Quiz #20: Cardiac Catheterization

PA and Lateral frames of venous and arterial catheters are given below.

Question 1: Trace the course of venous catheter. What diagnosis does this catheter-course lead you to?

Question 2: Trace the course of the arterial catheter. What side is the aortic arch? (Beware, this question is a trick question).

Click on the image to enlarge.

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Quiz #19: Echocardiogram - Aortic arch view

This is a suprasternal notch view of the aortic arch from a newborn baby.
Question 1: What is abnormal in Panel 1?
Question 2: Based on Panel 1 image, what vascular anomaly should be looked for?

Clue 1: Baby in Panel 1 has Tetralogy of Fallot with right aortic arch.
Clue 2: Panel 2 is the same view of aortic arch from a normal baby.

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(Click on the image to enlarge)


 

Quiz #18: EKG Rhythm Strip

This is an EKG recorded in a 2-day baby (Tetralogy of Fallot) after cardiac catheterization.

Question: What is this catheter-induced rhythm?

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(Click on the image to enlarge)

Quiz #17: Arterial pulse trace

Below is ICU monitor display for a teen ager.

Question 1: What is the name of the pulse for the pattern shown in the arterial line trace?

Question 2: Name 3 causes for this pattern of pulse in any patient?

Link to the answer.

(Click on the image to enlarge)

Quiz #16: Echocardiogram - Pericardial effusion - M mode

Image below is M-mode recording in parasternal short axis view, in a patient with pericardial effusion. What ominous sign is being demonstrated in this image?

(Click on the image for larger image)

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Quiz #15: 12-lead EKG - Inverted P

Question: What is the diagnosis for the inverted P?

(Clue: You may compare with the EKG in Quiz #14)

Click on the image to enlarge.

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Quiz #14: 12-lead EKG

Question 1: What is the diagnosis?

Question 2: Please provide 2 salient findings that support the diagnosis.

(Click on the image for enlarge)

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Quiz #13: Statistics - Z-score

A newborn (weight 3 kg, length 50 cm) has aortic valve annulus of 6.0 mm. One published report states the following normal values for aortic valve annulus in newborns of same body size: Mean 7.3 mm & Range of 6.38 mm – 8.22 mm (Range is reported as 2 standard deviations from the mean).
Question 1: What is the Z-score of our patient with 6.0 mm diameter?

Bonus Question: Please provide the steps of deriving the Z-score.

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Quiz #11: CVP trace

The two snap shots were taken 1 minute apart from a postoperative patient.
What is the difference between the CVP traces in each of the panels? (Top panel - Clock time is 13:44 Hrs and Bottom panel - Clock time is 13:45 Hrs).
Click on the image to enlarge.


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Quiz #10: Clinical Examination

Question 1: What is the sign in figure 1 called?

Question 2: What is the sign in figure 2 called?

Question 3: According to new diagnostic criteria for this condition, if both these signs are positive in a child, how many "System Score" points does the child get?

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Quiz #9: Where is the tip of the PA line?

This patient returned from operating room 20 minutes ago. He has a pulmonary artery line. What is the location of the PA line tip based on the CXR and the PA pressure trace?
Clue: PA line pressure trace holds the answer. CXR helps to corroborate.

(To see a larger image, click on the image)
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Quiz #8: Barium Swallow Study

Question 1: Describe the salient findings.
Question 2: What is the diagnosis?


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Quiz #7: Barium Swallow study

Question 1: Describe the finding in PA view.
Question 2: Describe the finding in Lateral view.
Question 3: What is the diagnosis?

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Quiz #6: Barium Swallow Study

Esophagogram:
1) Describe the finding.
2) What is the diagnosis?

Additional "bonus" questions:
3) What tracheal anomaly is associated with this condition?
4) What is the common cardiac defect associated with this condition?

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Quiz #5: EKG (12-lead)

Sinus rhythm EKG from a 17-year old patient:
1) What is the diagnosis? (Answer is obvious, of course!)
2) Where is the accessory pathway located?
(Click on the image to see a larger image)

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Quiz #4: EKG - Pacemaker

4 month old, s/p VSD repair. Postoperative day #3. Temporary pacemaker is on, for complete AV block. Set to DDD mode. What is wrong?

Click on the image to see a larger image.

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Quiz #3: Surgical anatomy - Arrangement of Atrial Appendages

In figure 1, the arrows point to atrial appendages. What is the name for this arrangement of atrial appendages? What lesions are associated with this atrial arrangement?

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Quiz #2: Abdominal Aortogram

1 year old boy, referred for heart murmur evaluation. History of recurrent pneumonia (2 episodes in past 3 months) involving right lower lobe. After initial evaluation, underwent this abdominal angiogram. (There is a video below. Make sure, you watch until the contrast completely clears. In case the video does not play, you will have to satisfy with the still frame!)


1) What is the diagnosis?
2) What is the characteristic sign in Chest X-ray you would expect?
3) A cath intervention was performed after this angiogram. What intervention was it?

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Quiz #1: What is the surgery(surgeries) shown in this image?

Front cover of January 2012 issue:
1) What surgery (surgeries are shown in this image?
2) Name the components of the surgery(surgeries) shown in the image.

Please leave your answers in comments section. Answer will be posted in approx. 7-10 days.

Link to the answer