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Dr. Constable Cardiac Final > Final Questions > Flashcards

Final Questions Flashcards

1
Q

Which of the following is a TRUE statement?

a. The primary goal of preoperative evaluation and therapy for cardiac surgical procedures is to quantify and reduce the patient’s risk during surgery and the postop period
b. A preoperative serum creatinine greater than 2.0 has been identified as an independent risk factor for cardiac complications after noncardiac surgery.
c. functional status is a simple and useful risk index for patients undergoing most general and thoracic surgical procedures
d. none of the above
e. all of the above

A

e. all of the above

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2
Q

In patients with known coronary artery disease (CAD), the most important risk factors that need to be assessed preoperatively are which of the following?
a. the ischemic threshold or the heart rate at which ischemia occurs
b. The patient’s ventricular function or Ejecttion fraction (EF)
C. stability of symptoms
d. current medical therapy
e. All of the above

A

e. All of the above

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3
Q 
All of the following conditions are Major Clinical Predictors based on ACC/AHA Guidelines on perioperative Cardiac Evaluation EXCEPT?
a.  Unstable Coronary Syndromes
B.  Advanced age
C.  Decompensated Heart Failure
D.  Significant arrhythmias
E.  Severe Valvular Disease
A

B. Advanced age

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4
Q

High surgical risk procedures based on ACC/AHA guidelines on Perioperative Cardiac Evaluation include which of the following?

a. Aortic procedures
b. vascular procedures
c. prolonged procedures with large fluid shifts
d. procedures with large amounts of blood loss
e. All of the above

A

e. All of the above

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5
Q

Recommendations have been made to the overall management of Diabetic patients to help minimize their perioperative cardiovascular risk and include all of the following EXCEPT?
a. Aggressive control to d. maintain blood glucose 150mg/dL

A

d. maintain blood glucose >150mg/dL

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6
Q

Which of the following is a reason to cannulate the left internal jugular vein rather than the right?

a. a straight line to the left atrium
b. the lower dome of the left lung than of the right lung
c. Avoiding endangering the thoracic duct
d. the inability to cannulate the right internal jugular vein

A

d. the inability to cannulate the right internal jugular vein

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7
Q

Which event could explain a decrease in the mixed venous oxygen saturation (SvO2) from 75% to 62%?

a. cooling the patient to 27*C
b. Acutre blood loss
c. Epinephrine 25mcg IV
d. Myocardial ischemia
e. Both B and D

A

e. Both B and D

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8
Q

Factors that contribute to an overestimation of left ventricular end-diastolic volume (LVEDV) from a pulmonary artery catheter include each of the following EXCEPT?

a. Mitral stenosis
b. High PEEP
c. Mitral Regurgitation
d. Measuring PCWP at end inspiration in the pt on a ventilator
e. none of the above

A

e. none of the above

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9
Q

In the five electrode system of EKG monitoring, which 2 leads detect 90% of ischemic episodes if analyzed simultaneously?

a. II and V5
b. I and aVL
c. I and V5
d. II and aVL

A

a. II and V5

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10
Q

Systolic pressure variation is highly suggestive of which of the following conditions?

a. Hypervolemia
b. Hypovolemia
c. Acute Water intoxication
d. congestive heart failure (CHF)

A

b. Hypovolemia

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11
Q

Remifentanil is metabolized primarily by…

a. Kidneys
b. liver
c. Hoffman elimination
d. Pseudocholinesterase
e. Nonspecific esterases

A

e. Nonspecific esterases

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12
Q

Complications attributed to ketamine when used for coronary artery surgery include each of the following EXCEPT?

a. hypertension
b. tachycardia
c. bradycardia
d. increased plasma Epinephrine levels

A

c. bradycardia

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13
Q

Etomidate is characterized by each of the following statements EXCEPT?
A. may initiate myoclonus
b. produces a cataleptic trance known as dissociative amnesia
c. Increased incidence of epileptform activity in pts with a known hx of seizure disorder
d. can induce a rare phenomenon of adrenal suppression (Addison’s disease)

A

b. produces a cataleptic trance known as dissociative amnesia

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14
Q

Sufentanil has which of the following characteristics when compared to Fentanyl?

a. Seven to ten times more potent
b. lowere volume of distribution
c. faster recovery time
d. All of the above are correct
e. none of the above are correct

A

d. All of the above are correct

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15
Q

Which of the following pt factors have been associated with an increased risk of the development of postoperative Acute Kidney Injury (AKI)?

a. Advanced age
b. Hypertension
c. Diabetes Mellitus
d. Ventricular Dysfunction
e. All of the above

A

e. All of the above

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16
Q

which of the following is a FALSE statement regarding coronary anatomy?

a. The posterior descending artery (PDA) arises from the Right Coronary Artery in approx. 85% of individuals
b. The SA node is perfused by either the RCA or the Circumflex Artery
c. The PDA arises from the LAD in approx. 85% of individuals
d. The Circumflex artery branches into the obtuse marginal and supply the lateral free wall of the left ventricle

A

c. The PDA arises from the LAD in approx. 85% of individuals

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17
Q

Which of the following is NOT a determinant of O2 delivery?

a. Hemoglobin
b. SpO2
c. PaO2
d. Cardiac Output
e. Left Atrial Pressure (LAP)

A

e. Left Atrial Pressure (LAP)

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18
Q

Which of the following is NOT a determinant of O2 demand?

a. Heart rate
b. contractility
c. SpO2
d. Afterload
e. Wall thickness

A

c. SpO2

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19
Q

Intraoperative myocardial ischemia can be detected by which of the following?

a. ST segment depression
b. ST segment elevation
c. Pulmonary Artery Pressure changes
d. Regional Wall Motion Abnormality (RWMA) on TEE
e. All of the above

A

e. All of the above

20
Q

Which of the following statements is a CORRECT intervention if ischemia is detected?

a. ensure adequate oxygenation (100% FiO2)
b. Maintain MAP with vasopressors
c. Maximize Preload, Heart Rate, Rhythm, and Afterload
d. Insertion of IABP by surgeon
e. All of the above

A

e. All of the above

21
Q

The blood flow during total cardiopulmonary bypass is:

a. Not adjustable
b. virtually nonpulsatile
c. provides pulsatile pressure
d. A pulsatile flow
e. Mimics normal flow in all respects

A

b. virtually nonpulsatile

22
Q

The continuance of pulmonary ventilation during cardiopulmonary bypass:

a. Leads to hypercarbia
b. Leads to improved systemic arterial blood gas values
c. decreases post operative ventilator times
d. may interfere with the surgery and may decrease surfactant
e. All of the above

A

d. may interfere with the surgery and may decrease surfactant

23
Q

The PaCO2 of a pt on cardiopulmonary bypass:

a. is determined by the O2 concentration of the fresh gas
b. Is generally adjusted through changes in the fresh gas flow rate
c. is generally adjusted through pulmonary ventilation
d. should be maintained at less than 30mmHg
e. is determined by the type of oxygenator

A

b. Is generally adjusted through changes in the fresh gas flow rate

24
Q

When an adult patient is on total cardiopulmonary bypass:

a. Mean arterial pressure is generally maintained above 60 mmHg
b. Blood is pumped from the vena cava & drains by gravity into the aorta for circulation
c. the level of blood in the venous reservoir of the pump reflects the central venous pressure of the patient
d. venous pressure elevation is of no consequence
e. venous return ot the pump is always started before arterial infusion

A

a. Mean arterial pressure is generally maintained above 60 mmHg

25
Q

Advantage(s) of membrane oxygenators over bubble oxygenators include:

a. lower cost
b. lower priming volumes
c. simplicity
d. Less damage to ertyrocytes
e. All of the above

A

d. Less damage to ertyrocytes

26
Q

Mitral stenosis is usually due to:

a. Rheumatic fever
b. malignant hyperthermia
c. hypoxia
d. hypercalcemia

A

a. Rheumatic fever

27
Q

Mitral stenosis will usually result in:

a. embolic events and atrial fibrillation
b. ventricular fibrillation
c. heparin sensitivity
d. essential hypertension

A

a. embolic events and atrial fibrillation

28
Q

Aortic stenosis is associated with which of the following?

a. reduced stroke volume
b. increased stroke volume
c. maintained stroke volume because of eccentric hypertrophy
d. maintained stroke volume because of concentric hypertrophy

A

d. maintained stroke volume because of concentric hypertrophy

29
Q

Aortic regurgitation causes:

a. increased forward stroke volume
b. increased arterial diastolic pressure
c. pressure overload of left ventricle
d. volume overload of left ventricle

A

d. volume overload of left ventricle

30
Q

Mitral regurgitation management includes which of the following?

a. slow heart rate
b. maintain or decrease stroke volume
c. maintain or decrease contractility
d. maintain or slightly increase preload

A

d. maintain or slightly increase preload

31
Q

Mitral regurgitation has a regurgitant volume that is based on all EXCEPT:

a. mitral valve size
b. heart rate
c. pressure gradient between atria and ventricle
d. aortic diastolic pressure

A

d. aortic diastolic pressure

32
Q

How should afterload be managed MOST EAGERLY in the hypertrophic cardiomyopathy patient?

a. maintained
b. decreased
c. increased
d. All of the above

A

c. increased

33
Q

Associated with mitral regurgitation is:

a. Pressure overload
b. Decrease left ventricular end diastolic volume
c. backward flow into ventricle
d. reduction in forward stroke volume

A

d. reduction in forward stroke volume

34
Q

Acute aortic regurgitation presents with a sudden onset of pulmonary edema and:

a. hypertension
b. hypotension
c. acute renal failure
d. none of the above

A

b. hypotension

35
Q

Aortic stenosis can be caused by all of the following EXCEPT:

a. Rheumatic valvular disease
b. Infective endocarditis
c. senile calcification (aortic valve sclerosis)
d. bicuspid valve
e. cardiac tamponade

A

e. cardiac tamponade

36
Q

Chronic hypertension has which of the following effects on the autoregulation curve?

a. Shifts the curve LEFT
b. Shifts the curve RIGHT
c. Shifts the curve UP
d. Shifts the curve DOWN

A

b. Shifts the curve RIGHT

37
Q

When compared to Open Aortic Repair, Endovascular Aortic Repair has all of the following benefits EXCEPT:

a. Lower incidence of a major cardiovascular complication
b. Lower incidence of postop neurological complications
c. Lower incidence of requiring blood product transfusions
d. Lower estimates of intraoperative blood loss
e. None of the above. All are true

A

e. None of the above. All are true

38
Q

Spinal cord protection may be obtained by which of the following?

a. prolonging the aortic cross clamp time
b. decreasing mean arterial pressure (MAP)
c. decreasing cerebral spinal pressure using a spinal drain
d. None of the above
e. All of the ABOVE

A

c. decreasing cerebral spinal pressure using a spinal drain

39
Q

Which of the following is a true statement regarding anesthetic goals in vascular surgery?

a. Maintain hemodynamics to preserve myocardial function
b. maintain body temperature
c. maintain oxygen carrying capacity
d. Initiate interventions that protect renal function
e. All of the Above

A

e. All of the Above

40
Q

Which of the following is a reasonable intervention prior to the aorta being cross clamped by the surgeon?

a. Afterload reduction using a Sodium Nitroprusside infusion
b. Preload reduction using Nitroglycerin infusion
c. Increase mean arterial pressure (MAP) using a phenylephrine infusion
d. Both A and B are correct
e. All of the Above

A

d. Both A and B are correct

41
Q

After starting one-lung ventilation with oxygen and isoflurane, a tidal volume of 500 mL and a rate of 10 bpm, the O2 sat begins to fall.
All of the following are acceptable means to improve O2 saturation EXCEPT:
a. Confirm 100% FIO2
b. Return to 2 lung ventilation
c. Clamp the PA of the non-ventilated lung
d. Add 5cm of PEEP to non-ventilated lung
e. Add 10cm of CPAP to non-ventilated lung

A

d. Add 5cm of PEEP to non-ventilated lung

42
Q

The QT interval is prolonged by

a. hyperkalemia
b. hypokalemia
c. hypercalcemia
d. hypocalcemia

A

d. hypocalcemia

43
Q

A patient is undergoing a mediastinoscopy when there is a sudden loss of pulse and pressure wave being monitored at the right wrist. THe mediastinoscope is withdrawn with resumption of normal vital signs. The most likely cause of the problem is?

a. Cardiac arrest
b. superior vena cava syndrome
c. air in the mediastinum
d. compression of the innominate artery
e. anesthetic overdose

A

d. compression of the innominate artery

44
Q

Hypoxic pulmonary vasoconstriction (HPV) is?

a. decreased by hypocapnia
b. not affected by volatile anesthetics
c. increased by hypoxia
d. increased by alkalosis
e. both a & c are correct

A

e. both a & c are correct

45
Q

Which of the following is the most effective method of analgesia after thoracotomy?

a. Lumbar epidural
b. Thoracic epidural
c. IV PCA
d. Transdermal narcotics
e. TENS unit

A

b. Thoracic epidural

46
Q

Which of the following is a TRUE statement?

a. The primary goal of preoperative evaluation and therapy for cardiac surgical procedures is to quantify and reduce the patients risk during surgery and the postoperative period
b. A preoperative serum creatinine greater than 2.0 has been identified as an independent risk factor for cardiac complications after noncardiac surgery
c. Functional status is a simple and useful risk index for patients undergoing most general and thoracic surgical procedures
d. None of the above
e. ALL of the above

A

e. ALL of the above

Dr. Constable Cardiac Final (1 decks)

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