Advanced Principles II Exams Flashcards
The neuron is the basic functional cell of the CNS? True or false? This question was repeated.
True
The somatic nervous system contains sensory neurons for the control of? Choose 3
a. Skin innervation
b. Muscle innervation
c. Joints innervation
Arteries arising from Circle of Willis give rise to? This question was repeated.
a. Pial arteries
Neurons may be classified according to their specific function: ______ are multipolar and innervate and control effector tissues such as muscles and glands. This question was repeated.
a. Motor neurons
In 60% of patients the SA node is a branch of the right coronary artery whereas in the remaining arises from the?
a. Circumflex artery
Appropriate preop medications for patients who present for posterior fossa surgery who are diagnosed with space occupying lesions (SOL) or hydrocephalus from the 4th ventricle would include? Choose 3
a. Antihypertensives
b. Corticosteroids
c. Benzodiazepines
d. Fentanyl
a. Antihypertensives
b. Corticosteroids
c. Benzodiazepines
d. Fentanyl (WRONG answer)
The major components of the intracranial cavity include? Choose 3
- Brain
- CSF
- Blood
Select the true statements concerning Schwann cells. Choose 3? This question was repeated.
a. Schwann cells are responsible for forming myelin
b. Schwann cell myelinates only one axon
c. Node of Ranvier is the site of electrical impulse propagation
d. Schwann cells are completely coated in myelin
a. Schwann cells are responsible for forming myelin
b. Schwann cell myelinates only one axon
c. Node of Ranvier is the site of electrical impulse propagation
d. Schwann cells are completely coated in myelin (WRONG answer)
Select the true statements concerning Anterior Spinal Artery Syndrome (ASAS). Choose 3?
a. ASAS may also result from sustained hyperperfusion
b. ASAS typically manifests as motor weakness greater than sensory change
c. ASAS results from obstruction of the feeder vessels to the Ant. Spinal Artery
d. ASAS treatment is aimed at relieving existing pathologic cause/condition
a. ASAS may also result from sustained hyperperfusion (WRONG answer)
b. ASAS typically manifests as motor weakness greater than sensory change
c. ASAS results from obstruction of the feeder vessels to the Ant. Spinal Artery
d. ASAS treatment is aimed at relieving existing pathologic cause/condition
Which of the following is the BEST treatment for anesthesia issues that may arise during a craniofacial venous malformation repair? Choose 2
a. Keep PaCO2 at 60
b. Consider patient ability to maintain patent airway post USP grade 95% ethanol injection
All of these statements are true concerning implantable cardioverter-defibrillators (ICDs) EXCEPT?
a. ICDs are not indicated for the primary prevention of sudden death
evere contrast induced anaphylactoid reactions include all EXCEPT? Choose 3
a. Bronchospasm
b. cardiovascular shock
c. Respiratory arrest
d. Cardiac arrest
a. Bronchospasm (WRONG answer)
b. cardiovascular shock
c. Respiratory arrest
d. Cardiac arrest
Cerebral blood flow is supplied by 4 larger arteries which merge to form the?
a. Circle of Willis
When ICP exceeds _____ mm/Hg CBF progressivle decreases and a vicious cycle is established: produces brain edema which in turn increases ICP. This question was repeated.
a. 30 mm/Hg
(6th edition nagelhout pg 663) - “when ICP exceeds 30mmhg, CBF progressively decreases and a vicious cycle is established, ischemia produces brain edema, which in turn increases ICP and further precipitates ischemia.”
Although a rare event, trigeminocardiac reflex may be treated by which of the following BEST choices?
a. anticholinergic prophylaxis
Not indicated for ssep:
NMBD (source:I emailed Dr.M; She said the “best answer” was NMBD)
High risk for cardiac cath
75f with 1 vessel block, ASA IV?
Not an ablation indication :
drug abuse lifestyle
Select the true statement regarding supratentonial Masses choose 3
- Supratentorial massless problems usually arise from a result of local and generalized pressure
- anesthetic actions include conserve cerebral auto regulation and co2 responsiveness
- issues can arise from surgical exposure
- Surgeon could have issues
Cerebral bloodflow is maintained at a constant
• The cerebral blood flow is maintained fairly stable for a MABP of 60-160.****
CushingsTriad
– Irregular respiration (Hypoventilation)
– Bradycardia
– Hypertension
All are true except (can’t remember the rest of the answers)
– CO2 – most powerful factor
– O2 – hypoxia is a potent stimulus
Autoregulation all are true EXCEPT
- People with hypoperfusion/ cerebral ischemia, autoregulation is shifted to right (wrong answer)
- People with chronic HTN, autoregulation is shifted to the right
The Most common arteries affected by hemorrhagic stroke:
Middle Cerebral Artery
Posterior Cerebral Artery
Midbrain Arteries
What about of CSF occupies the entire cerebral cavity?
150ml
Reabsorption of CSF in through the
Arachnoid villi
Normal ICP 1-20. Acute increase in ICP of 22. Treatment?
Hyperventilation (PCO2 25-30 mmhg)
Acute changes seen in ICP (all except): Altered mentation Visual disturbances Headache Gait Disturbances
Altered mentation
Visual disturbances
Headache
Gait Disturbances (WRONG Answer)
CPP goal is to maintain above 50-55….
< 40 hypoperfusion?
Most common primary brain tumor?
Astrocytoma
Most inhalational anesthetics:
Decrease CMR
Increase CBF
Most IV anesthetics:
Decrease CMR
Decrease CBF
All gases EXCEPT this one decrease CMR?
N20
ICP may be mild and can be prevented by hypocapnia (the only gas with these properties):
ISOflurane
All are true EXCEPT of etomidate:help?
Has no CV effects
Should use in caution with hx of seizures
…ummmm
Increases CMRO2???
The neuron is NOT the basic functional cell of the CNS? T or F
False
Allergic reaction that includes angioedema would be classified as
moderate
Man tells you he is allergic to contrast.Procedure is tomorrow. What is the BEST course of action?
Steroid today. Histamine before surgery.
Contraindications (relative) for sitting position:
C-spine
Intra-cardiac defects
MILD Hypovolemia
???
Select all that are true of posterior fossa surgery??
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral , three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d .Ensure large airway and bite block placements
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral , three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d. . Ensure large airway and bite block placements (WRONG: Avoid)
Select all that are true of posterior fossa surgery??
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral , three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d .Ensure large airway and bite block placements
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral , three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d. . Ensure large airway and bite block placements (WRONG: Avoid)
What drug would you not give prior to clipping of aneurysm?
phenylephrine
Triple H therapy includes: (choose 3)
Hypertension
Hypervolemia
Hemodilution
(all of the wrong answers included hyper/hypothermia)
Which is NOT a risk factor for protamine allergy?
Family history of malignant hypothermia
What is the advantage of using newer radiographic contrast compared to older radiographic contrast?
Newer radiographic contrast has a lower osmolar load
All are true of Right sided catheterization except:
Performed for diagnostic purposes
May be done Brachial, femoral, and IJ
NOT EJ
What are irreversible:
ASA
Thienophyridine
Law that applies to aneurysms?
Law of Laplace
During the management of an angioplasty and stenting for treatment of atherosclerotic stenosis of the cervical, vertebral, and intracranial arteries, which of the following are NOT true?
Hypoperfusion is associated with this procedure.
85 y/o man, history of MI, Cr 1.8, BUN 22, K 5 (other labs that were normal) needs emergent heart cath. Which of the following is the BEST action?
Hydrate, avoid NSAIDS, limit contrast, proceed with case
All of the following are true of AVMs except?
They are emergent and require emergency treatment
Best candidate for awake craniotomy?
38-year-old with tumor near motor area with history of uncontrolled seizures
AVM surgery with ICP 22. What is the best action?
Hyperventilate because the ICP is too high.
All of the following increase CBF and ICP under normal circumstances EXCEPT.
midazolam
Barbiturates do all of the following EXCEPT
Protect against global ischemia.
Which is wrong regarding air embolism? Add 8 of PEEP Suction through CVV Stop N2O Place pt in Right-lateral recumbent with head slightly up
Place pt in Right-lateral recumbent with head slightly up
this was the answer; this answer would have been correct if it had been Left-lateral recumbent
Aortic stenosis is eccentric. T/F?
False
75 year old man has aortic stenosis and his heart rate drops to 39?
Atropine 0.4 mg IV
Duchenne muscular dystrophy is what cardiomyopathy?
Dilated cardiomyopathy
Congenital heart disease when patients are pregnant…? Choose 3
a. Beta blockers interfere with fetal growth and response of fetus to stress during labor
b. Amiodarone affects the fetus thyroid function
c. 3rd stage (delivery of placenta) can be associated with hypovolemia, uterine atony and hemorrhage
d. Cardioversion is dangerous and contraindicated
d. Cardioversion is dangerous and contraindicated - WRONG ANSWER
When do women experience the most cardiac complications in pregnancy?
First half of the 3rd trimester
First half of second trimester
Last half of first trimester
Last month of pregnancy
Last month of pregnancy - CORRECT ANSWER
Obstructive cardiomyopathy….? Select 3
Increase preload
Increase afterload
Decrease contractility
All of the following occur in restrictive cardiomyopathy EXCEPT?
10 year old female
85 year old male
25 year old female
45 year old male
10 year old female - CORRECT ANSWER → its rare in children!
Marfan syndrome? Choose 5
Tall and slender Disproportionate arms and legs High arch palate and crowned teeth Heart murmurs are common Flat feet Low set ears Small chest bone that protrudes inward and upward Extreme farsightedness
Marfan syndrome? Choose 5
Tall and slender - true Disproportionate arms and legs - true High arch palate and crowned teeth - true Heart murmurs are common - true Flat feet - true
Low set ears - WRONG ANSWER
Small chest bone that protrudes inward and upward - WRONG ANSWER
Extreme farsightedness - WRONG ANSWER
Question about Tricuspid Atresia? Choose 3
a. Cyanosis is usually present at birth
b. Early survival is depend on prostaglandin E1 infusion
c. Success of the fontan procedure is reliant upon low PVR and low atrial pressure
Which is true regarding dilated cardiomyopathy? All valves are involved Tricuspid valve is involved Mitral stenosis Mitral regurgitation
Mitral regurgitation
Which formula represents the amount of blood ejected from the L ventricle with each heartbeat (Stroke Volume formula)?
SV = EDV - ESV
Mediastinoscopy question….? Choose 3 but may have been Choose 4
a. Patients with lung cancer may have Eaton-Lambert syndrome with sensitivity to NDMR and Depolarizers
b. The most severe complication of mediastinoscopy is major hemorrhage
c. A bronchial blocker can be used to provide lung isolation in the event of an emergency
d. Prior mediastinoscopy is not an absolute contraindication to the procedure
d. Prior mediastinoscopy is not an absolute contraindication to the procedure
(THIS IS A MAJOR CONTRAINDICATION!!) WRONG ANSWER
Contraindicated in ASD?
Air in tubing
All are true about VSD EXCEPT?
Recurrent pulmonary infections are NOT common
Hypertrophic Obstruction worsens by?
Decreased contractility
Catecholamines
Increased preload
Increased afterload
Catecholamines - CORRECT ANSWER (b/c it increases contractility)
Appropriate treatments for hypercyanotic spells….? Pick 4
Esmolol Propranolol Fluids and phenylephrine Ephedrine and epinephrine Knees to chest
Ephedrine and epinephrine - WRONG ANSWER
Question about pts with cyanotic heart disease…?
Increased minute ventilation and normocapnia
Neosynephrine is preferred over ephedrine for mitral stenosis. T/F?
True
Question about aortic stenosis and HR, preload, afterload preferred?
Low HR 60-90, NSR, maintain and optimize preload, maintain afterload and contractility
Benefits of beta 1 stimulation? Chose 2
Negative chronotropic
Positive inotrope
Positive dromotrope
Negative dromotrope
Positive inotrope
Positive dromotrope
Negative chronotropic - WRONG ANSWER
Negative dromotrope - WRONG ANSWER
Benefits of beta 1 stimulation? Chose 2
Negative chronotropic
Positive inotrope
Positive dromotrope
Negative dromotrope
Positive inotrope
Positive dromotrope
Negative chronotropic - WRONG ANSWER
Negative dromotrope - WRONG ANSWER
Benefits of beta 2 stimulation? Choose 2
Vasodilation
Stabilization of mast cell protection
Histamine release
Bronchoconstriction
Vasodilation
Stabilization of mast cell protection
PV Loop: Which one shows decreased afterload?
Smallest loop
All will increase Right to left shunt in TOF EXCEPT
Decrease PVR
Which is true about aortic stenosis? Choose 2
Avoid bradycardia because SV is fixed
Avoid tachycardia because SV is fixed
Describes situations in which left-to-right intracardiac shunts are reversed d/t increased PVR levels equal to or greater than SVR
Eisenmenger’s Syndrome
- The neuron is the basic functional cell of the CNS? True or false?
True
The somatic nervous system contains sensory neurons for the control of? Choose 3
a. Skin innervation
b. Muscle innervation
c. Joints innervation
a. Skin innervation
b. Muscle innervation
c. Joints innervation
Arteries arising from Circle of Willis give rise to?
Pial Arteries
Neurons may be classified according to their specific function: ______ are multipolar and innervate and control effector tissues such as muscles and glands.
a. Motor neurons
In 60% of patients the SA node is a branch of the right coronary artery whereas in the remaining arises from the?
a. Circumflex artery
Appropriate preop medications for patients who present for posterior fossa surgery who are diagnosed with space occupying lesions (SOL) or hydrocephalus from the 4th ventricle would include? Choose 3
a. Antihypertensives
b. Corticosteroids
c. Benzodiazepines
d. Fentanyl
a. Antihypertensives
b. Corticosteroids
c. Benzodiazepines
d. Fentanyl (WRONG answer)
The major components of the intracranial cavity include? Choose 3
- Brain
- CSF
- Blood
Select the true statements concerning Schwann cells. Choose 3?
a. Schwann cells are responsible for forming myelin
b. Schwann cell myelinates only one axon
c. Node of Ranvier is the site of electrical impulse propagation
d. Schwann cells are completely coated in myelin
a. Schwann cells are responsible for forming myelin
b. Schwann cell myelinates only one axon
c. Node of Ranvier is the site of electrical impulse propagation
d. Schwann cells are completely coated in myelin (WRONG answer)
Select the true statements concerning Anterior Spinal Artery Syndrome (ASAS). Choose 3?
a. ASAS may also result from sustained hyperperfusion
b. ASAS typically manifests as motor weakness greater than sensory change
c. ASAS results from obstruction of the feeder vessels to the Ant. Spinal Artery
d. ASAS treatment is aimed at relieving existing pathologic cause/condition
a. ASAS may also result from sustained hyperperfusion (WRONG answer)
b. ASAS typically manifests as motor weakness greater than sensory change
c. ASAS results from obstruction of the feeder vessels to the Ant. Spinal Artery
d. ASAS treatment is aimed at relieving existing pathologic cause/condition
Which of the following is the BEST treatment for anesthesia issues that may arise during a craniofacial venous malformation repair? Choose 2
a. Keep PaCO2 at 60
b. Consider patient ability to maintain patent airway post USP grade 95% ethanol injection
All of these statements are true concerning implantable cardioverter-defibrillators (ICDs) EXCEPT?
a. ICDs are not indicated for the primary prevention of sudden death
Severe contrast induced anaphylactoid reactions include all EXCEPT? Choose 3
a. Bronchospasm
b. cardiovascular shock
c. Respiratory arrest
d. Cardiac arrest
a. Bronchospasm (WRONG answer)
b. cardiovascular shock
c. Respiratory arrest
d. Cardiac arrest
Cerebral blood flow is supplied by 4 larger arteries which merge to form the?
a. Circle of Willis
When ICP exceeds _____ mm/Hg CBF progressive decreases and a vicious cycle is established: produces brain edema which in turn increases ICP.
a. 30 mm/Hg
(6th edition nagelhout pg 663) - “when ICP exceeds 30mmhg, CBF progressively decreases and a vicious cycle is established, ischemia produces brain edema, which in turn increases ICP and further precipitates ischemia.”
Although a rare event, trigeminocardiac reflex may be treated by which of the following BEST choices?
a. anticholinergic prophylaxis
Propofol cbf / cmr / icp
what does it do to each? increase or decrease?
cbf decrease;
cmr decrease;
icp decrease
Not indicated for ssep:
NMBD (source:I emailed Dr.M; She said the “best answer” was NMBD)
High risk for cardiac cath
a. 75f with 1 vessel block, ASA IV?
Not an ablation indication:
a. drug abuse lifestyle
Select the true statement regarding supratentonial Masses choose 3
Supratentorial mass-less problems usually arise from a result of local and generalized pressure
b. Anesthetic actions include conserve cerebral auto regulation and co2 responsiveness
c. Surgeons could have issues that arise from surgical exposure
Cerebral blood flow is maintained at a constant
•
The cerebral blood flow is maintained fairly stable for a MABP of 60-160.****
Cushings Triad
– Irregular respiration (Hypoventilation)
– Bradycardia
– Hypertension
VAE choose 3 ?? treatment of VAE?
- inform surgeon
- d/c n2o and increase 02 flows
- modify anesthetic
- have surgeon flood field with fluids
- provided jugular vein compression
- aspirate the right atrial catheter
- provide CV support
- change pt position
. Autoregulation all are true EXCEPT
- People with hypoperfusion/ cerebral ischemia, autoregulation is shifted to right (wrong answer)
- People with chronic HTN, autoregulation is shifted to the right
. The Most common arteries affected by hemorrhagic stroke:
a. Middle Cerebral Artery
b. Posterior Cerebral Artery
c. Midbrain Arteries
- What about of CSF occupies the entire cerebral cavity?
150ml
Normal ICP 1-20. Acute increase in ICP of 22. Treatment?
a. Hyperventilation (PCO2 25-30 mmhg)
. Acute changes seen in ICP (all except):
a. Altered mentation
b. Visual disturbances
c. Headache
d. Gait Disturbances
Altered mentation
b. Visual disturbances
c. Headache
d. Gait Disturbances (WRONG Answer)
CPP goal is to maintain above 50-55….
< 40 hypoperfusion?
Most inhalational anesthetics:
a. Decrease CMR
b. Increase CBF
Most IV anesthetics:
a. Decrease CMR
b. Decrease CBF
All gases EXCEPT this one decrease CMR?
a. N20
. ICP may be mild and can be prevented by hypocapnia (the only gas with these properties):
a.
ISOflurane
All are true EXCEPT of etomidate:
a. Has no CV effects
b. Should use in caution with hx of seizures
c. …ummmm
d. Increases CMRO2???
All are true EXCEPT of etomidate:
a. Has no CV effects
b. Should use in caution with hx of seizures
c. …ummmm
d. Increases CMRO2???
The neuron is NOT the basic functional cell of the CNS? T or F
a. False
Allergic reaction that includes angioedema would be classified as
a. moderate
Man tells you he is allergic to contrast. Procedure is tomorrow. What is the BEST course of action?
a. Steroid today. Histamine before surgery.
Contraindications (relative) for sitting position:
a. C-spine/ degenerative diseases of C-spine
b. Intra-cardiac defects
c. severe Hypovolemia
d. Severe hydrocephalus
e. lesion vascularity
f. Significant CVD
Select all that are true of posterior fossa surgery??
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral, three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d. Ensure large airway and bite block placements
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral, three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d. Ensure large airway and bite block placements (WRONG: Avoid)
What drug would you not give prior to clipping of aneurysm?
a. phenylephrine
Triple H therapy includes: (choose 3)
a. Hypertension
b. Hypervolemia
c. Hemodilution
d. (all of the wrong answers included hyper/hypothermia)
Which is NOT a risk factor for protamine allergy?
a. Family history of malignant hypothermia
What is the advantage of using newer radiographic contrast compared to older radiographic contrast?
a. Newer radiographic contrast has a lower osmolar load
. All are true of Right sided catheterization except:
a. Performed for diagnostic purposes
b. May be done Brachial, femoral, and IJ
c. NOT EJ
What are irreversible:
a. ASA
b. Thienophyridine
Law that applies to aneurysms?
a. Law of Laplace
During the management of an angioplasty and stenting for treatment of atherosclerotic stenosis of the cervical, vertebral, and intracranial arteries, which of the following are NOT true?
a. Hypoperfusion is associated with this procedure.
85 y/o man, history of MI, Cr 1.8, BUN 22, K 5 (other labs that were normal) needs emergent heart cath. Which of the following is the BEST action?
a. Hydrate, avoid NSAIDS, limit contrast, proceed with case
All of the following are true of AVMs except?
a. They are emergent and require emergency treatment
Best candidate for awake craniotomy?
a. 38-year-old with tumor near motor area with history of uncontrolled seizures (I think this is the right answer)
AVM surgery with ICP 22. What is the best action?
a. Hyperventilate because the ICP is too high.
. All of the following increase CBF and ICP under normal circumstances EXCEPT.
a. midazolam
Barbiturates do all of the following EXCEPT
a. Protect against global ischemia.
What are s/s of cushing’s triad? (choose 3) - not sure of the exact question or the exact answers
a. Intracranial HTN
b. Arterial HTN
c. Bradycardia
d. Fast, deep respirations
a. Intracranial HTN
b. Arterial HTN
c. Bradycardia
d. Fast, deep respirations (WRONG?)
Which is wrong regarding air embolism?
a. Add 8 of PEEP
b. Suction through CVV
c. Stop N2O
d. Place pt in Right-lateral recumbent with head slightly up
d. Place pt in Right-lateral recumbent with head slightly up (this was the answer; this answer would have been correct if it had been Left-lateral recumbent)
If the PaCO2 is raised to 50–60 mmHg, cerebral venous outflow will greatly exceed extracranial venous outflow, and the pressure gradient will favor movement of a
sclerosing agent, chemotherapeutic agent, or glue away from vital intracranial drainage pathways
- Epinephrine (T/F) High dose = Beta + increase PVR; Low dose = Alpha + decrease PVR
- False
- MVR causes
. Viral
a. Toxins
b. Autoimmune
- ASD
. If there is no CHF present,
there are minimal alterations in Volatile anesthetic requirements
- TOF: Pre-operative preparations
. Premedicate with sedative
- All of the following are true of Left to Right shunt except:
.
Recurrent pulmonary infections are very unlikely (False statement)
- Patient in for ACL repair. Father died of heart?
. ACRM: Use Amiodarone; Deep anesthesia
- 3 S&S of TET/Hypercyanotic Spells
. Loss of consciousness
a. Arterial hypoxemia with increasing cyanosis
b. Seizures
- Spherical LV hypertrophy on chest x-ray; Pulmonary venous congestion
. Dilated Cardiomyopathy
- 2 Determinants of Anesthesia for Aortic Stenosis
. CO
a. HR/BP?
- Ebstein anomaly is associated with
. WPW
- In Right to Left of TOF: All increase R to L shunt
. Decrease PVR?
- RCM
. Titrate Fentanyl
- Congenital heart disease problems except
.
a. Hypotension? Sudden Death?
- EPI effects on BP and HR
. Increase systolic, decrease diastolic and increase HR
- Parasympathetic innervation of the heart is
. Dorsal motor vagal
- Critical Aortic Stenosis 3 S&S:
. Syncope
a. Angina pectoris
b. DOE
- Epinephrine (T/F): Neurotransmitter vs Peripheral Hormone
.
FALSE??????
- Patient has left recurrent laryngeal nerve damage what condition is suspected
a. Mitral Stenosis
Hypertrophic cardiomyopathy is associated with
a. Contractile mechanism
Hypertrophic cardiomyopathy
a. Diastolic and systolic cardiomyopathy
. 19 % of patients with cyanotic heart disease also present with
a. Scoliosis
Patients with cyanotic heart disease have?
a. Increased minute ventilation and normocarbia
Mitral regurgitation appropriate anesthetic considerations
a. Keep heart rate 80-100
Aortic stenosis patient heart rate 46
a. Atropine 0.4mg bp dropped to 90/50 give 10-20mg of ephedrine
. Direct and indirect acting medication
a. Ephedrine
Aortic stenosis is eccentric T/F?
a. False
Eccentric is
a. Chamber size and volume enlargement
. Marfan Syndrome associated with what 5 traits:
a. Tall and slender
b. Disproportionate arms and legs
c. High arch palate and crowned teeth
d. Heart murmurs are common (MR)
e. Flat feet
All of the following occur in restrictive cardiomyopathy EXCEPT?
a. 10-year-old female
Epi at low doses is greater beta 2 than beta 1 T/F?
a. True??? → False, they are equal
. Question about Tricuspid Atresia? Choose 3
a. Cyanosis is usually present at birth
b. Early survival is depending on prostaglandin E1 infusion
c. Success of the fontan procedure is reliant upon low PVR and low atrial pressure
. How does EPI change from low dose to high dose?
a. Beta 1, Alpha 1
Which one does not need prostaglandin E1
a. IHSS
Question about sudden death?
a. Dysrhythmias
What does oxytocin do to svr ___ and HR and PVR
a. Decrease, increase
Oxytocin DECREASES SVR
Increases HR /PVR
Hypertrophic cardiomyopathy first line treatment
a. Fluids
VSD associated with what post-op ?
a. 3rd degree heart block post op
PV Loop of increased Preload, Afterload
know the loops!
All are symptoms of aortic stenosis EXCEPT?
a. Diastolic murmur
. Mediastinoscopy question….? Choose 3
a. Patients with lung cancer may have Eaton-Lambert syndrome with sensitivity to NDMR and Depolarizers
b. The most severe complication of mediastinoscopy is major hemorrhage
c. A bronchial blocker can be used to provide lung isolation in the event of an emergency
Adrenaline is the same as EPI
a. True
Benefits of beta 2 stimulation? Choose 2
a. Vasodilation
b. Stabilization of mast cell protection
Alpha 2 receptors are found
a. Presynaptic
What is the most common CHD
a. VSD
Reversal of a shunt
a. Eisenmenger’t sydrome
Which is true about aortic stenosis? Choose 2
a. Avoid bradycardia because SV is fixed
b. Avoid tachycardia because SV is fixed
How do you treat bradycardia in a patient with aortic stenosis?
• The onset of junctional rhythm or bradycardia requires prompt treatment with ephedrine, atropine, or glycopyrrolate
What is the best way treat a patient with aortic stenosis during induction, maintenance, etc.?
- ** Maintain NSR- prevent hypotension
- Avoid regional – spinal and epidural will lead to shock
- Iv induction that does not decrease SVR- etomidate and Benzodiazepines
- Avoid ketamine d/t ketamine
- Volatiles and opioids plus nitrous may be used for maintenance
- Marked left ventricular dysfunction=maintenance should be nitrous oxide with opioids or opioids alone.
- Neuromuscular blocking drugs with minimal hemodynamic effects are best.
- Maintain IV fluid volume at normal levels
- Persistent tachycardia should be treated with B blockers Such as esmolol.
- SVT terminated with cardioversion
- Lidocaine, amiodarone and defibrillator should be available- d/t high propensity for ventricular dysrhythmias
What are the features of Tricuspid Atresia?
- Absence or permanent closure of the tricuspid valve
- Blood flow cannot enter the right ventricle
- Blood flow must go to the left atrium via the Patent foramen ovale or ASD then flows into the left ventricle and through a VSD- into the right ventricle and the pulmonary circulation
- If no VSD- pulmonary blood flow is accomplished through a PDA or bronchial vessels.
- Are cyanotic and have a small right ventricle
- Right to left shunt=cyanosis (clubbing in older children) tachypnea, prominent a waves, failure to thrive, all in the absence of abnormal pulses, hepatic enlargement or overt heart failure.
- Holosystolic murmur-
What is Eisenmenger’s Syndrome?
- Severe pulmonary HTN as a result of Left to right intracardiac shunt
- Common cause is unrepaired VSD
- Enlargement of the right ventricle and atrium lead to dysrhythmias such as atrial fibrillation or flutter
What are the features of ventricular septal defect? What must you monitor for?
- VSD- the most prevalent form of congenital heart disease in children
- Treat VSD of unknown severity like a patient with CHF and pulmonary HTN.
- Eisenmenger syndrome
What are the features of atrial septal defect? What must you be vigilant about?
- ASD’s are more commonly diagnosed in adults
- Requires all of the monitor and access needed for CP bypass and capacity to treat and manage potential post-operative heart block
How does congenital heart disease (CHD) complicate pregnancy? When would a patient with CHD have complications?
- Cardiac complications, spontaneous abortions, premature delivery, thrombolic complications, peripartum endocarditis (presenting usually in last month of pregnancy and up to 5 months postpartum), poor fetal outcomes can occur
- Successful pregnancy term with delivery is possible
- Almost 50% of cyanotic women have worsening outcomes
- Most major physiologic changes occur prior to 3rd trimester… if pt has maintained good functional status to this point, risk is dramatically lowered
- Epidural will help with pain/response to labor
- Bearing down (associated with 2nd stage) requires close observation
- No favored method (c/s vs vaginal birth)
- 3rd stage (delivery of placenta) can be associated with hypovolemia, uterine atony and hemorrhage….
- Oxytocin decreases SVR and increases HR and PVR
- Methylergonovine (methergine) increases SVR
- (both of these can be poorly tolerated)
- Some mothers will be taking drugs for cardiac condition
- B-blockers can interfere with fetal growth and response of fetus to stress during labor
- Amiodarone can affect fetal thyroid function
- Maternal cardioversion could be safe with close fetal monitoring
Scoliosis in CHD? Prevalence?
•Scoliosis can occur in approximately 19% of pts with CHD (most commonly in cyanotic pts)
Intracardiac shunts put patient at risk for what?
Ebstien’s Anomaly CHD?
- Produces acyanotic lesion – but can be associated with other shunting lesions that in combination with RVOT obstruction renders these patients cyanotic.
- Malformed tricuspid valve
- Symtpoms- CHF, Syncope, Dysrhythmias or no symptoms
- If associated shunting lesion patient at risk for paradoxical EMBOLi and hypoxia. Dpending on the right to left shunt
Duchene Muscular Dystrophy? Which population of patients? Etc.
- Pseudohypertrophic muscular dystrophy
- Most common and most severe form of childhood progressive muscular dystrophy caused by mutation on X chromosome.
- Aortic stenosis patient’s heart rate drops to 46…what do you do?
a. Atropine 0.4mg and if DP drops to 90/50 then give 10-20 mg of ephedrine → pretty sure this should be neo hm.. (What about refractory bradycardia w/ neo?) also 10-20 mg Ephedrine is a hefty dose
Direct and indirect acting medication?
a. Ephedrine
All are symptoms of aortic stenosis EXCEPT?
a. Diastolic murmur
Mediastinoscopy question….? Choose 3
a. Patients with lung cancer may have Eaton-Lambert syndrome with sensitivity to NDMR and Depolarizers
b. The most severe complication of mediastinoscopy is major hemorrhage
c. A bronchial blocker can be used to provide lung isolation in the event of an emergency
Benefits of beta 2 stimulation? Choose 2
a. Vasodilation
b. Stabilization of mast cell protection
- Levophed is the same as Norepinephrine. True or False?
a. True
- In the awake lateral position. Abdominal contents are placed?
a. Cephalad in the dependent lung
- Factors that reduce HPV?
a. Hemodilution
b. Hypervolemia
c. Hypothermia
- Lung separation is done?
a. One lung ventilation
- Most modern pacemakers are?
a. Bipolar
- Creation of the Reed Switch enabled?
a. the PM to convert from synchronous to asynchronous with the application of a magnet
- Second letter for the pacemaker code is?
a. Ability to sense
- Beta 1 stimulation
a. Positive chronotropic
b. Positive dromotropic
- Three-legged stool
a. Respiratory mechanics
b. Cardiopulmonary reserve
c. Lung parenchymal function
The metabolic requirement for O2 is reduced by ______ for each _____ C drop in core body temperature sinus rhythm can’t be obtained until temp is____.
a. 50%, 7, 34
- ACT, PT, and PTT are prolonged, and platelets become nonfunctional as the temp is decreased to
a. 28 C
- True about renal dysfunction and CABG? Choose 3
a. Renal dysfunction is related to length of time on bypass (longer than 3 hrs)
b. Hypothermia depresses renal tubular function
c. Urinary output is the single most important intraoperative monitor of renal system during CABG
- What is vulnerable to traumatic injury as it is subjected to high shear forces after blunt trauma or rapid deceleration?
a. Aortic isthmus
- Aortic wall and lined by endothelium?
a. Intima
- Abg ph-7.36 pac02 60, hc03 -30
a. Compensated Respiratory Acidosis
- Patient has volume of air that can be inspired with maximal effort and above normal tidal breathing
a. Inspiratory Reserve Volume
- T/F- Intrapleural pressure becomes more positive during inspiration and less negative during expiration
a. False - it becomes more negative during inspiration and less negative during expiration
- Patient is COPD, on 4L NC at home. Arrives for right sided pneumonectomy due to cancer. Hx of DVT and has been on coumadin for 5 years and took his last dose last night.
a. General anesthesia, 8.5 ETT with bronchial blocker, opioids, anticoagulation plan post op, plan for post op ventilation????
- Bronchogenic carcinoma is the most frequent indication for?
a. Sleeve lobectomy
- Position for OLV? Choose 3
a. Common position is lateral decubitus
b. A roll is placed beneath the torso just caudal to the axilla to prevent compression of the neurovascular bundle and forward rotation of the humeral head (better considered an axillary support roll because if positioned in the axilla it could cause compression of the neurovascular area)
c. Hyperabduction of the arms is prevented to keep the brachial plexus from stretching against the humeral head
- The distance from the carinal bifurcation to the right upper lobe is ______ compared to _____ left mainstem bronchus.
a. 1.5-2 cm, 4-5 cmq
- Neuroprotective measures during heart and vascular surgeries (choose 3)
a. Systemic hypothermia
b. Topic cerebral cooling
c. ???
- In a spontaneously breathing, upright pt, perfusion ______ from the apex to base of the lung.
a. Increases
- The first branch of the aortic arch
a. The innominate artery
- The sympathomimetic amine depends on
a. Dose of drug
b. Affinity to receptor
c. Population of receptor
- The American Thoracic Society considers an ____ improvement in forced expiratory volume 1 (FEV1) post-bronchial therapy to be significant.
a. 12%
- HPV?
a. Triggered by Alveolar hypoxia
b. Peak at 30 seconds (wrong) == 15 mins
- The vo2 max is 15, the DLCO and FEV1 is less than 40%
a. Increased risk
b. PFT
c. More testing
- _______ is the single most important step in reducing the heart’s myocardial O2 consumption by 90%
• Pleural rupting myocardial electromechanical activity
- Aortic systolic BP results from summated effects of: (choose 3)
a. Stroke volume
b. Aortic compliance
c. Peripheral Vascular Resistance
d. Systemic Vascular Resistance
a. Stroke volume
b. Aortic compliance
c. Peripheral Vascular Resistance
d. Systemic Vascular Resistance (WRONG)
First branch of aortic arch is the ____
a. Innominate artery
_____ is the mechanism by which autoregulation during OLV allows a reflex intrapulmonary feedback mechanism that improves gas exchange and arterial oxygenation.
a. Hypoxic Pulmonary Vasoconstriction (HPV)
- _____ tests the lungs ability to allow transport of gas across the alveolar-capillary membrane.
• Diffusion capacity
Leads are often inserted at the completion of cardiac surgery. Pacing wires are directly sewn, by the CV surgeon onto the epicardium. This describes _____.
• Epicardial pacing
Correct placement of transcutaneous pacing pads are? (Choose 2)
- Anteriorly on right upper chest and anteriorly on the left lower chest
- Anteriorly mid chest and posteriorly between the scapulae
- ____ is the pressure in the potential space between the lung pleura and the chest wall pleura. While _____ is the pressure of air inside the alveoli.
- Pleural pressure
* Alveolar pressure
Lower airway consists of: (choose 3)
- Trachea
- Conducting Airways
- Respiratory Airways
- Patient has Dilated cardiomyopathy. The astute SRNA can expect the pt to have?
a. Tricuspid valve regurgitation
- All of the following should be avoided in mitral stenosis EXCEPT:
a. Calcium channel blockers to treat HR in presence of A-Fib
- All of the following are appropriate for treatment of mitral regurgitation EXCEPT:
a. Avoid pancuronium
- With dilated cardiomyopathy, which of the following would be the BEST anesthetic management plan?
a. Promote afterload reduction, avoid large fluid blouses, opioids are good, etomidate is better choice over propofol
- ACT measurement
• 400 seconds to initiate bypass
