Previous exam 2010 Flashcards Preview

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Flashcards in Previous exam 2010 Deck (54):
1

What is mechanism of action of Vasopressin, what receptor types, location, physiological effect

causes peripheral vasoconstriction which increases blood pressure

second messenger system--acts on peripheral vasculature
Antidiruetic
increases calcium

2

Outline 6 limitation for a language barrier for obtaining onset

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3

CANMEDS role for CVICU full with only 2 discharges but 8 cases booked. How do you manage?

.

4

List 4 CANMEDS roles and how each applies to the above situation

MR
valve morpholoy
thrombus
High wilkins score
Calcification

5

Pt has a DDD AICD for LVEF and VT and needs a bowel resection. Gen Surg Consult
What happens when you put magnet on?
If the pt has VT while magnet on what should be done
If the pt has a DDD pacemaker , what mode is the pacemaker in while magnet is on
List 2 options you advise the Gen surg team to do regarding safe cautery use for this case

Magnet stops the anti-tach

Bipolar
magnet---

6

Pt has HR 140 after pacemaker implant (Dd pacemaker mediated tachycardia)
What are 3 conditions required for this diagnosis
1 parameter you can change

If you change this parameter what is the consequence

retrograde conduction
Must have atrial sensing
Dual chamber

Risk of AV block**
loss of av synchrony

7

Describe function of following pacing modes
AOO
AAI
DDI
DDD
VOO

Pacing
Sensing
Respond to sensing

8

Identify 3 acute aortic syndromes

Acute aortic dissection
Intra mural hematoma
Penetrating athersclerotic ulcer

9

Patient is hypertensive, chest pain, CT diagnosis IMH
What is the mechanism
What is the natural history
What would you do

Bleeding in the media without intimal tear secondary to vasavasorum rupture
Spontaneous or secondary to plaque rupture
Can heal or progress to dissection
With acute presentation more chance that will progress into dissection so manage as a dissection

10

What are 5 surgical techniques to avoid SAM

Avoid excessive under sizing of annuloplasty
Ensure posterior leaflet height of less than 15 mm
Resection of excessive septal hypertrophy
Chords to anterior leaflet
mitral valve replacement

*Avoid inotropes
Avoid Hypovolemia
Avoid tachycardia
Increase afterload

11

Pt needs redo CABG with patent LITA, occluded OM, stenotic RCA. 5 adverse event you consent this patient

Death
Stroke
MI
Bleeding
AKI

12

Radial artery use.
What's the 1 most important prognostic factor
>5 year patency rate: Radial to LAD? Radial to RCA?

Ensuring you have a high grade lesion to avoid competitive flow (greater 90% on right and > 70% on left

13

Endovein vs open vein
List 4 advantages
List 4 limitations

less morbidity
wound complications are less
time, patency,

14

List 3 risk factors for recurrence/residual lesion after coarctation repair

end to end repair
subclavian flap
aortic arch hypoplasia

15

Peforming a TGA and notice that neonatal cerebral infrared spectrometer has changed. You're on CPB.
List 4 management steps

Change position of cannula
avoid kinking/check pressure

16

Arch dissection after completion of a ? on CPB. Assume central cannulation. with a clamp proximal to the innominate
Outline 5 management steps

Iatrogenic aortic arch dissection

17

3 distinct mechanisms how NO works

inhibits angiotensin II


Increase cGMP leading to vasodilatation
Improve oxygenation by dilatation of ventilated area
Anti platelet effect
Inhibition of proliferation of smooth muscle

18

3 potential limitations of NO administration

inhaled
toxic byproducts
abnormal

19

List 3 requisite anatomical features of complete AV canal defect

common av valve
lack septum

20

Pt with TOF and has developed severe PI years after initial repair. List 5 indication for pulmonary valve replacement

Right ventricular dysfunction
Right ventricular end diastolic
Severe PI
Symptoms of TR

21

Ischemic MR. Recent literature states certain subgroups benefit from reverse remodelling

List 4 preoperative predicators that suggest improved remodeling after CABG + IMR repair

LVEDD < 65
LVESD < 50
Low shericity index

22

Acute RV failure post transplantation. List 5 steps of management

Milrinone
NO
pre-load
IABP
decreased PVR
HR > 100

23

List 6 brain death criteria for organ Donation

Apnea test
bilateral motor response
explainable death
brain stem
warm @ 37
absecene of cofounding factors
Two physician

24

Carcinoid valve disease

Cause TR
Also cause pulmonary valve stenosis

25

Patient has severe TR and AF, RVSO 40
Draw CVP tracing relative to ECG tracing
4 causes of isolated TR

6 cath signs of constrictive vs restrictive pericarditis

26

4 CRT indications

Only 1 class 1 indication

LV<35%, NSR, QRS >150 with LBBB, FCC 2,3 or ambulatory 4

27

LVAD insertion. Pt has previous mechanical AVR, has a PFO, moderate MR, moderate RC failure. The aortic valve is functioning well
Outline 3 important operative steps

Would you do a MV procedure in this patient

Replace mec valve for bio
Close PFO
Repair TV

No MVR for regurg

28

4 risk factors for RV failure post LVAD placement

Low RVSWI
Pre-op pressors
High bilirubin and ALT
High creat and BUN
Pre-op ventilation
Tric regurg

29

Aortic valve repair:
List 3 ideal anatomic indications

List 4 techniques to repair aortic valve

Leaflet perforation
Leaflet prolapse
Dilatation of STJ or VAJ

Patch
Plication
STJ remodelling
VAJ annuloplasty

30

List 5 proved benefits of off pump CABG

reduced stay in hospital
reduced transfusion requirement
reduced release of cardiac enzymes
reduced stay in ICU
reduced time of post op intubation
potential reduction in rates of acute kidney injury

31

Small aortic root. Can only fit a # 19 sizer. List 4 distinct operative techniques and options

posterior root enlargement
stentless aortic valve
another stented bioprosthetic aortic valve with low gradients

32

5 contraindications to SVR

RV dysfunction
Asymptomatic
Restrictive diastolic pattern

33

What is definition of FFR
How the physiological measurement is done
What is given to mimic this physiology condition
What's the criteria for significant stenosis

.

34

What is Transit time flowmetry. What 3 variable are measured

1. maximum peak flow, the minimum peak flow, the mean flow, the back flow
2. pulsatility index (maximum peak flow – minimum peak flow/mean flow).
3. Diastolic flow pattern and %
There are no strictly normal values (the flow in the graft is depending on the length of the graft, the driving pressure, the resistances to the flow and to the size of the graft itself), an acceptable value for the pulsatility index has to be 3 or below.

The presence of a huge diastolic flow guarantees an unrestricted flow into the graft

35

LVAD causing reverse remodeling of heart

What are 3 parameters that suggest positive remodeling at the organ level?

What is this reverse remodelling process called

2 histological features

2 hormonal features

.

36

What is mechanism of Diastolic dysfunction

inability of myocardial relaxation/loss of myocardial compliance

37

What is risk factors for diastolic dysfunction

3 pharmacological treatments

Age, diabetes, HBP

Volume, beta blockers, CCB

38

Pt is post op AVR + MVR with fever, low BP, CVP ok and fluid increases by BP low.

What condition is this?

3 biochemical markers in this condition?

3 pharmacological (or other treatment)

Distributive shock

Pressors, volume, antibiotics, steroid

39

Post op renal dysfunction with pre-op Cr 103.

List 4 preop risk factors for developing renal failure post op

What 1 medication will icnrease risk of ARF and is its effect

Pt develops high K. List 4 pharamacological treatment, doses and route while awaiting dialysis

Prep RF
Age
Diabetes
Long CPB
Redo
CHF

ACEI, vasodilatation and renal hypoperfusion

Calcium
Dextrose and insulin
Beta 2 agonist
Bicarbonate
Diuretic
Hydration

40

List 4 meds to treat pulmonary artery hypertension and route

NO inh
Milrinone inh or IV
Slidenafil PO
Epoprostenol inh

41

Patient requires CABG. on plavix.

What is mechanism of plavix

Half life of plavix?

How many days of platelet inhibition to wear off?

.

42

What are indications for native valve endocarditis. List 5

Symptoms of CHF because of local valve destruction/AI
persistent infection despite antibiotic coverage
recurrent embolic events
fungla/staph auerus blood cultures--highly virulent organism
presence of heart block/abscess fistula

43

Want to conduct RCT on new drug on 180 pts on composite mortality and stroke in high risk aortic cases. You conclude a negative study.
What single statisical test would you perform
2 theoretical reasons why this study might be negative

.

44

List 3 limitations for metanalysis

selection bias/publication bias/search bias
Heterogenity
Lack of control for confounding variable.

45

What is mode of inheritance in Marfan

What's the genetic abnormality

Autosomal dominant
Mutation in FBN1 that encode for fibrillin-1

46

5 clinical manifestations of Marfan syndrome

Cardiac
Ao root dilatation and dissection
Mitral valve prolapse
Mitral valve Ca
PA dilatation

Eyes
Ectopic lentis

MSK
Pectus
Scoliosis
Arm span on height ratio over 1.05

47

4 features of Dresslers syndrome

Post MI or cardiotomy
Fever, malaise, pleuritic, effusion
Respond to Antiinflammatory or steroid

48

Traumatic aortic rupture
List 3 advantages of TEVAR
List 3 limitations of TEVAR

Avoid aortic cross clamping of aorta
avoid systemic hepar/thoractomy/single lung ventilation/complications associated with hypothermia
disadvantages
limited availability
possibility of anatomical restrictions including tortuous artery, small access peripheral vessels, lack of landing zone, requirement of coverage of close proximintt vessels, requirement for follow-up, long term results of device closure unknown.

49

List 3 absolute contraindications to IABP

Dissection
AI
AAA
Severe peripheral vasculopathy

50

List 5 major complications of IABP

Bleeding
Infection
Thrombocytopenia
Leg ischemia
Thromboembolic

51

List 3 things you have to do when it comes to a medical error?

Tell patient and family
Talk to medical team
Fill papers for hospital

52

Syntax trial
What is the mean follow up period
What is the primary endpoint
Identify if the primary endpoint was increased, decreased, not significant when compared to stroke rate with PCI and CABG
Mortality rate with CABG to PCI

2 limitations of syntax

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53

4 classifications of vascular rings causing tracheal symptoms (stridor) and dysphagia

Double aortic arch
Right aortic aortic with abberant left subclavain and ligamentous arteriousm
Left aortic with abberanta right subclavian
pulmonary artery sling

54

What is the INTERMACs classification

Interagency registry for mechanically assisted circulatory support (INTERMACS)

They have 7 profiles of which 80% are implanted in 2 profiles.
Level 1 Crash and Burn (hypotensive, IABP
Level 2 Sliding on Inotropes (ok BP, worsening renal)
Level 3 Dependent stability (moderate hypotension
Level 4 Frequent flyer (usually
Level 5 Housebound
Level 6 walking wounded
Level 7 placeholder (NHYA II or III)

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