CMC certification 2026 correct answers
HIT (heparin induced thrombocytopenia) - correct answers Bivalirudin and Argatroban are
direct thrombin inhibitors and alternatives for anticoagulation for patients with HIT.
- HIT is an immune mediated adverse drug reaction caused by antibodies that develop after
exposure to heparin, platelets become activated placing patients at risk for development of
thrombosis
pericarditis - correct answers inflammation of pericardial sac, chest pain-sharp,stabbing, dull,
achy
pain improved with sitting &leaning foward, pain worse with cough, positional changes and
inspiration,
pericardial friction rub, fever, Diffuse ST changes (depression of PR interval, concave ST
segment in limb leads,st elevation in leads I and II
Papillary muscle rupture - correct answers -associated with anterior or inferior wall MI
- hemodynamic instability, new loud systolic murmur, acute mitral regurgitation, large V
waves on PAOP waveform
- treatment - hemodynamic support, Emergent surgical repair/valve replacement
Ventricular septal rupture - correct answers -associated with septal wall MI
-oxygen rich blood shunts to right side of heart from the left
Symptoms of ventricular septal rupture - correct answers -acute SOB
-S3 heart sound
-crackles
-holosystolic murmur
- PA Catheter insertion--> falsely increaed CO, because CO reading is derived from the right
ventricle, increased Svo2 due to left to right shunting, large V waves on CVP waveform,
diagnosed by ECHO
,- treatement surgical repair
cardiogenic shock - correct answers S3 pulmonary edema, tachycardia, dysrhythmias, signs
of decreased perfusion (mottling), decreased UOP <0.5ml/kg/hr, hypotension, low CO/CI,
elevated SVR often > 1600 dynes/sec/cm, elevated RAP/CVP, PAOP >16 mmhg, decreased
svo2 (<65%)
other diagnostics for cardiogenic shock - correct answers - cardiac catheterization if related
to ischemia- PCI for reperfusion
- ABG- mixed respiratory and metabolic acidosis:hypoxemia- lactic acidosis due to decreased
perfusion and anaerobic metabolism
-ECHO: decreased wall motion,reduced ejection fraction
-Chestxray: pulmonary edema &congestion, may note opacity due to enlarged pulmonary
vasculature, enlarge d heart, Kerley B lines in lower zones from interstitial edema,
- BUN/CR- monitor for acute kidney injury
- monitor other organs for dysfunction and failure
supportive treatment for cardiogenic shock - correct answers -mechanical support
(IABP,impella)
-vasopressors to support blood pressure (use with caution as they increase SVR and
workload of heart)
-positive inotrope to improve contractility
-diuretics
afterload reduction / venous vasodilators
cardiogenic pulmonary edema - correct answers -fluid in the alveolus due to increased
alveolar hydrostatic pressures
- impaired gas exchange, hypercapnia
- hypoxemia- S3 heart sound, shortness of breath, crackles, pinky frothy sputum, anxiety
Causes of cardiogenic pulmonary edema - correct answers myocardial infarction, heart
failure, hypertensive crisis, mitral regurgitation, tamponade
,Treatment of pulmonary edema - correct answers -decrease preload
-loop diuretics
-nitroglycerin
-morphine
- CPAP or BIPAP
- Positive inotrope to improve contractility
Cardiac output (CO) - correct answers 4-8 L/min
Cardiac index (CI) - correct answers 2.5-4 L/min/m2
Stroke volume (SV) - correct answers 50-100 ml/beat
Stroke volume index - correct answers 35-60 ml/beat/m2
Right ventricular stroke work index (RVSWI) - correct answers 5-10 g/m2/beat
Left ventricular stroke work index (LVSWI) - correct answers 50-62 g/m2/beat
SVO2 - correct answers 60-75%
Scvo2 - correct answers over 70% (70-85%)
pulmonary artery pressure - correct answers 25/10 mmHG
PAOP - correct answers 8-12 mmHG
, RAP/CVP - correct answers 2-8 mmHG
SVR - correct answers 900-1400 dynes/sec/cm-5
SVRI - correct answers 1970-2390 dynes/sec/cm-5/m2
PVR - correct answers 90-250 Dynes/sec/cm-5
LV pressure - correct answers 100 mmhg
Cardiac output formula - correct answers CO=SVxHR
MAP= - correct answers CO x SVR
Cardiac output can be measures with - correct answers Pulmonary artery catheter,
echocardiogram, indirectly via functional hemodynamics, noninvasive methods
(bioreactance and continuous digit CO), fick equation
in low output states patients compensate with - correct answers tachycardia, CO may be
normal when the patient is tachycardic with lower SV
Stroke volume formula - correct answers SV= end diastolic volume- end systolic volume
SV=EDV-ESV
Typical EDV - correct answers 120 ml
amount of blood in the heart at the end of diastole
Typical ESV - correct answers 50 ml
amount of blood in the ventricles at end of ejection/systole
HIT (heparin induced thrombocytopenia) - correct answers Bivalirudin and Argatroban are
direct thrombin inhibitors and alternatives for anticoagulation for patients with HIT.
- HIT is an immune mediated adverse drug reaction caused by antibodies that develop after
exposure to heparin, platelets become activated placing patients at risk for development of
thrombosis
pericarditis - correct answers inflammation of pericardial sac, chest pain-sharp,stabbing, dull,
achy
pain improved with sitting &leaning foward, pain worse with cough, positional changes and
inspiration,
pericardial friction rub, fever, Diffuse ST changes (depression of PR interval, concave ST
segment in limb leads,st elevation in leads I and II
Papillary muscle rupture - correct answers -associated with anterior or inferior wall MI
- hemodynamic instability, new loud systolic murmur, acute mitral regurgitation, large V
waves on PAOP waveform
- treatment - hemodynamic support, Emergent surgical repair/valve replacement
Ventricular septal rupture - correct answers -associated with septal wall MI
-oxygen rich blood shunts to right side of heart from the left
Symptoms of ventricular septal rupture - correct answers -acute SOB
-S3 heart sound
-crackles
-holosystolic murmur
- PA Catheter insertion--> falsely increaed CO, because CO reading is derived from the right
ventricle, increased Svo2 due to left to right shunting, large V waves on CVP waveform,
diagnosed by ECHO
,- treatement surgical repair
cardiogenic shock - correct answers S3 pulmonary edema, tachycardia, dysrhythmias, signs
of decreased perfusion (mottling), decreased UOP <0.5ml/kg/hr, hypotension, low CO/CI,
elevated SVR often > 1600 dynes/sec/cm, elevated RAP/CVP, PAOP >16 mmhg, decreased
svo2 (<65%)
other diagnostics for cardiogenic shock - correct answers - cardiac catheterization if related
to ischemia- PCI for reperfusion
- ABG- mixed respiratory and metabolic acidosis:hypoxemia- lactic acidosis due to decreased
perfusion and anaerobic metabolism
-ECHO: decreased wall motion,reduced ejection fraction
-Chestxray: pulmonary edema &congestion, may note opacity due to enlarged pulmonary
vasculature, enlarge d heart, Kerley B lines in lower zones from interstitial edema,
- BUN/CR- monitor for acute kidney injury
- monitor other organs for dysfunction and failure
supportive treatment for cardiogenic shock - correct answers -mechanical support
(IABP,impella)
-vasopressors to support blood pressure (use with caution as they increase SVR and
workload of heart)
-positive inotrope to improve contractility
-diuretics
afterload reduction / venous vasodilators
cardiogenic pulmonary edema - correct answers -fluid in the alveolus due to increased
alveolar hydrostatic pressures
- impaired gas exchange, hypercapnia
- hypoxemia- S3 heart sound, shortness of breath, crackles, pinky frothy sputum, anxiety
Causes of cardiogenic pulmonary edema - correct answers myocardial infarction, heart
failure, hypertensive crisis, mitral regurgitation, tamponade
,Treatment of pulmonary edema - correct answers -decrease preload
-loop diuretics
-nitroglycerin
-morphine
- CPAP or BIPAP
- Positive inotrope to improve contractility
Cardiac output (CO) - correct answers 4-8 L/min
Cardiac index (CI) - correct answers 2.5-4 L/min/m2
Stroke volume (SV) - correct answers 50-100 ml/beat
Stroke volume index - correct answers 35-60 ml/beat/m2
Right ventricular stroke work index (RVSWI) - correct answers 5-10 g/m2/beat
Left ventricular stroke work index (LVSWI) - correct answers 50-62 g/m2/beat
SVO2 - correct answers 60-75%
Scvo2 - correct answers over 70% (70-85%)
pulmonary artery pressure - correct answers 25/10 mmHG
PAOP - correct answers 8-12 mmHG
, RAP/CVP - correct answers 2-8 mmHG
SVR - correct answers 900-1400 dynes/sec/cm-5
SVRI - correct answers 1970-2390 dynes/sec/cm-5/m2
PVR - correct answers 90-250 Dynes/sec/cm-5
LV pressure - correct answers 100 mmhg
Cardiac output formula - correct answers CO=SVxHR
MAP= - correct answers CO x SVR
Cardiac output can be measures with - correct answers Pulmonary artery catheter,
echocardiogram, indirectly via functional hemodynamics, noninvasive methods
(bioreactance and continuous digit CO), fick equation
in low output states patients compensate with - correct answers tachycardia, CO may be
normal when the patient is tachycardic with lower SV
Stroke volume formula - correct answers SV= end diastolic volume- end systolic volume
SV=EDV-ESV
Typical EDV - correct answers 120 ml
amount of blood in the heart at the end of diastole
Typical ESV - correct answers 50 ml
amount of blood in the ventricles at end of ejection/systole
