Download Blood-Device Interactions

Biol1120: Biomaterials
Exam 2 2013
Choose the BEST answer for each question. Place all answers on the answer sheet.
Blood-Device Interactions
1. A sudden and complete obstruction of a synthetic vascular graft due to thrombosis is most
likely to occur in
a. Abdominal aortic vascular grafts
b. Vascular access graft in peritoneal dialysis
c. Vascular access graft in hemodialysis
d. Coronary vascular graft
2. The following is not a typical reason for cardiac valve thrombosis
a. Turbulence in blood flow around artificial valve components
b. Lack of endothelialization of the valve material
c. Intimal narrowing at anastomosis
d. Trauma due to surgical procedure
3. The vasodilatory event most prevalent in patients who were treated with early ECMO and
dialysis membranes was initiated by
a. Binding of HMW kininogen to the membrane directly
b. Binding of platelets to the membrane directly
c. Binding of Factor XII to the membrane directly
d. Binding of C5 to the membrane directly
4. The physiological event that is directly related to the thrombogenicity of the vascular graft
material is initiated by
a. Binding and activation of bradykinin
b. Binding and activation of Factor X
c. Binding and activation of Factor XII
d. Binding and activation of fibrinogen
5. As stated in class, drug-loaded coronary stents have been associated with late stage
thrombosis that is related to activation of
a. Tissue factor
b. Factor XII
c. Factor IX
d. Kalikrein
6. As listed in the power point, the three key control points for regulating coagulation are: (fill
in the blanks)
a. calcium
b. platelets
c. thrombin
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7. The nucleophile groups located on early cellulose membranes attracted binding of
___________directly to the membrane
a. C3a
b. C3b
c. C4
d. C5a
8. As stated in the lecture, neutropenia resulting from C5 conversion is due to
a. A reduction in neutrophil production in the bone marrow
b. Lysis/damage of neutrophils as they interact with the membrane
c. Filtration of neutrophils by the dialysis membrane
d. Sequestration of neutrophils in various locations throughout the body
9. The coagulation protein that initiates the amplification of C3 on a biomaterial surface is
a. Thrombin
b. Fibrinogen
c. C2
d. C3
10. The complement protein that initiates the amplification of C3 on a biomaterial surface is
a. C4a
b. C4b
c. C2
d. C3
ECMO/Dialysis
11. The double-walled veno-venous catheter used for blood access for ECMO perfusion
a. Is used primarily for adult patients
b. Can be used in patients whose heart is not pumping
c. Accesses both the venous and arterial circulation
d. Is more invasive then the other circulatory access options
12. Residual plasticizers used to fabricate the ECMO membrane that are released into the blood
initiate
a. A chronic inflammatory response
b. Massive coagulation on the membrane
c. A hypersensitivity reaction
d. An autoimmune response
13. The types of cells that bind to an ECMO membrane are determined by
a. Blood flow across the membrane
b. Gas exchange across the membrane
c. The amount of plasticizers trapped in the membrane
d. The types of proteins that bind to the membrane
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14. The natural solutes that can be used to determine renal clearance are __urea________and
__creatinine__________.
15. Most excess water is removed during hemodialysis by
a. Diffusion
b. Convection
c. Ultrafiltration
d. Perfusion
16. As stated in lecture, the single most common adverse event associated with peritoneal
dialysis is
a. Thrombosis
b. Hypersensitivity
c. Inflammation
d. Infection
17. The two options for dialysis vascular access are __AV fistula___ and ___vascular graft__.
18. The membrane primarily used for ECMO is fabricated from
a. Polypropylene
b. Polyurethane
c. Cellulose
d. Cellulose acetate
19. ECMO can be performed on patients who have either heart and lung failure or lung failure
alone (T/F)
20. The following ECMO perfusion set up can be used for patients with heart and lung failure
a. Double lumen veno-venous
b. Veno-venous
c. Veno-arterial
Cardiac Pacing and Stimulation
21. The portion of the cardiac neural conduction pathway that sets the pace of the heart is the
a. Bundle of His
b. Purkinje fibers
c. Atrio-ventricular node
d. Sino-atrial node
22. When a patient requires pacing of three chambers of the heart, the pacing device most often
used to manage cardiac stimulation and heart function is called _ICD_____.
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23. Chronic inflammation of the electrode leads can be minimized by incorporating
____________ into the leads themselves.
a. Steroids
b. Heparin
c. Potassium chloride
d. Dexamethasone
24. The four pacemaker components that are housed in the pulse generator unit that is implanted
subcutaneously are (write in order of function)
_sensing______, ___control_______, __pacing_______, ____power_______
25. Sick sinus syndrome is a heart condition that can include
a. Tachycardia and ectopic pacing
b. Bradycardia
c. Bradycardia and tachycardia
d. Ectopic pacing and heart block
26. The voltage of each lithium battery that is housed in the pulse generator is
a. 1.5V
b. 2.6V
c. 3.3V
d. 5.2V
27. Endocardial implantation of a pacemaker unit
a. Can be performed under local anesthesia
b. Must be performed under general anesthesia
c. Is only implemented for pediatric implantation
d. Is often performed on an outpatient basis
28. The two primary adverse events (listed in the power point) that are associated with the
pacemaker housing are __fibrosis______ and __Twiddler’s syndrome______.
Septal Defect Repair
29. The atrial and ventricular septa are primarily comprised of
a. Connective tissue
b. Smooth muscle tissue
c. Neural conductive tissue
d. Epithelial tissue
30. Fetal circulation
a. Is an open looped system that includes the pulmonary vasculature
b. Involves both the ductus arteriosis and the atrial septal opening
c. Involves only the ductus arteriosis
d. Involves only cardiac shunting mechanisms
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31. Atrial septal defects
a. Always manifest clinical symptoms
b. Result in the escape of blood from the arterial side of the circulation back into
the venous side of the circulation
c. Are always diagnosed prior to the age of 6
d. Correlate with an 80% mortality rate
32. Repair and closure of ventricular septal defects
a. Are only addressed in older patient populations
b. Can only be accomplished following atrial defect closures
c. Are primarily accomplished by endovascular (noninvasive approach) procedures
d. Are primarily accomplished by intracardiac procedures
33. The most relevant material characteristic of the nitinol struts that support ASD closure
devices is
a. Fatigue strength
b. Impact strength
c. Tensile strength
d. Compressive strength
34. Thermoplastic materials that can be used in ASD closure devices
a. Become liquid when heated and solid when cooled
b. Become solid when heated and liquid when cooled
c. Can be molded but not extruded
d. Can be extruded but not molded
35. Patients that present with a patent Ductus Arteriosis
a. Have arterial blood that escapes into the venous circulation
b. Have venous blood that escapes into the arterial circulation
c. Always present with an associated ASD
d. Always present with an associated VSD
36. The host response most closely associated with successful implant of an ASD closure device
is
a. Neoendothelialization
b. Foreign body giant cell response
c. Ulceration
d. Extensive fibrosis
37. The primary plasma protein (in the highest concentration in blood) that binds to both ASD
and VS closure devices is
a. Albumin
b. Thrombin
c. Fibrinogen
d. Complement
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Aortic Vessel Repair
38. The definition of an Aortic Aneurysm is:
a. A localized narrowing of a blood vessel due to atherosclerosis.
b. A diseased cardiac vessel that may cause localized myocardial infarction.
c. A localized dilation or enlargement of a blood vessel caused by weakening of the
vessel wall.
d. A lower extremity vascular blockage that causes localized pain and edema.
39. Different types of Aortic Aneurysms include:
a. Supra-renal Abdominal Aortic Aneurysm
b. Infra-renal Abdominal Aortic Aneurysm
c. Ascending Thoracic Aortic Aneurysm
d. All of the above
40. Different types of Aneurysms include:
a. Saccular, Fusiform, Dissecting
b. Saccular, Elliptical, Rectangular
c. Fusiform, Round, Arching
d. None of the above
41. The most common type/shape of Abdominal Aortic Aneurysms are:
a. Ascending
b. Descending
c. Fusiform
d. Saccular
42. How are Aortic Aneurysms diagnosed?:
a. Physical Examination
b. CT Scan / Angiogram
c. Routine Blood Work
d. Both A and B
43. What famous person died of complications associated with an Abdominal Aortic Aneurysm?:
a. Joseph Lister
b. Albert Einstein
c. Louis Pasteur
d. Hippocrates
44. What biomaterials are typically utilized in open-technique Aortic Vascular Grafts?:
a. Expanded Polytetrafluroethylene (ePTFE)
b. Polyethylene Terephthalate (Dacron)
c. Nitinol
d. A and B
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45. What Aortic Vascular Graft biomaterial facilitates lumen expansion and intravascular
anchoring during an minimally invasive Aortic Aneurysm repair procedure?:
a. Nitinol
b. Angioplasy Balloon
c. Expanded Polytetrafluroethylene (ePTFE)
d. None of the above
46. A minimally invasive technique utilized to implant aortic grafts within the lumen of a given
vessel is called:
a. Laparoscopic Surgery
b. Endoscopic Surgery
c. Endovascular Surgery
d. Open Aortic Vessel Surgery
47. At which point is the risk of Abdominal Aortic Aneurysm (AAA) rupture typically deemed
greater than the risk of surgical intervention, and thereby a positive indicator to operate?:
a. Aneurysm Diameter of 3-5 cm.
b. Aneurysm Diameter equal to or greater than 8.5 cm.
c. Aneurysm Diameter of 1-3 cm.
d. Aneurysm Diameter equal to or greater than 5.5 cm.
Cardiac Valves / Repair
48. The definition of a Cardiac Valve is:
a. One of four structures within the heart that prevent backflow of blood by
opening/closing with each heart beat.
b. A localized atrial nerve bundle that regulates pumping action of the heart.
c. One of six structures within the heart that prevent backflow of blood by
opening/closing with each heart beat.
d. A conduit that permits multidirectional blood flow within the heart.
49. The four Cardiac Valves are:
a. Aortic, Leftlet, Mitral, Pulmonary
b. Tricuspid, Pulmonary, Mitral, Aortic
c. Aortic, Atrial, Ventricular, Septal
d. None of the above
50. This vessel carries deoxygenated blood from the right ventricle to the lungs for oxygenation.
a. Pulmonary Vein
b. Aorta
c. Inferior Vena Cava
d. Pulmonary Artery
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51. The four chambers of the heart include the following:
a. Right Atrium, Right Ventricle, Left Atrium, Left Ventricle
b. Right Aorta, Right Ventricle, Left Aorta, Left Ventricle
c. Right Atrium, Right Valve, Left Atrium, Left Valve
d. None of the above
52. Where is the Mitral Valve located within the heart?:
a. Between the Right Atrium and Right Ventricle
b. Between the Left Ventricle and the Aorta
c. Between the Left Atrium and Left Ventricle
d. Between the Pulmonary Vein and Right Atrium
53. Which valvular disease classification is associated with stiff or fused leftlets that cause
narrowing of the valve opening?:
a. Valvular Insufficiency / Regurgitation
b. Valvular Stenosis
c. Valvular Prolapse
d. Both B and C
54. Which valvular disease(s) is/are most frequently diagnosed, primarily due to higher pressures
associated with the left side of the heart?:
a. Aortic Valve Stenosis
b. Mitral Valve Insufficiency/Regurgitation
c. Tricuspid Valve Insufficiency/Regurgitation
d. Both A and B
55. Which of the following valvular disease classifications best describes a potential reason for
backflow of blood into the left atrium during systole?
a. Aortic Stenosis
b. Tricuspid Valve Stenosis
c. Pulmonary Valve Insufficiency/Regurgitation
d. Mitral Valve Insufficiency/Regurgitation
56. Which of the following is not a type of mechanical heart valve?:
a. Porcine Valve
b. Disk Valve
c. Ball Valve
d. Bileftlet Valve
57. Which of the following is a primary disadvantage associated with mechanical heart valves?:
a. Calcification
b. Limited Durability Post-Implantation
c. Xenograft Rejection
d. Daily Anti-coagulation Medication
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