2018 Board Review Pre-Test:
MCS III: Adverse Events and Patient Management

MCS III: Adverse Events and Patient Management - Joseph G. Rogers, MD

Please complete this brief Pre-Test to give a baseline for learning .

Question Title

* 1. Circulatory support with continuous flow LVADs result in reduced pulse pressure. What is the most reliable method to assess the blood pressure in the clinic setting?

A. Palpation of the brachial pulse with slow reduction of the cuff

B. Doppler assessment of either the brachial or radial pulse with a brachial cuff

C. Standard auscultation using a brachial cuff

D. An automatic cuff

Question Title

* 2. The most common lesion in the GI tract associated with mucosal bleeding in a continuous flow VAD patient is:

A. AV malformation in the small bowel

B. Pre-existent sigmoid diverticular disease

C. Ischemic colitis of the descending colon

D. Deulifoy lesion of the stomach

Question Title

* 3. A 34 y/o male who had an axial flow LVAD implanted two years ago comes to the office complaining of fatigue and exertional dyspnea for 24 hours. He has noticed that the pump flows are lower than usual. He denies chest pain or palpitations. On exam, his MAP is 58. No pulse is detectable. There are basilar crackles. The JVP is elevated at 14 cm. Auscultation of the heart demonstrates typical VAD sounds. The heart sounds are not heard. The abdomen is benign. There is a trace of edema.
Review of the LVAD data demonstrates: Speed=9400 RPM, Flow=3.8 l/min, Pulsatility Index=2.8.

The next first test that should be performed is:

A. Echocardiogram

B. Right heart catheterization

C. ECG

D. Chest x-ray

Question Title

* 4. You are asked to evaluate a 32 y/o woman with a history of a non-ischemic cardiomyopathy who had an axial flow LVAD implanted 12 hours prior. Since returning from the operating room, her urine output has been 10-15 cc/hour and there has been minimal bleeding from the chest tube. The PA catheter readings are as follows: RA=22 mmHg, PA=40/20 mmHg, and the PCWP=12 mmHg. The mixed venous oxygen saturation=45%. The current medications include milrinone 0.375 mcg/kg/min, dobutamine 7.5 mcg/kg/min, and epinephrine at 0.04 mcg/kg/min. The patient is also on inhaled nitric oxide at 40 ppm.

The most likely diagnosis is:

A. LVAD malfunction

B. Pericardial tamponade

C. Right heart failure

D. Hypovolemic shock

Question Title

* 5. Please provide your first and last name.
Pre-test questions will not be scored, your name is required solely to confirm completion.

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