Fundamentals of Anesthesia Final Flashcards
- Examples of systolic cardiac murmurs include:
a. mitral stenosis
b. aortic stenosis
c. aortic regurgitation
d. answers b and c
aortic stenosis
- Examples of diastolic cardiac murmurs include:
a. aortic regurgitation
b. mitral stenosis
c. mitral regurgitation
d. answers a and b
aortic regurgitation
- In the triad of symptoms in aortic stenosis, which symptom is evident of the late process of the disease, and indicates a 1-2 year life expectancy?
a. angina pectoris
b. CHF
c. onset of initial murmur
d. syncope
CHF
When caring for a patient with aortic stenosis, what are the hemodynamic goals?
a. NSR, low preload, low afterload, lower coronary perfusion pressures
b. Any rate controlled rhythm is appropriate, high afterload, high preload
c. NSR, maintain preload, high afterload, maintain BP as if treating left main disease (requiring higher perfusion pressures)
d. None of the above are correct
*NSR, maintain preload, high afterload, maintain BP as if treating left main disease (requiring higher perfusion pressures)
- An EF < 40% is one indicator of “poor” left ventricular function.
a. True b. False
True
- In patients with aortic stenosis, anesthetic techniques include:
a. Avoid excessive myocardial depression d/t agents and induction drugs
b. Treat dysrhythmias promptly, as patients with AS rely on their “atrial kick” heavily
c. Avoid tachycardia, as it precipitates ischemia
d. Avoid hypotension
e. All of the above
All of the above
The following patients require higher perfusion pressures:
a. Acute infarct and left main stenosis patients
b. Renal/cerebral insufficiency patients
c. Chronic hypertensive patients
d. All of the above
All of the above
Which induction drug decreases the BP the most?
a. Propofol
b. Etomidate
c. Lidocaine
d. Versed
Propofol
- Which opioid, when administered in appropriate doses, causes little or no change in contractility, little myocardial depression, and has a long half-life (t1/2)?
a. Sufentanil
b. alfentanil
c. fentanyl
d. remifentanil
fentanyl
- In patients with “sick” hearts, induction doses of propofol are likely to cause:
a. Increased BP and HR, vasoconstriction, no depression of contractility, no inotropic
changes
b. Profound negative inotropic effects, pronounced depression of contractility, vasodilation, bradycardia and hypotension, and vascular smooth muscle relaxation
c. Hypertension and tachycardia, positive inotropic effects, vasoconstriction, no change in contractility
d. None of the above
Profound negative inotropic effects, pronounced depression of contractility, vasodilation, bradycardia and hypotension, and vascular smooth muscle relaxation
- Nitrous oxide, isoflurane, sevoflurane and desflurane all produce:
a. Positive inotropic effects, vasoconstriction, decreased afterload
b. Positive chronotropic effects, vasodilation, increased afterload
c. Negative inotropic effects, decreased SNS activity, vasoconstriction
d. Negative inotropic effects, vasodilation, decreased afterload, decreased SNS activity
Negative inotropic effects, vasodilation, decreased afterload, decreased SNS activity
- Ketamine causes:
a. Generalized CV stimulation, increased myocardial work, inhibition of reuptake of
norepinephrine, stimulation of SNS
b. Generalized CV depression, decreased CO, decreased HR, decreased BP
Generalized CV stimulation, increased myocardial work, inhibition of reuptake of
norepinephrine, stimulation of SNS
Which muscle relaxant causes minimal CV effects?
a. Norcuron b. Pancuronium c. Anectine
d. Rocuronium
Norcuron
Aortic stenosis is recognized by its characteristic diastolic murmur best heard in the 3rd left intercostal space with transmission into the neck.
a. True
b. False
False
Calcium channel blockers, such as nifedipine and verapamil, are generally contraindicated in patients with:
a. EF >60%, SBP >90mmHg, sick sinus syndrome, 2nd or 3rd AV block
b. EF >60%, SBP >90mmHg, atrial fibrillation and/or flutter, 2nd or 3rd AV block
c. EF
EF
- Contraindications to beta blockers, such as atenolol and labetolol, generally include:
asthma, COPD, HR
True
- The effects of Nitroglycerin include:
a. Dilates veins > arteries, increases coronary artery flow, relaxes wall tension, is the drug of choice for vasospasm, and may increase HR and worsen ischemia
b. Dilates arteries > veins, decreases coronary artery blood flow, decreases HR, and increases the size of the heart
c. Dilates veins > arteries, increases coronary artery blood flow, increases wall tension, may decrease HR and worsen ischemia
d. Inhibits HPV, decreases SVR and BP, never used in patients with AS
Dilates veins > arteries, increases coronary artery flow, relaxes wall tension, is the drug of choice for vasospasm, and may increase HR and worsen ischemia
The myocardium extracts about 75% of oxygen from the arterial blood.
a. True
b. False
True
The most important factor and primary determinant of myocardial oxygen consumption is HR.
a. True
b. False
True
Which factor is a portion of supply as well as demand?
a. Perfusion pressure
b. CAD
c. HR
d. CO
HR
- Diastole is an extremely important part of the coronary cycle because:
a. Most coronary blood flow occurs during diastole
b. Diastole defines the time available for coronary vascular perfusion
c. The LV is perfused almost entirely during diastole
d. All of the above
All of the above
- Coronary vessel perfusion is:
a. CPP = DBP minus PAWP
b. CPP = SBP plus PAWP
c. CPP = DBP plus PAWP
d. CPP = DBP minus SBP
CPP = DBP minus PAWP
- The most important cellular components of the vessel wall are:
a. Vascular smooth muscle and tunica media
b. Vascular smooth muscle and vasa vasorum
c. Endothelium and vascular smooth muscle
d. Endothelium and basement membrane
Endothelium and vascular smooth muscle
Procedure/s that are considered intermediate risk by the ACC/AHA guidelines include:
a. Open aortic aneurysm repair
b. Lower extremity revasularizations
c. Ruptured aneurysm repair
d. Carotid endarterectomy
Carotid endarterectomy
The 1st most common cause of morbidity/mortality associated with carotid endarterectomy is:
a. Stroke
b. Myocardial ischemia
Myocardial ischemia
Which vessels supply 80-90% of the cerebral blood supply?
a. Carotid arteries
b. vertebral arteries
Carotid arteries
The most common site of atherosclerosis leading to TIA or stroke is the carotid bifurcation.
a. True
b. False
True
- Regional anesthesia for CEA incorporates superficial and deep cervical plexus blocks of the nerves at:
a. C6-C7 b. L1-L5 c. C2-C4 d. none of the above
C2-C4
For anesthesia for CEA, the primary goal is to maintain adequate cerebral perfusion without stressing the heart. That may be accomplished by:
a. Close regulation of BP, maintaining at or slightly above the patient’s normal
b. Avoid tachycardia and monitor leads II and V5
c. No glucose in the IVF
d. Steady PaCO2 at 35-40mmHg
e. All of the above
All of the above
- Increased CO2 generally causes:
a. Cerebral steal
b. decreased cerebral perfusion
c. increased cerebral perfusion
Cerebral steal
- During CEA, many surgeons will monitor stump pressure to evaluate the adequacy of cerebral perfusion. Adequate stump pressure is >60mmHg and reflects:
a. Mean arterial pressure caudad to cross clamp
b. Pressure generated by back pressure from the Circle of Willis
c. Mean arterial pressure cephalad to cross clamp
d. Answers b and c are correct
Answers b and c are correct
- Which drug reverses the effects of heparin?
a. propranolol
b. propofol
c. pradaxa
d. protamine
protamine
During CEA, the anesthesia provider may expect reflex bradycardia d/t surgical manipulation at the carotid baroreceptor. What drug would you have immediately available to treat this issue?
a. anectine b. propofol c. heparin
d. protamine e. atropine
Atropine
During aortic cross clamp, which organ/s is/are at greatest risk for injury?
a. kidneys b. liver c. heart
d. none of the above
kidneys
Which type of aneurysm is confined to the ascending aorta?
a. DeBakey type I
b. DeBakey type II
c. DeBakey type III
d. Stanford type B
DeBakey type II
When cross clamping is required at the aorta distal to the left subclavian or between the subclavian and the left common carotid, where is the BP monitoring most accurate?
a. Right upper extremity and the left femoral artery
b. Right upper extremity and the right femoral artery
c. Left upper extremity only
d. Left femoral artery only
Right upper extremity and the left femoral artery
The Artery of Adamkiewicz supplies the___________ and arises on the ____side.
a. Posterior spinal artery / right side
b. Posterior spinal artery / left side
c. Anterior spinal artery /right side
d. Anterior spinal artery / left side
Anterior spinal artery / left side
Paraplegia is a major complication of cross clamping the aorta.
a. True b. False
true
Methods to protect the spinal cord include:
a. Mild hypothermia, methylprednisolone, increased blood glucose, mannitol
b. Profound hypothermia and increased blood glucose levels
c. Monitoring motors and SSEPS, methylprednisolone, mild hypothermia, and avoiding increases in blood glucose level
d. None of the above
Monitoring motors and SSEPS, methylprednisolone, mild hypothermia, and avoiding increases in blood glucose level
The following drug is a pure D1 agonist and preserves renal blood flow during hypotension under GETA:
a. dopamine
b. mannitol
c. Lasix
d. fenoldopam
fenoldopam
- Which portion of the kidney receives 90% of the blood flow?
a. Inner medulla
b. Outer stripe of inner medulla
c. Outer cortex
d. None of the above
Outer cortex
- Which portion of the kidney is most vulnerable to ischemia?
a. Outer stripe of inner medulla
b. Outer cortex
c. Inner stripe of outer medulla
d. Inner stripe of cortex
Inner stripe of outer medulla
What is the “functional” unit of the kidney?
a. The nephron
b. The outer cortex
c. The inner medulla
d. None of the above
The nephron
- Blood is delivered to the glomerulus via the ______________, and exits the glomerulus via the ________________.
a. Efferent arteriole/Afferent arteriole
b. Afferent arteriole/Efferent arteriole
c. Efferent arteriole/Efferent Arteriole
d. Afferent arteriole/Afferent Arteriole
Afferent arteriole/Efferent arteriole
___Reabsorbs the bulk of the filtered fluid
a. Loop of Henle
b. Proximal Tubule
c. Distal tubule/ Collecting Duct
B
___Make final adjustments on urine pH
a. Loop of Henle
b. Proximal Tubule
c. Distal tubule/ Collecting Duct
C
__Countercurrent Multiplier
a. Loop of Henle
b. Proximal Tubule
c. Distal tubule/ Collecting Duct
A
__Maintains osmotic gradient in medulla
a. Loop of Henle
b. Proximal Tubule
c. Distal tubule/ Collecting Duct
A
The following are/is potentially nephrotoxic agents:
a. NSAIDS
b. Aminoglycosides
c. Radiographic Dye
d. All of the above
All of the above
The most accurate method available to assess overall renal function is:
a. Creatinine clearance
b. BUN
c. Sodium clearance
d. FENa clearance
Creatinine clearance
- Normal GFR =______mL/min
a. <12
b. 50-80
c. 12-50
d. 125
125
- In Extracorporeal Shock-Wave Lithotripsy procedures, the ECG placement should be of good quality, as the _____waves trigger the shock waves.
a. P
b. T
c. ST segment
d. R
R