Vascular 10 Q

Question 1

Permanent, localized out pouching or dilation of the vessel wall –> peaking of the arterial wall due to high pressure in the arterial system

Answer 1

Aortic Aneurysm

Question 2

What test determines length, diameter, and presence of a thrombus for aortic aneurysms?

Answer 2

CT

Question 3

With AAA, there is dull vague pain in the abdomen, back, and flank. If it is acute and severe what does this indicate?

Answer 3

Ruptured AAA

Question 4

Your patient states “I can feel my heart beat in my stomach” and you palpate a pulsatile mass. What is this finding consistent with?

Answer 4

AAA

Question 5

What is a lethal complication of an emergency aortic aneurysm repair?

Answer 5

Intrabdominal hypertension that leads to multi system organ failure

Question 6

What is the biggest and most modifiable risk factor for aortic aneurysm?

Answer 6

Smoking

Question 7

An aortic aneurysm can mimic an _ or _

Answer 7

MI or kidney failure

Question 8

Is anterior or posterior rupture of an aortic aneurysm worse?

Answer 8

Anterior is worse (often death before hospital)

Question 9

4 signs for an aortic aneurysm rupture?

Answer 9

Turner’s sign, back/flank pain, mass, hypotension

Question 10

Asymptomatic aortic aneurysm needs surgical repair if it is _ cm in women and _ cm in men

Answer 10

5 cm in women; 5.5 cm in men

Question 11

What type of shock do you need to worry about in a patient with a ruptured AAA

Answer 11

hypovolemic shock

Question 12

Seen with aortic aneurysms, what syndrome can occur due to microemboli from an aortic thrombus?

Answer 12

Blue toe syndrome

Question 13

Are aortic aneurysms more likely in African American men or caucasian men?

Answer 13

Caucasian men

Question 14

Aneurysm that is uniform in shape

Answer 14

Fusiform

Question 15

What type of aneurysm presents with deep diffuse chest pain that may extend to the intrascapular area?

Answer 15

Thoracic Aortic Aneurysm

Question 16

Aneurysm that is pouch like

Answer 16

Saccular

Question 17

At least one layer is still intact and bound by arterial wall or wall of heart

Answer 17

True aneurysm

Question 18

After surgical repair of an aneurysm, the HOB should be no more than

Answer 18

45 degrees

Question 19

Result of a false lumen through which blood flows

Answer 19

Aortic Dissection

Question 20

The initial goal for treating aortic dissection is to decrease _ and _

Answer 20

HR, BP

Question 21

If an aneurysm shows growth of _ to _ cm on CT there needs to be intervention

Answer 21

0.5-1 cm

Question 22

What is the target SBP for aneurysms?

Answer 22

100

Question 23

Fluid accumulation in the pericardial sac that puts pressure on the heart

Answer 23

Cardiac tamponade

Question 24

The distal port of the swan Ganz measures __. Normal PA is 15-30/4-12

Answer 24

pulmonary artery pressure and PCWP

Question 25

SVR (systemic vascular resistance) is the left heart after load. What is the normal?

Answer 25

SVR 800-1200

Question 26

On the swan Ganz, you must "wedge" to get PAWP. Do not wedge for longer than 10-15 seconds as it can cause capillary rupture. What is the normal PAWP?

Answer 26

PAWP 6-12

Question 27

The proximal swan ganz cath port measures _ _ pressure. What is the normal?

Answer 27

CVP 3-8 | CVP is also the RAP (right atrial pressure--pressure in superior vena cava)

Question 28

Cardiac index is more specific than CO because it takes BSA into account. What is the normal CI?

Answer 28

2.5-4.5 liters

Question 29

Pulmonary vascular resistance (PVR) is the right heart after load. It is normally 1/6th of the SVR. What is the PVR normal?

Answer 29

50-250

Question 30

What are the 3 determinants of stroke volume?

Answer 30

Preload, after load, contractility

Question 31

normal cardiac output? Formula to calculate?

Answer 31

4-8 L; heart rate x stroke volume

Question 32

Indications for an a-line include acute HTN, acute hypotension, and frequent ABG's. What should an a-line never be used for?

Answer 32

Medication administration

Question 33

_ should be performed before A-line insertion. Always make sure the stop cocks are secure.

Answer 33

Allen test

Question 34

What are the 5 Ps to remember for monitoring post A-line insertion?

Answer 34

Pain, paralysis, paresthesia, pallor, pulse

Question 35

Central line that measures pressures inside the heart. Flow is directed with a balloon. Typically has 5 lumens. The distal lumen resides in the pulmonary artery to help monitor PA pressure and o2 saturation.

Answer 35

Swan Ganz Catheter

Question 36

2 possible complications of a swan ganz catheter

Answer 36

air embolus, pulmonary infarction

Question 37

Swan Ganz catheter: 1. PA distal lumen is (color) _ 2. Proximal infusion hub is (color) _ 3. Balloon inflation valve is (color) 4. Injectate lumen hub is (color)

Answer 37

1. yellow 2. clear/white 3. red 4. Blue

Question 38

The proximal lumen hub (clear/white) on the swan ganz is for?

Answer 38

Connection of all cardiac infusion drugs

Question 39

Increased cardiac output indicates a hyperdynamic state such as _ or _

Answer 39

fever or early sepsis

Question 40

PA numbers will be elevated with _ & _ and decreased with _

Answer 40

elevated: heart failure, cardiac tamponade Decreased: hypovolemia

Question 41

Reflects the average CO for the past 3-6 minutes. Measures q30-60 seconds.

Answer 41

Continuous cardiac output

Question 42

Inject saline into proximal lumen of PA catheter. Thermistor detects differences in blood temp and calculates CO. Uses the average of 3 measurements

Answer 42

Intermittent cardiac output measurement

Question 43

Decreased SVR Indicates: A. vasoconstriction B. Vasodilation

Answer 43

Vasodilation

Question 44

Determines adequacy of tissue oxygenation. Reflects balance of arterial blood, tissue perfusion, and oxygen consumption

Answer 44

venous oxygen saturation | (SVO2, ScVO2) Svo2 is from PA cath and ScVO2 is from CVP

Question 45

Normal venous oxygen saturation is (SvO2, ScVO2)

Answer 45

60-80%

Question 46

Each thin black line on the swan ganz represents _ cm

Answer 46

10

Question 47

Each thick black line on the swan ganz represents _ cm

Answer 47

50

Question 48

During hemodynamic monitoring, where should you zero the transducer after insertion and after patient moves?

Answer 48

Phlebostatic axis

Question 49

CPP is needed to ensure blood flow to the brain. What is the normal and how do you calculate it?

Answer 49

60-100; CPP=MAP-ICP