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CARDIAC SURGERY CSC TEST WITH COMPLETE SOLUTIONS
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CARDIAC SURGERY CSC TEST WITH COMPLETE SOLUTIONS
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CARDIAC SURGERY CSCTEST WITH COMPLETE
SOLUTIONS
Youbarebcaringbforbabpatientbwithbanbintra-
aorticbballoonbpumpbandbnotebbloodbinbthebtubing.bYourbinitialbactionbshouldbbe:
A.bStopbthebballoonbpumpbandbnotifybthebphysician.
B.bAdministerb100%boxygenbtobhelpbdisplacebthebheliumbandbnotifybthebphysician
C.bLeavebthebIABPbrunningbandbnotifybthebphysician.
D.bPurgebthebIABPbmanuallybtobclearbthebbloodbfrombthebtubing.b-bcorrectbanswer-
A.bBloodbinbthebIABPbtubingbindicatesbabballoonbrupturebwhichbcanbcausebgasbemb
olus.bHowever,bheliumbisbthoughtbtobbebeasilybabsorbedbinbthebpresencebofbballoonb
rupturebandboxygenbisbnotbgenerallybindicated.bThebappropriatebactionbisbtobdisconn
ectbthebballoonbfrombthebconsoleborbturnbitbonbstandbybsobthebmovementbofbheliumbi
sbstoppedbandbnotifybthebphysician.bThebnursebwillbneedbtobpreparebforbIABPbremov
albandbreplacementbifbneeded.
WhenbcaringbforbabpatientbimmediatelybpostbCABGbthebnursebrecognizesbthatbthebm
ostblikelybcausebofbhypotensionbinbthebimmediatebpost-operativebperiodbis
,A.bDecreasedbcirculatingbvolumebrequiringbnobinterventionbunlessbpersistentb>b12bh
ours.
B.bLVbfailurebrequiringbanbinotropebasbfirstblinebtreatmentbforbanybhypotension.
C.bDecreasedbcirculatingbvolumebrepresentingbthebneedbforbincreasedbfluidbadminist
ration.
D.bLVbfailurebrequiringbanbassistbdevice.b-bcorrectbanswer-
C.bHypotensionbinbthebimmediatebpostoperativebperiodbisbusuallybcausedbbyblowbcir
culatingbvolumebandbrespondsbtobtreatmentbwithbfluids.bVolumebisbthebfirstblinebtreat
mentbforbhypotension.bIfbtherebisbnobimmediatebresponsebtobvolumebadministration,b
500bmgbofbIVbcalciumbchloridebisboftenbgiven.bExistingbvasopressors,bsuchbasbnore
pinephrine,bcanbalsobbebadjusted.bItbisbimportantbforbhypotensionbtobbebpromptlybtre
ated.bPersistentbhypotensionbcanbresultbinbhypoperfusionbandbendborganbdamage.b
LVbfailurebisbnotbthebmostbcommonbcausebofbhypotensionbinbthebimmediatebpost-
operativebperiodbandbthereforebinotropicbagentsbarebnotbfirstblinebagentsbusedbinbthe
btreatmentbofbhypotension.bHypotensionbthatbdoesbnotbrespondbtobfluidbadministratio
nbmaybrequirebanbinotrope.
Preoperativebclopidogrelbshouldbbebheldbforbhowbmanybdaysbinbthebelectivebsurgery
bpatient:
A.Itbdoesbnotbneedbtobbebheld.
B.b1-2bdays.
C.b5-7bdays.
D.b30bdays.b-bcorrectbanswer-
C.bClopidogrelbinhibitsbthebP2Y12breceptorbonbthebplateletbforbtheblifetimebofbthebpla
teletb(10bdays).bInhibitedbplateletsbcannotbparticipatebinbclotting,bsobthebriskbofbbleed
ingbincreasesbwithbantiplateletbdrugs.bMostbclinicalbtrialsbhavebidentifiedbanbincrease
dbriskbinbbleeding,btransfusion,bandbre-
explorationbwhenbclopidogrelbisbtakenbwithinb5bdaysbofbsurgery,bandbnobincreasebinb
bleedingborbtransfusionsbwhenbclopidogrelbisbstoppedbforb>b5bdaysbpriorbtobsurgery.
bTherefore,bclopidogrelbshouldbbebstoppedbforb5btob7bdaysbpriorbtobelectivebsurgery.
bEmergentbsurgerybcanbbebdonebregardlessbofbwhenbtheblastbdosebofbclopidogrelbw
asbtaken,bbutbwillbbebassociatedbwithbincreasedbbleedingbandbneedbforbplateletbtran
sfusions.
ThebtermbOPCABbrefersbto:
A.bcombinationbopenbheartbsurgerybandbpercutaneousbprocedure.
B.bCABGbsurgerybwithoutbthebusebofbcardiopulmonarybbypassb(CPB).
C.bthebusebofbthoracotomybinsteadbofbsternotomy.
D.bpatientsbwhobarebfastbtrackedbtobbebdischargedbinblessbthanb5bdays.b-
bcorrectbanswer-B.bOPCABbrefersbtoboff-
pumpbcoronarybarterybbypass.bSurgerybisbdonebwithoutbCPBbbutbitbstillbinvolvesbabm
edianbsternotomy.b
MIDCABb(minimallybinvasivebdirectbcoronarybarterybbypass)bisbperformedbonbabbeati
ngbheartbwithoutbCPBbandbwithoutbthebusebofbabmedianbsternotomy.bMIDCABbisbco
mmonlybdonebthroughbanbanteriorbthoracotomybincisionbandbisbusedbtobbypassbtheb
midbtobdistalbLADbwithbableftbinternalbmammarybarteryb(LIMA)bgraft.bAbministernoto
mybcanbalsobbebusedbtobgainbaccessbduringbMIDCAB.
Whichbofbthebfollowingbpatientsbisbatbhighestbriskbforbneurologicalbcomplicationsbafte
rbCABG?
,A.bAb63-year-boldbpatientbwithbabBMIbofb30bundergoingbOPCAB
B.bAb85-year-oldbpatientbwithbanbatheroscleroticbaortabundergoingbCPB
C.bAbpreviouslybhealthyb50-year-oldbwomanbundergoingbCPB
D.bAb67-year-
oldbmanbhavingbabMIDCABbtobthebLADbwithbnobknownbhistorybofbhypertensionb-
bcorrectbanswer-
B.bSeverebatherosclerosisbofbthebaorta,badvancedbage,busebofbCPB,baorticbcross-
clamping,bdiabetes,bhypertension,bfemalebsex,bandbhistorybofbstrokebplacebpatientsb
atbhighbriskbforbneurologicalbcomplicationsbfollowingbcardiacbsurgery.bOtherbfactorsb
contributingbtobneurologicalbcomplicationsbincludebalcoholbabuse,bheartbfailure,barrh
ythmias,bandbhyperglycemia.
Thebnursebcaringbforbthebpostboperativebcardiacbsurgerybpatientbrecognizesbthebfollo
wingbasbpotentialbcontributorsbtobpost-
operativebvasodilationbthatbcanbcausebhypotension:
A.bCoolingbthatboccursbwhilebonbcardiopulmonarybbypass,bandbusebofbvasodilatorsb
postbop.
B.bUsebofbnorepinephrineborbdopaminebtobsupportbBPbimmediatelybpost-op.
C.bInflammatorybresponsebduebtobCPBbandbusebofbnorepinephrinebtobsupportbBP
D.bRewarmingbthatboccursbafterbreturnbtobthebICU,bandbthebinflammatorybresponsebt
obusebofbcardiopulmonarybbypassbduringbsurgeryb-bcorrectbanswer-
D.bIntraoperativebcoolingbresultsbinbvasoconstriction;brewarmingbafterbsurgerybcause
sbvasodilationbandbcanbcontributebtobhypotensionbifbvolumebadministrationbisbinadeq
uatebforbthebincreasedbsizebofbthebvascularbspacebcausedbbybvasodilation.bThebuse
bofbCPBbstimulatesbanbinflammatorybresponsebthatbresultsbinbvasodilationbthatbcontri
butesbtobhypotension.
Norepinephrinebandbdopaminebcausebperipheralbvasoconstriction,bnotbvasodilation.
Abcharacteristicbofbabfast-trackbpathwaybafterbCABGbwouldbinclude:
A.banticipatedbdischargebbetweenbpost-opbdaysb7bandb8.
B.babdefinedbmedicationbstrategybtobpreventbpostoperativebatrialbfibrillation.
C.bliberalbusebofbopioidbmedicationsbtobincreasebpatientbcomfortbduringbthebventilato
rbweaningb
process.
D.bextubationbbybthebthirdbpost-opbdayb-bcorrectbanswer-C.bLow-
riskbpatientsbcanbbebselectedbforbfastbtrackingbafterbCABG.bThesebpatientsbarebtarg
etedbforbearlybextubation,bearlybambulation,bandbearlybdischarge.bPatientsbwhobarebf
astbtrackedbreceivebsedationbandbanalgesiabtoballowbforbearlybextubation.bPharmaco
logicalbstrategiesbtobpreventbatrialbfibrillationbandbearlybphasebIbcardiacbrehabilitation
barebalsobkeybcomponentsbofbfastbtracking.
Youbarebcaringbforbanbearlybpost-
operativebCABGbpatientbwhobremainsbhypotensivebdespitebtreatmentbwithbadequate
bfluidbadministrationbandbanbalphabconstrictingbagent.bYoubknowbthatbonebpotentialb
post-operativebcomplicationbresponsiblebforbthisbpersistentbhypotensionbcouldbbe:
A.bAcutebkidneybinjury.
B.bAcutebsaphenousbveinbgraftbclosure.
C.bAcutebrespiratorybdistressbsyndromeb(ARDS).
D.bVasoplegia.b-bcorrectbanswer-
D.bVasoplegiabisbabformbofbvasodilatorybshockbthatbcanboccurbafterbseparationbfromb
, CPB.bItbisbcharacterizedbbybsignificantbhypotensionbdespitebadequatebfluidbresuscita
tion,blowbSVR(duebtobvasodilation),bandbisbresistantbtobvasopressors.bWhenbvasopr
essorsb(norepinephrine,bepinephrine,bhighbdosebdopamine,borbvasopressin)barebnotb
ablebtobmaintainbbloodbpressurebinbthebpresencebofbadequatebfillingbpressures,bthen
bvasoplegiabmaybbebpresent.bTherebarebseveralbtheoriesbbehindbthebcausebofbvaso
plegia,bincludingbleukocytebactivationbandbthebreleasebofbpro-
inflammatorybmediatorsbduringbcardiopulmonarybbypass,bandbvasoplegiabhasbbeenb
associatedbwithblong-
termbusebofbACEbinhibitors,bcalciumbchannelbblockers,bamiodarone,bandbheparin.bP
atientsbwithbEFb<35%,bheartbfailurebandbdiabetesbarebatbhigherbrisk.bVasoplegiabcan
balsobbebseenbafterbOPCAB.b
Acutebrespiratorybdistressbsyndromeb(ARDS)bandbacutebkidneybfailurebcanbbothbbeb
complicationsbinbthebcardiacbsurgerybpatient,bbutbdobnotbtypicallyboccurbearlybinbtheb
post-
operativebcoursebandbarebnotbnecessarilybassociatedbwithbhypotensionbandbfailurebt
obrespondbtobvasopressors.b
Anbacutebsaphenousbveinbocclusionbcanboccurbasbabresultbofbpersistentbhypotensio
n.bThebmostbdirectbclinicalbsignsbofbacutebsaphenousbveinbgraftbclosurebwouldbbebth
osebofbischemia.
Mediastinalbdrainagebinbthebfollowingbamountbmeetsbcriteriabforbre-exploration:
A.b>b300bml/hrbforb2-3bhours.
B.b>b200bml/hrbforb4bhours.
C.b>b400bmlbtob500bmlbforb1bhour.
D.bAllbofbthebabove.b-bcorrectbanswer-
D.bChestbtubebdrainagebcriteriabforbsurgicalbre-exploration:
•b>b400btob500bmlbforb1bhour
•b>b300bml/hrbforb2btob3bhours
•b>b200bml/hrbforb4bhoursb
•bAcutebonsetbofbbleedingb>300bml/hrbafterbperiodbofbstablebandbminimalbbleeding
PatientsbwithbprolongedbCPBbtimesbareblikelybtobexperience:
A.bAnbincreasedblikelihoodbofbearlybextubation.
B.bAnbincreasebinbcoagulopathies.
C.bAbdecreasebinbtotalbbodybfluidbduebtobdehydration.
D.bAbdecreasebinbchestbtubebdrainage.b-bcorrectbanswer-
B.bCoagulopathybisbpresentbtobsomebdegreebwithballbCPB.bDuringbCPB,bbloodbcont
actsbthebnon-
physiologicalbsurfacesbofbthebbypassbcircuitbandbanbinflammatorybresponsebisbinitiat
ed.bAbcoagulopathybcanbdevelopbfrombactivationbofbplateletsbandbthebfibrinolyticbsys
tem.bClottingbfactors,bplatelets,bandbRBCsbarebdilutedbduringbCPB.bAblongerbpumpbt
imebisbassociatedbwithbincreasedbcoagulopathies.
Postoperatively,bpatientsbhavebanbincreasedbamountbofbtotalbbodybfluidbduebtobprimi
ngbofbthebCPBbpumpbandbadministrationbofbfluidsbduringbsurgery.bExtrabvolumebisbgi
venbtobthebpatientbduringbcardiopulmonarybbypassbtobassurebadequatebcirculatingbv
olumebthroughbthebcardiopulmonarybcircuit.
Longbpumpbtimesbarebassociatedbwithbincreasedbbleedingbandbthereforebincreasedb
chestbtubebdrainage,bandbprolongsbtimebtobextubation.
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