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Q1. Which coronary arterial vessels are most susceptible to ischaemia?
a) Myocardial arterial vessels.
b) Epicardial arterial vessels
c) Pericardial arterial vessels
d) All vessels are equally affected
Q2. What is not true about left dominant coronary circulation?
a) It is seen in 20% of the population
b) Left circumflex artery supplies the Posterior descending artery
c) Left circumflex artery terminates as obtuse marginal branch
d) Left circumflex artery may originate from right coronary sinus.
Q3. Which of the following is not an indication for Coronary artery Bypass grafting (CABG)?
a) Left main coronary artery disease stenosis more than 60%.
b) One, two or three vessel disease with proximal left Anterior descending artery (LAD) stenosis
c) Three vessel disease with impaired ventricular function (less than 50%)
d) Double vessel disease with patent left anterior descending artery (LAD)
Q4. Which is not a pathological stage in mitral stenosis
a) Fusion of commisures
b) Commisural fusion with subvalvular shortening of chordae
c) Calcification of leaflets and chorda
d) Fixation of valve alone with free subvalvular system
Q5. Which of the following pathological change does not occur in mitral stenosis
A) Increased left atrial pressure
B) Left atrium dilatation
C) Ventricular hypertrophy
d) Embolisation of clots
Q6. Most common congenital anomaly associated with coarctation of aorta is
a) Ventricular septal defect (VSD)
b) Atrial septal defect ( ASD)
c ) Bicuspid Aortic valve
d) Patent ductus arteriosis (PDA)
Q 7 which one of the following is not a clinical feature of Coarctation of Aorta
b) Rib notching
c ) Prominent pulsation under the ribs
d ) Radio femoral delay
Epicardial vessels are the most susceptible to to coronary artery disease and Intramyocardial vessels are the least susceptible
90% of the people have Right dominant coronary system , that means Right coronary artery ends as Posterior descending artery. If the Left circumflex artery supplies major branches to posterior descending artery, this system is called the left dominant system.
Left circumflex artery arises from Left Main coronary artery (LMCA) and gives of marginal branches, It ends as obtuse marginal artery.
in 0.5% cases it arises from Right coronary sinus
Main indications for coronary artery bypass grafting are
LMCA (Left Main coronary Artery) stenosis more than 60%
LAD or LCA stenosis more than 70%
Two or three vessel disease with LVEF (Left ventricular ejection fraction) less than50%
Two or three vessel disease with proximal LAD stenosis
All the above three are progressive pathological stages . There is fixation of both the valve and the subvalvular system. The pathological stage predicts the suitability of balloon valvuloplasty, commisurotomy or valve replacement
Also the valvular fibrosis and calcification may be related to repeated inflamation or turbulent flow.
Schwartz text book surgery 8th edition page 663.
Ventricular hypertrophy does not occur as the stenosed mitral valve protects left ventricle
All these congenital anomalies are seen with Coatctation of Aorta but Bicuspid Aortic Valve is the most common seen in 25-40% cases.
In coarctation of Aorta there is narrowing of lumen of Aorta distal to the left subclavian artery. There is hypertension and not hypotension because of left ventricular obstruction. There is increased formation of collaterals particularly of intercostal and internal mammary arteries leading to rib notching and predominant precordial pulsation. Femoral pulse is of low volume and delayed.
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