Previous exam 2010 Flashcards by Naser Zalloum

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

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Outline 6 limitation for a language barrier for obtaining onset

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

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

MR
valve morpholoy 
thrombus
High wilkins score
Calcification

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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—

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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

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Describe function of following pacing modes
AOO
AAI 
DDI
DDD
VOO

Pacing
Sensing
Respond to sensing

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Identify 3 acute aortic syndromes

Acute aortic dissection
Intra mural hematoma
Penetrating athersclerotic ulcer

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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

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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

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

Death
Stroke
MI
Bleeding
AKI

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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

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Endovein vs open vein
List 4 advantages
List 4 limitations

less morbidity
wound complications are less
time, patency,

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

end to end repair
subclavian flap
aortic arch hypoplasia

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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

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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

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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

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3 potential limitations of NO administration

inhaled
toxic byproducts
abnormal

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List 3 requisite anatomical features of complete AV canal defect

common av valve

lack septum

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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

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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

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Acute RV failure post transplantation. List 5 steps of management

Milrinone 
NO 
pre-load
IABP
decreased PVR 
HR > 100

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

Carcinoid valve disease

Cause TR

Also cause pulmonary valve stenosis

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

4 CRT indications

Only 1 class 1 indication LV<35%, NSR, QRS >150 with LBBB, FCC 2,3 or ambulatory 4

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

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 ```

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

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 ```

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

5 contraindications to SVR

RV dysfunction Asymptomatic Restrictive diastolic pattern

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

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

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

What is mechanism of Diastolic dysfunction

inability of myocardial relaxation/loss of myocardial compliance

What is risk factors for diastolic dysfunction 3 pharmacological treatments

Age, diabetes, HBP Volume, beta blockers, CCB

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

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 ```

List 4 meds to treat pulmonary artery hypertension and route

NO inh Milrinone inh or IV Slidenafil PO Epoprostenol inh

Patient requires CABG. on plavix. What is mechanism of plavix Half life of plavix? How many days of platelet inhibition to wear off?

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

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

List 3 limitations for metanalysis

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

What is mode of inheritance in Marfan What's the genetic abnormality

Autosomal dominant | Mutation in FBN1 that encode for fibrillin-1

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

4 features of Dresslers syndrome

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

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.

List 3 absolute contraindications to IABP

Dissection AI AAA Severe peripheral vasculopathy

List 5 major complications of IABP

``` Bleeding Infection Thrombocytopenia Leg ischemia Thromboembolic ```

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

``` 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

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

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)