Advanced Principles II Exams Flashcards
(242 cards)
1
Q
The neuron is the basic functional cell of the CNS? True or false? This question was repeated.
A
True
2
Q
The somatic nervous system contains sensory neurons for the control of? Choose 3
A
a. Skin innervation
b. Muscle innervation
c. Joints innervation
3
Q
Arteries arising from Circle of Willis give rise to? This question was repeated.
A
a. Pial arteries
4
Q
Neurons may be classified according to their specific function: ______ are multipolar and innervate and control effector tissues such as muscles and glands. This question was repeated.
A
a. Motor neurons
5
Q
In 60% of patients the SA node is a branch of the right coronary artery whereas in the remaining arises from the?
A
a. Circumflex artery
6
Q
Appropriate preop medications for patients who present for posterior fossa surgery who are diagnosed with space occupying lesions (SOL) or hydrocephalus from the 4th ventricle would include? Choose 3
a. Antihypertensives
b. Corticosteroids
c. Benzodiazepines
d. Fentanyl
A
a. Antihypertensives
b. Corticosteroids
c. Benzodiazepines
d. Fentanyl (WRONG answer)
7
Q
The major components of the intracranial cavity include? Choose 3
A
- Brain
- CSF
- Blood
8
Q
Select the true statements concerning Schwann cells. Choose 3? This question was repeated.
a. Schwann cells are responsible for forming myelin
b. Schwann cell myelinates only one axon
c. Node of Ranvier is the site of electrical impulse propagation
d. Schwann cells are completely coated in myelin
A
a. Schwann cells are responsible for forming myelin
b. Schwann cell myelinates only one axon
c. Node of Ranvier is the site of electrical impulse propagation
d. Schwann cells are completely coated in myelin (WRONG answer)
9
Q
Select the true statements concerning Anterior Spinal Artery Syndrome (ASAS). Choose 3?
a. ASAS may also result from sustained hyperperfusion
b. ASAS typically manifests as motor weakness greater than sensory change
c. ASAS results from obstruction of the feeder vessels to the Ant. Spinal Artery
d. ASAS treatment is aimed at relieving existing pathologic cause/condition
A
a. ASAS may also result from sustained hyperperfusion (WRONG answer)
b. ASAS typically manifests as motor weakness greater than sensory change
c. ASAS results from obstruction of the feeder vessels to the Ant. Spinal Artery
d. ASAS treatment is aimed at relieving existing pathologic cause/condition
10
Q
Which of the following is the BEST treatment for anesthesia issues that may arise during a craniofacial venous malformation repair? Choose 2
A
a. Keep PaCO2 at 60
b. Consider patient ability to maintain patent airway post USP grade 95% ethanol injection
11
Q
All of these statements are true concerning implantable cardioverter-defibrillators (ICDs) EXCEPT?
A
a. ICDs are not indicated for the primary prevention of sudden death
12
Q
evere contrast induced anaphylactoid reactions include all EXCEPT? Choose 3
a. Bronchospasm
b. cardiovascular shock
c. Respiratory arrest
d. Cardiac arrest
A
a. Bronchospasm (WRONG answer)
b. cardiovascular shock
c. Respiratory arrest
d. Cardiac arrest
13
Q
Cerebral blood flow is supplied by 4 larger arteries which merge to form the?
A
a. Circle of Willis
14
Q
When ICP exceeds _____ mm/Hg CBF progressivle decreases and a vicious cycle is established: produces brain edema which in turn increases ICP. This question was repeated.
A
a. 30 mm/Hg
(6th edition nagelhout pg 663) - “when ICP exceeds 30mmhg, CBF progressively decreases and a vicious cycle is established, ischemia produces brain edema, which in turn increases ICP and further precipitates ischemia.”
15
Q
Although a rare event, trigeminocardiac reflex may be treated by which of the following BEST choices?
A
a. anticholinergic prophylaxis
16
Q
Not indicated for ssep:
A
NMBD (source:I emailed Dr.M; She said the “best answer” was NMBD)
17
Q
High risk for cardiac cath
A
75f with 1 vessel block, ASA IV?
18
Q
Not an ablation indication :
A
drug abuse lifestyle
19
Q
Select the true statement regarding supratentonial Masses choose 3
A
- Supratentorial massless problems usually arise from a result of local and generalized pressure
- anesthetic actions include conserve cerebral auto regulation and co2 responsiveness
- issues can arise from surgical exposure
- Surgeon could have issues
20
Q
Cerebral bloodflow is maintained at a constant
A
• The cerebral blood flow is maintained fairly stable for a MABP of 60-160.****
21
Q
CushingsTriad
A
– Irregular respiration (Hypoventilation)
– Bradycardia
– Hypertension
22
Q
All are true except (can’t remember the rest of the answers)
A
– CO2 – most powerful factor
– O2 – hypoxia is a potent stimulus
23
Q
Autoregulation all are true EXCEPT
A
- People with hypoperfusion/ cerebral ischemia, autoregulation is shifted to right (wrong answer)
- People with chronic HTN, autoregulation is shifted to the right
24
Q
The Most common arteries affected by hemorrhagic stroke:
A
Middle Cerebral Artery
Posterior Cerebral Artery
Midbrain Arteries
25
What about of CSF occupies the entire cerebral cavity?
150ml
26
Reabsorption of CSF in through the
Arachnoid villi
27
Normal ICP 1-20. Acute increase in ICP of 22. Treatment?
Hyperventilation (PCO2 25-30 mmhg)
28
```
Acute changes seen in ICP (all except):
Altered mentation
Visual disturbances
Headache
Gait Disturbances
```
Altered mentation
Visual disturbances
Headache
Gait Disturbances (WRONG Answer)
29
CPP goal is to maintain above 50-55….
< 40 hypoperfusion?
30
Most common primary brain tumor?
Astrocytoma
31
Most inhalational anesthetics:
Decrease CMR
| Increase CBF
32
Most IV anesthetics:
Decrease CMR
| Decrease CBF
33
All gases EXCEPT this one decrease CMR?
N20
34
ICP may be mild and can be prevented by hypocapnia (the only gas with these properties):
ISOflurane
35
All are true EXCEPT of etomidate:help?
Has no CV effects
Should use in caution with hx of seizures
…ummmm
Increases CMRO2???
36
The neuron is NOT the basic functional cell of the CNS? T or F
False
37
Allergic reaction that includes angioedema would be classified as
moderate
38
Man tells you he is allergic to contrast.Procedure is tomorrow. What is the BEST course of action?
Steroid today. Histamine before surgery.
39
Contraindications (relative) for sitting position:
C-spine
Intra-cardiac defects
MILD Hypovolemia
???
40
Select all that are true of posterior fossa surgery??
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral , three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d .Ensure large airway and bite block placements
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral , three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d. . Ensure large airway and bite block placements (WRONG: Avoid)
41
Select all that are true of posterior fossa surgery??
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral , three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d .Ensure large airway and bite block placements
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral , three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d. . Ensure large airway and bite block placements (WRONG: Avoid)
42
What drug would you not give prior to clipping of aneurysm?
phenylephrine
43
Triple H therapy includes: (choose 3)
Hypertension
Hypervolemia
Hemodilution
(all of the wrong answers included hyper/hypothermia)
44
Which is NOT a risk factor for protamine allergy?
Family history of malignant hypothermia
45
What is the advantage of using newer radiographic contrast compared to older radiographic contrast?
Newer radiographic contrast has a lower osmolar load
46
All are true of Right sided catheterization except:
Performed for diagnostic purposes
May be done Brachial, femoral, and IJ
NOT EJ
47
What are irreversible:
ASA
| Thienophyridine
48
Law that applies to aneurysms?
Law of Laplace
49
During the management of an angioplasty and stenting for treatment of atherosclerotic stenosis of the cervical, vertebral, and intracranial arteries, which of the following are NOT true?
Hypoperfusion is associated with this procedure.
50
85 y/o man, history of MI, Cr 1.8, BUN 22, K 5 (other labs that were normal) needs emergent heart cath. Which of the following is the BEST action?
Hydrate, avoid NSAIDS, limit contrast, proceed with case
51
All of the following are true of AVMs except?
They are emergent and require emergency treatment
52
Best candidate for awake craniotomy?
38-year-old with tumor near motor area with history of uncontrolled seizures
53
AVM surgery with ICP 22. What is the best action?
Hyperventilate because the ICP is too high.
54
All of the following increase CBF and ICP under normal circumstances EXCEPT.
midazolam
55
Barbiturates do all of the following EXCEPT
Protect against global ischemia.
56
```
Which is wrong regarding air embolism?
Add 8 of PEEP
Suction through CVV
Stop N2O
Place pt in Right-lateral recumbent with head slightly up
```
Place pt in Right-lateral recumbent with head slightly up
| this was the answer; this answer would have been correct if it had been Left-lateral recumbent
57
Aortic stenosis is eccentric. T/F?
False
58
75 year old man has aortic stenosis and his heart rate drops to 39?
Atropine 0.4 mg IV
59
Duchenne muscular dystrophy is what cardiomyopathy?
Dilated cardiomyopathy
60
Congenital heart disease when patients are pregnant…? Choose 3
a. Beta blockers interfere with fetal growth and response of fetus to stress during labor
b. Amiodarone affects the fetus thyroid function
c. 3rd stage (delivery of placenta) can be associated with hypovolemia, uterine atony and hemorrhage
d. Cardioversion is dangerous and contraindicated
d. Cardioversion is dangerous and contraindicated - WRONG ANSWER
61
When do women experience the most cardiac complications in pregnancy?
First half of the 3rd trimester
First half of second trimester
Last half of first trimester
Last month of pregnancy
Last month of pregnancy - CORRECT ANSWER
62
Obstructive cardiomyopathy….? Select 3
Increase preload
Increase afterload
Decrease contractility
63
All of the following occur in restrictive cardiomyopathy EXCEPT?
10 year old female
85 year old male
25 year old female
45 year old male
10 year old female - CORRECT ANSWER → its rare in children!
64
Marfan syndrome? Choose 5
```
Tall and slender
Disproportionate arms and legs
High arch palate and crowned teeth
Heart murmurs are common
Flat feet
Low set ears
Small chest bone that protrudes inward and upward
Extreme farsightedness
```
Marfan syndrome? Choose 5
```
Tall and slender - true
Disproportionate arms and legs - true
High arch palate and crowned teeth - true
Heart murmurs are common - true
Flat feet - true
```
Low set ears - WRONG ANSWER
Small chest bone that protrudes inward and upward - WRONG ANSWER
Extreme farsightedness - WRONG ANSWER
65
Question about Tricuspid Atresia? Choose 3
a. Cyanosis is usually present at birth
b. Early survival is depend on prostaglandin E1 infusion
c. Success of the fontan procedure is reliant upon low PVR and low atrial pressure
66
```
Which is true regarding dilated cardiomyopathy?
All valves are involved
Tricuspid valve is involved
Mitral stenosis
Mitral regurgitation
```
Mitral regurgitation
67
Which formula represents the amount of blood ejected from the L ventricle with each heartbeat (Stroke Volume formula)?
SV = EDV - ESV
68
Mediastinoscopy question….? Choose 3 but may have been Choose 4
a. Patients with lung cancer may have Eaton-Lambert syndrome with sensitivity to NDMR and Depolarizers
b. The most severe complication of mediastinoscopy is major hemorrhage
c. A bronchial blocker can be used to provide lung isolation in the event of an emergency
d. Prior mediastinoscopy is not an absolute contraindication to the procedure
d. Prior mediastinoscopy is not an absolute contraindication to the procedure
(THIS IS A MAJOR CONTRAINDICATION!!) WRONG ANSWER
69
Contraindicated in ASD?
Air in tubing
70
All are true about VSD EXCEPT?
Recurrent pulmonary infections are NOT common
71
Hypertrophic Obstruction worsens by?
Decreased contractility
Catecholamines
Increased preload
Increased afterload
Catecholamines - CORRECT ANSWER (b/c it increases contractility)
72
Appropriate treatments for hypercyanotic spells….? Pick 4
```
Esmolol
Propranolol
Fluids and phenylephrine
Ephedrine and epinephrine
Knees to chest
```
Ephedrine and epinephrine - WRONG ANSWER
73
Question about pts with cyanotic heart disease...?
Increased minute ventilation and normocapnia
74
Neosynephrine is preferred over ephedrine for mitral stenosis. T/F?
True
75
Question about aortic stenosis and HR, preload, afterload preferred?
Low HR 60-90, NSR, maintain and optimize preload, maintain afterload and contractility
76
Benefits of beta 1 stimulation? Chose 2
Negative chronotropic
Positive inotrope
Positive dromotrope
Negative dromotrope
Positive inotrope
Positive dromotrope
Negative chronotropic - WRONG ANSWER
Negative dromotrope - WRONG ANSWER
77
Benefits of beta 1 stimulation? Chose 2
Negative chronotropic
Positive inotrope
Positive dromotrope
Negative dromotrope
Positive inotrope
Positive dromotrope
Negative chronotropic - WRONG ANSWER
Negative dromotrope - WRONG ANSWER
78
Benefits of beta 2 stimulation? Choose 2
Vasodilation
Stabilization of mast cell protection
Histamine release
Bronchoconstriction
Vasodilation
| Stabilization of mast cell protection
79
PV Loop: Which one shows decreased afterload?
Smallest loop
80
All will increase Right to left shunt in TOF EXCEPT
Decrease PVR
81
Which is true about aortic stenosis? Choose 2
Avoid bradycardia because SV is fixed
| Avoid tachycardia because SV is fixed
82
Describes situations in which left-to-right intracardiac shunts are reversed d/t increased PVR levels equal to or greater than SVR
Eisenmenger’s Syndrome
83
1. The neuron is the basic functional cell of the CNS? True or false?
True
84
The somatic nervous system contains sensory neurons for the control of? Choose 3
a. Skin innervation
b. Muscle innervation
c. Joints innervation
a. Skin innervation
b. Muscle innervation
c. Joints innervation
85
Arteries arising from Circle of Willis give rise to?
Pial Arteries
86
Neurons may be classified according to their specific function: ______ are multipolar and innervate and control effector tissues such as muscles and glands.
a. Motor neurons
87
In 60% of patients the SA node is a branch of the right coronary artery whereas in the remaining arises from the?
a. Circumflex artery
88
Appropriate preop medications for patients who present for posterior fossa surgery who are diagnosed with space occupying lesions (SOL) or hydrocephalus from the 4th ventricle would include? Choose 3
a. Antihypertensives
b. Corticosteroids
c. Benzodiazepines
d. Fentanyl
a. Antihypertensives
b. Corticosteroids
c. Benzodiazepines
d. Fentanyl (WRONG answer)
89
The major components of the intracranial cavity include? Choose 3
1. Brain
2. CSF
3. Blood
90
Select the true statements concerning Schwann cells. Choose 3?
a. Schwann cells are responsible for forming myelin
b. Schwann cell myelinates only one axon
c. Node of Ranvier is the site of electrical impulse propagation
d. Schwann cells are completely coated in myelin
a. Schwann cells are responsible for forming myelin
b. Schwann cell myelinates only one axon
c. Node of Ranvier is the site of electrical impulse propagation
d. Schwann cells are completely coated in myelin (WRONG answer)
91
Select the true statements concerning Anterior Spinal Artery Syndrome (ASAS). Choose 3?
a. ASAS may also result from sustained hyperperfusion
b. ASAS typically manifests as motor weakness greater than sensory change
c. ASAS results from obstruction of the feeder vessels to the Ant. Spinal Artery
d. ASAS treatment is aimed at relieving existing pathologic cause/condition
a. ASAS may also result from sustained hyperperfusion (WRONG answer)
b. ASAS typically manifests as motor weakness greater than sensory change
c. ASAS results from obstruction of the feeder vessels to the Ant. Spinal Artery
d. ASAS treatment is aimed at relieving existing pathologic cause/condition
92
Which of the following is the BEST treatment for anesthesia issues that may arise during a craniofacial venous malformation repair? Choose 2
a. Keep PaCO2 at 60
| b. Consider patient ability to maintain patent airway post USP grade 95% ethanol injection
93
All of these statements are true concerning implantable cardioverter-defibrillators (ICDs) EXCEPT?
a. ICDs are not indicated for the primary prevention of sudden death
94
Severe contrast induced anaphylactoid reactions include all EXCEPT? Choose 3
a. Bronchospasm
b. cardiovascular shock
c. Respiratory arrest
d. Cardiac arrest
a. Bronchospasm (WRONG answer)
b. cardiovascular shock
c. Respiratory arrest
d. Cardiac arrest
95
Cerebral blood flow is supplied by 4 larger arteries which merge to form the?
a. Circle of Willis
96
When ICP exceeds _____ mm/Hg CBF progressive decreases and a vicious cycle is established: produces brain edema which in turn increases ICP.
a. 30 mm/Hg
(6th edition nagelhout pg 663) - “when ICP exceeds 30mmhg, CBF progressively decreases and a vicious cycle is established, ischemia produces brain edema, which in turn increases ICP and further precipitates ischemia.”
97
Although a rare event, trigeminocardiac reflex may be treated by which of the following BEST choices?
a. anticholinergic prophylaxis
98
Propofol cbf / cmr / icp
what does it do to each? increase or decrease?
cbf decrease;
cmr decrease;
icp decrease
99
Not indicated for ssep:
NMBD (source:I emailed Dr.M; She said the “best answer” was NMBD)
100
High risk for cardiac cath
a. 75f with 1 vessel block, ASA IV?
101
Not an ablation indication:
a. drug abuse lifestyle
102
Select the true statement regarding supratentonial Masses choose 3
Supratentorial mass-less problems usually arise from a result of local and generalized pressure
b. Anesthetic actions include conserve cerebral auto regulation and co2 responsiveness
c. Surgeons could have issues that arise from surgical exposure
103
Cerebral blood flow is maintained at a constant
| •
The cerebral blood flow is maintained fairly stable for a MABP of 60-160.******
104
Cushings Triad
– Irregular respiration (Hypoventilation)
– Bradycardia
– Hypertension
105
VAE choose 3 ?? treatment of VAE?
1. inform surgeon
2. d/c n2o and increase 02 flows
3. modify anesthetic
4. have surgeon flood field with fluids
5. provided jugular vein compression
6. aspirate the right atrial catheter
7. provide CV support
8. change pt position
106
. Autoregulation all are true EXCEPT
* People with hypoperfusion/ cerebral ischemia, autoregulation is shifted to right (wrong answer)
* People with chronic HTN, autoregulation is shifted to the right
107
. The Most common arteries affected by hemorrhagic stroke:
a. Middle Cerebral Artery
b. Posterior Cerebral Artery
c. Midbrain Arteries
108
28. What about of CSF occupies the entire cerebral cavity?
150ml
109
Normal ICP 1-20. Acute increase in ICP of 22. Treatment?
a. Hyperventilation (PCO2 25-30 mmhg)
110
. Acute changes seen in ICP (all except):
a. Altered mentation
b. Visual disturbances
c. Headache
d. Gait Disturbances
Altered mentation
b. Visual disturbances
c. Headache
d. Gait Disturbances (WRONG Answer)
111
CPP goal is to maintain above 50-55….
< 40 hypoperfusion?
112
Most inhalational anesthetics:
a. Decrease CMR
| b. Increase CBF
113
Most IV anesthetics:
a. Decrease CMR
| b. Decrease CBF
114
All gases EXCEPT this one decrease CMR?
a. N20
115
. ICP may be mild and can be prevented by hypocapnia (the only gas with these properties):
a.
ISOflurane
116
All are true EXCEPT of etomidate:
a. Has no CV effects
b. Should use in caution with hx of seizures
c. …ummmm
d. Increases CMRO2???
117
All are true EXCEPT of etomidate:
a. Has no CV effects
b. Should use in caution with hx of seizures
c. …ummmm
d. Increases CMRO2???
118
The neuron is NOT the basic functional cell of the CNS? T or F
a. False
119
Allergic reaction that includes angioedema would be classified as
a. moderate
120
Man tells you he is allergic to contrast. Procedure is tomorrow. What is the BEST course of action?
a. Steroid today. Histamine before surgery.
121
Contraindications (relative) for sitting position:
a. C-spine/ degenerative diseases of C-spine
b. Intra-cardiac defects
c. severe Hypovolemia
d. Severe hydrocephalus
e. lesion vascularity
f. Significant CVD
122
Select all that are true of posterior fossa surgery??
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral, three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d. Ensure large airway and bite block placements
a. Risks include VAE, quadriplegia, macroglossia, pneumocephalus
b. Lateral, three-quarter prone, and park bench positions
c. Avoid excessive neck rotation and flexion of knees towards chest
d. Ensure large airway and bite block placements (WRONG: Avoid)
123
What drug would you not give prior to clipping of aneurysm?
a. phenylephrine
124
Triple H therapy includes: (choose 3)
a. Hypertension
b. Hypervolemia
c. Hemodilution
d. (all of the wrong answers included hyper/hypothermia)
125
Which is NOT a risk factor for protamine allergy?
a. Family history of malignant hypothermia
126
What is the advantage of using newer radiographic contrast compared to older radiographic contrast?
a. Newer radiographic contrast has a lower osmolar load
127
. All are true of Right sided catheterization except:
a. Performed for diagnostic purposes
b. May be done Brachial, femoral, and IJ
c. NOT EJ
128
What are irreversible:
a. ASA
| b. Thienophyridine
129
Law that applies to aneurysms?
a. Law of Laplace
130
During the management of an angioplasty and stenting for treatment of atherosclerotic stenosis of the cervical, vertebral, and intracranial arteries, which of the following are NOT true?
a. Hypoperfusion is associated with this procedure.
131
85 y/o man, history of MI, Cr 1.8, BUN 22, K 5 (other labs that were normal) needs emergent heart cath. Which of the following is the BEST action?
a. Hydrate, avoid NSAIDS, limit contrast, proceed with case
132
All of the following are true of AVMs except?
a. They are emergent and require emergency treatment
133
Best candidate for awake craniotomy?
a. 38-year-old with tumor near motor area with history of uncontrolled seizures (I think this is the right answer)
134
AVM surgery with ICP 22. What is the best action?
a. Hyperventilate because the ICP is too high.
135
. All of the following increase CBF and ICP under normal circumstances EXCEPT.
a. midazolam
136
Barbiturates do all of the following EXCEPT
a. Protect against global ischemia.
137
What are s/s of cushing’s triad? (choose 3) - not sure of the exact question or the exact answers
a. Intracranial HTN
b. Arterial HTN
c. Bradycardia
d. Fast, deep respirations
a. Intracranial HTN
b. Arterial HTN
c. Bradycardia
d. Fast, deep respirations (WRONG?)
138
Which is wrong regarding air embolism?
a. Add 8 of PEEP
b. Suction through CVV
c. Stop N2O
d. Place pt in Right-lateral recumbent with head slightly up
d. Place pt in Right-lateral recumbent with head slightly up (this was the answer; this answer would have been correct if it had been Left-lateral recumbent)
139
If the PaCO2 is raised to 50–60 mmHg, cerebral venous outflow will greatly exceed extracranial venous outflow, and the pressure gradient will favor movement of a
sclerosing agent, chemotherapeutic agent, or glue away from vital intracranial drainage pathways
140
1. Epinephrine (T/F) High dose = Beta + increase PVR; Low dose = Alpha + decrease PVR
1. False
141
3. MVR causes
. Viral
a. Toxins
b. Autoimmune
142
4. ASD
| . If there is no CHF present,
there are minimal alterations in Volatile anesthetic requirements
143
5. TOF: Pre-operative preparations
. Premedicate with sedative
144
6. All of the following are true of Left to Right shunt except:
.
Recurrent pulmonary infections are very unlikely (False statement)
145
7. Patient in for ACL repair. Father died of heart?
. ACRM: Use Amiodarone; Deep anesthesia
146
8. 3 S&S of TET/Hypercyanotic Spells
. Loss of consciousness
a. Arterial hypoxemia with increasing cyanosis
b. Seizures
147
9. Spherical LV hypertrophy on chest x-ray; Pulmonary venous congestion
. Dilated Cardiomyopathy
148
10. 2 Determinants of Anesthesia for Aortic Stenosis
. CO
| a. HR/BP?
149
11. Ebstein anomaly is associated with
. WPW
150
12. In Right to Left of TOF: All increase R to L shunt
. Decrease PVR?
151
13. RCM
. Titrate Fentanyl
152
14. Congenital heart disease problems except
| .
a. Hypotension? Sudden Death?
153
15. EPI effects on BP and HR
. Increase systolic, decrease diastolic and increase HR
154
2. Parasympathetic innervation of the heart is
. Dorsal motor vagal
155
17. Critical Aortic Stenosis 3 S&S:
. Syncope
a. Angina pectoris
b. DOE
156
18. Epinephrine (T/F): Neurotransmitter vs Peripheral Hormone
.
FALSE??????
157
19. Patient has left recurrent laryngeal nerve damage what condition is suspected
a. Mitral Stenosis
158
Hypertrophic cardiomyopathy is associated with
a. Contractile mechanism
159
Hypertrophic cardiomyopathy
a. Diastolic and systolic cardiomyopathy
160
. 19 % of patients with cyanotic heart disease also present with
a. Scoliosis
161
Patients with cyanotic heart disease have?
a. Increased minute ventilation and normocarbia
162
Mitral regurgitation appropriate anesthetic considerations
a. Keep heart rate 80-100
163
Aortic stenosis patient heart rate 46
a. Atropine 0.4mg bp dropped to 90/50 give 10-20mg of ephedrine
164
. Direct and indirect acting medication
a. Ephedrine
165
Aortic stenosis is eccentric T/F?
a. False
166
Eccentric is
a. Chamber size and volume enlargement
167
. Marfan Syndrome associated with what 5 traits:
a. Tall and slender
b. Disproportionate arms and legs
c. High arch palate and crowned teeth
d. Heart murmurs are common (MR)
e. Flat feet
168
All of the following occur in restrictive cardiomyopathy EXCEPT?
a. 10-year-old female
169
Epi at low doses is greater beta 2 than beta 1 T/F?
a. True??? → False, they are equal
170
. Question about Tricuspid Atresia? Choose 3
a. Cyanosis is usually present at birth
b. Early survival is depending on prostaglandin E1 infusion
c. Success of the fontan procedure is reliant upon low PVR and low atrial pressure
171
. How does EPI change from low dose to high dose?
a. Beta 1, Alpha 1
172
Which one does not need prostaglandin E1
a. IHSS
173
Question about sudden death?
a. Dysrhythmias
174
What does oxytocin do to svr ___ and HR and PVR
a. Decrease, increase
Oxytocin DECREASES SVR
Increases HR /PVR
175
Hypertrophic cardiomyopathy first line treatment
a. Fluids
176
VSD associated with what post-op ?
a. 3rd degree heart block post op
177
PV Loop of increased Preload, Afterload
know the loops!
178
All are symptoms of aortic stenosis EXCEPT?
a. Diastolic murmur
179
. Mediastinoscopy question….? Choose 3
a. Patients with lung cancer may have Eaton-Lambert syndrome with sensitivity to NDMR and Depolarizers
b. The most severe complication of mediastinoscopy is major hemorrhage
c. A bronchial blocker can be used to provide lung isolation in the event of an emergency
180
Adrenaline is the same as EPI
a. True
181
Benefits of beta 2 stimulation? Choose 2
a. Vasodilation
| b. Stabilization of mast cell protection
182
Alpha 2 receptors are found
a. Presynaptic
183
What is the most common CHD
a. VSD
184
Reversal of a shunt
a. Eisenmenger't sydrome
185
Which is true about aortic stenosis? Choose 2
a. Avoid bradycardia because SV is fixed
| b. Avoid tachycardia because SV is fixed
186
How do you treat bradycardia in a patient with aortic stenosis?
• The onset of junctional rhythm or bradycardia requires prompt treatment with ephedrine, atropine, or glycopyrrolate
187
What is the best way treat a patient with aortic stenosis during induction, maintenance, etc.?
- ** Maintain NSR- prevent hypotension
- Avoid regional – spinal and epidural will lead to shock
- Iv induction that does not decrease SVR- etomidate and Benzodiazepines
- Avoid ketamine d/t ketamine
- Volatiles and opioids plus nitrous may be used for maintenance
- Marked left ventricular dysfunction=maintenance should be nitrous oxide with opioids or opioids alone.
- Neuromuscular blocking drugs with minimal hemodynamic effects are best.
- Maintain IV fluid volume at normal levels
- Persistent tachycardia should be treated with B blockers Such as esmolol.
- SVT terminated with cardioversion
- Lidocaine, amiodarone and defibrillator should be available- d/t high propensity for ventricular dysrhythmias
188
What are the features of Tricuspid Atresia?
- Absence or permanent closure of the tricuspid valve
- Blood flow cannot enter the right ventricle
- Blood flow must go to the left atrium via the Patent foramen ovale or ASD then flows into the left ventricle and through a VSD- into the right ventricle and the pulmonary circulation
- If no VSD- pulmonary blood flow is accomplished through a PDA or bronchial vessels.
- Are cyanotic and have a small right ventricle
- Right to left shunt=cyanosis (clubbing in older children) tachypnea, prominent a waves, failure to thrive, all in the absence of abnormal pulses, hepatic enlargement or overt heart failure.
- Holosystolic murmur-
189
What is Eisenmenger’s Syndrome?
- Severe pulmonary HTN as a result of Left to right intracardiac shunt
- Common cause is unrepaired VSD
- Enlargement of the right ventricle and atrium lead to dysrhythmias such as atrial fibrillation or flutter
190
What are the features of ventricular septal defect? What must you monitor for?
- VSD- the most prevalent form of congenital heart disease in children
- Treat VSD of unknown severity like a patient with CHF and pulmonary HTN.
- Eisenmenger syndrome
191
What are the features of atrial septal defect? What must you be vigilant about?
- ASD’s are more commonly diagnosed in adults
- Requires all of the monitor and access needed for CP bypass and capacity to treat and manage potential post-operative heart block
192
How does congenital heart disease (CHD) complicate pregnancy? When would a patient with CHD have complications?
* Cardiac complications, spontaneous abortions, premature delivery, thrombolic complications, peripartum endocarditis (presenting usually in last month of pregnancy and up to 5 months postpartum), poor fetal outcomes can occur
* Successful pregnancy term with delivery is possible
* Almost 50% of cyanotic women have worsening outcomes
* Most major physiologic changes occur prior to 3rd trimester… if pt has maintained good functional status to this point, risk is dramatically lowered
* Epidural will help with pain/response to labor
* Bearing down (associated with 2nd stage) requires close observation
* No favored method (c/s vs vaginal birth)
* 3rd stage (delivery of placenta) can be associated with hypovolemia, uterine atony and hemorrhage….
* Oxytocin decreases SVR and increases HR and PVR
* Methylergonovine (methergine) increases SVR
* (both of these can be poorly tolerated)
* Some mothers will be taking drugs for cardiac condition
* B-blockers can interfere with fetal growth and response of fetus to stress during labor
* Amiodarone can affect fetal thyroid function
* Maternal cardioversion could be safe with close fetal monitoring
193
Scoliosis in CHD? Prevalence?
•Scoliosis can occur in approximately 19% of pts with CHD (most commonly in cyanotic pts)
194
Intracardiac shunts put patient at risk for what?
| Ebstien’s Anomaly CHD?
- Produces acyanotic lesion – but can be associated with other shunting lesions that in combination with RVOT obstruction renders these patients cyanotic.
- Malformed tricuspid valve
- Symtpoms- CHF, Syncope, Dysrhythmias or no symptoms
- If associated shunting lesion patient at risk for paradoxical EMBOLi and hypoxia. Dpending on the right to left shunt
195
Duchene Muscular Dystrophy? Which population of patients? Etc.
- Pseudohypertrophic muscular dystrophy
| - Most common and most severe form of childhood progressive muscular dystrophy caused by mutation on X chromosome.
196
3. Aortic stenosis patient’s heart rate drops to 46…what do you do?
a. Atropine 0.4mg and if DP drops to 90/50 then give 10-20 mg of ephedrine → pretty sure this should be neo hm.. (What about refractory bradycardia w/ neo?) also 10-20 mg Ephedrine is a hefty dose
197
Direct and indirect acting medication?
a. Ephedrine
198
All are symptoms of aortic stenosis EXCEPT?
a. Diastolic murmur
199
Mediastinoscopy question….? Choose 3
a. Patients with lung cancer may have Eaton-Lambert syndrome with sensitivity to NDMR and Depolarizers
b. The most severe complication of mediastinoscopy is major hemorrhage
c. A bronchial blocker can be used to provide lung isolation in the event of an emergency
200
Benefits of beta 2 stimulation? Choose 2
a. Vasodilation
| b. Stabilization of mast cell protection
201
8. Levophed is the same as Norepinephrine. True or False?
a. True
202
9. In the awake lateral position. Abdominal contents are placed?
a. Cephalad in the dependent lung
203
10. Factors that reduce HPV?
a. Hemodilution
b. Hypervolemia
c. Hypothermia
204
11. Lung separation is done?
a. One lung ventilation
205
12. Most modern pacemakers are?
a. Bipolar
206
13. Creation of the Reed Switch enabled?
a. the PM to convert from synchronous to asynchronous with the application of a magnet
207
14. Second letter for the pacemaker code is?
a. Ability to sense
208
15. Beta 1 stimulation
a. Positive chronotropic
| b. Positive dromotropic
209
16. Three-legged stool
a. Respiratory mechanics
b. Cardiopulmonary reserve
c. Lung parenchymal function
210
The metabolic requirement for O2 is reduced by ______ for each _____ C drop in core body temperature sinus rhythm can’t be obtained until temp is____.
a. 50%, 7, 34
211
18. ACT, PT, and PTT are prolonged, and platelets become nonfunctional as the temp is decreased to
a. 28 C
212
19. True about renal dysfunction and CABG? Choose 3
a. Renal dysfunction is related to length of time on bypass (longer than 3 hrs)
b. Hypothermia depresses renal tubular function
c. Urinary output is the single most important intraoperative monitor of renal system during CABG
213
20. What is vulnerable to traumatic injury as it is subjected to high shear forces after blunt trauma or rapid deceleration?
a. Aortic isthmus
214
21. Aortic wall and lined by endothelium?
a. Intima
215
22. Abg ph-7.36 pac02 60, hc03 -30
a. Compensated Respiratory Acidosis
216
23. Patient has volume of air that can be inspired with maximal effort and above normal tidal breathing
a. Inspiratory Reserve Volume
217
24. T/F- Intrapleural pressure becomes more positive during inspiration and less negative during expiration
a. False - it becomes more negative during inspiration and less negative during expiration
218
25. Patient is COPD, on 4L NC at home. Arrives for right sided pneumonectomy due to cancer. Hx of DVT and has been on coumadin for 5 years and took his last dose last night.
a. General anesthesia, 8.5 ETT with bronchial blocker, opioids, anticoagulation plan post op, plan for post op ventilation????
219
26. Bronchogenic carcinoma is the most frequent indication for?
a. Sleeve lobectomy
220
27. Position for OLV? Choose 3
a. Common position is lateral decubitus
b. A roll is placed beneath the torso just caudal to the axilla to prevent compression of the neurovascular bundle and forward rotation of the humeral head (better considered an axillary support roll because if positioned in the axilla it could cause compression of the neurovascular area)
c. Hyperabduction of the arms is prevented to keep the brachial plexus from stretching against the humeral head
221
28. The distance from the carinal bifurcation to the right upper lobe is ______ compared to _____ left mainstem bronchus.
a. 1.5-2 cm, 4-5 cmq
222
29. Neuroprotective measures during heart and vascular surgeries (choose 3)
a. Systemic hypothermia
b. Topic cerebral cooling
c. ???
223
30. In a spontaneously breathing, upright pt, perfusion ______ from the apex to base of the lung.
a. Increases
224
31. The first branch of the aortic arch
a. The innominate artery
225
32. The sympathomimetic amine depends on
a. Dose of drug
b. Affinity to receptor
c. Population of receptor
226
33. The American Thoracic Society considers an ____ improvement in forced expiratory volume 1 (FEV1) post-bronchial therapy to be significant.
a. 12%
227
34. HPV?
a. Triggered by Alveolar hypoxia
| b. Peak at 30 seconds (wrong) == 15 mins
228
35. The vo2 max is 15, the DLCO and FEV1 is less than 40%
a. Increased risk
b. PFT
c. More testing
229
36. _______ is the single most important step in reducing the heart’s myocardial O2 consumption by 90%
• Pleural rupting myocardial electromechanical activity
230
37. Aortic systolic BP results from summated effects of: (choose 3)
a. Stroke volume
b. Aortic compliance
c. Peripheral Vascular Resistance
d. Systemic Vascular Resistance
a. Stroke volume
b. Aortic compliance
c. Peripheral Vascular Resistance
d. Systemic Vascular Resistance (WRONG)
231
First branch of aortic arch is the ____
a. Innominate artery
232
_____ is the mechanism by which autoregulation during OLV allows a reflex intrapulmonary feedback mechanism that improves gas exchange and arterial oxygenation.
a. Hypoxic Pulmonary Vasoconstriction (HPV)
233
40. _____ tests the lungs ability to allow transport of gas across the alveolar-capillary membrane.
• Diffusion capacity
234
Leads are often inserted at the completion of cardiac surgery. Pacing wires are directly sewn, by the CV surgeon onto the epicardium. This describes _____.
• Epicardial pacing
235
Correct placement of transcutaneous pacing pads are? (Choose 2)
* Anteriorly on right upper chest and anteriorly on the left lower chest
* Anteriorly mid chest and posteriorly between the scapulae
236
43. ____ is the pressure in the potential space between the lung pleura and the chest wall pleura. While _____ is the pressure of air inside the alveoli.
* Pleural pressure
| * Alveolar pressure
237
Lower airway consists of: (choose 3)
* Trachea
* Conducting Airways
* Respiratory Airways
238
45. Patient has Dilated cardiomyopathy. The astute SRNA can expect the pt to have?
a. Tricuspid valve regurgitation
239
46. All of the following should be avoided in mitral stenosis EXCEPT:
a. Calcium channel blockers to treat HR in presence of A-Fib
240
47. All of the following are appropriate for treatment of mitral regurgitation EXCEPT:
a. Avoid pancuronium
241
48. With dilated cardiomyopathy, which of the following would be the BEST anesthetic management plan?
a. Promote afterload reduction, avoid large fluid blouses, opioids are good, etomidate is better choice over propofol
242
49. ACT measurement
• 400 seconds to initiate bypass
