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6 Cards in this Set
- Front
- Back
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You are an internist who has referred a 65 year old man who has been experiencing increasing angina to a cardiologist for diagnostic studies. He is a non-insulin dependent diabetic and had one
documented non-Q wave myocardial infarction about 4 years ago. Cardiac catheterization with coronary angiography reveals the following findings: · 30% stenosis of the left main coronary artery · 80% stenosis in the mid left anterior descending coronary artery · 100% proximal occlusion of the circumflex artery · 70% proximal stenosis of RCA · Left ventricular EF = 40% · Mild aortic valve regurgitation · Nuclear imaging tests reveal moderate wall motion hypokinesis of a portion of the poster – inferior left ventricular wall (area that had received blood supply from the now occluded circumflex artery). For long term survival and freedom from MIs, the best treatment for this patient is A. 3-vessel CABG to the right, circumflex and LAD using the internal mammary artery as the graft to the LAD coronary artery B. 2-vessel CABG to the right and LAD coronary arteries (using internal mammary artery graft to the LAD) plus replacement or repair of the aortic valve C. angioplasty plus placement of stents in both the right coronary artery and the left main coronary arteries D. aggressive medical management with statins, anti-anginal drugs and ASA only, since his low ejection fraction and diabetes make him a high risk for surgery or PTCA |
A. 3-vessel CABG to the right, circumflex and LAD using the internal mammary artery as the graft to the left anterior descending coronary artery
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When considering the overall likelihood your patient has for developing atherosclerotic coronary
artery disease, some risk factors cannot be changed – like age, gender and family history. Other factors, if changed, might lower risk – like homocysteine levels and oxidative stress. Some factors, however, have been proven to lower risk if they are modified or controlled. These factors include smoking, LDL level, thrombogenic factors, high fat/cholesterol diet and A. psychosocial factors B. lipoprotein level (a) C. hypertension D. low socioeconomic status |
C. hypertension
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Which of the following statements is TRUE regarding the natural history of coronary artery disease?
A. Distal LAD lesions do not result in poorer survival compared to proximal LAD lesions B. Patients with 1-vessel and 2-vessel disease have equivalent survival at 5 years C. Hemodynamic instability successfully treated with IABP does not adversely affect outcome D. Severe resting LV dysfunction significantly reduces survival E. Left main disease and 4-vessel disease have equivalent survival at 5 years. |
D. Severe resting LV dysfunction significantly reduces survival
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A 28 year old intoxicated man is the driver of a car involved in a high speed head-on motor vehicle collision. He is determined to be brain-dead after 72 hours and the organ procurement agency approaches his family for organ donation. Conditions which would prevent the use of this individual’s heart for transplantation include all of the following EXCEPT
A. presence of moderate aortic valve insufficiency on echocardiogram B. history of treatment for seminoma 5 years ago C. temperature of 102o F since yesterday with positive blood cultures D. a blood alcohol concentration of 0.11% at the time of admission to the ER 3 days ago |
D. a blood alcohol concentration of 0.11% at the time of admission to the ER 3 days ago
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In one month, J. Doe will celebrate the “seventh anniversary” of his successful cardiac transplant. At this point in his post-transplant course, his greatest risk of death is from
A. acute rejection B. lymphoma C. coronary artery disease developing in the donor heart D. renal failure E. infection |
C. coronary artery disease developing in the donor heart
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Identify the correct statement about cardiac transplantation.
A. The majority of cardiac transplant recipients are in the 35-50 age group B. The use of cyclosporine for immunosuppression therapy has measurably improved survival C. Diabetes mellitus develops in >33% of the patients who are five years or more post-cardiac transplant due to immune suppression medication D. If a patient is able to survive three years post-transplant, his risk of death from graft rejection drops to <1%. E. Improvement in overall survival occurred with the institution of routine scheduled monitoring for rejection with 2-D echocardiograms |
B. The use of cyclosporine for immunosuppression therapy has measurably improved survival
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