TRUELEARN 13 NOV 2018

Question 1

where is the pain usually located for ascending aortic dissection? descending thoracic?

Answer 1

• ascending: midsternum

- descending: interscapular

Question 2

what are the differences between the DeBakey and Stanford classifications for aortic dissections?

Answer 2

DeBakey:

• differentiates patients based on location and extent of aortic dissection
• groups patients into four types

Stanford:

• functional classification
• type A: ascending (higher frequency)
• type B: descending, thoracoabdominal regardless of retrograde involvement of arch

Question 3

the stanford classification system for aortic dissections states the _____________ artery as the differentiating point between type A and B

Answer 3

left subclavian

Question 4

which is more common - type A or type B aortic dissections?

Answer 4

type A

Question 5

what is the management for type B aortic dissections?

Answer 5

• airway
• IV access
• ICU admission
• pain control
• BP CONTROL WITH BETA BLOCKERS

Question 6

type B aortic dissections account for __% of all acute aortic dissections

Answer 6

40%

Question 7

what beta blockers are used for managing acute type B aortic dissections?

Answer 7

propanolol or esmolol

Question 8

HR goal of

Answer 8

60

Question 9

what is the goal systolic BP in acute type B aortic dissections?

Answer 9

100-120

Question 10

when is surgery advised for type A or type B aortic dissections?

Answer 10

neurologic compromise (lower extremity

Question 11

what is the MOA of dobutamine?

Answer 11

• low dose: beta-1 agonist (increased contractility)

- high dose: beta-2 agonist (peripheral vasodilatory)

Question 12

what is the EKG pattern seen in PE?

Answer 12

• sinus tach
• S1Q3T3 with T wave inversion in anterior leads
• right heart strain on echo with akinesia of mid wall

Question 13

what is the current utility in PA catheters?

Answer 13

distinguishing cardiogenic from noncardiogenic sources of shock and respiratory distress

Question 14

in cardiac tamponade, what will be seen with intracardiac monitoring?

Answer 14

equalization of right atrial, right ventricular end diastolic, and pulmonary artery wedge pressures

Question 15

the cross sectional area of a normal MITRAL valve is between __ and __ cm2

Answer 15

4 and 6

Question 16

when is a patient considered to have severe mitral stenosis?

Answer 16

• valve area < 1 cm2
  and
• transvalvular gradient rises above 10 mm Hg

Question 17

the cross sectional area of a normal AORTIC valve is between __ and __ cm2

Answer 17

3 and 4

Question 18

what are the parameters for severe aortic stenosis?

Answer 18

• valve area < 1 cm2
• aortic jet velocity > 4 m/s
• mean transvalvular gradient > 40 mm Hg

Question 19

what is the rate control agent of choice in a patient with atrial fibrillation who is stable and has no underlying lung disease? what about with underlying COPD or bronchospasm?

Answer 19

• BB

- CCB

Question 20

• atrial natriuretic peptide is released in response to _____________
• what is the role of ANP?

Answer 20

• increased atrial volume

- antagonizes the renin-angiotensin-aldosterone system

Question 21

cardiac tamponade causes hypotension due to impairment of _______ atrial filling

Answer 21

right

Question 22

inspiratory capacity + expiratory reserve volume =

Answer 22

vital capacity

Question 23

what vasoactive drugs are given in neurogenic shock with

• bradycardia
• tachycardia

Answer 23

• bradycardia: dopamine

- bradycardia: neo or levo

Question 24

what is the MOA of milrinone?

Answer 24

• phosphodiesterase type III inhibitor

- blocks degradation of cyclic AMP

Question 25

what is the treatment for alveolar hypoventiliation which is manifested by an increase in end tidal CO2?

Answer 25

increasing tidal volume

Question 26

what is the treatment for a CO2 embolus?

Answer 26

• left lateral decubitus position

- aspiration from central line

Question 27

what are the PaO2/FiO2 cutoffs for mild / moderate / severe ARDS?

Answer 27

• mild: 200-300
• moderate: 100-200
• severe: < 100

Question 28

what is the BEST way to differentiate ARDS from cardiogenic pulmonary edema?

Answer 28

PA catheter to measure pulmonary artery wedge pressure

Question 29

what is the treatment for mediastinitis?

Answer 29

• debridement

- muscle flap coverage

Question 30

what vessel has the best patency rate for CABG?

Answer 30

internal thoracic arteries

Question 31

what is the best approach for a type A aortic dissection repair?

Answer 31

median sternotomy