"TUF"Questions
Mumble Jumble
Short Cuts
Watch the "Arch"
Falling off the Cliff
100
This anatomic abnormality is the primary lesion that drives all other components of Tetralogy of Fallot.
A. Overriding aorta
B. Ventricular septal defect
C. Right ventricular hypertrophy
D. Anterior malalignment of the infundibular septum
What is Anterior Malalignment of the infundibular septum ?
100
This anatomic feature most reliably distinguishes right atrial isomerism from left atrial isomerism.
A. Orientation of the cardiac apex
B. Bronchial anatomy
C. Presence or absence of a spleen
D. Ventricular looping pattern
What is bronchial anatomy
100
This extracardiac arteriovenous connection is the most common cause of high-output cardiac failure in neonates.
A. Pulmonary arteriovenous malformation
B. Cerebral arteriovenous malformation
C. Vein of Galen malformation
D. Coronary arteriovenous fistula
What is Vein of Galen malformation?
100
These are two famous Utah arches
What is delicate arch ?
What is Turret arch?
100
This ventilatory change most improves pulmonary blood flow and oxygenation in a mechanically ventilated Glenn patient.
What is reducing PEEP and allowing spontaneous or negative-pressure breathing?
200
This anatomic feature most strongly predicts the need for a transannular patch during TOF repair.
A. Degree of aortic override
B. Size of the ventricular septal defect
C. Pulmonary valve annulus hypoplasia
D. Severity of right ventricular hypertrophy
What is Pulmonary valve annulus hypoplasia
200
In left atrial isomerism, this venous abnormality often alters systemic venous return and impacts surgical planning.
A. Persistent left superior vena cava
B. Interrupted inferior vena cava with azygous continuation
C. Total anomalous pulmonary venous return
D. Inferior sinus venosus defect
What is interrupted IVC with azygous conitnuation
200
This anatomic feature best explains why large hepatic hemangiomas can cause profound cardiovascular compromise in infants.
A. Direct drainage into the portal venous system
B. High-flow arterial input with low-resistance venous drainage
C. Compression of hepatic veins causing venous obstruction
D. Associated pulmonary venous abnormalities
What is high-flow arterial input with low resistance venous drainage?
200
In critical coarctation, prostaglandin improves systemic perfusion primarily by reversing this physiologic derangement.
A. Pulmonary overcirculation
B. Right-to-left ductal shunting
C. Excessive left ventricular preload
D. Pathologic left ventricular afterload
What is pathological left ventricular after load?
200
Progressive cyanosis and polycythemia in a Glenn patient with preserved ventricular function are most often due to this adaptation.
A. Pulmonary AV malformations
B. Venovenous collaterals
C. Progressive AV valve regurgitation
D. Ventricular diastolic dysfunction
What are veno-venous collaterals
300
During a hypercyanotic (“tet”) spell, this physiologic change is the primary cause of acute hypoxemia.
A. Sudden increase in pulmonary vascular resistance
B. Increased right-to-left shunting due to RVOT obstruction
C. Decreased systemic venous return
D. Acute left ventricular systolic dysfunction
What is Increased right to left shunting due to RVOT obstruction
300
This gastrointestinal abnormality is common in infants with heterotaxy syndrome and is the primary reason for heightened concern about acute abdominal emergencies.
A. Duodenal atresia
B. Intestinal malrotation
C. Hirschsprung disease
D. Necrotizing enterocolitis
What is intestinal malrotation?
300
In infants with large extracardiac AV shunts, this physiologic change is the primary driver of ventricular dilation and heart failure.
A. Increased pulmonary vascular resistance
B. Increased systemic vascular resistance
C. Increased venous return (preload)
D. Decreased myocardial contractility
What is increased venous return?
300
On Doppler echocardiography, this finding best indicates significant coarctation rather than isolated flow acceleration.
A. Peak instantaneous gradient >20 mmHg
B. Turbulent color flow at the isthmus
C. Diastolic runoff with a saw-tooth Doppler pattern
D. Increased velocity in the ascending aorta
What is diastolic run off with a saw tooth doppler pattern
300
A Glenn patient with preserved ventricular function, stable saturations, hepatomegaly, ascites, pleural effusions, and rising venous pressures best fits this single-ventricle failure phenotype.
What is Glenn Pathway failure / Obstruction ?
400
This bedside maneuver improves oxygenation during a tet spell primarily by increasing this physiologic parameter
What is knee-chest positioning and what is increasing SVR
400
This physiologic complication is a major contributor to early postoperative instability in heterotaxy patients, independent of cardiac anatomy.
A. Pulmonary vascular disease
B. Ventricular diastolic dysfunction
C. Abnormal atrioventricular conduction system
D. Systemic inflammatory response
What is an abnormal atrioventricular conduction system?
400
Despite preserved ventricular systolic function, infants with large extracardiac AV shunts often develop systemic hypoperfusion due to this mechanism.
A. Reduced coronary artery perfusion
B. Decreased oxygen delivery from anemia
C. Preferential flow through low-resistance shunt beds
D. Impaired pulmonary gas exchange
What is preferential flow through low-resistance shunt beds ?
400
This percentage of patients with coarctation of the aorta have this associated congenital cardiac anomaly, which is the most common coexisting defect.
What is bicuspid aortic valve and more than 50%
400
In a failing Glenn with preserved systolic function, this finding most strongly argues against proceeding to Fontan completion.
A. Mild systemic desaturation
B. Venovenous collaterals
C. Elevated pulmonary vascular resistance
D. Moderate AV valve regurgitation
What is elevated pulmonary vascular resistance
500
An adolescent with repaired Tetralogy of Fallot (transannular patch in infancy) has severe pulmonary regurgitation. Name 4 other parameters that help you suggest a management strategy from a ventricular mechanics and arrhythmia-prevention standpoint ?
What is RVEDV, RVEF, QRS duration, exercise tolerance and Arrhythmias
500
A child with heterotaxy syndrome, left atrial isomerism, balanced AV canal, interrupted IVC with azygous continuation, normal pulmonary venous return, and preserved ventricular function is being evaluated for cavopulmonary palliation. This surgical modification optimizes systemic venous routing and long-term Fontan physiology.
What is kawashima procedure
500
A neonate with severe high-output cardiac failure, pulmonary overcirculation, and systemic hypoperfusion due to a large extracardiac AV shunt is refractory to maximal medical therapy. This management strategy most directly addresses the underlying pathophysiology while minimizing acute hemodynamic collapse.
What is Staged catheter or surgical based shunt reduction?
500
In infants with coarctation and aortic arch hypoplasia, this specific anatomic measurement identifies patients who are unlikely to achieve adequate arch growth following conventional subclavian flap aortoplasty or resection with end-to-end anastomosis, thereby requiring extended arch repair to prevent long-term hypertension and reintervention
What is arch index ? - Transverse arch to ascending aorta ratio of <0.25
500
A Glenn patient has preserved ventricular systolic function, normal indexed PVR, acceptable oxygen saturation, recurrent pleural effusions, ascites, rising hepatic congestion, and a Glenn pressure of 17 mmHg. Cardiac catheterization shows no anatomic obstruction.
What is the primary driver of failure?
What is ventricular diastolic dysfunction ?