Week 4 HF/trauma/vascular Flashcards
A 65-year-old male with a history of hypertension and smoking presents with a thoracic aortic aneurysm measuring 5.5 cm. What is the most likely pathophysiological mechanism contributing to the development of this patient’s aortic aneurysm?
degenerative changes in the aortic wall d/t HTN and atherosclerosis
- Question: A patient presents with acute tearing chest pain radiating to the back and a blood pressure differential between arms. Which pathophysiological event is most likely occurring?
aortic dissection (rupture p/w severe hypotension)
- Question: A 30-year-old patient with Marfan syndrome is evaluated for elective surgery. What should be the primary anesthetic concern regarding the patient’s vascular system?
propensity for rapid aortic dilation and risk of dissection
- Question: In preoperative evaluation for aortic surgery, which factor is the most critical predictor of postoperative renal failure?
The presence of preoperative renal dysfunction
- Avoidance of hypovolemia, hypotension, low CO, and nephrotoxic drugs are important to decrease the likelihood of postoperative renal failure
- Question: In a patient undergoing surgery for a descending thoracic aortic aneurysm, what is the primary anesthetic goal regarding blood pressure management?
keeping BP elevated to ensure adequate spinal cord perfusion
- Question: Which complication is most critical to monitor for immediately after thoracic aortic surgery?
paraplegia
- Question:For a patient with Marfan syndrome undergoing elective non-cardiac surgery, what is the most important anesthetic consideration related to the aorta?
careful monitoring and control of BP to prevent dissection
- Question: A patient with a descending thoracic aneurysm is undergoing preoperative evaluation. Which aspect is most critical to assess preoperatively for anesthesia planning?
Presence of coexisting pulmonary disease
- Question: During the surgical repair of a thoracic aortic aneurysm, what is the most effective strategy to protect renal function?
use of mannitol before aortic clamping
-Renal protection is achieved by direct instillation of renal preservation fluid (4℃ lactated Ringer solution with 25g mannitol/L and 1 g methylprednisolone/L) and can be administered directly by the surgeon into the renal artery
- Question: In a patient with systemic hypertension undergoing surgery, which of the following intraoperative findings is most indicative of hypertensive heart disease-related left ventricular hypertrophy?
Diastolic dysfunction and elevated filling pressures
- Question: In distinguishing between aortic dissection and aneurysm, which clinical feature is more indicative of an aortic dissection?
Acute onset of tearing chest pain
- Question: A patient with untreated systemic hypertension is at increased risk for perioperative morbidity and mortality primarily due to:
endothelial dysfunction and associated vasculopathy
- Question: A patient with an aortic aneurysm is undergoing surgery. The nurse anesthesiologist notices an increase in blood pressure during the procedure. What is the most likely cause of hypertension in this scenario?
compensation for decreased aortic compliance
- Question: A 60-year-old male patient with untreated hypertension is scheduled for an abdominal surgery. His blood pressure is consistently above the target despite multiple antihypertensive medications. This is an example of:
refractory HTN
- Question: A patient with a known aortic dissection is found to have elevated serum creatinine levels. What is the most likely pathophysiological mechanism for this renal impairment?
Direct renal artery involvement in dissection
- Question: A patient with chronic heart failure (CHF) is scheduled for elective surgery. Preoperative evaluation indicates elevated jugular venous pressure and peripheral edema. What is the most likely mechanism for these findings?
Increased preload d/t fluid retention
- Question: During thoracic aortic aneurysm repair, the nurse anesthesiologist must be vigilant for signs of spinal cord ischemia. Which monitoring technique is most effective for detecting early signs of spinal cord ischemia?
SSEP
- Question: A patient with dilated cardiomyopathy (DCM) is undergoing non-cardiac surgery. Which anesthetic strategy is most appropriate to minimize myocardial stress?
maintenance of normovolemia and careful use of vasodilators
- Question: A 70-year-old patient undergoing vascular surgery has a history of chronic hypertension. What is the most appropriate intraoperative hemodynamic goal for this patient?
slightly elevated BP to ensure organ perfusion
- Question: A 55-year-old male patient with hypertrophic cardiomyopathy (HCM) is scheduled for elective non-cardiac surgery. What anesthetic approach is most appropriate to reduce the risk of exacerbating his condition?
maintaining a normal to slightly elevated preload
- Question: During thoracoabdominal aortic aneurysm repair, the nurse anesthesiologist must be aware of the potential for ischemic injury to the spinal cord. The great radicular artery of Adamkiewicz plays a key role in this. What specific function does this artery serve that is crucial during this surgery?
supplies anterior spinal artery ensuring blood flow to lower 2/3 of spinal cord
- Question: A patient with dilated cardiomyopathy (DCM) undergoing surgery exhibits signs of acute heart failure intra-operatively. Which intervention is most appropriate?
cautious fluid management and potential use of diuretics
- Question: In a patient undergoing aortic aneurysm repair with a supraceliac aortic cross-clamp, which hemodynamic change is most commonly observed immediately after clamping?
increased SVR and systemic BP
- Question: A patient with acute heart failure is undergoing emergency surgery. Which of the following strategies is most appropriate to optimize cardiac output?
balancing fluid administration w/ inotropic support as needed
- Question: In the case of infrarenal aortic cross-clamping, which of the following is the most expected hemodynamic response?
Minimal change in systemic BP
- Question: A patient with advanced HFpEF (Heart failure with preserved ejection fraction) is scheduled for a major abdominal surgery. What is the most appropriate anesthetic management to prevent exacerbation of heart failure symptoms in this patient?
maintaining a balanced intravascular volume and avoiding rapid rhythm changes
- Question: When managing a patient with thoracic aortic cross-clamping, which pharmacologic strategy is most appropriate to mitigate the hemodynamic effects?
utilizing vasodilators to manage increased BP
- Question: A patient with a history of left ventricular assist device (LVAD) implantation is undergoing non-cardiac surgery. What is the most crucial aspect of anesthesia management for this patient?
maintaining adequate preload to prevent suction events
- Question: During aortic cross-clamping above the renal arteries, what immediate hemodynamic change is most expected?
- Question: A patient with restrictive cardiomyopathy is scheduled for elective surgery. Which of the following is the most appropriate anesthetic management strategy?
maintaining SR to avoid significant bradycardia
- Question: What is the primary renal concern during aortic surgery involving cross-clamping near the renal arteries?
Decrease in renal blood flow, increase in renal vascular resistance, ischemia-reperfusion insult to kidneys leading to renal failure
- Question: A patient with HFpEF (heart failure with preserved ejection fraction) is undergoing major surgery. What is the primary focus for anesthesia management in this patient?
avoiding rapid changes in HR and rhythm
- Question: What is the primary cardiovascular response seen with thoracic aortic cross-clamping?
increased SVR
- Question: In a patient with HFrEF (heart failure with reduced ejection fraction) undergoing vascular surgery, which of the following strategies is most crucial to optimize perioperative outcomes?
Judicious use of inotropic support and strict control of fluid balance
- Question: In thoracoabdominal aortic surgery, what factor most significantly contributes to the risk of spinal cord ischemia?
duration of aortic cross-clamping
- Question: In a patient with heart failure with preserved ejection fraction (HFpEF) undergoing non-cardiac surgery, which of the following is the most crucial for preventing perioperative heart failure exacerbation?
careful fluid management and avoidance of tachycardia
- Question: During thoracic aortic aneurysm repair, which monitoring technique is most effective in assessing real-time spinal cord perfusion?
SSEP
- Question: During a surgical procedure, a patient with heart failure with preserved ejection fraction (HFpEF) develops acute pulmonary edema. What is the most appropriate initial treatment?
furosemide or other loop diuretics reduce LV filling pressures, decrease pulmonary venous congestion and improve clinical symptoms
- Question: What is a primary anesthetic challenge in thoracic aortic aneurysm repair?
managing rapid fluid shifts and blood loss
- Question: A 68-year-old patient with advanced heart failure with preserved ejection fraction (HFpEF) and a history of pulmonary hypertension is undergoing an urgent non-cardiac surgery. Midway through the surgery, the patient develops marked systemic hypotension and signs of right heart failure. What is the most appropriate management strategy?
administration of PDE inhibitors and careful fluid management
- Question: A 70-year-old male patient with a history of hypertension and smoking is scheduled for a carotid endarterectomy. During the procedure, which of the following monitoring techniques is most crucial for detecting cerebral ischemia during cross-clamping of the carotid artery?
transcranial doppler U/S allows continuous monitoring OR neuro assessment if they are awake
- Question: During a major vascular surgery, a patient with dilated cardiomyopathy (DCM) and severe systolic dysfunction exhibits a sudden decrease in cardiac output. Echocardiography reveals worsening left ventricular function without significant valvular pathology. Which intervention should be prioritized?
incremental use of an inotrope w/ vasodilator properties
- Question: A 68-year-old male with a history of hypertension and smoking is scheduled for a carotid endarterectomy due to significant carotid artery stenosis. During surgery, the patient’s blood pressure drops suddenly. What is the most likely cause of the sudden drop in blood pressure in this patient?
surgical stimulation of carotid sinus
- Question: A patient with hypertrophic obstructive cardiomyopathy (HOCM) undergoing an elective orthopedic procedure develops sudden hypotension and pulmonary edema. The most likely cause is dynamic left ventricular outflow tract obstruction. What is the optimal management strategy?
infusion of a short-acting beta-blocker and cautious fluid administration
- Question: A 30-year-old female presents with episodic bilateral finger pallor and cyanosis, triggered by cold exposure. What could this be?
neurogenic vasospasm, an episodic vasospastic ischemia of the digits. Raynaud’s phenomenon-vasospastic ischemia
- Question: A patient undergoing surgery has a history of pericarditis with occasional pericardial effusions. Which anesthetic approach is most appropriate to prevent exacerbation of pericarditis?
cautious fluid management and low PP ventilation
- Question: A 68-year-old patient undergoing carotid endarterectomy develops sudden hypertension during cross-clamping of the carotid artery. What is the most likely pathophysiological mechanism behind this observation?
increased SVR
- Question: During a thoracic surgery, a patient with a history of blunt cardiac trauma presents with new-onset hemodynamic instability. What is the most likely cause?
ventricular rupture or tamponade
- Question: During carotid endarterectomy, which of the following is the best indicator of adequate cerebral perfusion in the absence of invasive monitoring techniques?
Transcranial doppler if asleep, neuro assessment if awake
- Question: A patient with constrictive pericarditis is undergoing an elective non-cardiac procedure. Which of the following anesthetic strategies is most appropriate?
maintain adequate venous return by avoiding hypovolemia
- Question: During an emergency abdominal surgery, a patient with a history of constrictive pericarditis develops acute hypotension and decreased cardiac output. What is the most likely cause, and how should it be managed?
reduced ventricular filling; cautious fluid resuscitation and inotropic support
- Question: A patient with cardiac tamponade due to penetrating chest trauma is undergoing emergency surgery. Which anesthetic management strategy is most critical?
immediate surgical decompression of the tamponade
- Question: A patient undergoing elective surgery has a history of acute pericarditis. Which anesthetic management approach is most appropriate to mitigate the risk of exacerbating pericarditis?
cautious fluid management and low positive pressure ventilation
- Question: During an elective procedure, a patient with a known pericardial cyst experiences sudden cardiac arrest. What is the most likely cause, and how should it be managed?
cardiac tamponade; urgent surgical exploration
- Question: A young athlete experiences commotio cordis during a sports event and is brought to the hospital. Despite successful resuscitation, he remains hemodynamically unstable. What is the most appropriate anesthetic management during emergency surgery?
careful fluid management and readiness for defibrillation
- Question: A patient presents with a blunt chest trauma from a motor vehicle collision. Imaging reveals an aortic injury near the isthmus. What is the most critical consideration for anesthesia management during surgical repair?
strict BP control to reduce shear stress on aorta
