WorksheetsAortic Stenosis
Total questions: 20
Worksheet time: 10mins
Recall: Which statement best describes the pathophysiology of aortic stenosis? Choose the most accurate description of how it affects blood flow and the left ventricle.
Narrowing of the aortic valve obstructs outflow from the left ventricle, causing increased LV pressure and concentric hypertrophy
Dilation of the aortic valve allows regurgitation into the left ventricle, leading to eccentric hypertrophy
Stiffening of the mitral valve prevents LV filling, reducing end-diastolic volume without pressure changes
Narrowing of the pulmonary valve increases right ventricular afterload, leading to RV hypertrophy
Strategic thinking: A 68-year-old with exertional chest pain, syncope episodes, and a harsh systolic ejection murmur radiating to the carotids is suspected of having aortic stenosis. Which diagnostic approach most directly confirms valve narrowing and gradient severity?
Chest X-ray to assess cardiomegaly and pulmonary congestion
Electrocardiogram to detect left ventricular hypertrophy patterns
Echocardiography with Doppler to measure transvalvular gradients and valve area
Cardiac biomarkers to evaluate myocardial injury
Recall: Which statement best describes the pathophysiology of an Atrial Septal Defect (ASD)?
An opening between the left and right ventricles allows oxygenated blood to mix with deoxygenated blood
A persistent opening in the atrial septum permits left-to-right shunting of oxygenated blood from the left atrium to the right atrium
A narrowing of the aortic valve creates increased left ventricular outflow resistance
A patent ductus arteriosus keeps fetal circulation pathways open between the aorta and pulmonary artery
Application: A 17-year-old presents with easy fatigability, dyspnea on exertion, and a fixed split S2 on auscultation. Based on these findings, which initial diagnostic test is most appropriate to confirm Atrial Septal Defect?
Chest X-ray to assess lung fields and cardiac silhouette
Electrocardiogram to detect ventricular arrhythmias
Echocardiography to visualize interatrial septal defect and flow across it
Cardiac enzymes to evaluate myocardial injury
Recall the fundamental pathophysiology of a ventricular septal defect (VSD). Which statement best describes the hemodynamic consequence in an unrepaired VSD?
Right-to-left shunt from the right ventricle to the left ventricle causing cyanosis
Left-to-right shunt from the left ventricle to the right ventricle increasing pulmonary blood flow
Obstruction of outflow from both ventricles resulting in decreased systemic perfusion
Complete separation of the ventricles preventing any mixing of blood
A 6‑month‑old infant presents with poor feeding, tachypnea, and a pansystolic murmur at the left lower sternal border. Which diagnostic test is most appropriate to confirm a ventricular septal defect and assess its size and location?
Chest X‑ray to visualize cardiomegaly and pulmonary edema
Electrocardiogram to detect conduction abnormalities
Transthoracic echocardiography with Doppler to delineate the septal defect and shunt
Pulse oximetry to measure peripheral oxygen saturation
Patent ductus arteriosus (PDA) is a condition where a fetal vascular connection remains open after birth. Which statement best describes the pathophysiology of PDA?
Persistent connection between the pulmonary artery and the aorta causing left-to-right shunt
Failure of the foramen ovale to close leading to right-to-left shunt
Narrowing of the aortic isthmus obstructing systemic outflow
Single common arterial trunk supplying both systemic and pulmonary circulations
A term infant presents with a continuous “machinery” murmur and bounding pulses. Which associated finding most strongly supports the diagnosis of PDA?
Wide pulse pressure with signs of pulmonary overcirculation
Cyanosis that improves with squatting
Diminished femoral pulses compared with brachial pulses
Fixed splitting of the second heart sound
A 6-month-old presents with cyanosis and a history of "tet spells" relieved by squatting. Based on TOF pathophysiology, which mechanism most directly explains why squatting improves symptoms?
It increases systemic vascular resistance, reducing right-to-left shunt across the VSD
It decreases venous return to the right heart, lowering RV pressure
It increases pulmonary valve opening, enhancing forward flow to lungs
It raises heart rate, improving cardiac output despite the shunt
Coarctation of the aorta most directly leads to which hemodynamic consequence due to narrowing of the aortic lumen?
Uniform blood pressure in upper and lower extremities
Decreased pressure proximal and increased pressure distal to the narrowing
Increased pressure proximal with decreased perfusion distal to the narrowing
Global reduction in systemic vascular resistance
A 3-week-old infant presents with poor feeding, irritability, and weak femoral pulses. Which initial diagnostic study is most appropriate to confirm suspected coarctation of the aorta?
Chest X-ray to assess pulmonary consolidation
Echocardiography to visualize the aortic narrowing and flow
CT of the brain to rule out intracranial pathology
Spirometry to evaluate obstructive lung disease
Truncus arteriosus is best described as which congenital cardiac anomaly?
Failure of the truncal vessel to divide, resulting in a single arterial trunk supplying systemic, pulmonary, and coronary circulation
Narrowing of the aortic valve causing left ventricular outflow obstruction
Persistence of the fetal ductus arteriosus connecting the pulmonary artery to the aorta
A defect in the interventricular septum allowing left-to-right shunt
Which finding best supports a diagnosis of congestive heart failure by indicating fluid overload from impaired cardiac pumping?
Elevated jugular venous pressure with bilateral ankle edema
Localized pleuritic chest pain that worsens with inspiration
Unilateral calf tenderness after a long flight
Sudden brief palpitations without dyspnea
Recall: Which statement best defines Cor Pulmonale in the context of cardiovascular diseases?
Right-sided heart failure secondary to chronic pulmonary hypertension
Left ventricular hypertrophy due to systemic hypertension
Acute myocardial infarction caused by coronary artery occlusion
Congenital malformation of the aortic valve
Which pathophysiologic process most directly leads to Coronary Artery Disease by reducing myocardial oxygen supply?
Acute dilation of coronary arteries
Atherosclerotic plaque formation causing luminal narrowing
Increased venous return improving perfusion
Enhanced collateral circulation preventing ischemia
Which of the following is a common risk factor that contributes to the development of Coronary Artery Disease?
Chronic hypotension reducing arterial wall stress
Hyperlipidemia promoting atherosclerotic plaque formation
High dietary fiber intake lowering LDL
Regular aerobic exercise increasing coronary stenosis
A 17-year-old presents with fever, migratory joint pain, and new-onset heart murmur weeks after a sore throat. Which cause most strongly supports RHD?
Post-streptococcal autoimmune reaction
Atherosclerotic plaque rupture
Congenital septal defect
Pulmonary embolism
Which combination of signs and symptoms is most consistent with RHD affecting the mitral valve?
Dyspnea on exertion, fatigue, and diastolic murmur due to mitral stenosis
Sudden chest pain, ST-elevation, and hypotension due to coronary thrombosis
Wheezing, productive cough, and cyanosis due to bronchospasm
Claudication, diminished leg pulses, and calf pain due to peripheral artery disease
Which diagnostic approach is most appropriate to confirm RHD?
Echocardiography to assess valvular structure and function
Spirometry to measure forced expiratory volume
Abdominal ultrasound to evaluate hepatic steatosis
EEG to detect abnormal cortical activity
Which clinical sign most directly suggests venous thrombosis rather than arterial occlusion?
Cool, pale limb with diminished pulses
Sudden severe chest pain radiating to left arm
Unilateral calf swelling with warmth and tenderness
Diffuse abdominal pain worsened by eating
