Final Exam Review Flashcards
Mixed venous oxygen saturation is measured at __________ while central venous oxygen saturation is measured at the __________.
Pulmonary artery right atrium
When does the mitral valve close?
at the beginning of isovolumetric contraction
A procedure that requires opening the left heart to air requires more than one vent to adequately de-air the heart before separation from the CPB… T/F
true
Does parasympathetic stimulation increase myocardial oxygen demand?
No
the frank starling law talks about…
LV end diastolic muscle length and LV muscle function
T/F As ventricular volume increases, a larger force from each muscle cell is prequired t produce any given intraventricular pressure.
True
If your patients O2 delivery is 1000ml/min, and their O2 consumption is 500 ml/min, What is their SvO2
50%
A stress test on a 45 yr old male shows lateral akenisis, what EKG leads are going to show the changes?
V5, V6
The patient has an end diastolic volume of 200ml. The patient’s end systolic volume is 100ml. Heart rate is 50 BPM Does this patient have severe LV dysfunction?
No
T/F In a patient with atrial fibrillation, the measurement of stroke volume variation by the FloTrac transducer is not accurate, but the cardiac index and stroke volume measurements are accurate.
True
When placing a PA catheter and you notice that you have 45cm of catheter in the patient, yet you continue to see an RV waveform. Based on your understanding of PA catheterization, you can assume that:
The cath is most likely curling in right ventricle
Venous cannulation for CPB can be accomplished via (2)
the right atrium, the vena cava
Your patient is undergoing intraabdominal heated chemotherapy infusion following exploratory laparotomy and tumor debulking under a balanced general anesthetic. Your core body temperature is 38.7 degrees C. You notice a cardiac index of 3.1 L/min and and SvO2 of 51%. Your knowledge of hemodynamic monitoring allows you to realize that the patient’s oxygen consumption is ________________, with the most likely cause being ________________.
increased; hyperthermia
T/F a CVP of 12 ALWAYS means the patient has an adequate fluid volume status.
FALSE BITCHES!!!!!
Your 47 y/o female patient is undergoing laproscopic hemicolectomy. Within 5 minutes after insufflation of the peritoneum with carbon dioxide, your hemodynamic parameters are as follows. Of note, the patients starting hemoglobin was 12.1 mg/dl & you have experienced no blood loss, you are ventilating with positive pressure and tidal volumes of 8ml/kg, PEEP 5, and the patient is in NSR. ABP 83/43 CI 1.9 SVV 20 ScvO2 63% The next most appropriate intervention should be to:
give a 500ml bolus of fluids
Typical ejection fraction is ______%. <_______% indicates severe cardiac disease.
60-65 40
The EKG correlates to coronary anatomy. Inferior wall changes are most likely seen in which leads?
II, III, aVF
You are performing a pre-op evaluation on a 69 y/o male patient who is scheduled for an elective inguinal hernia repair the following day. The patient states he underwent coronary angiography 6 months ago and two drug-eluding stents were placed in his LAD artery. The patient states he has no anginal symptoms and a exercies tolerance of 7 METs. The most appropriate way to proceed in this case is?
Cancel this elective case because national guidelines state patients with drug eluding stents should wait over 1 year before stopping anti-platelet agents to undergo elective surgery
T/F In a normally functioning heart, there is a moment when the aortic valve and mitral valve are open at the same time.
False
T/F CVP is a reliable indicator of volume responsiveness (increase in cardiac output in response to a fluid challenge).
False
Please use the picture below to answer question. Match the wave to what it represents. This is a Central Venous Pressure Waveform in NSR.
X wave
Downward displacement of the ventricle during systole
In a hyperkalemic patient, you would expect to see _____________on ECG.
peaked t waves
What is the equation for EF?
EDV-ESV/EDV × 100
T/F
The total amount of O2 dissolvd in your plasma contributes in a large way to O2 delivery.
False
You are caring for a 67 y/o male who just came off of CPB following a 4 vessel CABG. His hemodynamic parameters are as follows:
ABP 83/43 MAP 56
HR 101 in NSR
SaO2 99%
Hgb 11 g/dl
PAP 55/25
CVP 23
CI 1.5, CO 2.3
SvO2 48%
You surmise that his low SvO2 is related to ________________, and your most appropriate initial intervention should be to ___________.
decreased oxygen delivery; start inotropic support
Use the diagram below to answer question. Match the appropriate waveform to its corresponding physiologic occurrence.
Stroke Volume
D
Use the diagram below to answer question. Match the appropriate waveform to its corresponding physiologic occurrence.
closure of the aortic valve
B
T/F
The carotid artery is much larger on the left side and more likely to be punctured on attempts to cannulate the left IJ, that is why cannuation of the IJ is performed preferentially on the right side.
false
You are ready to place a pulmonary artery catheter into your patient via a RIJ 9fr introducer. This patient has a pre-existing left bundle branch block. Based on your knowledge of pulmonary artery catheter insertion, you know to possibly expect _______________, and prepare to treat this complication with _____________________.
complete AV block
transcutaneous pacing
The retrograde cardioplegia cannula is inserted either blindly or under direct visualization into the ____________ via the lower portion of the _______________.
coronary sinus
right atrium
The formula below represents which calculation?
[(MAP-CVP)/CO] x 80
SVR
Total oxygen delivery is approximately ________________, while total oxygen consumption is typically _______________; yielding a normal SvO2 of approximately _____________.
1000 ml/min; 250 ml/min; 75%
T/F
In a normally functioning heart, ALL valves are closed during isovolumetric contraction.
True story
In the simplest terms, an (accurate) low SvO2 reading means there is a(n) _________________ oxygen demand or a(n) ____________ oxygen supply to the tissues.
increased
decreased
A patient shows a 95% occlusion of the right coronary artery on angiogram is most likely to show ECG evidence of ischemia during stress test in which leads?
II, III, aVF
T/F
With associated cardiac problems, hypovolemia can lead to decreased tissue perfusion.
True
The common method of determining when the PA catheter has reached the pulmonary artery from the right ventricle is by noting which phenomena?
diastolic “step-up”
T/F
Decreased heart rate causes an increase in myocardial oxygen consumption.
false
You are performing a pre-op evaluation on a 54 y/o male patient for open hemicolectomy. The patient denies CAD, stroke, diabetes, or CHF. He experiences only dyspnea on exertion with activity of 5 METs or above, which he states is his baseline and attributes to his 60 pack/year smoking history. Based on your knowledge of the AHA/ACC perioperative evaluation guidelines for non-cardiac surgery, you know this patient…..
Should proceed to the operating room
What effect will NTG have on EDV?
decreases it
The antegrade cardioplegia cannula is inserted directly into the ____________________, and functions include delivering cardioplegia and __________________.
ascending aorta; venting the left heart
Please use the picture below to answer question. Match the wave to what it represents. This is a Central Venous Pressure Waveform in NSR.
a Wave
atrial contraction
Use the diagram below to answer question. Match the appropriate waveform to its corresponding physiologic occurrence. Use the letters on the diagram as your answers on the answer sheet.
Represents the systemic vascular resistance
C
The use of stroke volume variation in guiding fluid resuscitation is aimed at
determining where a patient is on the Frank-Starling curve
indicating when hypovolemia & fluid responsiveness is present
preventing over-resuscitation thus hypervolemia and its deleterious effects
Cardioplegia arrests the heart with high concentrations of potassium. The reason the heart rate slows (and then stops) when hyperkalemia is present is
The resting membrane potential becomes more positive because potassium flows more slowly down its concentration gradient from inside to outside of the cell.
Please use the picture below to answer question. Match the wave to what it represents. This is a Central Venous Pressure Waveform in NSR
c Wave
Tricuspid valve elevation during early ventricular contraction
Active cardiac conditions for which the patient should undergo further testing before elective non-cardiac surgery include (3)
Unstable angina
Severe aortic stenosis
New onset CHF exacerbation
T/F
A sudden increase in mean arterial pressure will cause the PVR will decrease in response to change in mean arterial pressure.
False
Increased pCO2 will cause
increased right ventricular afterload/increased cerebral blood flow
Mitral stenosis is the failure of the mitral valve to ______________ properly during ventricular ______________.
open
diastole
What can be attributed to the systemic inflammatory response syndrome caused by cardiopulmonary bypass
interstitial pulmonary edema & acute lung injury
decreased SVR
platelet dysfunction
coagulopathy
T/F
Anesthetic management of a patient immediately prior to abdominal aortic cross clamp removal includes nipride infusion.
False
A 60 kg patient is undergoing mediastinoscopy to r/o lymph node involvement During the mediastinoscopy the right radial A-line shows a damped waveform with a pressure reading of 40/10. Left hand pulse oximetry waveform remained unchanged reading 98% on 40% fiO2. Most likely cause of A-line pressure is:
Innominate artery compression
Your 46 y/o male patient has just undergone aortic valve replacement for a congenital bicuspid valve. His preoperative EF was 55% with normal PA pressures and normal CI. Upon separation from cardiopulmonary bypass, your CI is 1.7, PA pressures 55/25, SVR 2100, and ABP 77/40. Your drug of choice in treating this scenario would be:
epinephrine + nicardipine
T/F
Your patient has an esophageal stricture and that is a contraindication for a TEE?
False
T/F
If the pressure of fresh gas traveling through the oxygenator exceeds the pressure of blood traveling through the oxygenator, bubbles will be created & travel to the patients arterial system.
True
The EKG correlates to coronary anatomy. Inferior wall changes are most likely seen in which leads?
II, III, aVF
T/F
In comparison to Open vascular surgery, endovascular infra renal AAA repair is associated with less variations in systemic vascular resistance.
True
This test is used to differentiate between different types of coagulopathy (platelet dysfunction, factor dilution, residual heparin effect).
TEG
Heparin exerts its anti-coagulating properties by
Binding with anti thrombin III
The most common reason for failure to wean from cardiopulmonary bypass is?
poor LV function
You are performing a preoperative evaluation on a 64 y/o male for CABG. The patients relevant history includes 50 pack/year smoker, COPD, previous CVA, previous femoral-popliteal bypass x 3, and an axillary-femoral bypass. Before proceeding to the operating room you should assess for and consult with the surgeon about?
the availability of venous conduit for the RSVGs
For an uncomplicated cardiopulmonary bypass case (simple CABG/valve) the perfusionist will usually cool the patient to?
32 degrees
A vessel used for coronary artery bypass grafting, such as the LIMA, that retains its native arterial blood flow is termed a ___________ graft.
pedicle
Aortic regurgitation is the failure of the aortic valve to _______________ properly during ventricular ________________.
close
diastole
What drugs WILL increase coronary artery blood flow?
Nicardipine
nitroglycerin
Magnesium is usually given before separation from CPB to help prevent postoperative ___________.
a-fib
J.S. is scheduled to have an aortic valve replacement (AVR). During the induction of anesthesia, J.S. converts to atrial fibrillation with a rapid ventricular response and a decrease in blood pressure. Your course of treatment would be?
Aggressive treatment of atrial fibrillation with cardioversion
Which of the following intraoperative events would not increase myocardial oxygen demand?
parasympathetic stimulation
In aortic valve replacement surgery, the sutures are placed in the native annulus very close to ventricular tissue. Knowing this, you should anticipate __________________ after separation from CPB.
ventricular dysrhythmias
The medical management prophylaxis of the patient with coronary artery disease who is awaiting CABG surgery could include….
Nitrates, calcium channel blockers, Beta blockers
Is LR hypertonic, isotonic, or hypotonic?
hyPOtonic
Normal minimal dose of Heparin pre-Cardiopulmonary Bypass is _________.
300 Units/kg
blood bank PRBC’s have….
reduced oxygen carrying capacity
acidotic pH
contains a calcium chelating agent (CPD-A)
Cross clamp removal at the conclusion of abdominal aortic aneurysm repair frequently causes
acidosis
Drug X was given to a patient with the following parameters: MAP=55, HR 104, CVP 8, ESV=30, EDV=70. After drug administration, the following parameters were noted: MAP= 65, HR 92, CVP 11, ESV=45, EDV=75. What is the most likely drug that was given?
Phenylephrine IV
The goal of modified ultrafiltration (MUF) is to remove
excess volume & inflammatory mediators
……. hehehehe you said muff!
T/F
Retrograde cardioplegia will be injected via Aortic Root cannula
False
TJ is a 65 year old male with a history of aortic stenosis (AS). Immediately after induction of general anesthesia for an AVR (aortic valve replacement), his BP decreases to 80/30. HR is 95. The best drug/treatment to increase the BP in patients with AS is:
phenylephrine
Epinephrine may be required to “come off CPB”. What is not true about the drug?
It has negative chronotropic effect
Reverse saphenous vein grafts used for coronary artery bypass grafting generally obtain their arterial blood flow from the
ascending aorta
The surgeon is inserting cannulas for cardiopulmonary bypass. Below is the list of medications the patient has received up to this point.
Fentanyl 500 mcg
Midazolam 5 mg
Ancef 1 gm
Vancomycin 1 gm
Propofol 120 mg
Pancuronium 10 mg
Lidocaine 50 mg
Amicar 5 gm
Ephedrine 10 mg
Based on this information you should
Stop the surgeon and administer the appropriate heparin dose
During your preoperative evaluation of Mr Green, you discover that your he was taking a nonsteroidal anti-inflammatory agent. You would suspect that the patient may have problems intraoperatively with hemostasis. What would be the most affected?
Platelet aggregation
T/F
An intra-aortic balloon pump is a valid means of treating LV systolic failure in the patient with critical aortic regurgitation.
false
T/F
The mere presence of coronary artery disease is an indication to use etomidate as your induction agent.
False….
but if you ask me its a pretty good fucking reason!
T/F
Vascular surgery patients are at greater risk for intra operative myocardial infarction due to coexisting diseases
true
T/F
Aortic aneurysm repair via endovascular stent graft REQUIRES aortic cross clamping
false
A complication of thoracic aorta surgery is paraplegia most commonly due to:
spinal cord ischemia
The ability of cardioplegia to arrest the heart lies with its
high potassium concentration & low temperature
Normal saline has a __________ pH
slightly acidotic
When using cerebral oximetry during CPB, the CRNA should
Place the probe before induction to determine a baseline reading
The surgeon is performing an off-pump CABG and is working in the region of posterolateral branches of the RCA. The surgeon needs help from the anesthesia team in order to access this area. He will ask you to do the following: (Use your knowledge of the anatomical position of the coronary arteries to answer this question).
Trendelenberg and rotate to the left
