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Wireless electrical energy transmission was first used in clinical surgery by W.W.L. D.  Pulmonary hypertension is a common late complication. Survival rate for both of these complications is improved by early rather than late repair. E.  Intravenous digitalis with diuresis using furosemide as needed. It is best diagnosed by cardiac catheterization and angiography. DISCUSSION: Echocardiography is the best method for confirming the diagnosis of a PDA. This infection can be delayed, but not stopped, by the use of a velour covering on the wire. The other variables do not ensure adequate bypass flow. A. As the balloon collapses in the aorta, the absence of the balloon volume, or “abyss,” creates a decrease in ventricular afterload. In patients with tricuspid atresia a competent mitral valve is important for satisfactory cardiac output after the Fontan procedure. DISCUSSION: Postnatal stabilization of infants with hypoplastic left heart syndrome requires patency of the ductus arteriosus and balance of the systemic and the pulmonary circulation. a. There is a rich and quite effective collateral circulation in the coronary arterial bed. But if multivessel disease or unfavorable anatomy is found, operative bypass should be carried out early since results are best within 30 days of the MI. Tricuspid valve replacement is a relative contraindication to mechanical valve replacement, owing to the increased incidence of tricuspid valve thrombosis with a mechanical prosthesis. Send. Left (or right) anterior thoracotomy is easily performed, especially in the emergency room, and gives adequate exposure to certain areas of the heart. If atropine is unsuccessful epinephrine is given. Resistance calculations are made at a voltage near that of the pacemaker's output. 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. A. DISCUSSION: Closed chest massage is not as effective as open-chest massage in normalizing blood pressure or perfusion of vital organs, and closed chest massage does generally deliver 5% to 15% of normal coronary and cerebral blood flow. D.  Reoperation after repair of discrete supravalvular aortic stenosis is rare unless abnormalities of the valve itself also exist. As per my experience good interviewers hardly plan to ask any particular question during your Job interview and these model questions are asked in the online technical test and interview of many Medical Industry. Interstitial fluid accumulates during bypass; however, this occurs later during bypass. A=F, B=T, C=F, D=F, E=T. A. DISCUSSION: The exercise ejection fraction is the single most important radionuclide variable relating to subsequent cardiac death or myocardial infarction, and this single variable contains 80% of the prognostic information in the test. During the effective refractory period, both slow calcium channels and fast sodium channels are closed and the myocardium cannot be excited. C.  Presence of left main coronary disease. B.  Mitral valve replacement with either a bioprosthesis or a mechanical valve requires warfarin anticoagulation. Jaypee Gold Mini Standard Atlas Orthodontics PDF Free Download: Tara v shanbhag Pharmacology For Medical Graduates PDF 4th Edition Free Download:2021. DISCUSSION: Bioprosthetic valves have a relatively low incidence of hemolysis. Decreased pulmonary vascular resistance may increase pulmonary blood flow at the expense of systemic blood flow and alter the loading conditions of the left ventricle, which may complicate early arterial repair. DISCUSSION: In the early postoperative period after repair of obstructed forms of TAPVC, acute episodes of pulmonary hypertension may develop as a response to stress. Hg. If these three findings are present in a person who has a penetrating chest wound, intracardiac injury is almost certain and operative intervention is mandatory. 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. Banding of the pulmonary artery is never a consideration in patients with tetralogy of Fallot, since the predominant physiologic effect of the defect results from too little pulmonary blood flow to begin with. A.  Surgical repair is indicated only when the systolic gradient exceeds 75 mm. DISCUSSION: Ostium primum defects, or “partial” AV canal defects, are commonly associated with a “cleft” of the anterior leaflet of the mitral valve. The truncal valve is most commonly tricuspid (65%) or quadricuspid (25%); least likely bicuspid (9%). D.  An opening snap after the second heart sound. m. is considered a contraindication to operation. The anterior leaflet is large and “sail-like,” while the other two leaflets are rudimentary. In addition, because AV synchrony is re-established between the right atrium and right ventricle, right-sided cardiac output is restored to normal. Operation improves survival in patients with severe, symptomatic mitral valve disease. The most commonly used physiologic parameters in rate-modulated pacemakers at the present time are body motion and minute ventilation. Associated aortic stenosis, mitral stenosis and coarctation are common with VSDs. Then potassium channels reopen, allowing potassium out, and rapid repolarization occurs. B. A.  Spontaneous closure of VSDs occurs in 25% to 50% of patients during childhood. Quickly memorize the terms, phrases and much more. Check out our free MCQ bank for medical students that has over 3000 free medical questions. The chest film is not particularly helpful and may be normal or show cardiomegaly with pulmonary congestion. B. 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. They usually occur in the right ventricle. D.  Improve the ejection fraction of the left ventricle in many patients in whom it is significantly depressed preoperatively. The conduction bundle in patients with perimembranous VSDs does run along the posteroinferior rim of the defect on the left ventricular side. Left … A. MOSBY CARDIOVASCULAR PHYSIOLOGY 10TH EDITION PDF FREE DOWNLOAD: LANGE CARDIOVASCULAR PHYSIOLOGY 9TH EDITION PDF FREE DOWNLOAD:2021. The most common indication for permanent pacing occurs in patients with the sick sinus syndrome. Patients with coronary fistulas occasionally suffer congestive heart failure early. Immediate cardioversion is rarely indicated for new-onset atrial fibrillation. A 60-year-old man with class II angina, 75% proximal right coronary artery lesion, and normal ventricular function. Reoperation is rare after this procedure unless associated aortic valve disease is also present. C.  Origin of the right coronary artery from the pulmonary artery. DISCUSSION: Secundum ASDs can frequently be closed primarily, although the use of a prosthetic or pericardial patch is indicated for large defects. Digitalis along with a diuretic in the postoperative period can be troublesome owing to the potential toxicity of digitalis while the patient has ongoing fluid and electrolyte shifts. In the presence of a normal left ventricle the left-sided cardiac output is also normal, despite the fact that left-sided AV synchrony is not present; however, because the left atrium is allowed to fibrillate, the vulnerability to thromboembolism remains unchanged postoperatively. Nitroglycerin IV is of value to limit infarct size but not Ca-channel blockers which have no such benefit. 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. This causes a functional pulmonary atresia, which increases right-to-left shunting across the ASD. Patients with atypical signs and symptoms should have angiography to confirm or exclude the diagnosis. A.  Perimembranous lesions are located in the region of the membranous portion of the interventricular septum near the anteroseptal commissure of the tricuspid valve. The tricuspid valve is usually insufficient. Her recent ECHO is grossly normal. The Taussig-Bing malformation can be repaired using an intraventricular tunnel technique described by Kawashima. This lesion, by site and histology, is the most common primary cardiac tumor. of 10% solution. Instead, operative repair is made, preferably before the age of 6 months. B.  Tachypnea and failure to thrive are symptoms frequently associated with large VSDs. However, it is relatively contraindicated for significant disease in the left main coronary, for multiple obstructive lesions in the same artery, and for vessels less than 2 mm in diameter. DISCUSSION: Hepatic failure and anasarca are indeed common symptoms of severe, long-standing tricuspid valve disease with increased venous pressure. Medical management typically consists of diuretics and afterload reduction; however, once the compensatory mechanisms begin to fail, survival is limited. B. 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. Double-outlet right ventricle is associated with a noncommitted VSD in approximately 10% of patients in surgical series. AVSD is a defect of endocardial cushion development which produces morphologic abnormalities of both AV valves and both atrial and ventricular septa. Invasive procedures, with the attendant risk of tumor embolization, are not warranted. C.  In the United States doubly committed or juxta-arterial VSDs are most commonly associated with aortic insufficiency. Origin of the left coronary artery from the pulmonary artery. Pulmonary hypertension is distinctly unusual with tetralogy of Fallot unless the patient has had excessive pulmonary blood flow from collaterals or systemic-to-pulmonary artery shunts for a long time. Patient's sensation of irregular heart rhythm. C.  Adjuvant chemotherapy and irradiation are efficacious in prolonging survival. Natural history of this anomaly allows only 20% one-year survival, b. a. Spontaneous closure of the VSD is rare, b. A. D.  High-pressure liquid chromatography (HPLC). Precise histologic classification is not imperative, as all have a similar clinical picture with rapid systemic dissemination and aggressive local invasion. A 60-year-old man with unstable angina, three-vessel disease, and an ejection fraction of 35%. Recognition of these benefits has steadily increased the use of DDD pacemakers in the last decade, and at the present time DDD is the most common pacing mode. DISCUSSION: Relative to medical therapy alone, surgical therapy has been shown to improve survival in patients with severe, symptomatic mitral valve disease. Absence of a pulmonary artery is unusual but can present in as many as 3% of patients. a. Although sympathetic nerves produce coronary vasoconstriction, the autoregulatory vasodilatory responses to increased myocardial demand overwhelm that effect. Increased vulnerability to thromboembolism. These patients can be carefully followed until such time as an imbalance develops or they become candidates for a bidirectional superior cavopulmonary (Glenn) anastomosis or a Fontan procedure. Systolic pressures compress intramyocardial vessels, so maximal coronary flow is during diastole. The mortality attributable to warfarin therapy approaches 1% per patient-year. All Free Medical Books; Cardiology; Cardiovascular; Oxford Handbooks; MCQs … 2.Which is not true in the management of Unstable Angina? Maximal coronary artery perfusion occurs in this part of the cardiac cycle. The use during reoperation of the contralateral IMA does not increase the risk of sternal wound complications. C.  The hospital mortality rate is highest when a subaortic VSD is present. For supraventricular arrhythmias, EPS requires catheters placed in the right atrium and ventricle, coronary sinus and His bundle. The “paradoxical hypertension” seen postoperatively is thought to relate to sympathetic nerve stimulation and does not reflect an incomplete repair. DISCUSSION: At the time of pacemaker implantation, in addition to measuring pulse amplitude (voltage and current) and pulse width, resistance is also determined. C.  A 60-year-old nondiabetic man with class III angina symptoms and focal discrete lesions in the mid-right coronary artery and mid-left circumflex artery. The size of an ASD is not relevant except that in patients with this syndrome, the right side of the heart will decompress across the ASD until antegrade flow can be established. There is an added benefit from heparin and antiplatelet drugs to prevent rethrombosis. Gamma globulin, 2 gm. 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. DISCUSSION: Bipolar impulse generators can be placed either in the subcutaneous tissue or beneath the muscle. Reoperative procedures carry a higher operative mortality due to technical difficulties, more advanced disease, and less complete revascularization. Cardiology is a large and critical branch of internal medicine, and as such covers, a vast amount of the knowledge tested in Membership of the Royal Colleges of Physicians (MRCP) exams. This is in contradistinction to patients with ostium primum defects, who often have a left axis deviation. DISCUSSION: The left ventricle is usually able to compensate for a long time for the increased volume load imposed by aortic insufficiency. Significantly relieves angina symptoms. Thrombolytic drugs were initially given intracoronary but can be used effectively when given systemically IV. The success rate for out-of-hospital resuscitation may be as high as 30% to 60%. Complete repair always requires closure of the VSD, detachment of the pulmonary arteries from the common trunk, and re-establishment of an outflow tract from the right ventricle to the pulmonary artery. DISCUSSION: Medically refractory angina is one of the major indications for implementing the intra-aortic balloon pump. Echocardiography is the technique of choice in the evaluation of intracardiac tumors, and findings suggestive of myxoma occur in 95% of patients examined. D.  Membranous obstruction of the ostium of the left main coronary artery. 11 focused sequences of questions are followed by detailed explanatory answers, which draw in the relevant aspects of the current syllabus, refer you to further reading and provide you … In former years such pumps were inserted prophylactically before induction of anesthesia for coronary bypass surgery. When neither left or right bundle-branch block prolong the VA interval, the bundle is in the septum. D.  The conduction bundle runs along the posteroinferior rim of a perimembranous VSD. Class 3 drugs inhibit potassium influx into cells and Class 4 drugs affect slow channel-dependent pacemaker tissue (SA and AV nodes). a. Transseptal puncture should be used for definitive diagnosis, b. The classic murmur of PDA is a continuous or mechanical murmur heard over the precordium and radiating to the medial third of the clavicle. Your email address will not be published. HAEMATOLOGY AT A GLANCE 4TH EDITION PDF FREE DOWNLOAD: THE ENDOCRINE SYSTEM AT A GLANCE 3RD EDITION PDF FREE DOWNLOAD: CARDIOVASCULAR PHYSIOLOGY 11TH EDITION PDF FREE DOWNLOAD:2021. 1. However, better sensing function is directly related to electrode area and is adversely affected by small electrode size. Use of arterial grafts for CABG has increased with the left internal mammary artery used most commonly; when at least one mammary artery is used, the early mortality rate is improved. Monomorphic ventricular tachycardia is the arrhythmia most amenable to surgical resection. DISCUSSION: Both techniques are equally accurate for measuring left ventricular ejection fraction. Inferior MIs involving the right coronary frequently have parasympathetic activity with bradycardia, hypotension and a prominent Q wave in lead 3. E.  Atrial balloon septostomy to improve atrial mixing. Latest cardiology MCQs and Case Scenarios She is on rate control with bisoprolol, and is currently asymptomatic with a heart rate of 76bpm. The intraaortic pump is contraindicated because diastolic augmentation worsens aortic regurgitation. The corridor procedure allows the sinus node to drive the heart in normal sinus rhythm, but because of the total isolation of the sinoatrial and AV nodes from the remainder of the atria, the atria may continue to fibrillate. Cardiology. Cardiology MCQs: Share on Twitter Share on Facebook Share on WhatsApp Share on Telegram Share on Email. Free. D.  A light clamp should be applied to the IMA pedicle to limit cardiac warming during cardioplegic arrest at the time of reoperation. DISCUSSION: Twenty per cent of primary cardiac tumors are some variant of sarcoma. If chest pain persists, IV nitroglycerin should be used to limit infarct size, c. Ca-channel blockers are also of value to limit infarct size, d. Morphine IV can be used but has no therapeutic effect. Mitral valve replacement with preservation of both leaflets or at least the posterior leaflet is well described and is probably advisable for most patients to preserve left ventricular function and reduce the probability of ventricular-annular separation. Systemic embolization, infective endocarditis, and onset of atrial fibrillation are each complications of mitral stenosis that portend a risk of further complication with continued medical therapy. All of the risk factors described plus a history of diabetes mellitus can predict cardiogenic shock. Acyanotic patients with tetralogy of Fallot (“pink tets”) can usually be followed for several months and their defects repaired electively as a first-stage procedure (usually by age 6 months). General Medicine MCQs: (Best For Undergraduates) Each Block Contains 40 MCQs. Fortunately the pulmonary valvar insufficiency that results is well tolerated in the absence of tricuspid insufficiency or ventricular dysfunction. C.  Complete heart block is a common complication. cm., patients become symptomatic. DISCUSSION: Subaortic stenosis is rarely encountered in neonates. Tricuspid valve replacement is an indication for using a tissue valve because of the significant incidence of valve thrombosis when a mechanical valve is in the tricuspid position. DISCUSSION: Recommended treatment for asystole is administration of atropine. The balloon pump is quite effective in helping to wean patients who have postcardiotomy left ventricular failure from cardiopulmonary bypass. A.  Gated equilibrium techniques provide more accurate measurements of ejection fraction than initial-transit methods. D.  Standard chest massage generally provides less than 15% of normal coronary and cerebral blood flow. D.  Mortality attributable to warfarin therapy approaches 5% per patient-year. Extensive collateral development involves the mammary and intercostal arteries producing rib notching on the chest radiograph. The Fontan operation should not be performed when ventricular ejection fraction is less than 30% or ventricular end-diastolic pressure is greater than 15 mm. a. Following cardiac surgery heparinization is usually delayed for 12 to 24 hours. A. The oxygen saturation of the blood in the coronary sinus is usually about 30% to 35% and varies with the magnitude of cardiac disease. Left ventricular imaging time for a gated equilibrium study is at least 10 times that of an initial-transit study. Aortic valve incompetence does develop over time in some patients with VSD, presumably as a result of progressive prolapse of the right aortic cusp through the defect. The ideal lesion for PTCA is focal symmetric stenosis in an epicardial vessel. C.  Both techniques require the same radiopharmaceuticals. The coronary arterial bed has minimal effective collaterals. MCQ’s for cardiology is written by the high levels of cardio specialist and consultants. 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. If the patient is in the operating room, this incision is easily performed and always provides excellent exposure for all areas of the heart. Atrial balloon septotomy results in improved admixture and oxygen delivery in these patients and should be performed promptly if peripheral acidemia and severe cyanosis are present. The rapidity of the development of pulmonary vascular disease is increased by the coexistence of a VSD. The most common cause of acquired complete heart block in adults is sclerodegenerative disease of the cardiac skeleton and AV conduction system. The findings suggest an atrial septal defect (ASD) that can be confirmed by 2D echocardiography eliminating the need for cardiac catheterization. At times, because of the remote location of the VSD and because of other compelling anatomic features, complete repair cannot be performed. A continuous “machinery” murmur is characteristic of patent ductus arteriosus typically seen in the premature infant. It may contain from two to six cusps, but most often there are three and, next most often, four.

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