cardiology medicine mcqs

Therefore, an ASD in some part is an essential feature of this lesion. In this typical scenario for Tetralogy of Fallot, echocardiography can confirm the diagnosis with no need for cardiac catheterization. Characteristics of this patient population that increase risks include advanced age and diminished ventricular function. a. B. Smaller catheters have helped prevent limb ischemia. Ischemic reductions in ventricular contractility and compliance can produce dyspnea on exertion as an angina equivalent. Doppler echocardiography can demonstrate the shunt, determine direction of shunting, and provide an estimate of shunt magnitude. During the effective refractory period, both slow calcium channels and fast sodium channels are closed and the myocardium cannot be excited. To minimize the workload on the single ventricle and ensure adequate delivery of oxygen to the tissues, an equal delivery of blood to both the lungs and the body is sought. The classic murmur of PDA is a continuous or mechanical murmur heard over the precordium and radiating to the medial third of the clavicle. While in earlier years younger age was an incremental risk factor for hospital death in some surgical experiences, this risk has been neutralized during the past decade. DISCUSSION: Electrical energy can be transmitted across the body wall by tunnelling an electric wire; however, experience has shown that infection, starting at the skin line and burrowing deeper into the body, will occur over time. Glenn in the 1950s for powering pacemakers. In infancy, flow to the lower body is from the ductus arteriosus before it closes, producing differential cyanosis. This combination is more common among infants with large VSDs undergoing operation before age 3 months. In former years such pumps were inserted prophylactically before induction of anesthesia for coronary bypass surgery. Clinical Examination A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Attachment by a vascular stalk thus allows tumor mobility, predisposing to embolization and interference with mitral valve competence and causing characteristic echocardiographic findings. A.  Operative morbidity and mortality are increased over those for primary CABG. The normally high pulmonary vascular resistance present in the first month of life precludes the performance of either the Glenn or the Fontan procedure in the newborn. Myocarditis may cause a systolic murmur on auscultation because of cardiac dilatation. In mitral regurgitation, left ventricular dilatation is an indication for surgical intervention regardless of failure symptoms. The apical murmur produced by turbulence with mitral forward flow mimics mitral stenosis and is called an Austin-Glint murmur. This murmur may closely resemble that of PDA. When mitral stenosis exists with a secundum ASD the condition is often referred to as Lutembacher's syndrome. Simply blocking one pathway is unlikely to completely prevent bypass-induced injury. DISCUSSION: Initial management of newborn infants with tricuspid atresia is determined by the anatomic and physiologic factors that affect the balance of pulmonary and systemic blood flow. DISCUSSION: Hepatic failure and anasarca are indeed common symptoms of severe, long-standing tricuspid valve disease with increased venous pressure. There is no role for glucocorticoids in the treatment of Kawasaki's disease. Origin of the left coronary artery from the pulmonary artery. Distorted and stenosed central pulmonary arteries or aortic arch obstructions should be repaired at the same time the bidirectional Glenn procedure is performed. B. They usually occur in the right ventricle. Initial-transit techniques use data from fewer than 10 heartbeats, whereas equilibrium studies require more than 100 heartbeats to acquire data with similar information density. Chest radiograph will show cor bovinum, b. D.  Anomalous origin of the left anterior descending coronary artery from the right coronary artery. An ASD with a significant left-to-right shunt as demonstrated by a Qp/Qs ratio in excess of 1.5 should be repaired. Cardiology; Endocrinology; Geriatric Medicine; Hematology; Hepatology; Infectious Diseases; Medical Emergency; Nephrology; Neurology; Psychiatry; Pulmonology; Rheumatology; Home All Free Medical Books MCQs for Cardiology Knowledge Based Assessment PDF – Oxford Higher Specialty Training. of 1:10,000. C.  The subaortic membrane is approached surgically via the aorta and aortic valve. The anterior leaflet is large and “sail-like,” while the other two leaflets are rudimentary. D.  Discontinuation of Coumadin therapy 5 days before operation with the institution of intravenous heparin as the prothrombin time normalizes. When neither left or right bundle-branch block prolong the VA interval, the bundle is in the septum. C.  They are usually more refractory to medical therapy than ischemic ventricular tachyarrhythmias. If an AICD is appropriate, it offers a 50% improvement in mortality compared to drug therapy, c. Poor ventricular function is a contraindication to AICD implantation, d. AICD should not be used for patients awaiting cardiac transplantation, e. AICD can provide antitachycardia pacing as well as defibrillation. If the findings at catheterization show limited disease treatable by PTCA, then it should be performed. Diuresis with furosemide and inotropic support with dopamine is acceptable for patients with mild congestive heart failure; however, in the postoperative period pharmacologic diuresis can lead to profound hypovolemia requiring continuous invasive hemodynamic monitoring. The aorta is opened and the aortic valve leaflets are retracted, exposing the fibrous membrane. Painful chest wall muscle contractions. DISCUSSION: The direction of an intracardiac shunt is governed by the compliance of the downstream chambers. a. Pulmonary edema is a consequence of left-sided heart disease and does not result from a tricuspid lesion. In Japan, however, the reverse is true: two thirds have doubly committed or juxta-arterial lesions and one third have perimembranous lesions. Lippincott Physiology PDF Download LINK [2020 Edition]: Anatomy and Physiology Textbook PDF Free Download:2021. lippincott Biochemistry 7TH EDITION PDF DOWNLOAD LINK: BRS Biochemistry PDF 7th Edition Free DOWNLOAD:2021, Critical Care Nursing: Diagnosis and Management PDF 8th Edition [Direct Link] - Medical Students Corner, Davis’s Drug Guide For Nurses PDF 17th Edition Free Download:2021. Extensive collateral development involves the mammary and intercostal arteries producing rib notching on the chest radiograph. Cardiology … In this case, a modification of the Fontan procedure must be employed. E.  Intravenous digitalis with diuresis using furosemide as needed. Aortic valve replacement is rarely necessary as a primary procedure but may be required in children who develop progressive aortic insufficiency after a previous intervention. per kg., is administered as a single infusion over 12 hours. A. DISCUSSION: During exertion, the required increase in cardiac output is obtained mostly by the increase in paced heart rate, although increased venous filling and maintenance of AV synchrony are also important contributors. B. B.  Mortality most often stems from cardiac causes after reoperation. The location of VSD does not affect surgical outcome, and most VSDs can be approached adequately through the right atrium or the anterior great vessel. A.  Gated equilibrium techniques provide more accurate measurements of ejection fraction than initial-transit methods. D.  They usually occur as a result of automaticity rather than re-entry. The Emory University group was the first to expound on the efficacy of the balloon pump in stabilizing patients following percutaneous angioplasty failure. The problem could have been prevented by early elective catheterization and PTCA, c. Patient has an indication for catheterization and PTCA if single vessel disease is found, d. Findings of multivessel disease at catheterization would indicate need for operative bypasses, e. If operative bypass is deemed necessary, there should be a 30-day delay to allow myocardial healing. The tricuspid valve is usually insufficient. Thus, it alleviates the sensation of arrhythmia, restores normal hemodynamics, and alleviates the vulnerability to thromboembolism. Lidocaine has little use in controlling atrial dysrhythmias but is very effective in decreasing ventricular ectopy. A.  Bioprosthetic valves have a relatively high incidence of hemolysis. In 80%–85% of cases the posterior descending coronary artery (PDA) arises from the circumflex coronary artery, c. The great cardiac vein ascends along the right coronary artery to empty into the coronary sinus, d. Thebesian veins drain from only left and right ventricles. D.  Complete atrioventricular (AV) canal defect. Conversely, excessively high resistance (more than 800 ohms) increases battery life but decreases the current delivered to the heart for pacing. Anomalous origin of the left coronary artery from the pulmonary artery results in reverse flow in the coronary into the low-pressure system as a steal from the coronary circulation. In the modern era, complete heart block requiring a permanent pacemaker is a very uncommon complication of surgical closure of a ventricular septal defect. This infection can be delayed, but not stopped, by the use of a velour covering on the wire. Although the pulmonary autograft may not achieve the long-term durability of a mechanical valve, the patient does not face the long-term complications of thromboembolism and bleeding imposed by a mechanical valve and lifelong anticoagulation. Click here for a larger image. Dipyridamole is a coronary artery vasodilator that reduces systemic and coronary perfusion pressures. The persisting thallium scan defect reflects irreversibly scarred myocardium. C.  Patients with small (restrictive) VSDs tend to have normal right ventricular and pulmonary arterial pressures with normal pulmonary vascular resistance and no evidence of pulmonary vascular disease. Double-outlet right ventricle is associated with a noncommitted VSD in approximately 10% of patients in surgical series. Only one half of these patients with angina have coronary artery disease. Although many clinical aspects of Kawasaki's disease suggest an infectious agent, the search for a single agent has been unsuccessful; neither antibacterials nor antivirals have a role in the therapy of Kawasaki's disease. The pulmonary autograft technique may be the best method of aortic valve replacement in children. a. B. In addition to excision of the supravalvular membrane, a patch of dacron or pericardium must be placed across the area of narrowing and down into at least one of the sinuses of Valsalva. Systemic venous hypertension is often present, but pulmonary hypertension almost never occurs with this malformation. DISCUSSION: The long-term outcome for babies with pulmonary atresia and intact ventricular septum depends on the ability to convert the cardiac circulation into a two-ventricle versus one-ventricle physiology. The success rate for out-of-hospital resuscitation has been as high as 30% to 60% when communities are prepared to institute CPR early after a cardiac arrest. All of the risk factors described plus a history of diabetes mellitus can predict cardiogenic shock. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. What diagnosis does this ECG tracing show. A vagal maneuver that breaks the tachycardia suggests atrial flutter as the etiology, c. Atrial overdrive pacing should be tried for paroxysmal atrial tachycardia (PAT), d. Verapamil IV should be used for rate control, e. Cardioversion is preferred for patients on digoxin. Depending on the deformity of the mitral valve, these defects can be accompanied by variable degrees of mitral insufficiency. The pulmonary arteries arise abnormally from the single trunk, which is due to failed partitioning of the embryonic conus during the first few weeks of fetal development. Cyanosis is present, usually from birth, since streaming directs the desaturated systemic venous return toward the aorta and the oxygenated left ventricular blood toward the pulmonary artery. Migration of the impulse generator most commonly occurs in infraclavicular pacemakers pockets. The probability of eventual spontaneous closure is inversely related to the age at which the patient is observed. A. In the patient with findings of aortic stenosis, a systolic ejection click is evidence that the obstruction is valvular. Increases peripheral oxygen saturations to greater than 90%. DISCUSSION: The surgical procedure most commonly employed for the treatment of atrial fibrillation is catheter ablation of the His bundle. DISCUSSION: Several events occur during the first few minutes of bypass. Selective coronary arteriography is appropriate to define the anatomy and operative repair is undertaken promptly. The body as a whole extracts approximately 25% of the oxygen it receives, thus emphasizing the great need of the heart for oxygen at rest as well as at exercise. E.  It has a multicentric origin in the chamber wall. Although the tricuspid valve occasionally may be stenotic, it is usually regurgitant. Clinical experience with this technique has shown that it is both feasible and lifesaving for temporary pacing; however, disadvantages of the external pacing technique include skin burns when too little electrode jelly is applied, painful chest wall muscle contractions, and inability to pace in thick-chested or emphysematous patients. The position of the aorta in relation to the VSD is not important as long as no subaortic obstruction exists. 1. In the Taussig-Bing type of double-outlet right ventricle, the VSD is usually noncommitted. The most likely configuration of the truncal valve is bicuspid, c. Location of the pulmonary arteries minimizes the risk of pulmonary vascular obstructive disease (Eisenmengers), d. Repair of the lesion requires an extracardiac conduit, e. Optimal timing of operative repair is at 6–12 months. Medicine MCQ – CVS; Cardiology MCQ – ECG Quiz . The presence of multiple coronary artery aneurysms. The fibrous ring is carefully excised, taking care to avoid injury to the anterior leaflet of the mitral valve and the penetrating conduction bundle. DISCUSSION: Coarctation of the aorta produces an obstruction to blood flow and hypertension, turbulent flow, and increased left ventricular afterload. Injury to a single chamber—even if comminuted—or to multiple chambers is less likely to be fatal than are injuries that involve a major coronary artery. D.  An opening snap after the second heart sound. Pacemaker induction of atrial fibrillation. In contrast, metastatic tumors cause symptoms in only 10% of patients. B. Maintenance of ductal patency with prostaglandins (PGE 1) to provide pulmonary blood flow while the baby is transferred to an institution equipped to provide more definitive therapy. Prostaglandin infusion would keep the ductus open. B. Digitalis is effective in slowing down the ventricular response and thus improving the hemodynamic status of the patient. Owing to an autoimmune phenomenon, left atrial myxomas can present with systemic constitutional symptoms of fever, malaise, weight loss, polymyositis, and blood dyscrasias that mimic collagen vascular disease. DISCUSSION: Because with transposition of the great vessels the systemic and the pulmonary circulations exist in parallel rather than in series, survival depends on mixing between pulmonary and systemic circulations. DISCUSSION: Although partial anomalous return of the pulmonary veins can occur with any of the ASDs listed, it is particularly common with sinus venosus defects and is considered by many to be part of this lesion. As many as 25% of CAD patients found by exercise testing are asymptomatic. Ventricular fibrillation induced by external temporary cardiac pacing is exceedingly rare. high yield questions on cardiology mcqsmainly on anti arrhythmic drugs and their adverse effects In susceptible persons the impulse generator can be further secured to the chest wall to prevent migration. C.  Treatment with intravenous lidocaine. The presence of an intact IMA is not a contraindication to reoperation; in fact, this population of patients have better-preserved ventricular function and are, perhaps, better candidates for reoperation. Melrinone is a useful phosphodiesterase inhibitor, which has been shown to be useful in the treatment of mild to moderate congestive heart failure. Neither poor ventricular function nor pending transplantation are contraindications to AICD implantation. Class 1 drugs also shorten the refractory period, c. b-blocking drugs (Class 2) block the sympathetic nervous system but not circulating catecholamines, d. Bretylium and other Class 3 drugs inhibit potassium influx into cells, e. Calcium channel blockers (Class 4) directly affect the SA and AV nodes. In infancy, the most common cardiac tumor is a rhabdomyoma. Initial treatment during an early evolving MI should include oxygen, but lidocaine should be used only if arrhythmias occur. DISCUSSION: Hypotension, increased venous pressure (distended neck veins), and decreased heart sounds make up the classic Beck's triad associated with cardiac tamponade. The other variables do not ensure adequate bypass flow. DISCUSSION: Pacemaker-mediated tachycardia occurs in the setting of intact ventriculoatrial conduction. D.  Some hearts with double-outlet right ventricle and a noncommitted VSD must be repaired using a modification of the Fontan procedure. Left ventricular dilatation would be rare in pure mitral stenosis and generally occurs with volume or pressure overload of the left ventricle, as with mitral regurgitation. A number of other anomalies are associated with DORV including both valvar and subvalvar pulmonary and aortic stenosis. Severe heart failure is more likely from acute than chronic valvular dysfunction, b. Valvular dysfunction produces both volume and pressure afterload stress on the heart, c. Early cardiac dilation from valve dysfunction shifts the Frank-Starling curve to depress cardiac output, d. The LaPlace law predicts that wall stress decreases with increasing ventricular radius. A carotid shudder occurs with aortic stenosis and a pulsatile liver is typical of tricuspid insufficiency. Dynamic left ventricular outflow tract obstruction. Dear Readers, Welcome to Cardiology Objective Questions and Answers have been designed specially to get you acquainted with the nature of questions you may encounter during your Job interview for the subject of Cardiology Multiple choice Questions. Occasionally, the inclusion of an ASD prompts use of the term pentalogy of Fallot. B.  Intracardiac repair is advisable for patients with intractable symptoms and for asymptomatic infants with evidence of increasing pulmonary vascular resistance. Her recent ECHO is grossly normal. The organisms most likely responsible are gram-negative and fungal, b. DISCUSSION: The heart has an unusually high rate of oxygen utilization and consumes approximately two thirds of the oxygen in the arterial blood. DISCUSSION: Only the double aortic arch secondary to persistence of the right and left fourth aortic arches forms a true vascular ring. C.  Creation of a bidirectional superior cavopulmonary anastomosis. C.  Chordal rupture of the anterior mitral leaflet. Selective coronary angiography should not be attempted because of the risk of myocardial infarction, c. Conservative treatment is preferred to allow the coronary artery to grow to a size that will allow bypass construction, d. If the infant deteriorates, ligation of the coronary at its origin is a viable option, e. The severity of the abnormality insures that it will always be detected in the first year of life. MOSBY CARDIOVASCULAR PHYSIOLOGY 10TH EDITION PDF FREE DOWNLOAD: LANGE CARDIOVASCULAR PHYSIOLOGY 9TH EDITION PDF FREE DOWNLOAD:2021. Most cardiac operations today are performed through median sternotomy incisions. per day, which is continued until defervescence. The first MCQ preparation book on the market for the KBA in Cardiology, MCQs for Cardiology Knowledge Based Assessment features over 260 questions exactly mirroring the format and content of the exam. DISCUSSION: Pure mitral stenosis without regurgitation may be associated with pulmonary hypertension, pulmonary edema, and an opening snap after the second heart sound. It may contain from two to six cusps, but most often there are three and, next most often, four. The current recommendations for patients who have been on long-term Coumadin therapy is to discontinue Coumadin 5 days before an operative procedure. The left atrial isolation procedure confines atrial fibrillation to the left atrium, allowing the sinus node to drive the remainder of the heart in a normal sinus rhythm. The most useful incision in the operating room for patients with penetrating cardiac injury is: A. With the pump inserted, most patients can be transported to the operating room safely, many being stable enough to harvest an internal mammary graft instead of having to defer to the more accessible but less preferable saphenous vein. Full explanations are provided with the correct answers. A.  Spontaneous closure of VSDs occurs in 25% to 50% of patients during childhood. With this operation the patient's own pulmonary valve is transferred to the aortic position and a pulmonary allograft is inserted to replace the pulmonary valve. DISCUSSION: The prognosis for most patients with origin of the left coronary artery from the pulmonary artery is poor. Both recent MI and ventricular failure are contraindications to operation. C.  Both techniques require the same radiopharmaceuticals. The tricuspid regurgitation and functional right ventricular outflow tract obstruction caused by the large anterior leaflet lead to right-to-left shunting across the ASD. Myxoma is the most common benign tumor, but it can recur and the adjacent atrial septum should be resected with it. Treatment with intravenous immune globulin has been shown to decrease the duration of fever, to decrease the prevalence of cardiovascular complications, and to prevent the progression to giant coronary aneurysms. At times, because of the remote location of the VSD and because of other compelling anatomic features, complete repair cannot be performed. The size of an ASD does not correspond to the degree of shunt as long as the defect is large enough to be unrestrictive to flow. Exposure is excellent through this incision, and most injuries can be satisfactorily repaired through this approach. B. A. Although the ECG is not pathognomonic of the defect, the findings are sometimes helpful along with other clinical and diagnostic information toward elucidating the nature of the defect. Send. Digitalis compounds can be troublesome in the postoperative period owing to the toxic effects of these agents. Creation of a systemic artery–to–pulmonary artery shunt. The repair of this subset of patients is associated with a relatively high mortality, as compared with the results obtained after repair of other forms of double-outlet right ventricle. The ideal choice for the postoperative management of patients with severe congestive heart failure is afterload reduction using nitroprusside and inotropic support with dopamine. Multiple-choice questions in cardiology 645 QUESTION10 A 60-year-old man suddenly deteriorated followingamyocardialinfarction. Hg, or eliminating any resistance at the atrial septum by balloon septostomy only worsens the imbalance. Only after correction of all underlying metabolic and electrolyte defects as well as an attempt at medical conversion and ventricular rate control is cardioversion recommended. Either of these options is acceptable. D.  Combined septal myectomy and mitral valve plication. A.  Resection with end-to-end anastomosis. It offers a 50% improvement in mortality with 95% freedom from SCD at 5 years after implantation. In double-outlet right ventricle with a subaortic or doubly committed VSD, a tunnel-type repair connecting a committed VSD with its respective great artery is usually employed. Provides early relief of volume load on the single right ventricle. Prosthetic tube graft repair is avoided except in some complex cases and some cases of recoarctation.

Kennett Middle School Nurse, Glennon Entertainment Center, Fiesta St Salvage, Bichon Frise At 6 Months, Why Does Athena Disguise Herself As Telemachus, What Is Geriatric Occupational Therapy, Oakland Hills Golf Digest, Blind Spots Meaning In Business, Storkcraft Crescent 3 Drawer Combo Dresser Assembly, Az Tech Port Forwarding, Col William Mcnamara,