Quiz #29: CT scan, Vascular Anomaly

Quiz 29: CT scan (Vascular Anomaly)

CT scan images from a 8-mo old boy with stridor, vomiting and weighs 5.6 kg. Figure 1 shows Anterior and Left lateral views. Figure 2 shows 3D reconstruction of trachea-bronchial tree (Barium swallow was not performed).

Questions:

1)      What is the arch sidedness?

2)      What is the diagnosis?

3)      Does the patient need intervention and why?

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Quiz #28: EKG

Quiz #28: EKG

3 year old, post-op day 1.

1)      What is the ventricular rate? (Note: Paper speed).

2)      What is the atrial rate?

3)      What is the diagnosis?

4)      In the past 4 hrs patient has become hypotensive with lower urine output and needed multiple fluid boluses and increase in Dopamine dose. What is the first line treatment?

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Quiz #27: EKGs on the day of surgery

6 yr old boy, s/p Repair of subaortic membrane. Two EKGs with time of recording are given - both were recorded on the day of surgery. Second EKG was performed because bedside nurse noted a change in EKG trace on the monitor. Patient is sleeping without any complaints.

Questions:

1) Describe the most significant change between the two EKGs.

2) What are the possible reasons for change?
3) How would you proceed further?

Link to the answer

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EKG 1: Recorded at 12:44 Hrs

EKG 2: Recorded at 22:44 Hrs. 

Quiz #25: Echo - Identify the vessel (again)!

Going with the same theme as Quiz #24.

Subcostal sagittal (bicaval) view in a newborn with severe cyanosis.

(Some labels are given. Clue: A vertical vessel flowing downwards, behind the IVC).

Question 1:

1)      Name the vessel shown by arrow.

2)      Provide a possible diagnosis. (I won’t be upset if you gave a second possible diagnosis as well!)

Link to the answer

Quiz #24: Echo: Identify the vessel

Subcostal saggital view from a newborn with multiple congenital heart defects.

Questions:

1)      Name the vessel shown by the arrow.

2)      What defect would you suspect from this observation?

Link to answer

Quiz #23: Shunt Calculation

Hypothetical case: 32 year old male with VSD and Eisenmenger syndrome. Necessary data are given.

Questions:

1)      What is the overall Qp/Qs?

2)      Calculate the effective pulmonary blood flow (Qep).

3)      Calculate the amount of right to left shunt.

4)      Calculate the amount of left to right shunting.

Link to the answer

Quiz #22: ICU monitor interpretation

5 month old baby. Postoperative day 1 after closure of membranous VSD. Panel 1 and Panel 2 were recorded few minutes apart.

Questions:

1)      What is the arrhythmia in Panel 1?

2)      What type of pacing is done in Panel 2?

3)      Describe the important difference between the CVP waveform in Panel 1 and Panel 2. What is the reason for the difference?

4)      Comment about AV conduction in Panel 2.

5)   Why does arterial line trace have a “flat top”? How will you rectify this issue?

Link to the answer



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