USMLE heart

1. Blockage of which of the following arteries would lead to ischemia of the apex of the heart? a. Anterior interventricular (descending)
b. Left circumflex
c. Posterior interventricular (descending)
d. Right marginal e. Right coronary.

2. If the ductus arteriosus does not spontaneously close off soon after birth (to become the ligamentum arteriosum), it may have to be surgically ligated. When clamping or ligating it, what important structure immediately behind it must be identified and saved? a. arch of the azygos vein.

b. internal thoracic artery
c. left phrenic nerve
d. left recurrent laryngeal nerve
e. left superior intercostal vein.

3. A hand slipped behind the heart at its apex can be extended upwards until stopped by a line of pericardial reflection that forms the: a. Cardiac notch
b. ostomediastinal recess
c. Hilar reflection
d. Oblique pericardial sinus
e. Transverse pericardial sinus.

4. A stethoscope placed over the left second intercostal space just lateral to the sternum would be best positioned to detect sounds associated with which heart valve? a. aortic b. pulmonary c. mitral d. tricuspid.

5. Which valves would be open during ventricular systole?
a. Aortic and pulmonary b. Aortic and tricuspid
c. Mitral and aortic d. Tricuspid and mitral
e. Tricuspid and pulmonary

6. Which chamber’s anterior wall forms most of the sternocostal surface of the heart? a. Left atrium b. Left ventricle .
c. Right atrium d. Right ventricle.

7. A 3rd-year medical student was doing her first physical exam. In order to properly place her stethoscope to listen to heart sounds, she palpated bony landmarks. She began at the jugular notch, then slid her fingers down to the sternal angle. At which rib (costal cartilage) level were her fingers? a. 1 b. 2 c. 3 d. 4.

8. A patient involved in an automobile accident presents with a sharp object puncture of the middle of the sternum at about the level of the 4th or 5th costal cartilage. If the object also penetrated pericardium and heart wall, which heart chamber would most likely be damaged? a. Left atrium b. Left ventricle.

c. Right atrium d. Right ventricle

9. Which statement is true of the right atrioventricular valve? a. it is also called the mitral valve
b. it is open during ventricular diastole
c. it transmits oxygenated blood
d. it is opened by the pull of chordae tendineae
e. it consists of 2 leaflets.

10. A 23-year-old male injured in an industrial explosion was found to have multiple small metal fragments in his thoracic cavity. Since the pericardium was torn inferiorly, the surgeon began to explore for fragments in the pericardial sac. Slipping her hand under the heart apex, she slid her fingers upward and to the right within the sac until they were stopped by the cul-de-sac formed by the pericardial reflection near the base of the heart. Her fingertips were then in the: a. Coronary sinus b. Coronary sulcus.

c. Costomediastinal recess d. Oblique sinus
e. Transverse sinus

11. An elderly lady suffers a coronary occlusion and subsequently it is noted that there is a complete heart block (that is, the right and left bundles of the conduction system have been damaged). The artery most likely involved is the: a. acute marginal branch b. circumflex branch

c. anterior interventricular (Left anterior descending)
d. obtuse marginal
e. posterior interventricular (posterior descending)

12. During fetal life and sometimes persisting into the adult there is an opening between the right and left atria; this opening is called the: a. atrioventricular canalb. coronary sinus
c. foramen ovale d. sinus venosus
e. truncus arteriosis.

13. The heart sound associated with the mitral valve is best heard: a. In the jugular notch
b. In the second left intercostal space
c. In the second right intercostal space
d. In the fifth left intercostal space
e. To the right of the xiphoid process

14. Which heart valve has leaflets described as “anterior, left and right”? a. Aortic b. Pulmonary
c. Left atrioventricular d. Right atrioventricular.

15. In preparation for thoracic surgery, a median sternal splitting procedure was carried out. But an improper depth setting on the saw blade resulted in a slight nick on the underlying sternocostal surface of the heart. Which heart chamber would most likely have been opened had the blade completely penetrated this wall? a. Left atrium b. Left ventricle.

c. Right atrium d. Right ventricle

16. The sound associated with tricuspid stenosis (narrowing) in a 40-year-old male would be best heard at which location on the anterior chest wall? a. Below the left nipple
b. In the right 2nd intercostal space near the sternum
c. Over the apex of the heart
d. Over the sternal angle
e. Xiphoid area, just off the sternum.

17. Blockage of blood flow in the proximal part of the anterior interventricular artery could deprive a large area of heart tissue of blood supply, unless a substantial retrograde flow into this artery develops via an important anastomosis with which other artery? a. Circumflex b. Left marginal.

c. Posterior interventricular d. Right coronary
e. Right marginal

18. Traumatic, acceleration/deceleration injuries to the aorta usually occur where its mobile and fixed portions meet. This would be at the: a. at the ligamentum arteriosum
b. junction of aortic arch with the descending portion
c. junction of the ascending aorta with the heart
d. origin of the brachiocephalic artery on the arch
e. point where the descending aorta passes through the diaphragm.

19. Which structure does NOT lie in the coronary sulcus?
a. circumflex artery b. coronary sinus
c. right coronary arteryd. right marginal artery
e. left coronary artery.

20. Which structure contains postganglionic sympathetic fibers? a. greater thoracic splanchnic nerve
b. recurrent laryngeal nerve
c. sympathetic trunk
d. ulnar nerve
e. agus nerve.

21. Which posterior mediastinal structure is most closely applied to the posterior surface of the pericardial sac? a. Aorta b. Azygos vein c. Esophagus
d. Thoracic duct e. Trachea.

22. In obstruction of the superior or inferior vena cava, venous blood is returned to the heart by an alternate route via the azygos vein, which becomes dilated in the process. Which of the following structures might it compress as a result? a. trachea b. root of the left lung

c. phrenic nerve d. thoracic duct .
e. descending aorta.

23. Elevated systolic blood pressure in the right ventricle suggests stenosis of which valve? a. Aortic b. Mitral c. Pulmonary d. Tricuspid.

24. During examination of a 62-year-old man, the senior resident tells you to put your stethoscope on the left 5th intercostal space, slightly below the nipple, and listen for a clearly audible murmur. You hear it distinctly and know it must be associated with severe stenosis of which heart valve? a. Aorticb. Mitral

c. Pulmonary d. Tricuspid

25. A 26-year-old male is brought into the emergency room after having been kicked in the chest by a horse. After examination, it is concluded that the most likely immediate danger is cardiac tamponade (bleeding into the pericardial sac). You prepare to draw off some of the blood from the sac to relieve the pressure on the heart. The safest site at which to insert the needle of the syringe in order to miss the pleura would be: a. Just below the nipple on the left.

b. Just to the left of the xiphisternal junction
c. Near the sternal angle
d. Through the jugular notch
e. 4th left intercostal space in the midaxillary line.

26. A 22-year-old male involved in an automobile accident presents with symptoms suggestive of myocardial contusion due to blunt trauma, specifically compression of the sternocostal surface of the heart by the sternum when his chest hit the steering wheel. Which heart chamber was most likely damaged? a. Left atrium b. Left ventricle

c. Right atrium d. Right ventricle.

27. While attempting to suture the distal end of a coronary bypass onto the anterior interventricular artery, the surgeon accidentally passed the needle through the adjacent vein. Which vein was damaged? a. Anterior cardiac vein

b. Coronary sinus
c. Great cardiac vein
d. Middle cardiac vein
e. Small cardiac vein

28. While listening to a patient’s heart sounds with a stethoscope, you identify a high-pitched sound in the second right intercostal space, just lateral to the edge of the sternum. Your correct conclusion is that you have detected stenosis of which heart valve? a. Aortic b. Mitral.

c. Pulmonary d. Tricuspid




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