Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

From Flashcardlet big > Previous exam 2004 > Flashcards

Previous exam 2004 Flashcards

1
Q

What is management post PA rupture

A

.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are indications for Pulmonary valve replacement in a 15 year old with a TOF repair

A

PVR with RV failure or overload
symptomatic
arrythmias
severe TR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is mechanism of amiodarone induced lung toxicity

A 
Direct injury to lung
	accumulation of cellular drug phospholipid complexes that interfere with normal cell pathways
	toxic oxygen 
	chronic inflammtion 
Indirect immunologic reaction

Treatment is just cessation of amiodarone and corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you reverse dipyridamole toxicity

A

Persantine (antiplatelet agent) inhibits adenosine deaminase and phosphdiesterase which cases an ccumulation of adnonsine, cAMP. These inhibit platelet aggregation and may cause vasodilation

platelet transfusion to reverse effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mechaniam of protamine-induced pulmonary hypertension. What do you do if need to re-op

A

Protamine is administered at 1-2 mg/100units of heparin
heparin protaimine complex causes the release of thromboxane
Alternatives to protamine
Give a protamine test dose of 1 mg over 10 minutes
heparinases
recombinatn PF4
Hedadimethreine bromide
time
methylene blue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Torrential venous bleeding on dissecting out the SVC for bicaval cannulation. Name 3 potential sources

A 
SVC
Right pulmonary artery
Right atrium
Left atrial roof
Azygous vein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Draw pressure volume loops…How do inotropes shift the curve.

A

.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List 4 qualities on echo that would help determine if Balloon plasty for mitral stenosis is ok

A 
Mitral regurgitation > 2+ 
Massive or bicommissural calcification
left atrial thrombosis 
Severe aortic valve disease or severe tricusoid stenosis + regurgtiation
severe CAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

VAD inserted for support..CVP gets elevated, decreased cardiac output, and urine output decreases

A

Likely cause is bleeding

Second option is right heart failure

Could be patent foramen ovale with left to right shunting and now you have RV overload and failure.

Echo, return to OR,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Indications to do CABG in shock situation

A

.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Indications for surgery of Left ventricular aneurysm

A 
angina
congestive heart failure
selected ventricular arrhythmias
increasing size
embolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List 8 symptoms of Left atrial myxoma

A 
Heart Failure 
Embolization 
Fever 
Weight loss 
Elevated ESR 
Hemoystic anemia 
Leukocytosis 
Arthralgia 
Tumor plop
Right sided heart failure--ascites, edema, heptomegaly
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List 2 inclusion criteria for patients to receive cardiac resynchronization

A

advanced heart failure

intra-ventricular conduction delay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does resynchronizatino improve symptoms

A

Improves ventricular contraction (Left ventricue)
improves the coordination of global contraction
Associated with reverse remodelling
Decreased MR jet areas
Reduction in LV mass
Improvement in hemodynamics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List 4 factors in determining decision to use a radial artery

A 
Lack of conduits 
younger patient age
extent of proximal stenosis
target vessel run off
-ive Allen test/vascular assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Two reasons why initial use of radial is associated with poor results

A

Vasospam

Use of vessels with low grade proximal stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Laplace formula

A

Tension = Pressure x radius/ 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

4 reasons why you would develop mesenteric ischemia post AVR with calcium

A

Emboli
Aortic dissection
hypoperfusion 2nd to low blood pressure
Mesenteric vasoconstriction secondary to epinephrine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

4 risk factors for post op AF after CABG

A

Advanced age
beta blocker withdrawal
preexisting AF
Extended cross clamp time

Incidence of AF post CABG is 25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are absolute contraindications to Ross Procedure

A

Advanced 3 vessel CAD
Extremes of Age (< 1 year or > 70)
Marfan syndrome
Multi system organ failure
Extensive multi valve pathology necessitating replacement of one or more valves
Large aortic root diameter (> 30mm)
Severely decreased left ventricular function

21
Q

What are medical and surgical outcomes for major studies

A

CASS 4 years 88%(surgical) and 63% (medical)
VA 3 yeas 84% (surgical) and 60% (medical)
ECSS 3 years 93% (surgical) and 81% (medical)

22
Q

Lose 700 cc blood over 30 minutes when on CPB. List 4 possible reasons for loss

A 
volume in pleural space
aortic dissection 
retroperitoneal hematoma 
Bleeding at cnnulation site
Vasodilation, secondary to plegia/druga
Aggressive diuresis
23
Q

List 3 indications for surgery for chronic AI

A

Symptomatic patients (NYHA III or IV)
asymptomatic patients with LVEF < 50%
patients undergoing CAD or surgery of ascending aorta

Class IIa
asymptomatic patients with EF > 50% with severe LD dilation LVEDD > 70 mm or LVESD > 50 mm

24
Q

4 complications of Endovascular stenting of descending aortic aneurysm

A

Aortic rupture
endoleak
stent migration
paraplegia

25
Q

What is the Ratelli procedure

A

Performed for procedures such as
d-TGA
DORV and VSD
RVOTO

It consists of the a Gore Tex patch that directs oxygenated blood from the left ventricle to the aorta,while at the same time closing the VSD. The pulmonary valve is surgically closed and an artificial conduit and valve are constructed from the right ventricle to the pulmonary bifurcation

26
Q

What are factors to consider when performing endovascular stenting

A

Adquate landing zone
Non tortuous aorta
Appropriate vascular access
Normal aorta of normal size at proximal neck
Normal aorta of normal size at distal neck
Absence of thrombus at landing zone

27
Q

High vent pressure/return while on pump
List 3 causes
How would you exclude them
What would you do

A

Bradycardia
V.Fib/tachy
Aortic valve insufficiency
Distortion of heart/secondary incompentence of valve

repair the aortic valve
Pace
Defibrillate 
restore heart to normal anatomic position 
Arrest and unclamp while venting LV
28
Q

List 8 common post op pulmonary complications

A 
Atelectasis 
Pleural effusion 
Pneumothorax
Pneumonia
Hemothorax
ARDS
TRALI 
Chylothorax 
Pulmonary contusion post thoracotomy
29
Q

Etiology that increases likelihood of aortic dissection

A 
Hypertension 
Connective tissue disorder/Marfan 
Pregnancy 
Iatrogenic 
Drug use--Cocaine 
pre-existing aneurysm 
Congenital valvular abnormalities
30
Q

What chamber is not well perfused with retrograde

What percentage returns to the right ostia, left, and RV

A

Right ventricle

Right ostia = 5-15%
Left ostia = 70-80%
Thesbian veins

31
Q

Describe the Konno operation

A

Longitudinal aortic incision on the anterior wall
Incision continue to the left of the right coronary artery
across the aortic annulus
into the right ventricle below the pulmonary valve
into the interventricular septum
Ellipitcal piece of dacron to close the septal defect
place the valve
Close the aorta with a patch

32
Q

What are current LDL, Choleserol and HDL ration for patients with CAD

A

.

33
Q

What test would you perform for myocardial contusion? What therapies? New murmur is detected?

A

TTE
Telemetry for 48 hours

2 Therapies
	Supportive
	IABP
	Telemetry 
Watch for mitral valve rupture and tricuspid rupture
34
Q

What are hemodynamic effects of IABP

A

Left ventricle systolic pressure—-Decrease (afterload reduction)
Left diastolic pressure——-decrease (ventricular empyting is enhanced)
Aortic diastolic pressure—increases (balloon augmentation)
Aortic systolic pressure—decreases (after load reduction)

35
Q

How does plavix work

A

Inhibits platelet aggregation

Inhibits ADPs ability to bind to the platelet receptor (P2Y12) and the ADP mediated activation of GPIIb/IIIa complex. This is irreversible.

36
Q

What is mechanism of LMWH

A

Inhibits both factor Xa and thrombin

Not reversed with protamine and does not affect PTT and ACT

37
Q

What is mechanism of HIT

A

severe immune mediated drug reaction.
Heparin binds to platelet factor 4 forming a highly reactive antigenic complex on the surface of platelets.
Patient then develops an antibody (IgG) to the heparin/PF4 antigenic complex
Antibody activates the platelets via Fc receptors
Thormbocytopenia develops

38
Q

4 things in sequence for treatment of anticoagulation

A 
Stop all Heparin 
Start 
Argatroban
Danaparoid
Lepirudin 
Warfarin after several days
TTE
39
Q

3 Ways that retrograde perfusion avoid neurologic injury

A

Washes out debris from arterial system
Improved cooling of the brain
improved nutritions of the brain

40
Q

4 potential benefits of off pump CABG

A 
Decrease whole body inflammatory response 
smaller heparin dose
less hemodilution 
shorter LOS 
Shorter ICU 
fewer pulmonary complications
41
Q

List the cardiac manifestations of carcinoid syndrome

A

Carcinoid heart disease is reported in approximately 50 to 60% of all patients with malignant carcinoid syndrome
occurs on the right side of the heart
Fibrous deposits adhering to the surface of the valvular endocardium
thickening of the endocardium of the cardiac chambers and papillary muscle and deformation of the valve cusps and chordae tendinae. Can result in combined diseases
Tricuspid valve is affected most commonly

42
Q

Different ways to identify calcified aorta

A

CXR
CT scan
Epiaortic Scanning
Digital palpation

43
Q

Techniques to repair mitral valve

A 
Chordal transfer
Neochords
Triangular resection
Chordal shortening 
Alfieri stitch 
leaflet extension
44
Q

3 characteristics of ASD not amenable to Amplatz device closure

A 
Rim insufficient to allow proper seating (minimum is 5 mm) 
Large ASD 
	maximum 20 mm 
Small body wight < 10 kg
Ostium Primum
45
Q

Why close an ASD to avoid decompression sickness

A

Scuba diving can cause formation of inert bubbles that collect.
Formed in venous system and crosses into arterial system through ASD
Two types
I: emboli around skeletal join, knees, elbow, and shoulders
II: progress of type I to involve CNS and CVS

46
Q

What are principles of surgery for constrictive pericarditis

A

Sternotomy
On or Off pump
Release ventricles from the densely adherent adhesions
Phrenic to phrenic anteriorly and posteriorly–from entrance of vena Cava and pulmonary veins to diaphragm

47
Q

What is the Duke Criteria for Endocarditis
Major:

Minor: 
	Predisposing condition 
	fever
	immunological 
		Oslers
		Roth spots
	vascular 
		janeway 
		septic emboli
	echo not meeting critieria
	mircobiologic phenomena
A

.

48
Q

Define classifications of Aortic Dissections

A

Stanford A: involving the ascending aorta
Stanford B: dissection limited to the descending aorta, not involving the ascending aorta

Debakey I: involving the ascending aorta and extending into the descending aorta
Debakey II: dissection involving only the ascending aorta
Debakey IIa: dissection limited to the thoracic descending aorta
Debakey IIb: involving the whole descending aorta

From Flashcardlet big (79 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions