THE CARDIOVASCULAR SYSTEM

1
THE CARDIOVASCULAR SYSTEM

• JAMEEL AL-ATA, M.D.
• Assistant Professor Consultant Pediatric
  Cardiologist
• King Abdulaziz University Hospital

2
The finding of substernal thrust on palpation of
the precordium is most likely to be associated
with which one of the following?
1.
a.
Left ventricular hypertrophy
b.
Right ventricular hypertrophy
c.
An ejection click
d.
Systemic hypertension
e.
Pericardial effusion
3
2.
A still murmur is
a.
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
4
Electrocardiograms are useful in the diagnosis of
each of the following EXCEPT
3.
a.
Congenital heart disease
b.
Rheumatic heart disease
c.
Electrolyte disorders
d.
Endocrine and metabolic disease
e.
Prematurity
5
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 syndrome
c.
Right ventricular outflow obstruction
d.
Coarctation of the aorta
e.
Endocardial fibroelastosis
6
Congenital rubella syndrome is associated with
which of the following?
5.
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 ASD
e.
VSD and pulmonary artery stenosis
7
Which of the following is the most common
congenital heart defect in infants and children
(excluding the neonatal period)?
6.
a.
ASD
b.
VSD
c.
PDA
d.
Coarctation of the aorta
e.
Tetralogy of Fallot
8
Tetralogy of Fallot consists of each of the
following cardiac malformations EXCEPT
7.
a.
Pulmonary stenosis
b.
VSD
c.
ASD
d.
Dextroposition of the aorta
e.
Right ventricular hypertrophy
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8.
Each of the following statements about
transposition of the great arteries is true EXCEPT
a.
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
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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.
Echocardiography
c.
Blalock-Taussig procedure (subclavian pulmonary
anastomosis)
d.
Brock procedure (infundibular resection)
e.
Home oxygen availability
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14
Which one of the following is NOT present in
tricuspid atresia?
10.
a.
Left axis deviation on electrocardiogram
b.
Patent foramen ovale
c.
Right ventricular hypoplasia
d.
Split second heart sound
e.
Diminished pulmonary vascularity on plain
anteroposterior chest film
15
Which of the following statements regarding
ventricular septal defect is correct?
11.
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
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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 ovale
e.
It causes heart failure in 50 of infants with
the defect
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18
Which of the following is the most serious atrial
septal defect?
13.
a.
Ostium primum defect
b.
Ostium secundum defect
c.
Endocardial cushion defect with common
atrioventricular canal
d.
Patent foramen ovale
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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 pressure
b.
Pulmonary hypertension
c.
Systemic hypotension
d.
Mitral stenosis
e.
Tricuspid stenosis
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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 artery
e.
At the level of the diaphragm
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16.
In total anomalous pulmonary venous return, the
anomalous vein most often enters the
a.
Coronary sinus
b.
Left superior vena cava
c.
Right superior vena cava
d.
Portal vein
e.
Ductus venosus
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17.
The syndrome of idiopathic hypercalcemia,
hypertelorism, and mental retardation is
associated with which one of the following?
a.
Supravalvular aortic stenosis
b.
Valvular aortic stenosis
c.
Subvalvular aortic stenosis
d.
Aortic insufficiency
e.
Patent ductus arteriosus
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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.
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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).
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19.
Reversion of this patients electrocardiogram to
normal will occur most readily with which of the
following?
a.
Vagal stimulation
b.
Digoxin
c.
Quinidine
d.
D-C cardioversion
e.
Phenytoin-(Dilantin)
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20.
The most common underlying factor in children who
develop acute bacterial endocarditis is which of
the following?
a.
Congenital heart disease
b.
Dental surgery
c.
Streptococcal pharyngitis
d.
Acute rheumatic fever
e.
Tonsillectomy
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21.
Which of the following is the most important
procedure in the diagnosis of subacute bacterial
endocarditis?
a.
Complete blood count
b.
Urinalysis (microscopic)
c.
Erythrocyte sedimentation rate
d.
Blood cultures
e.
Electrocardiogram
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22.
Which of the following is the most common
immediate valvular lesion resulting from acute
rheumatic fever?
a.
Mitral insufficiency
b.
Mitral stenosis
c.
Aortic insufficiency
d.
Aortic stenosis
e.
Tricuspid insufficiency
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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 pressure
b.
Decreased liver size
c.
Decreased P-R interval on electrocardiogram
d.
Decreased heart rate
e.
Increased urinary output
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24.
Pulsus paradoxus is associated with
a.
pericarditis
b.
endocarditis
c.
Rheumatic fever
d.
myocarditis
e.
Postperfusion syndrome
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25.
The combination of tachycardia, enlarged liver, a
cardiac gallop without murmurs, and a cranial
bruit is most likely
a.
Congestive heart failure from viral myocarditis
b.
Congestive heart failure from mucocutaneous lymph
node syndrome
c.
Congestive heart failure from an intracranial
hemangioma
d.
Thyrotoxicosis
e.
Aneurysm of the circle of Willis (intracranial
aneurysm)
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26.
Potentially curable forms of hypertension in
children include each of the following EXCEPT
a.
Neuroblastoma
b.
Pheochromocytoma
c.
Medullary cystic disease
d.
Renal artery stenosis
e.
Ingestion of excessive amounts of licorice
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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
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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.
38
Important other history would include which of
the following? (Choose as many as are
appropriate).
28.
a.
Renal trauma
b.
Immunizations
c.
Drug use
d.
Smoking
e.
Visual problems
f.
Nocturnal cough
g.
Personality change
h.
Excessive sweating
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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?
29.
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Cont. (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
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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
1.51 indicates renal involvement on the side
with the higher level
e.
The natural history of essential hypertension is
not known
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31.
The most common cardiac tumor in childhood is
a.
Rhabdomyosarcoma
b.
Mesothelioma
c.
Papilloma
d.
Lipoma
e.
Myxoma