Beyond BASIC – Cardiac Intensive Care

Pre-course Test

1. Regarding the pressure-volume loop.

a. ‘b’ represents aortic valve opening

b. ESPVR, the end systolic pressure volume relationship, is analogous to the left
ventricular contractility
c. EDPVR, the end diastolic pressure volume relationship, is analogous to preload
d. ‘D’ is mitral valve closure
e. ‘C’ is aortic valve closure

2. Concerning left ventricular afterload and the Law of Laplace:

T=Patm x R /2H

a. T is the ventricular thickness

b. R is the ventricular radius
c. Patm is the transmural pressure between the pericardium and the ventricular
cavity
d. Reduced T equates with a reduce afterload
e. H is the ventricular height between the cardiac apex and aortic valve

3. Complications of cardiopulmonary bypass include:

a. hyperthermia
b. acute respiratory distress syndrome
c. microembolism
d. bleeding
e. systemic inflammatory response syndrome

4. Common indications for intra-aortic balloon pump include:

a. ventricular septal defect
b. refractory angina
c. acute mitral regurgitation
d. patent foramen ovale
e. severe aortic regurgitation

5. Complications of intra-aortic balloon pumps include:

a. thrombocytopenia
b. limb ischaemia
c. worsening myocardial ischaemia
d. worsening of myocardial contractility
e. balloon rupture

6. Regarding epicardial pacemakers:

a. undersensing risks R on T
b. undersensing can cause failure to pace
c. oversensing can be treated with use of the emergency pacing mode
d. oversensing can lead to pacemaker induced tachycardia
e. AV dyssynchrony is usually seen in AOO pacing

7. The following factors make fast track surgery less likely:

a. moderate to severe obstructive lung disease
b. chronic kidney disease stage 3
c. re-do sternotomy
d. body mass index greater than 35
e. prolonged cardiopulmonary bypass

8. Aortic Dissection often presents with:

a. acute aortic stenosis
b. cardiac tamponade
c. myocardial ischaemia
d. stroke
e. dynamic left ventricular outflow obstruction

9. Factors that pre-dispose to systolic anterior motion of the mitral valve are:
a. mitral valve repair
b. bulging intraventricular septum
c. hypovolaemia
d. poor left ventricular systolic function
e. excessive vasoconstriction

10. Concerning cardiac arrest after cardiac surgery:

a. In a PEA arrest with epicardial pacing in situ, emergency pacing should be
activated
b. If adrenaline is given, a dose of 1000mcg should be given
c. For VF/pulseless VT immediate CPR and defibrillation is recommended
d. Re-sternotomy should be considered if the cardiac arrest has not been reversed
in 20 minutes of CPR
e. External chest compressions provide better brain perfusion than internal chest
compressions

11. Heparin Induced Thrombocytopenia (HIT) is more likely if:

a. the platelet count is less than 10 x 109/L
b. the onset of platelet drop is 5-10 days post heparin exposure
c. there is confirmed new thrombosis
d. IgG antibodies to platelet factor 4 are produced
e. The patient is septic

12. Indications for VA-ECMO may include:

a. drug overdose with refractory cardiovascular collapse
b. pulmonary embolus with circulatory collapse
c. severe acute respiratory distress syndrome
d. refractory cardiac arrest with prolonged downtime
e. severe sepsis with multi-organ failure

13. During a VA-ECMO run, the following suggest haemolysis:

a. green urine
b. rising d-dimer
c. rising conjugated bilirubin
d. rising haemaglobin
e. rising LDH

14. Concerning cardiac pathologies:

a. aortic stenosis patients often have myocardial ischaemia
b. a low pressure gradient across the aortic valve excludes aortic stenosis
c. patients for mitral repair with severe regurgitation usually will not need post-op
inotropes if the LV function pre-op is normal
d. right ventricular systolic dysfunction usually improves post-op on discontinuing
mechanical ventilation
e. left ventricular systolic dysfunction usually improves upon initiation of
mechanical ventilation

15. Regarding cardiac tamponade in post-operative cardiac surgical patients:

a. a large pericardial effusion greater than 2cm on echo is diagnostic of cardiac
tamponade
b. cardiac tamponade is a clinical diagnosis
c. electrical alternans is pathognomic of cardiac tamponade
d. pulsus paradoxus can occur in the setting of cardiac tamponade
e. severe bronchospasm can cause pulsus paradoxus

16. Regarding haemodynamic assessment with echocardiography:

a. Severe hypokinesia is less than 20% wall thickening of the left ventricular
myocardium
b. Dyskinesia is no thickeneing of the myocardium
c. Ejection fraction cannot be accurately assessed by ‘eyeballing’ alone
d. The normal TAPSE (tricuspid annular plane systolic excursion) is 16-20mm
e. A peak systolic velocity of the lateral tricuspid annular plane using tissue
Doppler imaging of greater than 10cm/s is normal

17. Regarding the basic transthoracic echocardiography windows:

a. the parasternal short axis view can be achieved in the third intercostal space
with the probe marker pointed to the patient’s left shoulder
b. the parasternal long axis view can be achieved in the third intercostal space with
the probe marker pointed to the patient’s right shoulder
c. the aortic valve is visualized in the apical four chamber view
d. the aortic valve is visualized in the subcostal view
e. the tricuspid valve is visualized in the parasternal long axis view
18. When siting a pulmonary artery catheter:
a. a pressure of 35/5 mmHg indicates the catheter is in the pulmonary artery
b. the pulmonary artery is usually reached at 20cm in adults
c. it is rare that the catheter needs to be inserted more than 60cm
d. the normal diastolic pulmonary artery pressure is 8-15mmHg
e. normal right ventricular systolic pressure is 20-30mmHg

19. Regarding the CVP trace:

a. cannon a-waves indicated atrio-ventricular dyssynchrony
b. giant v-waves are caused by tricuspid regurgitation
c. CVP should be measured at end expiration
d. Y-descent represents tricuspid valve opening
e. C-waves occur due to ventricular contraction

20. Risk factors for acute kidney injury after cardiac surgery include:
a. female sex
b. diabetes mellitus
c. eGFR < 90 ml/min
d. cardiopulmonary bypass time > 45 minutes
e. high body mass index