Cardiac bits

Question 1

right lower zone - the veins clearly lie in a more - what direction

Answer 1

horizontal orientation

Question 2

upper lobe vessels are substantially smaller than their lower lobe counterparts, rarely measuring greater than whst in the first interspace

Answer 2

3mm

Question 3

descending portion of the right lower lobe artery should measure less than WHAT wide

Answer 3

16mm

Question 4

Pulmonary capillary wedge pressure grading (PCWP)

Answer 4

Mild
Redistribution PCWP 13-18 mmHg
Moderate
Interstitial oedema PCWP 18-25 mmHg
Severe
Alveolar oedema PCWP >25-30 mmHg

Question 5

PCWP relates to pulmonary venous hypertension how

Answer 5

Graded I - III cooresponds to mild to severe

Question 6

Grade I features of PVH

Answer 6

Upper lobe redistribution
Hilar blurring
Effacement of hilar angle

Question 7

Grade II of PVH features

Answer 7

Interstitial pulmonary oedema

Pleural effusion

Question 8

Grade III of PVH features

Answer 8

Alveolar oedema
Perihilar/lower zone
Often asymmetrical: right greater than left (R>L)
Acinar shadowing

Question 9

How can emphysema affect the vascular pattern of lungs?

Answer 9

If lower lobe is affected - can cause upper lobe diversion

if upper lobes affected - cause lower zone crowding

Question 10

how does the hilar angle relate to PVH

Answer 10

if the veins expand they can obliterate the hilar angle

Question 11

Kerley lines are named after who?

Answer 11

Peter James Kerley - Irish radiologist died in 1978, worked at westminster hospital.

Question 12

lamellar effusion

Answer 12

accumulation of fluid in the loose subpleural interstitium (i.e. not in the true pleural space)

Question 13

two types of pulmonary oedema

Answer 13

hydrostatic - cardiogenic

increased permeability - ARDS

Question 14

Features of ARDS pulomnary oedema

Answer 14

Changes that may be delayed
Uniform distribution
Septal lines (rare)
Air bronchograms (common)
Vascular pattern usually normal
Effusions less common and small

absence of septal lines and effusions

Question 15

pulmonary vascular bed normally has much WHAT resistance than the systemic capillary bed.

Answer 15

Lower

Question 16

Pulmonary hypertension two types?

Answer 16

Primary

Secondary

Question 17

Primary PHT tpyes

Answer 17

Familial

Question 18

Secondary PHT types -

Answer 18

Thromboembolic
Chronic obstructive pulmonary disease (COPD)
Pulmonary fibrosis
Sarcoidosis
Intracardiac shunts:
Ventricular septal defect (VSD)
Atrial septal defect (ASD)
Patent ductus arteriosus (PDA)
Pulmonary veno-occlusive disease

Question 19

do chest xr signs correlate to severirty of PHT disease?

Answer 19

no

Question 20

what size of main pulmonary artery is concerning

Answer 20

> 3.3cm

Question 21

What syndrome occurs in large untreated left to right shunts

Answer 21

Eisenmenger

Question 22

Eisenmenger syndrome is seen in what conditions?

Answer 22

ASD, VSD, and PDA

Question 23

pulomonary oligaemia can be causes by what?

Answer 23

Massive PE in adults

Right to left shunt in paeds

Question 24

Pulmonary venous hypertension is characterised

Answer 24

a distinct vascular redistribution from the lower lung zones to the upper zones and there may be additional features of interstitial oedema and frank alveolar oedema

Question 25

Pulmonary venous hypertension is characterised

Answer 25

enlargement of the central pulmonary arteries with a diminution in size of the peripheral pulmonary vessels known as peripheral pruning

Question 26

Single chamber pacing in the ventricle (Fig 1) is indicated for

Answer 26

atrial fibrillation with a sustained or intermittent slow ventricular response

Question 27

Single chamber pacing in the atrium (Fig 2) is usually indicated for

Answer 27

sick sinus disease.

Question 28

Dual chamber pacemakers are usually used in

Answer 28

complete heart block

Question 29

Biventricular pacing of the atrium (Fig 1a) is increasingly used in

Answer 29

drug refractory advanced heart failure

Question 30

implantable cardiac defribrillator features

Answer 30

bigger box, thicker wire