Deck 23: Circulation and the Heart

Question 1

What is the threshold of the width of the normal heart shadow (maximal size of the internal dimension of the thorax that is still normal) on a PA chest radiograph, taken with a typical protocol?

A) 15%
B) 25%
C) 50%
D) 75%

Answer 1

50%

Question 2

Which of the following diagnostic imaging modalities may be helpful in providing anatomic and functional information about patients with valvular heart disease?

A) Conventional chest radiography
B) Magnetic resonance imaging
C) Nuclear scintigraphy
D) Doppler ultrasonography

Answer 2

Doppler ultrasonography

Question 3

Localized dilatation evident arterial wall involving all three arterial layers describes a __________ aneurysm.

A) false
B) true
C) cystic
D) saccular

Answer 3

true

Question 4

Which of the following aneurysm types is associated with vessel tear commonly near the ligamentum arteriosum?

A) Congenital
B) Posttraumatic
C) Atherosclerotic
D) Mycotic

Question 5

A(n) __________ aorta appearance may result from the rupture of the tunica intima with reconnection of the associated hematoma with the aortic lumen.

A) tortuous
B) uncoiled
C) double barrel
D) saccular

Question 6

Which of the following heart chambers may be enlarged due to tricuspid valve disease?

A) Right atrium
B) Left atrium
C) Right ventricle
D) Left ventricle

Question 7

Which of the following is the most common cause of aneurysm?

A) Atherosclerosis
B) Syphilis
C) Cystic medial necrosis
D) Posttraumatic conditions

Question 8

The most common artery involved with aneurysm is the __________.

A) thoracic aorta
B) descending aorta
C) iliac artery
D) popliteal artery

Question 9

Which part of the aorta is commonly involved in aneurysms associated with syphilis?

A) Ascending
B) Thoracic
C) Suprarenal abdominal
D) Infrarenal abdominal

Question 10

Hematomas associated with aortic dissection commonly result from vasa vasorum hemorrhage related to __________.

A) cystic medial necrosis
B) posttraumatic conditions
C) mycoses
D) hypertension

Question 11

Acquired valvular heart disease may be caused by all of the following except __________.

A) arteriosclerosis
B) hypertension
C) rheumatic fever
D) pulmonary venous hypertension

Question 12

Mediastinal lesions that follow the contour of the aorta usually raise concern for which of the following?

A) Aortic aneurysm
B) Teratoma
C) Neurofibroma
D) Ventricular aneurysm

Question 13

Cystic medial necrosis-related aneurysm is seen in patients with __________.

A) congenital discontinuity of the aortic wall.
B) Takayusa disease
C) Marfan syndrome
D) syphilis

Question 14

The terms "butterfly," "bat's wings," "sunburst," and "fan-shaped" are all descriptions of the radiographic appearance of pulmonary edema, described by which of the following?

A) Interstitial pattern proximally, air-space pattern distally in the lung
B) Interstitial pattern distally, air-space pattern proximally in the lung
C) Interstitial pattern distally and proximally in the lung
D) Air-space pattern distally and proximally in the lung

Question 15

Hematoma with separation of the middle and outer third of the aortic wall longitudinally, with proximal and distal extension, describes an aortic __________.

A) aneurysm
B) dissection
C) delamination
D) arteritis

Question 16

In aortic dissection, inward displacement of a calcified atherosclerotic plaque more than 1 cm from the outer vessel wall in the descending aorta is known as the _________ sign.

A) calcification
B) thumbnail
C) fleck
D) migration

Question 17

Which of the following is not a radiographic feature of pulmonary edema due to congestive heart failure?

A) Enlarged heart shadow
B) Caudalization of blood flow
C) Peribronchial cuffing
D) Pleural effusion

Question 18

Assuming the fluid is free to move, what portion of the angles is most likely to contain effusion on upright PA and lateral chest radiograph?

A) Posterior costophrenic
B) Lateral costophrenic
C) Left cardiophrenic
D) Right cardiophrenic

Question 19

Large left ventricle, prominent ascending arch, small aortic knob, and valve calcification are associated with __________.

A) aortic stenosis
B) aortic insufficiency
C) mitral valve prolapse
D) mitral stenosis

Question 20

Which of the following causes of acquired valvular heart disease is most common in underdeveloped countries?

A) Rheumatic fever
B) Congenital heart defects
C) Atherosclerosis
D) Hypertension

Question 21

Which of the following is the most common congenital heart defect recognized in adults?

A) ASD
B) VSD
C) TAPVR
D) Aortic stenosis

Question 22

What percentage of aneurysms greater than 10 cm are expected to rupture?

A) 20%
B) 40%
C) 60%
D) 80%

Question 23

Patients with congenital heart disease are categorized based on the presence or absence of __________.

A) aortic coarctation
B) floppy mitral valve
C) cyanosis
D) cardiac contour abnormality

Question 24

Dense, 1-2 mm horizontal lines perpendicular to the pleural of the lower lung in a patient with pulmonary edema are known as Kerley ____ lines.

A) A
B) B
C) C
D) D

Question 25

Which of the following is the most common congenital heart defect associated with cyanosis after 1 year of age?

A) Tricuspid atresia
B) Ebstein anomaly
C) Pulmonary stenosis
D) Tetralogy of Fallot

Question 26

Aneurysms of the aortic arch or descending aorta rarely rupture if their diameter is less than __________.

A) 10 cm
B) 6 cm
C) 5 cm
D) 3 cm

Question 27

Which of the following is associated with injury to the thoracic duct and leaking lymphatic fluid into the pleural space?

A) Hydrothorax
B) Hemothorax
C) Chylothorax
D) Pneumothorax

Question 28

A(n) __________ sign is created when capillary pressure draws effusion upward along the body wall.

A) bat wing
B) pseudotumor
C) extrapleural
D) meniscus

Question 29

Which of the following is the most common clinical presentation for patients with aneurysm of the aorta?

A) Asymptomatic
B) Sternal chest pain
C) Dyspnea
D) Vena cava syndrome

Question 30

Cardiac evaluation indicates a patient has high-output cardiac failure in spite of normal preload, afterload, myocardial contractility, and heart rate. Which of the following conditions is most likely the underlying cause?

A) Takayusa disease
B) Rheumatic fever
C) Paget's disease
D) Mild anemia

Question 31

A blood pressure difference of __________ mm Hg is strongly suggestive of coarctation of the aorta.

A) 5
B) 10
C) 15
D) 20

Question 32

Accumulation of more than __________ milliliters of fluid in the pleural space is indicative of pleural effusion.

A) 2
B) 4
C) 5
D) 10

Question 33

Which of the following is the most common cause of pulmonary edema?

A) Left-sided heart disease
B) Right-sided heart disease
C) Near drowning
D) Renal failure

Question 34

Which of the following is the most common congenital heart defect?

A) Bicuspid aortic valve
B) Atrial septal defect
C) Ventricular septal defect
D) Patent ductus arteriosus

Question 35

Which radiographic projection would be most beneficial in assessing small, early pleural effusions?

A) PA chest
B) Lateral chest
C) Lateral decubitus
D) Apical lordotic

Question 36

Inward deformity of the proximal descending aorta with bulging of the vessel immediately above and below is associated with the __________ sign.

A) S
B) figure 3
C) gull wing
D) aortic knob

Question 37

Bat wing, butterfly, and perihilar haze appearances are associated with __________.

A) pleural effusion
B) pulmonary edema
C) cephalization of blood flow
D) thickening of the interlobar fissures

Question 38

Tetralogy of Fallot is composed of obstructive pulmonary outflow tract, right ventricular hypertrophy, aorta overriding the interventricular septum, and __________.

A) atrial septal defect
B) ventricular septal defect
C) patent ductus arteriosus
D) coarctation of the aorta

Question 39

Hypertrophy of the intercostal arteries causing inferior rib notching is the result of collateral circulation developing as a result of __________.

A) acquired valvular disease
B) coarctation of the aorta
C) congenital heart disease
D) congestive heart failure

Question 40

Which of the following is representative of interstitial accumulation of fluid associated with congestive heart failure?

A) Thickening of the interlobar fissures
B) Pulmonary edema
C) Kerley lines
D) Pleural effusion

Question 41

A 58-year-old male patient presents with acute onset chest pain, dyspnea, cough, and hemoptysis. Chest radiographic examination reveals decreased vascular markings in the left midlung as well as a triangular pleural-based radiopacity distally, adjacent to the chest wall. Which of the following diagnostic imaging modalities would be most helpful in initial follow-up?

A) Magnetic resonance imaging
B) Ventilation and perfusion radionuclide scan
C) Conventional tomography
D) Expiration radiographs