CCTC EXAM Q&A
You are caring for 25 year old male patient who is on heart transplant waitlist. He is
clinically deteriorating and went to the cath lab. His hemodynamics are as follows:
Pulm artery pressure mean =30, pulm capillary wedge pressure = 22, cardiac output
= 2.0, cardiac index = 1.5, creatinine 3.2, HR of 150s, SBP of 70. You can anticipate
next steps to manage his heart failure will be:
1. IV inotropes
2. Mechanical support as bridge to transplant
3. Consult renal and possible evaluate for kidney transplant
4. Endomyocardial biopsy once return to cath lab
5. All of the above
a. 1, 2 and 3
b. 1 only
c. 1 and 2 only
d. 1, 2, 3 and 4 only
e. All of the above - ANSWER-c. 1 and 2 only
Cardiac index is decreased, cardiac output is decreased, increased creatinine/ HR,
decreased SBP
Inotropes help with squeezing of the heart
Mechanical support as bridge to transplant
You are caring for a 25 year old candidate who is undergoing a heart transplant this
evening. He is asking you questions about the procedure. In explaining the surgical
procedure, it is important to provide patients and families with information and
diagrams/photos about which of the following?
A. Surgical incision
B. Immunosuppression medications
C. Various tubes and invasive monitoring that may be used
D. A and C only
E. All of the above - ANSWER-D. A and C only
Main goal to discuss is SURGICAL PROCEDURE, not about immunosuppression
(post-procedure)
You are caring for a 42 year old female heart transplant recipient. She is being
prepared for an endomyocardial biopsy. Which of the following should the transplant
coordinator explain to the recipient?
A. An echocardiogram is needed follow the biopsy
B. Endocardial tissue is obtained from the atrium
C. An overnight stay at the hospital is needed for observation
D. The internal jugular vein is the most common approach - ANSWER-D. The
internal jugular vein is the most common approach
,Not routine for an echo with a biopsy
Biopsy is obtained from the right ventricle
Not usually admitted, generally outpatient
You are discussing medications with a 35 year old post heart transplant recipient. He
has brought his wife to the clinic appointment. He has expressed concerns regarding
impotence post transplant. You are reviewing his medication list. Which medication
is known to have the side effect of impotence?
A. Lisinopril
B. Amlodipine
C. Atenolol
D. Lasix - ANSWER-C. Atenolol (beta blocker)
A heart transplant candidate is clinically deteriorating and is in the CICU. He was
taken to the cath lab to reassess hemodynamics and possible intervention. The
coordinator reviewed the listing status for this patient who is on a MCSD with device
malfunction and mechanical failure. The correct status for this patient is:
A. Status 1
B. Status 2
C. Status 3
D. Status 4 - ANSWER-B. Status 2
Four years post-heart transplant, a recipient with known coronary artery
vasculopathy (CAV) calls to report sudden onset of shortness of breath, nausea,
diaphoresis, and fatigue. Vital signs are BP= 160/94, HR = 80, Temp 36.8. The
transplant coordinator should anticipate which of the following diagnostic procedures
to be performed?
A. Chest CT scan
B. Echo
C. V/Q scan
D. Left heart catherization - ANSWER-D. Left heart catherization
Gold standard on ruling out coronary disease
A 65 year old male is being evaluated for heart transplant. Absolute contraindications
to heart transplant would be:
1. History of carcinoma within the last year
2. History of alcohol abuse
3. Recent pulmonary infarction
4. Positive CMV IGG antibody
A. 1 and 3
B. 1 and 4
C. 2 and 4
D. 3 and 4 - ANSWER-A. 1 and 3
,1. History of carcinoma within the last year
3. Recent pulmonary infarction
History of alcohol abuse and positive CMV Igg antibody are not absolute
A 52 year old female is admitted to the CICU. The clinical manifestations of rejection
are likely to include:
1. Hypertension
2. Fever >101 degrees
3. Hypotension
4. Atrial dysrhythmias
a. 1 and 2
b. 3 and 4
c. 2 and 4
d. 1 and 4 - ANSWER-b. 3 and 4
3. Hypotension
4. Atrial dysrhythmias
Hypertension is an long term complication of transplant. Fever indicates infection.
What criteria to list for Status 3 for heart transplant for ADULTS? - ANSWER-
Dischargeable LVAD for discretionary 30 days
Multiple inotrope or single high dose inotrope with continuous hemodynamic
monitoring
VA ECMO after 7 days, percutaneous endovascular circulatory support device or
IABP after 14 days
Non-dischargeable , surgically implanted non-endovascular after 14 days
MCSD with one of the following: device infection, hemolysis, pump thrombosis, right
heart failure, mucosal bleeding, aortic insufficiency
What criteria to list for Status 4 for heart transplant for ADULTS? - ANSWER-
Dischargeable LVAD without discretionary 30 days
Inotropes without hemodynamic monitoring
Re-transplant
One of the following:
congenital heart disease, ischemic heart disease with intractable angina,
hypertrophic cardiomyopathy, restrictive cardiomyopathy , amyloidosis
What is Status 1A for heart transplant for PEDIATRICS? - ANSWER-Ventilator,
mechanical assistance, ductal dependent pulmonary or systemic circulation
maintained by stent/prostaglandins, congenital heart disease on inotropes in hospital
What is Status 1B for heart transplant for PEDIATRICS? - ANSWER-High dose
inotropes, restrictive or hypertrophic cardiomyopathy < 1 year at the time of listing
What is Status 2 for heart transplant for PEDIATRICS? - ANSWER-Active listing, not
meeting any Status 1A or 1B criteria
, What is Status 5 for heart transplant for ADULTS? - ANSWER-On waitlist for at least
one other organ at same hospital (dual organ)
What is Status 6 for heart transplant for ADULTS? - ANSWER-All candidates that
don't meet any other criteria
You have been managing a 25 year old male outpatient on your heart transplant
waitlist. He currently has been doing well with compensated cardiac function with
biventricular systolic heart failure with NYHA class II symptoms and ACC/AHA stage
D heart failure (previously supported by ECMO). HE just has been admitted to CICU
for decompensated heart failure. His signs and symptoms would likely include:
1. BNP 15,000, creatinine 2.0, heart rate >100, blood pressure <100
2. BNP 100, creatinine 2.0, heart rate >100, blood pressure <100
3. BNP 1500, creatinine 2.0, peripheral edema, decreased abdominal fullness
4. BNP 100, blood pressure <100, peripheral edema, increased abdominal fullness -
ANSWER-1. BNP 15,000, creatinine 2.0, heart rate >100, blood pressure <100
Tachycardia / Decreased BP = decompensated not getting good squeeze
Increased BNP (rise with heart failure)
Increased creatinine (rise with end organ dysfunction)
A 21 year old male on your heart transplant wait list was admitted to hospital. He has
the diagnosis of congenital heart disease. He was previously waiting at home without
inotropes. He clinically deteriorated in the CICU and now has been placed on
ECMO. He continues to be an appropriate transplant candidate. The transplant
coordinator should update his listing status. What was this patient's listing status at
admission and what should the candidate's updated listing status be now?
1. Status 6 on admission, update to status 1
2. Status 4 on admission, update to status 2
3. Status 5 at admission, update to status 1
4. Status 4 at admission, update to status 1 - ANSWER-4. Status 4 at admission
(due to CHD), update to status 1 (VA ECMO), placed on ECMO at admission.
You just completed the evaluation of a 15 month old heart transplant candidate in the
CICU. The committee agreed to move forward with listing and you have met with the
family and completed all the necessary paperwork. You will be listing that patient
today. The patient has a history of congenital heart disease and is on a high dose
milrinone infusion. His blood type is O (isotiters are zero). How will you list this
patient?
1. ABO compatible, status 1A
2. ABO compatible, status 1B
3. ABO incompatible, status 1A
4. ABO incompatible, status 1B - ANSWER-3. ABO incompatible, status 1A
You are caring for 25 year old male patient who is on heart transplant waitlist. He is
clinically deteriorating and went to the cath lab. His hemodynamics are as follows:
Pulm artery pressure mean =30, pulm capillary wedge pressure = 22, cardiac output
= 2.0, cardiac index = 1.5, creatinine 3.2, HR of 150s, SBP of 70. You can anticipate
next steps to manage his heart failure will be:
1. IV inotropes
2. Mechanical support as bridge to transplant
3. Consult renal and possible evaluate for kidney transplant
4. Endomyocardial biopsy once return to cath lab
5. All of the above
a. 1, 2 and 3
b. 1 only
c. 1 and 2 only
d. 1, 2, 3 and 4 only
e. All of the above - ANSWER-c. 1 and 2 only
Cardiac index is decreased, cardiac output is decreased, increased creatinine/ HR,
decreased SBP
Inotropes help with squeezing of the heart
Mechanical support as bridge to transplant
You are caring for a 25 year old candidate who is undergoing a heart transplant this
evening. He is asking you questions about the procedure. In explaining the surgical
procedure, it is important to provide patients and families with information and
diagrams/photos about which of the following?
A. Surgical incision
B. Immunosuppression medications
C. Various tubes and invasive monitoring that may be used
D. A and C only
E. All of the above - ANSWER-D. A and C only
Main goal to discuss is SURGICAL PROCEDURE, not about immunosuppression
(post-procedure)
You are caring for a 42 year old female heart transplant recipient. She is being
prepared for an endomyocardial biopsy. Which of the following should the transplant
coordinator explain to the recipient?
A. An echocardiogram is needed follow the biopsy
B. Endocardial tissue is obtained from the atrium
C. An overnight stay at the hospital is needed for observation
D. The internal jugular vein is the most common approach - ANSWER-D. The
internal jugular vein is the most common approach
,Not routine for an echo with a biopsy
Biopsy is obtained from the right ventricle
Not usually admitted, generally outpatient
You are discussing medications with a 35 year old post heart transplant recipient. He
has brought his wife to the clinic appointment. He has expressed concerns regarding
impotence post transplant. You are reviewing his medication list. Which medication
is known to have the side effect of impotence?
A. Lisinopril
B. Amlodipine
C. Atenolol
D. Lasix - ANSWER-C. Atenolol (beta blocker)
A heart transplant candidate is clinically deteriorating and is in the CICU. He was
taken to the cath lab to reassess hemodynamics and possible intervention. The
coordinator reviewed the listing status for this patient who is on a MCSD with device
malfunction and mechanical failure. The correct status for this patient is:
A. Status 1
B. Status 2
C. Status 3
D. Status 4 - ANSWER-B. Status 2
Four years post-heart transplant, a recipient with known coronary artery
vasculopathy (CAV) calls to report sudden onset of shortness of breath, nausea,
diaphoresis, and fatigue. Vital signs are BP= 160/94, HR = 80, Temp 36.8. The
transplant coordinator should anticipate which of the following diagnostic procedures
to be performed?
A. Chest CT scan
B. Echo
C. V/Q scan
D. Left heart catherization - ANSWER-D. Left heart catherization
Gold standard on ruling out coronary disease
A 65 year old male is being evaluated for heart transplant. Absolute contraindications
to heart transplant would be:
1. History of carcinoma within the last year
2. History of alcohol abuse
3. Recent pulmonary infarction
4. Positive CMV IGG antibody
A. 1 and 3
B. 1 and 4
C. 2 and 4
D. 3 and 4 - ANSWER-A. 1 and 3
,1. History of carcinoma within the last year
3. Recent pulmonary infarction
History of alcohol abuse and positive CMV Igg antibody are not absolute
A 52 year old female is admitted to the CICU. The clinical manifestations of rejection
are likely to include:
1. Hypertension
2. Fever >101 degrees
3. Hypotension
4. Atrial dysrhythmias
a. 1 and 2
b. 3 and 4
c. 2 and 4
d. 1 and 4 - ANSWER-b. 3 and 4
3. Hypotension
4. Atrial dysrhythmias
Hypertension is an long term complication of transplant. Fever indicates infection.
What criteria to list for Status 3 for heart transplant for ADULTS? - ANSWER-
Dischargeable LVAD for discretionary 30 days
Multiple inotrope or single high dose inotrope with continuous hemodynamic
monitoring
VA ECMO after 7 days, percutaneous endovascular circulatory support device or
IABP after 14 days
Non-dischargeable , surgically implanted non-endovascular after 14 days
MCSD with one of the following: device infection, hemolysis, pump thrombosis, right
heart failure, mucosal bleeding, aortic insufficiency
What criteria to list for Status 4 for heart transplant for ADULTS? - ANSWER-
Dischargeable LVAD without discretionary 30 days
Inotropes without hemodynamic monitoring
Re-transplant
One of the following:
congenital heart disease, ischemic heart disease with intractable angina,
hypertrophic cardiomyopathy, restrictive cardiomyopathy , amyloidosis
What is Status 1A for heart transplant for PEDIATRICS? - ANSWER-Ventilator,
mechanical assistance, ductal dependent pulmonary or systemic circulation
maintained by stent/prostaglandins, congenital heart disease on inotropes in hospital
What is Status 1B for heart transplant for PEDIATRICS? - ANSWER-High dose
inotropes, restrictive or hypertrophic cardiomyopathy < 1 year at the time of listing
What is Status 2 for heart transplant for PEDIATRICS? - ANSWER-Active listing, not
meeting any Status 1A or 1B criteria
, What is Status 5 for heart transplant for ADULTS? - ANSWER-On waitlist for at least
one other organ at same hospital (dual organ)
What is Status 6 for heart transplant for ADULTS? - ANSWER-All candidates that
don't meet any other criteria
You have been managing a 25 year old male outpatient on your heart transplant
waitlist. He currently has been doing well with compensated cardiac function with
biventricular systolic heart failure with NYHA class II symptoms and ACC/AHA stage
D heart failure (previously supported by ECMO). HE just has been admitted to CICU
for decompensated heart failure. His signs and symptoms would likely include:
1. BNP 15,000, creatinine 2.0, heart rate >100, blood pressure <100
2. BNP 100, creatinine 2.0, heart rate >100, blood pressure <100
3. BNP 1500, creatinine 2.0, peripheral edema, decreased abdominal fullness
4. BNP 100, blood pressure <100, peripheral edema, increased abdominal fullness -
ANSWER-1. BNP 15,000, creatinine 2.0, heart rate >100, blood pressure <100
Tachycardia / Decreased BP = decompensated not getting good squeeze
Increased BNP (rise with heart failure)
Increased creatinine (rise with end organ dysfunction)
A 21 year old male on your heart transplant wait list was admitted to hospital. He has
the diagnosis of congenital heart disease. He was previously waiting at home without
inotropes. He clinically deteriorated in the CICU and now has been placed on
ECMO. He continues to be an appropriate transplant candidate. The transplant
coordinator should update his listing status. What was this patient's listing status at
admission and what should the candidate's updated listing status be now?
1. Status 6 on admission, update to status 1
2. Status 4 on admission, update to status 2
3. Status 5 at admission, update to status 1
4. Status 4 at admission, update to status 1 - ANSWER-4. Status 4 at admission
(due to CHD), update to status 1 (VA ECMO), placed on ECMO at admission.
You just completed the evaluation of a 15 month old heart transplant candidate in the
CICU. The committee agreed to move forward with listing and you have met with the
family and completed all the necessary paperwork. You will be listing that patient
today. The patient has a history of congenital heart disease and is on a high dose
milrinone infusion. His blood type is O (isotiters are zero). How will you list this
patient?
1. ABO compatible, status 1A
2. ABO compatible, status 1B
3. ABO incompatible, status 1A
4. ABO incompatible, status 1B - ANSWER-3. ABO incompatible, status 1A
