Primary pulmonary hypertension ……..all are true...Except
an associated with HIV infection has been seen.
medial hypertrophy and fibrinoid necrosis are seen in ALL branches of the pulmonary arterial tree and result in pulmonary vascular obstruction
physicial signs are usually unimpressive until right sided heart failure sets in
5 out of every ten cases are familial.
most patients die within 2-3 years of diagnosis.
Cor pulmonale ……..all are true except
may be acute or chronic
the first physical sign is raised JVP
may be caused by postpoli syndrome
the usual end result of many chronic debilitating lung diseases
it is defined as right sided heart failure
You have been asked to examine this 70 year old gentleman with COPD who presents with excessive day time somnolence ……you noticed that he is a little bit dark in color …..You will then examine which one of the followings:
the chest for any new changes …
fundoscpe
trying to count the respiratory rate for hypoventilation
his heart for any heart failure
his neck for any swelling
Pulmonary thromboembolisom ……all are true except:
has diverse clinical manifestations ranging from totally asymptomatic to sudden death
Bed side echocardiography is a useful and rapid tool in cases of acute massive pulmonary theromboembolism
symptomatic pulmonary thromboembolism occurs up to 1% of all post operative patients.
Autopsy incidence of post operative thromboembolism is 10-25 %
up to 50% of all pulmonary thromboemboli came from the leg veins
Chest x ray findings in pulmonary thromboembolism …all are true except
may be normal
subtle changes may be present like regional oligmemia
peripheral wedge shaped opacities are commonly seen
elevation of the diaphragm is a well recognized sign
abscess formation has been documented .
ECG changes in acute pulmonary thromboembolism…all are true except:
sinus tachycardia is the commonest
RBBB has been documented
atrial fibrillation may be seen
S1 Q3 T3 pattern is common and useful
T inversion over the right chest leads
Treatment of acute pulmonary thromboembolism all are true except
Emergency embolectomy is rarely needed
Thrombolytics should be used in a massive pulmonary thromboembolism proved by CT or angiography
heparin therapy has been shown to decrease mediator induced pulmonary vasoconstriction
heparin therapy has not been shown to reduce the overall mortality in pulmonary thromboembolism,
oral anticoagulants have no place in the management of life threatening thromboembolic disease
General measures in the acute thromboembolic events: all are true except:
opiates may be necessary to relieve pain and disstress
the use of inotropic agents is of great value in massive events
duiretics and vasodilators should be avoided at all times
O2 should be given to all hypoxemic patients
resuscitation by external cardiac massage may be successful in moribund patients by dislodging and breaking up a large central embolus
Congenital heart disease…all are true regarding the incidence of various typesyes my father i …except
the commonest type is VSD -about 30 %
atrial septal defects -10%
patent ductus arteriosus -10%
tetralogy of fallot -16 %
Coarctation of aorta -7%
Congenital heart disease …..All are true except:
Aortic regurgitation may occur in VSD due to loss of support of the right coronary cusp
fallot tetralogy patients are protected from Eisenmenger's syndrome because of the pulmonic steosis
ASD primum usually presents in infancy with arrhythmias
preventing the closure a Patent Ductus arteriosus with certain medications is useful in certain congenital heart diseases like tricuspid atresia
transpositon of great vessels is the commonest cause of "cardiac cyanosis at birth"
Congenital heart diseases may have certain associations …..All are true except
ASD and triphalyngeal thumb
infant of a psychiatric mother -Epstein anomaly
maternall rubella and infant PDA
epileptic mother and interrupted aortic arch in the neonate
Noonan's syndrome and mitral stensois
In Aortic Regurgitation the following clues are important in the etiology of the regurgitation ……all are true except
bilateral small irregular pupils
long standing back pain with upper lobes fibrosis
Both cubital fossae examination may be of great help
hand examination can give no extra information
slit lamp examination is useful in certain cases
Mitral stenosis…..all are true...Except
Giant CV waves may be seen
pulmonary edema in pregnancy is an indication for emergency valvotomy
Transmitral diastolic gradient of more than 15 mmHg indicates mild-moderate degree of stenosis
an episode of pulmonary edema without a precipitating cause is an indication for surgery what ever the severity of stenosis was.
although secondary pulmonary hypertension is common, yet Graham Steel murmur is rare
ECG findings in uncomplicated congenital heart disease…..all are true..except
ASD secondum-partial RBBB
ASD primum -Left axis deviation
VSD-biventricular hypertrophy
PDA-RVH usually seen than LVH
coarcatation of aorta -LVH
Chest X ray findings in congenital heart disease…….which one is true