Cardiovascular Interventional Procedures — MCQs

10 questions

MC late complication of central venous line is:

Thrombolysis can be considered in all of these conditions, except:

Sitaram a 40-year old man, met with an accident and comes to emergency department with engorged neck veins, pallor, rapid pulse and chest pain Diagnosis is -

Which of the following is the best management for radiation induced occlusive disease of carotid artery?

Pulmonary embolism is most commonly caused by:

Which is the best test to detect pulmonary embolism?

True about Aortic transection:

What is the appropriate management for a male patient who presents to the hospital with abdominal pain from cholecystitis and is incidentally detected with an asymptomatic abdominal aortic aneurysm?

A patient comes to the casualty with a severe headache. His BP was found to be 160/100 mmHg. CT scan revealed a subarachnoid hemorrhage. What is the next best step in the management of this patient?

Q10

Which one of the following is the investigation of choice in a patient with haematemesis?

Cardiovascular Interventional Procedures Indian Medical PG Practice Questions and MCQs

Question 1: MC late complication of central venous line is:

A. Sepsis (Correct Answer)
B. Thromboembolism
C. Cardiac arrhythmias
D. Air embolism

Explanation: **Sepsis** - **Catheter-related bloodstream infections (CRBSIs)** are the most common late complication of central venous lines, leading to sepsis [1]. - The risk of sepsis increases with the **duration** of catheter placement, frequency of line access, and inadequate aseptic technique [1]. *Air embolism* - An **air embolism** is typically an immediate or early complication during insertion or removal of the central line, or connection/disconnection of administration sets. - It is not considered a late complication as it occurs due to a sudden entry of air into the venous system. *Thromboembolism* - While **thrombosis** can complicate central venous lines, leading to potential thromboembolism, it is less common than sepsis as a late complication [2]. - The formation of a thrombus is often localized to the catheter tip or vessel wall and may or may not lead to a symptomatic embolism [2]. *Cardiac arrhythmias* - **Cardiac arrhythmias** can occur during central venous line insertion if the guidewire or catheter tip irritates the myocardium, making it an immediate or early complication. - This is usually a transient event and not a long-term or late complication associated with the mere presence of the catheter.

Question 2: Thrombolysis can be considered in all of these conditions, except:

A. Blood pressure of more than 185/110 mmHg (Correct Answer)
B. Ischemic stroke within 2 hours
C. Onset of symptoms <4 hours
D. MRI showing density in less than 1/3rd of the area supplied by MCA

Explanation: ***Blood pressure of more than 185/110 mmHg*** - A **blood pressure** greater than **185/110 mmHg** is an absolute contraindication for thrombolysis due to the significantly increased risk of developing **hemorrhagic transformation**. - **Aggressive blood pressure control** is necessary to reduce the risk of intracranial hemorrhage before considering thrombolytics. *Ischemic stroke within 2 hours* - This is within the **therapeutic window** for thrombolysis, which typically extends up to **4.5 hours** from symptom onset [1]. - Earlier administration of thrombolytics within this window generally leads to **better outcomes** and reduced disability [1]. *Onset of symptoms <4 hours* - An onset of symptoms less than **4.5 hours** is a primary **inclusion criterion** for intravenous thrombolysis in acute ischemic stroke [1]. - This timeframe allows for the maximum benefit from **clot dissolution** while minimizing the risk of adverse events. *MRI showing density in less than 1/3rd of the area supplied by MCA* - A **diffusion-weighted MRI** showing an infarct core of less than one-third of the **Middle Cerebral Artery (MCA)** territory is an indicator that the amount of **irreversibly damaged tissue** is small. - This suggests a larger volume of **salvageable penumbra**, making thrombolysis more likely to be beneficial.

Question 3: Sitaram a 40-year old man, met with an accident and comes to emergency department with engorged neck veins, pallor, rapid pulse and chest pain Diagnosis is -

A. Pulmonary laceration (lung injury)
B. Splenic rupture (abdominal trauma)
C. Hemothorax (blood in the pleural cavity)
D. Cardiac tamponade (fluid accumulation in the pericardium) (Correct Answer)

Explanation: ***Cardiac tamponade (fluid accumulation in the pericardium)*** - **Engorged neck veins (elevated JVP)**, **pallor** (due to decreased cardiac output), and a **rapid pulse** ("pulsus paradoxus" or tachycardia from compensatory mechanisms) in the context of trauma are classic signs of **cardiac tamponade**. - **Chest pain** can result from the acute compression of the heart, leading to reduced ventricular filling and cardiac output. *Pulmonary laceration (lung injury)* - A pulmonary laceration would primarily present with **respiratory distress**, **hemoptysis**, and potential **air leak syndromes** (e.g., pneumothorax), not typically engorged neck veins as a primary sign. - While it can cause chest pain and rapid pulse, it doesn't explain the combination of engorged neck veins and significant cardiovascular compromise seen here without other prominent respiratory symptoms. *Splenic rupture (abdominal trauma)* - Splenic rupture typically presents with **left upper quadrant abdominal pain**, **abdominal tenderness**, and signs of **hypovolemic shock** (pallor, rapid pulse, hypotension), but not generally engorged neck veins. - The primary location of trauma and symptoms would be abdominal, not chest pain and engorged neck veins. *Hemothorax (blood in the pleural cavity)* - A hemothorax would cause **chest pain**, **dyspnea**, **diminished breath sounds** on the affected side, and signs of **hypovolemic shock** if severe (pallor, rapid pulse). - However, it typically leads to **collapsed neck veins** due to hypovolemia, rather than engorged neck veins, unless there's a co-existing tension pneumothorax or cardiac tamponade.

Question 4: Which of the following is the best management for radiation induced occlusive disease of carotid artery?

A. Carotid endarterectomy
B. Low dose aspirin
C. Carotid bypass procedure
D. Carotid angioplasty and stenting (Correct Answer)

Explanation: ***Carotid angioplasty and stenting*** - **Radiation-induced carotid artery disease** often involves the distal part of the carotid artery, making it less amenable to surgical endarterectomy. - **Angioplasty and stenting** offer a less invasive approach with good technical success in these challenging cases, especially given the increased fragility and fibrosis of radiated tissues. *Carotid endarterectomy* - **Carotid endarterectomy** in previously radiated fields is associated with a significantly higher risk of complications, including **cranial nerve injury**, **wound infection**, and **carotid artery rupture**, due to tissue fibrosis and scarring. - The disease often extends beyond the easily accessible segment for endarterectomy in radiation-induced cases. *Low dose aspirin* - **Low-dose aspirin** is an important component of medical therapy for **atherosclerotic disease** and **stroke prevention**, but it is insufficient as a sole treatment for symptomatic or high-grade occlusive disease of the carotid artery. - It helps manage the underlying **atherosclerotic process** but does not directly address the severe stenosis or occlusion. *Carotid bypass procedure* - **Carotid bypass procedures** are complex surgical interventions usually reserved for cases of **carotid artery occlusion** or **recurrent stenosis** after previous interventions where endarterectomy or stenting is not feasible. - While an option, it is more invasive and technically demanding than angioplasty and stenting, particularly in already radiated tissues with compromised vascular integrity.

Question 5: Pulmonary embolism is most commonly caused by:

A. Deep vein thrombosis (DVT) of the leg (Correct Answer)
B. Fat embolism from pelvic fracture
C. Cardiac emboli from heart disease
D. Increased pulmonary pressure (a consequence of PE)

Explanation: ***Deep vein thrombosis (DVT) of the leg*** - **Deep vein thrombosis (DVT)** in the leg is the most common source of emboli that travel to the lungs, leading to pulmonary embolism [1]. - The thrombus breaks off from the deep veins, typically in the **lower extremities**, and propagates through the venous system to the pulmonary arteries [1]. *Increased pulmonary pressure (a consequence of PE)* - **Increased pulmonary pressure** is a physiological consequence of a significant pulmonary embolism, as blood flow is obstructed, but it is not the cause of the embolism itself. - This option describes a **downstream effect**, rather than the origin of the embolus. *Fat embolism from pelvic fracture* - **Fat embolisms** can occur after long bone fractures (especially pelvic or femur fractures) and surgeries, but they are a less common cause of PE compared to DVT. - While they can lead to pulmonary symptoms, the mechanism involves **fat globules** entering the circulation, distinct from a thrombus. *Cardiac emboli from heart disease* - **Cardiac emboli** typically originate from the heart (e.g., from atrial fibrillation, mural thrombi after myocardial infarction, or valvular disease) and usually cause **systemic emboli** leading to strokes or limb ischemia. - While rare, paradoxal emboli can occur via a patent foramen ovale but are not the leading cause of "pulmonary" embolism.

Question 6: Which is the best test to detect pulmonary embolism?

A. D dimer assay
B. MRI
C. Ventilation Perfusion scan
D. CT with IV contrast (Correct Answer)

Explanation: ***CT with IV contrast*** - **CT pulmonary angiography (CTPA)** is the **gold standard** for diagnosing pulmonary embolism due to its high sensitivity and specificity [1]. - It directly visualizes the **pulmonary arteries** and can detect emboli, making it the most definitive imaging test [1]. *D dimer assay* - A **negative D-dimer** can effectively **rule out PE** in low-to-intermediate probability patients, but a positive result is non-specific and requires further investigation. - It is a screening test with **poor specificity** in many clinical situations, such as surgery, trauma, cancer, or pregnancy, where D-dimer levels can be elevated for other reasons. *MRI* - **Magnetic resonance angiography (MRA)** can be used for PE diagnosis, particularly in patients unable to receive iodinated contrast or radiation. - However, it has **lower spatial resolution** and is generally less available and slower than CTPA, making it a second-line option. *Ventilation Perfusion scan* - A **V/Q scan** measures airflow (ventilation) and blood flow (perfusion) in the lungs to detect mismatches suggestive of PE [1]. - While useful, particularly in patients with **renal insufficiency** or **contrast allergy**, it often yields indeterminate results and is less sensitive than CTPA for definitive diagnosis [1].

Question 7: True about Aortic transection:

A. Surgical repair is the definitive treatment
B. Associated with high mortality if untreated
C. Most commonly caused by deceleration injury in motor vehicle accidents
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - All three statements about aortic transection are medically accurate, making this the correct answer. - **Aortic transection** is typically caused by **deceleration injury** (especially in motor vehicle accidents), has **extremely high mortality if untreated** (approaching 90% within 24 hours), and requires **urgent surgical or endovascular repair** as definitive management. - The injury occurs when sudden deceleration causes **shearing forces** at the **aortic isthmus** (near the ligamentum arteriosum), where the mobile aortic arch meets the fixed descending aorta. *Surgical repair is the definitive treatment - Incomplete alone* - While this statement is true, selecting only this option would miss the critical information about etiology and prognosis. - Treatment options include **open surgical repair** or **TEVAR (thoracic endovascular aortic repair)**, with endovascular approaches increasingly preferred when anatomically feasible. *Associated with high mortality if untreated - Incomplete alone* - This is accurate but doesn't capture the mechanism of injury or treatment approach. - Without treatment, **80-90% of patients die within 24 hours** due to free rupture and exsanguination. *Most commonly caused by deceleration injury in motor vehicle accidents - Incomplete alone* - True regarding mechanism, but omits the critical prognostic and therapeutic information. - **High-speed MVA** and **falls from height** are classic causes, with the descending aorta tethered by intercostal arteries while the heart and arch continue moving forward.

Question 8: What is the appropriate management for a male patient who presents to the hospital with abdominal pain from cholecystitis and is incidentally detected with an asymptomatic abdominal aortic aneurysm?

A. Immediate surgery
B. Monitor till size reaches 55 mm (Correct Answer)
C. Monitor till size reaches 45 mm
D. USG monitoring till size of the aneurysm reaches 70 mm

Explanation: ***Monitor till size reaches 55 mm*** - For **asymptomatic abdominal aortic aneurysms (AAAs)** in male patients, elective repair is generally recommended when the aneurysm reaches 5.5 cm (55 mm) in diameter. - This size balances the risk of rupture against the risks associated with surgery. *Immediate surgery* - Immediate surgery is reserved for patients with a **symptomatic** or **ruptured AAA**, indicated by severe abdominal pain, hypotension, and a pulsatile mass. - An incidentally detected, asymptomatic AAA typically does not warrant emergency surgical intervention. *Monitor till size reaches 45 mm* - A 45 mm aneurysm in a male patient is typically managed with **regular surveillance** rather than immediate intervention. - The risk of rupture at this size is generally considered low enough to avoid the risks of elective surgery. *USG monitoring till size of the aneurysm reaches 70 mm* - Monitoring an AAA until it reaches 70 mm (7 cm) is **not safe practice** due to a significantly increased risk of rupture as the aneurysm grows beyond 5.5 cm. - Guidelines recommend intervention at 5.5 cm to prevent life-threatening rupture.

Question 9: A patient comes to the casualty with a severe headache. His BP was found to be 160/100 mmHg. CT scan revealed a subarachnoid hemorrhage. What is the next best step in the management of this patient?

A. Nimodipine
B. Angiography (Correct Answer)
C. Surgery
D. Fibrinolytic therapy

Explanation: ***Angiography*** - Following the diagnosis of **subarachnoid hemorrhage (SAH)** by CT scan, **cerebral angiography** is the next crucial step to identify the source of bleeding. - This procedure helps locate and characterize the **aneurysm** or other vascular malformations, which is essential for planning definitive treatment. *Nimodipine* - **Nimodipine** is a calcium channel blocker used to prevent and treat **vasospasm**, a common complication after SAH. - While important in SAH management, it is typically initiated after the source of bleeding has been identified and secured, or as an adjunct immediately after diagnosis, but not the *next best step* before identifying the source. *Surgery* - **Surgical clipping** or **endovascular coiling** are definitive treatments for ruptured aneurysms after SAH. - However, surgery is performed *after* the aneurysm has been identified and localized through angiography, making angiography the prerequisite next step. *Fibrinolytic therapy* - **Fibrinolytic therapy** is used to dissolve blood clots in conditions like ischemic stroke or myocardial infarction. - It is **contraindicated** in hemorrhagic stroke, including subarachnoid hemorrhage, as it would worsen the bleeding.

Question 10: Which one of the following is the investigation of choice in a patient with haematemesis?

A. Flexible upper gastrointestinal endoscopy (Correct Answer)
B. Contrast enhanced CT scan
C. Barium meal for stomach and duodenum
D. Selective left gastric angiography

Explanation: ***Flexible upper gastrointestinal endoscopy*** - This is the **investigation of choice** for haematemesis as it allows for direct visualization of the upper gastrointestinal tract to identify the source of bleeding [1]. - It also enables **therapeutic intervention**, such as injection sclerotherapy, banding, or clip application, to stop the bleeding [1]. *Contrast enhanced CT scan* - A CT scan is generally **not the primary investigation** for acute haematemesis because it offers less diagnostic accuracy for mucosal lesions and cannot provide therapeutic intervention [1]. - While it can identify large bleeds or structural abnormalities, it is **less sensitive for smaller bleeds** or subtle mucosal abnormalities compared to endoscopy. *Barium meal for stomach and duodenum* - A barium meal is **contraindicated in acute gastrointestinal bleeding** as the barium can obscure endoscopic views and interfere with subsequent attempts at endoscopy or angiography [1]. - It provides **limited diagnostic information** about the active bleeding site and offers no therapeutic capabilities. *Selective left gastric angiography* - Angiography is typically reserved for cases of **severe, persistent bleeding** where endoscopy has failed to locate or control the bleed. - It is an **invasive procedure** with potential complications and is not indicated as the initial diagnostic investigation.

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