Imaging & Diagnostics Questions - Set 1¶
Question 1¶
What Z-score threshold for the left anterior descending artery defines a small aneurysm in Kawasaki disease?
A) Z 2.0-2.5 B) Z 2.5-5.0 C) Z 5.0-7.5 D) Z 7.5-10.0 E) Z ≥10.0
Answer
**Correct Answer: B** Kawasaki coronary classification: - No involvement: Z <2.0 - Dilation only: Z 2.0-2.5 - **Small aneurysm: Z 2.5-5.0** - Medium aneurysm: Z 5.0-10.0 - Giant aneurysm: Z ≥10.0 or ≥8mm **Board Pearl:** Small CAA = Z 2.5-5.0; Giant = Z≥10 or ≥8mmQuestion 2¶
In a patient with HCM, what septal thickness on echo is considered diagnostic in adults?
A) ≥10mm B) ≥12mm C) ≥15mm D) ≥18mm E) ≥20mm
Answer
**Correct Answer: C** HCM diagnosis: - **≥15mm** wall thickness in adults (without other cause) - In children: Z-score ≥2 for age - Or ≥13mm with family history/positive genetic test **Board Pearl:** HCM = wall thickness ≥15mm adults, Z≥2 in childrenQuestion 3¶
What is the LA:Ao ratio threshold indicating hemodynamically significant PDA in a preterm infant?
A) >1.0 B) >1.2 C) >1.4-1.5 D) >2.0 E) >2.5
Answer
**Correct Answer: C** LA:Ao >1.4-1.5 suggests **hemodynamically significant PDA**: - Indicates LA volume overload - Correlates with shunt magnitude - Combined with PDA size, flow reversal, LV dilation **Board Pearl:** hsPDA = LA:Ao >1.4-1.5 + diastolic flow reversal + LV dilationQuestion 4¶
What cardiac MRI finding is pathognomonic for ARVC?
A) Late gadolinium enhancement in lateral wall B) RV fatty infiltration C) Akinetic segments with fibrofatty replacement in RV D) Global RV dilation E) Pericardial effusion
Answer
**Correct Answer: C** ARVC MRI criteria: - Regional RV akinesia/dyskinesia - **Fibrofatty replacement** (characteristic but not required) - RV dilation with reduced function - Task Force Criteria for diagnosis Note: Fatty infiltration alone is not diagnostic (can be normal variant). **Board Pearl:** ARVC = regional RV dyskinesia + fibrofatty replacement on MRIQuestion 5¶
What is the first-line imaging modality to evaluate suspected coarctation of the aorta in a stable 8-year-old?
A) Chest X-ray B) Echocardiogram C) CT angiography D) MRI E) Cardiac catheterization
Answer
**Correct Answer: B** **Echocardiography** is first-line for suspected coarctation: - Shows narrowing, gradient, flow pattern - Evaluates associated lesions (BAV, VSD) - Non-invasive CT/MRI for better anatomic definition if surgery planned. **Board Pearl:** Coarctation workup = echo first; CT/MRI for surgical planningQuestion 6¶
In fetal echocardiography, what view is most helpful for detecting d-TGA?
A) Four-chamber view B) Outflow tract views C) Three-vessel view D) Aortic arch view E) Ductal arch view
Answer
**Correct Answer: B** **Outflow tract views** essential for d-TGA detection: - Four-chamber view appears normal in d-TGA - Outflow views show parallel great arteries - Three-vessel view also abnormal - d-TGA often missed if only 4-chamber used **Board Pearl:** d-TGA = normal 4-chamber view; need outflow tract views to diagnoseQuestion 7¶
What echo finding suggests elevated pulmonary vascular resistance in a patient with VSD?
A) LA dilation B) Bidirectional or right-to-left shunting C) LV hyperdynamic function D) Increased mitral E wave velocity E) Pulmonary valve doming
Answer
**Correct Answer: B** **Bidirectional or R→L shunting** suggests elevated PVR: - Normal: L→R shunt through VSD - Elevated PVR: Shunt becomes bidirectional, then R→L - Indicates Eisenmenger syndrome developing **Board Pearl:** VSD shunt reversal (R→L) = elevated PVR/EisenmengerQuestion 8¶
A patient with Williams syndrome should have echo surveillance for which lesion?
A) Coarctation of aorta B) Supravalvar aortic stenosis C) Bicuspid aortic valve D) Mitral valve prolapse E) Patent foramen ovale
Answer
**Correct Answer: B** **Williams syndrome = supravalvar aortic stenosis**: - Elastin gene deletion - Progressive narrowing common - Also peripheral pulmonary stenosis - May also have coronary ostial stenosis **Board Pearl:** Williams syndrome = supravalvar AS + peripheral PSQuestion 9¶
What is the appropriate imaging modality to evaluate coronary arteries in a teenager with Kawasaki disease history and exercise-induced symptoms?
A) Echocardiography B) CT coronary angiography C) Cardiac MRI D) Exercise stress echocardiography E) Coronary catheterization
Answer
**Correct Answer: B** **CT coronary angiography** for KD follow-up: - Excellent coronary visualization - Detects stenosis, calcification, aneurysm morphology - Less invasive than cath - MRI also acceptable but less spatial resolution for coronaries **Board Pearl:** KD coronary surveillance = CTA or cath if symptoms/high-riskQuestion 10¶
In cardiac MRI, what does late gadolinium enhancement (LGE) indicate?
A) Edema (acute inflammation) B) Fibrosis or scar C) Active infection D) Fat infiltration E) Increased blood flow