Thorax

Question 1

1. A 2 day old neonate is diagnosed with transposition of the great arteries. Which structure is responsible for the division of the truncus arteriosus into the great arteries?

A. Septum secundum
B. Septum primum
C. Bulbar septum
D. Aorticopulmonary septum
E. Endocardial cushions

Answer 1

D. Aorticopulmonary septum.
The aorticopulmonary septum functions to divide the truncus arteriosus and bulbis ccordis into the aorta and pulmonary trunk. Not C b/c the bulbar septum is derived from the bulbis cordis and will give rise to the IVS inf. to the aorticopulmonary septum, eventually fusing with it.

Question 2

2. A 32 year old woman in her third trimester of pregnancy is undergoing a routine ultrasound examination.The examination of the fetus reveals enlarged and echogenic lungs, inverted diaphragm, and fetal ascites. Which condition is best characterized by these signs?

A. Laryngeal atresia
B. Tracheal atresia
C. Polyhydramnios
D. Lung hypoplasia
E. Oligohydramnios

Answer 2

A. Laryngeal Atresia.
Laryngeal Atresia (congenital high airway obstruction syndrome) is a rare obstruction of the upper fetal airway. Distal to the site of the atresia, the airways dilate, lungs enlarge and become echogenic, the diaphragm flattens or inverts, and fetal ascites and/or hydrops develop.

Not B b/c tracheal atresia results from failure of or unequal division of the trachea and esophagus, and doesn’t present this way.

Not C b/c polyhydramnios is excess amniotic fluid, and it’s often associated with esophageal atresia and tracheoesophageal fistula (TEF).

Not E b/c Oligohydramnios is decrease in amniotic fluid, and is associated with pulmonary hypoplasia.

Question 3

A 2 yr old is seen in the pediatric cardiology unit for a congenital heart condition. Which of the following conditions occur most often?

A. Membranous ventricular septal defect (VSD)
B. Tetralogy of Fallot
C. Muscular VSD
D. Ostium secundum defect (OSD)
E. Ostium primum defect

Answer 3

A. VSD’s account for 25% of congenital heart defects. The most common of these are defects in the membranous portion of the IVS (membranous VSDs)

Question 4

A 2 day old is diagnosed w/ transposition of the great arteries. If this condition were to be left untreated for more than 4 months, it would be fatal. Which of the following structures must remain patent so that the infant can survive until surgical correction of the malformation?

A. Ductus arteriosus
B. Umbilical arteries
C. Umbilical vein
D. Coarctation of the aorta
E. Pulmonary stenosis

Answer 4

A. Ductus arteriosus must remain patent (PDA)
In a case of transposition of the great arteries, oxygenated blood travels from the left ventricle to the pulmonary trunk, where it will eventually reach the lungs. In contrast, the aorta would be carrying deoxygenated blood to the system, which is why a PDA is necessary for the oxygenated and deoxygenated blood to mix so that some oxygenated blood gets to the tissues.

Question 5

A 2 day old neonate female is diagnosed with pulmonary stenosis, overriding of the aorta, VSD, and hypertophy of the rt. ventricle. Which condition is best characterized by these signs?

A. Tetralogy of Fallot
B. Atrial septal defect (ASD)
C. Transposition of great vessels
D. Pulmonary atresia
E. VSD

Answer 5

A. Tetralogy of Fallot.
Tetralogy of Fallot presents w/

1. Pulmonary stenosis
2. Overriding of the aorta
3. VSD
4. Rt. ventricular hypertrophy

Question 6

A 5-yr old boy is admitted to the hospital with severe dyspnea. During physical examination a loud systolic murmur and a wide, fixed, split S2 sound is noted. What is the most likely diagnosis?

A. VSD
B. ASD
C. Tetralogy of Fallot
D. Transposition of great arteries
E. Aortic Stenosis

Answer 6

B. ASD
Heart murmur at S2 localizes the defect at an AV valve. ASD causes a diastolic murmur in the tricuspid valve.

Not E b/c aortic stenosis causes a murmur at S1.

This is wrong b/c TM1 and AP2
Tricuspid and mitral valve make the S1 sound
Aortic and pulmonary make the S2 sound
Correct answer is E.

Question 7

Match the genetic/congenital disorder with the heart defect:

1. DiGeorge syndrome
2. Maternal Diabetes
3. Trisomy 21 (Down’s)
4. Monosomy X (Turner’s)

A. Tetralogy of Fallot and truncus arteriosus
B. Coarctation of Aorta
C. ASDs and VSDs
D. Transposition of great arteries

Answer 7

1. A
2. D
3. C
4. B

Question 8

A 3yr old pt presents w/ a clinically significant ASD. The ASD usually results from incomplete closure of which of the following structures?

A. Foramen ovale
B. Ligamentum arteriosum
C. Ductus arteriosus
D. Sinus venarum
E. Coronary sinus

Answer 8

A. Foramen ovale
ASD is due to patent foramen ovale.
ASD is a communication betw. Rt. atrium and left atrium in the formation of the atrial septum. The foramen ovale, opening in the foramen secundum, usually closes at brth, but if it remains patent, than the pt has an ASD.

Not C b/c patent ductus arteriosus (PDA) is not associated w/ ASDs.

Question 9

A premature infant has RDS. Which cells are deficient in synthesizing surfactant in this syndrome?

A. Alveolar capillary endothelial 
B. Bronchial mucous
C. Bronchial respiratory epithelium
D. Type I alveolar
E. Type II alveolar

Answer 9

E. Type II alveolar

Type II alveolar cells are the only cells that synthesize surfactant