Quiz 3

Question 1

Risk factors associated with development of atherosclerotic disease

Answer 1

Elevated triglycerides
CIGARETTE SMOKING
C-reactive protein
Hypercholesterolemia
Homocysteine
Hypertension
DIABETES MELLITUS
Obesity
Genetic predisposition
Gender (male>female)
Impaired long term glucose regulation

Question 2

look at slide 9, 10, and 11

Answer 2

.

Question 3

risk factors for AAA

Answer 3

Aging population

Men > Women

African Americans

Question 4

contributing factors of AAA

Answer 4

• Cigarette smoking (increases risk 8x)
• HTN (60%)
• Atherosclerosis (90%)
• Proteolysis of elastin and collagen within a vessel wall
• Genetic predisposition
• Obesity

Question 5

Risk of rupture very low for AAAs less than __ cm in diameter, Risk of rupture increases dramatically for aneurysms greater than __ cm in diameter, Surgical intervention recommended for aneurysms greater than ___ cm in diameter.

Answer 5

4

5

5.5

Question 6

5 year survival rate for untreated AAA is ___ and the 10 year mortality rate is ____ (untreated)

Answer 6

81%

100%

Question 7

how much heparin with EVAR. and what ABX?

Answer 7

50-100 units/kg

cephalosporins (cepha-, cefa-) like cefazolin

Question 8

contraindications to elective AAA repair

Answer 8

• Recent MI
• Intractable angina
• Severe pulmonary dysfunction
• Chronic renal insufficiency

Question 9

High risk AAA repair:

Answer 9

• > 85 years
• Home O2, PaO2 <50mmHg, FEV1<1L/s
• Serum creatinine >3mg/dL
• Class III-IV angina
• Resting EF <30%
• Recent CHF
• Complex ventricular ectopy
• Severe, noncorrectable CAD

Question 10

These ______ levels of aortic occlusion have a significant impact on the cardiovascular system as well as on other vital organs rendered ischemic or hypoperfused. Ischemic complications may result in renal failure, hepatic ischemia and coagulopathy, bowel infarction, and paraplegia.

Answer 10

higher

Question 11

Aortic Cross-Clamping

Answer 11

Hypertension above the cross-clamp

Hypotension below the cross-clamp

Organs proximal to aortic occlusion may experience a redistribution of blood volume

Absence of blood flow distal to the clamp

Increase in afterload will cause an increase in myocardial wall tension

MAP and SVR also increase above clamp

Cardiac output decreases or remain unchanged

PAOP may increase or remain unchanged

Question 12

Pharmacologic intervention: AAA/aortic cross-clamp

Answer 12

• Nitroglycerin - often the drug of choice because of its primary effect of decreasing preload and thus decreasing myocardial O2 demand.
• Dopamine and dobutamine - inotropic agents used to improve cardiac output
• Nipride - decrease afterload
• Isoflurane - may decrease SVR

Question 13

The more _______ the clamp - the higher on the aortic arch/the _______ the magnitude and severity of cross-clamping responses

Answer 13

proximal

greater

Question 14

Interruption of blood flow to the Artery of ____________ in the absence of collateral blood flow has caused post operative paraplegia.

Answer 14

Adamkiewicz

also known as greater radicular artery

Question 15

once unclamped, do what?

Answer 15

Give volume and start pressors

Question 16

look at slide 51

Answer 16

.

Question 17

Declamping Shock Syndrome:

Answer 17

• Liberation of anaerobic metabolites
• Decrease SVR
• Decrease venous return
• Reactive hyperemia
• Further decrease in preload and afterload
• Hemodynamic instability

Question 18

use A-line and pulse ox on which side of body

Answer 18

Left

Question 19

look at slide 62

Answer 19

.

Question 20

Stroke risk factors

Answer 20

Cigarette smoking
HTN
Abnormal ECG
Prior MI
Hyperlipidemia
Angina
DM

Question 21

look at slide 67

Answer 21

.

Question 22

imaging very suggestive of increased risk of adverse cardiac events.

Answer 22

Dipyridamole-thallium imaging

Question 23

blindness in 1 eye, a sign of impending stroke

Answer 23

amaurosis fugax