Test Bank For Gray's Anatomy for Students 4th Edition
By Richard L. Drake; A. Wayne Vogl; Adam W. M.
Mitchell
1 A 2-day-old newborn is diagnosed with transposition of the great arteries. Which
structure is responsible for the division of the truncus arteriosus into the great
arteries?
A. Septum secundum
B. Septum primum
C. Bulbar septum
D. Aorticopulmonary septum
E. Endocardial cushions - ANSWER:1 D. The aorticopulmonary septum functions to
divide the truncus arteriosus and bulbus cordis into the aorta and
pulmonary trunk. The septum secundum forms an
incomplete separation between the two atria. The septum
primum divides the atrium into right and left halves. The
bulbar septum is derived from the bulbus cordis and will
give rise to the interventricular septum inferior to the
aorticopulmonary septum, eventually fusing with it. The
endocardial cushions play a role in the division of the AV
canal into right and left halves, by causing the AV cushions
to approach each other.
2 A 32-year-old woman in her third trimester of pregnancy is undergoing a routine
ultrasound examination. The examination of the fetus reveals enlarged and
echogenic lungs, inverted diaphragm, and fetal ascites. Which condition is best
characterized by these signs?
A. Laryngeal atresia
B. Tracheal atresia
C. Polyhydramnios
D. Lung hypoplasia
E. Oligohydramnios - ANSWER:2 A. Laryngeal atresia (congenital high airway
obstruction
syndrome) is a rare obstruction of the upper fetal airway.
Distal to the site of the atresia, the airways dilate, lungs
enlarge and become echogenic, the diaphragm flattens or
inverts, and fetal ascites and/or hydrops develop. Tracheal
atresia is a rare obstruction of the trachea, commonly found
with a tracheoesophageal fistula, probably resulting from
the unequal division of foregut into esophagus and trachea.
Polyhydramnios is an excess of amniotic fluid, often
associated with esophageal atresia or tracheoesophageal
fistula. Lung hypoplasia is reduced lung volume, often seen
in infants with a congenital diaphragmatic hernia.
Oligohydramnios, or a decrease in amniotic fluid, is
,associated with stunted lung development and pulmonary
hypoplasia.
3 A 2-year-old child is seen in the pediatric cardiology unit for a congenital heart
condition. Which of the following conditions occurs most often?
A. Membranous ventricular septal defect
B. Tetralogy of Fallot
C. Muscular ventricular septal defect
D. Ostium secundum defect
E. Ostium primum defect - ANSWER:3 A. Ventricular septal defects account for 25%
of
congenital heart defects. The most common of these are
defects in the membranous portion of the interventricular
septum (membranous ventricular septal defects).
4 A 2-day-old is diagnosed with transposition of the great arteries. If this condition
were to be left untreated for more than 4 months, it would be fatal. Which of the
following structures must remain patent so that the infant can survive until surgical
correction of the malformation?
A. Ductus arteriosus
B. Umbilical arteries
C. Umbilical vein
D. Coarctation of the aorta
E. Pulmonary stenosis - ANSWER:4 A. In a case of transposition of the great arteries,
oxygenated blood travels from the left ventricle into the
pulmonary trunk, where it will eventually reach the lungs. In
contrast, the aorta would be carrying deoxygenated blood
into the systemic circulation. A patent ductus arteriosus
acts as a shunt between the aorta and pulmonary trunk,
allowing oxygenated and deoxygenated blood to mix and
therefore allowing some oxygenated blood to reach the
tissues. None of the other answer choices would correct
this problem; with these structures remaining patent, the
body would still not receive sufficient oxygenated blood for
survival to be possible.
5 A 2-day-old newborn female is diagnosed with pulmonary stenosis, overriding of
the aorta, ventricular septal defect, and hypertrophy of the right ventricle. Which
condition is best characterized by these signs?
A. Tetralogy of Fallot
B. Atrial septal defect
C. Transposition of the great vessels
D. Pulmonary atresia
E. Ventricular septal defect - ANSWER:5 A. Tetralogy of Fallot is always characterized
by four
cardiac defects: pulmonary stenosis, ventricular septal
defect (VSD), overriding aorta, and these in turn lead to
,right ventricular hypertrophy. An atrial septal defect (ASD)
is characterized by the communication between the two
atria. In a case of transposition of the great vessels, the
aorta arises from the right ventricle and the pulmonary trunk
arises from the left ventricle.
6 A 2-day-old newborn female is diagnosed with pulmonary stenosis, overriding of
the aorta, ventricular septal defect, and hypertrophy of the right ventricle. Which of
the following embryologic mechanisms is most likely responsible for the
development of this cluster of anomalies?
A. Superior malalignment of the subpulmonary infundibulum
B. Defect in the aorticopulmonary septum
C. Endocardial cushion defect
D. Total anomalous pulmonary venous connections
E. Atrioventricular canal malformation - ANSWER:6 A. Superior malalignment of the
subpulmonary
infundibulum causes stenosis of the pulmonary trunk. This
leads to the four symptoms mentioned and is known as
tetralogy of Fallot. A defect in formation of the
aorticopulmonary septum is characteristic of transposition
of the great arteries. An endocardial cushion defect is
associated with membranous ventricular septal defects.
7 A 5-year-old boy is admitted to the hospital with severe dyspnea. During physical
examination a loud systolic murmur and a wide, fixed, split S2 sound is noted. What
is the most likely diagnosis?
A. Ventricular septal defect
B. Atrial septal defect
C. Tetralogy of Fallot
D. Transposition of the great arteries
E. Aortic stenosis - ANSWER:7 B. The murmur at S2 localizes the defect at an
atrioventricular valve. An atrial septal defect causes a
diastolic murmur in the tricuspid valve, whereas a ventricular septal defect would
cause a pansystolic murmur. Transposition of the great arteries and aortic stenosis
will cause a murmur at S1, and tetralogy of Fallot does not cause a murmur at S1 or
S2
.
8 A 3-month-old infant is diagnosed with Down syndrome. A routine cardiovascular
examination reveals that the infant suffers from arrhythmias. What other cardiac
conditions are most likely to occur with Down syndrome?
A. Tetralogy of Fallot
B. Transposition of the great arteries
C. Atrial septal and ventricular septal defects
D. Truncus arteriosus
E. Coarctation of the aorta - ANSWER:8 C. Down syndrome (more properly called
"trisomy 21") is
, associated with cardiovascular abnormalities such as
arrhythmias and atrial and ventricular septal defects. It is
also characterized by mental retardation, brachycephaly,
flat nasal bridge, upward slant of the palpebral fissure,
protruding tongue, simian crease, and clinodactyly of the
fifth digit.
9 A 3-month-old infant is diagnosed with a deletion at the 22q11 chromosome. A
routine cardiovascular examination reveals severe congenital cardiac malformation.
Which of the following malformations will most likely be associated with 22q11
syndrome?
A. Tetralogy of Fallot and truncus arteriosus
B. Transposition of the great arteries
C. Atrial septal and ventricular septal defects
D. Coarctation of the aorta
E. Aortic atresia - ANSWER:9 A. Tetralogy of Fallot and truncus arteriosus are
associated with DiGeorge syndrome (22q11).
Transposition of the great arteries is associated with
maternal diabetes. ASDs and VSDs are present in
individuals with Down syndrome. Coarctation of the aorta is
related to Turner syndrome. Marfan syndrome is present in
individuals with aortic atresia.
10 A 28-year-old woman in her third trimester of pregnancy with a complaint of
dizziness for several days is admitted to the hospital. Physical examination reveals
that she has diabetes mellitus. Which of the following cardiac malformations is most
likely to affect the fetus when the mother has this disease?
A. Tetralogy of Fallot
B. Transposition of the great arteries
C. Atrial septal and ventricular septal defects
D. Truncus arteriosus
E. Coarctation of the aorta - ANSWER:10 B. Transposition of the great arteries is
associated with
maternal diabetes. Tetralogy of Fallot and truncus
arteriosus are associated with DiGeorge syndrome
(22q11). ASDs and VSDs are present in individuals with
Down syndrome. Coarctation of the aorta is related to
Turner syndrome. Marfan syndrome is present in
individuals with aortic atresia.
11 During cardiac catheterization of a 6-year-old child, the radiologist notes that the
contrast medium released into the arch of the aorta is visible immediately in the left
pulmonary artery. What is the most likely explanation for this finding?
A. Atrial septal defect
B. Mitral stenosis
C. Patent ductus arteriosus
D. Patent ductus venosus
By Richard L. Drake; A. Wayne Vogl; Adam W. M.
Mitchell
1 A 2-day-old newborn is diagnosed with transposition of the great arteries. Which
structure is responsible for the division of the truncus arteriosus into the great
arteries?
A. Septum secundum
B. Septum primum
C. Bulbar septum
D. Aorticopulmonary septum
E. Endocardial cushions - ANSWER:1 D. The aorticopulmonary septum functions to
divide the truncus arteriosus and bulbus cordis into the aorta and
pulmonary trunk. The septum secundum forms an
incomplete separation between the two atria. The septum
primum divides the atrium into right and left halves. The
bulbar septum is derived from the bulbus cordis and will
give rise to the interventricular septum inferior to the
aorticopulmonary septum, eventually fusing with it. The
endocardial cushions play a role in the division of the AV
canal into right and left halves, by causing the AV cushions
to approach each other.
2 A 32-year-old woman in her third trimester of pregnancy is undergoing a routine
ultrasound examination. The examination of the fetus reveals enlarged and
echogenic lungs, inverted diaphragm, and fetal ascites. Which condition is best
characterized by these signs?
A. Laryngeal atresia
B. Tracheal atresia
C. Polyhydramnios
D. Lung hypoplasia
E. Oligohydramnios - ANSWER:2 A. Laryngeal atresia (congenital high airway
obstruction
syndrome) is a rare obstruction of the upper fetal airway.
Distal to the site of the atresia, the airways dilate, lungs
enlarge and become echogenic, the diaphragm flattens or
inverts, and fetal ascites and/or hydrops develop. Tracheal
atresia is a rare obstruction of the trachea, commonly found
with a tracheoesophageal fistula, probably resulting from
the unequal division of foregut into esophagus and trachea.
Polyhydramnios is an excess of amniotic fluid, often
associated with esophageal atresia or tracheoesophageal
fistula. Lung hypoplasia is reduced lung volume, often seen
in infants with a congenital diaphragmatic hernia.
Oligohydramnios, or a decrease in amniotic fluid, is
,associated with stunted lung development and pulmonary
hypoplasia.
3 A 2-year-old child is seen in the pediatric cardiology unit for a congenital heart
condition. Which of the following conditions occurs most often?
A. Membranous ventricular septal defect
B. Tetralogy of Fallot
C. Muscular ventricular septal defect
D. Ostium secundum defect
E. Ostium primum defect - ANSWER:3 A. Ventricular septal defects account for 25%
of
congenital heart defects. The most common of these are
defects in the membranous portion of the interventricular
septum (membranous ventricular septal defects).
4 A 2-day-old is diagnosed with transposition of the great arteries. If this condition
were to be left untreated for more than 4 months, it would be fatal. Which of the
following structures must remain patent so that the infant can survive until surgical
correction of the malformation?
A. Ductus arteriosus
B. Umbilical arteries
C. Umbilical vein
D. Coarctation of the aorta
E. Pulmonary stenosis - ANSWER:4 A. In a case of transposition of the great arteries,
oxygenated blood travels from the left ventricle into the
pulmonary trunk, where it will eventually reach the lungs. In
contrast, the aorta would be carrying deoxygenated blood
into the systemic circulation. A patent ductus arteriosus
acts as a shunt between the aorta and pulmonary trunk,
allowing oxygenated and deoxygenated blood to mix and
therefore allowing some oxygenated blood to reach the
tissues. None of the other answer choices would correct
this problem; with these structures remaining patent, the
body would still not receive sufficient oxygenated blood for
survival to be possible.
5 A 2-day-old newborn female is diagnosed with pulmonary stenosis, overriding of
the aorta, ventricular septal defect, and hypertrophy of the right ventricle. Which
condition is best characterized by these signs?
A. Tetralogy of Fallot
B. Atrial septal defect
C. Transposition of the great vessels
D. Pulmonary atresia
E. Ventricular septal defect - ANSWER:5 A. Tetralogy of Fallot is always characterized
by four
cardiac defects: pulmonary stenosis, ventricular septal
defect (VSD), overriding aorta, and these in turn lead to
,right ventricular hypertrophy. An atrial septal defect (ASD)
is characterized by the communication between the two
atria. In a case of transposition of the great vessels, the
aorta arises from the right ventricle and the pulmonary trunk
arises from the left ventricle.
6 A 2-day-old newborn female is diagnosed with pulmonary stenosis, overriding of
the aorta, ventricular septal defect, and hypertrophy of the right ventricle. Which of
the following embryologic mechanisms is most likely responsible for the
development of this cluster of anomalies?
A. Superior malalignment of the subpulmonary infundibulum
B. Defect in the aorticopulmonary septum
C. Endocardial cushion defect
D. Total anomalous pulmonary venous connections
E. Atrioventricular canal malformation - ANSWER:6 A. Superior malalignment of the
subpulmonary
infundibulum causes stenosis of the pulmonary trunk. This
leads to the four symptoms mentioned and is known as
tetralogy of Fallot. A defect in formation of the
aorticopulmonary septum is characteristic of transposition
of the great arteries. An endocardial cushion defect is
associated with membranous ventricular septal defects.
7 A 5-year-old boy is admitted to the hospital with severe dyspnea. During physical
examination a loud systolic murmur and a wide, fixed, split S2 sound is noted. What
is the most likely diagnosis?
A. Ventricular septal defect
B. Atrial septal defect
C. Tetralogy of Fallot
D. Transposition of the great arteries
E. Aortic stenosis - ANSWER:7 B. The murmur at S2 localizes the defect at an
atrioventricular valve. An atrial septal defect causes a
diastolic murmur in the tricuspid valve, whereas a ventricular septal defect would
cause a pansystolic murmur. Transposition of the great arteries and aortic stenosis
will cause a murmur at S1, and tetralogy of Fallot does not cause a murmur at S1 or
S2
.
8 A 3-month-old infant is diagnosed with Down syndrome. A routine cardiovascular
examination reveals that the infant suffers from arrhythmias. What other cardiac
conditions are most likely to occur with Down syndrome?
A. Tetralogy of Fallot
B. Transposition of the great arteries
C. Atrial septal and ventricular septal defects
D. Truncus arteriosus
E. Coarctation of the aorta - ANSWER:8 C. Down syndrome (more properly called
"trisomy 21") is
, associated with cardiovascular abnormalities such as
arrhythmias and atrial and ventricular septal defects. It is
also characterized by mental retardation, brachycephaly,
flat nasal bridge, upward slant of the palpebral fissure,
protruding tongue, simian crease, and clinodactyly of the
fifth digit.
9 A 3-month-old infant is diagnosed with a deletion at the 22q11 chromosome. A
routine cardiovascular examination reveals severe congenital cardiac malformation.
Which of the following malformations will most likely be associated with 22q11
syndrome?
A. Tetralogy of Fallot and truncus arteriosus
B. Transposition of the great arteries
C. Atrial septal and ventricular septal defects
D. Coarctation of the aorta
E. Aortic atresia - ANSWER:9 A. Tetralogy of Fallot and truncus arteriosus are
associated with DiGeorge syndrome (22q11).
Transposition of the great arteries is associated with
maternal diabetes. ASDs and VSDs are present in
individuals with Down syndrome. Coarctation of the aorta is
related to Turner syndrome. Marfan syndrome is present in
individuals with aortic atresia.
10 A 28-year-old woman in her third trimester of pregnancy with a complaint of
dizziness for several days is admitted to the hospital. Physical examination reveals
that she has diabetes mellitus. Which of the following cardiac malformations is most
likely to affect the fetus when the mother has this disease?
A. Tetralogy of Fallot
B. Transposition of the great arteries
C. Atrial septal and ventricular septal defects
D. Truncus arteriosus
E. Coarctation of the aorta - ANSWER:10 B. Transposition of the great arteries is
associated with
maternal diabetes. Tetralogy of Fallot and truncus
arteriosus are associated with DiGeorge syndrome
(22q11). ASDs and VSDs are present in individuals with
Down syndrome. Coarctation of the aorta is related to
Turner syndrome. Marfan syndrome is present in
individuals with aortic atresia.
11 During cardiac catheterization of a 6-year-old child, the radiologist notes that the
contrast medium released into the arch of the aorta is visible immediately in the left
pulmonary artery. What is the most likely explanation for this finding?
A. Atrial septal defect
B. Mitral stenosis
C. Patent ductus arteriosus
D. Patent ductus venosus
