Cardiac and Thoracic

Question 1

Increased pulmonary resistance, left axis on EKG, and a mitral regurgitation murmur (due to a cleft mitral valve) in a 14 year old:

Answer 1

ostium primum defect

ostium secundum defect would show up later in life

Question 2

Single and dual pacemakers are used for

Answer 2

bradycardia

Question 3

The mortality rate exceeds 50% when severe pulmonary pressure (>__ mm Hg) occurs.

Answer 3

85

Question 4

VSD results from the failure of fusion of what parts?

Answer 4

the uppermost part of the interventricular septum with the aortic septum; membranous defects account for 90% of cases

Question 5

In full-term infants born with persistent PDA, the anomaly must be closed or excised between (what ages??) to avoid cardiac complications, including endocarditis

Answer 5

6 months and 3 years

Question 6

An increase in oxygen saturation between the IVC and the RV suggests what cardiac anomaly?

Answer 6

ASD

Question 7

Tetralogy of fallot features (increased/decreased) pulmonary vascularity

Answer 7

decreased

Question 8

Pressure in the intermediate third of the esophagus seen on esophagram after a barium swallow is a result of aortic stenosis resulting from which valvular disease?

Answer 8

aortic stenosis

Question 9

In the face of unstable angina, __% of patients will develop an MI in 3 months.

Answer 9

30%

Question 10

How does 99mTc pyrophosphate scintigraphy work to shed light on a perfusion defect?

How about 201TI (Thallium 201) scintigraphy?

Answer 10

Following injection of 99mTc pyrophosphate, scintigraphy may show a hot spot in the infarcted area (as long as it is not too small). The hot spot is developed as the radiotracer forms a complex with calcium in necrotic tissue. The test should be requested within the first 18 hours following the onset of acute MI.

Following 201Tl scintigraphy, a “cold spot” occurs because of hypo perfusion. The test is performed where exercise or dipyridamole (Persantine) injection can be given.

Question 11

Thrombolytics are only effective if administered within __ hours of an MI.

Answer 11

6

Question 12

Name 3 factors that contribute to sudden cardiac death:

Answer 12

electrolyte abnormalities, hypoxia, and conduction system defect

Question 13

What is a normal cardiac index?

Answer 13

> 2.2

Question 14

What is the first intervention for paroxysmal tachycardia?

Answer 14

alternate pressure on the carotid sinuses (but not in someone with carotid bruit or TIA!).  The common carotid artery usually divides at the level of the upper border of the thyroid cartilage or
hyoid bone (C3). The carotid sinus may be located either on the proximal internal carotid artery or distal common carotid bifurcation.

Question 15

What are causes of a bounding pulse?

Answer 15

aortic incompetence, PDA, hyperthyroidism, peripheral AV fistula, anemia

Question 16

What are causes of a decreased (small) pulse?

Answer 16

aortic stenosis, heart failure, pulmonary HTN, pulmonary incompetence, mitral stenosis, pericardial effusion

Question 17

What is the only vessel approved for stunting by the FDA?

Answer 17

iliac artery

Question 18

What is the most important cause of death in the first year of patients with ToF?

Answer 18

CVA

Question 19

Congenital rubella results in which congenital cardiac malformation?

Answer 19

open PDA

Question 20

What is the indication for surgical correction of pulmonary stenosis?

Answer 20

Moderate stenosis: gradient showing 50-80 mm Hg between right ventricle between right ventricle and pulmonary artery

Question 21

T/F: If mediastinal nodes are positive in lung cancer, the patient is not a surgical candidate.

Answer 21

True! That is why mediastinoscopy is the next step in a confirmed malignant lung nodule

Question 22

What is the surgical standard of care for achalasia?

Answer 22

myotomy with partial fundoplication

Question 23

A __mm gradient is termed critical aortic stenosis, and the valve should be replaced in a symptomatic patient.

Answer 23

50