CTVS

Tetrology of Fallot

by

Q Autopsy finding  in a patient who dies of Tetrology of Fallot is

a)  Brachiocephalic vein draining into the left renal vein
b)  Inferior vena cava (IVC) draining to the superior mesenteric vein
c)  Atrial Septal Defect (ASD)
d) Decreased vascularity of the lung field

Answer

Complications of Surgery of Aortic aneurysm

by

Q) A 68 year old man undergoes repair of infra renal aortic aneurysm. On 2nd POD he has abdominal pain, bloody diarrhea and tachycardia. BP is 120/70. Abdomen is mildly distended and tender especially in the left lower quadrant.

How will you proceed

a) Send stool for clostridium and spores

b) CT Abdomen

c) Exploratory laparotomy

d) Higher antibiotics

Ans b 

Get a contrast CT Abdomen as bowel ischemia is a likely diagnosis 

Incidence of bowel ischemia after repair of aortic aneurysm is around 2-6%. It is because of loss of inferior mesenteric artery artery at the time of surgery and inadequate colonic collaterals. 

Spores and clostridium difficle diarrhea occurs after prolonged antibiotic use. Also there is no bloody diarrhea in it.

Exploratory laparotomy will be required after CT Shows full thickness gangrene and not before

Antibiotic escalation will not help at this stage.

 

TAPVD

by

Q) Total anomalous pulmonary venous drainage (TAPVD) is associated with 

a) Endocardial cushion defect

b) Sinus Venosus ASD

c) Defects in Fossa ovalis

d) Completely separate entity

Answer 

Aortic rupture

by

Q) Most common site for traumatic aortic rupture is 

a) Distal to the origin of left subclavian artery

b) Point of entry of aorta above the diaphragm

c) Root of aorta

d) Point distal to Left carotid artery

Answer 

a) Distal to origin of subclavian artery

Traumatic aortic rupture leads to sudden death after high impact automobile accident or fall from height. Aorta is relatively fixed distal to ligament arteriosum just distal to the origin of subclavian artery and this is the most common site of traumatic rupture especially partial rupture in which adventitia is intact.

Specific clinical findings are 

  1. Asymmetry of BP in upper limbs or upper and lower limbs
  2. Widened pulse pressure
  3. Chest wall contusions

Bailey page 355

http://www.msdmanuals.com/professional/injuries-poisoning/thoracic-trauma/aortic-disruption-traumatic

Atrial Septal Defect

by

Q) Most common type of Atrial Septal Defect (ASD) is:

A. Ostium Primum
B. Ostium Secundum
C. Sinus Venosus
D. All are equal

 

ASDs
■ Common defects
Ostium secundum: fossa ovalis defect (approximately 70 per cent of ASDs)
Ostium primum: atrioventricular septal defect (approx imately 20 per cent of ASDs)
Sinus venosus defect: often associated with anomalous pulmonary venous drainage (approximately 10 per cent of ASDs)
Patent foramen ovale: common in isolation, usually no left-to-right shunt (not strictly an ASD)

 Rarer defects
Inferior vena cava defects: a low sinus venosus defect and may allow shunting of blood into the left atrium
Coronary sinus septal defect: also known as unroofed coronary sinus with the left superior vena cava draining to the left atrium as part of a more complex lesion

 

error: Content is protected !!