Aorta

AORTA

Q. 1

Which of the following represent the commonest variation in the arteries arising from the arch of aorta?

 A

Absence of brachiocephalic trunk

 B

Left vertebral artery arising from the arch

 C

Presence of retroesophageal subclavian artery

 D

Left common carotid artery arising from brachiocephalic trunk

Q. 1

Which of the following represent the commonest variation in the arteries arising from the arch of aorta?

 A

Absence of brachiocephalic trunk

 B

Left vertebral artery arising from the arch

 C

Presence of retroesophageal subclavian artery

 D

Left common carotid artery arising from brachiocephalic trunk

Ans. D

Explanation:

Most common anomaly of the aortic arch seen in 10-20% individuals is characterized by the origin of the left common carotid artery from the brachiocephalic  (innominate) trunk.
  
Other common anomalies include: A four vessel arch with separate origins for the right common carotid and right subclavian arteries (2.5%), Origin of the left vertebral artery directly from a four vessel aortic arch typically between the ostia of the left common carotid and subclavian arteries ( 2.4- 5.8%).

Q. 2

All the following are anterior branches of abdominal aorta except ?

 A

Coeliac trunk

 B

Superior mesentric artery

 C

Inferior mesentric artery

 D

Inferior phrenic artery

Q. 2

All the following are anterior branches of abdominal aorta except ?

 A

Coeliac trunk

 B

Superior mesentric artery

 C

Inferior mesentric artery

 D

Inferior phrenic artery

Ans. D

Explanation:

Inferior phrenic artery is a lateral branch of abdominal aorta.


Q. 3

Which among the following accompanies aorta through the aortic opening of the diaphragm?

 A

Azygous Vein

 B

Vagus Nerve

 C

Thoracic Duct

 D

Both A and C

Q. 3

Which among the following accompanies aorta through the aortic opening of the diaphragm?

 A

Azygous Vein

 B

Vagus Nerve

 C

Thoracic Duct

 D

Both A and C

Ans. D

Explanation:

The aortic hiatus is located approximately at the level of the twelfth thoracic vertebra (T12).
Through it passes the aorta, the azygos vein, and the thoracic duct; occasionally the azygos vein and hemi-azygos vein passes through the right crus.


Q. 4

Which of the following structure lie at the level of arch of aorta?

 A

Left bronchus

 B

Tracheal bifurcation

 C

Ligament of teres

 D

Bifurcation of pulmonary trunk

Q. 4

Which of the following structure lie at the level of arch of aorta?

 A

Left bronchus

 B

Tracheal bifurcation

 C

Ligament of teres

 D

Bifurcation of pulmonary trunk

Ans. B

Explanation:

Tracheal bifurcation occur at the level of lower border of T4 vertebrae, and the arch of aorta commences at the level of the sternal angle and ends at the lower border of T4. 
 
Structures located anteriorly and to the left of aortic arch are:
  • Left lung and pleura
  • Left vagus and left phrenic nerve
  • Left superior intercostal vein
Structures located posteriorly and to the right of aortic arch are:
  • Vertebral column
  • Esophagus
  • Trachea
  • Superior vena cava
Structures located above the arch of aorta:
  • Brachiocephalic artery
  • Left common carotid artery
  • Left subclavian artery
Structures located below the arch of aorta:
  • Bifurcation of the pulmonary trunk
  • Left principal bronchus

Q. 5

Coarctation of aorta may be associated with all of the following except :

 A

Bicuspid aortic valve

 B

Turner’s syndrome

 C

Renal artery stenosis

 D

PDA

Q. 5

Coarctation of aorta may be associated with all of the following except :

 A

Bicuspid aortic valve

 B

Turner’s syndrome

 C

Renal artery stenosis

 D

PDA

Ans. C

Explanation:

Answer is C (Renal artery stenosis)

Renal artery stenosis is not associated with any form of congenital heart disease. In young it is usually a result of fibromuscular dysplasia and in elderly due to atheromatous plaques secondary to hypertension and diabetes.

  • Turner’s syndrome is associated with coarctation of aorta and bicuspid valve.
  • Most common associated congenital cardiac anomaly with coarctation of aorta is bicuspid aortic valve
  • PDA may be associated.

Q. 6

All of the following causes death in coarctation of Aorta except:

 A

Infective endocarditis

 B

CCF

 C

Intra cranial hemorrhage

 D

Anterior MI

Q. 6

All of the following causes death in coarctation of Aorta except:

 A

Infective endocarditis

 B

CCF

 C

Intra cranial hemorrhage

 D

Anterior MI

Ans. D

Explanation:

Answer is D (Anterior MI)

Myocardial Infarction has not been listed as a hazard /cause of death in coarctation of Aorta

Causes of death in coarctation of Aorta (CSDT / CMDT)

  • Congestive Heart Failure
  • Endo carditis
  • Aortic Rupture
  • Intracranial
  • Hemorrhage       
  • Hypertension
  • Aortic dissection

Death is most frequently caused by complication of Hypertension such as stroke or aortic dissection. Other causes include endocarditis and congestive heart failure


Q. 7

Coarctation of the aorta is common in which syndrome

 A

Down’s

 B

Turner’s

 C

Klinefelter’s

 D

Noonan’s

Q. 7

Coarctation of the aorta is common in which syndrome

 A

Down’s

 B

Turner’s

 C

Klinefelter’s

 D

Noonan’s

Ans. B

Explanation:

Answer is B (Turner’s syndrome) :

 


Q. 8

Arch of aorta develops from:     

 A

Right fourth aortic arch artery

 B

Left third aortic arch artery

 C

Left fourth aortic arch artery

 D

Right third aortic arch artery

Q. 8

Arch of aorta develops from:     

 A

Right fourth aortic arch artery

 B

Left third aortic arch artery

 C

Left fourth aortic arch artery

 D

Right third aortic arch artery

Ans. C

Explanation:

Ans. Ans. C: Left fourth aortic arch artery

The fourth aortic arch persists on both sides, but its ultimate fate is different on the right and left sides.

  • On the left it forms part of the arch of the aorta, between the left common carotid and the left subclavian arteries.
  • On the right it forms the most proximal segment of the right subclavian artery, the distal part of which is formed by a portion of the right dorsal aorta and the seventh intersegmental artery

Q. 9

True about arch of aorta are all of the following except:  

 A

Situated behind the lower half of the manubrium sterni

 B

Right common carotid artery arises from the arch of aorta

 C

It ends at the sternal end of the left second costal cartilage

 D

Begining and end of the arch lies at same level

Q. 9

True about arch of aorta are all of the following except:  

 A

Situated behind the lower half of the manubrium sterni

 B

Right common carotid artery arises from the arch of aorta

 C

It ends at the sternal end of the left second costal cartilage

 D

Begining and end of the arch lies at same level

Ans. B

Explanation:

The arch of the aorta is a continuation of the ascending aorta.

  • It lies behind the manubrium sterni and arches upward, backward, and to the left in front of the trachea (its main direction is backward).
  • It then passes downward to the left of the trachea and, at the level of the sternal angle, becomes continuous with the descending aorta.

Branches

  • The brachiocephalic artery arises from the convex surface of the aortic arch.

–  It passes upward and to the right of the trachea and divides into the right subclavian and right common carotid arteries behind the right sternoclavicular joint.

  • The left common carotid artery arises from the convex surface of the aortic arch on the left side of the brachiocephalic artery. It runs upward and to the left of the trachea and enters the neck behind the left sternoclavicular joint.
  • The left subclavian artery arises from the aortic arch behind the left common carotid artery.

– It runs upward along the left side of the trachea and the esophagus to enter the root of the neck.

– It arches over the apex of the left lung.


Q. 10

Arch of aorta begins and ends at which level:

 A

T2

 B

T3

 C

T4

 D

T5

Q. 10

Arch of aorta begins and ends at which level:

 A

T2

 B

T3

 C

T4

 D

T5

Ans. C

Explanation:

The arch of the aorta (Transverse Aorta) begins at the level of the upper border of the second sternocostal articulation of the right side, and runs at first upward, backward, and to the left in front of the trachea; it is then directed backward on the left side of the trachea and finally passes downward on the left side of the body of the fourth thoracic vertebra, at the lower border of which it becomes continuous with the descending aorta.


Q. 11

In coarctation of aorta the rib changes are seen from:

 A

1-12th

 B

3-6th

 C

4-9th

 D

8-12th

Q. 11

In coarctation of aorta the rib changes are seen from:

 A

1-12th

 B

3-6th

 C

4-9th

 D

8-12th

Ans. C

Explanation:

Ans. 4-9th


Q. 12

Best diagnosis for dissecting aorta is:

 A

CT scan

 B

MRI

 C

Angiography

 D

X-ray

Q. 12

Best diagnosis for dissecting aorta is:

 A

CT scan

 B

MRI

 C

Angiography

 D

X-ray

Ans. B

Explanation:

Ans. MRI


Q. 13

Not a direct branch of arch of aorta ‑

 A

Left common carotid artery

 B

Left subclavian artery

 C

Brachiocephalic trunk

 D

Right common carotid artery

Q. 13

Not a direct branch of arch of aorta ‑

 A

Left common carotid artery

 B

Left subclavian artery

 C

Brachiocephalic trunk

 D

Right common carotid artery

Ans. D

Explanation:

Branches of arch of aorta are :-

i)      Brachiocephalic trunk

ii)     Left common carotid artery

iii)    Left subclavian artery

Right common carotid artery and right subclavian artery arise from brachiocephalic trunk (Brachiocephalic trunk divides into right common carotid and right subclavian arteries).


Q. 14

Which is a direct branch of arch of aorta‑

 A

Right subclavian artery

 B

Right common carotid artery

 C

Brachiocephalic trunk

 D

Right coronary artery

Q. 14

Which is a direct branch of arch of aorta‑

 A

Right subclavian artery

 B

Right common carotid artery

 C

Brachiocephalic trunk

 D

Right coronary artery

Ans. C

Explanation:

This is indirect repeat from previous sessions. See explanation-6 of session-9.


Q. 15

At the level of Arch of aorta, the relationship of left vagus nerve and left phrenic nerve‑

 A

Phrenic nerve anterior, vagus nerve posterior

 B

Phrenic nerve posterior, vagus nerve anterior

 C

Both in same plane anteroposteriorly

 D

Variable in relationship

Q. 15

At the level of Arch of aorta, the relationship of left vagus nerve and left phrenic nerve‑

 A

Phrenic nerve anterior, vagus nerve posterior

 B

Phrenic nerve posterior, vagus nerve anterior

 C

Both in same plane anteroposteriorly

 D

Variable in relationship

Ans. A

Explanation:

Phrenic nerve anterior, vagus nerve posterior


Q. 16

Vasa Vasorum of ascending aorta arises from ‑

 A

Left coronary artery

 B

Anterior interventricular artery

 C

Posterior interventricular artery

 D

Left atrium

Q. 16

Vasa Vasorum of ascending aorta arises from ‑

 A

Left coronary artery

 B

Anterior interventricular artery

 C

Posterior interventricular artery

 D

Left atrium

Ans. A

Explanation:

Clinical anatomy

“Both coronary arteries supply vasa vasorum of ascending aorta”    

“Coronary arteries are vasa vasorum of ascending aorta” 

Vasa vasorum of ascending aorta and arch of aorta arise from :

i) Coronary arteries (at their ostia).

ii) Brachiocephalic trunk.

iii) Bronchial artery.

Vasa vasorum of descending aorta arise from’:

i) Intercostal arteries (thoracic part).

ii) Lumbar and mesenteric arteries (abdominal part).


Q. 17

Which of the following is not a branch of Arch of aorta ‑

 A

Branchiocephalic trunk

 B

Left subclovion artery

 C

Left common carotic artery

 D

Right subclavian artery

Q. 17

Which of the following is not a branch of Arch of aorta ‑

 A

Branchiocephalic trunk

 B

Left subclovion artery

 C

Left common carotic artery

 D

Right subclavian artery

Ans. D

Explanation:

Ans. is ‘d’ i.e., Right subclavian artery


Q. 18

All are true about branches of aorta are all except‑

 A

Gives three branches

 B

Branches arise from convexity

 C

Branchiocephalic trunk arise from arch of aorta

 D

Coronary arteries arise from arch of aorta

Q. 18

All are true about branches of aorta are all except‑

 A

Gives three branches

 B

Branches arise from convexity

 C

Branchiocephalic trunk arise from arch of aorta

 D

Coronary arteries arise from arch of aorta

Ans. D

Explanation:

Ans. is ‘d’ i.e., Coronary arteries arise from arch of aorta

Arch of aorta

It lies in the superior mediastinum, behind the lower half of manubrium sterni. It begins as a continuation of ascending aorta at the level of upper border of right second sternocostal junction (sternal angle) and continues as descending aorta on the left side at lower border of T4 vertebra. Thus begining and end of arch of aorta are at the same level, although it begins anteriorly and ends posteriorly. Arch of aorta has following features :-

i) Left surface is crossed by 4 nerves from anterior to posterior : left phrenic, superior cervical cardiac branch of left sympathetic trunk, inferior cervical cardiac branch of left vagus, and left vagus nerve.

ii) Left recurrent laryngeal nerve winds round the arch.

iii) Three branches arise from convexity :- brachiocephalic trunk, left common carotid artery and left subclavian artery.


Q. 19

In deceleration accident, which of the following fixed part of aorta is not ruptured

 A

At the level of aortic valve

 B

Behind the esophagus

 C

Where it pierces the crura of diaphragm

 D

At ligamentum arteriosum

Q. 19

In deceleration accident, which of the following fixed part of aorta is not ruptured

 A

At the level of aortic valve

 B

Behind the esophagus

 C

Where it pierces the crura of diaphragm

 D

At ligamentum arteriosum

Ans. B

Explanation:

Ans. b. Behind the esophagus

The majority of blunt injuries to the thoracic aorta occur at aortic isthmus just distal to the left subclavian artery. Other locations include the transverse arch, proximal ascending aorta, and descending aorta just proximal to the diaphragm.”- Sevitt S. The mechanisms of traumatic rupture of the thoracic aorta. Br J Surg 1977; 64; 166

“Tethering of aorta by the ligamentum arteriosum is believed to account for the high frequency of aortic injury in the isthmus region.”

Traumatic Aortic Rupture

  • Traumatic aortic rupture is a cause of sudden death after an automobile collision or fall from a great height°.
  • Vessel is relatively fixed distal to the ligamentum arteriosum, just distal to the origin of the left subclavian artery°.
  • Causes: Trauma to the chest, Rapid deceleration injury

Clinical Presentation:

  • Traumatic aortic rupture is lethal in 75-90% of patients and only 15-20% arrive at the hospital alive°.
  • Approx. 90% of those who arrive alive at the hospital have an injury in the region of the aortic isthmus >Injuries to the ascending aortae.
  • Usually associated with other injuries like solid organ.

Diagnosis:

  • X-ray chest: Widened mediastinume
  • Aortography: Gold standard for diagnosis
  • Contrast enhanced CT, Trans-esophageal Echocardiography (TEE) is useful in making diagnosis.

Traumatic Aortic Rupture

Clinical Features

  • History of high-speed decelerationQ injury
  • Flail chestQ
  • Fractured sternumQ
  • SVC syndromeQ
  • Multiple or 1st or 2nd rib fracturesQ
  • Upper extremity hypertension or pulse deficitsQ
  • Hematoma in the carotid sheathsQ
  • Interscapular bruitsQ
  • Hoarseness with normal larynxQ

Radiographic Features

  • Widening of mediastinum° (70%)Q
  • Esophageal deviation to the rightQ
  • Tracheal deviation to rightQ
  • Left° apical cap (65%)Q
  • Downward displacement of left main stem bronchusQ
  • Right paratracheal stripe thickeningQ
  • Deviation of NG tube to rightQ
  • Left hemothoraxQ
  • Displaced left paraspinal stripeQ
  • Displaced right paraspinal stripeQ

Treatment:

  • Control of systolic BP to less than 100 mm HgQ
  • Endovascular intra-aortic stentingeQ
  • Direct repair or excision and grafting using a Dacron graftQ

Q. 20

Arch of Aorta develops from which aortic arch artery ‑

 A

Right Pt

 B

Right 3rd

 C

Left 4th

 D

Left 3rd

Q. 20

Arch of Aorta develops from which aortic arch artery ‑

 A

Right Pt

 B

Right 3rd

 C

Left 4th

 D

Left 3rd

Ans. C

Explanation:

Ans. is ‘c’ i.e., Left 4th 



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