1. During fetal life, in which of the following structures is the percent hemoglobin/oxygen saturation level of fetal blood the lowest?
(A) Ductus arteriosus
(B) Left ventricle
(C) Inferior vena cava
(D) Umbilical vein
(E) Right atrium
(F) Descending aorta
2. An infant born 2 weeks premature presents with a machine-like diastolic and systolic murmur heard over the left sternoclavicular joint. What will be observed in the infant as a result of this defect?
(A) There will be blood flow from the arch of the aorta into the pulmonary trunk through the defect.
(B) The pulmonary trunk will have a significantly smaller diameter than the ascending aorta.
(C) The infant will be cyanotic at birth.
(D) There will be blood flow from the left ventricle to the right ventricle through the defect.
(E) The aorta overrides the interventricular septum and collects blood from both the right and left ventricles.
3. Your patient presents with pneumonia. Examination of lateral-view chest films reveals that the pneumonia is localized just inferior to the horizontal fissure. Where would the pneumonia most likely be localized?
(A) Inferior lobe of the left lung
(B) Inferior lobe of the right lung
(C) Middle lobe of the right lung
(D) Middle lobe of the left lung
(E) Superior lobe of the left lung
A mother brings her 5-year-old to the ER with the complaint that her child's lips turn blue after exertion and that the child gasps for air. The mother reveals that the child often assumes a squatting position when the lips are bluish. Echocardiography reveals a boot-shaped heart indicative of light ventricular hypertrophy. Which of the following is the most likely congenital defect of this infant?
(A) Ostium secundum defect
(B) Patent ductus arteriosus
(C) Mitral valve stenosis
(D) Anterior and superior displacement of the aorticopulmonary septum
(E) Coarctation of the aorta
A 56-year-old man is brought to the emergency room by his wife. The patient complains of intense chest pain. Over a period of years, the patient has exhibited pains radiating down the medial aspect of the left arm following exertion. The patient is in shock with low blood pressure and diminished radial pulses. Heart sounds are weak. Despite administration of oxygen and stimulants, the patient expires 3 hours after administration. Autopsy would most likely reveal an occlusion of which coronary blood vessel at its origin?
(A) Right coronary artery
(B) Posterior interventricular artery
(C) Anterior interventricular artery
(D) Left coronary artery
(E) Circumflex artery
A patient experiences heart block as a result of occlusion of branches of the anterior interventricular branch of the left coronary artery. Which structure was most likely affected by the vascular insult?
(A) Cardiac plexus
(B) Sinoatrial node
(C) Atrial node
(D) Bundle of His
(E) Vagal branches
A 27-year-old male worker comes to the hospital complaining of fatigue upon exertion. He had been diagnosed previously with high blood pressure. An exam reveals elevated pressure in both common carotid arteries but diminished pulses in both femora] arteries. Radiology reveals a hypertrophic left ventricle, a stenosis of the aorta, and bilateral erosion of the lower thoracic ribs. The site of the aortic narrowing is most likely
(A) between the brachiocephalic trunk and the left common carotid artery
(B) immediately distal to the left subclavian artery
(C) in the ascending aorta
(D) between the left common carotid artery and the left subclavian artery
(E) between the right common carotid artery and the right subclavian artery
8. A 45-year-old housewife is admitted to the hospital. She is having great difficulty swallowing and has lost 20 pounds In the last 3 months because of reliance on a liquid diet. She has become hoarse and frequently spits up bloody sputum. A barium swallow reveals cancer of the esophagus at the level of the T3 vertebra. If there is an anterior expansion of the carcinoma, which nearby structure is most likely to be invaded?
(A) Left atrium
(B) Superior vena cava
(C) Right ventricle
(E) Ascending aorta
9. In a horizontal section extending through the superior mediastinum, which of the following structures will not be seen?
(A) Arch of the aorta
(B) Superior vena cava
(D) Left atrium
10. In postnatal life, the right atrium contains the fossa ovalis, a shallow depression in the interatrial septum. Which embryonic structure forms the floor of the fossa?
(A) Septum secundum
(B) Septum primum
(C) Endocardial cushion
(D) Bulbus cordis
11. Which of the following structures does not become subdivided by a septum during fetal heart development?
(A) Truncus arteriosus
(B) Primitive atrium
(C) Sinus venosus
(D) Bulbus cordis
(E) Primitive ventricle
12. A 56-year-old male patient presents with a sliding hiatal hernia in the diaphragm. Which other structure might be compressed as it courses through the same opening in the diaphragm?
(A) Right phrenic nerve
(B) Right greater splanchnic nerve
(C) Thoracic duct
(D) Azygous vein
(E) Right vagal branches
13. During a thoracocentesis to remove pleural exudate, a patient feels a twinge of pain as the needle enters the pleural sac. Which nerve fibers carried the painful sensations?
(A) Intercostal nerve
(B) Greater splanchnic nerve
(C) Phrenic nerve
(D) Iliohypogastric nerve
(E) Vagus nerve
14. Which of the following labeled structures drains into a remnant of the sinus venosus from the fetal heart?
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