home made practice exam

Question 1

Define zone for stenting

Answer 1

0 ascending and brachiocephalic a.
1 common carotid a. Region
2 left subclavian region
3 isthmus region
4 descending

Question 2

Cut off when aorta rupture or dissect

Answer 2

Ascending 6 cm ( lifetime risk jump to 30%)
Descending 7 cm (lifetime risk jump to 40%)

Yearly risk of composite of death,rupture or dissection

Overall if more than 6 cm 14%
If between 5 and cm 6,5%

Question 3

Growth rate of aneurysm

Answer 3

Ascending 0,1 cm per year

Descending 0,3 cm per year

Question 4

Time for safe DHCA depending on Temp

Answer 4

15 degree 25 min
20 degree 20 min
25 degree 15 min

Question 5

Way to monitor brain in arch surgery

Answer 5

NIRS
Jugular sat
Transcranial Doppler
EEG
Evoked potential

Question 6

Ante grade perfusion: rate and pressure

Answer 6

10 cc/kg/min
Pressure between 50-60
As low as 40 acceptable
More 70-80 if carotid lesion

Question 7

Axillary cannulation

Advantages and disadvantages

Answer 7

Advantages
   Antegrade flow
   Less malperfusion risk
   Less arch manipulation (stroke)
   Easy to convert to cerebral perfusion 

Disadvantages
Vessel trauma
Plexus trauma

Question 8

What about Femoral cannulation

Answer 8

Advantages
Fast
Easy

Disadvantages
Malperfusion
Retrograde perfusion (stroke)

Question 9

Alpha vs ph stat

Answer 9

Alpha
Maintain cerebral autoregulation
Better enzymatic function

Ph
Cerebral vasodilatation ( easier cooling but more stroke risk)
Left shift of oxyHb curve ( better oxygen availability)

Question 10

What about retrograde perfusion

Answer 10

Good for cooling and flushing debris
Better than DHCA alone
Not so good for nutritional support

Risk of cerebral edema

Maximal pressure 25 mmHg and flow between 300-500cc per min

Question 11

Surgical adhesives pro and con

Answer 11

Pro
   Hemostatic
   Reinforce tissue
   Anastomotic support
   Reduce transfusion

Con
   Toxicity (aldehyde part)
   Need a dry field
   Preparation time
   Infection risk
   Stricture ( so avoid in peds)
   Embolisation

Question 12

3 characteristics of CRT patient

Answer 12

FC > II
EF < 35
Conduction delay 150ms

Question 13

Succes rate of CRT

Answer 13

66%

Question 14

Class 1 indication PPM

Answer 14

Sinus node dysfunction
Symptomatic Brady
Chronotropic incompetence
Symptomatic Brady because of required med

AV dysfunction
   3 and advanced AV block with
      Symptoms
      Required med therapy causing bradycardia
      Pause 3 sec
      Rate less than 40
      After KT ablation
      After cardiac surg
      LV dysfct

After MI
Alterning LBBB and RBBB with 2 degree
Symptomatic 2 or 3 degree

Question 15

Indication class 1 defibrillator

Answer 15

Cardiac arrest with VF or VT after excluding reversible cause
Structural heart disease with VT
Syncope unknown origins, VT induced in lab
40 days after MI and EF < 35 and symptoms
40 days after MI and EF < 30 no symptoms
40 days after MI and EF < 40 with inducible VT
Non ischemic CMP with EF < 40 and symptoms

But if surgically revascularized may wait 3 months before taking the decision

Question 16

Most common complication of device (PPM, defibrillator

Answer 16

Lead displacement 2%

Question 17

Cryo pro and con

Answer 17

Pro
Spare collagen structure

Con
Longer
Bad on beating heart

Other sources are radiofrequency, HIFU, microwave and laser

Question 18

Indications to do a MAZE

Answer 18

Symptomatic AF undergoing an other cardiac procedure
Asymptomatic AF undergoing an other cardiac surgery with no extra risk to do it
Stand alone AF if meds or KT failed when symptomatic

Controversial : contraindications to ACO

Question 19

Prevention of AF CCS guidelines

Answer 19

Start beta blocker preoperatively
Preoperatively or postoperative amio
Magnesium
Atrial pacing

Question 20

Cardiac neoplasia
Name 4 more frequent
Primary benign adult
Primary benign peds
Primary malignant
Secondary

Answer 20

Benign adult
   Myxoma
   Lipoma
   Fibroelastoma
   Hemangioma

Benign peds
    Rhabdomyoma
    Teratoma
    Fibroma
    Hemangioma

Primary malignant
   Angiosarcoma
   Rhabdomyosarcoma
   Mesothelioma
   Fibrosarcoma

Secondary
   Leukaemia
   Melanoma
   Lung
   Breast

Question 21

Aortic dissection classification

Answer 21

Stanford
A involving ascending
B not involving ascending

DeBakey
  I ascending and descending
  II ascending
  IIIa descending until diaphragm
  IIIb descending and below diaphragm

Independent from the tear*****