THE CARDIOVASCULAR SYSTEM

JAMEEL AL-ATA, M.D.

Assistant Professor & Consultant Pediatric Cardiologist

King Abdulaziz University Hospital

1. The finding of substernal thrust on palpation of the precordium is most likely to be associated with which one of the following?

a. Left ventricular hypertrophy

b. Right ventricular hypertrophyc. An ejection click

d. Systemic hypertensione. Pericardial effusion

2. A still murmur isa. An early diastolic murmur signifying

mitral stenosis

b. An innocent murmur that disappears on jugular pressure

c. An innocent, musical, vibratory ejection murmur heard best when the patient is in the recumbent position

d. An innocent, blowing, early systolic murmur that increases in intensity on expiration

e. A blowing diastolic murmur most frequently heard in the newborn period

3. Electrocardiograms are useful in the diagnosis of each of the following EXCEPT

a. Congenital heart disease

b. Rheumatic heart diseasec. Electrolyte disorders

d. Endocrine and metabolic diseasee. Prematurity

4. Each of the following is a critical congenital heart disease of the neonate EXCEPT

a. Transposition of the great vessels

b. Hypoplastic left heart syndromec. Right ventricular outflow obstruction

d. Coarctation of the aortae. Endocardial fibroelastosis

5. Congenital rubella syndrome is associated with which of the following?

a. Patent ductus arteriosus (PDA) and branch pulmonary artrery stenosis

b. Ventricular septal defect (VSD) and PDA

c. Atrial septal defect (ASD) and PDA

d. VSD and ASDe. VSD and pulmonary artery stenosis

6. Which of the following is the most common congenital heart defect in infants and children (excluding the neonatal period)?

a. ASD

b. VSDc. PDA

d. Coarctation of the aortae. Tetralogy of Fallot

7. Tetralogy of Fallot consists of each of the following cardiac malformations EXCEPTa. Pulmonary stenosis

b. VSDc. ASD

d. Dextroposition of the aortae. Right ventricular hypertrophy

8. Each of the following statements about transposition of the great arteries is true EXCEPTa. It is the primary cause of death from

cyanotic congenital heart disease in the first year of life

b. Congestive heart failure occurs by 4 months of age when a VSD is present

c. A VSD, PDA, and/or an ASD must be present for the newborn to survive

d. The electrocardiogram is often normal initially in the newborn period

e. More females than males are affected

9. In recent years the development of which of the following has improved the survival rate of infants with transposition of the great arteries?a. Rashkind procedure (balloon atrial

septostomy)

b. Echocardiographyc. Blalock-Taussig procedure (subclavian

pulmonary anastomosis)

d. Brock procedure (infundibular resection)e. Home oxygen availability

10. Which one of the following is NOT present in tricuspid atresia?a. Left axis deviation on electrocardiogram

b. Patent foramen ovalec. Right ventricular hypoplasia

d. Split second heart sounde. Diminished pulmonary vascularity on

plain anteroposterior chest film

11. Which of the following statements regarding ventricular septal defect is correct?

a. It is most easily diagnosed at birth

b. Congestive heart failure usually develops within the first month of life

c. The defect is usually small and closes spontaneously

d. Surgery should usually be performed within the first six months to prevent subacute bacterial endocarditis

e. Pulmonary hypertension will develop rapidly if the defect is not treated surgically

12. Which one of the following statements about atrial septal defect is true?

a. The murmur is caused by rapid flow from the left atrium to the right atrium

b. The second heart sound is variably split

c. High flow through the pulmonary artery causes a palpable thrill at the upper left sternal border

d. The defect is a patent foramen ovalee. It causes heart failure in 50% of infants

with the defect

13. Which of the following is the most serious atrial septal defect?a. Ostium primum defect

b. Ostium secundum defectc. Endocardial cushion defect with

common atrioventricular canald. Patent foramen ovale

14. A diastolic as well as a systolic murmur in a child with a patent ductus arteriosus generally indicates which one of the following?a. Normal or only slightly elevated

pulmonary arterial pressureb. Pulmonary hypertensionc. Systemic hypotension

d. Mitral stenosise. Tricuspid stenosis

15. The majority of coarctations of the aorta occur

a. Between the origin of the right subclavian artery and the right carotid artery

b. Between the right and left carotid arteries

c. Between the left carotid artery and the left subclavian artery

d. Below the left subclavian arterye. At the level of the diaphragm

16. In total anomalous pulmonary venous return, the anomalous vein most often enters the

a. Coronary sinusb. Left superior vena cavac. Right superior vena cava

d. Portal veine. Ductus venosus

17. The syndrome of idiopathic hypercalcemia, hypertelorism, and mental retardation is associated with which one of the following?

a. Supravalvular aortic stenosisb. Valvular aortic stenosisc. Subvalvular aortic stenosis

d. Aortic insufficiencye. Patent ductus arteriosus

QUESTIONS 18-19

A teenage girl comes to the clinic complaining that her “heart beats fast sometimes”. She is otherwise well, healthy, and doing well in school. She denies taking any drugs, and she does not smoke cigarettes. Physical examination is unremarkable. Pulse rate is 80 per minute. You decide to do an electrocardiogram.

18. Below are five electrocardiograms. Which is most likely to be from this patient? (If you were to have a tracing when she is symptomatic).

19. Reversion of this patient’s electrocardiogram to normal will occur most readily with which of the following?

a. Vagal stimulationb. Digoxinc. Quinidine

d. D-C cardioversione. Phenytoin-(Dilantin)

20. The most common underlying factor in children who develop acute bacterial endocarditis is which of the following?

a. Congenital heart diseaseb. Dental surgeryc. Streptococcal pharyngitis

d. Acute rheumatic fevere. Tonsillectomy

21. Which of the following is the most important procedure in the diagnosis of subacute bacterial endocarditis?

a. Complete blood countb. Urinalysis (microscopic)c. Erythrocyte sedimentation rate

d. Blood culturese. Electrocardiogram

22. Which of the following is the most common immediate valvular lesion resulting from acute rheumatic fever?

a. Mitral insufficiencyb. Mitral stenosisc. Aortic insufficiency

d. Aortic stenosise. Tricuspid insufficiency

23. Evidence that digitalis has had an effect in an infant with congestive heart failure would include each of the following EXCEPT

a. Diminished venous pressureb. Decreased liver sizec. Decreased P-R interval on

electrocardiogramd. Decreased heart ratee. Increased urinary output

24. Pulsus paradoxus is associated with

a. pericarditisb. endocarditisc. Rheumatic fever

d. myocarditise. Postperfusion syndrome

25. The combination of tachycardia, enlarged liver, a cardiac gallop without murmurs, and a cranial bruit is most likelya. Congestive heart failure from viral

myocarditis

b. Congestive heart failure from mucocutaneous lymph node syndrome

c. Congestive heart failure from an intracranial hemangioma

d. Thyrotoxicosise. Aneurysm of the circle of Willis

(intracranial aneurysm)

26. Potentially curable forms of hypertension in children include each of the following EXCEPTa. Neuroblastomab. Pheochromocytoma c. Medullary cystic disease

d. Renal artery stenosise. Ingestion of excessive amounts of

licorice

27. Each of the following statements about hyperlipidemia in children is true EXCEPT

a. Screening programs have not been shown to be cost beneficial

b. Cholesterol is the major blood lipid implicated in the pathogenesis of arteriosclerotic heart disease

c. Dietary regulation is the most important treatment modality

d. Colestipol is the most effective cholesterol-lowering agent available

e. Surgical therapy (portocaval shunts) has shown promising results

QUESTIONS 28-29

A 16-year old girl comes to your office because of dizziness and throbbing heartaches occurring two or three times a day. She has no other complaints and is otherwise in good health. There is no family history of hypertension.

28. Important other history would include which of the following? (Choose as many as are appropriate).a. Renal traumab. Immunizationsc. Drug use

d. Smokinge. Visual problemsf. Nocturnal coughg. Personality changeh. Excessive sweating

29. There is no history of renal trauma. Immunizations are up to date. She neither smokes nor drinks, but does take oral contraceptives. Her vision is fine, and she has no cough at all. There has been no personality change or excessive sweating. On physical examination you find that blood pressure is 140/100 mm Hg; pulse is 90 per minute; height and weight are in the 25th percentile. The remainder of the physical examination including funduscopic examination and complete neurologic examination, is normal. There are no abdominal bruits, and her thyroid gland is normal. Which one of the following would be indicated at this point?

Con’t. (29)

a. Repeat blood pressure measurements at least twice over the next few weeks

b. Order complete blood count, urinalysis, urine culture, and intravenous urogram

c. Measure urinary catecholamines, 17-hydroxysteroids, and 7-ketosteroids

d. Tell her to discontinue oral contraceptives

e. Begin antihypertensive therapy

30. Each of the following is true about hypertension in children EXCEPT

a. Essential hypertension is the most common form

b. Most newborns with hypertension have hyperthyroidism

c. Renal disease if the most likely etiology in childhood if hypertension is secondary

d. A discrepancy in renin secretion of greater than 1.5:1 indicates renal involvement on the side with the higher level

e. The natural history of essential hypertension is not known

31. The most common cardiac tumor in childhood is

a. Rhabdomyosarcoma b. Mesothelioma c. Papilloma

d. Lipoma e. Myxoma