Cardiac Surgery MCQ (Multiple Choice questions)
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Q8 . In a 13 year old boy with increasing dyspnea and holosystolic murmur and left axis deviation on ECG. What is the probable diagnosis
a) Ostium Secundum defect
b) Ostium Primum defect
c) Tetrology of Fallot
d) Right sided aortic arch
Q9. ASD association with Mitral insufficiency is seen in
a) Ostium secundum
b) Ostium primum
c) Coronary sinus defect
d) Sinus Venosus defect
Q10. Contraindication of Fontan procedure
a) Age 24 years
b) Right pulmonary artery stenosis
c) Left ventricular end diastolic pressure 18 mm Hg
d) Severe mitral insufficiency
Q11. Not a clinical feature of coarctation of aorta
a) Interscapular murmur
b) Diminished femoral pulse
c) More blood pressure in arms than legs
d) Peripheral cyanosis
Q12. False about the pathophysiology of ebstein's anomaly is ?
a) There is gross insufficiency of tricuspid valve
b) Left to right shunt is prominent
c) There is malformation of tricuspid valve leaflets which is partly attached to fibrous tricuspid annulus and partly to right ventricle
d) In neonates high pulmonary resistance can cause TR and cyanosis
A 8) b Ostium primum
Ostium primum defects are seen in adolescents with pan systolic murmur of MR, increased pulmonary pressure and left axis deviation.
Ostium seundum defects present in later age group
Tetrology of fallot present with cyanosis, SOB, clubbing poor weight gain etc
Right aortic arch will have symptoms of pressure on trachea and esophagus
9. b Ostium primum
OP forms 15-20% of all ASD
These defects are malformations in endocardial cushion development and are associated with maldeveloped AV valves particularly clefts in ant mitral leaflet.
Sinus Venosus ASD present as abnormality in insertion of SVC or IVC
OS are defects in foramen ovalis
10. C Left ventricular end diastolic pressure more than 18 mm Hg
Fontan procedure is done for malformation of tricuspid atresia when there is complete agenesis of tricuspid valve and there is no communication between the right atrium and right ventricle.
The venous blood enters the RA but can not go in the RV. It goes to the LA through stretching of foramen ovale.
Fontan procedure is to bypass the right heart and channel both IVC and SVC to pulmonary aerteries. Operation consists of graft between SVC to right pulmonary artery and RA to left pulmonary artery
Left ventricular end diastolic pressure is the "preload" in LV i.e the pressure in the LV after it has been filled with blood from LA.
Contraindications of Fontan procedure are
- High pulmonary vascular resistance ie pressure more than 4 Woods units
- Congenital hypoplasia of pulmonary artery
- Severe diastolic dysfunction of LV (Normal is 3-12mmHg)
11. d Peripheral cyanois
In coarctation of aorta there is narrowing of the aorta. Mainly it occurs in the descending aorta after the aortic arch. The blood pressure in the arms is more because less blood is flowing beyond coarctation and less of it goes to the lower limbs.
Turbulent flow at the narrowing causes a pan systolic murmur heard between the scapular borders.
Cyanois is not a feature
Ebstein's anomaly is a congenital malformation of the tricuspid valve. The incompetent tricuspid valve divides the right ventricle into two parts
1. Proximal - Atrialised RV
2. RV proper
Associated defects such as patent foramen ovale, VSD, PDA, Pulmonary flow obstruction are common.
Shunting is right to left from right heart to left.
Pulmonary artery hypertension is rare.