Your-Doctor Multiple Choice Questions (MCQ)

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Category: Cardiology--->Adult Congenital Heart Disease and Pregnancy
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Question 6#Print Question

Which one of the following statements regarding the Fontan operation is correct?

a. It is a palliative procedure in patients with congenital cyanotic heart disease when a biventricular repair is not possible; the result is univentricular physiology with diversion of systemic venous return to the pulmonary arteries
b. Patients should have a near-normal life expectancy as chronic cyanosis is corrected and the pulmonary vasculature is protected from systemic pressures
c. It is one potential solution for transposition of the great arteries; systemic venous blood is diverted to the subpulmonary ventricle via an atrial baffle and pulmonary venous return is redirected to the systemic ventricle
d. It is a corrective procedure for patients with functionally univentricular cyanotic heart disease; the end result is a biventricular repair
e. It is a palliative procedure in patients with congenital cyanotic heart disease when a biventricular repair is not possible; the result is univentricular physiology with a systemic arterial to pulmonary shunt to increase pulmonary blood flow

Question 7#Print Question

You are asked to review a 27-year-old female with complex congenital heart disease. She is normally managed at another centre, and limited information is available. She has had a number of operations in early life but has recently been well. Her parents tell you that she has ‘one main pumping chamber’. The history is of deterioration over the last week with fevers and headache. On examination the patient is cyanosed (baseline saturations 85% on room air) and agitated with GCS 13–15. Temperature is 38.4°C, BP is 120/80 mmHg, and heart rate is 100 bpm (regular). A bedside echocardiogram is attempted but the image quality is very poor. The ED team have initiated supportive treatment with high-flow O2 and IV fluids. Blood cultures have been taken. The chest X-ray is suspicious for right basal consolidation.

What would you advise?

a. There is evidence of severe sepsis with compromise; in view of the complex congenital heart disease there is a risk of rapid decompensation and the patient should be moved to the ITU with a view to intubation if the hypoxia deteriorates
b. The patient requires an immediate TOE as she is in a high-risk category for concomitant endocarditis and TTE is non-diagnostic
c. In view of the temperature and reduced GCS she should have an urgent CT head
d. After adequate blood cultures have been taken, initiate empirical antibiotics for pneumonia and move to CCU for supportive treatment; involve the ITU team in case of deterioration; aim for saturations >93% and plan for TOE when stabilized to rule out endocarditis
e. Urgently contact the team she is under to establish the underlying diagnosis; aim for transfer if stabilized with supportive treatment

Question 8#Print Question

When describing cardiac anatomy, what does the term ‘situs solitus’ refer to?

a. Normal orientation of the cardiac apex within the thorax, e.g. leftward pointing cardiac apex
b. Normal orientation of the cardiac atria, e.g. morphological left atrium on the left and morphological right atrium on the right
c. Mirror image of the cardiac structures and abdominal viscera, e.g. left-sided structures on the right and vice versa
d. Normal orientation of the cardiac structures but with mirror images of the abdominal viscera
e. Both atria are morphologically left-sided with associated cardiac and visceral organ abnormalities

Question 9#Print Question

You are asked to review a 22-year-old male who has presented to the ED with sudden-onset chest pain and breathlessness. He has been diagnosed with a probable acute pulmonary embolism by the emergency team. They have asked for an echocardiogram to look for ‘right heart strain’ as he appears to be mildly compromised and they are considering thrombolysis if he decompensates. Auscultation of the heart sounds has revealed a loud continuous murmur and the CXR shows some pulmonary congestion.

What are you likely to see on echocardiography?

a. A dilated and hyperdynamic RV with evidence of acute TR secondary to raised pulmonary pressure
b. A jet of colour flow extending back into the RVOT from the pulmonary artery in the short-axis parasternal view
c. A jet of colour extending from the right coronary sinus into the right ventricle
d. A jet of colour across the apical interventircular septum in the four-chamber view
e. A flail mitral valve leaflet with severe mitral regurgitation

Question 10#Print Question

A haematology SHO contacts you regarding a patient with congenital cyanotic heart disease. The patient has trisomy 2 and an unrepaired complete AVSD with Eisenmenger physiology and chronic cyanosis. The patient was seen recently in clinic and was doing reasonably well. The full blood count has been highlighted to the haematology team as the patient has a haemoglobin (Hb) of 27. The haematology records document a previous venesection when the Hb was around the same figure and the patient had developed headaches thought to be due to hyperviscosity. The SHO would like some advice on whether they should arrange for daycase venesection to reduce the risk of hyperviscosity complications and symptoms. 

What advice should you give?

a. As the patient is asymptomatic there is no indication for venesection
b. Daycase venesection should be arranged with volume replacement based on the Hb to prevent hyperviscosity complications
c. The haematocrit (Hct) should be checked; if Hct > 65%, daycase isovolumic venesection is indicated
d. The iron status should be checked first; in the presence of iron deficiency this should be treated first, prior to venesection
e. The haematocrit and iron status should be checked: if Hct > 60% and the patient is iron replete, venesection should be performed: If the patient is iron deplete, venesection can be performed with pulsed iron and volume replacement

Category: Cardiology--->Adult Congenital Heart Disease and Pregnancy
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