Congenital Heart Defects
A newborn exhibits difficulty breathing, a loud heart murmur, and bluish discoloration of the skin (cyanosis). Echocardiography reveals a ventricular septal defect and an overriding aorta. What congenital heart defect is most likely present?
A) Tetralogy of Fallot
B) Atrial Septal Defect (ASD)
C) Patent Ductus Arteriosus (PDA)
D) Ventricular Septal Defect (VSD)
A) Tetralogy of Fallot
Which week does the heart start beating?
week 4
A 60-year-old patient with a history of mitral valve prolapse develops infective endocarditis. Blood cultures identify the causative agent as an alpha-hemolytic, gram-positive cocci. What is the most likely organism responsible for this case?
A) Staphylococcus aureus
B) Streptococcus pneumoniae
C) Enterococcus faecalis
D) Streptococcus viridans
Answer: D) Streptococcus viridans
In a patient with severe mitral stenosis, how would the pressure-volume (PV) loop be affected?
A) The loop would shift to the right.
B) The loop would shift to the left.
C) The loop would become wider.
D) The loop would become narrower.
D) The loop would become narrower.
What imaging technique is often used for the prenatal diagnosis of congenital heart defects?
Ultrasound
In the formation of the atrial septum, the foramen ovale plays a crucial role in allowing blood to bypass the lungs during fetal development. Which embryonic structures contribute to the formation of the foramen ovale, and what cellular process is primarily involved in its closure after birth?
A) Septum primum and septum secundum; closure by apoptosis
B) Atrioventricular cushions and ductus arteriosus; closure by fibrosis
C) Bulbus cordis and truncus arteriosus; closure by endocardial cushion fusion
D) Neural crest cells and aorticopulmonary septum; closure by epithelial-to-mesenchymal transition (EMT)
A) Septum primum and septum secundum; closure by apoptosis
A patient with a history of intravenous drug use presents with fever, chills, and a new heart murmur. Echocardiography reveals vegetations on the tricuspid valve. What is the most likely causative agent of infective endocarditis in this case?
A) Streptococcus viridans
B) Staphylococcus aureus
C) Enterococcus faecalis
D) Escherichia coli
Answer:
B) Staphylococcus aureus
In a patient with heart failure, the pressure-volume (PV) loop demonstrates an increase in end-diastolic volume and a decrease in ejection fraction. Which of the following conditions is most likely contributing to this altered PV loop?
A) Aortic stenosis
B) Mitral regurgitation
C) Left ventricular hypertrophy
D) Dilated cardiomyopathy
D) Dilated cardiomyopathy
What are the five right-to-left shunts?
truncus arteriosus, transposition of the great vessels, tricuspid atresia, tetralogy of fallot, and total anomalous pulmonary venous return
A defect affecting the fetal blood vessel that connects the pulmonary artery to the descending aorta likely derives from which aortic arch?
6th aortic arch (Ductus arteriosus defect)
In the management of infective endocarditis, which drug class is commonly recommended as prophylaxis for individuals undergoing certain dental or invasive procedures to prevent bacterial endocarditis?
A) Penicillins
B) Fluoroquinolones
C) Aminoglycosides
D) Beta-lactamase inhibitors
A) Penicillins (like amoxicillin)
What may arise from a variety of factors, including underlying medical conditions such as congenital heart defects or cystic fibrosis, nutritional challenges like inadequate caloric intake, environmental influences such as exposure to toxins, and neglect?
Failure to thrive
For survival, hypoplastic left heart syndrome requires which two shunts?
Atrial Septal Defect (or PFO) and Patent Ductus Arteriosus
Describe the pathway of flow for the majority of the oxygenated blood in fetal circulation (starting with the IVC).
IVC -> Right atrium -> foramen ovale -> Left atrium -> Left ventricle -> aorta -> brain and rest of circulation
A 23-year-old man who injects heroin is brought to the hospital by paramedics after being found unconscious and resuscitated with naloxone. His temperature is 39°C (102.2°F). Upon examination, there is a prominent jugular venous pulse and a “blowing” systolic heart murmur loudest at the left lower sternal border. The murmur varies with respiration, becoming louder with inspiration.
Which of the following is the most likely cardiac diagnosis in this patient?
A. Aortic regurgitation
B. Aortic stenosis
C. Mitral regurgitation
D. Mitral stenosis
E. Tricuspid regurgitation
F. Tricuspid stenosis
E. Tricuspid Regurgitation
A 60-year-old man with a history of systolic heart failure is brought to the emergency department because of shortness of breath. Auscultation of the chest discloses diffuse pulmonary crackles and an S3 heart sound.
Which point on the Jugular Venous Pressure tracing best corresponds to the patient’s third heart sound?
y-descent
What is the treatment for Transposition of the Great Vessels without a VSD?
Ballon atrial septostomy (BAS)
A 1-hour-old newborn boy is evaluated for cyanosis of the fingers and lips that does not change with high-flow oxygen. S1 and S2 are normal on examination. Further studies show that the blood in the pulmonary arteries has higher oxygen content than does the blood in the ascending aorta. Echocardiography shows bifurcating pulmonary artery arising posteriorly from the left ventricle in the parasternal long-axis view.
Which of the following is most likely responsible for this newborn’s condition?
A Congenital agenesis of tricuspid valve
B Defect in the septum primum
C Failure of the aorticopulmonary septum to spiral
D Failure of the pulmonary veins to connect to the left atrium
E Patent of the ductal portion of the 6th aortic arch
C Failure of the aorticopulmonary septum to spiral
A 24-year-old man comes to the clinic because of a 3-day history of fever, night sweats, and fatigue. He has become short of breath in the past day. He has a history of congenital valvular heart disease. Temperature is 39.4°C (103°F) and oxygen saturation is 88% on room air. Physical examination reveals a new holosystolic murmur best heard at the apex. Skin examination reveals multiple 1- to 2-mm red-purple spots on both legs, but no increase in temperature or lower limb swelling.
If the patient is not treated, which of the following complications is most likely to occur in the next month?
A. Impetigo
B. Pulmonary embolus
C. Pyelonephritis
D. Renal artery stenosis
E. Stroke
F. Ventricular hypertrophy
E. Stroke
A 72-year-old man presents with new onset of palpitations. His ECG shows a narrow complex arrhythmia with an irregularly irregular rhythm at a rate of 170 beats/min. P waves are absent.
Which component of Jugular Venous pressure tracing is most likely to be abnormal in this patient?
A wave