which of the following symptoms differentiates pathological dyspnea from physiological changes in pregnancy?
A. Fatigue
B. Dyspnea with exertion
C. Orthopnea and progressive worsening
D. Increased respiratory rate

Answer 15

1. C. Orthopnea and progressive worsening
   * Rationale: While mild dyspnea is physiological, orthopnea and progressive worsening are pathological signs indicating heart failure or pulmonary congestion.
   * Buzz Words: Pathological dyspnea, orthopnea, progressive worsening, heart failure.

Question 16

A grade 3/6 systolic murmur in a pregnant woman is:
A. Likely benign if unaccompanied by other findings
B. Always indicative of pathological changes
C. Suggestive of pulmonary hypertension
D. Diagnostic of anemia

Answer 16

1. B. Always indicative of pathological changes
   * Rationale: A grade 3/6 systolic murmur or louder is pathological and suggests valvular disease such as mitral or aortic regurgitation.
   * Buzz Words: Grade 3/6 murmur, pathological, valvular disease.

Question 17

Which clinical finding in pregnancy suggests arrhythmias or significant cardiac pathology?
A. Persistent tachycardia with S4
B. Functional systolic murmur
C. Mild fatigue and exercise intolerance
D. Increased respiratory effort

Answer 17

1. A. Persistent tachycardia with S4
   * Rationale: Tachycardia is physiological in pregnancy, but persistent tachycardia combined with an S4 suggests significant cardiac pathology like arrhythmias or heart failure.
   * Buzz Words: Tachycardia, S4, arrhythmias, cardiac pathology.

Question 18

What symptom is most likely to be an early indicator of pulmonary congestion in pregnancy?
A. Hemoptysis
B. Nocturnal cough
C. Cyanosis
D. Syncope

Answer 18

1. B. Nocturnal cough
   * Rationale: A nocturnal cough is an early sign of pulmonary congestion, often due to left ventricular dysfunction or heart failure.
   * Buzz Words: Nocturnal cough, pulmonary congestion, heart failure.

Question 19

Which ECG finding is most commonly seen in pregnancy due to diaphragm elevation?
A. Right axis deviation
B. 15-degree left axis deviation
C. ST-segment elevation
D. Deep Q waves in lead I

Answer 19

B. 15-degree left axis deviation
Rationale: Pregnancy causes diaphragm elevation due to the growing uterus, shifting the heart’s electrical axis to the left. This finding is a normal adaptation and does not indicate pathology.
Buzz Words: ECG, left axis deviation, diaphragm elevation, normal pregnancy adaptation.

Question 20

What is a normal finding on ECG during pregnancy that should not raise concern?
A. Prolonged PR interval
B. Flattened T waves
C. Complete heart block
D. ST-segment depression in all leads

Answer 20

B. Flattened T waves
Rationale: Pregnancy-induced hormonal changes and increased cardiac output often cause flattened T waves or minor ST changes, which are benign and physiologically normal.
Buzz Words: Flattened T waves, hormonal changes, benign ECG findings.

Question 21

What is the primary use of chest radiography in diagnosing heart disease during pregnancy?
A. To assess arrhythmias
B. To evaluate heart size and pulmonary vasculature
C. To confirm diastolic dysfunction
D. To detect fetal anomalies

Answer 21

B. To evaluate heart size and pulmonary vasculature
Rationale: Chest radiography is useful for assessing cardiomegaly and pulmonary congestion, but it must be performed with appropriate fetal shielding to minimize radiation exposure.
Buzz Words: Chest radiography, heart size, pulmonary vasculature, fetal shielding.

Question 22

What is the most significant advantage of echocardiography in pregnancy-related heart disease?
A. It involves minimal radiation exposure.
B. It evaluates right ventricular geometry more effectively than other imaging.
C. It provides detailed information about chamber size, valve function, and ventricular performance.
D. It is the least expensive diagnostic modality.

Answer 22

C. Provides detailed information about chamber size, valve function, and ventricular performance
Rationale: Echocardiography is the gold standard in pregnancy-related cardiac evaluations due to its ability to assess structural abnormalities without radiation risk.
Buzz Words: Echocardiography, valve function, ventricular performance, no radiation.

Question 23

Which diagnostic tool is most effective in detecting complex cardiac abnormalities in pregnant women?
A. Electrocardiography (ECG)
B. Transesophageal echocardiography
C. Chest radiography
D. Cardiac catheterization

Answer 23

B. Transesophageal echocardiography
Rationale: Transesophageal echocardiography (TEE) offers superior visualization of complex cardiac structures, particularly in cases where transthoracic echocardiography is inconclusive.
Buzz Words: Transesophageal echocardiography, complex cardiac abnormalities, superior imaging.

Question 24

Which diagnostic modality provides the most accurate evaluation of right ventricular geometry during pregnancy?
A. Transthoracic echocardiography
B. Transesophageal echocardiography
C. Cardiac MRI
D. Chest radiography

Answer 24

C. Cardiac MRI
Rationale: Cardiac MRI provides highly detailed and reproducible imaging of right ventricular geometry and function without radiation, making it ideal for complex assessments.
Buzz Words: Cardiac MRI, right ventricular geometry, reproducibility, no radiation.

Question 25

What precaution minimizes fetal radiation exposure during chest radiography in pregnancy? A. Minimizing fluoroscopy time B. Using lead shielding C. Positioning the patient in a supine position D. Avoiding radiography until postpartum

Answer 25

B. Using lead shielding Rationale: Lead shielding is essential during chest radiography to protect the fetus from radiation exposure while enabling necessary maternal evaluation. Buzz Words: Radiation exposure, lead shielding, fetal safety.

Question 26

Why is technetium-99m rarely used in diagnosing heart disease during pregnancy? A. It has limited diagnostic value in cardiac diseases. B. It exposes the fetus to radiation. C. It is less accurate than echocardiography. D. It is contraindicated due to high maternal risk.

Answer 26

B. It exposes the fetus to radiation Rationale: While technetium-99m can be diagnostic for cardiac issues, its use in pregnancy is rare due to fetal radiation risks. Buzz Words: Technetium-99m, fetal radiation, rare use in pregnancy.

Question 27

Which diagnostic modality is preferred for evaluating valve regurgitation in pregnancy? A. Cardiac MRI B. Chest radiography C. Echocardiography D. Fluoroscopy

Answer 27

C. Echocardiography Rationale: Echocardiography is the first-line diagnostic tool for detecting valvular abnormalities, including regurgitation, without radiation exposure. Buzz Words: Echocardiography, valve regurgitation, first-line tool.

Question 28

What is the primary limitation of cardiac catheterization in pregnant women? A. Inaccurate assessment of left ventricular function B. High risk of maternal complications C. Potential fetal radiation exposure D. Difficulty in positioning the patient

Answer 28

C. Potential fetal radiation exposure Rationale: Cardiac catheterization poses significant radiation risks to the fetus, limiting its use to critical cases where benefits outweigh risks. Buzz Words: Cardiac catheterization, fetal radiation, limited use.

Question 29

Which imaging modality provides detailed evaluation of ventricular function without the risk of radiation in pregnancy? A. Echocardiography B. Cardiac MRI C. Chest radiography D. Cardiac catheterization

Answer 29

B. Cardiac MRI Rationale: Cardiac MRI offers detailed imaging of ventricular function and cardiac structures, making it valuable for pregnant patients when echocardiography is inconclusive. Buzz Words: Cardiac MRI, ventricular function, no radiation.

Question 30

Why are atrial and ventricular premature contractions on ECG considered normal during pregnancy? A. They result from hormonal fluctuations. B. They are due to increased blood volume and cardiac workload. C. They indicate progressive diastolic dysfunction. D. They occur due to electrolyte imbalances.

Answer 30

B. Due to increased blood volume and cardiac workload Rationale: Increased blood volume and cardiac workload in pregnancy often cause premature contractions, which are typically benign unless associated with other symptoms. Buzz Words: Premature contractions, cardiac workload, benign.

Question 31

In which situation is fluoroscopy most likely indicated in a pregnant woman? A. Routine assessment of cardiac function B. Evaluation of complex congenital heart disease with minimal fluoroscopy time C. Diagnosis of diastolic dysfunction D. Exclusion of arrhythmias

Answer 31

B. Evaluation of complex congenital heart disease with minimal fluoroscopy time Rationale: Fluoroscopy is rarely used in pregnancy but may be necessary for congenital heart disease evaluation. Fetal exposure is minimized by reducing fluoroscopy time. Buzz Words: Fluoroscopy, congenital heart disease, minimal exposure.

Question 32

Which imaging modality has higher reproducibility for evaluating cardiac function in pregnancy but is less commonly used due to cost and availability? A. Transthoracic echocardiography B. Transesophageal echocardiography C. Cardiac MRI D. Chest radiography

Answer 32

C. Cardiac MRI Rationale: While Cardiac MRI provides reproducible and detailed assessments of cardiac anatomy, it is less commonly used due to high cost and limited availability. Buzz Words: Cardiac MRI, reproducibility, cost, availability.

Question 33

Which of the following ECG changes is typical during pregnancy and does not suggest pathology? A. Prolonged PR interval B. Q wave in lead DIII C. ST-segment elevation D. Frequent ventricular tachycardia

Answer 33

B. Q wave in lead DIII Rationale: A Q wave in lead DIII is a common and benign finding during pregnancy due to the leftward shift of the heart caused by the growing uterus. Buzz Words: Q wave, lead DIII, benign ECG changes.

Question 34

Which symptom is most concerning for left-sided heart failure in a pregnant woman? A. Mild dyspnea on exertion B. Orthopnea C. Increased respiratory effort D. Fatigue after physical activity

Answer 34

B. Orthopnea Rationale: Orthopnea, or difficulty breathing while lying flat, is a hallmark of left-sided heart failure or mitral stenosis. It reflects pulmonary venous congestion worsening in the supine position. Buzz Words: Orthopnea, left-sided heart failure, mitral stenosis, pulmonary congestion.

Question 35

Nocturnal cough in a pregnant woman is most commonly associated with: A. Physiological dyspnea B. Pulmonary edema or left ventricular dysfunction C. Gastroesophageal reflux disease (GERD) D. Anxiety-related hyperventilation

Answer 35

B. Pulmonary edema or left ventricular dysfunction Rationale: Nocturnal cough is often caused by pulmonary congestion due to left ventricular dysfunction. This symptom differentiates heart failure from normal pregnancy-related dyspnea. Buzz Words: Nocturnal cough, pulmonary congestion, left ventricular dysfunction, heart failure.

Question 36

Hemoptysis during pregnancy is most indicative of which condition? A. Pulmonary edema B. Mitral stenosis or severe pulmonary hypertension C. Hyperemesis gravidarum D. Lower respiratory tract infection

Answer 36

B. Mitral stenosis or severe pulmonary hypertension Rationale: Hemoptysis is a red-flag symptom indicating severe mitral stenosis or pulmonary hypertension, both of which increase pulmonary vascular pressure and may lead to blood-tinged sputum. Buzz Words: Hemoptysis, pulmonary hypertension, mitral stenosis, increased pulmonary pressure.

Question 37

A pregnant woman with syncope during exertion should be evaluated for: A. Simple vasovagal syncope B. Arrhythmias, aortic stenosis, or cardiomyopathy C. Gestational hypertension D. Dehydration

Answer 37

B. Arrhythmias, aortic stenosis, or cardiomyopathy Rationale: Exertional syncope suggests serious cardiac issues like arrhythmias, aortic stenosis, or cardiomyopathy, all of which impair cardiac output. This symptom requires urgent evaluation. Buzz Words: Exertional syncope, arrhythmias, aortic stenosis, cardiomyopathy, reduced cardiac output.

Question 38

Chest pain radiating to the back in a pregnant woman with Marfan syndrome raises concern for: A. Aortic dissection B. Pulmonary embolism C. Myocardial infarction D. Tension pneumothorax

Answer 38

A. Aortic dissection Rationale: Chest pain radiating to the back in a pregnant woman with Marfan syndrome strongly suggests aortic dissection, a life-threatening condition that must be promptly addressed. Buzz Words: Chest pain, Marfan syndrome, aortic dissection, radiating to back.

Question 39

Which characteristic differentiates heart disease-related dyspnea from physiological dyspnea of pregnancy? A. Dyspnea on exertion B. Dyspnea with orthopnea and progression over time C. Increased oxygen demand causing shortness of breath D. Mild dyspnea in the third trimester

Answer 39

B. Dyspnea with orthopnea and progression over time Rationale: Physiological dyspnea is mild and associated with exertion. Progressive dyspnea, especially with orthopnea, signals heart disease and potential pulmonary congestion. Buzz Words: Progressive dyspnea, orthopnea, pulmonary congestion, pathological dyspnea.

Question 40

Recurrent syncope during pregnancy, particularly with exertion, should prompt evaluation for: A. Vasovagal syncope B. Severe aortic stenosis or arrhythmias C. Gestational diabetes D. Anemia

Answer 40

B. Severe aortic stenosis or arrhythmias Rationale: Exertional syncope is a warning sign of aortic stenosis or arrhythmias, which compromise blood flow during increased physical demands. Buzz Words: Exertional syncope, aortic stenosis, arrhythmias, cardiac pathology.

Question 41

A distinguishing symptom of congestive heart failure in pregnancy is: A. Increased fatigue B. Nocturnal cough C. Mild dyspnea at rest D. Lower extremity edema

Answer 41

B. Nocturnal cough Rationale: A nocturnal cough is an early indicator of congestive heart failure (CHF) due to worsening pulmonary congestion in the recumbent position. Buzz Words: Nocturnal cough, CHF, pulmonary congestion.

Question 42

Hemoptysis in pregnancy requires immediate evaluation because it may indicate: A. Gastrointestinal bleeding B. Pulmonary embolism or mitral stenosis C. Gestational hypertension D. Physiological hypervolemia

Answer 42

B. Pulmonary embolism or mitral stenosis Rationale: Hemoptysis in pregnancy often indicates pulmonary embolism or mitral stenosis, both of which are life-threatening and require immediate workup. Buzz Words: Hemoptysis, pulmonary embolism, mitral stenosis, emergency evaluation.

Question 43

Chest pain in a pregnant woman with hypertension and pain radiating to the back should raise suspicion for: A. Myocardial infarction B. Aortic aneurysm or dissection C. Tension pneumothorax D. Pulmonary hypertension

Answer 43

B. Aortic aneurysm or dissection Rationale: Hypertension with chest pain radiating to the back raises suspicion for aortic dissection, particularly in high-risk conditions like Marfan syndrome. Buzz Words: Aortic dissection, hypertension, chest pain, radiating to back.

Question 44

Orthopnea in a pregnant woman is most commonly associated with: A. Right-sided heart failure B. Left-sided heart failure or mitral stenosis C. Physiological anemia D. Pulmonary hypertension

Answer 44

B. Left-sided heart failure or mitral stenosis Rationale: Orthopnea is a hallmark of pulmonary venous congestion caused by left-sided heart failure or mitral stenosis. Buzz Words: Orthopnea, left-sided heart failure, mitral stenosis, pulmonary venous congestion.

Question 45

Syncope due to vasovagal response in pregnancy is typically: A. Associated with exertion and serious conditions B. Benign and caused by hormonal changes C. Indicative of arrhythmias D. Suggestive of cardiomyopathy

Answer 45

B. Benign and caused by hormonal changes Rationale: Vasovagal syncope is common and benign during pregnancy, often caused by hormonal changes and vasodilation, as opposed to exertion-related cardiac pathology. Buzz Words: Vasovagal syncope, benign, hormonal changes, vasodilation.

Question 46

What symptom is an early sign of pulmonary congestion in pregnancy? A. Cyanosis B. Nocturnal cough C. Syncope D. Hemoptysis

Answer 46

B. Nocturnal cough Rationale: A nocturnal cough is an early indicator of pulmonary congestion, often due to left ventricular dysfunction in heart failure. Buzz Words: Nocturnal cough, pulmonary congestion, left ventricular dysfunction.

Question 47

Which symptom combination most strongly indicates heart disease in pregnancy? A. Fatigue and mild dyspnea B. Progressive dyspnea and syncope on exertion C. Lower extremity edema and fatigue D. Chest pain and mild palpitations

Answer 47

B. Progressive dyspnea and syncope on exertion Rationale: The combination of progressive dyspnea and syncope strongly suggests significant cardiac pathology, such as heart failure or arrhythmias. Buzz Words: Progressive dyspnea, syncope, cardiac pathology.

Question 48

Which symptom should prompt immediate evaluation in a pregnant woman with suspected heart disease? A. Dyspnea on exertion B. Orthopnea with nocturnal cough C. Mild fatigue and exercise intolerance D. Lower extremity swelling

Answer 48

B. Orthopnea with nocturnal cough Rationale: Orthopnea and nocturnal cough are red flags for heart disease and congestive heart failure, requiring immediate evaluation. Buzz Words: Orthopnea, nocturnal cough, CHF, urgent evaluation.

Question 49

Central cyanosis in a pregnant woman suggests: A. Anemia B. Right-to-left cardiac shunt or congenital heart disease C. Physiological changes of pregnancy D. Pulmonary embolism

Answer 49

B. Right-to-left cardiac shunt or congenital heart disease Rationale: Central cyanosis in pregnancy is pathological and suggests systemic hypoxia due to right-to-left cardiac shunting or cyanotic congenital heart disease. These conditions impair oxygenation and require urgent evaluation. Buzz Words: Central cyanosis, hypoxia, right-to-left shunt, congenital heart disease.

Question 50

Clubbing of the fingers in pregnancy is most commonly associated with: A. Cyanotic congenital heart disease and chronic hypoxia B. Nutritional deficiencies C. Normal physiological changes D. Gestational hypertension

Answer 50

A. Cyanotic congenital heart disease and chronic hypoxia Rationale: Clubbing is a sign of chronic hypoxia, often linked to cyanotic congenital heart disease. It indicates long-term oxygen deprivation rather than a physiological change in pregnancy. Buzz Words: Clubbing, chronic hypoxia, cyanotic heart disease.

Question 51

Persistent neck vein distention in pregnancy is indicative of: A. Right-sided heart failure or elevated central venous pressure (CVP) B. Increased plasma volume of pregnancy C. Gestational anemia D. Pulmonary hypertension alone

Answer 51

A. Right-sided heart failure or elevated central venous pressure (CVP) Rationale: Persistent neck vein distention signals right-sided heart failure or elevated CVP, often due to pulmonary hypertension or tricuspid regurgitation. Buzz Words: Neck vein distention, right-sided heart failure, elevated CVP.

Question 52

What does Kussmaul’s sign (persistent jugular venous distention during inspiration) suggest? A. Physiological changes in pregnancy B. Constrictive pericarditis or severe tricuspid regurgitation C. Left-sided heart failure D. Hypervolemia of pregnancy

Answer 52

B. Constrictive pericarditis or severe tricuspid regurgitation Rationale: Kussmaul’s sign (jugular venous distention that worsens during inspiration) is associated with constrictive pericarditis or tricuspid regurgitation, not physiological pregnancy changes. Buzz Words: Kussmaul’s sign, constrictive pericarditis, tricuspid regurgitation.

Question 53

A systolic murmur grade 3/6 or greater during pregnancy is most concerning for: A. Anemia B. High-output states like thyrotoxicosis C. Valvular lesions such as mitral or aortic regurgitation D. Physiological changes of pregnancy

Answer 53

C. Valvular lesions such as mitral or aortic regurgitation Rationale: Loud systolic murmurs (≥3/6) suggest significant valvular lesions, such as mitral or aortic regurgitation, which require further investigation. Buzz Words: Systolic murmur, valvular lesions, mitral regurgitation, aortic regurgitation.

Question 54

What does a diastolic murmur in pregnancy typically indicate? A. Physiological changes of pregnancy B. Mitral stenosis or aortic insufficiency C. Increased cardiac output D. Functional murmurs

Answer 54

B. Mitral stenosis or aortic insufficiency Rationale: A diastolic murmur in pregnancy is always pathological and most often caused by mitral stenosis or aortic insufficiency, conditions requiring immediate evaluation. Buzz Words: Diastolic murmur, mitral stenosis, aortic insufficiency.

Question 55

Cardiomegaly detected on imaging in a pregnant woman most commonly suggests: A. Pulmonary edema B. Chronic volume overload or cardiomyopathy C. Physiological cardiac remodeling D. Transient pericardial effusion

Answer 55

B. Chronic volume overload or cardiomyopathy Rationale: Cardiomegaly, detected on imaging, is indicative of chronic volume overload or cardiomyopathy. These conditions can result from valvular disease or myocardial dysfunction. Buzz Words: Cardiomegaly, chronic volume overload, cardiomyopathy, ventricular enlargement.

Question 56

Persistent tachycardia (>100 bpm at rest) in pregnancy is most likely to be pathological when associated with: A. Fatigue and mild dyspnea B. Arrhythmias like atrial fibrillation or ventricular tachycardia C. Physiological hypervolemia D. Normal pregnancy-related changes

Answer 56

B. Arrhythmias like atrial fibrillation or ventricular tachycardia Rationale: Persistent tachycardia (>100 bpm) is pathological when associated with arrhythmias, such as atrial fibrillation or ventricular tachycardia, and often signals underlying cardiac disease. Buzz Words: Persistent tachycardia, atrial fibrillation, ventricular tachycardia, arrhythmias.

Question 57

A persistently split second heart sound (S2) in pregnancy is concerning for: A. Right bundle branch block or pulmonary hypertension B. Normal inspiration-induced venous return changes C. Increased systemic vascular resistance D. Left ventricular hypertrophy

Answer 57

A. Right bundle branch block or pulmonary hypertension Rationale: A persistently split second heart sound (S2) is pathological and often caused by pulmonary hypertension or right bundle branch block. Buzz Words: Split S2, pulmonary hypertension, right bundle branch block.

Question 58

A fourth heart sound (S4) during pregnancy is pathological and most commonly associated with: A. Increased venous return B. Reduced ventricular compliance (e.g., hypertensive heart disease or aortic stenosis) C. Hyperdynamic circulation D. Functional cardiac changes

Answer 58

B. Reduced ventricular compliance (e.g., hypertensive heart disease or aortic stenosis) Rationale: S4 is pathological and reflects reduced ventricular compliance, commonly associated with hypertensive heart disease or aortic stenosis. Buzz Words: S4, ventricular compliance, hypertensive heart disease, aortic stenosis.

Question 59

Pulmonary hypertension during pregnancy is defined as a resting pulmonary arterial pressure greater than: A. 20 mmHg B. 25 mmHg C. 30 mmHg D. 35 mmHg

Answer 59

B. 25 mmHg Rationale: Pulmonary hypertension is diagnosed when the pulmonary arterial pressure exceeds 25 mmHg at rest, a critical threshold for severe complications in pregnancy. Buzz Words: Pulmonary hypertension, pressure >25 mmHg, diagnostic threshold.

Question 60

Which congenital cardiac lesion is most commonly associated with pulmonary hypertension in pregnancy? A. Atrial septal defect (ASD) B. Tetralogy of Fallot C. Eisenmenger syndrome D. Patent foramen ovale

Answer 60

C. Eisenmenger syndrome Rationale: Eisenmenger syndrome, caused by long-standing left-to-right shunts reversing into right-to-left shunts, is a major cause of pulmonary hypertension in pregnancy. Buzz Words: Eisenmenger syndrome, pulmonary hypertension, right-to-left shunt.

Question 61

What is the most likely cause of cyanosis in a pregnant woman with a history of Tetralogy of Fallot repair? A. Left-sided heart failure B. Right-to-left shunting due to residual defect C. Physiological anemia of pregnancy D. Increased oxygen demand during pregnancy

Answer 61

B. Right-to-left shunting due to residual defect Rationale: Residual defects after Tetralogy of Fallot repair can lead to right-to-left shunting, resulting in cyanosis during pregnancy. Buzz Words: Cyanosis, residual defect, Tetralogy of Fallot, right-to-left shunting.

Question 62

Which clinical finding is least likely to be physiological in a pregnant woman? A. Functional systolic murmur B. Persistent diastolic murmur C. Mild jugular venous distention during inspiration D. Increased resting heart rate

Answer 62

B. Persistent diastolic murmur Rationale: A diastolic murmur is always pathological in pregnancy, in contrast to functional systolic murmurs, which are common and benign. Buzz Words: Persistent diastolic murmur, pathological, mitral stenosis, aortic insufficiency.

Question 63

What does persistent tachycardia and fourth heart sound (S4) during pregnancy indicate? A. Hyperdynamic circulation B. Reduced ventricular compliance or pathological cardiac dysfunction C. Physiological tachycardia D. Increased stroke volume

Answer 63

B. Reduced ventricular compliance or pathological cardiac dysfunction Rationale: Tachycardia paired with an S4 sound reflects reduced ventricular compliance, indicating significant cardiac dysfunction like hypertensive heart disease. Buzz Words: Tachycardia, S4, ventricular compliance, cardiac dysfunction.

Question 64

Which diagnostic criterion defines pulmonary hypertension in pregnancy? A. Pulmonary arterial pressure >25 mmHg at rest B. Pulmonary arterial pressure >30 mmHg at rest C. Pulmonary arterial pressure >25 mmHg during exertion D. Pulmonary arterial pressure >30 mmHg during exertion

Answer 64

A. Pulmonary arterial pressure >25 mmHg at rest Rationale: Pulmonary hypertension is diagnosed with a resting pulmonary arterial pressure >25 mmHg, a critical marker for poor maternal and fetal outcomes. Buzz Words: Pulmonary hypertension, >25 mmHg, diagnostic criterion.

Question 65

Which of the following findings is considered a normal adaptation during pregnancy? A. Diastolic murmur B. Functional systolic murmur C. Progressive dyspnea at rest D. Persistent neck vein distention

Answer 65

B. Functional systolic murmur Rationale: A functional systolic murmur is common in pregnancy due to increased cardiac output and hypervolemia. It is typically soft and not associated with other pathological findings. Buzz Words: Functional systolic murmur, physiological, hypervolemia, increased cardiac output.

Question 66

Which of the following is a pathological finding in a pregnant woman? A. Mild dyspnea on exertion B. Orthopnea and nocturnal cough C. Mild lower extremity edema D. Increased resting heart rate

Answer 66

B. Orthopnea and nocturnal cough Rationale: These symptoms are hallmarks of congestive heart failure or left-sided heart failure due to pulmonary congestion and require immediate evaluation. Buzz Words: Orthopnea, nocturnal cough, heart failure, pulmonary congestion.

Question 67

A diastolic murmur during pregnancy is: A. A normal finding due to increased blood flow B. Always pathological and requires further evaluation C. Indicative of physiological anemia D. Associated with gestational hypertension

Answer 67

B. Always pathological and requires further evaluation Rationale: A diastolic murmur is never physiological and often indicates mitral stenosis or aortic insufficiency, requiring urgent assessment. Buzz Words: Diastolic murmur, pathological, mitral stenosis, aortic insufficiency.

Question 68

Which symptom would be considered pathological in pregnancy? A. Fatigue after physical activity B. Progressive dyspnea not relieved by rest C. Mild swelling of the lower extremities D. Increased cardiac output causing a soft systolic murmur

Answer 68

B. Progressive dyspnea not relieved by rest Rationale: Progressive dyspnea at rest suggests heart failure or pulmonary congestion, differentiating it from the physiological dyspnea of pregnancy, which occurs with exertion and improves with rest. Buzz Words: Progressive dyspnea, not relieved by rest, heart failure.

Question 69

What differentiates a functional systolic murmur from a pathological murmur during pregnancy? A. Functional murmurs are loud (grade 3/6 or higher). B. Functional murmurs are soft, without associated symptoms. C. Pathological murmurs occur only during inspiration. D. Functional murmurs are always associated with cyanosis.

Answer 69

B. Functional murmurs are soft, without associated symptoms. Rationale: Functional murmurs in pregnancy are typically soft (grade ≤2/6) and unaccompanied by cyanosis or other symptoms. Loud murmurs (≥3/6) or diastolic murmurs warrant further evaluation. Buzz Words: Functional murmur, soft, no associated symptoms, physiological.

Question 70

Which clinical sign is most concerning for congestive heart failure in pregnancy? A. Mild lower extremity edema B. Cyanosis and orthopnea C. Increased respiratory rate during exertion D. Functional systolic murmur

Answer 70

B. Cyanosis and orthopnea Rationale: Cyanosis combined with orthopnea indicates severe hypoxia due to conditions like right-to-left shunts or pulmonary hypertension, suggesting serious pathology. Buzz Words: Cyanosis, orthopnea, hypoxia, pathological.

Question 71

What distinguishes physiological dyspnea from pathological dyspnea in pregnancy? A. Pathological dyspnea occurs with exertion only. B. Physiological dyspnea is progressive and unrelieved by rest. C. Pathological dyspnea is often associated with orthopnea or pulmonary edema. D. Physiological dyspnea is always accompanied by tachycardia.

Answer 71

C. Pathological dyspnea is often associated with orthopnea or pulmonary edema. Rationale: Pathological dyspnea is progressive, unrelieved by rest, and frequently associated with orthopnea, pulmonary edema, or nocturnal cough, distinguishing it from physiological dyspnea. Buzz Words: Pathological dyspnea, orthopnea, pulmonary edema, progressive.

Question 72

Clubbing of the fingers in a pregnant woman is indicative of: A. Physiological adaptation to increased cardiac output B. Chronic hypoxia, often due to cyanotic congenital heart disease C. Nutritional deficiencies related to pregnancy D. Gestational diabetes

Answer 72

B. Chronic hypoxia, often due to cyanotic congenital heart disease Rationale: Clubbing occurs as a response to chronic oxygen deprivation, commonly seen in cyanotic congenital heart diseases. It is never physiological in pregnancy. Buzz Words: Clubbing, chronic hypoxia, cyanotic congenital heart disease.

Question 73

Persistent neck vein distention in pregnancy is most commonly associated with: A. Right-sided heart failure or elevated central venous pressure (CVP) B. Physiological venous stasis due to uterine compression C. Pulmonary hypertension only D. Increased plasma volume

Answer 73

A. Right-sided heart failure or elevated central venous pressure (CVP) Rationale: Persistent jugular venous distention points to right-sided heart failure or elevated CVP, especially if associated with Kussmaul’s sign or pulmonary hypertension. Buzz Words: Neck vein distention, right-sided heart failure, elevated CVP.

Question 74

Which of the following findings is most consistent with congestive heart failure in pregnancy? A. Mild fatigue and increased heart rate B. Nocturnal cough and pulmonary edema C. Lower extremity edema that resolves with rest D. Functional systolic murmur

Answer 74

B. Nocturnal cough and pulmonary edema Rationale: Nocturnal cough and pulmonary edema are key indicators of congestive heart failure, distinguishing it from physiological adaptations like mild fatigue or edema. Buzz Words: Nocturnal cough, pulmonary edema, congestive heart failure.

Question 75

A loud systolic murmur (grade 3/6 or higher) during pregnancy is: A. Always physiological due to hypervolemia B. Indicative of a pathological condition such as valvular disease C. Associated with gestational hypertension D. Typically resolves postpartum without intervention

Answer 75

B. Indicative of a pathological condition such as valvular disease Rationale: A loud systolic murmur (≥3/6) is pathological and often linked to valvular lesions such as mitral or aortic regurgitation, necessitating further workup. Buzz Words: Systolic murmur ≥3/6, pathological, valvular disease.

Question 76

What clinical feature is most likely to indicate a pathological cardiac condition rather than a normal pregnancy adaptation? A. Increased resting heart rate B. Persistent tachycardia with gallops (S3/S4) C. Mild fatigue in the third trimester D. Functional systolic murmur

Answer 76

B. Persistent tachycardia with gallops (S3/S4) Rationale: Persistent tachycardia with gallops (S3 or S4) reflects ventricular dysfunction or reduced compliance, which are signs of pathological cardiac issues. Buzz Words: Tachycardia, gallops, S3, S4, ventricular dysfunction.

Question 77

Cyanosis in pregnancy is a pathological finding most commonly associated with: A. Physiological dyspnea B. Congenital heart disease or right-to-left shunt C. Hyperdynamic circulation D. Gestational hypertension

Answer 77

B. Congenital heart disease or right-to-left shunt Rationale: Cyanosis due to right-to-left shunts (e.g., Eisenmenger syndrome) is pathological, often seen in congenital heart disease. It requires immediate evaluation. Buzz Words: Cyanosis, right-to-left shunt, congenital heart disease.

Question 78

Mild lower extremity edema in pregnancy is most likely due to: A. Right-sided heart failure B. Physiological venous stasis from uterine compression C. Pulmonary hypertension D. Chronic hypoxia

Answer 78

B. Physiological venous stasis from uterine compression Rationale: Mild lower extremity edema in pregnancy results from uterine compression of the venous system and is a common physiological adaptation. Generalized or severe edema suggests pathology. Buzz Words: Lower extremity edema, physiological, uterine compression, venous stasis.

Question 79

Which symptom is always pathological in pregnancy? A. Mild fatigue and dyspnea on exertion B. Nocturnal cough and orthopnea C. Functional systolic murmur D. Increased resting heart rate

Answer 79

B. Nocturnal cough and orthopnea Rationale: These symptoms indicate pulmonary congestion or heart failure, distinguishing them from normal pregnancy-related changes. Buzz Words: Nocturnal cough, orthopnea, pulmonary congestion, pathological.

Question 80

Progressive dyspnea in a pregnant woman that progresses to orthopnea is most indicative of: A. Normal physiological dyspnea B. Pulmonary congestion or left-sided heart failure C. Gestational anemia D. Increased metabolic demand

Answer 80

B. Pulmonary congestion or left-sided heart failure Rationale: Progressive dyspnea, especially when accompanied by orthopnea, is indicative of pulmonary congestion or left-sided heart failure, differentiating it from physiological dyspnea, which is mild and related to exertion. Buzz Words: Progressive dyspnea, orthopnea, pulmonary congestion, left-sided heart failure.

Question 81

Orthopnea in a pregnant woman is a hallmark of which condition? A. Pulmonary hypertension B. Left-sided heart failure or mitral stenosis C. Physiological changes in pregnancy D. Simple vasovagal syncope

Answer 81

B. Left-sided heart failure or mitral stenosis Rationale: Orthopnea occurs due to pulmonary venous congestion and is a hallmark of left-sided heart failure or mitral stenosis, conditions that require urgent evaluation. Buzz Words: Orthopnea, left-sided heart failure, mitral stenosis, pulmonary congestion.

Question 82

Nocturnal cough during pregnancy is most commonly associated with: A. Pulmonary embolism B. Pulmonary edema or left ventricular dysfunction C. Hyperemesis gravidarum D. Physiological dyspnea

Answer 82

B. Pulmonary edema or left ventricular dysfunction Rationale: A nocturnal cough signals pulmonary edema or left ventricular dysfunction, which are early indicators of congestive heart failure in pregnancy. Buzz Words: Nocturnal cough, pulmonary edema, left ventricular dysfunction, heart failure.

Question 83

Hemoptysis in a pregnant woman should prompt evaluation for: A. Mitral stenosis or pulmonary hypertension B. Physiological anemia of pregnancy C. Upper respiratory tract infection D. Pulmonary congestion from high cardiac output

Answer 83

A. Mitral stenosis or pulmonary hypertension Rationale: Hemoptysis during pregnancy is a red-flag symptom that often points to mitral stenosis or pulmonary hypertension, both of which elevate pulmonary vascular pressures. Buzz Words: Hemoptysis, mitral stenosis, pulmonary hypertension, elevated pressures.

Question 84

Recurrent syncope during pregnancy, particularly with exertion, suggests: A. Arrhythmias, severe aortic stenosis, or cardiomyopathy B. Simple vasovagal syncope C. Physiological changes in vascular tone D. Dehydration from hyperemesis gravidarum

Answer 84

A. Arrhythmias, severe aortic stenosis, or cardiomyopathy Rationale: Exertional syncope strongly suggests serious cardiac conditions like arrhythmias, aortic stenosis, or cardiomyopathy, which compromise cardiac output under stress. Buzz Words: Exertional syncope, arrhythmias, aortic stenosis, cardiomyopathy.

Question 85

Chest pain radiating to the back in a pregnant woman with Marfan syndrome is most concerning for: A. Aortic dissection B. Pulmonary embolism C. Myocardial ischemia D. Tension pneumothorax

Answer 85

A. Aortic dissection Rationale: Chest pain radiating to the back in a pregnant woman with Marfan syndrome is concerning for aortic dissection, a life-threatening emergency. Buzz Words: Chest pain, Marfan syndrome, aortic dissection, radiating to back.

Question 86

Cyanosis in a pregnant woman is most indicative of: A. Right-to-left shunt or congenital heart disease B. Gestational hypertension C. Physiological anemia D. High-output cardiac states

Answer 86

A. Right-to-left shunt or congenital heart disease Rationale: Cyanosis in pregnancy is pathological and typically due to right-to-left shunting or congenital heart disease, which impair systemic oxygenation. Buzz Words: Cyanosis, right-to-left shunt, congenital heart disease, hypoxia.

Question 87

Clubbing of fingers in a pregnant woman is most associated with: A. Chronic hypoxia from cyanotic congenital heart disease B. Gestational diabetes C. Nutritional deficiencies D. Physiological adaptations of pregnancy

Answer 87

A. Chronic hypoxia from cyanotic congenital heart disease Rationale: Clubbing is a long-term adaptation to chronic hypoxia, often seen in cyanotic congenital heart disease. It is not a physiological finding in pregnancy. Buzz Words: Clubbing, chronic hypoxia, cyanotic congenital heart disease.

Question 88

Persistent neck vein distention in a pregnant woman is most indicative of: A. Right-sided heart failure or elevated central venous pressure B. Physiological venous compression by the gravid uterus C. Pulmonary hypertension alone D. Gestational anemia

Answer 88

A. Right-sided heart failure or elevated central venous pressure Rationale: Persistent jugular venous distention is a classic sign of right-sided heart failure or elevated CVP, often caused by pulmonary hypertension or tricuspid regurgitation. Buzz Words: Neck vein distention, right-sided heart failure, elevated CVP.

Question 89

A systolic murmur graded ≥3/6 in a pregnant woman is most likely to indicate: A. High-output state due to increased cardiac output B. Valvular lesions such as regurgitation or stenosis C. Physiological changes in pregnancy D. Gestational hypertension

Answer 89

B. Valvular lesions such as regurgitation or stenosis Rationale: A loud systolic murmur (grade ≥3/6) is pathological, often caused by valvular lesions like regurgitation or stenosis, and requires further evaluation. Buzz Words: Loud systolic murmur, valvular lesions, regurgitation, stenosis.

Question 90

Which murmur in pregnancy is always pathological and requires further evaluation? A. Functional systolic murmur B. Diastolic murmur C. Soft systolic murmur (1/6 or 2/6) D. Mid-systolic click

Answer 90

B. Diastolic murmur Rationale: A diastolic murmur is never physiological in pregnancy and is strongly associated with conditions like mitral stenosis or aortic insufficiency. Buzz Words: Diastolic murmur, pathological, mitral stenosis, aortic insufficiency.

Question 91

Cardiomegaly detected on imaging in a pregnant woman most commonly suggests: A. Chronic volume overload or cardiomyopathy B. Physiological cardiac remodeling C. Increased plasma volume of pregnancy D. Hyperdynamic circulation

Answer 91

A. Chronic volume overload or cardiomyopathy Rationale: Cardiomegaly often reflects chronic volume overload or cardiomyopathy, conditions that strain the myocardium over time. Buzz Words: Cardiomegaly, chronic volume overload, cardiomyopathy.

Question 92

Persistent tachycardia (>100 bpm) during pregnancy should prompt evaluation for: A. Arrhythmias or heart failure B. Increased metabolic demand of pregnancy C. Physiological hypervolemia D. Gestational anemia

Answer 92

A. Arrhythmias or heart failure Rationale: Persistent tachycardia (>100 bpm) warrants evaluation for arrhythmias (e.g., atrial fibrillation) or heart failure, especially when accompanied by other symptoms. Buzz Words: Tachycardia, arrhythmias, heart failure.

Question 93

Persistent splitting of the second heart sound (S2) in pregnancy is most indicative of: A. Pulmonary hypertension or right bundle branch block B. Increased venous return from uterine compression C. Physiological changes in pregnancy D. Gestational hypertension

Answer 93

A. Pulmonary hypertension or right bundle branch block Rationale: A persistently split second heart sound (S2) is pathological and often linked to pulmonary hypertension or right bundle branch block. Buzz Words: Split S2, pulmonary hypertension, right bundle branch block.

Question 94

A fourth heart sound (S4) during pregnancy is pathological and most likely associated with: A. Reduced ventricular compliance or aortic stenosis B. Increased cardiac output from pregnancy C. Physiological changes in myocardial relaxation D. Right-sided heart failure

Answer 94

A. Reduced ventricular compliance or aortic stenosis Rationale: A pathological S4 sound reflects reduced ventricular compliance, commonly associated with aortic stenosis or hypertensive heart disease. Buzz Words: S4, reduced ventricular compliance, aortic stenosis.

Question 95

Pulmonary hypertension in pregnancy is defined by which criterion? A. Pulmonary arterial pressure >25 mmHg at rest B. Pulmonary arterial pressure >30 mmHg during exertion C. Right atrial pressure >10 mmHg D. Mean arterial pressure >100 mmHg

Answer 95

A. Pulmonary arterial pressure >25 mmHg at rest Rationale: Pulmonary hypertension is defined as a pulmonary arterial pressure >25 mmHg at rest, a critical threshold for maternal and fetal complications. Buzz Words: Pulmonary hypertension, >25 mmHg, diagnostic threshold.