Critical Care Exam Pro

Question 1

Hemodynamic changes in pregnancy 
CO
HR
LVSWI
SVR
PVR
MAP
PCWP
COP

Answer 1

CO +43%
HR + 10%
LVSWI +10%
SVR- 20%
PVR- 30%
MAP +4%
PCWP +30%
COP -14%

Question 2

PCWP in pregnancy

Answer 2

6-12

Question 3

CVP in pregnancy

Answer 3

4-10

Question 4

PVR

SVR in pregnancy

Answer 4

PVR- 55-100

SVR 1000-1400

Question 5

LVSWI

Answer 5

40-55

Question 6

who class 1

Answer 6

No increased risk

small PDA, Mild PS, repaired simple lesions, ectopic beats

Question 7

who class 2

Answer 7

mortality 5-15%
ASD/VSD
repaired tet 
arrythmias
mild left ventricular dysfunction 
HCM
biprosthetic valve 
repaired coarc
Marfan with aorta <40 mm
BAV with aorta <45 mm

Question 8

who class 3

Answer 8

mortality 25-50%
mechanical valve
systemic RV
cyanotic heart disease
complex CHD
BAV with aorta 40-50 mm 
Marfan aorta 40-45 mm

Question 9

who class 4

Answer 9

severe MS
severe AS
BAV with aorta >50 
Marfan with aorta >45
EF <30%
severe coarct 
severe pulmonary hypertension

Question 10

Cardiac C/S indications

Answer 10

aortic >40 mm
AA
recent MI
severe symptoms aortic stenosis

Question 11

pulmonary hypertension

Answer 11

25-30 mmhg
lower mortality <50 
lower motality with idiopathic vs cardiogenic
Delivery mod/severe 32-34 weeks
mild  35-37 week deliv

Question 12

pulmonary hypertension treatment

Answer 12

ca channel blocker
NO
prostacyclin derivatives
sildenafil (phosphodiesterase inhibitors)
Endothelin receptors blockers are teratogenic

enhanced treatments for at least 3 months

Question 13

what to give for PEA

Answer 13

epinephrine

atropine

Question 14

marfan treatments

Answer 14

ppx b blocker

Question 15

pp cardiomyopathy definition

Answer 15

EF<45%
fractional shortening <30 %
left ventricular end diasolic dimension >2.7cm/m

Question 16

pp cardiomyopathy treatment

Answer 16

O2 
reduce afterload- hydralazine
improve contractility- dig 
Reduce Myocardial demand
- beta blocker 
ppx anticoagulation
- wearable cardioverter
- LVAD
- ECMO

• recovery 50-75%
  AA 20-45%

Question 17

mortality with subsequent pregnancys with a history of PPCM

Answer 17

recovered- 20% reoccurance 0% mortality

decreased function
- 40-65% will have reoccurance
15% mortality

Question 18

In general what are high risk maternal cardiac lesions

Answer 18

aortic regurgitation/mitral regurg with NYHA class III/IV
Marfan syndrome (expecially with aortic regurg)
Severe aortic stenosis <1.5 cm, gradient >30 mmhg
Severe Mitral Stenosis <2 cm
LV dysfunction (pulmonary hypertension, EF decreased,
Mechanical valves
Poor functional class or cyanosis

Question 19

Goals in sepsis

Answer 19

CVP 8-12
MAP> 65 mmhg
normalize pulse
uop >0.5ml/kg/hr

Question 20

SIRS

Answer 20

Fever, tachycardia, tachypnea, leukocytosis, mental status change, hyperglycemia

Question 21

Septic shock

Answer 21

hypotension persists despite adequate fluid resuscitation

Question 22

Severe sepsis

Answer 22

sepsis wih organ dysfunction 
O2 requirement
Oligouria
Elevated creatinine >1-2
Hypotensive
Plt<100,000
Lactate>2 (>4 very bad)
Bilirubin >2
INR>1.5

Question 23

sepsis

Answer 23

SIRS from septic shock

Question 24

Sepsis treatment

Answer 24

fluids 20-30 ml/kg/hr
start with 20 and repeat as needed with 500 cc/bolus

-pressors as needed ( norepi)

Question 25

``` Lung volumes TLC VC RV FRC ``` changes in pregnancy

Answer 25

``` TLC- total VC- how much can be exhaled RV- left after VC FRC- left after normal breath ERV- FRV- RV ``` ``` decreased ERV/FRC/ RV VC preserved Incrased TV RR unchanged minute ventilation > 50% ``` - avoid over ventilation goal pCO2 30-32

Question 26

``` pregnancy ABC PaO2 PaCO2 HCO3 pH ```

Answer 26

PaO2- 101 PaCO2-up to 32 HCO3- up to 21 pH- 7.4-7.45

Question 27

DDX of dyspnea

Answer 27

``` allergic reaction aspiration pulmonary edema PE AFE maternal heart disease ```

Question 28

mild asthma

Answer 28

<1 hour <2 episodes/week PEFR>80%

Question 29

mild persistant

Answer 29

> 2x week

Question 30

Immunospressive medications in pregnancy

Answer 30

immunosuppression regimen in pregnant transplant recipients is the combination of a CNI (either tacrolimus or cyclosporine), azathioprine, and low-dose prednisone The use of mycophenolate mofetil, sirolimus everolimus- not recommended

Question 31

SLE treatment pregnancy

Answer 31

hydroxychloriquine -prednisone - can consider tacrolimus, cyclosporine, azathioprine

Question 32

zahara score

Answer 32

``` arrhythmias 1.5 NYHA class II 0.75 Left heart obstruction 2.5 Cardiac medication 1.5 Systemic AV valve 0.75 Pulmonary AV valve 0.75 ``` ``` 0-2.9% 0.5-1.5 7.5% 1.51-2.50 17.5% 2.51-3.50 43.1% >3.51 70% ```

Question 33

Carpreg

Answer 33

Prior heart failure, TIA, stroke before pregnancy -1 NYHA III/IV -1 Valvular and outflow tract obstruction AV<1.5, MV <2 LVOT gradient >30 - 1 Myocardial Dysfunction LVEF <40%, Cardiomyopathy -1 Mortality 0- 5% 1 - 27% >1 -75%

Question 34

NYHC

Answer 34

1- normal 2- fatigue with physical activity 3- fatigue with daily life 4- uncomfortable at rest

Question 35

Bacterial endocarditis ppx

Answer 35

prosthetic heart valve prior infective endocarditis unrepaired congenital heart disease repaired CHD for 6 months after repair with prosthetic material - discuss with cardiology ppx is ampicillin

Question 36

why is vaginal delivery perferred in cardiac disease

Answer 36

``` decresed blood loss decreased pain decreased fluid shifts decresed immobilization decreased thrombosis ```

Question 37

how do you alter labor management with cardiac disease

Answer 37

labor in lateral decubitus | "slow" epidural (maybe not aortic stenosis)

Question 38

work up for palpitations

Answer 38

EKG thyroid UDS - caffeine, smoking, alcohol use

Question 39

Pulmonary hypertension for esingmenger pearls

Answer 39

decreased SVR will cause worse R to L shift and potentially death due to lack of oxygenization NO/intravenous prostacyclin reduce PVR Anticoagulation delayed death can be seen 4-6 weeks

Question 40

Non-cardiogenic pulmonary edema

Answer 40

``` preeclampsia ARDS Sepsis DIC TRALI Anaphylaxis AFE ```

Question 41

Cardiogenic reasons for pulmonary edema

Answer 41

``` CHF Cor Pulmonale Myocardial infarction CHD Aquired valve lesions Ischemic heart disease Dysrhythmias Hypertension Intravascular overload B mimetic multifetal ```

Question 42

what is ARDS

Answer 42

decreased lung compliance with massive intrapulmonary shunting - in OB likely infection P/F ratio <200

Question 43

P/F ratio - looking for intrapulmonary shunt | blood flow but lung that is not oxygenated

Answer 43

PaO2/FiO2 x100 =P/F ratio high -good low- bad

Question 44

Inital Vent settings SIMV Goals

Answer 44

Rate 14-16 Tidal volume 6-10 ml/kg PEEP 5 Goals: PaO2 >60 SaO2 >95 PaCO2 30

Question 45

Group A Strep

Answer 45

most pp hypothermia pain out of proportion Nec Fash - take out the uterus!

Question 46

Indication for intubation

Answer 46

``` oxygenation - PO2 <60 ventilation PCO2 >40 maternal exhaustion Worsening acidosis altered conciousness ```

Question 47

ScVO2

Answer 47

how well is tissue being extracted - >70% eval by Central venous cath

Question 48

opioids for athma

Answer 48

fentanyl