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Cardiac Specialty Exam > Cardiac > Flashcards

Cardiac Flashcards

1
Q

If nitroglycerin is constituted with NTG 50 mg in D5W 250 ml, what volume rate of infusion will be required to administer 2.5 mcg kg-1min-1 to a 70-kg male?

A

50 ml/hr

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2
Q

Identify the rhythm in the accompanying rhythm strip.

A

Third degree AV block

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3
Q

A 42 year-old patient presents to preop clinic for evaluation prior to a laparoscopic cholecystectomy which has been scheduled for the following day. On the self- assessment form, he lists hypertension with no antihypertensive medications. On physical exam, pulse rate is 105/min. What previous study in the old chart should be reviewed to determine if further studies are warranted?

  • CXR
  • EGD
  • EKG
  • LFTs
  • PFTs
A

EKG

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4
Q

In clinical practice, systemic vascular resistance is equated to:

  • Left ventricular afterload
  • Left ventricular contractility
  • Left ventricular preload
  • Right ventricular afterload
  • Right ventricular preload
A

Left ventricular afterload

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5
Q

Which of the following tests is used to assess the anticoagulation effect of heparin?

  • Bleeding time
  • INR
  • Platelet function test
  • PT
  • PTT
A

PTT or ACT

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6
Q

Identify the rhythm in the accompanying rhythm strip.

A

Second degree AV block type II

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7
Q

Preload is determined with transesophageal echocardiography using the measurement of

  • Left atrial end-diastolic volume
  • Left ventricular end-diastolic volume
  • Left ventricular end-systolic volume
  • Righ atrial end-diastolic volume
  • Right ventricular end- diastolic volume
A

Left ventricular end-diastolic volume

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8
Q

The following laboratory results were obtained immediately after discontinuing cardiopulmonary bypass. Which value would require treatment?

  • Calcium (ionized) 0.9 meq/L
  • Glucose 120 mg/dL
  • Lactate 3.0 mmol/L
  • Potassium 5.2 meq/L
  • Sodium 138 meq/L
A

Calcium (ionized) 0.9 meq/L

Sara got this wrong.

  • 1mmol = 1 meq if Hydrogen
  • 1 mmol = 2 meq if Calcium since 2 valence electrons
  • So, normal values are:
    • 1.1-1.35 mmol/L or more importantly
    • 2.24 - 2.46 meq/L
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9
Q

During cardiopulmonary bypass, the anesthetist is responsible for which of the following actions?

  • Administration of anesthetic gases
  • Charting
  • Rewarming
  • Transfusion
  • Ventilation
A

Charting

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10
Q

What is the minimum value for ACT at which CPB may be initiated?

  • 100 sec
  • 200 sec
  • 300 sec
  • 400 sec
  • 500 sec
A

400 sec

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11
Q

In the immediate post CBP period, transfusion would be indicated at or below which of the following hemoglobin transfusions?

  • 3 gm/dL
  • 4 gm/dL
  • 7 gm/dL
  • 9 gm/dL
  • 11 gm/dL
A

7 gm/dL

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12
Q

The myocardium extracts oxygen from the coronary arteries?

  • 73%
  • 47%
  • 33%
  • 43%
  • 37%
A

73%

This is also known as SvO2. ScvO2 (central venous) closely correlate but is generally higher than ScvO2 since there is no admixture from the coronary sinus however the values trend together

ScvO2, SvO2 ~ 60-80%

In a healthy individual, normal SvO2 is between 60 percent and 80 percent.
If SvO2 is low (below 60 percent) then the oxygen supply is insufficient or the oxygen demand has increased.
If SvO2 is high (above 80 percent) then the oxygen demand has declined or the oxygen supply has increased.

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13
Q

The change left to right in the cardiac valve depicted in the accompanying figure represents

  • Abnormal mitral leaflet
  • Aortic stenosis
  • Mitral regurgitation
  • Normal pulmonary valve
  • Tricuspid regurgitation
A

Aortic stenosis

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14
Q

Each of the following parameters should be attained before terminating cardiopulmonary bypass EXCEPT

  • Heart rate of 80-100 bpm
  • Hb concentration greater than 10 g/dL
  • Ionized calcium level 1-1.3 mmol/dL
  • Lungs ventilated with an FiO2 of 1
  • Nasopharyngeal or bladder temperature of greater than 36 degrees celcius
A

Hb concentration greater than 10 g/dL

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15
Q

Coronary perfusion is defined as

  • CVP-LVEDP
  • DBP-LVEDP
  • MAP-LVEDP
  • PAP-LVEDP
  • NBP-LVEDP
A

CVP-LVEDP

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16
Q

The CVP tracing in a patient with severe tricuspid regurgitation would display which of the following tracings?

  • An increased “a” wave
  • Loss of the “a” wave
  • Loss of the “a” descent
  • Loss of the “y” descent
  • No negative deflection
A

No negative deflection?

or

An increased “a” wave?

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17
Q

The tip of an intra-aortic balloon pump balloon is normally placed in the

  • Abdominal aorta
  • Left ventricle
  • Pulmonary artery
  • Right ventricle
  • Thoracic aorta
A

Thoracic aorta

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18
Q

The highest morbidity and mortality for CABG surgery is related to comcomitant

  • Congestive heart failure
  • First-time cardiac surgery
  • Left circumflex disease
  • Obesity
  • Rheumatic heart disease
A

Congestive heart failure

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19
Q

Identify the rhythm in the accompanying thythm strip.

  • Atrial fibrillation
  • First degree AV block
  • Second degree AV block type I
  • Second degree AV block type II
  • Third degree AV block
A

Second degree AV block type I (Wenckebach)

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20
Q

The patient for which the image appears in the accompanying figure is undergoing

  • Atherotomy
  • Placement of endostent
  • Placement of intra-aortic balloon pump
  • Preparation for cardiopulmonary bypass
  • Thrombectomy
A

Placement of endostent

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21
Q

Following an on-pump CABG, a 72 year-old patient continues to bleed. If after 12 units of PRBCs have been administered, there is myocardial dysfunction, the most likely cause would be related to

  • Ca++ = 0.4 meq/L
  • K+ = 5.2 meq/L
  • Na+ = 123 meq/L
  • PaCO2 = 48 mmHg
  • pH = 7.24
A

Ca++ = 0.4 meq/L

Normal Ca++ levels are:

  • 8.8-10.4 mg/dL
  • 2.2-2.6 meq/L
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22
Q

For a normal patient, what percentage of cardiac output is dependent upon atrial kick?

  • 5%
  • 10%
  • 20%
  • 35%
  • 50%
A

20%

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23
Q

Which of the following drugs should be injected intravenously to treat both hypertension and tachycardia?

  • Atropine
  • Edrophonium
  • Epinephrine
  • Labetalol
  • Norepinephrine
A

Labetalol

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24
Q

Which of the following findings is a manifestion of diastolic dysfunction?

  • Decreased filling pressures
  • Decreased venous return
  • Reduced cardiac output
  • Reduced ventricular contractility
  • Reduced ventricular relaxation
A

Reduced ventricular relaxation

Diastolic failure appears when the ventricle can’t be filled properly because it can’t relax or because its wall is thick or rigid. This situation presents usually a concentric hypertrophy. In contrast, systolic heart failure has usually an eccentric hypertrophy.[3]

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25
Q

Wic of te following post-operative electrolyte disturbances would most likely result from rapid transfusion of citrate-preserved banked blood?

A

hypocalcemia

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26
Q

The arterial pressure waveform in the accompanying figure most likely represents a

  • High-fidelity waveform in a patient with aortic stenosis
  • High-fidelity waveform in a monitoring system with low tubing compliance
  • Low-fidelity waveform in a patient with mitral regurgitation
  • Low-fidelity waveform in a monitoring system with low resonant frequency
A

High-fidelity waveform in a monitoring system with low tubing compliance?

Sara got this one wrong

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27
Q

Which of the following transfusion strategies will most likely reduce the risk of a nonhemolytic febrile transfusion reaction?

A

Administration of PRBCs collected using a leukocyte reduction filter

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28
Q

Which of the following conditions would most likely be the cause of death for a patient with untreated pulmonary hypertension?

  • Acute MI
  • Left ventricular failure
  • Ogilvie’s syndrome
  • Pulmonary artery infarction
  • Right ventricular failure
A

Right ventricular failure

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29
Q

For the patient undergoing a redo sternotomy for CABG, the additional measure that should be taken compared to preparation for the first sternotomy would be using

  • Continuous cardiac output PA catheter
  • External defibrillator pads
  • Radial and femoral arterial cannulae
  • Rapid infusion blood delivery system
  • Transesophageal echocardiography
A

External defibrillator pads

30
Q

For the patient with CAD, myocardial oxygen supply/demand ratio will more be comproised with an increase in

  • Blood pressure
  • CVP
  • End-tidal CO2
  • Heart rate
  • Pulmonary artery pressure
A

Heart rate

31
Q

An 82 year-old man underwent CPB for four hours for repair of an ascending aortic aneurysm. At the end of the procedure, no blood products had been administered. Following protamine administration, uncontrolled bleeding began from the sternotomy and suture lines. Current laboratory measurements include

Hb: 0.8 gm/dL, PT: 13 sec, INR: 1.3 sec, PTT: 48 sec, Plts: 145 and Fibrinogen: 80 mg/dL

Appropriate initial management of his hemorrhage should include administration of:

  • Cryoprecipitate
  • FFP
  • PRBC
  • Platelets
  • Recombinant factor 7
A

Cryoprecipitate

because normal fibrinogen: 200-400 mg/dL

32
Q

Upon admission to the ER, a 44 year-old man who was involved in an MVA has a heart rate of 140 and BP of 80/60. ECHO reveals a moderate volume of pericardial fluid. If the pericardial fluid cannot be drained prior the the pt’s transfer to surgery, which of the following infusions will provide the best support of cardiac output?

  • Dobutamine
  • Dopamine
  • Epinephrine
  • Isoproterenol
  • Norepinephrine
A

Isoproterenol

33
Q

Which of the following symptoms would indicate the presence of MI in a non-anesthetised patient?

  • Headache
  • Jaw pain
  • Memory loss
  • Tinnitus
  • Vision changes
A

Jaw pain

34
Q

Which of the following actions respresents the best management for a patient with obstructive hypertrophic cardiomyopathy?

  • Decreasing inotropy
  • Increasing heart rate by pacing
  • Increasing heart rate pharmacologically
  • Reducing afterload
  • Restricting volume
A

Decreasing inotropy

Remember HOCM is also known as SAM: systolic anterior motion, and the treatment is: SLOW contractility, FULL of fluids, TIGHT svr

35
Q

Which of the following pressure measurements representts the best means for assessing right ventricular function?

  • Central venous pressure
  • Pulmonary artery diastolic pressure
  • Pulmonary artery occlusion pressure
  • Pulmonary artery systolic pressure
  • Right ventricular end-diastolic pressure
A

Right ventricular end-diastolic pressure

36
Q

Anesthetic management during cardiopulmonary bypass involves which of the following actions?

  • Hyperinflation of the lungs
  • Increasing muscle relaxant dosage
  • Maintaining PaCO2 = 30 mmHg
  • Providing mechanical ventilation
  • Providing neuromusclular blockage during coooling and rewarming
A

Providing neuromusclular blockage during coooling and rewarming

37
Q

Which of the following values is NOT needed in order to calculate pulmonary vascular resistance?

  • 80
  • Cardiac output
  • CVP
  • PA mean pressure
  • PAOP
A

CVP

  • PVR = (PAP-PAOP)/CO *80
  • Mean PAP = 15
  • Mean PAOP = 9
38
Q

In a patient with pulmonary hypertension, which of the following anesthetic techniques would most likely increase pulmonary vascular resistance?

A

Nitrous, then maybe desflurane

39
Q

Which of the following conditions will LEAST likely produce an increase in pulmonary vascular resistance?

  • Acidosis
  • Anemia
  • Hypercapnia
  • Hypoxemia
  • Sympathetic stimulation
A

Anemia

Hypercarbia acts as a direct vasodilator in the systemic circulation as a direct vasoconstrictor in the pulmonary circulation. An increase in catecholamines is responsible for most of the clinical signs and symptoms of hypercarbia. “Anesthesia Secrets”

40
Q

Calculate SVR using the following patient data:

BP: 140/80
HR: 82
RR: 16
Temp: 37.4
CVP: 12
CO: 5.6 L/min
PAP: 35/12
PAOP: 10

A

1257 dyne/sec/cm-5

(MAP-CVP)/CO *80

41
Q

Which of the following actions should be avoided in a patient with idiopathic, dilated cardiomyopathy?

  • Combining a volatile anesthetic with opioids
  • Endotracheal intubation with succinylcholine
  • Maintaining normovolemia
  • Maintaining SVR within normal limits
  • Neuromuscular blockade with pancuronium
A

Neuromuscular blockade with pancuronium

Avoid B1 stimulation since these pts have reduced systolic function, tachycardia associated with pancuronium should be avoided.

42
Q

Which of the following conditions is an absolute contraindication to performing TEE?

  • Duodenal ulcer
  • Esophagectomy
  • Gastritis
  • Laryngectomy
  • Poor dentition
A

Esophagectomy

43
Q

Left ventricular heart failure without right ventricular heart failure would exhibit each of the following signs or symptoms EXCEPT

  • DOE
  • Jugular venous distension
  • Orthopnea
  • Paroxysmal nocturnal dyspnea
  • Rales
A

Jugular venous distension

Sara got this one wrong

44
Q

An anterior myocardial infarction will be produced by occlusion of the

  • Coronary sinus
  • Left anterior descending coronary artery
  • Left circumflex coronary artery
  • Right main coronary artery
  • Thoracic duct
A

Left anterior descending coronary artery

45
Q

The measurements taken during and after placement of a PA catheter reveal that the pt has normal right ventricular function and pulmonary hypertension, which of the following pressure sequences represents the patient?

  • CVP: 12, RV: 32/14, PA: 29/17, PAOP: 25
  • CVP: 17, RV: 24/15, PA: 28/12, PAOP: 14
  • CVP: 5, RV: 25/0, PA: 25/14, PAOP: 18
  • CVP: 8, RV: 24/2, PA: 62/28, PAOP: 8
  • CVP: 6, RV: 24/10, PA: 56/32, PAOP: 8
A

CVP: 8, RV: 24/2, PA: 62/28, PAOP: 8

Normal RA: ~3
Normal RV: ~25 / 6
Normal PA: ~15 (mean)
Normal PAOP: ~8 (mean)

46
Q

If multiple doses of heparin fail to anticoagulate a patient for CPB, what is the most likely cause?

A

Antithrombin III deficiency

47
Q

Which of the following variables is NOT a risk factor for ischemic heart disease?

  • Cigarette smoking
  • Diabetes mellitus
  • Female gender
  • Hypertension
  • Increased age
A

Female gender

48
Q

For the patient with severe aortic stenosis, which of the following changes would contribute to decompensation?

  • Decreasing HR
  • Decreasing preload
  • Increasing inotropy
  • Increasing left-ventricular end-diastolic volume
  • Increasing systemic vascular resistance
A

Decreasing preload

49
Q

Which of the following conditions is a myocardial disease in which the left ventricle is thickened without obvious cause?

  • Congestive heart failure
  • Dilated cardiomyopathy
  • Obstructive hypertrophic cardiomyopathy
  • Pulmonary arterial hypertension
  • Restrictive cardiomyopathy
A

Obstructive hypertrophic cardiomyopathy

50
Q

What does a DDD pacemaker sense?

  • Atria and ventricles
  • Dual atria
  • SA node
  • Single atrium
  • Ventricles
A

Atria and ventricles

51
Q

If inotropes and afterload reduction have failed during an attempt to wean a patient from CPB, the next most appropriate step should utilize

  • AICD
  • ECMO
  • Intra-aortic balloon pump
  • Nitroglycerin infusion
  • Permanent pacemaker
A

Intra-aortic balloon pump

52
Q

Which of the following doses of heparin should be administered to anticoagulate a patient prior to initiate CPB?

  • 100 units/kg
  • 200 units/kg
  • 400 units/kg
  • 600 units/kg
  • 800 units/kg
A

400 units/kg

53
Q

What type of response does a VVI pacemaker provide?

  • Inhibition only
  • Pacing
  • Shocking
  • Triggering and inhibition
  • Triggering only
A

Inhibition only

54
Q

Which of the following terms describes the heart’s inability to pump a sufficient amount of blood to meet metabolic requirements?

  • Anemia
  • Coagulopathy
  • Heart failure
  • Sepsis
  • Thyrotoxicosis
A

Heart failure

55
Q

Which of the following infusion rates would be both safe and efficacious for a phenylephrine infusion being used for vasopressor support?

  • 0.25 mcg/min
  • 25 mcg/min
  • 100 mcg/min
  • 1 mg/min
  • Phenylephrine does not provide vasopressor support
A

25 mcg/min

56
Q

After inserting an arterial cannula into the right radial artery and the patient’s hand becomes cool and mottled, what is the most appropriate next step?

A

Remove the catheter

57
Q

What information listed below would be the LEAST useful for periop management of a patient with a permanent pacemaker or AICD?

  • Identification of device and manufacturer
  • Indications for the device
  • Interrogation of the device
  • Magnet’s effect on the device
  • Prior replacement of the device
A

Prior replacement of the device

58
Q

Which of the following signs is related to isolated left heart failure?

  • Elevated jugular venous pressure
  • Hepatomegaly
  • Jugular venous distension
  • Pedal edema
  • Rales
A

Rales

59
Q

The following laboratory values respresent which acid-base abnormality?

Na: 135 meq/L
K: 4.0 meq/L
Cl: 100 meq/L
Bicarb: 18 meq/L
BUN: 13 mg/dL
Creatinine: 0.8 mg/dL
pH: 7.29
PaCO2: 35 mmHg
PaO2: 276 mmHg
BE: -4 meq/L
Lacate: 6.2 mmol/L

A

Anion gap metabolic acidosis

Anion gap = (Na + K) - (Cl + Bicarb)

Normal Anion Gap ~ 8-16 meq/L

60
Q

The following ABG respresents which of the following acid-base disorders listed below?

  • pH: 7.49
  • PCO2: 42 mmHg
  • PO2: 210 mmHg
  • BE: +2.5 meq/L
A

metabolic alkalosis

61
Q

If shock therapy fails to treat ventricular tachycardia in an unstable patient, which of the following therapies would be the most appropriate treatment?

  • Adenosine
  • Amiodarone
  • Heparin
  • Lidocaine
  • Procainamide
A

Amiodarone

ACLS states that amio takes only 3-5 mins to work versus procainamide which takes about 20 mins.

62
Q

What is the appropriate initial thereapy for ventricular fibrillation occurring following median sternotomy?

  • Atropine 1 mg IV
  • Cardioversion
  • CPR
  • Defibrillation
  • Epinephrine 1mg IV
A

Defibrillation

63
Q

Soon after induction of general anesthesia, a 22 year-old IV drug abuser has the rhythm depicted in the accompanying strip. He has a pulse present via radial arter palpation; NIBP is 48/30 mmHg. The most appropriate intervention at this time would be

  • Epinephrine
  • Lidocaine
  • Synchronized cardioversion
  • Valsalva maneuver
  • Vasopressin
A

Synchronized cardioversion

64
Q

Which of the following has NO effect on cardiac inotropy?

  • Dobutamine
  • Epinephrine
  • Milrinone
  • Norepinephrine
  • Vasopressin
A

Vasopressin

65
Q

For the patient with mitral regurgitation undergoing general anesthesia, the best management technique would include maintaining

A

Heart rate at the upper limit of normal

66
Q

In the immediate post-cardiopulmonary bypass period, milrinone is particularly useful for treating right ventricular failure secondary to high pulmonary vascular resistance because milrinone

  • Decreases preload to the right ventricle
  • Improves left ventricular performance and decreases right ventricular afterload
  • Improves right ventricular contractility and decreases pulmonary vascular resistance
  • Provides positive chronotropy and improves cardiac output of the noncompliant right ventricle
A

Improves right ventricular contractility and decreases pulmonary vascular resistance

Milrinone is an inodilator

67
Q

Nitroglycerin is useful for treating myocardial ischemia because nitroglycerin

  • Constricts collaterally perfused coronary arteries
  • Increases pulmonary blood flow
  • Increases venous return
  • Reduces heart rate
  • Reverses acute coronary vasospasm
A

Reverses acute coronary vasospasm

68
Q

Upon admission to the OR from the ER, a 60 year-old man involved in an MVA has a heart rate of 140, BP of 80/60, CVP: 23 with large a waves in the CVP tracing. Pulsus paradoxus of 6 mmHg is noted. Which of the following is the most likely assessment?

  • Atrial flutter
  • Cardiac tamponade
  • Hypovolemia
  • Junctional tachycardia
  • Tension pneumothorax
A

Cardiac tamponade

Pulsus paradoxus is an exaggeration of the normal variation in the pulse during the inspiratory phase of respiration in which the pulse becomes weaker as one inhales and stronger as one exhales PP has been shown to be predictive of the severity of cardiac tamponade.

69
Q

(Integer response only)

Given the following patient data, calculate SVR in dyne/sec/cm-5

  • HR: 88
  • BP: 180/96
  • CVP: 13
  • CO: 3 L/min
  • PAP: 28/16 mmHg
A

2960

70
Q

(Integer response)

Calculate SVR in dyn/sec/cm-5 using the following hemodynamic measurements

  • HR: 112
  • BP: 140/90
  • MAP: 100
  • CVP: 10
  • PAOP: 15
  • CO: 5 L/min
A

1440 dyn/sec/cm-5

71
Q

What rhythm is depicted in the accompanying rhythm strip? (one word)

A

sinus

72
Q

A 58 year-old mentally handicapped man with severe AS and a history of syncope is to undergo complex dental extraction under general anesthesia prior to AVR. In POHA, he is diaphoretic and complaining of chest pain. His pulse is 135, blood pressure is 78/55, and t waves are inverted in V5. What is the most appropriate immediate management?

  • Epi 16 mcg IV
  • Esmolol 30 mg IV
  • Midazolam 2 mg IV
  • Nitroglycerin 50 mcg IV
  • Phenylephrine 100 mcg IV
A

Nitroglycerin 50 mcg IV

Cardiac Specialty Exam (2 decks)

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