Question 1

A child with aortic stenosis has aortic regurgitation, and the physician has recommended valve replacement surgery. His parents want to know which aortic valve prosthesis is best for their child. What type of valve would be best in this case?

Accepted Answer

A pulmonary valve autograft is best for children and young adults who have aortic stenosis as the patients will not require long-term anticoagulation. The Ross procedure is the commonly performed operation that uses this technique: the patient's own pulmonary valve is used to replace the diseased aortic valve.

Question 2

Which surgical procedure is used as a bridge to aortic valve replacement surgery in critically ill patient with end-stage aortic stenosis?

Accepted Answer

Balloon valvuloplasty is done for critically ill patients with end-stage aortic stenosis as a "bridge" to aortic valve replacement. Decalcification/debridement is considered in patients with mild to moderate aortic stenosis in whom the primary indication for surgery is coronary artery disease. Commissurotomy is useful in a small percentage of patients with aortic rheumatic valve disease with a trileaflet valve and minimal to no calcification.

Question 3

A pregnant patient is diagnosed with mitral stenosis. An echocardiogram shows that the valve cusps are pliable, there is minimal chordal thickening, and no subvalvular thickening or calcification. Which treatment option is suitable for her?

Accepted Answer

The best option for this patient with mitral stenosis, good leaflet pliability, minimal chordal thickening, and good subvalvular function is percutaneous balloon valvuloplasty. This procedure is considered suitable for pregnant patients who have mitral stenosis.

Question 4

An 80-year-old male who has diabetes is scheduled for CABG surgery. There is a 70 % obstruction in the left main coronary artery, a 60% obstruction in the right coronary artery, and depressed ventricular function. Which of the following is not a factor that increases this patient's risk for mortality associated with CABG surgery?

Accepted Answer

Numerous risk factors for mortality after CABG surgery have been identified in several major studies, but male gender is not one of them. In decreasing order of significance these risk factors are:
• Urgency of surgery (emergent or urgent)
• Reoperation
• Older age
• Poor ventricular function
• Female gender
• Left main coronary artery disease
Others risk factors include catastrophic conditions (cardiogenic shock, ventricular septal rupture, ongoing CPR), dialysis-dependent renal failure, end-stage COPD, diabetes, cerebrovascular disease, and peripheral vascular disease.

Question 5

Why is cardioplegia used during cardiac surgery?

Accepted Answer

Cardioplegia is used to stop the heart; this reduces the oxygen demand of the heart nearly 90%.Hypothermia is also used to further reduce myocardial metabolism.

Question 6

What are the contraindications of percutaneous transluminal angioplasty of the lower extremity?

Accepted Answer

Percutaneous transluminal angioplasty of the lower extremity is contraindicated in patients who are medically unstable, if the arterial occlusion that has been present for a long time, if there is poor distal run off, or in patients who have diabetes.

Question 7

Which of the following is the correct follow-up protocol for a patient who has had PCTA of the carotid artery?

Accepted Answer

The correct follow-up protocol for a patient who has had PCTA of the carotid artery includes an examination 1 week after the procedure to check neurological status. Additionally, Doppler ultrasound is performed every 3 to 6 months and then every year. Magnetic resonance imaging should be performed 3 months after the procedure, as well.

Question 8

Which of the following is not true about aneurysms?

Accepted Answer

Aneurysms are more common in the elderly, but they can occur in young people, as well. An aneurysm is defined as a localized, blood-filled dilation of a blood vessel (artery or vein) caused by cardiac disease or weakening of the blood vessel wall. Aneurysms are common in intracranial vessels, but are also found along the thoracic aorta, abdominal aorta, and in vessels of the extremities. Aneurysms typically occur in elderly patients, but can present in patients of any age group. The risk of aneurysm increases with age and is most likely to occur in individuals between the ages of 50 and 80.

Question 9

Which of the following statements is correct about aneurysms?

Accepted Answer

Abdominal aneurysms are more common in Caucasian patients than individuals of other ethnicities, and they are more common in men. Aneurysms typically occur in elderly patients, but can present in patients of any age group. Aneurysms are uncommon in individuals under 20 years of age. The risk of aneurysm increases with age and is most likely to occur in individuals between the ages of 50 and 80.

Question 10

Which of these drugs may be used to treat aneurysms?

Accepted Answer

There are different types of aneurysms and there specific treatments for each type, but many aneurysms are managed with anti-hypertensives, anti-coagulants, and anti-arrhythmics.

Question 11

Which of the following options can be used to prevent the development of aneurysm?

Accepted Answer

Options available for prevention of aneurysm include proper blood pressure control, avoid smoking, avoid straining, to exercise regularly, and maintain proper cholesterol level.

Question 12

Which of the following risk factors of aneurysm cannot be prevented?

Accepted Answer

Risk factors for the development of aneurysm that cannot be prevented include family history of aneurysms, and age. Hypertension can also put the individual at high risk.

Question 13

Which of the following factors puts an individual at increased risk of atherosclerotic disease?

Accepted Answer

Factors that can increase an individual's risk for atherosclerosis include elevated low-density lipoprotein (LDL) cholesterol, decreased high-density lipoprotein (HDL) obesity, and lack of physical activity. Elevated triglyceride levels, high blood pressure, and history of smoking are also risk factors.

Question 14

Which of the following conditions are not manifestations of atherosclerotic disease?

Accepted Answer

Deep vein thrombosis and pulmonary embolism are not manifestations of atherosclerotic disease. Atherosclerosis l manifests as coronary heart disease, myocardial ischemia and myocardial infarction, cerebrovascular insufficiency, stroke, peripheral vascular disease, limb ischemia, and aortic aneurysm.

Question 15

Which of the following pharmacological agents are used for treatment of atherosclerotic disease?

Accepted Answer

Pharmacologic agents used for the treatment of atherosclerotic disease include cholesterol-lowering medications such as statins, and medications that interfere with platelet aggregation, e.g., aspirin and clopidogrel. In situations where the atherosclerotic plaque is unstable, the anticoagulants heparin and warfarin are used.

Question 16

The 3 domains of adult learning include which of the following?

Accepted Answer

The 3 domains of adult learning include cognitive learning, psychomotor learning, and affective learning. Each type of learning impacts how an individual addresses adult learning and affects the knowledge the individual can acquire. Cognitive learning is defined as the ability to acquire knowledge or intellectual information through acquisition of facts, data, or by making decisions or drawing conclusions. Affective learning is defined as the ability of an individual to change their attitude, feeling, emotions, or interests toward a particular event or idea. Psychomotor learning is defined as an individual's ability to master physical or motor skills and/or activities.

Question 17

Which educational tool is most appropriate for a patient with reduced visual acuity?

Accepted Answer

The use of auditory tapes or CDs is highly effective in getting information across to patients with reduced visual acuity.

Question 18

A 70-year-old male patient is undergoing carotid endarterectomy. The surgeon wants to assess the patient's cerebral blood flow during the procedure. Which modalities may be used for this purpose?

Accepted Answer

Doppler study and an electroencephalogram may be used to assess cerebral blood flow to the brain during a carotid endarterectomy.

Question 19

Which of these investigations should be used to assess for restenosis after carotid endarterectomy?

Accepted Answer

Cardiac Doppler evaluation should be performed to assess for restenosis and artery patency at 6 months after carotid endarterectomy, and then yearly.

Question 20

Which complications are associated with peripheral thrombectomy?

Accepted Answer

Complications associated with peripheral thrombectomy include edema, hyperkalemia, cardiac arrhythmia, renal failure, and rhabdomyolysis.

Quiz 2: Problems