Clinical Anesthesia | Cardiac

Question 1

A 65-year-old patient with hypertrophic cardiomyopathy has chest pain prior to induction of anesthesia. Pulse is 80 bpm and blood pressure is 130/80 mmHg. The ECG (V5) shows sinus rhythm and new ST-segment depression. The most appropriate management is administration of

(A) furosemide
(B) metoprolol
(C) morphine
(D) nifedipine
(E) nitroglycerin

Answer 1

(B) metoprolol

The anesthetic management of patients with hypertrophic cardiomyopathy includes:

• Maintaining preload
• Maintaining afterload (using alpha-adrenergic
  agonists)

*Minimizing increases in contractility

*Avoiding tachycardia and maintaining sinus rhythm

Question 2

Which of the following is the most appropriate management of decreased cardiac output in patients with isolated aortic insufficiency?

(A) Dobutamine
(B) Esmolol
(C) Intra-aortic balloon counterpulsation
(D) Norepinephrine
(E) Positive pressure ventilation

Answer 2

(A) Dobutamine

Question 3

A 14-month-old child has tetralogy of Fallot with dynamic obstruction to right ventricular outflow. Which of the following is most likely to decrease cyanosis in this child?

(A) Calcium
(B) Epinephrine
(C) Nitroglycerin
(D) Nitroprusside
(E) Propranolol

Answer 3

(E) Propranolol

Question 4

A 70-kg 58-year-old man with unstable angina is scheduled to undergo coronary artery bypass grafting. Intravenous heparin and nitroglycerin are administered for four days before surgery. Before initiating cardiopulmonary bypass, 21,000 units of heparin are administered through the central venous catheter; five minutes later, activated clotting time is 280 seconds. Which of the following is the most appropriate next step in management?

(A) Discontinue nitroglycerin
(B) Administer additional heparin
(C) Administer cryoprecipitate
(D) Administer fresh frozen plasma
(E) Initiate cardiopulmonary bypass

Answer 4

(B) Administer additional heparin

Question 5

A 46-year-old patient who abuses intravenous drugs develops acute aortic valvular insufficiency from bacterial endocarditis. Which of the following statements concerning pressures measured through a pulmonary artery catheter is true?

(A) Pulmonary artery occlusion pressure will underestimate left ventricular end-diastolic pressure

(B) Pulmonary artery oxygen saturation will overestimate mixed venous oxygen saturation

(C) Thermodilution cardiac output determination will overestimate cardiac output

(D) Right ventricular end-diastolic pressure will equal left ventricular end-diastolic pressure

(E) The pulmonary artery occlusion pressure trace will most likely have large V waves

Answer 5

(A) Pulmonary artery occlusion pressure will underestimate left ventricular end-diastolic pressure

Question 6

Hemodilution is used during profound hypothermic cardiopulmonary bypass primarily because it

(A) decreases cold-induced coagulopathy
(B) decreases edema formation
(C) increases oxygen-carrying capacity of plasma
(D) increases oxygen dissociation from hemoglobin
(E) limits the cold-induced increase in blood viscosity

Answer 6

(E) limits the cold-induced increase in blood viscosity

Question 7

In the absence of coronary artery disease, isoflurane-induced vasodilation and tachycardia are beneficial hemodynamic goals for which of the following cardiac diseases?

(A) Aortic regurgitation
(B) Aortic stenosis
(C) Asymmetric septal hypertrophy (IHSS)
(D) Mitral stenosis
(E) Pulmonary regurgitation

Answer 7

(A) Aortic regurgitation