Invasive Registry Self Assessment

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Flashcards on Invasive Registry Self Assessment, created by hanxno on 10/04/2013.

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hanxno
Created by hanxno almost 6 years ago
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Question Answer
What short acting benzodiazapine is commonly used in the cath lab for sedation? midazolam (versed)
What is a quick easy way to check a patient's clotting time after being given heparin? ACT
How do ticlid and plavix act? They turn off platelet receptor sites
What is the normal range of potassium in the blood? 3.5 - 5.0
Name some antiplatelet medications. ASA, ticlid, plavix
How does heparin prevent clot formation? Prevents prothrombin conversion to thrombin. Combines with antithrombin.
Constrictive pericarditis is best diagnosed by ___. echo
Respiratory variation greater than 10 mmHg change with pulsus paradoxus greater than 10 mmHg are indications of ___. cardiac tamponade
Physiology effects of tamponade include ___, ___, and ___. pulmonary vein compression; bulging septum; aortic compression.
Pericardiocentisis as treatment of tamponade requires ___ needle placement. echo guided
Coumadin inactivates ___. vitamin K
Lovenox prevents factor X conversion to factor ___. XA
Heparin prevents conversion of prothrombin to ___. thrombin
Angiomax prevents conversion of prothrombin to ___ and prevents conversion of thrombin to ___. thrombin; fibrinogen
ReoPro sits on ___ receptor sites and is the only drug in its class that ___. IIb/IIIa; dissolve clots
The active agent in closure devises is ___. collagen
An increase in lactic acid will ___ heart rate. increase
Increases in pulmonary blood pressure (gas exchange) results in ___ blood velocity across the capillary bed and ___ O2 SAT. increased velocity; decreased O2 SAT
COPD leads to enlarged alveoli which can ___ or ___ the alveoli capillaries. crush or occlude
Endothelial cells secrete ___ causing vasodilation. nitric oxide
Phase one of the clotting cascade results in ___ adhesion and ___ site activation. platelet to collegen; IIb/IIIa receptor
Activated IIb/IIIa receptor sites allow ___ adhesion. platelet to platelet
ASA inactivates ___ and ___. arachidonic acid; thromboxane A2
Plavix stops ADP thus blocking ___ site preps. IIb/IIIa
What would increase LVEDP and not LV pressure? LV MI
What is the RV pressure of pulmonary stenosis? > 25 mmHg
What is the RA pressure of tricuspid regurgitation? Increased RA pressure
Does COPD increase or decrease PA pressure? increase
What right heart pressures does COPD affect? COPD increases PCWP, PA, RV, and RA systolic and diastolic pressures
MS ___ PA pressure. increases
MR ___ PA pressure. increases
Can PA systolic pressure ever be greater than RV systolic pressure? no
MR, MS, and LV MI each ___ PCWP. increase
Is LVEF = RVEF? yes
Why is RVEDP different from LVEDP? vascular resistance
Lidocaine can be used to treat ___. PVC's and v-tach
Lidocaine acts on the heart's conduction system by ___. increasing the refractory period
A right ventricular MI will cause an increase in ___ with no change in peak ejection pressure or PA pressure. RVEDP
Tricuspid stenosis increases the pressure in which heart chamber? right atrium
Where is an increase in RA pressure visible on a patient? JVD
What would cause a LV systolic pressure increase? aortic stenosis
Which blood chemistry test is used as a indicator for the use of a non-ionic contrast material rather than an ionic one? creatinine
Which blood gas changes would be expected in a patient that has begun to hyperventilate in anticipation of a catheterization? increased pH; decreased CO2
A ventricular gallop is associated with which heart sound? S3
Interstitial pulmonary adema is associated with an advanced degree of ___. heart failure
Based on the following data: O2 Consumption = 250 ml/min., AO = 21.0 vol. %, PA = 16.0 vol. %, BSA = 1.8 M2. What is the approximate cardiac output for the patient? 5 L/min
Based on the following data: O2 Consumption = 250 ml/min., AO = 21.0 vol. %, PA = 16.0 vol. %, BSA = 1.8 M2. What is the approximate cardiac index for the patient? 2.77 L/min/m2
If T-wave sensing occurs in ventricular demand or synchronous pacing, what must be done to the programmable generator? Longer refractory period
If a patient had a large S-wave in lead VI and a large R-wave in V5, you might suspect: LVH
What is most likely indicated from the following oximetry samples? SVC, 70%, RV, 86% IVC, 71%, PA, 86% Hi RA, 78%, LA, 94% Mid RA, 86%, LV, 94% Low RA, 83%, AO, 94% ASD, L to R shunt
On an ECG, which of the following may indicate a loose connection of a temporary pacing wire at the pulse generator spikes? Falling at irregular intervals
An ___ will markedly elevate right ventricular systolic pressure. Infundibular stenosis
An ___ may be caused by rapid accumulation of fluid in the pericardial sac. atrioventricular gradient
A patient has a cardiac output of 5 L/min. and a heart rate of 75 beats per minute. If stroke volume remains constant, what will be the effect of an increase in heart rate to 150 beats per minute? Cardiac output would: increase to 10 L/min
Cardiac myxomas are usually located in the: left atrium
Overdrive suppression of Torsade de Pointes and atrial flutter works by pacing the heart according to the following protocol: 10-40 beats/minute faster than the intrinsic HR
What is the BEST indicator of the exact moment the aortic and pulmonary valves open? Beginning of systolic rise on the arterial pressure.
In an aortic pressure recording, a gradual upstroke with a prominent low anacrotic notch is indicative of: aortic stenosis
A fall in pressure between the ___ and the ___ is characteristic of Tetralogy of Fallot? right ventricle; pulmonary artery
In an aortic pressure recording, a rapid upstroke with a large pulse pressure is indicative of: aortic insufficiency
What is MOST likely indicated by the following pressures: RV = 26/2, PA= 25/19, LA = mean of 18, LV = 142/8, AO = 145/75? mitral stenosis
In cardiac tamponade, venous pressures ___ and arterial pressures ___. rise; fall
What typically increases to compensate for constrictive diseases which impede filling? preload
What is responsible for the second heart sound (S2)? closure of semilunar valves (pulmonic and aortic tricuspid valves)
What may be considered the MOST common cause of confusion in determination of angina pectoris? indigestion
The ___ catheter will not handle an injection of 36-55 cc's at a rate of 12-18 cc/second. Lehman
The MOST commonly used scalpel blade used for the skin incision in preparation for a Sones technique of catheterization is the ___ blade. #15 blade
What is a major advantage of using high mA settings during angiography? decreased pulse width duration
The greatest problem associated with a femoral stick above the inguinal ligament is: a predisposition to inadequate compression and subsequent hematoma formation
What are factors that can diminish the validity of ventriculography? catheter tip too close to mitral valve; PVC's
A primary problem or complaint of the patient with mitral valve regurgitation is ___. shortness of breath
What is the approximate peak time for troponin? 12 hours (released 2-4 hours, persists up to 7 days)
What is the approximate peak time for CK-MB? 10-24 hours (back to normal 2-3 days)
What is the approximate peak time for LDH? 72 hours (back to normal 10 - 14 days)
Appropriate pre-med for a catheterization patient with a history of dye allergies includes: benadryl; cimetadone; prednisone
What anomaly is MOST commonly associated with inferior rib margin notching visible on a chest x-ray? coarctation of the aorta
What is the resultant condition when PCWP pressure exceeds the oncotic pressure of the plasma proteins? interstitial pulmonary edema (@ 25mmHG)
The MOST common effect of using a mA that is too low is ___. too few photons are generated
Which inotropic agent predominately stimulates Beta 1 receptors? epinephrine
Altering the ___ is NOT a mechanism of action for anti-tachycardia agents. parasympathetic response
Some mechanisms of action for anti-tachycardia agents include: slowing sodium influx; slowing calcium influx; altering sympathetic response
"Waveform damping" can be indicated by a: systolic pressure drop
"Waveform damping" may be caused by ___ in the ___. contrast media; pressure tubing
"Waveform damping" may represent restriction of ___ due to total or ___. coronary blood flow; partial occlusion
In x-rays, mA effects ___. exposure
In x-rays, kV effects ___. contrast
In x-rays, mA has the greatest influence over ___. ultimate density of the film
Which electrolyte imbalance aggravates digitalis toxicity? hypokalemia (low potassium)
Which medication inhibits sodium reabsorption causing an increase in urine output? lasix (furosemide)
What is a MAJOR indication for the administration of sodium bicarbonate? metabolic acidosis
Rapid injection of procainamide may cause ___. hypotension
Nifedipine is what class of drug? calcium channel blocker
The most common effect of using a pulse width that is too slow is ___. blurring
The electrical current that determines the number of photons generated by an x-ray tube is called the ___. milliamperage, mA
The anode produces ___ within the x-ray tube. photons
Cesium-iodide is commonly used as a the ___ for an image intensifier. fluorescent coating
How many cc's of contrast should be placed in a 20 cc syringe when prepping the PTCA balloon catheter? 10 cc
Which of the following is purely contraindicated for the use of inta-aortic counterpulsation? AI
What are some typical side effects of thrombolytics? internal bleeding, allergic reactions, reperfusion arrhythmias (when given for MI)
What are some contraindications for the use of thrombolitycs? CPR, pregnancy, recent CVA
The threshold for an implantable pacemaker can be described as: the minimum amount of mA required to elicit a ventricular response
The first derivative of the LV pressure is a measure of ___. myocardial contractility
The most common mechanism of tachycardia is ___. re-entry
Can a NIH catheter be introduced by an over-the-wire method? No, NIH has no end hole
The amount of stretch inherent in balloon materials is described as ___. compliance
A commonly seen complication following a transvenous pacemaker implant is ___. lead dislodgement
Which leads are commonly affected by an anterior infarction? I, aVL, V1, V2, V3, V4
The BEST location for an IVC filter is ___. below the renal veins
Which view of the heart is provided by leads V3 and V4? anterior wall
In the presence of a L to R VSD, a mixed venous blood sample can BEST be obtained from where? RA
Reprogramming the ___ can override a DDD pacemaker induced tachycardia. atrial refractory period
When the device settings for intra-aortic counter pulsation are properly set, the systemic BP should ___ and the diastolic BP should ___. systolic decreased; diastolic increased
One complication of mechanical heart valves is ___. hemolytic anemia
Proper inflation of an intra-aortic counter pulsation balloon results in ___. increased coronary perfusion
Which temporary pacemaker adjustment would change the unit from the demand mode to the asynchronous mode? decrease pacer sensitivity
Under normal functioning circumstances, what is considered a normal MEAN BP range for systemic circulation? 70 - 105 mmHg
Oxygen capacity is defined as: Hgb x 1.36 x 10
In the AP projection, which structure is the most posterior? LA
Which artery usually lies in the posterior interventricular groove? The distal right coronary artery/PDA
Where is the MAJOR component of vascular resistance generated? arterioles
What activity is associated with the arterial dicrotic notch? isometric relaxation
What is a typical finding during cardiac catheterization for a patient with suspected hypertrophic cardiomyopathy? decreased LV compliance; normal systolic function
What disease state is MOST commonly associated with reduced upstroke velocity in arterial pressure tracing? aortic stenosis
The degree of cyanosis in TOF is chiefly determined by what? pulmonary vascular resistance
For what condition is the Fontan procedure an appropriate surgical correction? tricuspid atresia
What condition is associated with different blood pressures in the upper and lower extremities? coarctation of the aorta
Medical treatment with anti-inflammatory agents is most common for what condition? constrictive pericarditis
A multipurpose catheter is considered primarily to be a ___ heart catheter. right
Which method of measuring cardiac output is least desirable in the detection of a shunt? thermodilutuion
Which approach is necessary to perform transseptal left heart catheterization? right femoral vein
What is the formula for calculating systemic vascular resistance? mean AO - mean RA divided by CO
Which cardiac output should be used to calculate valve regurgitation? Fick
Which right heart pressure best reflects LV preload? PCWP
Which balloon is used for valvuloplasty? Inoue
Aortic stenosis demonstrates a pressure that is elevated in the left ventricle and a pressure that is lower in the ___. Aortic arch
If a patient has a pulsatile mass below the sheath site, and a bruit is present, what should be suspected? Pseudoaneurysm
An abdominal aortic pulsation greater than 3.0 cm can be a finding for what pathology? Aortic aneurysm
Back pain not relieved with nitroglycerin, morphine or oxygen and is not associated with EKG changes can indicate ___. aortic dissection
Which stent is self expanding? Wallstent
A catheter is 2.66 mm. What French size is it? 8F
In relation to a coronary lesion, where should the wire be placed? 3-4 cm distal
Which lesion is best addressed with a rotoblador? a calcified lesion
Which catheter should be used to cannulate an LAD with a high takeoff? Amplatz
Landmarks for an internal jugular approach include the: head of the sternocleidomastoid muscle and the clavicular head
If the patient complains of pain down the leg when attempting to cannulate the right femoral artery, which way do you move the needle? medial
Coronary arteries perfuse best during ___. diastole
What is the purpose of the IABP? Increase coronary perfusion, decrease afterload.
A common complication of a rotoblador is ___. distal embolization
AN IMA catheter most nearly resembles a ___. JR4
What is the recommended rate of burr rotation when using a rotoblador? 180,000 - 210,000
Over tightening of the touhy bourst will ___. prevent balloon inflation or deflation
The best device for management of an acute thrombus in a vessel is ___. angiojet
Which device employs the use of sterile heparinized saline to evacuate thrombus? angiojet
Calcified lesions are best managed with which device? cutting balloon
What is the formula for calculating cardiac output? CO = HR x SV
Stroke volume is: related to preload
Preload is most impacted by: increased filling volumes
A patient with chronic, untreated hypertension would demonstrate: increased afterload
Vascular resistance/pressure is most influenced by? Radius of the vessel
The formula for BP is: BP = CO x SVR
What component of a PCWP indicates Mitral Insufficiency? v-wave
RV waveforms indicating greater than normal pressure indicate what pathologies? Pulmonary Hypertension or Pulmonic Stenosis
An elevated RVEDP is found in which pathology? RV infarct
If the RV waveform is 2x the normal value, where would this be demonstrated in the physical assessment? JVD
What is the most common cause of Pulmonic Stenosis? Congenital anomalies
The blue proximal port of the swan is located how far back from the distal tip of the swan? 30 cm
When performing a thermodilution cardiac output, the operator injects 10cc of saline into the ___ and the temp change is measured in the ___ RA, PA
After the transducer is zeroed it falls onto the floor. The pressure being read off the transducer is now reading _____ higher
A pressure gradient from the LV to the aorta indicates: aortic stenosis
LVEDP is hemodynamically measured on the waveform at: the ventricular upstroke where it coincides with the EKG r-wave.
Pulsus Paradoxus is a sign of: cardiac tamponade
Signs of LV failure include: orthopnea, pulmonary congestion, decreased exercise tolerance
Equalization of RVEDP and LVEDP are found in: Restrictive Pericarditis
Signs of Right Heart Failure include: JVD
If a patient demonstrates a systemic blood flow of 4 L/min and a pulmonary blood flow of 16 L/min, what is the shunt direction and shunt flow? L to R, 4:1
What is Flamm's equation? 3 SVC + IVC divided by 4
The formula used to calculate MAP is Systolic + 2(Diastolic) divided by 3
What are the four anomalies associated with Tetrology of Fallot? pulmonic stenosis, overriding aorta, RV hypertrophy, VSD
Which fetal anomaly is characterized by a large ventricular septal defect over which a large, single great vessel arises? Truncus arteriosus
If the shunt ratio on a patient is measuring 5:1, what does that tell you? There is a left to right shunt
What does RAD stand for? Radiation Absorbed Dose
Which component of the x-ray system converts light rays into images? The image intensifier
What is the maximum annual dose of radiation one can receive? 5 REM
Lead protection should be at least how many millimeters of lead? 0.5 mm
What is the minimum safe distance to position oneself from the x-ray source? 6 feet
In an x-ray tube the cathode is ___ and the anode is ___ Cathode is negative Anode is positive
Which view exposes the operator to the greatest amount of radiation? Lateral (the greatest distance from AP)
What converts x-rays into an image? The image intensifier
The contrast that is best for a patient is: Low osmolality
Radiolucent means: x-rays are permitted to pass through
Radiopaque means: x-rays are NOT permitted to pass through
Reopro works on: IIb/IIIa receptors
Heparin potentiates the action of: antithrombin
Fibrinogen is converted to fibrin by the action of: thrombin
There are ___ known pathways to initiate the clotting cascade. 2
Aspirin inhibits the release of ___ from the platelet. Arachadonic Acid
Which agent is not an antiplatelet? Heparin
If a patient has diabetes and renal failure with a creatinine of 2.0 what would you give? fluids to hydrate, consider pre-procedure hydration
If a patient is taking NPH insulin, which medication should not be given? protamine
Which medicine is most commonly given with SVT? Adenosine
If a patient has a creatinine greater than 1.4, contrast volume should be minimized. true
Lidocaine converts from 2GM in 500cc to: 4mg in 1cc; (2000mg in 500cc); (2000/500 = 4)
Dopamine concentration 1600mcg/ml in 250cc yields a concentration of: 400mg in 250cc (1600 x 250 divided by 1000) (1.6 x 250)
The best short acting medication/anxietyolitic to sedate a patient is: versed/midazolam
The drug of choice for treating coronary spasm is: nitroglycerin
Amiodarone is used to treat: atrial and ventricular arrhythmias
The labs that best evaluate kidney function are: creatinine, creatinine clearance, GFR
What medication is used as a preload and afterload reducer? nitroglycerin
Diabetic patients have a greater incidence of developing ___ post contrast administration. renal failure
Which EKG rhythm is most likely to become lethal? Mobitz II
Which EKG rhythm has asynchronous p-waves and r-waves, each recorded at their intrinsic rate? 3rd degree heart block
What arrhythmia presents with a saw-tooth pattern? atrial flutter
An EKG demonstrates ST elevation in leads II, III, and AVf. What type of infarct would you suspect? inferior wall
An EKG demonstrates ST elevation in leads II, III, AVf. Which coronary artery is most likely occluded? RCA
How do you test the defibrillator? Discharge into the defibrillator (dummy load)
What happens if you deliver a shock to a patient on the t-wave? You can put the patient into v-fib
In a 1st degree heart block, where is the conduction delay? AV node
What is the normal PR interval? 0.12 - 0.20
If a patient is attached to the monitor, v-tach is the rhythm, the patient has no pulse and is not responding, what should you do? unsynchronized cardioversion
A patient is on the monitor in a SVT, BP is 70, the patient is diaphoretic, dusky and SOB. What should you do? Do immediate synchronized cardioversion
A common complication of placing a pacing electrode/wire is: perforation, pericardial effusion, tamponade
A pacing generator that paces both chambers, senses in the ventricle, and inhibits QRS complexes is a: DVI
A pacing generator that paces both chambers, senses in both chambers, and triggers OR inhibits is a: DDD
A pacing generator that paces in the atria, senses in the atria, and inhibits pacing is a: AAI
What are the two primary vessels used in adult cardiac catheterization? radial and femoral
Which of the following are the MOST common catheter positions for performing an initial VT study? HRA HIS RVA CS (test answer may be HRA HIS RVOT RVA)
Which two of the seven major zones of the left ventricle are NOT visualized in a 30 degree RAO LV angiogram? posterior and septal
Which of the following represents the greatest risk of complication during ventriculography? air or thrombus embolism
For which of the following purposes is a Fogarty catheter used? stripping clots
When doing a right heart catheterization on a patient with LBBB, which of the following is appropriate? Insertion of a temporary pacemaker prior to right heart catheterization.