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SURGERY II > Block 9 > Flashcards

Block 9 Flashcards

1
Q

invented the fogarty catheter that is being used to remove thrombus that has been formed within the arterial system.

A

THOMAS FOGARTY

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2
Q

professor of vascular surgery who attempted the first cannulation of vessels and taking an x-ray of the wire which is located inside his blood vessels which allows physicians today to do interventional procedures intraluminally of the blood vessels.

A

ANDREAS GRUNTZIG

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3
Q

very famous thoracic and cardiovascular surgeon. He pioneered the treatment for aortic aneurysms and aortic dissections. He is also part of the team who first invented the artificial heart.

A

MICHAEL DEBAKEY

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4
Q

invented the palmaz stent which is used to open up blood vessels and also to close those vessels that are abnormally open.

A

JULIO PALMAZ

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5
Q

one of the endovascular surgeons who invented the stent graft that is being used to exclude large vessel aneurysms.

A

JUAN PARODI

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6
Q

These are signs that will tell you that the patient may have an arterial occlusive disease.

A
  1. Pallor on leg elevation
  2. Dependent rubor
  3. Ischemic ulcer
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7
Q

Most common chronic arterial occlusive disease

A

Atherosclerosis

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8
Q

Intermittent claudication

A

pain, cramping, discomfort with exercise, relieved with rest

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9
Q

Affects muscle group distal to site of pathology

A

Intermittent claudication

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10
Q

it is an arterial occlusive disease involving the iliacs.

A

Leriche’s syndrome

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11
Q

Associated with drop in pressure in affected extremity

A

Intermittent claudication

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12
Q

abdominal pain, discomfort after consumption of large meal

A

Visceral angina

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13
Q

Visceral angina can happen in patients with?

A

Superior mesenteric artery occlusion

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14
Q
  • “Fear of eating”

* Weight loss

A

Visceral angina

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15
Q

Chronic arterial ischemia signs

A 
• Chronic
• Hair loss
• Thin shiny-looking skin
• Brittle, thickened and/or deformed nails
• Critical limb ischemia
→ This happens when occlusion of the blood vessel already reaches 95% or more.
• Coolness of distal extremity
• Elevation pallor of toes
• Dependent rubor upon lowering below heart level
• Delayed wound healing
• Ulceration
• gangrene
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16
Q

2 classifications of peripheral arterial disease

A
  1. Fontaine classification

2. Rutherford classification

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17
Q

Fontaine Classification:

Stage I

A

Asymptomatic

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18
Q

Fontaine Classification:

Stage IIa

A

Mild claudication

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19
Q

Fontaine Classification:

Stage IIb

A

Moderate to severe claudication

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20
Q

Fontaine Classification:

Stage III

A

Ischemic rest pain

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21
Q

Fontaine Classification:

Stage IV

A

Ulceration or gangrene

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22
Q

Rutherford Classification:

Grade 0

A

Asymptomatic

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23
Q

Rutherford Classification:

Grade 1

A

Mild claudication

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24
Q

Rutherford Classification:

Grade 2

A

Moderate claudication

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25
Q

Rutherford Classification:

Grade 3

A

Severe claudication

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26
Q

Rutherford Classification:

Grade 4

A

Ischemic rest pain

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27
Q

Rutherford Classification:

Grade 5

A

Minor tissue loss (equivalent to ulceration)

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28
Q

Rutherford Classification:

Grade 6

A

Major tissue loss (equivalent to gangrene)

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29
Q

These classifications are for chronic occlusive arterial disease and should not be confused in patients having an acute arterial occlusion.

A

Fontaine and Rutherford classification

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30
Q

Decrease LDL to

A

<100 mg/dl

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31
Q

Virchow’s triad:

A

o Stasis
o Endothelial injury
o Hypercoagulability

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32
Q

Medications given for chronic arterial ischemia:

A
  1. Trental
  2. Pletal
  3. Aspirin
  4. Plavix
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33
Q

generally last resort for chronic arterial ischemia, reserved for life-style changing pathology

A

Arterial bypass graft

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34
Q

Surgical procedures for chronic limb ischemia

A
  1. Arterial bypass graft
  2. Balloon angioplasty with or without wall stent
  3. Endarterectomy
  4. Embolectomy
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35
Q

Thrombolytic agents:

A

Tissue Plasminogen Activator (tPa)
Streptokinase
Urokinase

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36
Q

Management for CLI candidate for revascularization:

A
  1. Imaging (Duplex, angiography, MRA, CTA)

2. Revascularization as appropriate

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37
Q

Management for CLI not candidate for revascularization:

Stable pain and lesion

A

Medical treatment (non-operative)

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38
Q

Management for CLI not candidate for revascularization:

Not tolerable pain, spreading infection

A

Amputation

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39
Q

The hardening of tissue or part due to chronic inflammation

A

Sclerosis

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40
Q

Any of a group of chronic diseases in which thickening, hardening and loss of elasticity of arterial walls result in impaired blood circulation.

A

Arteriosclerosis

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41
Q

A form of arteriosclerosis characterized by the formation of atheromatous plaques containing cholesterol & lipids on the innermost walls of large and medium sized arteries.

A

Atherosclerosis

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42
Q

Most common cause of chronic arterial occlusive disease

A

Atherosclerosis

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43
Q

Hypertension

A

A systolic blood pressure of >140 mmHg and/or a diastolic blood pressure of >90 mmHg

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44
Q

a.k.a. accelerated hypertension

A

Malignant hypertension

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45
Q

a.k.a. essential hypertension- unknown etiology

A

Primary hypertension

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46
Q

clot that is localized on a specific area

A

Thrombotic

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47
Q

a thrombus that travels

A

Embolic

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48
Q

6Ps of Acute Arterial Occlusion

A 
→ Pain
→ Pulselessness
→ Pallor
→ Paresthesia
→ Paralysis 
→ Polar (Poikilothermy)
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49
Q

Clinical Category of Acute Limb Ischemia

Description/Prognosis:
Not immediately threatened

A

Viable

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50
Q

Clinical Category of Acute Limb Ischemia

Description/Prognosis:
Salvageable if promptly treated

A

Threatened marginally

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51
Q

Clinical Category of Acute Limb Ischemia

Description/Prognosis:
Salvageable with immediate revascularization

A

Threatened immediately

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52
Q

Clinical Category of Acute Limb Ischemia

Description/Prognosis:
Major tissue loss or permanent nerve damage

A

Irreversible

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53
Q

Clinical Category of Acute Limb Ischemia

Sensory Loss:
None

A

Viable

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54
Q

Clinical Category of Acute Limb Ischemia

Sensory Loss:
Minimal (toes) or none

A

Threatened marginally

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55
Q

Clinical Category of Acute Limb Ischemia

Sensory Loss:
More than toes; associated with rest pain

A

Threatened immediately

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56
Q

Clinical Category of Acute Limb Ischemia

Sensory Loss:
Profound, anesthetic

A

Irreversible

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57
Q

Clinical Category of Acute Limb Ischemia

Muscle weakness:
None

A
  1. Viable

2. Threatened marginally

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58
Q

Clinical Category of Acute Limb Ischemia

Muscle weakness:
Mild, moderate

A

Threatened immediately

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59
Q

Clinical Category of Acute Limb Ischemia

Muscle weakness:
Profound paralysis (rigor)
A

Irreversible

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60
Q

Clinical Category of Acute Limb Ischemia

Arterial Doppler Signals:
Audible

A

Viable

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61
Q

Clinical Category of Acute Limb Ischemia

Arterial Doppler Signals:
(Often) Inaudible

A

Threatened marginally

62
Q

Clinical Category of Acute Limb Ischemia

Arterial Doppler Signals:
(Usually) Inaudible

A

Threatened immediately

63
Q

Clinical Category of Acute Limb Ischemia

Arterial Doppler Signals:
Inaudible

A

Irreversible

64
Q

Clinical Category of Acute Limb Ischemia

Venous Doppler Signals:
Audible

A
  1. Viable
  2. Threatened marginally
  3. Threatened immediately
65
Q

Clinical Category of Acute Limb Ischemia

Venous Doppler Signals:
Inaudible

A

Irreversible

66
Q

Management for Category I on arterial duplex:

A
  1. Imaging

2. Revascularization

67
Q

Management for Category IIA on arterial duplex:

A
  1. Imaging

2. Revascularization

68
Q

Management for Category IIB on arterial duplex:

A

Revascularization

69
Q

Management for Category III on arterial duplex:

A

Amputation

70
Q

A clot or piece of plaque which has moved within the arterial system from its point of origin and has lodged at a new location, leading to a sudden interruption of blood flow to an organ or a body part, e.g. digit, leg, arm, brain

A

Embolism

71
Q

Most common source of arterial embolism

A

Heart

72
Q

Conditions that cause arterial embolism in the heart

A
  1. Atrial fibrillation

2. Myocardial infarction

73
Q

Arterial Embolism that occurs in the brain

A

Stroke

74
Q

Arterial embolism that occurs on the distal portion of the leg

A

Blue digit syndrome

75
Q

Most common cause of acute mesenteric ischemia

A

Arterial embolism

76
Q

Therapy for arterial embolism

A

→ Embolectomy
→ Bypass
→ Anticoagulation

77
Q

The Aortic hiatus at the level of T12 contains the following structures, EXCEPT:

A. Aorta
B. Anterior (left) and posterior (right) vagal trunks
C. Azygos vein
D. Thoracic duct

A

Anterior (left) and posterior (right) vagal trunks

A number of structures pass through the aortic hiatus:
▪ Aorta
▪ Azygos vein and hemiazygos vein
▪ Thoracic duct

78
Q

TRUE, regarding Coronary Artery Disease, EXCEPT:

A. More severe stenoses also occlude, but may not have acute ischemia due to protective collaterals
B. Development of collaterals are important in restoring regional perfusion
C. Acute ischemia commonly develops only in vessels with greater than 50% stenosis
D. Rupture and thrombosis of an atherosclerotic plaque is the most common cause of unstable angina and acute myocardial infarction

A

Acute ischemia commonly develops only in vessels with greater than 50% stenosis

Acute ischemia commonly develops only in vessels with “lesser” than 50% stenosis.

79
Q

The following are Unfavorable Outcomes in patients with coronary artery disease, EXCEPT:

A. Acute aortic dissection
B. Unstable Angina
C. Acute Myocardial Infarction
D. Stable Angina

A

Acute aortic dissection

Unfavorable Outcomes:

  1. Stable Angina
  2. Unstable Angina
  3. Acute Myocardial Infarction
  4. Death
80
Q

Beck’s triad consists of the following, EXCEPT:

A. Hypotension
B. Pulsus paradoxus
C. Muffled heart tones
D. Distended neck veins

A

Pulsus paradoxus

Beck triad is a collection of three clinical signs associated with pericardial tamponade which is due to an excessive accumulation of fluid within the pericardial sac. The three signs are: low blood pressure (weak pulse or narrow pulse pressure), muffled heart sounds, and raised jugular venous pressure.

81
Q

Indication for elective repair of an abdominal aortic aneurysm, EXCEPT:

A. Asymptomatic patient with a 6cm infrarenal aortic aneurysm
B. Asymptomatic patient with a 4.4 cm AAA
C. 5.5cm asymptomatic AAA
D. Leaking AAA

A

Asymptomatic patient with a 4.4 cm AAA

According to the 2018 SVS guidelines, if the AAA is between 4.0 and 4.9 cm, surveillance imaging at 12-month intervals is suggested. If the AAA is between 5.0 and 5.4 cm, surveillance imaging at 6-month intervals is suggested. If there is any evidence of rapid growth (>1 cm in 1 year), the AAA should be repaired. Patients with AAAs 5-6 cm in diameter may benefit from repair, especially if they have other contributing factors for rupture.

82
Q

Arterial embolism may present with one of the following, EXCEPT:

A. Blue toe syndrome
B. Stroke
C. Acute mesenteric ischemia
D. Popliteal entrapment syndrome

A

Popliteal entrapment syndrome

Arterial embolism will manifest such as your atrial fibrillation, or myocardial infarction. It is also caused by stroke, an existing plaque/thrombus, bullet fragments causing arterial embolism, blue digit syndrome. Arterial embolism is also the most common cause of acute mesenteric ischemia.

83
Q

The following are “ CYANOTIC” heart disease, EXCEPT:

A. Hypoplastic Left Heart Syndrome
B. Eisenmenger’s Disease
C. Single Ventricle
D. Coarctation of the Aorta

A

Coarctation of the Aorta

CoA belongs to Acyanotic CHD

84
Q

Increased Pulmonary Blood flow occurs in, EXCEPT:

A. VSD
B. ASD
C. PDA
D. TOF

A

D. TOF

VSD, ASD, and PDA all belong to the Acyanotic CHDs with increased pulmonary blood flow. TOF belongs to the cyanotic CHDs with normal to decreased pulmonary blood flow. Very large VSD, accompanied by RVH that’s why shunting is a direct left-to-right. No Eisenmengerization.

85
Q

What is the most common Congenital Heart Disease occurring in a frequency of 1:1000?

A. TOF
B. PDA
C. VSD
D. ASD

A

C. VSD

86
Q

The following are TRUE regarding Patent Ductus Arteriosus, EXCEPT:

A. Presentation depends on the degree of left-to-right shunt (pulmonary overcirculation and steal from systemic perfusion)
B. Indomethacin is given to induce medical closure
C. PDA is more common in Term than in Preterm infants
D. Communication between upper descending aorta and left main pulmonary

A

C. PDA is more common in Term than in Preterm infants

PDA increases dramatically with INCREASING PREMATURITY*

▪ Choice A: The ductus arteriosus is derived from the sixth aortic arch and normally extends from the main or left pulmonary artery to the upper descending thoracic aorta, distal to the left subclavian artery.

▪ Choice B: PDA results in a left-to-right shunt that depends on both the size of the ductal lumen and its total length. In isolated patent ductus arteriosus (PDA), signs and symptoms are consistent with left-to-right shunting. The shunt volume is determined by the size of the open communication and the pulmonary vascular resistance (PVR). (Source: Medscape)

▪ Choice D: In premature infants, aggressive intervention with indomethacin or ibuprofen to achieve early closure of the PDA.

87
Q

The following are Ductal- dependent lesions, EXCEPT:

A. Tricuspid atresia
B. Truncus Arteriosus
C. TOF
D. Ebstein’s anomaly

A

B. Truncus Arteriosus

TOF, Ebstein’s anomaly, and tricuspid atresia are ductal-dependent lesions.

Truncus arteriosus is a ductal-independent mixing lesion.

88
Q

This is commonly performed in carotid stenosis, right coronary artery stenosis.

A

Endarterectomy

89
Q

Relatively the same as embolectomy but wala mo ya gina kuha ang embolus. You insert a catheter into the blood vessel. Part of the area of the balloon where your area of stenosis is, and then inflate that balloon to stretch the plaque or buk-on mo sya. Usually it requires mga 15-60 mmHg of pressure to crack open that very hard stenotic area without damaging the intima. Once the plaque has cracked, mahumok na na sya and can increase the caliber of the lumen already. But if the plaque is too hard, the balloon may not be enough to open up the blood vessel so in order for that blood vessel to remain patent, you insert an expandable stent that is usually made of metal. It’s like a mesh, cylindrical section. It will push to keep that vessel patent, so that is stenting.

A

Balloon angioplasty with or without wall stent

90
Q

if you remove the plaque during this procedure, slice first the intima to get the clot and when you excise it there would be incomplete layer of your intima (not intact) ky ginkuha mo na imo plaque. That exposes already your endothelium and that can lead to clot formation also like in the virchows triad.

A

Endarterectomy

91
Q

surgical procedure wherein a catheter is inserted into the artery that contains a blood clot and at the tip of the catheter is a balloon that you can inflate and you remove the blood clot.

A

Embolectomy

92
Q

Contraindications for treatment with CLI

A
  1. Patients not fit for revascularization
  2. Revascularization not technically possible
  3. Benefit cannot be expected
93
Q

Incidence ratio of atherosclerosis in men:women

A

2:1

94
Q

Common sites of atherosclerosis:

A

Any arterial bifurcation, most notably:
→ Carotid bifurcation
→ Aortic bifurcation

95
Q

Most common site of atherosclerosis in the lower extremity

A

below the inguinal ligament

96
Q

Risk factors for atherosclerosis:

A
  1. Hypertension
  2. Diabetes
  3. Hyperlipidemia
  4. Tobacco abuse
  5. Male gender
  6. Family history
  7. Age
97
Q

a medical emergency where there is a severe rise in the blood pressure. Cause is unknown but frequent history of hypertension, esp. HTN due to renal disorders.

A

Malignant: a.k.a. accelerated hypertension

98
Q

Therapy for arterial embolism:

A

→ Embolectomy
→ Bypass
→ Anticoagulation

99
Q

Clotting of a vessel – generally due to a preexisting atherosclerosis

A

Thrombosis

100
Q

Other causes of thrombosis:

A

→ Trauma, surgery, etc.
→ Low perfusion states (shock)
→ Dehydration

101
Q

Therapy for thrombosis:

A

→ Anticoagulation, heparin, Coumadin
→ Lysis, tPa, streptokinase, urokinase
→ Bypass

102
Q

A cyanotic newborn infant with a chest X-ray finding of “ egg-onside” is suggestive of:

A. Tricuspid Atresia
B. Transposition of the Great Arteries
C. Tetralogy of Fallot
D. Truncus Arteriosus

A

B. Transposition of the Great Arteries

103
Q

In Acute Limb Ischemia, the presence of sensory loss more than the
toes, mild muscle weakness, inaudible arterial Doppler signal and
audible venous Doppler signal suggest:

A. Stage II- A ALI
B. Stage II-B ALI
C. Stage I ALI
D. Stage III ALI

A

B. Stage II-B ALI

104
Q

In Acute Limb Ischemia, the most common source of Emboli is from:

A. The heart
B. DVT from the lower extremities
C. Existing thrombus
D. Existing atheromatous plaques

A

A. The heart

105
Q

Which of the following is NOT a clinical sign of cardiac tamponade?

A. Pulsus Paradoxus
B. Distended neck veins
C. Hypotension
D. Kaussmaul’s respiration

A

D. Kaussmaul’s respiration

106
Q

A patient who sustained a myocardial infarction involving the anterior, apical and anteroseptal wall of the heart
is most likely to have blockage of which coronary arterial branch?

A. Distal circumflex coronary artery
B. Proximal right coronary artery
C. Obtuse marginal branch
D. Proximal left anterior descending artery

A

D. Proximal left anterior descending artery

The most specific segments (anterior, anteroseptal, and all apical segments except the infero-apical)
correspond to LAD.

107
Q

What structure lies at the apex of the Triangle of Koch?

A. AV Bundle of His
B. Atrioventricular node
C. Right Bundle Branch
D. Left Bundle Branch

A

B. Atrioventricular node

▪ Base – Coronary Sinus, Thebesian Veins (located mostly at Right atrium)
▪ Lateral – Tendon of Todaro (tendinous structure connecting the valve of the inferior vena cava ostium to
the central fibrous body) and anteroseptal leaflet commissure/ septal annulus of the tricuspid valve.
▪ Apex- the AV node

108
Q

In the fetal circulation, blood from the inferior vena cava that enters the right atrium preferentially flows into:

A. The right ventricle through the tricuspid valve
B. The descending aorta via the ductus Arteriosus
C. The left atrium through the Foramen ovale
D. Lungs through the pulmonary artery

A

C. The left atrium through the Foramen ovale

Oxygen-rich blood from the placenta passes through the umbilical vein directly to the fetal liver, where
the circulation splits and flows into both the ductus venosus (20%–30% of flow) and portal sinus circulation. It then
passes into the inferior vena cava and enters the right atrium. The majority of this blood flows through the foramen
ovale, into the left atrium, then the left ventricle, and empties into the aorta (a small portion travels through the
pulmonary arteries to perfuse lung tissue)

109
Q

True statements regarding the tricuspid valve, EXCEPT:

A. It has 3 leaflets, namely, the anterior, septal, and posterior leaflets
B. The leaflets are all attached to papillary muscles via the chordae tendinae
C. It’s incompetence results in regurgitation of blood from the right ventricle to the right atrium
D. It guards the left atrioventricular orifice

A

D. It guards the left atrioventricular orifice

110
Q

“Rib notching” due to dilated and tortuous intercostal arteries is seen in which condition?

A. Atrial Septal Defect
B. Patent Ductus Arteriosus
C. Coarctation of the Aorta
D. Tetralogy of Fallot

A

C. Coarctation of the Aorta

Due to diminished blood flow below coarctation, collaterals develop (for compensation) and occurs at
the subcostal/intercostal arteries to increase blood flow in lower portion of the body.

▪ Prominent/tortuous subcostal/intercostal arteries erode the ribs producing a radiographic sign- “rib notching”

111
Q

Which of the following statements is NOT TRUE regarding Patent Ductus Arteriosus?

A. Causes a LEFT to RIGHT shunt
B. It causes pulmonary overcirculation
C. It shunts blood from the aorta to the pulmonary artery
D. It shunts blood from the pulmonary vein to the aorta

A

D. It shunts blood from the pulmonary vein to the aorta

Patent Ductus Arteriosus Causes Left to right shunting that results in:

  1. Blood goes back to the pulmonary artery then to the lungs
  2. Increase pulmonary blood flow
  3. Produces volume overload
112
Q

When auscultating the chest, the Pulmonary Valve is best heard when the stethoscope is placed on the:

A. 2nd ICS right parasternal border
B. Xiphoid area on the left para sternal border
C. 2nd ICS left parasternal border
D. 5th ICS left midclavicular line
E. 2nd ICS left midclavicular line
A

C. 2nd ICS left parasternal border

The pulmonary valve can be heard opposite the aortic valve, in the 2nd intercostal space along the edge
of the sternum.

113
Q

The venous drainage of the heart enters the heart mostly via the:

A. Thebesian veins
B. Coronary Sinus
C. Inferior Vena Cava
D. Superior Vena Cava

A

B. Coronary Sinus

114
Q

The coronary arteries:

A. Arise from the ascending aorta and fill during diastole.
B. Arise from the arch of the aorta and fill during systole.
C. Arise from the ascending aorta and fill during systole.
D. Arise from the arch of the aorta and fill during diastole.

A

A. Arise from the ascending aorta and fill during diastole.

115
Q

The most common type of Atrial Septal Defect:

A

Secundum

116
Q

The most common type of Ventricular Septal Defect:

A

Peri-membranous

117
Q

Injury to this structure can result during patch closure of perimembranous VSD’s:

A

AV node

118
Q

The following are ACYANOTIC congenital heart defects EXCEPT:

A. VSD
B. AVSD
C. ASD
D. Hypoplastic left heart syndrome

A

D. Hypoplastic left heart syndrome

119
Q

The following congenital cardiac anomalies result in increased
pulmonary blood flow, EXCEPT:

A. VSD
B. PDA
C. Coarctation of the Aorta
D. ASD

A

C. Coarctation of the Aorta

120
Q

The following can lead to decreased pulmonary blood flow, EXCEPT:

A. Aortic stenosis
B. Pulmonary stenosis
C. Coarctation of the aorta
D. PDA

A

D. PDA

121
Q

The following are ductal-independent mixing lesions, EXCEPT:

A. Ebstein’s anomaly
B. Total anomalous pulmonary venous connection
C. d-Transposition of the Great Arteries
D. OptTricuspid Atresia

A

A. Ebstein’s anomaly

122
Q

The following have ducal-dependent systemic blood flow, EXCEPT:

A. d-TGA
B. Interrupted aortic arch
C. TAPVC with obstruction
D. Hypoplastic left heart syndrome

A

A. d-TGA

123
Q

Chest x-ray finding in Tetralogy of Fallot:

A. ‘egg-on-side”
B. Scimitar sign
C. Coure en Sabot
D. Rib notching

A

C. Coure en Sabot

124
Q

The following requires elective surgical repair, EXCEPT:

A. Asymptomatic ascending Thoracic aortic aneurysm 7.5cm
B. Saccular aneurysm of the descending aorta
C. Acute ascending aortic dissection
D. Asymptomatic Infrarenal Abdominal aortic aneurysm <5.5cm

A

D. Asymptomatic Infrarenal Abdominal aortic aneurysm <5.5cm

125
Q

Operative indications for Type B aortic dissection

A. Rupture
B. Progressive dissection
C. Malperfusion
D. None of the above

A

A. Rupture

Indications (Type B or Stanford Type B):
▪ Rupture
▪ Severe pain
▪ Threatening of the visceral organs/visceral ischemia

126
Q

Refers to Leriche’s syndrome EXCEPT:

A. Erectile dysfunction
B. Aortoiliac occlusive disease
C. Pale cold legs
D. None of the above

A

D. None of the above

127
Q

Average growth rate of an abdominal aortic aneurysm:

A. 3-4 mm/year
B. 8-10 mm
C. 2 mm/year
D. 11-15mm/yr

A

A. 3-4 mm/year

128
Q

Thrombolytic agent:

A. Unfractionated heparin
B. Rivaroxaban
C. Clopidogrel
D. Urokinase

A

D. Urokinase

129
Q

Characteristics of the Fetal Circulation, EXCEPT:

A. Low impedance and high flow of the pulmonary circulation
B. Presence of shunts
C. Parallel circulation
D. Mixing of venous return and preferential streaming

A

A. Low impedance and high flow of the pulmonary circulation

130
Q

The umbilical vein postnatally becomes the:

A. Sinus Venosus
B. Ligamentum arteriosum
C. Hypogastric ligament
D. Ligamentum teres

A

D. Ligamentum teres

131
Q

The umbilical artery postnatally becomes the:

A. Sinus Venosus
B. Ligamentum teres
C. Hypogastric ligament
D. Ligamentum arteriosum

A

C. Hypogastric ligament

132
Q

Normal to decreased pulmonary blood flow is in
the following cyanotic lesions, EXCEPT:

A. Transposition of the great arteries
B. Tricuspid atresia
C. Tetralogy of Fallot
D. Pulmonary atresia

A

A. Transposition of the great arteries

133
Q

Normal to decreased pulmonary blood flow is seen in the following Acyanotic lesion, EXCEPT:

A. Anomalous left coronary artery to the pulmonary artery (ALCAPA)
B. Aortic stenosis
C. Coarctation of the aorta
D. Endocardial cushion defect

A

D. Endocardial cushion defect

134
Q

Normal to increased pulmonary blood flow can be seen in the following lesions, EXCEPT:

A. Tricuspid atresia
B. Transposition of the great arteries
C. Hypoplastic left heart syndrome
D. Truncus arteriosus

A

A. Tricuspid atresia

135
Q

Prostaglandin E infusion in patients with Patent ductus
arteriosus (PDA) results in:

A. Closure of the PDA
B. Cyanosis
C. Maintained patency of the PDA
D. None of the above

A

C. Maintained patency of the PDA

136
Q

Effect of Indomethacin to the PDA:

A. Cyanosis
B. Closure of the PDA
C. None of the above
D. Maintained patency of the PDA

A

B. Closure of the PDA

137
Q

The following are TRUE regarding Ebstein’s anomaly, EXCEPT:

A. The anterior leaflet is large and “sail-like”
B. There is “atrialization” of the right ventricle
C. The septal and posterior leaflets of the tricuspid valve
are displaced superiorly
D. The remaining part of the right ventricle that lies below
the displaced leaflet is smaller

A

C. The septal and posterior leaflets of the tricuspid valve

are displaced superiorly

138
Q

Preferred repair for patients with Hypoplastic left heart syndrome:

. Fontan Procedure
B. Nikaidoh procedure
C. Blalock Taussig Shunt
D. Norwood Procedure

A

D. Norwood Procedure

139
Q

A Blalock-Taussig Shunts connects the:

A. Superior vena cava to the pulmonary artery
B. Aorta to the pulmonary artery
C. Subclavian artery to the pulmonary artery
D. Subclavian artery to the pulmonary vein

A

C. Subclavian artery to the pulmonary artery

140
Q 
Location of the Sino-atrial (S-A) node in relation to the Atrio-Caval Junction:
A. Superolateral
B. Inferior
C. Medial
D. Anterolateral
A

A. Superolateral

141
Q

Left-to right shunt, EXCEPT:

A. PDA
B. VSD
C. Patent foramen Ovale
D. ASD

A

C. Patent foramen Ovale

142
Q

Right-to-Left shunt, EXCEPT:

A. Patent foramen Ovale
B. TAPVR
C. TGA with intact ventricular septum
D. Eisenmenger syndrome

A

C. TGA with intact ventricular septum

143
Q

Overriding of the aorta of more than 50% is seen in what lesion?

A. Double Outlet Right Ventricle
B. Tetralogy of Fallot
C. Transposition of the great arteries
D. Tricuspid atresia

A

A. Double Outlet Right Ventricle

144
Q

The Collette and Edwards classification is used to describe:

A. Aortic Dissections
B. Thoracoabdominal aneurysms
C. Interrupted aortic arch
D. Truncus arteriosus

A

D. Truncus arteriosus

145
Q

True of Transposition of the Great Arteries, EXCEPT:

A. Can be repaired using Senning’s, Mustard’s or Jatene’s Operation
B. The Aorta is connected to the right ventricle
C. The Main pulmonary artery is connected to the left ventricle
D. None of the above

A

D. None of the above

146
Q

In the Ostium primum type of Atrial septal defect, the defect is located:

A. Low in the atrial septum
B. At the coronary sinus
C. At the mid portion of the septum
D. High in the atrial septum

A

A. Low in the atrial septum

147
Q

The murmur of Atrial Septal Defects is due to:

A. Increased flow through the pulmonary valve
B. Turbulence across the atrial septal defect
C. Regurgitation of the tricuspid valve
D. Is best heart at the 2nd intercostal space right sternal border

A

A. Increased flow through the pulmonary valve

148
Q

The “pistol-shot murmur” of Aortic Insufficiency is best heard at the:

A. At the Apex
B. 2nd ICS right sternal border
C. 2nd ICS left sternal border
D. On the femoral artery

A

D. On the femoral artery

149
Q

The opening snap and diastolic rumbling murmur best heard at the apex is characteristic of:

A. Aortic Regurgitation
B. Mitral stenosis
C. Mitral regurgitation
D. Aortic Stenosis

A

B. Mitral stenosis

150
Q

A Continuous Machinery-like murmur is heard in patients with:

A. VSD
B. ASD
C. Coarctation of the aorta
D. PDA

A

D. PDA

SURGERY II (2 decks)

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