Focused Study Flashcards
Review of lab values. (215 cards)
1
Q
BNP
A
<100 pg/mL
2
Q
What is the normal lab value for:
Troponin
A
0-0.4
3
Q
What is the normal lab value for:
BUN
A
7-12 MG/DL
4
Q
What is the normal lab value for:
CREATININE
A
0.6-1.2 MG/DL
5
Q
What is the normal lab value for:
AST
A
10-40 U/L
6
Q
What is the normal lab value for:
ALT
A
5-45 U/L
7
Q
What is the normal lab value for:
TOTAL BILIRUBIN
A
0.3-1.2 MG/DL
8
Q
What is the normal lab value for:
AMYLASE
A
approx. 25-85 U/L
9
Q
What is the normal lab value for:
LIPASE
A
approx. 0-160 U/L
10
Q
What is the normal lab value for:
C-PEPTIDE
A
0.5-2 ng/mL
C-peptide is low or absent in individuals whose pancreas is not making insulin.
11
Q
What is the normal lab value for:
PSA
A
<4.0
A normal PSA level is considered to be 4.0 nanograms per milliliter (mg/mL) of blood. For men in their 50s or younger, a PSA level should be below 2.5 in most cases. Older men often have slightly higher PSA levels than younger men.
12
Q
What is the normal lab value for:
WBC
A
5-10
13
Q
What is the normal lab value for:
RBC
A
4-6
14
Q
What is the normal lab value for:
HGB
A
12-18
15
Q
What is the normal lab value for:
HCT
A
37-52
16
Q
What is the normal lab value for:
PLT
A
150-450
17
Q
What is the normal lab value for:
INR ON COUMADIN
A
2-3.5
18
Q
What is the normal lab value for:
GGT
A
Children 0-20 IU/L
Adults 0-40 IU/L
19
Q
What is the normal lab value for:
ALBUMIN
A
3.5-5.5 G/DL
20
Q
What is the normal lab value for:
ALKALINE PHOSPHATASE
A
45-145 U/L
21
Q
What is the normal lab value for:
PT
A
10-14 SECONDS
22
Q
What is the normal lab value for:
PTT
A
32-45 SECONDS
23
Q
What is the normal lab value for:
INR FOR NON-COUMADIN PTS
A
<1.1
24
Q
What is the normal lab value for:
TACROLIMUS TROUGH
A
RANGE 5-12 NG/ML
INITIALLY 8-12 NG/ML
12 HOUR TROUGH
12-18 HOUR HALF LIFE
25
# What is the normal lab value for:
CYCLOSPORINE TROUGH
RANGE 100-250
175-250 1ST YEAR POST
100-150 GREATER THAN 1 YEAR POST
## Footnote
12 HOUR TROUGH
10-40 HOUR HALF LIFE
26
# What is the normal lab value for:
SIROLIMUS TROUGH
6-12 NG/ML
## Footnote
7-12 DAY STEADY STATE D/T 62 HOUR HALF LIFE
27
# What is the normal lab value for:
EVEROLIMUS TROUGH
3-8 NG/ML
28
# What is the normal lab value for:
Alpha-fetoprotein (hepatocellular carcinoma marker) range
10-20 ng/mL
29
# What is the normal lab value for:
Ca19-9 (cholangiocarcinoma and pancreatic cancer marker) range
0-35 units/mL
30
# What is the normal lab value for…
Creatinine Clearance
Male: 100-150 mL/min
Female: 100-130 mL/min
31
# What is the normal lab value for…
24-Hour Creatinine Clearance
500-2000 mg/day
32
# What is the normal lab value for…
HgA1c
Normal 4 - 5.6%
Pre-diabetic 5.7 - 6.4%
Diabetic 6.5%+
33
# What is the normal lab value for…
CRP
<10 mg/dL
## Footnote
This value is the normal value to indicate severe infections. Values >1.0 mg/dL may indicate minor infection.
34
# What is the normal lab value for…
ESR
Children: 0-10 mm/hour
Men: 0-15 mm/hour
Women: 0-20 mm/hour
35
At what frequency is antibody testing done when there is no evidence of sensitization?
Every 6 months
36
At what frequency is antibody testing done with patients with antibodies >10%?
Monthly
37
At what frequency is antibody testing done with LVAD patients?
Weekly or with a heart offer
38
At what frequency is antibody testing done for blood transfusions?
1-2 weeks after the event
39
What is the recommended frequency for antibody screening for pediatric, retransplant patients, or for pregnant women?
Every 3 months
40
AFP is a tumor marker for what hepatic malignancy typically seen in kids?
AFP is a tumor marker for what hepatic malignancy typically seen in adults?
Hepatoblastoma
Hepatocellular carcinoma
## Footnote
Normal range is 10-20 ng/mL
41
CA 19-9 is a tumor marker for what 2 malignancies?
Cholangiocarcinoma and pancreatic cancer
## Footnote
Normal range is 0-37 units/mL
42
What is the treatment for Poor Early Graft Function?
| Liver
Prostaglandin
43
What should you assess for changes in the stoma output of an intestinal transplant patient?
* Volume: acute increase
* Color: melena or frank blood
* Consistency: increased watery fluid
44
What is the normal stool output volume for adults post-intestine transplant?
1-2 L/day
45
What is the normal stool output volume for children post-intestine transplant?
40-60 mL/kg/day
46
When must labs be drawn and in what timeframe for a liver patient that is Status 1A or 1B?
New labs drawn every 7 days.
The labs must be no older than 2 days.
47
When must labs be drawn and in what timeframe for a liver patient that is MELD 25 or greater (ages 18 or older).
New labs drawn every 7 days.
The labs must be no older than 2 days.
48
When must labs be drawn and in what timeframe for a liver patient that is MELD/PELD 25 or greater (less than 18 years old).
New labs drawn every 14 days.
The labs must be no older than 3 days.
49
When must labs be drawn and in what timeframe for a liver patient that is MELD/PELD 19 to 24?
New labs drawn every 30 days.
The labs must be no older than 7 days.
50
When must labs be drawn and in what timeframe for a liver patient that is MELD/PELD 11 to 18?
New labs drawn every 90 days.
The labs must be no older than 14 days.
51
When must labs be drawn and in what timeframe for a liver patient that is MELD/PELD 10 or less?
New labs drawn every 365 days.
The labs must be no older than 30 days.
52
What are the qualifications for Adult Status 1A liver patients?
| 5 items
* In ICU with life expectancy <7 days
* Acute liver failure (<8 weeks)
* Hepatic Artery Thrombosis within 7 days of transplant
* Primary Graft Non-Function
* Acute decompensated Wilson's Disease
53
What lab values are used to calculate a MELD score?
| 5 items
* Creatinine
* Albumin
* INR
* Bilirubin
| SCAIB
54
What is the criteria for a listing exception for Hepatopulmonary Syndrome?
PaO2 <60 mmHg
55
What is the criteria for a listing exception for Portopulmonary Syndrome?
MPAP >35 mmHg
56
What labs and factors are used to calculate a PELD score?
* Creatinine
* Albumin
* Bilirubin
* INR
* Growth
* Age (< 1 year)
CIA BAG
57
What are the qualifications for Pediatric Status 1A liver patients?
| 4 items
* Fulminant Liver Failure
* Primary non-function within 7 days of transplant
* Hepatic artery thrombosis within 14 days of transplant
* Acute decompensated Wilson's disease
58
What are the qualifications for Pediatric Status 1B liver patients?
| 3 items
* Non-metastatic hepatoblastoma
* Metabolic diseases
* Chronic liver disease with a PELD >25, and 1 of the following:
* on a vent
* has GI bleeding requiring 10 mL/kg of blood replacement in the previous 24 hours
* dialysis
* GCS <10 in last 48 hours
59
Combo liver/kidney transplant patient exceptions may be submitted for a GFR less than what?
1. 30
2. 25
3. 20
4. 15
B
60
Liver exceptions may be submitted for an ALT greater than or equal to what?
1. 1000
2. 1250
3. 1500
4. 2000
4
61
Liver exceptions may be submitted for an INR greater than or equal to what?
2.0
62
Liver exceptions may be submitted for a total bilirubin greater than or equal to what?
10
63
What does Status I indicate in an intestine transplant patient?
Transplant is required in the near future
| * Permanent intestinal failure
* Poor venous access
* Liver dysfunction
64
What does Status II indicate in an intestine transplant patient?
Transplant required, but stable liver function and venous access
65
What electrolyte imbalances would you see in ATN?
1. increased sodium and potassium
2. increased potassium and magnesium
3. decreased potassium and magnesium
4. decreased sodium and potassium
2
66
What patterns/comparisons do you notice in the table of Banff 2017 Classification of T-Cell Rejection that will help you remember the info?
| See table in answer.
## Footnote
* Type I classifications have varying degrees of tubulitis and significant interstitial inflammation.
* Type II classifications have varying degrees of arteritis.
* Type III has transurethral arteritis and/or arterial fibrinoid necrosis of smooth muscle.
67
What are 3 biopsy findings of kidney antibody-mediated rejection?
* chronic tissue injury
* Antibody endothelium interaction
* DSA
68
What is the treatment for severe cellular rejection (kidney)?
Thymoglobulin
69
What is the treatment for antibody-mediated rejection (kidney)?
| 3 items
* Rituximab
* IVIG
* Plasmapheresis
70
After a bladder drainage (BD) transplant, rejection can be tracked by monitoring what? With rejection, would the levels be high or low?
urine amylase levels
low
71
An arterial thrombosis post pancreas transplant will show which of the following?
a. low glucose levels
b. low amylase levels
c. high glucose levels
d. high amylase levels
e. stable glucose levels
f. stable amylase levels
g. a and b only
h. d and e only
i. c and f only
j. depending on the situation, could be all of the above
I
## Footnote
abrupt high glucose levels and stable amylase levels
72
Rejection in a bladder drainage (BD) transplant will show which of the following changes?
a. elevated serum amylase
b. low serum amylase
c. elevated urine amylase
d. low urine amylase
e. a and c only
f. b and d only
g. a and d only
h. b and c only
G
73
What are the possible donor derived infections?
| 8 items
* CMV
* HIV
* EBV
* Fungal
* Toxoplasma
* Hepatitis
* Syphilis
* PPD (Tuberculosis)
74
What does a postive serum IgM result indicate?
a recent exposure, not active infection
75
What does a positive serum IgG result indicate?
* A non-recent exposure
* not an active infection
* has antibody/immunity
76
What does a blood PCR test for?
active infection
77
CMV of the liver causes...
vanishing bile duct syndrome
78
CMV of the heart causes...
coronary artery vasculopathy
79
CMV of the lungs causes...
bronchiolitis obliterans
80
CMV of the kidney causes...
glomerulopathy
81
What is the 1st choice medication preference for CMV prevention?
Valganciclovir
## Footnote
Other options include ganciclovir, acyclovir, valacyclovir
82
CMV preemptive therapy is given when for heart transplant patients? What is given?
During ATG for rejection, IV ganciclovir
83
What medication is given for CMV treatment?
IV ganciclovir followed by oral valgan
84
With what conditions would oral valgan not be given?
| 3 items
* severe disease
* GI disease
* fluctuating renal function
85
What medication is given in place of ganciclovir for resistant organisms or for patients intolerant of gancivlovir?
Foscarnet
86
What is used to treat EBV?
acyclovir
87
What are the treatment options for PTLD: Early Malignant Polyclonal Polymorphic B-cell Lymphoma?
| 3 items
* ganciclovir
* Gammaglobulin Anti-B cell antibodies
* decrease immunosuppression
88
What are the treatment options for PTLD: Monoclonal Polymorphic B-cell Lymphoma?
* chemo
* radiation
* resection
* decrease immunosuppression
89
What are 2 antibiotics used to treat C. Diff?
* flagyl
* oral vancomycin
90
Where in the body does the bacterial infection, Nocardia, affect?
| 3 items
* brain (CNS effects)
* lungs (pneumonia)
* skin (most common) (cellulitis)
91
What is the treatment for Nocardia?
Sulfas (ceftriaxone)
92
What is the treatment for HBV?
* HBV immune globulin
* Entevavir, tenofovir, lamivudine, adefovir, interferon
93
Hep B Core Ab + means what?
Exposure to the actual disease
94
Hep B Surface Ab + means what?
you had the vaccination and are protected
95
Hep B Surface Ag + means what?
the disease is active
96
What is the treatment for HCV?
* ribavin
* ledipasvir (sofosbuvir)
97
What are the 2 strains of polyomavirus that can cause disease in humans?
BK and JC
98
What does BK virus typically cause?
| 4 items
* uretral ulceration
* ureteral stenosis
* graft rejection/loss
* tubulo-interstitial nephritis
99
What body part does the JC virus typically affect?
brain
100
JC clinic manifestations typically involve...
CNS changes
101
JC virus typically results in what within 2-6 months of onset of symptoms?
death
102
What is the treatment for JC and BK?
* no specific antiviral treatment
* reduction in immunosuppression
103
What fungus is typically found only in the eastern US?
histoplasmosis and
blastomycosis
104
What fungus is typically found only in Arizona (west and southwest)
coccidioidmycosis
105
How are fungal infections treated?
| 5 items
* fluconazole
* voriconazole
* micafungin
* amphotericin B
* nystatin
106
How is cryptosporidium treated?
spiramycin
107
How is strongyloidosis treated?
| 3 items
* albendazole
* ivermectin
* antibacterial agents (for concomitant disease)
108
What is the treatment for toxoplasmosis?
| 3 items
* Pyrimethamine + folinic acid
* Sulfadiazone + Pyrimethamine + folinic acid
* Clindamycin + Pyrimethamine + folinic acid
109
The presence of which organisms in a positive blood culture are unlikely to indicate bacteremia?
| 3 items
* cornybacterium
* non-anthracis bacillus
* propionibacterium acnes
110
The presence of which organism in a blood culture should be assumed to indicate true bacteremia unless proven otherwise?
coagulase-negative staphylococci
111
The presence of which organisms in a blood culture are likely to indicate true bacteremia?
| 5 items
* staph aureus
* staph pneumoniae
* enterobacteriaceae
* p. aeruginos
* c. albicans
112
What is given to prevent recurrent Hep B in liver recipients?
lamivudine
113
What is given to prevent bacterial translocation in intestinal recipients?
| 4 items
* tobramycin
* colistimethate
* amphotericin B
* IV antibiotics
114
Corticosteroids belong to what class of medications?
Interleukin 1 inhibitors
115
Which medications are calcineurin inhibitors?
| 2 items
* tacro
* cyclosporine
116
Which medications are antiproliferative agents?
| 2 items
* azathioprine
* mycophenolate mofetil
117
Which medications are mTOR inhibitors?
| 2 items
* sirolimus
* everolimus
118
Which medications are antibodies?
| 6 items
* Atgam
* thymoglobulin
* basilixamab
* rituximab
* alemtuzumab
* IVIG
119
Is ATG monoclonal or polyclonal?
polyclonal
120
Is basiliximab monoclonal or polyclonal?
monoclonal
121
Why would a polyclonal antibody (ATG) be used intraoperatively?
to reduce delayed graft function
122
Why would a polyclonal antibody (ATG) be used for induction?
to prevent acute rejection
123
Why would a polyclonal antibody (ATG) be used for rescue?
to treat rejection
124
What are polyclonal antibodies mechanism of action?
cytoxotic t-cell depletion
125
What is the mechanism of action for CNIs?
inhibition of t-cell activation
## Footnote
This leads to reduced circulating t-cell activators.
126
CNIs can cause what hematological conditions?
| 3 items
* HUS
* Thrombocytopenic Purpura
* Thrombocytopenia
127
What is the most common side effect of CNIs?
HTN
128
What is the dermatological side effect of tacrolimus?
hair loss
129
Drugs/foods that increase tacro/cyclosporine levels include...
| 7 items
* antifungals ('azole meds)
* metoclopramide
* grapefruit/pomegranate juice
* simepravir
* 'mycin meds
* diltizame, verapamil
* amiodarone
130
Drugs/foods that decrease tacro/cyclosporine levels include...
| 10 items
* cholestyramine
* kayexalate
* ocreatide
* probucol
* Mg and Al antacids
* rifampin
* herbs
* nafcillin
* phenytoin
* phenobarbitol
131
What is the mechanism of action for mTOR inhibitors?
inhibiting t-cell activation and proliferation
132
What 3 hematological lab results may be caused by sirolimus?
* neutropenia
* thrombocytopenia
* leukopenia
133
Sirolimus can cause which of the following?
1. hyperlipidemia and hypertriglyceridemia
2. hyperlipidemia and hypotriglyceridemia
3. hypolipidemia and hypertriglyceridemia
4. hypolipidemia and hypotriglyceridemia
1
134
Sirolimus may cause what in relation to its inhibition of cell and muscle proliferation?
delayed wound healing
135
What side effects of the mouth can be caused by sirolimus?
mouth ulcers
136
What is the treatment for interstitial pneumonitis while on sirolimus?
discontinuation of drug
137
How does sirolimus affect a UA?
causes proteinuria
138
What are the 2 black box warnings for sirolimus?
* hepatic artery thrombosis liver patients
* bronchial anastomotic dehiscence lung transplant patients
139
What is everolimus used for?
prevention of rejection in low-mod risk renal transplant recipients
140
What 3 medications can everolimus be used with?
* basiliximab
* low dose cyclosporine
* corticosteroids
141
Everolimus is given at the same time as what other medication?
cyclosporine
142
What is the dosing for everolimus?
0.75 mg PO BID
143
When is azathioprine used?
for those who don't tolerate mycophenolate
144
What is the mechanism of action for azathioprine?
inhibits t-cell proliferation
145
What is the dosing for azathioprine?
1-3 mg/kg/day
146
What are the side effects of azathioprine?
| 9 items
* leukopenia
* thrombocytopenia
* nausea/vomiting
* macrocytic anemia
* alopecia
* pancreatitis
* hepatotoxicity
* malignancy
* infection
147
What drugs does azathioprine have an interaction with?
| 2 items
* allopurinol
* mycophenolate
## Footnote
Allopurinol: Switch to cellcept. Causes profound pancytopenia.
Mycophenolate: separate stopping and starting by 24 hours
148
What is the mechanism of action of mycophenolate mofetil?
Inhibits T and B cell proliferation
149
What delays mycophenolate absorption?
food
150
What are the mycophenolate drug interactions?
| 6 items
* ganciclovir, valgan..., acycl...
* cyclosporine
* sirolimus
* aza
* cholestyramine
* aluminum/mag containing antacids
151
Mycophenolate drug interactions with ganciclovir, valganciclovir, acyclovir, and sirolimus may cause what?
increased risk of bone marrow suppression
152
The drug interaction between mycophenolate and cyclosporine may cause what?
decreased level of mycophenolate
153
The drug interaction between mycophenolate and aza may cause what?
toxicity
## Footnote
24 hours between stopping one and starting another
154
The drug interaction between mycophenolate and cholestyramine may cause what?
decrease in mycophenolate levels
155
The drug interaction between mycophenolate and antacids may cause what?
decreased absorption
156
What is rituximab used for?
| 2 items
* humoral rejection
* PTLD
157
What are the treatments for antibody mediated rejection?
| 6 items
* plasmapheresis
* IVIG
* rituximab
* antithymocyte globulin
* cyclophosphamide
* bortezomib
158
What medications are used to prevent PCP?
| 4 items
* sulfamethoxazole/trimethoprime
* pentamidine inhalation
* dapsone
* atovaquone
159
A double lung transplant will usually be required for which kind of lung diseases?
| 2 items
* Restrictive disease
* Septic disease
160
What are the indications for a heart-lung transplant?
| 3 items
* irreparable congenital cardiac defects with end-stage pulmonary hypertension
* end-stage lung disease with left heart failure
* end-stage lung disease with irreparable ischemic heart disease
161
Included is a table with the systemic, venous, heart, and lung pressures summarized.
## Footnote
Correction: stroke volume = 60-100
162
# On the Pulmonary Function Test, what is the following:
TLC
Total lung capacity
| The total volume of gas contained in the lungs
163
# On the Pulmonary Function Test, what is the following:
FRC
Functional residual capacity
| The volume of gas left in lungs after comfortable expiration
164
# On the Pulmonary Function Test, what is the following:
RV
Residual volume
| The volume of gas left in the lungs after forced expiration
165
# On the Pulmonary Function Test, what is the following:
VC
Vital capacity
| The difference between TLC and RV lung volumes
166
The FVC represents
the entire volume exhaled from the lungs in a forced breath
167
The FEV1 represents
the volume of gas exhaled in the first second of exhalation
168
The FEV1/FVC ratio determines if
the lung disease is obstructive
| A low ratio means obstructive lung disease
169
The TLC determines if
the lung disease is restrictive
| A low TLC and FVC means restrictive lung disease
170
At what age does the Lung Allocation Score begin?
12
171
Be familiar with the variables used in the Lung Allocation Score...
* FVC/Percent of FVC
* PA systolic/mean
* Central venous pressure
* PCW pressure
* PaO2 at rest
* 6 minute walk test distance
* Functional status
* Presence of DM
* Use of assisted ventilation
* Age
* Serum creatinine/hemoglobin/hematocrit/bilirubin
* Blood gas (venous or arterial) pH/pCO2
* Height/weight
* Disease diagnosis
172
Patients that are <12 years of age are categorized in one of two groups for lung transplant allocation scores. What are the groups?
| 2 items
Priority 1
Priority 2
173
What are the requirements for being assigned Priority 1 for lung transplant listing?
| 2 items
Have at least one of the following:
* respiratory failure
* pulmonary hypertension
174
What are the clinical requirements for respiratory failure determination for Priority 1 patients?
| 4 items
* requires continuous mechanical ventilation
* Requires supplemental O2 delivered by any means to achieve FiO2 greater than 50% in order to maintain O2 sats > 90%
* Has an arterial or capillary PCO2 greater than 50 mmHg
* Has a venous PCO2 greater than 56 mmHg
175
What are the clinical requirements for pulmonary hypertension determination for Priority 1 patients?
| 2 items
* pulmonary vein stenosis involving 3 or more vessels
One of the following despite medical therapy:
* Cardiac index less than 2 L/min/m2
* Syncope
* Hemoptysis
* Suprasystemic PA pressure
176
If a patient <12 years of age does not meet Priority 1 requirements, at what Priority will they be listed?
Priority 2
177
For adult patients with an LAS over 50, how often must requirements be updated?
Every 2 weeks
178
What is the normal Pulmonary Artery Pressure: Systolic (PASP)?
15 - 25 mmHg
179
What is the normal Pulmonary Artery Pressure: Diastolic (PADP)?
8 - 15 mmHg
180
What is the normal Mean Pulmonary Artery Pressure (MPAP)?
10 - 20 mmHg
181
What is the normal Pulmonary Artery Wedge Pressure (PAWP)?
6 - 12 mmHg
182
What is the normal Central Venous Pressure (CVP)?
2 - 6 mmHg
(The pressure of blood within the large veins that empty into the right atrium.)
183
What is the normal Left Atrial Pressure (LAP)?
6 - 12 mmHg
184
What is the normal cardiac output (CO)?
4 - 8 L/min
185
What is the normal Cardiac Index (CI)?
2.5 - 4 L/min/m2
(A measurement of the heart’s pumping ability, normalized to body surface area.)
186
What is the normal Stroke Volume (SV)?
60 - 100 mL/beat
187
What is the normal Stroke Volume Index (SVI)?
33 - 47 mL/m2/beat
(a measure of the left ventricle output, calculated by dividing the stroke volume (SV) by the patient’s body surface area.)
188
What is the normal Systemic Vascular Resistance (SVR)?
800 - 1200 dynes * sec/cm5
(The resistance in the circulatory system that is used to create blood pressure, the flow of blood, and is also a component of cardiac function.)
189
What is the normal Systemic Vascular Resistance Index (SVRI)?
2000 - 2400 dynes * sec/cm5/m2
(The resistance the heart has to pump against to circulate blood throughout the body.)
190
What is the normal Pulmonary Vascular Resistance (PVR)?
<250 dynes * sec/cm5
191
What is the normal Pulmonary Vascular Resistance Index (PVRI)?
255 - 285 dynes * sec/cm5/m2
192
What immunosuppression should not be given in a heart/lung transplant until at least 6 weeks post-transplant?
Sirolimus
193
What are the biopsy grading scales for lungs?
Grade 0 - no rejection
Grade 1 - minimal acute cellular rejection
Grade 2 - mild acute cellular rejection
Grade 3 - moderate acute cellular rejection
Grade 4 - severe acute cellular rejection
194
A comparison table to PFTs and lung transplant indications (obstructive, restrictive, septic, vascular)...
195
What are the 4 classes in the NYHA Heart Failure Classification System?
196
What are the 4 stages in the AHA/ACC system?
197
Per OPTN listing criteria, a Status 1 heart patient includes someone that has what possible criteria?
| 3 items
* VA ECMO
* non-dischargeable, surgically implanted, non-endovascular biventricular support device
* MCSD with life-threatening ventricular arrhythmia
198
Per OPTN listing criteria, a Status 2 heart patient includes someone that has what possible criteria?
| 6 items
* Non-dischargeable, surgically implanted, non-endovascular LVAD
* IABP (intra-aortic balloon pump)
* v-tach/v-fib, mechnical support not required
* MCSD with device malfunction/mechanical failure
* TAH, BiVAD, RVAD, or VAD for single ventricle patients
* Percutaneous endovascular MCSD
199
Per OPTN listing criteria, a Status 3 heart patient includes someone that has what possible criteria?
* Dischargeable LVAD for discretionary 30 days
* Multiple inotropes or single high-dose inotrope with continuous hemodynamic monitoring
* VA ECMO after 7 days; percutaneous endovascular circulatory support device or IABP after 14 days
* Non-dischargeable, surgically implanted, non-endovascular LVAD after 14 days
MCSD with one of the following:
* device infection
* hemolysis
* right heart failure
* mucosal bleeding
* aortic insufficiency
200
Per OPTN listing criteria, a Status 4 heart patient includes someone that has what possible criteria?
* Dischargeable LVAD without discretionary 30 days
* Inotropes without hemodynamic monitoring
* Re-transplant
One of the following diagnoses:
* CHD
* Ischemic heart disease with intractable angina
* hypertrophic cardiomyopathy
* restrictive cardiomyopathy
* amyloidosis
201
Per OPTN listing criteria, a Status 5 heart patient includes someone that has what possible criteria?
On the waitlist for at least one other organ at the same hospital
202
Per OPTN listing criteria, a Status 6 heart patient includes someone that has what possible criteria?
All remaining active candidates (not qualifying for 1-5)
203
Per OPTN listing criteria, a pediatric Status 1A heart patient includes someone that has what possible criteria?
* ventilator
* mechanical assistance
* ductal dependent pulmonary or systemic circulation maintained by stent or prostaglandins
* CHD on inotropes in the hospital
204
Per OPTN listing criteria, a pediatric Status 1B heart patient includes someone that has what possible criteria?
* high dose inotropes
* restrictive or hypertrophic cardiomyopathy <1 year at the time of listing
205
Per OPTN listing criteria, a pediatric Status 2 heart patient includes someone that has what possible criteria?
Active listing, not meeting 1A or 1B criteria
206
What are the indications for an automatic implantable cardiovascular defibrillator (AICD)?
| 4 items
* cardiac arrest
* recurrent VT
* prior MI with LVEF <35% with documented VT
* Prior MI with LVEF <30%
207
What are the indications for cardiac resynchronization therapy (CRT)?
| 3 items
* Moderate to severe HF: (NYHA class III or IV), EF <35%
* Wide QRS (duration > 120 ms)
* Symptomatic despite being stable, optimal heart failure drug therapy
208
Where is a ventricular assist device (VAD) implanted?
* within the pericardial space
209
What are treatments for left ventricular failure?
* Milrinone, epi, norepi, dobuatmine (increase CO and SVR)
* Pacing - atrial
* Prepare for: IABP, ECMO, LVAD
210
What agent reverses the affects of heparin?
protamine
211
According to the ISHLT 2004 biopsy grading scale for heart, what does a grade 0 indicate?
no acute cellular rejection
212
According to the ISHLT 2004 biopsy grading scale for heart, what does a grade 1R indicate?
* mild, low grade acute cellular rejection
* interstitial and/or perivasclar infiltrate with up to one focus of myocyte damage
213
According to the ISHLT 2004 biopsy grading scale for heart, what does a grade 2R indicate?
* moderate, intermediate grade acute cellular rejection
* 2 or more foci of infiltrate with associate myocyte damage
214
According to the ISHLT 2004 biopsy grading scale for heart, what does a grade 3R indicate?
* severe, high grade acute cellular rejection
* diffuse infiltrate with multifocal myocyte damage (+/- edema, +/- hemorrhage, +/- vasculitis)
215
What will testing show for antibody mediated rejection for heart transplant patients?
| 4 items
* intravascular macrophages
* capillary destruction
* neutrophilic infiltrates
* capillary fragmentation
