10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
These 10 free CAPE questions are organized by exam domain, so you can see how each part of the Clinical Applications in Perfusion Examination (CAPE) blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Anatomy & Physiology
Question 1
A normothermic adult on full cardiopulmonary bypass has a body surface area of 2.0 m², measured patient flow of 4.4 L/min, hemoglobin of 8.0 g/dL, arterial saturation of 100%, and PaO₂ of 200 mmHg. The team's minimum indexed oxygen delivery is 280 mL O₂/min/m². Venous return and circuit pressures permit increasing flow to 5.2 L/min. Use an oxygen-binding coefficient of 1.34 mL O₂/g hemoglobin and a dissolved-oxygen coefficient of 0.0031 mL O₂/dL/mmHg. Which estimate and adjustment fit the patient's current oxygen delivery?
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Correct answer: A - About 249 mL O₂/min/m²; increase blood flow to 5.2 L/min and reassess.
Domain 2: Pharmacology
Question 2
Before bypass, an adult has received 500 units/kg of unfractionated heparin, but the ACT remains 390 seconds against a validated local target above 480 seconds. Drug delivery, sampling, and instrument function have been verified. Antithrombin activity is 32% of normal. Antithrombin concentrate is available, and the patient has pulmonary edema. Which approach most directly restores heparin responsiveness while avoiding unnecessary volume?
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Correct answer: B - Administer antithrombin concentrate and repeat the ACT.
Question 3
On the second day after coronary bypass surgery, a patient's platelet count has fallen from 240 to 90 × 10⁹/L and is beginning to recover. There was no heparin exposure in the 100 days before the operation, no thrombosis is present, and the perioperative platelet fall has an established alternative explanation. A 4Ts score for heparin-induced thrombocytopenia (HIT), calculated from complete records, is 2. Pharmacologic thromboprophylaxis is still indicated, and there is no active bleeding. How should this assessment affect the scheduled unfractionated heparin prophylaxis?
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Correct answer: A - Continue heparin and platelet monitoring without routine HIT testing.
Domain 4: Laboratory Analysis
Question 4
Diffuse bleeding continues after separation from bypass and an initial protamine dose. The patient is normothermic, ionized calcium is 1.18 mmol/L, platelet count is 176 × 10⁹/L, and fibrinogen is 290 mg/dL. A kaolin thromboelastography R time is 18 minutes, but the paired heparinase R time is 6.5 minutes; the laboratory reference interval is 5-10 minutes for both channels. These paired results most specifically support which treatment?
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Correct answer: B - Titrate additional protamine to residual heparin.
Domain 6: Devices & Equipment
Question 5
A bypass circuit is arranged as pump, oxygenator, arterial filter, then arterial cannula. At a constant measured flow of 4.6 L/min, pressure immediately before the oxygenator rises from 210 to 335 mmHg over 20 minutes. Pressure immediately after the oxygenator, before the filter, changes from 185 to 190 mmHg. Temperature and hematocrit are unchanged, and both pressure channels have been checked. Where is the new resistance most strongly localized?
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Correct answer: B - Membrane oxygenator
Domain 7: Clinical Management
Question 6
Antegrade aortic-root cardioplegia has just begun in an adult undergoing aortic valve replacement for severe regurgitation. The cross-clamp is secure, but transesophageal echocardiography shows progressive left ventricular distention and electrical activity persists. The cardioplegia mixture and delivery tubing have been checked. What change best addresses the failed myocardial protection?
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Correct answer: C - Stop root cardioplegia, decompress the ventricle, and use direct ostial delivery.
Domain 8: Special Patient Groups
Question 7
The proposed circuit for a 3.0-kg term neonate contains 330 mL of acellular prime. The patient's hematocrit is 45%, and estimated blood volume is 90 mL/kg. The team requires a hematocrit of at least 28% at bypass initiation. Assuming complete mixing, no blood loss, and no other fluid additions, which prediction and priming decision are consistent with that plan?
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Correct answer: C - About 20%; revise the prime to include red cells before initiating bypass.
Domain 9: Special Procedures/Special Techniques
Question 8
During venovenous ECMO with femoral venous drainage and right internal jugular venous return, increasing circuit flow from 4.0 to 5.0 L/min lowers systemic arterial saturation from 89% to 83%. Drainage-line saturation rises from 67% to 91%, while post-oxygenator PaO₂ remains 380 mmHg. Hemoglobin, temperature, ventilator settings, and native cardiac function are unchanged. The most useful next assessment is to:
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Correct answer: D - Image cannula positions and look for drainage of the return jet.
Domain 10: Catastrophic Events & Device Failure
Question 9
A macro-air alarm stops the centrifugal arterial pump during full bypass. Visible air is present in the patient-directed arterial tubing. The automatic arterial clamp has not closed, and the flow display briefly becomes negative. The perfusionist has announced the emergency. Which action is required before troubleshooting the source?
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Correct answer: A - Clamp the patient-directed arterial line and keep arterial pumping stopped.
Domain 11: Monitoring
Question 10
Immediately after an aortic cannula is repositioned, right cerebral near-infrared spectroscopy falls from 68% to 43%; the left reading remains 67%. Both optodes have good contact, and the head is neutral. Patient flow, mean arterial pressure, hemoglobin, arterial saturation, and PaCO₂ are unchanged. Which finding should be sought first to explain this asymmetry?
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Correct answer: D - Cannula-related maldistribution of cerebral arterial flow.