Comprehensive Radiographic Pathology 5th Edition by Eisenberg – Test Bank A+

Description

1. What is the functional unit of the kidney?

a.	Lobule
b.	Nephron
c.	Glomerulus
d.	Ureterocele

ANS: B

The functional unit of the kidney is the nephron.

REF: p. 217

1. In an average person, the nephrons filter about _____ L of water out of glomerular blood each day.

a.	2
b.	10
c.	80
d.	190

ANS: D

The nephrons filter about 190 L of water out of the glomerular blood each day. Only about 1 to 2 L of water is excreted in urine, so about 99% of the filtered water is reabsorbed into the tubular blood.

REF: p. 217

1. Where does the formation of urine begin?

a.	Nephrons
b.	Bowman’s capsule
c.	Glomerulus
d.	Distal convoluted tubule

ANS: C

The formation begins in the glomerulus, which is a tuft of capillaries surrounded by the Bowman’s capsule. Nephrons are the basic, functional unit of the kidneys. The distal convoluted tubule is where the electrolyte and acid-base balance of the blood occurs.

REF: p. 217

1. Which of the following stimulates the rate of red blood cell production?

a.	Erythropoietin
b.	Angiotensin
c.	Renin
d.	Aldosterone

ANS: A

Erythropoietin is produced by the kidneys and stimulates red blood cell production. Angiotensin secretion is controlled by renin and affects blood pressure. Aldosterone is secreted by the adrenals and affects the reabsorption of sodium and chloride during urine formation.

REF: p. 219

1. A miniature replica of a kidney is termed:

a.	Ectopic kidney
b.	Hypoplastic kidney
c.	Compensatory hypertrophy
d.	Supernumerary kidney

ANS: B

A hypoplastic kidney is a miniature replica of a kidney with normal function. It must be differentiated from acquired atrophic kidney, which is smaller in size as a result of vascular or inflammatory disease.

REF: p. 220

1. A rare anomaly in which a kidney fails to develop is called:

a.	Unilateral renal agenesis
b.	Hypoplastic kidney
c.	Compensatory hypertrophy
d.	Supernumerary kidney

ANS: A

Unilateral renal agenesis is a rare anomaly in which one kidney fails to develop and is associated with various other developmental anomalies. Complete renal agenesis is not compatible with life.

REF: p. 220

1. What term is applied to an acquired condition that occurs when one kidney is required to do the job of two?

a.	Supernumerary kidney
b.	Crossed ectopia
c.	Compensatory hypertrophy
d.	Hypoplastic kidney

ANS: C

Compensatory hypertrophy is an acquired condition that occurs when one kidney is required to do the job of two.

REF: p. 220

1. A rare anomaly in which there is a third, rudimentary kidney is termed:

a.	An ectopic kidney
b.	Compensatory hypertrophy
c.	Hypoplastic kidney
d.	Supernumerary kidney

ANS: D

Supernumerary kidney is a rare anomaly in which there is a third, rudimentary kidney. These usually function normally, but acquire secondary infections, which require their eventual removal.

REF: p. 220

1. What is an ectopic kidney?

a.	A third rudimentary kidney
b.	A kidney that is not located in the normal location
c.	A kidney that is enlarged because it has to do the job of both kidneys
d.	The most common type of fusion anomaly

ANS: B

An ectopic kidney is a kidney that is not located in the normal location. It may be found in the pelvis or the thorax.

REF: p. 220

1. What is the most common type of fusion anomaly?

a.	Horseshoe kidney
b.	Crossed ectopia
c.	Doughnut kidney
d.	Unilateral renal agenesis

ANS: A

Horseshoe kidney is the most common type of fusion anomaly in which the kidneys are joined at their lower poles.

REF: p. 221

1. When the kidneys are fused at their lower poles, they are termed a(an):

a.	Doughnut kidney
b.	Lump kidney
c.	Horseshoe kidney
d.	Ectopic kidney

ANS: C

Horseshoe kidney is the term applied to the most common fusion anomaly, in which the kidneys are fused at their lower poles.

REF: p. 221

1. Refer to the image below. What developmental anomaly is demonstrated?

a.	Crossed ectopia
b.	Horseshoe kidney
c.	Unilateral renal agenesis
d.	Supernumerary kidney

ANS: B

The arrows point to the outline of the fused, horseshoe kidneys.

REF: p. 222

1. Cystic dilatation of the distal ureter near its insertion into the urinary bladder is called a:

a.	Ureterocele
b.	Pyelonephritis
c.	Ureteral aneurysm
d.	Renal cyst

ANS: A

A ureterocele is a cystic dilatation of the distal ureter near its insertion into the urinary bladder. Most occur in children with ureteral duplication.

REF: p. 223

1. What is a ureterocele?

a.	A nonsuppurative inflammatory process involving the tufts of the capillaries within the Bowman’s capsule
b.	A smaller than normal amount of urine
c.	A fusion anomaly in which the ureter is directly connected to the kidney
d.	A cystic dilatation of the distal ureter near its insertion into the urinary bladder

ANS: D

A ureterocele is a cystic dilatation of the distal ureter near its insertion into the urinary bladder. Most occur in children with ureteral duplication.

REF: p. 223

1. Which condition is most commonly found in children with ureteral duplication?

a.	Renal cyst
b.	Ureterocele
c.	Papillary necrosis
d.	Staghorn calculus

ANS: B

A ureterocele is a cystic dilatation of the distal ureter near its insertion into the urinary bladder. Most occur in children with ureteral duplication.

REF: p. 223

1. A nonsuppurative inflammatory process involving the tufts of the capillaries within the Bowman’s capsule is called:

a.	Ureterocele
b.	Pyelonephritis
c.	Glomerulonephritis
d.	Papillary necrosis

ANS: C

Glomerulonephritis is a nonsuppurative inflammatory process involving the glomerulus, which is the tufts of the capillaries within the Bowman’s capsule.

REF: p. 223

1. A smaller than normal amount of urine is termed:

a.	Polyuria
b.	Oliguria
c.	Hematuria
d.	Dysuria

ANS: B

Oliguria is a smaller than normal amount of urine, which is symptomatic of some urinary abnormalities.

REF: p. 225

1. What is oliguria?

a.	A smaller than normal amount of urine
b.	A larger than normal amount of urine
c.	The presence of protein molecules in the urine
d.	The presence of fat molecules in the urine

ANS: A

Oliguria is a smaller than normal amount of urine and is symptomatic of certain urinary conditions.

REF: p. 225

1. A suppurative inflammatory process of the kidney and renal pelvis is termed:

a.	Glomerulonephritis
b.	Papillary necrosis
c.	Cystitis
d.	Pyelonephritis

ANS: D

Pyelonephritis is a suppurative inflammatory process of the kidney and renal pelvis.

REF: p. 225

1. Which type of severe infection occurs almost exclusively in diabetic patients and causes acute necrosis of the entire kidney?

a.	Cystitis
b.	Papillary necrosis
c.	Glomerulonephritis
d.	Emphysematous pyelonephritis

ANS: D

Emphysematous pyelonephritis is a severe form of acute parenchymal and perirenal infection that occurs almost exclusively in patients with diabetes.

REF: p. 227

1. What is the most common hospital-acquired infection?

a.	Cystitis
b.	Pyelonephritis
c.	Vasculitis
d.	Tuberculosis

ANS: A

The most common hospital-acquired infection is cystitis, an infection of the urinary bladder.

REF: p. 228

1. Which imaging modality is the safest and most accurate in detecting renal calculi?

a.	Ultrasound
b.	Excretory urography
c.	Noncontrast helical CT
d.	MRI

ANS: C

Noncontrast helical CT is the safest, easiest, and most accurate modality for the diagnosis of kidney stones. Excretory urography can detect stones, but it is not as accurate as helical CT.

REF: p. 230

1. What term is applied to a renal calculus that completely fills the renal pelvis?

a.	Pelvolithiasis
b.	Staghorn calculus
c.	Pelvocalcinosis
d.	Nephrocalcinosis

ANS: B

A staghorn calculus is the term given to a stone that completely fills the renal pelvis.

REF: p. 232

1. What is nephrocalcinosis?

a.	A condition of calcium deposits within the renal parenchyma
b.	A renal calculus that fills the entire renal pelvis
c.	Excretion of calcium ions in the urine
d.	A severe infection of the renal parenchyma

ANS: A

Nephrocalcinosis is a condition of calcium deposits within the renal parenchyma. The pattern can vary from small, punctate densities to extensive, dense calcifications in the kidneys.

REF: p. 232

1. Calcium deposits within the renal parenchyma are termed:

a.	Staghorn calculus
b.	Nephrolithiasis
c.	Nephrocalcinosis
d.	Glomerulonephritis

ANS: C

Nephrocalcinosis is the condition of calcium deposits within the renal parenchyma. Nephrolithiasis is the medical term for kidney stones, and a staghorn calculus is a type of kidney stone that fills the renal pelvis and calyces. Glomerulonephritis is an infection.

REF: p. 232

1. What is the cause of hydronephrosis?

a.	Chronic glomerulonephritis
b.	Blockage above the level of the bladder
c.	Staghorn calculus
d.	Aldosterone deficiency

ANS: B

Blockage of urine passage into the urinary bladder causes the ureter and renal collecting system to dilate. Dilatation of the pelvis and calyces is called hydronephrosis.

REF: p. 234

1. Blockage above the level of the bladder causes dilatation of the renal pelvicalyceal system, which is called:

a.	Glomerulonephritis
b.	Cystitis
c.	Hypernephroma
d.	Hydronephrosis

ANS: D

Blockage of urine passage into the urinary bladder causes the ureter and renal collecting system to dilate. Dilatation of the pelvis and calyces is called hydronephrosis.

REF: p. 234

1. Stone formation in the bladder occurs primarily in _____ with obstruction or infection of the lower urinary tract.

a.	Children
b.	Young adults
c.	Elderly males
d.	Diabetic persons

ANS: C

Stone formation in the bladder occurs primarily in elderly males with obstruction or infection of the lower urinary tract.

REF: p. 232

1. What is the most common unifocal mass of the kidney?

a.	Staghorn calculus
b.	Hypernephroma
c.	Nephrocalcinosis
d.	Renal cyst

ANS: D

Simple renal cysts are the most common unifocal masses of the kidney. They are fluid-filled sacs that vary in size.

REF: p. 236

1. The most common renal neoplasm is a:

a.	Hypernephroma
b.	Nephroblastoma
c.	Pyelocarcinoma
d.	Renal cell sarcoma

ANS: A

The most common renal neoplasm is a hypernephroma, also called renal cell carcinoma. A nephroblastoma is the most common abdominal neoplasm in infants and children.

REF: p. 239

1. Which of these is a common symptom of a renal neoplasm?

a.	Hydronephrosis
b.	Painless hematuria
c.	Proteinuria
d.	Renal neoplasms are asymptomatic.

ANS: B

The most common symptom of renal neoplasm in persons over age 40 is painless hematuria.

REF: p. 239

1. What is the most common abdominal neoplasm of infancy and childhood?

a.	Hypernephroma
b.	Wilms’ tumor
c.	Polycystic kidneys
d.	Renal cell carcinoma

ANS: B

A Wilms’ tumor or nephroblastoma is the most common abdominal neoplasm in infancy and childhood.

REF: p. 242

1. What condition most commonly occurs in children who are severely dehydrated?

a.	Nephrolithiasis
b.	Glomerulonephritis
c.	Pyelonephritis
d.	Renal vein thrombosis

ANS: D

Renal vein thrombosis occurs most frequently in children who are severely dehydrated.

REF: p. 244

1. What is the imaging modality of choice to diagnose renal vein thrombosis?

a.	CT
b.	MRI
c.	US
d.	Excretory urography

ANS: C

Ultrasound (US) is the imaging modality of choice for imaging of renal vein thrombosis and can show the clot with Doppler.

REF: p. 245

1. Which of the following are causes of enlarged kidneys?

(1) Polycystic renal disease

(2) Renal vein thrombosis

(3) Nephrosclerosis

a.	1 and 2 only
b.	1 and 3 only
c.	2 and 3 only
d.	1, 2, and 3

ANS: A

Enlarged kidneys are indicative of polycystic renal disease, renal vein thrombosis, obstruction, and infiltrative processes, such as myeloma and lymphoma.

REF: p. 237 | p. 245

1. Which of the following are causes of small kidneys with smooth contours?

(1) Renal vein thrombosis

(2) Nephrosclerosis

(3) Chronic glomerulonephritis

a.	1 and 2 only
b.	1 and 3 only
c.	2 and 3 only
d.	1, 2, and 3

ANS: C

Small kidneys with smooth contours are indicative of chronic glomerulonephritis and nephrosclerosis. Renal vein thrombosis causes enlarged kidneys.

REF: p. 247

1. The medical term that means to void or empty the bladder of urine is:

a.	incontenience
b.	continate
c.	micturate
d.	uremia

ANS: C

Micturate is the medical term for voiding or emptying the bladder of urine.

REF: p. 217

1. What term is used to describe abnormally positioned kidneys?

a.	Kidney agenesis
b.	Ectopic kidney
c.	Kidney aplasia
d.	Hypertrophic kidney

ANS: B

Ectopic kidney describes a kidney that is abnormally placed.

REF: p. 217

1. Refer to the image. Note the arrows. What condition is indicated by the arrows in this image of an intravenous urogram?

a.	Ureterocele
b.	Kidney agenesis
c.	Ectopic kidney
d.	Hypertrophic kidney

ANS: C

A kidney that is misplaced from its normal position is termed an ectopic kidney. In this image, the kidney is located in the pelvis and may be more accurately described as a pelvic kidney.

REF: p. 220

1. Which urinary disease occurs almost exclusively in males and is defined as a thin transverse membrane that causes bladder outlet obstruction and may lead to severe hydronephrosis, hydroureter, and renal damage?

a.	Ureterocele
b.	Posterior urethral valves
c.	Benign prostatic hyperplasia
d.	Polycystic kidney disease

ANS: B

Posterior urethral valves are thin transverse membranes, found almost exclusively in males, which cause bladder outlet obstruction and may lead to severe hydronephrosis, hydroureter, and renal damage.

REF: p. 221

TRUE/FALSE

1. The functional unit of the kidney is the nephron.
2. True
3. False

ANS: T

The nephron is the functional unit of the kidney.

REF: p. 220

1. Urine formation begins in the glomerulus.
2. True
3. False

ANS: T

Urine formation begins in the glomerulus of the kidney.

REF: p. 223

1. A hypoplastic kidney is a small, third kidney and a rare developmental anomaly.
2. True
3. False

ANS: F

Supernumerary kidney is the term applied to a small, third kidney.

REF: pp. 228-229

1. Horseshoe kidney is the most common fusion anomaly of the urinary system.
2. True
3. False

ANS: T

Horseshoe kidney is fusion of the kidneys at the lower poles and is the most common fusion anomaly of the urinary system.

REF: p. 223

1. Ectopic kidney describes when a kidney fails to develop.
2. True
3. False

ANS: F

Ectopic kidney describes when a kidney is in an abnormal location.

REF: p. 230

1. Ureteroceles are commonly associated with duplicated ureters.
2. True
3. False

ANS: T

Ureteroceles are seen almost exclusively in children with duplication anomalies of the ureters.

REF: p. 239

1. Chronic cystitis is evidenced radiographically by a decrease in bladder size and wall irregularity.
2. True
3. False

ANS: T

Radiographic evidence of chronic cystitis is a decrease in bladder size and irregularity of the bladder wall.

REF: p. 219

1. Glomerulonephritis is the most common nosocomial infection.
2. True
3. False

ANS: F

Cystitis is the most common hospital-acquired or nosocomial infection.

REF: p. 220

1. Urinary calculi are asymptomatic while they are in the kidney.
2. True
3. False

ANS: T

Urinary calculi are asymptomatic while they are in the kidney. They become painful when they lodge in the ureter.

REF: p. 221

1. Painless hematuria is a common presentation of a hypernephroma.
2. True
3. False

ANS: T

A common symptom of a hypernephroma is painless hematuria.

REF: p. 223

MATCHING

Match the disease to its definition.

a.	Nonsuppurative inflammation of the tuft of the capillaries in the Bowman’s capsule
b.	Suppurative infection of kidney and renal pelvis
c.	Inflammation of the urinary bladder
d.	A destructive condition involving the terminal portion of the renal pyramids

1. Cystitis

1. Glomerulonephritis

1. Pyelonephritis

1. Papillary necrosis

1. ANS: C REF: p. 228

NOT: Rationale: Cystitis is inflammation of the urinary bladder caused by bacteria traveling up the urethra to cause an infection in the bladder. Glomerulonephritis is a bacterial infection of the glomerulus. Pyelonephritis is an infection of the kidneys and renal pelves caused by a pyogenic bacterium. Papillary necrosis is destruction of the papillae of the medulla and the terminal portion of the renal pyramids.

1. ANS: A REF: p. 223

NOT: Rationale: Cystitis is inflammation of the urinary bladder caused by bacteria traveling up the urethra to cause an infection in the bladder. Glomerulonephritis is a bacterial infection of the glomerulus. Pyelonephritis is an infection of the kidneys and renal pelves caused by a pyogenic bacterium. Papillary necrosis is destruction of the papillae of the medulla and the terminal portion of the renal pyramids.

1. ANS: B REF: p. 225

NOT: Rationale: Cystitis is inflammation of the urinary bladder caused by bacteria traveling up the urethra to cause an infection in the bladder. Glomerulonephritis is a bacterial infection of the glomerulus. Pyelonephritis is an infection of the kidneys and renal pelves caused by a pyogenic bacterium. Papillary necrosis is destruction of the papillae of the medulla and the terminal portion of the renal pyramids.

1. ANS: D REF: p. 228

NOT: Rationale: Cystitis is inflammation of the urinary bladder caused by bacteria traveling up the urethra to cause an infection in the bladder. Glomerulonephritis is a bacterial infection of the glomerulus. Pyelonephritis is an infection of the kidneys and renal pelves caused by a pyogenic bacterium. Papillary necrosis is destruction of the papillae of the medulla and the terminal portion of the renal pyramids.

Match the disease to the imaging modality that is most commonly used to diagnose it.

a.	Contrast-enhanced CT
b.	Ultrasound
c.	Noncontrast helical CT
d.	MRI

1. Glomerulonephritis

1. Pyelonephritis

1. Acute renal failure

1. Kidney stones

1. ANS: B REF: p. 225

NOT: Rationale: Ultrasound is the imaging modality of choice for many urinary diseases because it is not dependent upon renal function and does not further damage renal tissue with the administration of contrast media. Ultrasound is particularly useful in acute and chronic renal failure and glomerulonephritis. Pyelonephritis is demonstrated well by contrast-enhanced CT, which demonstrates cortical changes and abscesses. Kidney stones are best demonstrated by noncontrast helical CT.

1. ANS: A REF: p. 226

NOT: Rationale: Ultrasound is the imaging modality of choice for many urinary diseases because it is not dependent upon renal function and does not further damage renal tissue with the administration of contrast media. Ultrasound is particularly useful in acute and chronic renal failure and glomerulonephritis. Pyelonephritis is demonstrated well by contrast-enhanced CT, which demonstrates cortical changes and abscesses. Kidney stones are best demonstrated by noncontrast helical CT.

1. ANS: B REF: p. 246

NOT: Rationale: Ultrasound is the imaging modality of choice for many urinary diseases because it is not dependent upon renal function and does not further damage renal tissue with the administration of contrast media. Ultrasound is particularly useful in acute and chronic renal failure and glomerulonephritis. Pyelonephritis is demonstrated well by contrast-enhanced CT, which demonstrates cortical changes and abscesses. Kidney stones are best demonstrated by noncontrast helical CT.

1. ANS: C REF: p. 230

NOT: Rationale: Ultrasound is the imaging modality of choice for many urinary diseases because it is not dependent upon renal function and does not further damage renal tissue with the administration of contrast media. Ultrasound is particularly useful in acute and chronic renal failure and glomerulonephritis. Pyelonephritis is demonstrated well by contrast-enhanced CT, which demonstrates cortical changes and abscesses. Kidney stones are best demonstrated by noncontrast helical CT.

Eisenberg: Comprehensive Radiographic Pathology, 5^th Edition

Chapter 7: Cardiovascular System

Test Bank

MULTIPLE CHOICE

1. The heart is lined with a smooth, delicate membrane called the:

a.	Myocardium
b.	Pericardium
c.	Epicardium
d.	Endocardium

ANS: D

The innermost layer of the heart is a smooth delicate membrane called the endocardium. The myocardium is the specialized muscle layer, and the epicardium is the outermost layer. The pericardium is the sac that surrounds the heart.

REF: p. 251

1. The heart rate is controlled by the:

a.	Autonomic nervous system
b.	Sympathetic nervous system
c.	AV node
d.	Purkinje fibers

ANS: A

The autonomic nervous system controls the heart rate, whereas the sympathetic nervous system controls the release of epinephrine in times of stress to provide increased heart rate and force of contractions.

REF: p. 251

1. Which hormone increases heart rate and increases the force of its contractions?

a.	Acetylcholine
b.	Epinephrine
c.	Norepinephrine
d.	Cortisone

ANS: B

Epinephrine is released in response to the sympathetic nervous system, which controls our fight or flight responses.

REF: p. 251

1. The left atrioventricular (AV) valve is also called the:

a.	Tricuspid valve
b.	Mitral valve
c.	Quadcuspid valve
d.	Chordae tendineae

ANS: B

The left AV valve is also known as the mitral or bicuspid valve. The tricuspid valve is the right AV valve. The chordae tendineae anchor the papillary muscles, which attach to the cusps of the valves.

REF: p. 252

1. The _____ separates the right and left sides of the heart.

a.	Papillary muscle
b.	Myocardium
c.	Septum
d.	Endocardium

ANS: C

The septum is the partition that separates the chambers on the right and left sides of the heart. Papillary muscles attach to AV valve cusps. Myocardium is the muscle layer of the heart, and endocardium is the delicate inner layer of the heart.

REF: p. 251

1. The tricuspid valve is located:

a.	Between the left ventricle and aorta
b.	Between the left atrium and ventricle
c.	Between the right ventricle and the pulmonary artery
d.	Between the right atrium and ventricle

ANS: D

The tricuspid valve is also known as the right AV valve.

REF: p. 252

1. Deoxygenated venous blood returns to the heart via the:

a.	Right and left coronary arteries
b.	Pulmonary veins
c.	Superior and inferior vena cava
d.	Pulmonary arteries

ANS: C

The superior vena cava and inferior vena cava carry deoxygenated blood from the body to the heart.

REF: p. 253

1. The superior and inferior vena cava empty into the:

a.	Right atrium
b.	Left atrium
c.	Right ventricle
d.	Left ventricle

ANS: A

The superior and inferior vena cava empty into the right atrium to begin pulmonary circulation.

REF: p. 253

1. The right ventricle pumps blood into the:

a.	Pulmonary veins
b.	Aorta
c.	Superior and inferior vena cava
d.	Pulmonary artery

ANS: D

The right ventricle pumps deoxygenated blood into the pulmonary artery, which transports the blood to the lungs for oxygenation.

REF: p. 253

1. The pulmonary veins empty into the:

a.	Right atrium
b.	Right ventricle
c.	Left atrium
d.	Left ventricle

ANS: C

The pulmonary veins carry oxygenated blood from the lungs to the left atrium.

REF: p. 253

1. Deoxygenated blood is carried from the heart to the lungs via the:

a.	Pulmonary veins
b.	Pulmonary arteries
c.	Aorta
d.	Coronary arteries

ANS: B

The pulmonary arteries transport deoxygenated blood from the heart to the lungs; the pulmonary veins return oxygenated blood from the lungs to the heart.

REF: p. 253

1. Systole is defined as the:

a.	Contraction phase
b.	Relaxation phase
c.	Resting phase
d.	Mechanical phase

ANS: A

Systole is the contraction phase of the heartbeat cycle.

REF: p. 253

1. What term is applied to the contraction phase of the heart?

a.	Diastole
b.	Systole
c.	Impulse
d.	Synapse

ANS: B

Systole is the contraction phase of the heart.

REF: p. 253

1. What term is applied to the relaxed, filling phase of the heart?

a.	Synapse
b.	Impulse
c.	Systole
d.	Diastole

ANS: D

The relaxed, filling phase of the heart is diastole, whereas systole is the term applied to the contraction phase.

REF: p. 253

1. Which of the following is termed the “pacemaker” of the heart?

a.	Purkinje fibers
b.	Bundle of His
c.	SA node
d.	AV node

ANS: C

The SA node initiates the heartbeat and rhythm, so it is called the pacemaker of the heart. The other answers are other parts of the conduction system of the heart.

REF: p. 253

1. Which of the following is the correct order of the impulse of a heartbeat through the components of the conduction system?

a.	SA node, AV node, Bundle of His, Purkinje fibers
b.	AV node, Bundle of His, Purkinje fibers, SA node
c.	SA node, Bundle of His, AV node, Purkinje fibers
d.	AV node, Purkinje fibers, SA node, Bundle of His

ANS: A

The heartbeat is initiated at the SA node, passes to the AV node, then to the Bundle of His, and finally to the terminal Purkinje fibers.

REF: pp. 253-254

1. What is the function of the pericardium?

a.	Provide the contraction, pumping action of the heart
b.	Initiate the heartbeat
c.	Protect against friction and permit free movement of the heart during contraction
d.	Provide an intrinsic rhythm in case the autonomic nervous system fails

ANS: C

The pericardium is a well-lubricated, double-walled membranous sac that surrounds the heart and protects it against friction and allows free movement of the heart during contraction.

REF: p. 255

1. The double-walled membranous sac that protects against friction and permits the heart to move freely during contraction is called the:

a.	Epicardium
b.	Pericardium
c.	Endocardium
d.	Myocardium

ANS: B

The pericardium is the double-walled membranous sac that protects against friction and permits the heart to move freely during contraction.

REF: p. 255

1. The most common congenital cardiac lesions are:

a.	Tetralogy of Fallot
b.	Coarctation of the aorta
c.	Right-to-left shunts
d.	Left-to-right shunts

ANS: D

The most common congenital cardiac lesions are left-to-right shunts, which allow mixing of the systemic and pulmonary circulations.

REF: p. 255

1. A(n) _____ permits mixing of blood from system and pulmonary circulations as a result of a lack of closure of the foramen ovale after birth.

a.	Atrial septal defect
b.	Ventricular septal defect
c.	Tetralogy of Fallot
d.	Patent ductus arteriosus

ANS: A

Atrial septal defects are the most common type of left-to-right shunt and allow free communication between the left and right atria.

REF: p. 255

1. Which congenital cardiac lesion appears radiographically as an enlarged left atrium, left ventricle, and central pulmonary arteries, along with diffuse increased pulmonary vasculature?

a.	Atrial septal defect
b.	Patent foramen ovale
c.	Patent ductus arteriosus
d.	Tetralogy of Fallot

ANS: C

Patent ductus arteriosus causes a shunt from the higher pressure in the aorta to the lower pressure in the pulmonary artery. There is an increase in pulmonary blood flow and an increased return to the left atrium and ventricle, thus increasing the size of these structures on chest x-rays.

REF: p. 255

1. Which congenital cardiac lesion appears radiographically as an enlarged right atrium, right ventricle, and pulmonary outflow tract?

a.	Coarctation of the aorta
b.	Atrial septal defect
c.	Ventricular septal defect
d.	Patent ductus arteriosus

ANS: B

Atrial septal defect shunts blood from the higher pressure in the left atrium to the lower pressure in the right atrium. This creates a backup of pulmonary blood flow and increases the chambers on the right side of the heart.

REF: p. 255

1. What is the radiographic evidence of ventricular septal defect?

a.	Enlarged right atrium and ventricle
b.	Enlarged left ventricle
c.	Enlarged aorta
d.	Enlarged pulmonary trunk

ANS: D

The pulmonary trunk enlarges greatly in cases of a ventricular septal defect.

REF: p. 255

1. Which of the following is an abnormal vascular connection between the pulmonary artery and aorta?

a.	Patent ductus arteriosus
b.	Patent foramen ovale
c.	Rheumatic heart disease
d.	Chordae tendineae

ANS: A

The ductus arteriosus is a normal part of fetal circulation that should close shortly after birth. The ductus arteriosus bypasses the pulmonary circulation circuit.

REF: p. 255

1. All left-to-right shunts can be complicated by the development of:

a.	Pulmonary hypertension
b.	Congestive heart failure
c.	Rheumatic heart disease
d.	Mitral valve prolapse

ANS: A

All left-to-right shunts can be complicated by the development of pulmonary hypertension caused by increased vascular resistance within the pulmonary arteries.

REF: p. 256

1. Which imaging modality is the most definitive, yet the most invasive, for demonstration of the heart atria and ventricles?

a.	MRI
b.	Echocardiography
c.	CT
d.	Angiography

ANS: D

Angiography is the most definitive, but also the most invasive, modality for demonstration of the heart chambers.

REF: p. 256

1. What is the most common cause of cyanotic congenital heart disease?

a.	Coarctation of the aorta
b.	Tetralogy of Fallot
c.	Ventricular septal defect
d.	Atrial septal defect

ANS: B

Tetralogy of Fallot is the most common cause of cyanotic congenital heart disease and is a combination of four abnormalities.

REF: p. 256

1. Constriction of the aorta at the distal arch is termed:

a.	Coarctation of the aorta
b.	Tetralogy of Fallot
c.	Aortic prolapse
d.	Aortic valve insufficiency

ANS: A

Coarctation of the aorta is a constriction of the aorta at the distal arch.

REF: p. 257

1. Which of the following show up clinically as normal blood pressure in the upper extremities and low blood pressure in the lower extremities?

a.	Aortic prolapse
b.	Mitral valve prolapse
c.	Coarctation of the aorta
d.	Ventricular septal defect

ANS: C

Coarctation of the aorta causes a decrease in blood pressure in the lower extremities as a result of the loss of blood flow below the constriction.

REF: p. 257

1. Rib notching is a radiographic characteristic of:

a.	Ventricular septal defect
b.	Coarctation of the aorta
c.	Atrial septal defect
d.	Tetralogy of Fallot

ANS: B

Rib notching can be seen on chest x-rays of patients with coarctation of the aorta as a result of the increased pressure in the intercostal arteries.

REF: p. 257

1. Which of the following causes ischemic heart disease as a result of decreased oxygen to the myocardium?

a.	Mitral valve prolapse
b.	Tetralogy of Fallot
c.	Coronary artery disease
d.	Coarctation of the aorta

ANS: C

Coronary artery disease is an acquired disease in which the lumens of the coronary arteries are narrowed, thus decreasing the oxygen delivered to the myocardium.

REF: p. 259

1. What is atherosclerosis?

a.	Fatty deposits on the inner lining of arteries
b.	Loss of arterial wall elasticity
c.	Calcification of the aorta caused by metabolic error
d.	Sudden, acute arterial collapse

ANS: A

Atherosclerosis is the accumulation of fatty material on the inner lining of the artery.

REF: p. 259

1. Fatty deposits along the lining of arterials walls is termed:

a.	Coarctation
b.	Atherosclerosis
c.	Eisenmenger’s syndrome
d.	Myocardial infarction

ANS: B

Atherosclerosis is the accumulation of fatty material on the inner lining of the artery. Coarctation is a dramatic narrowing of the aorta. Eisenmenger’s syndrome is pulmonary hypertension related to congenital cardiac defects.

REF: p. 259

1. What is a myocardial infarction?

a.	An accumulation of fatty material on the myocardium
b.	A drastic increase in the size of myocardial cells
c.	Death of myocardial cells
d.	Neoplastic proliferation of myocardial cells

ANS: C

An infarct is an area of dead tissue cells.

REF: p. 260

1. Death of myocardial cells caused by a lack of blood supply is known as a:

a.	Congestive heart failure (CHF)
b.	Cardiogenic shock
c.	Cardiopulmonary ischemia
d.	Myocardial infarction

ANS: D

Myocardial infarction is a death of myocardial cells caused by a lack of blood supply. Generally the coronary arteries are stenotic from atherosclerotic plaque.

REF: p. 260

1. The inability of the heart to propel blood at a rate and volume sufficient to provide an adequate supple to the tissues is called:

a.	Myocardial infarction
b.	Congestive heart failure
c.	Cardiogenic shock
d.	Coronary angioplasty

ANS: B

CHF is the inability of the heart to propel blood at a rate and volume sufficient to provide an adequate supple to the tissues. Myocardial infarction is a death of myocardial cells caused by a lack of blood supply. Coronary angioplasty is a procedure to expand stenotic lesions in the coronary arteries. Cardiogenic shock is caused by decreased output, despite an adequate blood volume.

REF: p. 263

1. Which of the following are causes of congestive heart failure?

(1) Hypertension

(2) Impaired heart contractions

(3) Increased peripheral resistance to blood flow

a.	1 and 2 only
b.	1 and 3 only
c.	2 and 3 only
d.	1, 2, and 3

ANS: D

All of the conditions listed can cause CHF and an intrinsic cardiac abnormality.

REF: p. 263

1. An abnormal accumulation of fluid in the extravascular pulmonary tissues is termed:

a.	Pulmonary edema
b.	Congestive heart failure
c.	Pulmonary embolism
d.	Pulmonary infarct

ANS: A

Pulmonary edema is the abnormal accumulation of fluid in the extravascular pulmonary tissues. It is usually caused by an increase in pulmonary venous pressure as a result of left-sided heart failure.

REF: p. 265

1. The most common cause of pulmonary edema is:

a.	Mitral valve disease
b.	Embolism
c.	Bronchial tumor
d.	Elevated pulmonary venous pressure

ANS: D

The most common cause of pulmonary edema is an increase in pulmonary venous pressure, which results from left-sided heart failure.

REF: p. 265

1. Which of the following might cause pulmonary edema?

(1) Mitral valve disease

(2) Narcotic overdose

(3) Adult respiratory distress syndrome

a.	1 and 2 only
b.	1 and 3 only
c.	2 and 3 only
d.	1, 2, and 3

ANS: D

All of these may cause pulmonary edema; other causes include lymphatic blockage, lymphatic metastatic disease, uremia, exposure to noxious fumes, excessive oxygen, fat embolism, high altitudes, and various neurologic abnormalities.

REF: p. 265

1. The leading cause of strokes and CHF is:

a.	Myocardial infarction
b.	Cardiogenic shock
c.	Hypertension
d.	Pulmonary edema

ANS: C

Hypertension is the leading cause of strokes and congestive heart failure.

REF: p. 266

1. High blood pressure is defined as a systolic pressure above _____ mm Hg and a diastolic pressure above _____ mm Hg.

a.	90/140
b.	140/90
c.	100/70
d.	70/100

ANS: B

High blood pressure is defined as a systolic pressure above 140 mm Hg and a diastolic pressure above 90 mm Hg. As a person ages, the allowed systolic pressure is increased 10 mm Hg per decade over age 40.

REF: p. 266

1. What is an aneurysm?

a.	An area of an artery in which the lumen is narrowed or stenotic
b.	An area of an artery in which the walls are dilated
c.	A benign tumor of the inner lining of the arterial wall
d.	A malignant tumor of the muscular layer of the arterial wall

ANS: B

A localized dilatation of an artery defines aneurysm.

REF: p. 270

1. A localized dilatation of an artery is termed a(n):

a.	Aneurysm
b.	Coarctation
c.	Stenosis
d.	Dissection

ANS: A

A localized dilatation of an artery defines aneurysm.

REF: p. 270

1. When an artery is dilated, or bulging, on only one side of the arterial wall, it is termed a:

a.	Fusiform aneurysm
b.	Saccular aneurysm
c.	Lobar arterial tumor
d.	Unilobar arterial tumor

ANS: B

Aneurysms that involve only one side of the arterial wall are called saccular aneurysms.

REF: p. 270

1. When the entire circumference of the vessel wall is bulging, it is called a:

a.	Fusiform aneurysm
b.	Saccular aneurysm
c.	Lobar arterial tumor
d.	Unilobar arterial tumor

ANS: A

Fusiform aneurysms cause bulging in the entire circumference of the vessel.

REF: p. 270

1. A potentially fatal complication of closed chest trauma is:

a.	Aneurysm
b.	Aortic stenosis
c.	Traumatic rupture of aorta
d.	Aortic valve insufficiency

ANS: C

Traumatic rupture of the aorta is a potentially fatal complication of closed chest trauma. In almost all cases, the tear occurs just distal to the left subclavian artery at the site of the ductus arteriosus.

REF: p. 272

1. What is an aortic dissection?

a.	Complete tear of arterial wall
b.	Congenital anomaly in which the lumen is duplicated
c.	Traumatic disruption of the aorta from the root at the junction of the left ventricle
d.	Disruption of the intima allowing blood to flow between the layers of the wall

ANS: D

Aortic dissection is a disruption of the intima, the inner lining of the artery, which allows blood to flow between the layers.

REF: p. 272

1. What is a thrombus?

a.	A piece of a blood clot that enters the bloodstream
b.	An intravascular clot
c.	Traumatic aortic dissection
d.	A tear in the inner lining of the artery

ANS: B

A thrombus is an intravascular clot that forms in places where blood flow is slowed or where the vessel wall is damaged.

REF: p. 275

1. What is an embolism?

a.	A piece of a blood clot that enters the bloodstream
b.	A clot inside a blood vessel
c.	A tear in the lining of an artery
d.	A weakness in an artery wall

ANS: A

An embolism is a piece of thrombus that has broken way and entered the bloodstream.

REF: p. 276

1. An autoimmune disease that results from a reaction of a patient’s antibodies against antigens from a previous streptococcal infection is called:

a.	Infective endocarditis
b.	Pericardial effusion
c.	Infectious pericardial edema
d.	Rheumatic fever

ANS: D

Rheumatic fever is an autoimmune disease that results from a reaction of a patient’s antibodies against antigens from a previous streptococcal infection. It is not as common today because of the rapid treatment of strep infections with antibiotics.

REF: p. 279

1. What structures are typically damaged by rheumatic fever?

a.	Coronary arteries
b.	Myocardium and endocardium
c.	Red blood cells and blood platelets
d.	Heart valves

ANS: D

The heart valves almost always suffer major damage from rheumatic fever, usually the mitral and aortic valves.

REF: p. 279

1. Which of the following conditions is (are) complication(s) of rheumatic fever?

(1) Mitral valve stenosis

(2) Aortic valve insufficiency

(3) Aortic valve stenosis

a.	1 and 2 only
b.	1 and 3 only
c.	2 and 3 only
d.	1, 2, and 3

ANS: D

All of these conditions are complications of rheumatic fever. Stenosis is a narrowing of the opening, and insufficiency allows blood to regurgitate when the valve cusps are supposed to be closed.

REF: p. 280

1. Which imaging modality is the most sensitive and specific noninvasive method for diagnosing mitral valve stenosis?

a.	Chest radiography
b.	Echocardiography
c.	CT
d.	MRI

ANS: B

Echocardiography is the most sensitive and specific noninvasive method for evaluating mitral valve stenosis.

REF: p. 281

1. Which of the following might cause aortic valve insufficiency?

(1) Syphilis

(2) Infective endocarditis

(3) Deep vein thrombosis

a.	1 and 2 only
b.	1 and 3 only
c.	2 and 3 only
d.	1, 2, and 3

ANS: A

Aortic valve insufficiency is most commonly caused by rheumatic fever, but it may also be attributed to syphilis, infective endocarditis, and Marfan syndrome.

REF: p. 282

1. A disease in which the growth of nodules or vegetations on the heart valves is caused by deposits of bacteria or fungi is known as:

a.	Pericardial effusion
b.	Infectious pulmonary edema
c.	Infective endocarditis
d.	Deep vein thrombosis

ANS: C

Infective endocarditis is a disease in which the growth of vegetation on the heart valves is the result of bacteria or fungi. The vegetations can break apart and are filled with bacteria, creating septic emboli that can lodge in other parts of the body.

REF: p. 282

1. The accumulation of fluid in the membrane surrounding the heart is termed:

a.	Infective endocarditis
b.	Deep vein thrombosis
c.	Pericardial effusion
d.	Pulmonary edema

ANS: C

Pericardial effusion is an accumulation of fluid in the pericardial sac, the serous membrane surrounding the heart.

REF: p. 284

1. Which of the following is a major source of fatal pulmonary emboli?

a.	Pericardial effusion
b.	Pulmonary edema
c.	Deep vein thrombosis
d.	Infective endocarditis

ANS: C

Deep vein thromboses are clots in the deep veins of the lower extremities. These clots could break loose and become emboli, which usually lodge in the lungs, with drastic consequences. Infective endocarditis can also produce emboli, but these are septic emboli from the bacteria-filled vegetations on the heart valves.

REF: p. 285

1. Dilated and tortuous superficial veins of the leg are called:

a.	Varicose veins
b.	Deep vein thrombosis
c.	Vesiculitis
d.	Aneurysms

ANS: A

Varicose veins are dilated, tortuous, superficial veins of the lower legs.

REF: p. 287

1. Which of the following is a noninvasive technique used for diagnosis of deep vein thrombosis?

a.	Venography
b.	CT
c.	MRI
d.	Color-flow Doppler ultrasound

ANS: D

Although venography is a definitive imaging modality for the diagnosis of DVT, color-flow Doppler ultrasound has emerged as the modality of choice since it is noninvasive and has 95% accuracy.

REF: p. 286

1. All of the following are predisposing factors to the development of coronary artery disease except:

a.	Hypertension
b.	Obesity
c.	Congenital defects
d.	Smoking

ANS: C

Factors predisposing to the development of coronary artery disease include hypertension, obesity, smoking, a high-cholesterol diet, and lack of exercise.

REF: p. 255

1. How is cardiomegaly evaluated on a PA chest radiograph?

a.	Measurement of the cardiothoracic ratio
b.	Evaluation of the height of the right hemidiaphragm
c.	Evaluation of the left hemidiaphragm
d.	Cardiomegaly cannot be evaluated on a PA chest radiograph.

ANS: A

A simple measurement made on a posteroanterior (PA) chest to evaluate the heart size is the cardiothoracic ratio (C/T ratio), with greater than 50% indicating cardiomegaly

REF: p. 256

1. All of the following are causes of aortic stenosis, except:

a.	rheumatic heart disease
b.	coronary artery disese
c.	idiopathic calcific stenosis
d.	congenital valvular deformity

ANS: B

Aortic stenosis may be caused by rheumatic heart disease, a congenital valvular deformity (especially of a bicuspid valve), or a degenerative process of aging (idiopathic calcific stenosis).

REF: p. 256

TRUE/FALSE

1. Right-to-left shunts are the most common congenital cardiac lesions.
2. True
3. False

ANS: F

Left-to right shunts are the most common because of the pressure differential between the left and right sides of the heart. Shunts generally occur from a higher pressure to a lower pressure.

REF: p. 257

1. Tetralogy of Fallot involves four abnormalities.
2. True
3. False

ANS: T

Tetra is a prefix that means “four,” so this is a congenital condition of four simultaneous abnormalities.

REF: p. 270

1. The most common cause of cyanotic congenital heart disease is atrial septal defect.
2. True
3. False

ANS: F

Tetralogy of Fallot is the most common cause of cyanotic congenital heart disease. Atrial septal defect is the most left-to-right shunt disorder.

REF: p. 275

1. Rib notching demonstrated on chest radiographs is a characteristic of coarctation of the aorta.
2. True
3. False

ANS: T

Rib notching is a characteristic of coarctation caused by the pressure exerted by the increased blood flow through the costal arteries.

REF: p. 285

1. A fusiform aneurysm is a localized weakness that bulges out on only one side of the artery wall.
2. True
3. False

ANS: F

Fusiform aneurysms are weaknesses in the entire circumference of the arterial wall. Saccular aneurysms are localized bulges in an artery.

REF: p. 279

1. A thrombus is a piece of an embolism that has broken free into the circulating bloodstream.
2. True
3. False

ANS: F

A thrombus is an intravascular clot, which can give rise to an embolism.

REF: p. 279

1. Deep vein thrombosis is a primary source of pulmonary embolism.
2. True
3. False

ANS: T

DVT is a primary source of pulmonary embolism.

REF: p. 283

1. Regurgitation of blood through a heart valve means that blood is flowing backward from an opening that is too large or through cusps that do close properly.
2. True
3. False

ANS: T

Regurgitation refers to the backward flow of blood through a valve that is supposed to be closed. The backward flow is due to an opening that is too large or from valves that cannot close properly.

REF: p. 259

1. Rheumatic fever is a primary cause of valvular disease.
2. True
3. False

ANS: T

Rheumatic fever is a primary cause of valvular disease, especially on the mitral and aortic valves.

REF: p. 264

1. Radiography is of little value in the demonstration of infective endocarditis.
2. True
3. False

ANS: T

Heart size is often normal in infective endocarditis, so radiography of the chest is of little value.

REF: p. 282

MATCHING

Match the disease to its definition.

a.	Intravascular clot
b.	Fatty material deposits on inner arterial walls
c.	Clot material in the circulating blood
d.	Dead heart muscle cells

1. Atherosclerosis

1. Embolism

1. Myocardial infarct

1. Thrombus

1. ANS: B REF: p. 274

NOT: Rationale: Atherosclerosis is fatty material or plaque on the inner arterial walls. An embolism is a piece of clot that has broken free into the circulating bloodstream. Myocardial infarct is an area of dead muscle cells. Thrombus is an intravascular clot.

1. ANS: C REF: p. 276

NOT: Rationale: Atherosclerosis is fatty material or plaque on the inner arterial walls. An embolism is a piece of clot that has broken free into the circulating bloodstream. Myocardial infarct is an area of dead muscle cells. Thrombus is an intravascular clot.

1. ANS: D REF: p. 260

NOT: Rationale: Atherosclerosis is fatty material or plaque on the inner arterial walls. An embolism is a piece of clot that has broken free into the circulating bloodstream. Myocardial infarct is an area of dead muscle cells. Thrombus is an intravascular clot.

1. ANS: A REF: p. 275

NOT: Rationale: Atherosclerosis is fatty material or plaque on the inner arterial walls. An embolism is a piece of clot that has broken free into the circulating bloodstream. Myocardial infarct is an area of dead muscle cells. Thrombus is an intravascular clot.

Match the disease to its radiographic characteristic on a PA chest projection.

a.	Blurred vascular markings; “butterfly” pattern when severe
b.	Enlarged right atrium and ventricle
c.	Cardiomegaly; cardiothoracic ratio greater than 50%
d.	Enlarged left atrium, left ventricle, and pulmonary arteries

1. Atrial septal defect

1. Patent ductus arteriosus

1. Congestive heart failure