cardiothoracic by O055uE8i

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									  SURGICAL TECHNOLOGY:                                     Cardiothoracic Surgery

 TRUE/FALSE

 1.During coronary artery bypass surgery air is evacuated from the vein grafts with a 14-gauge
    needle.

 2.An autograft is tissue taken from the patient’s own body.

 3.Cardiac defibrillating is used in patients who are susceptible to ventricular bradycardia.

 4.When the subxiphoid approach is used in pacemaker implantation, the electrodes are placed
    with the aid of fluoroscopy.

 5.Cardiac dysrhythmia is an abnormal pattern of conductivity in the heart.

 6.Cannulation of the femoral artery and vein is performed when a partial bypass is needed to
    support the patient’s circulation during surgical resection of the descending thoracic aorta.

 7.Chronic inflammation of the pericardium can produce a fibrotic coating over the heart that
    constricts the ventricles.

 8.Transmyocardial revascularization (TMR) is a procedure in which a series of transmural
    channels is created with a laser to allow oxygenated blood from the left ventricle to perfuse
    the myocardium.

 9.Mitral valve disease is commonly caused by rheumatic heart disease.

10.An implantable ventricular assistive device is used for long-term support and utilizes a pump
    that is implanted into the patient’s chest or abdomen.

 MULTIPLE CHOICE

11.An enclosed cavity in the chest containing the heart and large vessels, trachea, esophagus, and
    lymph nodes is the ________.
 a. mediastinum
 b. pleural space
 c. chest cavity
 d. thoracic outlet



12.A device that produces electrical impulses that stimulate the heart muscle is ________.
 a. an electrode
 b. a pacemaker
 c. a generator
 d. an alligator clamp

13.Fibrillation is ________.
 a. a disturbance to the heartbeat
 b. a heart valve that is unable to close tightly
 c. a fast heart rate
 d. ineffectual quivering of the heart

14.Orthotopic transplantation ________.
 a. involves replacing one heart with another
 b. involves the insertion of a second (donor) heart into the recipient patient’s right
    pleural cavity
 c. involves bypassing the coronary arteries and placement of a graft
 d. is used to wean patients from the cardiopulmonary bypass when other means are
    ineffective

15.The ________ is not a cardiac heart valve.
 a. tricuspid
 b. aortic
 c. coronary
 d. mitral

16.Pulmonary valvulotomy is performed ________.
 a. to release the pulmonary congestion caused by congestive heart failure
 b. to release stenotic valves
 c. to repair an atrial septal defect
 d. to release fused valve leaflets and restore circulation from the right ventricle to the
    lungs

17.The goal of transmyocardial revascularization is to ________.
 a. improve the circulation of the heart using an autograft
 b. increase blood flow to the heart in patients with coronary disease
 c. repair a stenotic valve
 d. completely replace one heart with another




  18. Transmyocardial revascularization ________.
 a. is a sterile laser probe used to make channels from the pericardium to the
    epicardium
 b. increases blood flow to the heart in patients with coronary disease following a
    CAB procedure
 c. is a sterile laser probe used to make channels from the epicardium to the
    endocardium
 d. is a procedure in which channels are made to allow oxygenated blood from the
    right ventricle to perfuse the myocardium

19.Before closure of a coronary artery bypass radiopaque material may be placed around each
    vein graft on the aorta. This is done to ________.
 a. mark the veins in the event of future cardiac catheterization
 b. mark the coronary artery in the event of future cardiac ischemia
 c. make the vein graft radiopaque in the event of a future cardiac arrest
 d. make the bypass vein x-ray detectable to see if the vein is leaking in the
    postoperative period

20.An internal device used in patients who are susceptible to ventricular fibrillation or ventricular
    tachycardia is a/an ________.
 a. internal implantable cardiac defibrillator
 b. internal implantable cardiac pacemaker
 c. left ventricular assistive device
 d. internal aortic balloon pump

21.The ventricular defibrillation leads are inserted into the heart ________.
 a. transarteriorly
 b. through an open thoracotomy
 c. through an open sternotomy
 d. transvenously

22.During a pacemaker generator replacement procedure, just after the generator is disconnected
    from the pacer leads the surgeon must ________.
 a. ask the anesthesia provider to “heparinize” the patient
 b. place a moist 4 3 4 into the existing “pocket” to provide hemostasis
 c. connect the electrodes to the alligator cable to an external pacer generator
 d. place a Gelfoam soaked in thrombin into the “pocket”

23.A pacemaker is implanted to provide electrical simulation to the heart to ________.
 a. increase a slow heart rate
 b. stabilize a normal heart rate with a cardiac arrhythmia
 c. decrease a high heart rate
 d. repair a non-life-threatening dysrhythmia



 24.Bradycardia is ________.
 a. a heart rate of 40–60
 b. a heart rate of 70–100
 c. a heart rate of 60–120
 d. a heart rate higher than 120

25.Three approaches are used for permanent implantation. Which two do not require a
    thoracotomy?
 a. transvenous and epicardial
 b. transvenous and subxiphoid
 c. epicardial and subxiphoid
 d. epicardial and pericardial

26.When anastomosing an arterial Gore-Tex graft into place, the surgeon ________.
 a. will suture the distal end of the graft into place first
 b. will suture the proximal end of the graft into place first
 c. will suture the end of the graft into place first that is easiest to reach surgically
 d. will release the clamp from the sewn distal end of the graft to flush the debris from
    the graft before anastomosing the proximal end to the patient’s artery

27.Cardioplegia solution is used to ________.
 a. stop the heart’s pumping action
 b. reverse the effect of heparin
 c. prevent blood clots from forming
 d. treat ventricular arrhythmias

28.Why would your surgeon wish to infuse cardioplegic solution into the coronary arteries during
    an open heart procedure?
 a. The process is necessary to protect the coronary arteries from ischemia.
 b. The process is necessary for procedures that do not require bypass circulation.
 c. The infusion is done at the end of the procedure to start the heart beating again.
 d. The process protects the cardiac muscle from damage while the aorta is occluded
    and blood supply is interrupted.

29.The ________ incision is made in the procedure venous cannulation with a two-stage cannula.
 a. femoral
 b. brachial
 c. median sternotomy
 d. lateral thoracotomy




 30.The ________ is/are not a vascular instrument.
 a. Cooley vascular clamp
 b. DeBakey forceps
 c. Cushing forceps
 d. Potts-Smith scissors
31.Cardiopulmonary bypass ________.
 a. is only used in traumatic procedures or in cases where the heart needs to be opened
    up, as in septal defects
 b. collects the patient’s blood, removes excess carbon dioxide, oxygenates and warms
    the blood, and returns it to the patient’s body
 c. pumps the patient’s blood during open heart procedures when the heart is stopped
 d. oxygenates the patient’s blood and returns it to the patient during thoracic
    procedures

32.Constrictive pericarditis may develop as a result of all of the following except ________.
 a. viral infection
 b. tuberculosis
 c. chronic pericarditis
 d. previous surgery causing scarring

33.Manipulation of the heart during dissection may cause ________.
 a. ventricular fibrillation
 b. tachycardia
 c. bradycardia
 d. atrial septal defect (ASD)

34.A congenital stenosis, usually occurring near the junction of the fetal ductus arteriosus and the
    aorta, is called ________.
 a. patent ductus arteriosus
 b. coarctation of the thoracic aorta
 c. pectus excavatum
 d. pericardiectomy

35.Surgical closure of a patent ductus arteriosus is performed to prevent ________.
 a. oxygenated blood from recirculating through the lungs
 b. unoxygenated blood from recirculating through the lungs
 c. oxygenated blood from circulating to the heart
 d. unoxygenated blood from circulating to the heart




  36. A patent ductus arteriosus is a persistent fetal communication between the ________ and
    the descending thoracic aorta.
 a. carotid artery
 b. aortic arch
 c. pulmonary artery
 d. pulmonary veins
37.Which of the following conditions can be treated medically without surgery?
 a. coarctation of the aorta
 b. pectus excavatum
 c. patent ductus arteriosus
 d. cardioplegia infusion

38.Following the anastomosis of a vein or an artery and before closure of the wound, hemostasis
    at the suture line may be maintained with a topical hemostatic agent such as ________.
 a. Gelfoam soaked in protamine sulfate
 b. a Cooley vascular clamp
 c. Surgicel soaked in heparin sodium
 d. Gelfoam soaked in thrombin

39.A thymectomy is commonly performed for ________.
 a. Graves’ disease
 b. insulin-dependent diabetes mellitus
 c. myasthenia gravis
 d. muscular dystrophy

40.Which of the following procedures will require the placement of a chest tube before closure?
 a. thymectomy
 b. patent ductus arteriosus
 c. CABG
 d. implantation of a pacemaker

41.Diaphragmatic hernia is ________.
 a. a weakness in the diaphragm that allows abdominal organs to enter the thoracic
    cavity
 b. a weakness in the diaphragm that allows the lungs to enter the abdominal cavity
 c. a weakness in the esophagus that allows a fistula to form in the diaphragm
 d. a weakness in the pleural space that allows the diaphragm to enter the mediastinum

42.The surgical position of choice for a single-lung transplant is ________.
 a. prone
 b. lateral
 c. supine
 d. dorsal recumbent

43.During a double-lung transplant, the surgeon may use a bilateral, sequential technique. This
    technique will ________.
 a. decrease the need for high concentrations of inhalation anesthetics
 b. avoid the need for cardiopulmonary bypass
 c. circumvent the need for a postoperative pacemaker
 d. decrease the patient’s blood pressure
44.A patient might need a lung volume reduction to ________.
 a. remove a portion of a lung in which air is trapped in emphysematous lung tissue,
    improving the lung’s function
 b. remove lobes of the lung that have cancerous tumors
 c. decrease lung capacity in strong athletes so that the heart does not have to work so
    hard
 d. remove lung tissue in patients who have chronic pleurisy, reducing the incidence
    of the inflammatory disease

45.The surgical removal of the fibrin layer covering the visceral and parietal pleura that prevents
    complete expansion of the lung is called ________.
 a. lung volume reduction
 b. pneumonectomy
 c. decortication of the lung
 d. lobectomy

46.The procedure that removes an entire lung to debulk (reduce the size) a malignant tumor and
    slow the spread of cancer is called ________.
 a. lobectomy
 b. pneumonectomy
 c. decortication of the lung
 d. lung volume reduction

 47.________ is not a cause of bronchiectasis.
 a. Infection
 b. Pulmonary obstruction
 c. Tuberculosis
 d. Nonobstructive cancer

48.________ procedures may be performed either open or as a video-assisted thoracotomy.
 a. Lung biopsy
 b. Lobectomy
 c. Wedge resection
 d. All of the above




 49.The ________ nerves are carefully preserved during pneumonectomy.
 a. vagus, left recurrent laryngeal, and phrenic
 b. vagus, pneumatic, and phrenic
 c. phrenic, pneumatic, and epigastric
 d. pneumatic, vagus, and left recurrent laryngeal

50.The major structures connected to the lung include all of the following except ________.
 a. the bronchus
 b. the pulmonary artery
 c. the aorta
 d. the pulmonary vein

51.During decortication of the lung, the incision is made in the ________ intercostal space.
 a. third
 b. fifth
 c. seventh
 d. ninth

52.Why is it important for an organ transplant to be carried out quickly and efficiently?
 a. The implantation process is lengthy and tedious, and the team may tire before it is
    done with the case.
 b. The organ recipient is in poor health and may die before the organ is transplanted.
 c. There is limited blood supply to the donor organ.
 d. The donor organ has a limited period of viability.

53.What age is your surgical patient who is undergoing a patent ductus arteriosus?
 a. newborn
 b. preschool
 c. adolescent
 d. adult

54.In coarctation of the thoracic aorta, the heart becomes enlarged. This is due to ________.
 a. arterial blood recirculating through the lungs
 b. severe narrowing that obstructs the normal flow of blood through the thoracic aorta
     and to the upper extremities
 c. the heart’s burden of pumping blood through a stricture
 d. the enlarged thoracic aorta, thus the heart has to pump large volumes of blood
     through it




55.When placing a permanent pacemaker and a right or left subclavian venotomy is performed,
    the electrode is placed in the ________.
 a. right atrium
 b. right ventricular apex
 c. left atrium
 d. left ventricle

 COMPLETION

56.During coronary artery bypass surgery, the surgeon occludes the ascending aorta and inserts
    the indwelling catheter for infusion of ________ and venting of air.
 A. cardioplegic solution
 B. heparin

57.The ________ vein is commonly used as the vein graft for a CABG procedure.
 A. greater saphenous
 B. superior mesenteric

58.Two classifications of aneurysms are saccular and ________.
 A. fusiform
 B. ischemia

59.During decortication of the lung, the patient is placed in the ________ position.
 A. anterolateral
 B. posterolateral thoracotomy

60.Following a wedge resection, the surgeon inspects the suture line carefully for air leaks by
     filling the chest cavity with ________.
 A. cardioplegia solution
 B. warm saline solution

 MATCHING

 Match the following dysrhythmias with the best description of the anomaly:
 a. ventricular fibrillation                d. ventricular tachycardia
 b. atrial flutter                          e. atrial fibrillation
 c. bradycardia                             f. asystole


61.Heart rate over 100 beats per minute

62.Heart rate of 240 to 450 beats per minute

63.Chaotic, disorganized stimulation of the ventricle(s) that does not pump the blood

64.Chaotic, disorganized stimulation of the atrium (atria) that prevents atrial contraction (which
    helps fill the ventricle with blood)

65.Abnormally slow electrical impulses and heartbeat below 40 to 60 beats per minute

66.The absence of a heartbeat; cardiac standstill
Answers to Cardiothoracic Surgery

TRUE/FALSE

 1 ANS:    F
2 ANS:     T
3 ANS:     F
4 ANS:     F
5 ANS:     T
6 ANS:     T
7 ANS:     T
8 ANS:     T
9 ANS:     T
10 ANS:    T

MULTIPLE CHOICE

11 ANS:    A
12 ANS:    B
13 ANS:    D
14 ANS:    A
15 ANS:    C
16 ANS:    D
17 ANS:    B
18 ANS:    C
19 ANS:    A
20 ANS:    A
21 ANS:    D
22 ANS:        C
23 ANS:        A
24 ANS:        A
25 ANS:        B
26 ANS:        B
27 ANS:        A
28 ANS:    D
29 ANS:    A
30 ANS:    C
31 ANS:    B
32 ANS:    D
33 ANS:    A
34 ANS:    B
35 ANS:    A
36 ANS:    C
37 ANS:    A
38 ANS:    D
39 ANS:    C
  40 ANS:     B
  41 ANS:     A
  42 ANS:     B
  43 ANS:     B
  44 ANS:     A
  45 ANS:     C
  46 ANS:     B
  47 ANS:     D
  48 ANS:     D
  49 ANS:     A
  50 ANS:     C
  51 ANS:     B
  52 ANS:     D
  53 ANS:     A
  54 ANS:         C
  55 ANS:         B

  COMPLETION

  56   ANS:   A
  57   ANS:   A
  58   ANS:   A
  59   ANS:   B
  60   ANS:   B

  MATCHING

 61 ANS: D
62 ANS: B
63 ANS: A
64 ANS: E
65 ANS: C
66 ANS: F

								
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