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Cardiac Constable review of old quizzes > cardiac constable review of quizzes > Flashcards

cardiac constable review of quizzes 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 periodb. 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 proceduresd. none of the abovee. all of the above

A

E. All of the above (quiz 1)

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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 occursb. The patient’s ventricular function or Ejecttion fraction (EF)C. stability of symptomsd. current medical therapye. All of the above

A

E. All of the above (quiz 1)

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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 SyndromesB. Advanced ageC. Decompensated Heart FailureD. Significant arrhythmiasE. Severe Valvular Disease

A

B. Advanced Age (quiz 1)

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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 proceduresb. vascular proceduresc. prolonged procedures with large fluid shiftsd. procedures with large amounts of blood losse. All of the above

A

E. All of the above (quiz 1)

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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 maintain blood glucose 150 mg/dl

A

d. maintain blood glucose >150mg/dL (quiz 1)

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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 atriumb. the lower dome of the left lung than of the right lungc. Avoiding endangering the thoracic ductd. the inability to cannulate the right internal jugular vein

A

D. the inability to cannulate the right internal jugular vein (Quiz 2)

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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*Cb. Acute blood lossc. Epinephrine 25mcg IVd. Myocardial ischemiae. Both B and D

A

e. Both B and D (quiz 2)

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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 stenosisb. High PEEPc. Mitral Regurgitationd. Measuring PCWP at end inspiration in the pt on a ventilatore. none of the above

A

e. none of the above (quiz 2)

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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 V5b. I and aVLc. I and V5d. II and aVL

A

a. II and V5 (quiz 2)

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10
Q

Systolic pressure variation is highly suggestive of which of the following conditions?a. Hypervolemiab. Hypovolemiac. Acute Water intoxicationd. congestive heart failure (CHF)

A

b. Hypovolemia (quiz 2)

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11
Q

Remifentanil is metabolized primarily by…a. Kidneysb. liverc. Hoffman eliminationd. Pseudocholinesterasee. Nonspecific esterases

A

e. Nonspecific esterases (quiz 3)

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12
Q

Complications attributed to ketamine when used for coronary artery surgery include each of the following EXCEPT?a. hypertensionb. tachycardiac. bradycardiad. increased plasma Epinephrine levels

A

c. bradycardia (Quiz 3)

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13
Q

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

A

b. produces a cataleptic trance known as dissociative amnesia (quiz 3)

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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 distributionc. faster recovery timed. All of the above are correcte. none of the above are correct

A

d. All of the above are correct (quiz 3)

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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 ageb. Hypertensionc. Diabetes Mellitusd. Ventricular Dysfunctione. All of the above

A

e. All of the above (quiz 3)

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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 individualsb. The SA node is perfused by either the RCA or the Circumflex Arteryc. The PDA arises from the LAD in approx. 85% of individualsd. 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 (quiz 4)

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17
Q

Which of the following is NOT a determinant of O2 delivery?a. Hemoglobinb. SpO2c. PaO2d. Cardiac Outpute. Left Atrial Pressure (LAP)

A

e. Left Atrial Pressure (LAP) (quiz 4)

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18
Q

Which of the following is NOT a determinant of O2 demand?a. Heart rateb. contractilityc. SpO2d. Afterloade. Wall thickness

A

c. SpO2 (quiz 4)

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19
Q

Intraoperative myocardial ischemia can be detected by which of the following?a. ST segment depressionb. ST segment elevationc. Pulmonary Artery Pressure changesd. Regional Wall Motion Abnormality (RWMA) on TEEe. All of the above

A

e. All of the above (quiz 4)

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 vasopressorsc. Maximize Preload, Heart Rate, Rhythm, and Afterloadd. Insertion of IABP by surgeone. All of the above

A

e. All of the above (quiz 4)

21
Q

The blood flow during total cardiopulmonary bypass is:a. Not adjustableb. virtually nonpulsatilec. provides pulsatile pressured. A pulsatile flowe. Mimics normal flow in all respects

A

b. virtually nonpulsatile (Quiz 5)

22
Q

The continuance of pulmonary ventilation during cardiopulmonary bypass:a. Leads to hypercarbiab. Leads to improved systemic arterial blood gas valuesc. decreases post operative ventilator timesd. may interfere with the surgery and may decrease surfactante. All of the above

A

d. may interfere with the surgery and may decrease surfactant (quiz 5) **note that there are 2 quiz questions on CPB that have “all of the above” options and neither of them are correct

23
Q

The PaCO2 of a pt on cardiopulmonary bypass:a. is determined by the O2 concentration of the fresh gasb. Is generally adjusted through changes in the fresh gas flow ratec. is generally adjusted through pulmonary ventilationd. should be maintained at less than 30mmHge. is determined by the type of oxygenator

A

b. Is generally adjusted through changes in the fresh gas flow rate (quiz 5)

24
Q

When an adult patient is on total cardiopulmonary bypass:a. Mean arterial pressure is generally maintained above 60 mmHgb. Blood is pumped from the vena cava & drains by gravity into the aorta for circulationc. the level of blood in the venous reservoir of the pump reflects the central venous pressure of the patientd. venous pressure elevation is of no consequencee. venous return ot the pump is always started before arterial infusion

A

a. Mean arterial pressure is generally maintained above 60 mmHg (quiz 5)

25
Q

Advantage(s) of membrane oxygenators over bubble oxygenators include:a. lower costb. lower priming volumesc. simplicityd. Less damage to ertyrocytese. All of the above

A

d. Less damage to ertyrocytes (quiz 5)**note that there are 2 quiz questions on CPB that have “all of the above” options and neither of them are correct

26
Q

Mitral stenosis is usually due to:a. Rheumatic feverb. malignant hyperthermiac. hypoxia d. hypercalcemia

A

a. Rheumatic fever (quiz 6)

27
Q

Mitral stenosis will usually result in:a. embolic events and atrial fibrillationb. ventricular fibrillationc. heparin sensitivityd. essential hypertension

A

a. embolic events and atrial fibrillation (quiz 6)

28
Q

Aortic stenosis is associated with which of the following?a. reduced stroke volumeb. increased stroke volumec. maintained stroke volume because of eccentric hypertrophyd. maintained stroke volume because of concentric hypertrophy

A

d. maintained stroke volume because of concentric hypertrophy (quiz 6)

29
Q

Aortic regurgitation causes:a. increased forward stroke volumeb. increased arterial diastolic pressurec. pressure overload of left ventricled. volume overload of left ventricle

A

d. volume overload of left ventricle (quiz 6)

30
Q

Mitral regurgitation management includes which of the following?a. slow heart rateb. maintain or decrease stroke volumec. maintain or decrease contractilityd. maintain or slightly increase preload

A

d. maintain or slightly increase preload (quiz 6)

31
Q

Mitral regurgitation has a regurgitant volume that is based on all EXCEPT:a. mitral valve sizeb. heart ratec. pressure gradient between atria and ventricled. aortic diastolic pressure

A

d. aortic diastolic pressure (quiz 6)

32
Q

How should afterload be managed MOST EAGERLY in the hypertrophic cardiomyopathy patient?a. maintainedb. decreasedc. increasedd. All of the above

A

c. Increased (quiz 6)

33
Q

Associated with mitral regurgitation is:a. Pressure overloadb. Decrease left ventricular end diastolic volumec. backward flow into ventricled. reduction in forward stroke volume

A

d. reduction in forward stroke volume (quiz 6)

34
Q

Acute aortic regurgitation presents with a sudden onset of pulmonary edema and:a. hypertensionb. hypotensionc. acute renal failured. none of the above

A

b. hypotension (quiz 6)

35
Q

Aortic stenosis can be caused by all of the following EXCEPT:a. Rheumatic valvular diseaseb. Infective endocarditisc. senile calcification (aortic valve sclerosis)d. bicuspid valvee. cardiac tamponade

A

e. cardiac tamponade (quiz 6)

36
Q

Chronic hypertension has which of the following effects on the autoregulation curve?a. Shifts the curve LEFTb. Shifts the curve RIGHTc. Shifts the curve UPd. Shifts the curve DOWN

A

b. Shifts the curve RIGHT (quiz 7)

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 complicationb. Lower incidence of postop neurological complicationsc. Lower incidence of requiring blood product transfusions d. Lower estimates of intraoperative blood losse. None of the above. All are true

A

e. None of the above. All are true (quiz 7)

38
Q

Spinal cord protection may be obtained by which of the following?a. prolonging the aortic cross clamp timeb. decreasing mean arterial pressure (MAP)c. decreasing cerebral spinal pressure using a spinal draind. None of the abovee. All of the ABOVE

A

c. decreasing cerebral spinal pressure using a spinal drain (quiz 7)

39
Q

Which of the following is a true statement regarding anesthetic goals in vascular surgery?a. Maintain hemodynamics to preserve myocardial functionb. maintain body temperaturec. maintain oxygen carrying capacityd. Initiate interventions that protect renal functione. All of the Above

A

e. All of the Above (quiz 7)

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 infusionb. Preload reduction using Nitroglycerin infusionc. Increase mean arterial pressure (MAP) using a phenylephrine infusiond. Both A and B are correcte. All of the Above

A

d. Both A and B are correct (quiz 7)

41
Q

A pt 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 arrestb. Superior Vena Cava Syndromec. Air in the mediastinumd. Compression of the innominate arterye. Anesthetic overdose

A

d. Compression of the innominate artery (quiz 8)

42
Q

After starting one-lung ventilation with oxygen and isoflurane, a tidal volume of 500ml and a rate of 10bpm, the O2 sat begins to fall. All of the following are acceptable means to improve oxygen saturation EXCEPT?a. Confirm 100% FiO2b. Return to 2 lung ventilationc. Clamp the pulmonary artery of the non-ventilated lungd. Add 5cm H2O PEEP to the non-ventilated lunge. Add 10cm H2O CPAP to the non-ventilated lung

A

d. Add 5cm H2O PEEP to the non-ventilated lung (quiz 8)

43
Q

Hypoxic pulmonary vasoconstriction (HPV) is?a. Decreased by hypocapniab. Not affected by volatile anestheticsc. Increased by hypoxiad. Increased by alkalosise. Both a & c are correct

A

e. Both a & c are correct (quiz 8)

44
Q

Which of the following is the most effective method of analgesia after thorocotomy?a. Lumbar epiduralb. Thoracic epiduralc. IV PCAd. Transdermal narcoticse. TENS unit

A

b. Thoracic epidural (quiz 8)

45
Q

Which of the following is a TRUE statement?a. The primary goal of preoperative evaluation and therapy of cardiac surgical procedures is to quantify and reduce the patient’s 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 abovee. ALL of the above

A

e. ALL of the above (quiz 8)

Cardiac Constable review of old quizzes (1 decks)

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