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Board Prep > Module 10- Valvular Heart Disease & Hemostasis > Flashcards

Module 10- Valvular Heart Disease & Hemostasis Flashcards

1
Q

Frank starling mechanism aka

A

Hertometric autoregulation

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2
Q

Obstruction in HOCM is worsened by

A

Increase contractility

Decreased preload

Decreased afterload

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3
Q

On arterial waveform with HOCM may see

A

Biferiens pulse (bifid)

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4
Q

Symptoms of AI are severe when

A

Regurgitant volume is >60% of SV

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5
Q

Manifestations of which valve disorder

Diastolic murmur at left sternal border
Wide pulse pressure
Decreased diastolic pressure
bounding peripheral pulses

A

Chronic AI

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6
Q

Chronic MR due to

A

Rheumatic fever

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7
Q

Acute MR due do

A

Myocardial ischemia or infarction

Chordae tendonae rupture

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8
Q

Severe MR symptoms occur at what %

A

> 60% regurgitant volume

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9
Q

Which valve disorder is afib not tolerated at all

A

AS

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10
Q

Severe AS when AVA is

A

0.8-1cm

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11
Q

Critical AS when AVA

A

0.5-0.8cm2

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12
Q

Classic symptoms of AS

A

Syncope

Angina

Dyspnea

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13
Q

Spinal and epidural are contraindicated in what valve lesion

A

Severe AS

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14
Q

Mitral stenosis is usually caused by

A

Delayed complication of rheumatic fever

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15
Q

Mitral stenosis is when MVA

A

Less than 2 cm2

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16
Q

Which valve disorder can lead to enlarged LA causing pressure on left RLN = hoarseness

A

MS

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17
Q

Cardiac surgery patient is heparinized but ACT does not increase above 400. What are 2 causes

A

Antithrombin III deficiency

NTG reduces heparin efficacy

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18
Q

If patient has antithrombin III deficiency and isn’t responsive to heparin what should you do

A

2 units FFP

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19
Q

Normothermia pump flow during CBP is

A

50-70 ml/kg/min

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20
Q

What vessels can be compressed by mediastinoscope

A

Inominate artery- lose RUE flow

Right carotid

Right subclavian

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21
Q

Where do you place cuff and Aline for mediastinoscopy. Why

A

Cuff LUE- monitor for hemorrhage

Aline- RUE monitor for inominate occlusion

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22
Q

What is stump pressure

A

Backpressure from collateral flow through circle of willis via the contralateral carotid artery and vertebrobasilar system

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23
Q

During CEA where should PACO2 be kept

A

35-45mmHg

Avoid hypocapnia induced vasoconstriction

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24
Q

Overall result of aortic cross clamping in hemodynamics

A

Reduction in LV EF and CO

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25
Q

In anterior spinal artery syndrome what is lost? What sensations remain

A

Lose motor function and pinprick

Keep proprioception and vibration

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26
Q

Debakey I dissection

A

Originates in ascending aorta and involves ascending aorta, Arctic arch, and lengths of thoracic and abdominal aorta

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27
Q

Debakey II dissection

A

Confined to ascending aorta

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28
Q

Debakey III dissection

A

Confined to descending thoracic aorta

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29
Q

Stanford Type A dissection

A

Ascending aorta involvement

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30
Q

Stanford Type B dissection

A

Ascending aorta not involved

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31
Q

Define hypertensive crisis

A

BP > 180/120

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32
Q

In hypertensive emergency how fast/slow should BP be decreased

Drug of choice

A

25% within 30-60 minutes

Nipride or Cleviprex

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33
Q

What is the leading cause of postoperative hospital admission

A

Inadequate pain relief

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34
Q

Electrocautery interferes with what park of a pacemaker

A

The sensing mode

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35
Q

What electrolyte and acid-base imbalances can lead to loss of pacing

A

Acute hypokalemia

Acute hypercalcemia

Respiratory alkalosis

36
Q

Platelets release what substances that play a key role in initial vasoconstriction

A

Thromboxane A2

ADP

37
Q

Endothelium that is damaged releases key procoagulants. What are 2

A

Tissue factor (III)

vWF (VIII)

38
Q

What clotting factors are not produced by the liver

A

IV calcium

VIII vWF

III Tissue factor

39
Q

Function of thromboxane A2

A

Amplify the signal and action of more potent platelet agonists

40
Q

What clotting factors are Vitamin K dependent

A

II

VII

IX

X

41
Q

Factor VIII is necessary for

A

Platelet adhesion to collagen

vWF

42
Q

Function of GpIIb/IIIa

A

Binds fibrinogen and promotes platelet aggregation

43
Q

Protein C function

A

Vitamin K dependent ANTICOAGULANT

Promotes fibrinolysis

44
Q

Aplastic anemia is due to what

A

Lack of functioning bone marrow

Chemo

45
Q

Megaloblastic anemia is cause by what

A

Lack of vitamin B12 or folic acid

Large immature erythrocytes- RBCs fail to mature

46
Q

What kind of RNC seen in iron deficiency anemia

A

Hypochromic, microcytic RBC

47
Q

What will be seen in a patient with glucose-6-phosphate dehydrogenase deficiency

A

Hemolytic anemia

48
Q

What 2 drugs would you avoid in glucose-6-phosphate dehydrogenase deficiency

A

Nipride and prilocaine due to Increased risk of cyanide toxicity

ASA, PCN, streptomycin, sulfonamides, quinidine, and methylene blue

49
Q

What disease results from impaired synthesis of alpha-globin or beta-globin strands

A

Thalassemia

50
Q

What disease results form a mutation on both beta-globin strands

A

Sickle cell anemia

51
Q

What factors are in cryoprecipitate

A

VIII:C
VIII:vWF
XIII
Fibrinogen

52
Q

What drug can increase factor VIII:vWF

A

Desmopressin DDAVP

53
Q

What clotting factor is hemophilia A

A

VIII:C

Give factor VIII concentrate

54
Q

ACT and PTT measure which pathway

A

Intrinsic

55
Q

PT monitors which pathway

A

Extrinsic

56
Q

What does bleeding time measure

A

Quantity and quality of platelets

57
Q

Spontaneous bleeding occurs when platelet count falls below what

A

20,000

58
Q

How long should 3 Gs (herbals) be discontinued before surgery

A

2 weeks

59
Q

Herbals that inhibit platelet aggregation

A

Garlic
Fishoids
DHEA

60
Q

TEG interpretation

R

A

Reaction time

Intrinsic pathway

61
Q

TEG interpretation

K

A

Clot formation time

Thrombin formation or generation of fibrin from fibrinogen

62
Q

TEG interpretation

MA

A

Strength of clot

Platelet number and function

63
Q

TEG interpretation

(MA+ X)/MA

A

Measure of fibrinolysis

64
Q

3 steps of primary hemostasis

A

Adhesion

Activation

Aggregation

65
Q

What activates platelets

A

Activated factor II (thrombin)

66
Q

What aggregates platelets

A

Factor I - fibrinogen

67
Q

Extrinsic pathway

A

Factor III
Factor VII

For 37 cents you can buy the extrinsic pathway

68
Q

Intrinsic pathway

A

Factor XII
Factor XI
Factor IX
Factor VIII

If you cannot buy the intrinsic path for $12 you can buy it for $11.98

69
Q

Final common pathway

A 
Factor V
Factor X
Factor I
Factor II
Factor XIII

Final common pathway can be purchased at the 5 and dime (10) for $1 or $2 on the 13th

70
Q

Hemophilia B is factor what deficiency

A

Factor IX

71
Q

Heparin increases the activity of antithrombin III which binds what clotting factors

A 
II
IX
X
XI
XII
72
Q

Coumadin MOA

A

Competitively inhibits vitamin K synthesis of Vitamin K dependent clotting factors (II, VII, IX, X, protein C and S)

73
Q

Aprotinin MOA

A

Inhibits breakdown of fibrin by inhibiting plasmin

74
Q

What electrolytes are in Normosol R

A 
Sodium 
Potassium
Magnesium
Acetate
Gluconate
75
Q

Max dosage of Hetastarch and Dextan 40

A

20 ml/kg/day

76
Q

Most frequent infection associated with blood transfusion

A

Hepatitis C

77
Q

EBV female

A

65 ml/kg

78
Q

EBV male

A

75ml/kg

79
Q

EBV preterm neonate

A

90-100ml/kg

80
Q

EBV term neonate

A

80-90 ml/kg

81
Q

EBV 3 mo - 3 yrs

A

75-80 ml/kg

82
Q

EBV child

A

65-70 ml/kg

83
Q

MABL formula

A

MABL = EBV X (initial hct - acceptable hct)/initial Hct

84
Q

Hct of PRBC

A

50-80%

85
Q

What blood product is ABO compatibility not mandatory

A

Platelets

Board Prep (19 decks)

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