Previous exam 2003

Question 1

Mechanism of action of aprotinin

Answer 1

serine protease inhibitor
anti-inflammatory
platelet preservation
anti-fibrinolytic

Question 2

5 tenents of the Canadian health act

Answer 2

Public administration 
Comprehensiveness 
Portability 
Accessability 
Universality

Question 3

Heart not arrested while giving cardioplegia

Answer 3

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

Question 4

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

Answer 4

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

Question 5

Nitric oxide list the 3 things you need to deliver it

Answer 5

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

Question 6

List toxic metabolites of NO

Answer 6

No2
methemoglobin
peroxynitrite

Question 7

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

How do you confrim

Answer 7

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

Question 8

How do you manage HITT patient

Answer 8

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

Question 9

HOCM is what?

Answer 9

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

Question 10

What is HOCM anatomy

Answer 10

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

Question 11

Describe HOCM anatomy of LA

Answer 11

Enlargement
increased mass
endocardial lesion from MR jet

Question 12

Describe HOCM

Answer 12

1: 500 and autosomal dominant
myofibril disarray
fibrosis

Prolonged systolic septal apposition leads to SAM
reduced LVOT

70& familial and 30% sportaid

Question 13

What are effects of pregnany on LV

Answer 13

Increased diameter
increased LVEDV
increased stroke volume
increased compliance 
increased EF

Question 14

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

Answer 14

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

Question 15

List exposure of axillary artery

Answer 15

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

Question 16

How do you cannulate

Answer 16

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

Question 17

In a coarctation, collateral inflow is from

Answer 17

Internal mammary 
Vertebral 
Costocervical 
thryrocervical 
lateral throracic artery

Question 18

Outflow from the coarctation is

Answer 18

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

Question 19

Contraindications to Ross

Answer 19

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

Question 20

Most important test of hemolysis

Answer 20

serum haptoglobin

Question 21

Additional tests for hemolysis

Answer 21

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

Question 22

What are major side effects of prednison

Answer 22

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

Question 23

What is side effects of MMF

Answer 23

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

Question 24

Treatment for SAM

Answer 24

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

Question 25

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

Answer 25

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

Question 26

What are differences between remodeling and reimplantation

Answer 26

How do you size the graft for a root replacement

Question 27

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

Answer 27

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

Question 28

Why give bicarbonate for CPR

Answer 28

Class II indication for hyperkalemia particulary for prolonged resuscitation