NBCRNA CERTIFICATION COMPREHENSIVE EXAM
UPDATED QUESTIONS AND SOLUTIONS RATED A+
✔✔Most common cause of constrictive pericarditis? - ✔✔radiation or previous cardiac
surgery
✔✔When compared to acute pericarditis, what is more likely to occur with constrictive
pericarditis? - ✔✔Kussmauls sign
pulsus paradoxus
Atrial dysrhythmias
pericardial knock
increased venous pressure
Impaired diastolic filling! decreased ventricular compliance
✔✔s/sx of acute pericarditis? - ✔✔acute chest pain, increasing with inspiration
fever
pericardial friction rub
ST elevation
DOES NOT impair diastolic filling
✔✔Kussmaul's sign is associated with increased?
What would you see on a CVP waveform?
highly suggestive of what? - ✔✔jugular venous pressure
paradoxical rise in JVP during inspiration
- from restricted RV filling, and the high right-sided heart pressure is reflected back to
the jugular veins
x and y descents are exaggerated
highly suggestive of constrictive pericarditis
✔✔What pulsus is most likely to occur with pericardial tamponade? - ✔✔pulsus
paradoxus
✔✔What is the difference btw effusion and tamponade? - ✔✔effusion is accumulation of
fluid inside the pericardial sac, but it is not enough to impair cardiac filling
tamponade affects cardiac filling
,✔✔What is pulsus paradoxus? - ✔✔SBP decreases with each inspiration, and it
declines greater than 10mmHg
✔✔Antibiotic prophylaxis against endocarditis indicated if a patient has a hx of?? -
✔✔prosthetic heart valve
unrepaired cyanotic heart dx
hx of infective endocarditis
heart transplant with valvuloplasty
repaired congenital heart dx if repair < 6 months old or has residual defects that have
impaired endothelialization at the graft site
✔✔What are the synonyms for idiopathic hypertrophic subaortic stenosis? (4) - ✔✔1.
obstructive hypertrophic CMP (OHCM)
2. hypertrophic obstructive CMP
(HOCM)
3. Idiopathic hypertrophic subaortic stenosis (IHSS)
4. Asymmetric septal hypertrophy (ASH)
✔✔What helps reduce SV in a pt with hypertrophic CMP?
What are we always worried about with these patients? - ✔✔Valsalva maneuver
ephedrine
nitroprusside
- LVOT obstruction
✔✔what 4 conditions increase risk of LVOT obstruction? - ✔✔decreased preload,
afterload, increased HR and contractility
✔✔What are some conditions that decrease preload? - ✔✔vasodilators
neuraxial anesthesia
hypovolemia
postural changes (reverse T)
PPV
valsalva maneuver
✔✔What are some conditions that decrease afterload? - ✔✔vasodilators
neuraxial anesthesia
oxytocin
✔✔What are some conditions that increase contractility? - ✔✔beta agonists
digoxin
light anesthesia
✔✔What diseases cause secondary HTN? - ✔✔coarctation of the aorta
,Conn's dx (hyperaldosteronism)
Cushing's syndrome (Hyperadrenocorticism)
Pheo
pregnancy-induced HTN
✔✔Potential consequences of thoracic aorta cross-clamp include? - ✔✔spinothalamic
tract impairment
✔✔Spinal cord's blood supply: - ✔✔2 posterior spinal arteries (dorsal cord = sensory)
1 anterior spinal artery (anterior cord = motor)
✔✔What is the anterior spinal cord artery supplied by? - ✔✔vertebral arteries, as well
as 6-8 radicular arteries that arise from the aorta.
✔✔The artery of Adamkiewicz perfuses?
arises from? - ✔✔much of the thoracolumbar cord
*most important radicular artery
T8-T12 in 75% of the populations
✔✔s/sx of anterior spinal artery syndrome?
What is preserved? - ✔✔Beck's syndrome:
flaccid paralysis of LE
bowel and bladder dysfunction
loss of temp and pain sensation
touch and proprioception PRESERVED!
✔✔Becks triad?
consequence of what? - ✔✔distended jugular veins
muffled heart sounds
hypotension
cardiac tamponade
✔✔What is the best way to preserve spinal cord blood flow during an ascending aortic
aneurysm repair?
other ways to preserve? - ✔✔cerebrospinal fluid drainage
other ways: moderate hypothermia (30-32C)
prox HTN during xclamp MAP 100
Avoid hyperglycemia
partial CPB (LA to fem artery)
, drugs: corticosteroids, CCB and/or Mannitol
✔✔What increases after placement of infra-renal aortic cross-clamp? - ✔✔preload
mixed venous oxygen saturation
✔✔Potential complications of CEA: - ✔✔hematoma at surg site
ipsilateral RLN injury
Hemodynamic instability - HTN
Carotid body denervation - decreases the ventilatory response to hypoxia
✔✔How long should surgery be delayed after a DES is placed? - ✔✔1 year
365 days
12 months
✔✔How long should surgery be delayed after bare metal stent placed? - ✔✔90 days
3 months
✔✔Most common cause of death in a patient with LVAD? - ✔✔infection
✔✔Match the following with their hemodynamic data:
Cardiac tamponade
Pulm HTN
LV failure
ARDS
- CVP, PADP, PAOP - ✔✔Cardiac tamponade:
all three increased
Pulm HTN:
increased CVP, increased PADP, normal PAOP
LV failure:
normal CVP, increased PADP, increased PAOP
ARDS:
decreased CVP, increased PADP, normal PAOP
✔✔What dx is common in children, presents with "strawberry" tongue, and is associated
with an increased risk of coronary artery aneurysm? - ✔✔Kawasaki's disease
"mucocutaneous lymph node syndrome
✔✔What is Takayasu's arteritis? - ✔✔occlusive disease of the proximal aorta and its
main branches
- pulseless dx or occlusive thromboaortopathy or aortic arch syndrome
UPDATED QUESTIONS AND SOLUTIONS RATED A+
✔✔Most common cause of constrictive pericarditis? - ✔✔radiation or previous cardiac
surgery
✔✔When compared to acute pericarditis, what is more likely to occur with constrictive
pericarditis? - ✔✔Kussmauls sign
pulsus paradoxus
Atrial dysrhythmias
pericardial knock
increased venous pressure
Impaired diastolic filling! decreased ventricular compliance
✔✔s/sx of acute pericarditis? - ✔✔acute chest pain, increasing with inspiration
fever
pericardial friction rub
ST elevation
DOES NOT impair diastolic filling
✔✔Kussmaul's sign is associated with increased?
What would you see on a CVP waveform?
highly suggestive of what? - ✔✔jugular venous pressure
paradoxical rise in JVP during inspiration
- from restricted RV filling, and the high right-sided heart pressure is reflected back to
the jugular veins
x and y descents are exaggerated
highly suggestive of constrictive pericarditis
✔✔What pulsus is most likely to occur with pericardial tamponade? - ✔✔pulsus
paradoxus
✔✔What is the difference btw effusion and tamponade? - ✔✔effusion is accumulation of
fluid inside the pericardial sac, but it is not enough to impair cardiac filling
tamponade affects cardiac filling
,✔✔What is pulsus paradoxus? - ✔✔SBP decreases with each inspiration, and it
declines greater than 10mmHg
✔✔Antibiotic prophylaxis against endocarditis indicated if a patient has a hx of?? -
✔✔prosthetic heart valve
unrepaired cyanotic heart dx
hx of infective endocarditis
heart transplant with valvuloplasty
repaired congenital heart dx if repair < 6 months old or has residual defects that have
impaired endothelialization at the graft site
✔✔What are the synonyms for idiopathic hypertrophic subaortic stenosis? (4) - ✔✔1.
obstructive hypertrophic CMP (OHCM)
2. hypertrophic obstructive CMP
(HOCM)
3. Idiopathic hypertrophic subaortic stenosis (IHSS)
4. Asymmetric septal hypertrophy (ASH)
✔✔What helps reduce SV in a pt with hypertrophic CMP?
What are we always worried about with these patients? - ✔✔Valsalva maneuver
ephedrine
nitroprusside
- LVOT obstruction
✔✔what 4 conditions increase risk of LVOT obstruction? - ✔✔decreased preload,
afterload, increased HR and contractility
✔✔What are some conditions that decrease preload? - ✔✔vasodilators
neuraxial anesthesia
hypovolemia
postural changes (reverse T)
PPV
valsalva maneuver
✔✔What are some conditions that decrease afterload? - ✔✔vasodilators
neuraxial anesthesia
oxytocin
✔✔What are some conditions that increase contractility? - ✔✔beta agonists
digoxin
light anesthesia
✔✔What diseases cause secondary HTN? - ✔✔coarctation of the aorta
,Conn's dx (hyperaldosteronism)
Cushing's syndrome (Hyperadrenocorticism)
Pheo
pregnancy-induced HTN
✔✔Potential consequences of thoracic aorta cross-clamp include? - ✔✔spinothalamic
tract impairment
✔✔Spinal cord's blood supply: - ✔✔2 posterior spinal arteries (dorsal cord = sensory)
1 anterior spinal artery (anterior cord = motor)
✔✔What is the anterior spinal cord artery supplied by? - ✔✔vertebral arteries, as well
as 6-8 radicular arteries that arise from the aorta.
✔✔The artery of Adamkiewicz perfuses?
arises from? - ✔✔much of the thoracolumbar cord
*most important radicular artery
T8-T12 in 75% of the populations
✔✔s/sx of anterior spinal artery syndrome?
What is preserved? - ✔✔Beck's syndrome:
flaccid paralysis of LE
bowel and bladder dysfunction
loss of temp and pain sensation
touch and proprioception PRESERVED!
✔✔Becks triad?
consequence of what? - ✔✔distended jugular veins
muffled heart sounds
hypotension
cardiac tamponade
✔✔What is the best way to preserve spinal cord blood flow during an ascending aortic
aneurysm repair?
other ways to preserve? - ✔✔cerebrospinal fluid drainage
other ways: moderate hypothermia (30-32C)
prox HTN during xclamp MAP 100
Avoid hyperglycemia
partial CPB (LA to fem artery)
, drugs: corticosteroids, CCB and/or Mannitol
✔✔What increases after placement of infra-renal aortic cross-clamp? - ✔✔preload
mixed venous oxygen saturation
✔✔Potential complications of CEA: - ✔✔hematoma at surg site
ipsilateral RLN injury
Hemodynamic instability - HTN
Carotid body denervation - decreases the ventilatory response to hypoxia
✔✔How long should surgery be delayed after a DES is placed? - ✔✔1 year
365 days
12 months
✔✔How long should surgery be delayed after bare metal stent placed? - ✔✔90 days
3 months
✔✔Most common cause of death in a patient with LVAD? - ✔✔infection
✔✔Match the following with their hemodynamic data:
Cardiac tamponade
Pulm HTN
LV failure
ARDS
- CVP, PADP, PAOP - ✔✔Cardiac tamponade:
all three increased
Pulm HTN:
increased CVP, increased PADP, normal PAOP
LV failure:
normal CVP, increased PADP, increased PAOP
ARDS:
decreased CVP, increased PADP, normal PAOP
✔✔What dx is common in children, presents with "strawberry" tongue, and is associated
with an increased risk of coronary artery aneurysm? - ✔✔Kawasaki's disease
"mucocutaneous lymph node syndrome
✔✔What is Takayasu's arteritis? - ✔✔occlusive disease of the proximal aorta and its
main branches
- pulseless dx or occlusive thromboaortopathy or aortic arch syndrome
