Previous exam 2003 Flashcards Preview

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Flashcards in Previous exam 2003 Deck (28):
1

Mechanism of action of aprotinin

serine protease inhibitor
anti-inflammatory
platelet preservation
anti-fibrinolytic

2

5 tenents of the Canadian health act

Public administration
Comprehensiveness
Portability
Accessability
Universality

3

Heart not arrested while giving cardioplegia

Antegrade
adequare pressure and flow
is there AI?
Cross clamp completely across aorta
Is vent open
has there been aortic dissection
is there potassium in solution
is there a clamp on the line
Retrograde
cath position
balloon inflated
adequate pressure and flow
(100 to 200 cc at 30 to 40 mmHg)
LSCV
aortic cross clamp completely applied

4

Pregnant female, previous TOF. Outline dangers to fetus and mom

RV failure from volume overload
increased plasma by 50%
premature delivery
maternal mortality (2-5%)
Fetal mortality (30%)
IUGR

5

Nitric oxide list the 3 things you need to deliver it

ventilator, tubing and tank
ability to monitor toxic byproducts
ability to titrate concentration of oxygen and NO

6

List toxic metabolites of NO

No2
methemoglobin
peroxynitrite

7

Young female 1 week presents with SOB, thrombocytopena, and clot in RA. Diagnosis of HITT

How do you confrim

HIT assay
Function study of serotonin release test
platelet aggregation and activation test
platelet count (review for drop in platelet count)
HITT is a clinical diagnosis

8

How do you manage HITT patient

Spiral CT to assess thrombus burden in the PA
Thrombolytics contraindicated
Indication for emergent surgical thromboembolectomy
RV dysfunction
Hemodynamic instability
large central thrombus
use alternative anticoagulant for CPB---bivalrudin, argatroban, hirudin

9

HOCM is what?

Hypertrophic obstructive cardiomyopathy
Asymmetric LV hypertrophy and dynamic LVOTO
disorder of sarcomere proteins
90% involve LVOT
5% involve RVOT

10

What is HOCM anatomy

Left ventricle hypertrophy, asymmetric hypertrophy in the absence of an identifiable cause
90% of cases involvement of the outlet septum
Displaced papillary muscle
endocardial lesions at point of SAM/septal contact

11

Describe HOCM anatomy of LA

Enlargement
increased mass
endocardial lesion from MR jet

12

Describe HOCM

1: 500 and autosomal dominant
myofibril disarray
fibrosis

Prolonged systolic septal apposition leads to SAM
reduced LVOT

70& familial and 30% sportaid

13

What are effects of pregnany on LV

Increased diameter
increased LVEDV
increased stroke volume
increased compliance
increased EF

14

Patient in CSRU with low cardiac output. What things can you do...

optimize preload, hematocrit, afterload, heart rate/rhythm, circulatory support, respiratory function

15

List exposure of axillary artery

infraclavicular incision
approximately 1-2 cm below clavic, mid clavicular line
with division of pect min

16

How do you cannulate

8 mm Dacron graft graft end to side onto the axillary artery with a 24 F arterial cannula

17

In a coarctation, collateral inflow is from

Internal mammary
Vertebral
Costocervical
thryrocervical
lateral throracic artery

18

Outflow from the coarctation is

3rd and 4th intercostals
upper descending aorta
little outlow---external iliac arteries

19

Contraindications to Ross

Age < 1 and age > 70
Marfans or other Connective tissue disorder
Aortic to pulmonary annular discrepancy > 2-3 mm
severely decreased LVEF
multisystem organ failure
advanced 3 vessel CAD

20

Most important test of hemolysis

serum haptoglobin

21

Additional tests for hemolysis

LDH, peripheral smear, urine free hemoglobin, indirect bilirubin, urine hemosiderin

22

What are major side effects of prednison

Osteoporisis
Oral thrush
delayed wound healing
indigestion
increased appetitie
sodium retention
flushing/sweating
nervousnes or restlessness

Abrupt cessation results in Addisonian crisis--- results in tapering

23

What is side effects of MMF

Increased risk of infection and development of lymphoproliferative disorders
tremor or dizziness
rash
lower extremity swelling
Nausea, vomitting,

24

Treatment for SAM

Volume administration
Decrease hyperdynamic state
minimize inotropes
increase afterload
resect more valve tissue
increase ring size
Time

25

Pre-op risk factors for SAM in pt with standard p2 resection

hypovolemia
hyperdyanmic state
redundant leaflet tissue
small LV cavity
reduced aorto-mitral angle
use of small annuloplasty ring

26

What are differences between remodeling and reimplantation

How do you size the graft for a root replacement

27

Ways to determine the size of graft needed for Aortic Valve sparing

Use a sizer of the medtronic freestyle
Haggar dilator and then add 3-4?
TEE size of the STJ + X
Height of the

28

Why give bicarbonate for CPR

Class II indication for hyperkalemia particulary for prolonged resuscitation

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