USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

What congenital cardiac anomaly is associated with ruptured cerebral aneurysms?

1. Coarctation of the aorta

2. Patent ductus arteriosus

3. Aortic stenosis

4. Mitral regurgitation

The correct answer is: Coarctation of the aorta

Coarctation of the aorta is a congenital cardiac anomaly characterized by a narrowing of the aorta, typically occurring just distal to the left subclavian artery. This condition can lead to systemic hypertension and increased pressure load in the upper body, as blood flow is redirected around the constriction. The association between coarctation of the aorta and ruptured cerebral aneurysms primarily stems from the hypertension that often develops as a result of the coarctation. Chronic hypertension has been shown to contribute to the formation of cerebral aneurysms, as it exerts excessive stress on the vessel walls. Over time, this can lead to the weakening of the arterial wall, increasing the risk of aneurysm formation and subsequent rupture, particularly in the cerebral circulation. In contrast, the other listed conditions—patent ductus arteriosus, aortic stenosis, and mitral regurgitation—do not have the same direct association with increased risk of cerebral aneurysms and their rupture. While they may have other cardiovascular implications, the specific link to ruptured cerebral aneurysms is most clearly established in the context of coarctation of the aorta. This highlights why understanding the hemodynamic effects of congenital heart defects is