Health Assessment 2 Practice ?s

Question 1

What does the internal nasal cavity primarily consist of?
A) Septum
B) Epiglottis
C) Vocal cords
D) Cricoid cartilage

Answer 1

A) Septum

Divided by septum
Cribriform plate
Turbinates

Question 2

The hard and soft palates are part of which anatomical structure?
A) Larynx
B) Pharynx
C) Mouth
D) Trachea

Answer 2

C) Mouth

Mouth
Roof
Maxilla and palatine bones
Hard palate
Soft palate
Teeth

Question 3

What type of cartilage is the cricoid?
A) Paired
B) Unpaired
C) Flexible
D) Inverted

Answer 3

B) Unpaired

Unpaired
Thyroid
Cricoid - complete ring
Epiglottis

Paired
Arytenoid
Corniculate
Cuneiform

Question 4

How long is the adult trachea typically?
A) 5-10 cm
B) 10-15 cm
C) 15-20 cm
D) 20-25 cm

Answer 4

B) 10-15 cm

Trachea
Extends from inferior cricoid membrane to carina
10 to 15 cm - adult
C-shaped cartilage
Closed posteriorly by longitudinal trachealis muscle
Anteriorly bounded by tracheal rings

Question 5

What is the primary purpose of airway assessment?
A) Diagnosing infections
B) Planning surgery
C) Evaluating intubation possibilities
D) Assessing vocal abilities

Answer 5

C) Evaluating intubation possibilities

Question 6

What factor is most predictive of a difficult intubation?
A) History of snoring
B) Past difficult intubation
C) High BMI
D) Beard presence

Answer 6

B) Past difficult intubation

History Concerns
Past difficult intubation – most predictive factor

Report of excessive sore throat

Report of cut lip/broken tooth

Recent onset of hoarseness

History of OSA

Lesions intra-orally…. base of tongue, lingual tonsils

Question 7

What is considered an adequate inter-incisor distance for intubation?
A) > 3 cm
B) > 4 cm
C) > 5 cm
D) > 6 cm

Answer 7

D) > 6 cm

Prefer > 6 cm (3 finger breadths)

However, An inter-incisor distance of less than 3 cm (or 2 fingerbreadths), as measured from the upper to the lower incisors with maximal mouth opening, can suggest the possibility of difficult intubation

Question 8

What is the preferred sternal notch to chin distance in the context of airway assessment?
A) >10.5 cm
B) >11.5 cm
C) >12.5 cm
D) >13.5 cm

Answer 8

C) >12.5 cm

Head and neck mobilitysternomental distance

Distance between sternal notch and chin
Head in full extension
Mouth closed
>12.5 cm preferred

Question 9

The Mallampati score ranges from:
A) I to II
B) I to III
C) I to IV
D) I to V

Answer 9

C) I to IV

Question 10

Which condition is NOT typically associated with difficult mask ventilation?
A) Obesity
B) Snoring
C) Beard
D) Youth

Answer 10

D) Youth

“BOOTS” – predictor difficult BMV and potentially airway
Beard – gel
Obesity
Older
Toothless – “gather” cheek, 2 people
Sounds – snoring, stridor
Inability to maintain O2 saturations >90% with BMV

Question 11

What is the ideal sniffing position intended to align?
A) Oral, pharyngeal, and laryngeal axes
B) Nasal, oral, and tracheal pathways
C) Oral, bronchial, and diaphragmatic areas
D) Pharyngeal, laryngeal, and bronchial axes

Answer 11

A) Oral, pharyngeal, and laryngeal axes

Sniffing position
Cervical flexion and atlanto-occipital extension
Aligns oral, pharyngeal, and laryngeal axis

Ears level with the chest (sternal notch)..

Question 12

What does the “BOOTS” acronym stand for in predicting difficult airway management?
A) Beard, Obesity, Older, Toothless, Snoring
B) Breathing, Obstruction, Oropharyngeal, Trauma, Surgery
C) Blood, Oxygen, Opacity, Tumors, Swelling
D) Beard, Overbite, Occlusion, Tonsils, Speech

Answer 12

A) Beard, Obesity, Older, Toothless, Snoring

Question 13

What contributes to the LEMONS score for difficult intubation?
A) Length, Evaluation, Mouth, Obstruction, Neck, Saturation
B) Look, Evaluate, Mallampati, Obstruction, Neck Mobility
C) Look, Evaluate, Mouth opening, Obstruction, Neck mobility, Saturation
D) Larynx, Edema, Mallampati, Obesity, Neck mobility, Surgery

Answer 13

B) Look, Evaluate, Mallampati, Obstruction, Neck Mobility

LEMONS
L- Look – abnormal face, trauma, unusual anatomy
Evaluate – 3-3-2 rule (3 finger mouth opening, fingers along the floor of the mandible, 2 fingers between the space between the superior notch of the thyroid cartilage, and neck/mandible junction
Mallampati score – I-IV, relates mouth opening to size of tongue
Obstruction/obesity – tumor, infection
Neck mobility

Question 14

What is the primary reason for conducting an airway assessment before anesthesia?
A) To decide on the type of anesthesia
B) To prepare the patient mentally
C) To ensure proper medication is chosen
D) To identify potential intubation and ventilation challenges

Answer 14

D) To identify potential intubation and ventilation challenges

Question 15

Which of the following is NOT a paired laryngeal cartilage?
A) Arytenoid
B) Thyroid
C) Corniculate
D) Cuneiform

Answer 15

B) Thyroid

Question 16

In the context of airway assessment, what does a thick neck indicate?
A) Increased risk of hypoxemia
B) Decreased risk of laryngeal injury
C) Increased risk of difficult intubation
D) Decreased need for sedatives

Answer 16

C) Increased risk of difficult intubation

Facial deformities
Head and neck cancers
Burns
Goiter
Short or thick neck
>43 cm = difficulty w/ intubation
More predictive than high BMI
Receding mandible
Beard
C-collar

Question 17

The presence of what condition increases the complexity of airway management?
A) High blood pressure
B) Diabetes
C) Obstructive Sleep Apnea (OSA)
D) Hyperthyroidism

Answer 17

C) Obstructive Sleep Apnea (OSA)

Difficult Mask Vent
O: Obesity
BMI > 30 kg/m2
B: Beard
E: Edentulous
S: Snorer, OSA
E: Elderly, male
Age > 55

Mallampati 3 or 4

Question 18

What is indicated by the Mallampati Class IV?
A) Full visibility of tonsils, uvula, and soft palate
B) Visibility of only the hard palate
C) Full visibility of the soft palate only
D) Partial visibility of the uvula

Answer 18

B) Visibility of only the hard palate

Question 19

Which anatomical measurement is preferred to be greater than 6.5 cm for intubation?
A) Inter-incisor distance
B)Thyromental distance
B) Sternomental distance
C) Head extension distance
D) Neck rotation distance

Answer 19

B)Thyromental distance

Submandibular compliance
Prefer > 6.5 cm (3 finger breadths)
Tip of chin to thyroid notch

Question 20

What are the typical consequences of dental injuries during intubation?
A) High recovery rates without intervention
B) Low insurance claim rates
C) High percentage during tracheal intubation
D) No significant medical costs

Answer 20

C) High percentage during tracheal intubation

25% of closed insurance claims against anesthesia providers
75% occur during tracheal intubation
Difficult or emergency airway management

Laryngoscope blade
Rigid suction catheters
Oropharyngeal airway placement
Rigorous removal of airways
Biting down on ETT/LMA/airways during emergence

Incisor on right highest potential for injury
Also a slide that says left so who knows

Question 21

Which Mallampati class is characterized by visibility of the entire uvula and soft palate?
A) Class I
B) Class II
C) Class III
D) Class IV

Answer 21

A) Class I

Fauces, pillars, entire uvula, and soft palate

Question 22

What is the primary purpose of the sniffing position during airway management?
A) Comfort for the patient
B) Alignment of the pharyngeal axes
C) Prevention of aspiration
D) Reduction of neck strain

Answer 22

B) Alignment of the pharyngeal axes

Question 23

In the LEMONS score for difficult intubation, what does ‘E’ stand for?
A) Evaluate
B) Edema
C) Extension
D) Elevation

Answer 23

Evaluate – 3-3-2 rule (3 finger mouth opening, fingers along the floor of the mandible, 2 fingers between the space between the superior notch of the thyroid cartilage, and neck/mandible junction

Question 24

What anatomical characteristic is assessed by the thyromental distance?
A) Distance from the thyroid cartilage to the chin
B) Distance between the sternum and the chin
C) Distance from the thyroid cartilage to the mandible
D) Distance from the top of the thyroid gland to the base of the neck

Answer 24

A) Distance from the thyroid cartilage to the chin

Submandibular compliance
Prefer > 6.5 cm (3 finger breadths)
Tip of chin to thyroid notch

Question 25

For airway assessment, what is the significance of a high-arched palate?
A) Easier intubation
B) Indicator of robust health
C) Associated with difficult laryngoscopy
D) Reduces the risk of aspiration

Answer 25

C) Associated with difficult laryngoscopy

Identify pathologic characteristics
Tumor
Palate deformities
High arched palate, cleft palate
Macroglossia

Question 26

What does the “CORMACK-LEHANE classification” assess?
A) Severity of sleep apnea
B) Level of consciousness
C) Visibility of laryngeal structures during laryngoscopy
D) Ability to open the mouth

Answer 26

C) Visibility of laryngeal structures during laryngoscopy

Classification of laryngeal view
Trying to achieve the best view during DL
Grade I-IV

Procedure note we put this down

Question 27

How does obesity impact airway management?
A) Lowers risk of difficult ventilation
B) Increases risk of easy intubation
C) Increases risk of difficult mask ventilation
D) Has no impact on airway management

Answer 27

C) Increases risk of difficult mask ventilation

Question 28

What is the primary treatment for angioedema affecting airway management?
A) Immediate fluid resuscitation
B) Administration of antihistamines
C) Rapid sequence intubation
D) High-flow nasal oxygen

Answer 28

C) Rapid sequence intubation

then

Angioedema- FFP, TXA, steroids..

Question 29

What is the preferred action if the patient cannot be intubated and ventilated?
A) Wait for spontaneous recovery
B) Immediate administration of steroids
C) Preparation for cricothyrotomy
D) Increase sedative dosage

Answer 29

C) Preparation for cricothyrotomy

Best option for given choices

Question 30

The “BURP” maneuver in laryngoscopy stands for:
A) Backward, Upward, Rightward Pressure
B) Breathe, Unwind, Relax, Position
C) Backward, Upward, Rotate, Push
D) Breathe, Up, Right, Pressure

Answer 30

A) Backward, Upward, Rightward Pressure

Optimal external laryngeal manipulation (OELM)

Question 31

What is the key consideration when using a bougie during intubation?
A) Color of the device
B) Length corresponding to depth of insertion
C) Shape of the tip
D) Material it’s made from

Answer 31

B) Length corresponding to depth of insertion

essential
small tube for small hole strategically designed deflection at the tip
self-confirming
can intubate epiglottis-only views leave the laryngoscope in
lubricate the tube, pull back and rotate if you get stuck black stripe is 25 cm - at lips, mid trachea in an adult male the bougie is your friend

Question 32

The onset time for good intubating conditions with rocuronium compared to succinylcholine is:
A) Faster with rocuronium
B) The same for both
C) Slower with rocuronium
D) Not relevant to intubation success

Answer 32

B) The same for both

Succinylcholine possesses the fastest onset (45sec) and produces the shortest period of muscle relaxation (6 – 10min) compared to all other paralytic agents at standard doses. However, Rocuronium dosed at 1.6mg/kg IV, gives the same onset of muscle relaxation as succinylcholine [7] and gives a longer safe apnea time [8] making it the preferred paralytic of choice in the critically ill.

Question 33

The use of succinylcholine is contraindicated in patients with:
A) Low blood sugar
B) A history of fast recovery
C) A predisposition to malignant hyperthermia
D) Previous administration of atropine

Answer 33

C) A predisposition to malignant hyperthermia

rhabdomyolysis existing hyperkalemia multiple sclerosis ALS
muscular dystrophies / inherited myopathies
denervating injuries > 72 hours old (e.g. stroke, spinal cord injury) burns > 72 hours old
crush injury > 72 hours old
tetanus, botulism, and other exotoxin infections
severe infections >72 hours old (esp. intra-abdominal infections) immobilization (including patients found down)

predisposition to malignant hyperthermia bradycardia
fasciculations – increased ICP, myalgias, hastened desaturation masseter spasm

Question 34

What is the significance of “can’t intubate, can’t ventilate” scenario in airway management?
A) It indicates an easy airway
B) It is a common, non-urgent situation
C) It represents a critical emergency requiring immediate action
D) It suggests the patient should be awakened and the procedure postpone

Answer 34

C) It represents a critical emergency requiring immediate action

Emergency Pathway- Limit attempts and be aware of the passage of time. Call for help/For Invasive access.

Try an alternative approach as you prepare an invasive access.. If that attempt fails proceed with the invasive access.

Question 34

Based on the ASA Difficult Airway Algorithm for Adult Patients:
Before attempting intubation, if there is a significant increased risk of aspiration, the clinician should:
A) Proceed with a post-induction airway strategy.
B) Proceed with intubation with the patient awake.
C) Postpone the case immediately.
D) Use supraglottic airway devices.

Answer 34

B) Proceed with intubation with the patient awake.

Question 34

Based on the ASA Difficult Airway Algorithm for Adult Patients:
When intubation attempt after induction of general anesthesia fails, the next step should be to:
A) Wake the patient up immediately.
B) Limit attempts and consider calling for help.
C) Proceed with a non-emergency pathway.
D) Attempt mask ventilation with adequate confirmation by CO2.

Answer 34

D) Attempt mask ventilation with adequate confirmation by CO2

Also, consider calling for help

Question 34

Based on the ASA Difficult Airway Algorithm for Adult Patients:
In the case of adequate mask ventilation but unsuccessful intubation, what should be considered?
A) Immediate surgical airway.
B) Limit attempts and consider awakening the patient.
C) Continue attempts without limiting.
D) Proceed with emergency invasive access.

Answer 34

B) Limit attempts and consider awakening the patient.

Question 35

Based on the ASA Difficult Airway Algorithm for Adult Patients:
If supraglottic airway ventilation is not adequate, what is the advised action?
A) Continue with repeated attempts.
B) Transition immediately to awake intubation.
C) Limit attempts and be aware of the passage of time.
D) Attempt a different supraglottic device.

Answer 35

C) Limit attempts and be aware of the passage of time.

You are now in the emergency pathway..

Emergency Pathway- Limit attempts and be aware of the passage of time. Call for help/For Invasive access.

Try an alternative approach as you prepare an invasive access.. If that attempt fails proceed with the invasive access.

Question 36

Based on the ASA Difficult Airway Algorithm for Adult Patients:

In the algorithm, when should you consider calling for help or invasive access?
A) Only if mask ventilation is adequate.
B) After a single failed intubation attempt.
C) When supraglottic airway ventilation is not adequate and mask ventilation fails.
D) As soon as the patient arrives in the operating room.

Answer 36

C) When supraglottic airway ventilation is not adequate and mask ventilation fails.
(cannot intubate, cannot ventilate)

Cannot intubate is implied

Question 37

Which component is NOT included in the Mallampati classification?
A) Visibility of the uvula
B) Tongue size
C) Pharyngeal pillars
D) Nasal patency

Answer 37

D) Nasal patency
Rationale: The Mallampati classification involves visibility of intra-oral structures, not nasal structures.

However,
The lateral wall of the nasal passages is characterized by the presence of three turbinates (or conchae) that divide the nasal passage into three scroll-shaped meatuses: inferior meatus, between the inferior turbinate and the floor of the nasal cavity, is the preferred pathway for passage of nasal airway devices

Question 38

What is a contraindication for using a laryngeal mask airway (LMA)?
A) Elective surgery
B) Full stomach
C) Patient comfort
D) Short procedures

Answer 38

B) Full stomach
Rationale: LMAs are not recommended for patients at risk of aspiration, such as those with a full stomach.

Question 39

What differentiates a ‘difficult airway’ from a ‘failed airway’?
A) Difficult airway implies successful intubation after multiple attempts
B) Failed airway indicates successful mask ventilation
C) Difficult airway is a situation where the patient is conscious
D) Failed airway means multiple unsuccessful intubation attempts and unsuccessful mask ventilation

Answer 39

D) Failed airway means multiple unsuccessful intubation attempts and unsuccessful mask ventilation
Rationale: A ‘failed airway’ scenario indicates both unsuccessful intubation and mask ventilation, posing an immediate risk to patient safety.

Question 40

Awake fiberoptic intubation is recommended in patients with:
A) No risk of aspiration
B) Anticipated difficult airway
C) Stable cardiovascular status
D) Previous history of easy intubation

Answer 40

B) Anticipated difficult airway

Question 41

Which is NOT a key feature of the ASA Difficult Airway Algorithm?
A) Use of supraglottic airway devices
B) Immediate cricothyrotomy
C) Awake intubation
D) Pharmacological induction before airway assessment

Answer 41

B) Immediate cricothyrotomy
Rationale: Immediate cricothyrotomy is not a key feature but a last resort in the ASA Difficult Airway Algorithm.

Patient could be combative and need ketamine to calm down before a good assessment can be made.

Question 42

Which medication is NOT typically used to break a laryngospasm?
A) Succinylcholine
B) Propofol
C) Atropine
D) Lidocaine

Answer 42

C) Atropine
Rationale: Atropine is not used to break a laryngospasm; it is used to reduce secretions. Succinylcholine, Propofol, and Lidocaine can be used for laryngospasm.

Question 43

Signs of inadequate mask ventilation include all EXCEPT:
A) Rising CO2 levels
B) Cyanosis
C) Chest movement
D) Squeaking noises from the mask

Answer 43

C) Chest movement
Rationale: Adequate mask ventilation is confirmed by visible chest movement; its presence indicates effective ventilation.

Question 44

The “BURP” maneuver in laryngoscopy is used to:
A) Prevent vomiting
B) Optimize vocal cord visualization
C) Increase speed of intubation
D) Reduce patient discomfort

Answer 44

B) Optimize vocal cord visualization
Rationale: The “BURP” maneuver is used to improve the visualization of the vocal cords during laryngoscopy.

Question 45

The Brachial Plexus is formed by the anterior rami of which spinal nerves?
A) C1-C4
B) C5-C8 and T1
C) L1-L4
D) S1-S4

Answer 45

Answer: B) C5-C8 and T1

Question 46

Which muscle is NOT innervated by the Musculocutaneous Nerve?
A) Biceps Brachii
B) Coracobrachialis
C) Brachialis
D) Teres Major

Answer 46

Answer: D) Teres Major

Nerve roots–C5-C7.
Motor functions– muscles in the anterior compartment of the arm (coracobrachialis, biceps brachii and the brachialis).
Sensory functions– gives rise to the lateral cutaneous nerve of forearm, which innervates the lateral aspect of the forearm

Question 47

The Axillary Nerve provides motor innervation to which of the following muscles?
A) Pectoralis Major
B) Deltoid
C) Latissimus Dorsi
D) Biceps Brachii

Answer 47

Answer: B) Deltoid

Spinal roots: C5 and C6.
Sensory functions: Gives rise to the upper lateral cutaneous nerve of arm, which innervates the skin over the lower deltoid (‘regimental badge area’).
Motor functions:Innervates the teres minor and deltoid muscles.

Axillary nerve- and nerve block.. Shoulder pain.. Lateral area of the arm.. Axillary nerve block from tourniquet pain..

Question 48

The Median Nerve does NOT innervate which of the following muscles?
A) Flexor Carpi Radialis
B) Palmaris Longus
C) Flexor Carpi Ulnaris
D) Pronator Teres

Answer 48

Answer: C) Flexor Carpi Ulnaris - Just remember it doesn’t innervate your pinky which is ulnar side. First three fingers and the palm of your hand.

Nerve roots:C6 – T1 (also contains fibers from C5 in some individuals).
Motor functions:Innervates the flexor and pronator muscles in theanterior compartment of the forearm(except the flexor carpi ulnaris and part of the flexor digitorum profundus, innervated by theulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand.
Sensory functions:Gives rise to the palmar cutaneous branch, which innervates the lateral aspect of the palm, and the digital cutaneous branch, which innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand.

Tracks all the way down the arm.. Radial thumb, ulnar pinky, median is the middle

Question 49

Sensory innervation of the lateral aspect of the forearm is provided by which nerve?
A) Ulnar Nerve
B) Radial Nerve
C) Median Nerve
D) Musculocutaneous Nerve

Answer 49

Answer: D) Musculocutaneous Nerve

Axillary is high lateral
Radial is Inferior lateral - just above forearm, and the posterior side of your arm.
Ulnar is basically just your pinky.

Question 50

Which of the following is NOT a branch of the Lumbar Plexus?
A) Femoral Nerve
B) Obturator Nerve
C) Genitofemoral Nerve
D) Axillary Nerve

Answer 50

Answer: D) Axillary Nerve

Question 51

The Radial Nerve innervates all of the following except:
A) Triceps Brachii
B) Extensor Carpi Radialis
C) Flexor Carpi Ulnaris
D) Anconeus

Answer 51

Answer: C) Flexor Carpi Ulnaris

It basically innervates the whole backside of your arm and the back side of your hand.

Nerve roots– C5-T1.
Sensory– Innervates most of the skin of the posterior forearm, the lateral aspect of the dorsum of the hand, and the dorsal surface of the lateral three and a half digits.
Motor–Innervates the triceps brachii and the extensor muscles in the forearm.

Radial nerve near the radial artery..

Question 52

The Sacral Plexus gives rise to which major nerve of the lower limb?
A) Femoral Nerve
B) Sciatic Nerve
C) Tibial Nerve
D) Common Peroneal Nerve

Answer 52

Answer: B) Sciatic Nerve

The sacral plexus, L4-S4

Question 53

Which nerve is primarily involved in the wrist drop condition?
A) Ulnar Nerve
B) Radial Nerve
C) Median Nerve
D) Axillary Nerve

Answer 53

Answer: B) Radial Nerve

Question 54

The sacral plexus is formed by the anterior rami of which sacral spinal nerves?
A) S1-S4
B) S2-S4
C) S1-S3
D) S2-S5

Answer 54

A) S1-S4

Question 55

Which nerve is known as the largest nerve in the body and originates from the sacral plexus?
A) Femoral Nerve
B) Sciatic Nerve
C) Ulnar Nerve
D) Median Nerve

Answer 55

Answer: B) Sciatic Nerve

Question 56

What is the primary function of the musculocutaneous nerve?
A) Innervates the posterior compartment of the arm
B) Innervates the anterior compartment of the thigh
C) Innervates muscles in the anterior compartment of the arm
D) Provides sensory innervation to the posterior thigh

Answer 56

Answer: C) Innervates muscles in the anterior compartment of the arm

Question 57

The femoral nerve arises from which spinal roots?
A) L1-L3
B) L2-L4
C) L1-L4
D) L2-L3

Answer 57

Answer: B) L2-L4

Question 58

Which of the following muscles is NOT innervated by the axillary nerve?
A) Deltoid
B) Teres Minor
C) Teres Major
D) Biceps Brachii

Answer 58

Answer: D) Biceps Brachii

Question 59

The obturator nerve provides sensory innervation to which area?
A) The medial thigh
B) The lateral thigh
C) The anterior thigh
D) The posterior thigh

Answer 59

Answer: A) The medial thigh

Roots: L2, L3, L4.
Motor Functions: Innervates the muscles of the medial thigh – the obturator externus, adductor longus, adductor brevis, adductor magnus and gracilis.
Sensory Functions: Innervates the skin over the medial thigh.

Question 60

What is the sensory function of the lateral femoral cutaneous nerve?
A) Innervates the medial aspect of the thigh
B) Innervates the anterior and lateral thigh down to the knee
C) Provides sensation to the heel and sole of the foot
D) Provides sensation to the back of the thigh

Answer 60

Answer: B) Innervates the anterior and lateral thigh down to the knee

This nerve has a purely sensory function. It enters the thigh at the lateral aspect of the inguinal ligament, where it provides cutaneous innervation to the skin there.
Roots: L2, L3
Motor Functions:None.
Sensory Functions: Innervates the anterior and lateral thigh down to the level of the knee.

Question 61

Which of the following is not a typical function or characteristic of the lumbar plexus?
A) Innervating the muscles of the anterior thigh
B) Originating from the anterior rami of L1-L4 spinal nerves
C) Contributing to the formation of the sciatic nerve
D) Providing sensory innervation to the lower leg and foot

Answer 61

Answer: C) Contributing to the formation of the sciatic nerve

The anterior rami of the L1-L4 spinal roots divide into several cords. These cords then combine together to form the six major peripheral nerves of the lumbar plexus. These nerves then descend down the posterior abdominal wall to reach the lower limb, where they innervate their target structures.

A usefulmemory aid for the branches of the lumbar plexus is:I,IGetLeftoversOnFridays. This stands for theIliohypogastric,Ilioinguinal,Genitofemoral,Lateral cutaneousnerve of the thigh,ObturatorandFemoral.

Question 62

The iliohypogastric nerve innervates which of the following?
A) The internal oblique and transversus abdominis muscles
B) The quadriceps femoris muscle
C) The muscles of the posterior thigh
D) The adductor muscles of the thigh

Answer 62

Answer: A) The internal oblique and transversus abdominis muscles

And sits above the ilioinguinal nerve.

The iliohypogastric nerve is the first major branch of the lumbar plexus. It runs to the iliac crest, across the quadratus lumborum muscle of the posterior abdominal wall. It then perforates the transversus abdominis, and divides into its terminal branches.
Roots: L1 (with contributions from T12).
MotorFunctions: Innervates the internal oblique and transversus abdominis.
SensoryFunctions: Innervates the posterolateral gluteal skin in the pubic region.(Tip: an easy way to remember that the IlioHypogastric comes before the IlioInguinal is thatH comes beforeIin the alphabet!)

Question 63

The obturator nerve originates from which spinal roots?
A) L2, L3, L4
B) L4, L5, S1
C) L1, L2, L3
D) S1, S2, S3

Answer 63

Answer: A) L2, L3, L4

Roots: L2, L3, L4.
Motor Functions: Innervates the muscles of the medial thigh – the obturator externus, adductor longus, adductor brevis, adductor magnus and gracilis.
Sensory Functions: Innervates the skin over the medial thigh.

Question 64

Where is the stellate ganglion typically located?
A) Anterior to the neck of the first rib and occasionally extending to being anterior to the transverse process of the C7 cervical vertebra
B) Directly on the surface of the heart
C) Inside the thoracic vertebral column
D) Within the cranial cavity

Answer 64

Answer: A) Anterior to the neck of the first rib and occasionally extending to being anterior to the transverse process of the C7 cervical vertebra

Question 65

Which symptom is NOT typically alleviated by a stellate ganglion block?
A) Craniofacial hyperhidrosis
B) Refractory angina
C) Postherpetic neuralgia
D) Acute appendicitis

Answer 65

Answer: D) Acute appendicitis

Question 66

The stellate ganglion provides sympathetic fibers to all of the following EXCEPT:
A) The anterior rami of C7, C8, and T1.
B) The inferior cardiac nerve contributing to the cardiac plexus.
C) The lumbar plexus.
D) The brachial plexus.

Answer 66

Answer: C) The lumbar plexus.

Question 67

Which is NOT an indication for a stellate ganglion block?
A) Phantom limb pain
B) Chronic post-surgical pain
C) Hyperthyroidism
D) Meniere’s syndrome

Answer 67

Answer: C) Hyperthyroidism

Question 68

Which nerve is closely associated with the stellate ganglion and may be affected during a stellate ganglion block?
A) Median Nerve
B) Ulnar Nerve
C) Phrenic Nerve
D) Femoral Nerve

Answer 68

Answer: C) Phrenic Nerve

Question 69

What is a common symptom that might develop after a stellate ganglion block due to disruption in sympathetic nerve supply?
A) Tachycardia
B) Hyperhidrosis
C) Horner’s syndrome
D) Hypertension

Answer 69

Answer: C) Horner’s syndrome (including partial ptosis, miosis, and facial anhidrosis)

Question 70

What gene is associated with Malignant Hyperthermia (MH)?
A) RYR1
B) BRCA1
C) MYH7
D) CFTR

Answer 70

A) RYR1

Question 71

What is the primary treatment for scleroderma renal crisis?
A) NSAIDs
B) ACE inhibitors
C) Beta-blockers
D) Antimalarials

Answer 71

B) ACE inhibitors

Renal: Decreased renal blood flow and systemic HTN
Renal crisis – precipitated by corticosteroids, treatment ACE-I

Question 72

Which is NOT a component of CREST syndrome?
A) Calcinosis
B) Raynaud’s phenomenon
C) Esophageal dysmotility
D) Tricuspid regurgitation

Answer 72

D) Tricuspid regurgitation

T= Telangiectasis- dilation of capillaries causing red marks on surface of skin

Question 73

Duchenne Muscular Dystrophy (DMD) is caused by mutations in what gene?
A) Dystrophin
B) Hemoglobin
C) Collagen
D) Insulin

Answer 73

A) Dystrophin

Question 74

What is the typical initial symptom of Duchenne Muscular Dystrophy?
A) Cataracts
B) Waddling gait
C) Skin rash
D) Hearing loss

Answer 74

B) Waddling gait

Mutation in the dystrophin gene
Fatty infiltration =pseudohypertrophic
2-5 y/o boys

Initial symptoms: waddling gait, frequent falling, difficulty climbing stairs

Question 75

In Myasthenia Gravis, what is decreased at the neuromuscular junction?
A) Sodium channels
B) Acetylcholine receptors
C) Dopamine receptors
D) Potassium channels

Answer 75

B) Acetylcholine receptors

Chronic autoimmune disorder
NMJ - Decreased functional post-synaptic AChreceptors
Muscle weakness w/ rapid exhaustion of voluntary muscles
Partial recovery with rest
ACh receptor-bindingantibodies andthymusabnormalities

Question 76

What is the primary symptom of Myasthenia Gravis?
A) Muscle stiffness
B) Muscle weakness
C) Numbness
D) Pain

Answer 76

B) Muscle weakness

Ptosis, diplopia, and dysphagia – initial
Ocular, pharyngeal, and laryngeal muscle involvement
Dysarthria (Problems with the muscles that help produce speech, difficulty pronouncing words)
Pulmonary: isolated respiratory failure – occasional presenting manifestation- isolated respiratory failure as presentaion
MS: Arm, leg, or trunk muscle weakness – asymmetric
CV: Myocarditis – A Fib, heart block, or cardiomyopathy
Autoimmune diseases associated – RA, SLE, pernicious anemia, hyperthyroidism

Question 77

Which medication is preferred in Myasthenia Gravis for symptom control?
A) Pyridostigmine
B) Acetaminophen
C) Ibuprofen
D) Neostigmine

Answer 77

A) Pyridostigmine

Anticholinesterases
First line of treatment
Pyridostigmine > neostigmine

Thymectomy
Induces remission
Reduced use of immunosuppressives
Reduces ACh receptor antibody levels
Full benefit delayed

Question 78

Osteoarthritis is characterized by degeneration of what?
A) Muscles
B) Articular cartilage
C) Blood vessels
D) Nerve cells

Answer 78

B) Articular cartilage

Degenerative process affecting articular cartilage
Minimal inflammation
Joint trauma
Biomechanical stresses
Joint injury
Abnormal joint loading
Neuropathy
Ligament injury
Muscle atrophy
Obesity
Pain present with motion,relieved by rest

Question 79

The involvement of which joints is typical in Rheumatoid Arthritis?
A) Hip and shoulder
B) Spinal
C) Proximal interphalangeal and metacarpophalangeal
D) Distal interphalangeal

Answer 79

C) Proximal interphalangeal and metacarpophalangeal

Autoimmune-mediated, systemic inflammatory disease
Proximal interphalangeal and metacarpophalangeal joints
Rheumatoid nodules at pressure points
Rheumatoid factor

Question 80

What is the main characteristic of Systemic Lupus Erythematosus (SLE)?
A) Increased platelet count
B) Chronic inflammation
C) Muscle hypertrophy
D) Bone enlargement

Answer 80

B) Chronic inflammation

Multisystem chronic inflammatory
Antinuclear antibody production
Typical manifestations:
Antinuclear antibodies
Characteristic malarrash
Thrombocytopenia
Serositis
Nephritis

Question 81

What symptom is NOT associated with Systemic Lupus Erythematosus?
A) Malar rash
B) Butterfly-shaped rash
C) Thrombocytopenia
D) Hyperglycemia

Answer 81

D) Hyperglycemia

Question 82

Which medication is NOT commonly used to treat Systemic Lupus Erythematosus?
A) NSAIDs
B) Antimalarials
C) Corticosteroids
D) ACE inhibitors

Answer 82

D) ACE inhibitors

NSAIDs or ASA
Anti-malarial
Hydroxychloroquine and quinacrine
Corticosteroids
Immunosuppressants
Methotrexate, azathioprine

Question 83

What is a potential complication of Rheumatoid Arthritis in the cervical spine?
A) Atlantoaxial subluxation
B) Lumbar disc herniation
C) Thoracic kyphosis
D) Sacroiliac joint dysfunction

Answer 83

A) Atlantoaxial subluxation

Atlantoaxial subluxation
Odontoid process protrudes into the foramen magnum
Pressure on the spinal cord or impairs vertebral artery blood flow
Cricoarytenoid arthritis
Acute – hoarseness, dyspnea, and stridor w/ tenderness over the larynx; swelling and redness of arytenoids
Chronic – asymptomatic or variable degrees of hoarseness, dyspnea, and upper airway obstruction
Osteoporosis
NM: Weakened skeletal muscles
Peripheral neuropathies

Question 84

What is the key factor in diagnosing Malignant Hyperthermia?
A) High blood pressure
B) Elevated end-tidal CO2
C) Decreased heart rate
D) Low blood sugar

Answer 84

B) Elevated end-tidal CO2

Question 85

What is NOT a feature of the Duchenne Muscular Dystrophy?
A) Cardiomyopathy
B) Increased CK levels
C) Bone deformities
D) Cognitive impairment
E) None of the above

Answer 85

E) None of the above

CNS: Intellectual disability
MS: Kyphoscoliosis, skeletal muscle atrophy, serum CK 20-100x normal
CV: Sinus tachycardia, cardiomyopathy, EKG abnormalities
Pulmonary: weakened respiratory muscles and cough, OSA
GI: Hypomotility, gastroparesis

Question 86

Which symptom is least associated with Myasthenia Gravis?
A) Ptosis
B) Diplopia
C) Muscle rigidity
D) Dysphagia

Answer 86

C) Muscle rigidity

Ptosis, diplopia, and dysphagia
Dysarthria and difficulty handling saliva
Isolated respiratory failure
Arm, leg, or trunk muscle weakness
Myocarditis
Autoimmune diseases associated
RA, SLE, pernicious anemia, hyperthyroidism

Question 87

What is the first line of treatment for Rheumatoid Arthritis?
A) Corticosteroids
B) NSAIDs
C) Antimalarials
D) Biologics

Answer 87

D) Biologics

DMARDs (Disease-modifying antirheumatic drugs)
Halt or slow disease progression
Methotrexate

Tumor necrosis factor (TNF-alpha) inhibitors and interleukin(IL-1) inhibitors
TNF-alpha inhibitors > DMARDs
IL-1 inhibitors – slower onset and less effective

Surgery
Intractable pain, impairment ofjoint function, jointstabilization
Total replacement

Question 88

What is NOT a common side effect of systemic steroids used in SLE treatment?
A) Osteoporosis
B) Hypertension
C) Hyperglycemia
D) Hypothyroidism

Answer 88

D) Hypothyroidism - This is not a common side effect of systemic steroids used in SLE treatment.

NSAIDs or ASA – arthritis and serositis
Anti-malarial – dermatologic and arthritic manifestations (hydroxychloroquine and quinacrine)
Corticosteroids – tx for severe symptoms; thrombocytopenia and anemia
Suppresses glomerulonephritis and CV abnormalities effectively
Major cause of morbidity
Immunosuppressants – better alternative than high-dose steroids (methotrexate, azathioprine)

Question 89

Which of the following is not a characteristic of osteoarthritis?
A) Morning stiffness
B) Joint swelling
C) Neuropathy
D) Pain relieved by rest

Answer 89

C) Neuropathy - Neuropathy is not a characteristic of osteoarthritis.

Most common joint disease, leading chronic diseases ofthe elderly,and a major cause of disability
Degenerative process that affects articular cartilage w/ minimal inflammatory reaction in the joints
Joint trauma
Biomechanical stresses
Joint injury
Abnormal joint loading
Neuropathy
Ligament injury
Muscle atrophy
Obesity
Pain present with motion,relieved by rest
Morning Stiffness disappears with movement

Steroids – increase the rate of breakdown. PT – prehab- pain management before the replacement maybe..

Question 90

For Myasthenia Gravis, the Edrophonium/Tensilon Test is used for which purpose?
A) Confirm Rheumatoid Arthritis
B) Diagnose Myasthenic Crisis
C) Identify Cholinergic Crisis
D) Improve symptoms in Myasthenic Crisis

Answer 90

B) it’s a diagnostic test, positive if symptoms improve

Myasthenic crisis
Drug resistance or insufficient drug therapy
S/S: severe muscle weakness and respiratory failure
Cholinergic crisis
Excessive anticholinesterase treatment
S/S: muscarinic side effects – profound muscle weakness, salivation, miosis, bradycardia, diarrhea, abdominal pain

Edrophonium/Tensilon Test
1-2 mg IVP
Improves myasthenic crisis, makes cholinergic crisis worse

Question 91

Which is NOT a sign or symptom of Malignant Hyperthermia?
A) Hypercapnia
B) Hypotension
C) Muscle rigidity
D) Tachycardia

Answer 91

B) Hypotension

Question 92

What is the primary pathological process in Scleroderma?
A) Muscle atrophy
B) Vasculitis leading to fibrosis
C) Neurodegeneration
D) Inflammatory myopathy

Answer 92

B) Vasculitis leading to fibrosis - This is the primary pathological process in Scleroderma.

Question 93

Duchenne Muscular Dystrophy primarily affects which demographic?
A) Elderly men
B) Young women
C) Boys aged 2-5 years
D) Girls aged 2-5 years

Answer 93

C) Boys aged 2-5 years

Mutation in the dystrophin gene
Fatty infiltration =pseudohypertrophic
2-5 y/o boys

Initial symptoms: waddling gait, frequent falling, difficulty climbing stairs

Question 94

In patients with Systemic Lupus Erythematosus, what is NOT typically found?
A) Antinuclear antibodies
B) Thrombocytopenia
C) Elevated white blood cell count
D) Serositis

Answer 94

C) Elevated white blood cell count - This is not typically found in patients with Systemic Lupus Erythematosus.

Polyarthritis and dermatitis
Symmetrical arthritis
No spinal involvement
Avascular necrosis of femoral head or condyle
CNS: Cognitive dysfunction, psychological changes
CV: Pericarditis, coronary atherosclerosis, Raynaud’s
Pulmonary: Lupus pneumonia, restrictive lung disease, vanishing lung syndrome
Renal: Glomerulonephritis, decreased GFR

Question 95

What does the treatment for Systemic Lupus Erythematosus NOT commonly include?
A) NSAIDs
B) ACE inhibitors
C) Antimalarials
D) Corticosteroids

Answer 95

B) ACE inhibitors

Alleviating symptoms…
ACE-I for scleroderma

Question 96

What triggers a Malignant Hyperthermia crisis?
A) Exposure to cold temperatures
B) Inhaled anesthetics and succinylcholine
C) Antibiotics
D) Nonsteroidal anti-inflammatory drugs

Answer 96

B) Inhaled anesthetics and succinylcholine

Question 97

What are Heberden’s nodes associated with?
A) Rheumatoid Arthritis
B) Osteoarthritis
C) Systemic Lupus Erythematosus
D) Myasthenia Gravis

Answer 97

B) Osteoarthritis

Weight-bearing and distal interphalangeal joints
Heberden nodes
Distal interphalangeal joints

Degenerative disease – vertebral bodies and intervertebral disks
Protrusion of the nucleus pulposus
Compression of nerve roots
Middle to lower c-spine andl-spine

Question 98

Which of the following is NOT associated with Rheumatoid Arthritis?
A) Morning stiffness
B) Symmetrical joint involvement
C) Spinal cord compression
D) Rheumatoid nodules

Answer 98

A) morning stiffness

Question 99

The presence of what antibody is most associated with Systemic Lupus Erythematosus?
A) Rheumatoid factor
B) Antinuclear antibodies
C) Bence Jones protein
D) Anti-cyclic citrullinated peptide

Answer 99

B) Antinuclear antibodies

Question 100

What is NOT a recommended management practice for Malignant Hyperthermia?
A) Discontinue all triggering agents
B) Administer dantrolene
C) Increase room temperature
D) Hyperventilate with 100% oxygen

Answer 100

C) Increase room temperature

Question 101

Scleroderma affects the body by:
A) Decreasing muscle mass
B) Thickening and hardening the skin
C) Increasing bone density
D) Reducing cardiac output

Answer 101

B) Thickening and hardening the skin

Question 102

Which is NOT a symptom of Duchenne Muscular Dystrophy?
A) Difficulty climbing stairs
B) Frequent falling
C) Joint hypermobility
D) Waddling gait

Answer 102

C) Joint hypermobility

Question 103

Which treatment is not typically used for managing symptoms of Myasthenia Gravis?
A) Cholinesterase inhibitors
B) Corticosteroids
C) Antimalarials
D) Thymectomy

Answer 103

C) Antimalarials

Question 104

In the management of Osteoarthritis, what is NOT a recommended therapy?
A) Joint replacement surgery
B) High-impact exercises
C) Physical therapy
D) Pain relief medications

Answer 104

B) High-impact exercises

Question 104

Which feature is not associated with Rheumatoid Arthritis?
A) Osteoporosis
B) Fusiform swelling
C) Atlantoaxial subluxation
D) Heberden’s nodes

Answer 104

D) Heberden’s nodes

Atlantoaxial subluxation
Odontoid process protrudes into the foramen magnum
Pressure on the spinal cord or impairs vertebral artery blood flow
Cricoarytenoid arthritis
Acute – hoarseness, dyspnea, and stridor w/ tenderness over the larynx; swelling and redness of arytenoids
Chronic – asymptomatic or variable degrees of hoarseness, dyspnea, and upper airway obstruction
Osteoporosis
NM: Weakened skeletal muscles
Peripheral neuropathies

Question 105

The primary cause of death in Systemic Lupus Erythematosus is often related to:
A) Liver failure
B) Renal failure
C) Cardiac arrest
D) Malignant hyperthermia

Answer 105

C) Cardiac Arrest

Death during the course of SLE may be due to coronary atherosclerosis. The development and progression of coronary atherosclerosis is accelerated by treatment with corticosteroids

Question 106

What is NOT a symptom of SystemLupus Erythematosus?
A) Malar rash
B) Increased red blood cell count
C) Photosensitivity
D) Raynaud’s phenomenon

Answer 106

B) Increased red blood cell count

Rationale: SLE typically involves hematological changes like anemia (low red blood cell count), not an increased red blood cell count.

Question 107

Which condition is characterized by muscle weakness following repeated activities?
A) Osteoarthritis
B) Rheumatoid Arthritis
C) Myasthenia Gravis
D) Systemic Lupus Erythematosus

Answer 107

C) Myasthenia Gravis

Question 108

What is NOT a common complication of Systemic Lupus Erythematosus?
A) Glomerulonephritis
B) Pulmonary hypertension
C) Malignant hyperthermia
D) Thrombocytopenia

Answer 108

Answer: C) Malignant hyperthermia
Rationale: Malignant hyperthermia is a rare life-threatening condition usually triggered by certain anesthesia medications, not associated with SLE.

Question 109

What triggers Myasthenic Crisis?
A) Excessive anticholinesterase treatment
B) Insufficient anticholinesterase treatment
C) High doses of corticosteroids
D) Overuse of NSAIDs

Answer 109

Answer: B) Insufficient anticholinesterase treatment
Rationale: Myasthenic crisis can occur due to inadequate treatment with anticholinesterase medications, leading to severe muscle weakness.

Question 110

What is not a sign of a cholinergic crisis?
A) Muscle weakness
B) Salivation
C) Miosis (constricted pupils)
D) Hypercalcemia

Answer 110

Answer: D) Hypercalcemia
Rationale: Hypercalcemia is not a symptom of cholinergic crisis; typical signs include muscle weakness, salivation, and miosis (constricted pupils).

Question 111

Which medication is avoided in patients with Myasthenia Gravis due to risk of exacerbation?
A) Dantrolene
B) Succinylcholine
C) Pyridostigmine
D) Neostigmine

Answer 111

Answer: B) Succinylcholine
Rationale: Succinylcholine can exacerbate symptoms of Myasthenia Gravis and should be avoided due to its effect on neuromuscular transmission.

Question 112

What is not a part of the SHADE protocol for Malignant Hyperthermia?
A) Stop triggering agents
B) Hypothermia treatment
C) Dantrolene
D) Electrolyte correction

Answer 112

Answer: B) Hypothermia treatment

SHADE
Stop, heat control, activated charcoal, dantrolene, electrolyte (hyperkalemia)

Question 113

Which statement about Duchenne Muscular Dystrophy is FALSE?
A) Caused by a deficiency of dystrophin
B) Typically presents in early adulthood
C) Leads to progressive muscle weakness
D) Involves cardiomyopathy as a common complication

Answer 113

Answer: B) Typically presents in early adulthood
Rationale: Duchenne Muscular Dystrophy typically presents in early childhood, not adulthood.

Question 114

In scleroderma, what is not a typical feature?
A) Microvascular changes
B) Increased deposition of collagen
C) Autoimmune-mediated vasculitis
D) Hyperactive immune response leading to increased white blood cell count

Answer 114

Answer: D) Hyperactive immune response leading to increased white blood cell count
Rationale: Scleroderma involves autoimmune-mediated changes but does not typically feature a hyperactive immune response leading to increased white blood cell count.

Question 115

What percentage of surgical patients have Ischemic Heart Disease (IHD)?
A) 10%
B) 20%
C) 30%
D) 40%

Answer 115

C) 30%

Question 116

Which of these is NOT a first manifestation of IHD?
A) Angina pectoris
B) Acute Myocardial Infarction
C) Sudden death
D) Hypertension

Answer 116

Answer: D) Hypertension

Question 117

What are the two most important risk factors for the development of atherosclerosis involving the coronary arteries?
A) Female gender and decreasing age
B) Male gender and increasing age
C) Smoking and high cholesterol
D) Diabetes and sedentary lifestyle

Answer 117

Answer: B) Male gender and increasing age

Question 118

What type of angina develops in the setting of partial occlusion of a coronary artery?
A) Unstable angina
B) Prinzmetal angina
C) Stable angina
D) Microvascular angina

Answer 118

Answer: C) Stable angina

Stable angina typically develops in the setting of partial occlusion or significant (>70%) chronic narrowing of a segment of coronary artery.

Question 119

What leads to the typical chest pain of angina pectoris?
A) Increase in coronary blood flow
B) Balance between myocardial oxygen supply and demand
C) Stimulation of cardiac nociceptive and mechanosensitive receptors
D) Increase in cardiac contractility

Answer 119

Answer: C) Stimulation of cardiac nociceptive and mechanosensitive receptors

These substances stimulate cardiac nociceptive and mechanosensitive receptors whose afferent neurons converge with the upper five thoracic sympathetic ganglia and somatic nerve fibers in the spinal cord and ultimately produce thalamic and cortical stimulation that results in the typical chest pain of angina pectoris.

Question 120

Which condition is NOT commonly associated with angina pectoris?
A) Myocardial hypertrophy
B) Severe aortic stenosis
C) Aortic regurgitation
D) Pulmonary hypertension

Answer 120

Answer: D) Pulmonary hypertension

Question 121

What does chronic stable angina refer to?
A) Chest pain that changes in frequency or severity over a 2-month period
B) Chest pain that does not change appreciably in frequency or severity over 2 months
C) Increasing chest pain with physical activity
D) Chest pain relieved by nitroglycerin within 5 minutes

Answer 121

Answer: B) Chest pain that does not change appreciably in frequency or severity over 2 months

Question 122

Unstable angina is characterized by:
A) Chest pain that decreases in frequency without any treatment
B) Chest pain increasing in frequency and/or severity without an increase in cardiac biomarkers
C) Chest pain that only occurs at rest
D) Chest pain that is relieved by rest and medications

Answer 122

Answer: B) Chest pain increasing in frequency and/or severity without an increase in cardiac biomarkers

Question 123

Which of the following is a typical symptom of angina pectoris?
A) Retrosternal chest pain that radiates to the right shoulder
B) Retrosternal chest pain that does not change with physical activity
C) Retrosternal chest pain, pressure, or heaviness that may radiate to the neck, left shoulder, left arm, or jaw
D) Retrosternal chest pain accompanied by a high fever

Answer 123

Answer: C) Retrosternal chest pain, pressure, or heaviness that may radiate to the neck, left shoulder, left arm, or jaw

Question 124

What substance is released during stable angina that can slow atrioventricular conduction and decrease cardiac contractility?
A) Dopamine
B) Adenosine
C) Epinephrine
D) Acetylcholine

Answer 124

B) Adenosine

Also bradykinin

Question 125

What is considered the most common cause of stable angina?
A) Myocardial infarction
B) Atherosclerosis
C) Cardiomyopathy
D) Valvular heart disease

Answer 125

Answer: B) Atherosclerosis

Question 126

Which of the following is NOT a symptom of chronic stable angina?
A) Chest pain that does not change in frequency
B) Chest pain increasing in frequency or severity
C) Shortness of breath
D) Pain lasting several minutes

Answer 126

Answer: B) Chest pain increasing in frequency or severity

Question 127

At what percentage of occlusion does stable angina typically develop?
A) 50%
B) 60%
C) 70%
D) 80%

Answer 127

Answer: C) 70%

Question 128

What does the release of adenosine and bradykinin in the heart result in?
A) Increased heart rate
B) Decreased blood pressure
C) Chest pain
D) Increased cardiac contractility

Answer 128

C) Chest pain

Release of adenosine and bradykinin
Cardiac nociceptors
Afferent neurons
T1-T5 sympathetic ganglia

Slow AV conduction
Decrease cardiac contractility

Question 129

Which of the following is NOT a classic sign of angina pectoris?
A) Retrosternal chest pressure
B) Pain radiating to the neck and left arm
C) Lasts less than 5 min
D) Shortness of breath

Answer 129

Answer: C) Lasts less than 5 min

Question 130

What distinguishes unstable angina at rest?
A) Lasts less than 5 minutes
B) Typically lasting more than 10 minutes
C) Accompanied by a decrease in cardiac biomarkers
D) Resolves with physical activity

Answer 130

Answer: B) Typically lasting more than 10 minutes

Question 131

What is the main diagnostic tool for identifying Ischemic Heart Disease?
A) MRI scan
B) 12 lead ECG
C) Blood pressure measurement
D) Cholesterol levels

Answer 131

Answer: B) 12 lead ECG

Question 132

Which ECG change is NOT associated with myocardial ischemia?
A) ST-segment depression
B) T wave inversion
C) ST elevation
D) P wave enlargement

Answer 132

Answer: D) P wave enlargement

Question 133

Troponin levels increase within how many hours after myocardial injury?
A) 1 hour
B) 3 hours
C) 6 hours
D) 12 hours

Answer 133

Answer: B) 3 hours

Question 134

Which of the following is a major risk factor for Ischemic Heart Disease?
A) Low cholesterol
B) Young age
C) Smoking
D) Low blood pressure

Answer 134

Answer: C) Smoking

Question 135

What is NOT a goal of drug treatment in patients with clinical atherosclerosis?
A) Lowering LDL cholesterol below 70 mg/dL
B) Increasing HDL cholesterol above 160 mg/dL
C) Stabilizing plaque
D) Reducing inflammation

Answer 135

Answer: B) Increasing HDL cholesterol above 160 mg/dL

Question 136

What is the primary mechanism of action of statins in the context of IHD?
A) Blood thinning
B) Coronary plaque stabilization
C) Vasodilation
D) Increasing heart rate

Answer 136

Answer: B) Coronary plaque stabilization

Question 137

Which medication class is uniquely effective for treating Prinzmetal’s angina?
A) Beta-blockers
B) Calcium channel blockers
C) Nitrates
D) ACE inhibitors

Answer 137

Answer: B) Calcium channel blockers

Question 138

What is the significance of a patient’s ability to climb 2-3 flights of stairs in the context of cardiac reserve?
A) Indicates poor cardiac reserve
B) Suggests good cardiac reserve
C) Indicates risk of ventricular tachycardia
D) Suggests need for immediate surgery

Answer 138

Answer: B) Suggests good cardiac reserve

Question 139

Which diagnostic feature is characteristic of stable angina on an ECG?
A) ST segment elevation
B) Pathological Q waves
C) ST segment depression
D) Complete heart block

Answer 139

Answer: C) ST segment depression

1mm

Question 140

Troponin levels after myocardial injury remain elevated for how long?
A) 1-2 days
B) Up to 2 weeks
C) 24 hours
D) 5-7 days

Answer 140

Answer: B) Up to 2 weeks

Question 141

Which of the following is NOT a typical symptom of myocardial ischemia?
A) Sweating
B) Dyspnea
C) Skin pallor
D) Hyperglycemia

Answer 141

Answer: D) Hyperglycemia

Question 142

Percutaneous coronary intervention (PCI) is preferred over thrombolytic therapy when:
A) The patient has a history of bleeding disorders
B) There are no available cardiac catheterization facilities
C) The symptoms have been present for more than 12 hours
D) The patient has a contraindication to thrombolytic therapy

Answer 142

Answer: D) The patient has a contraindication to thrombolytic therapy

can’t do active bleeding

Question 142

Which medication class is only recommended to prolong life in patients with coronary artery disease (CAD)?
A) Calcium channel blockers
B) Nitrates
C) β-blockers
D) ACE inhibitors

Answer 142

Answer: C) β-blockers

Question 143

What is the primary mechanism of action for Calcium Channel Blockers in the management of ischemic heart disease?
A) Increase heart rate
B) Dilate coronary arteries
C) Increase oxygen consumption
D) Increase blood clotting

Answer 143

Answer: B) Dilate coronary arteries

Question 144

ACE inhibitors are used in cardiac therapy primarily because they:
A) Decrease myocardial hypertrophy
B) Increase coronary vasoconstriction
C) Promote interstitial myocardial fibrosis
D) Induce inflammatory responses

Answer 144

Answer: A) Decrease myocardial hypertrophy

Angiotensin converting enzyme converts angiotensin I to angiotensin II
Prevent ventricular remodeling, stabilize electrical activity of re-perfused heart and prevent the occurrence of reperfusion arrhythmias
Reduce myocardial workload and decrease myocardial oxygen demand

Does some things we might not want.. Good for aberrant conduction..
Patient might have exaggerated response, hypotensive..

Infusions for these patients – vasodilator and a constrictor

Question 145

The primary indication for revascularization in ischemic heart disease is:
A) Less than 30% occlusion of coronary arteries
B) Failure of medical therapy
C) Improved ejection fraction (EF) above 40%
D) Preference of the patient

Answer 145

Answer: B) Failure of medical therapy

Failure of medical therapy
> 50% L main coronary artery
> 70% epicardial coronary artery
Impaired EF <40%

CABG > PCI

Question 146

Which of the following is NOT typically part of the initial management for Unstable Angina/NSTEMI?
A) Bed rest and oxygen
B) Thrombolytic therapy
C) Sublingual nitroglycerin
D) β-blocker therapy

Answer 146

Answer: B) Thrombolytic therapy

Question 147

Dual Antiplatelet Therapy (DAPT) consists of:
A) ASA and P2Y12 inhibitor
B) Statins and beta-blockers
C) ACE inhibitors and statins
D) Nitrates and calcium channel blockers

Answer 147

Answer: A) ASA and P2Y12 inhibitor

Question 148

The recommended time to wait before surgery after PCI with a drug-eluting stent is:
A) 2 weeks
B) 6 weeks
C) 1 year
D) 5 days

Answer 148

Answer: C) 1 year

Minimum is 6 months but most of the slides say 1 year

Question 149

According to the Revised Cardiac Risk Index (RCRI), what is considered low risk for cardiac complications?
A) More than three RCRI risk factors
B) Less than one RCRI risk factor
C) Exactly two RCRI risk factors
D) More than one percent risk

Answer 149

Answer: B) Less than one RCRI risk factor

Low risk - <1%
≤1 RCRI risk factor
Elevated risk - >1%
>2 RCRI risk factors

Question 150

For patients undergoing elective major noncardiac surgery, poor functional capacity is indicated by:
A) Ability to climb more than 3 flights of stairs
B) METs greater than 4
C) METs less than 4
D) High rate of energy consumption at rest

Answer 150

Answer: C) METs less than 4

Question 151

The urgency of surgery classification “Emergency” means:
A) Surgery can be delayed without significant risk
B) Surgery is required within 6 to 24 hours
C) Surgery is needed within 6 hours or less
D) Surgery can be scheduled routinely

Answer 151

Answer: C) Surgery is needed within 6 hours or less

Question 152

Which medication is recommended to continue throughout the peri-operative period for cardiac risk patients?
A) ACE inhibitors
B) Statins
C) β-blockers
D) Glycopyrrolate

Answer 152

Answer: C) β-blockers

Question 153

After percutaneous coronary intervention (PCI), the minimum waiting period before surgery without stenting is:
A) 1 year
B) 6 weeks
C) 2 weeks
D) 5 days

Answer 153

Answer: C) 2 weeks

Question 154

Active cardiac conditions increasing perioperative risk include all EXCEPT:
A) Stable angina
B) Decompensated heart failure
C) Severe valvular heart disease
D) Significant dysrhythmias

Answer 154

Answer: A) Stable angina

Question 156

What is the result of an imbalance between coronary blood flow and myocardial oxygen consumption?

A) Hypertension
B) Ischemia
C) Tachycardia
D) Bradycardia

Answer 156

Answer: B) Ischemia

Question 157

Which type of angina is characterized by chest pain that does not change in frequency or severity over a two-month period?

A) Unstable angina
B) Chronic stable angina
C) Prinzmetal angina
D) Microvascular angina

Answer 157

Answer: B) Chronic stable angina

Question 158

Statins are primarily prescribed for their ability to:
A) Increase lipid oxidation
B) Reduce mortality in non-cardiac and vascular surgery
C) Promote inflammation
D) Increase matrix metalloproteinase activity

Answer 158

Answer: B) Reduce mortality in non-cardiac and vascular surgery

They decrease lipid oxidation

Question 159

When discontinuing P2Y12 inhibitors before surgery, what is the minimum discontinuation period for clopidogrel to reduce bleeding risk?
A) 24 hours
B) 5 days
C) 7 days
D) 12 hours

Answer 159

Answer: B) 5 days

Question 160

In dual antiplatelet therapy, discontinuation of P2Y12 inhibitors significantly increases the risk of:
A) Hypertension
B) Stent thrombosis
C) Hyperlipidemia
D) Diabetes

Answer 160

Answer: B) Stent thrombosis

Question 161

When is Percutaneous Coronary Intervention (PCI) preferred over thrombolytic therapy?
A) When patients have a history of severe bleeding
B) When a mature clot is present
C) When symptoms have been present for less than 1 hour
D) All of the above

Answer 161

Answer: B) When a mature clot is present

Question 162

In the context of drug therapy for ischemic heart disease, which medication class directly addresses the imbalance between myocardial oxygen supply and demand by slowing the heart rate?
A) Statins
B) Nitrates
C) Beta-blockers
D) ACE inhibitors

Answer 162

Answer: C) Beta-blockers

Question 163

Which condition is least likely to be directly improved by the administration of nitrates?
A) Angina pectoris
B) Ventricular tachycardia
C) Myocardial oxygen consumption
D) Preload on the heart

Answer 163

Answer: B) Ventricular tachycardia

Question 164

In the context of ischemic heart disease, why might patients with diabetes exhibit atypical symptoms?
A) Enhanced pain sensitivity
B) Lowered threshold for myocardial oxygen demand
C) Neuropathy affecting chest pain perception
D) Increased collateral coronary circulation

Answer 164

Answer: C) Neuropathy affecting chest pain perception

Question 165

What does the presence of new Q waves on an ECG typically indicate?

Answer 165

Answer: Myocardial infarction

Question 166

When is CABG preferred over PCI in the context of ischemic heart disease?

Answer 166

Answer: In patients with significant left main coronary artery disease

Question 167

What is an essential factor to consider before prescribing beta-blockers to patients with ischemic heart disease?

Answer 167

Answer: The presence of heart failure w/ bradycardia or reactive airway diseases

Question 168

For which type of angina is the decrease in peripheral vascular resistance particularly beneficial?

Answer 168

Answer: Stable angina due to decreased afterload and myocardial oxygen consumption

Question 168

Wall motion abnormalities in an echocardiogram may indicate:
A) Valvular heart disease
B) Ischemic heart disease
C) Pericarditis
D) Atrial fibrillation

Answer 168

Answer: B) Ischemic heart disease
Rationale: Wall motion abnormalities often indicate ischemic heart disease, as regions of the heart affected by inadequate blood supply due to blocked coronary arteries may move abnormally.

Question 169

CK-MB is a cardiac marker used to diagnose:
A) Rheumatic fever
B) Myocardial infarction
C) Heart failure
D) Hypertension

Answer 169

Answer: B) Myocardial infarction
Rationale: CK-MB (Creatine Kinase-MB) is an enzyme found in the heart muscle and is used as a marker to diagnose myocardial infarction. Levels rise 4-6 hours after a heart attack and peak at 12-24 hours.

Not as effective as Troponin

Question 170

What intervention is indicated to manage decreased blood pressure and prevent perioperative myocardial injury?
A) Administer β-Blockers
B) Administer α₂-Agonists
C) Administer Nitroglycerin
D) Administer Statins
E) Administer Fluids

Answer 170

E) Administer Fluids

Prevent hypotension

Question 171

What intervention is indicated to manage surgical stress on the neuroendocrine response?
A) Administer β-Blockers
B) Administer α₂-Agonists
C) Administer Nitroglycerin
D) Administer Statins

Answer 171

B) Administer α₂-Agonists

Analgesia

Question 172

What 2 leads give you the best whole view of the heart?

Answer 172

V5- anterior lateral, lead 2 inferior

Question 173

What is an indicative feature of vanishing lung syndrome often seen in systemic lupus erythematosus (SLE) patients?
A) Expansion of lung volumes and lowered diaphragm.
B) Elevated diaphragm and decreased lung volumes.
C) Symmetrical arthritis in the spine.
D) Increased GFR and proteinuria.

Answer 173

Answer: B) Elevated diaphragm and decreased lung volumes.

High diagram and mediastinum shift towards the effective lung

Rationale: Vanishing lung syndrome, as mentioned in the context of systemic lupus erythematosus (SLE), is characterized by decreased lung volumes and an elevated diaphragm, which can be identified through imaging techniques such as X-rays. This condition contrasts with conditions like pneumothorax, where there’s an increase in the space within the chest cavity. The syndrome may present with symptoms like dry cough, dyspnea, and recurrent atelectasis due to diaphragmatic weakness or phrenic neuropathy, which are not typical of standard pulmonary issues in SLE but represent a rare and severe manifestation.

Question 174

What is the most common hereditary bleeding disorder according to the text?
A) Hemophilia A
B) Hemophilia B
C) Von Willebrand Disease (vWD)
D) Factor V Leiden

Answer 174

Answer: C) Von Willebrand Disease (vWD)

Question 175

Which treatment is specifically noted for type 1 von Willebrand Disease?
A) Blood transfusions
B) Desmopressin (DDAVP)
C) Direct factor VIII infusion
D) Corticosteroids

Answer 175

Answer: B) Desmopressin (DDAVP)

Question 176

When analyzing vWF Disease, what lab result is typically prolonged?
A) PT
B) aPTT
C) Bleeding Time (BT)
D) ACT

Answer 176

Answer: C) Bleeding Time (BT)

Question 177

What factor concentrates are used for a Type 3 vWD?
A) Factor IX
B) Factor X
C) Factor VIII
D) Factor VII

Answer 177

Answer: C) Factor VIII

Question 178

DDAVP stimulates the release of vWF from which type of cells?
A) Red blood cells
B) White blood cells
C) Endothelial cells
D) Platelets

Answer 178

Answer: C) Endothelial cells

Question 179

Which side effect is NOT listed for DDAVP in the treatment of vWD?
A) Headache
B) Rubor
C) Hyponatremia
D) Hypernatremia

Answer 179

Answer: D) Hypernatremia

The side effects of DDAVP
Headache, rubor (flush), hypotension, tachycardia, hyponatremia, and water intoxication
In order to decrease water intoxication, hyponatremia, and consequent seizures, the administration of water, orally or intravenously, should be restricted for 4 to 6 hours after the use of the drug

Question 180

For managing hyponatremia, what restriction is recommended post-DDAVP administration?
A) Fluid restriction for 4 to 6 hours
B) Complete fasting for 12 hours
C) High salt diet
D) Unlimited fluid intake

Answer 180

Answer: A) Fluid restriction for 4 to 6 hours

Question 181

What is a critical value increase after administering one unit of cryoprecipitate?
A) Hematocrit by 10%
B) Hemoglobin by 1 g/dL
C) Fibrinogen levels by 50 mg/dL
D) Platelet count by 30,000/mm³

Answer 181

Answer: C) Fibrinogen levels by 50 mg/dL

Can be used for vWF disease if unresponsive to DDAVP
1 unit raises the fibrinogen levels by 50 mg/dL

Question 182

Factor VIII concentrate differs from cryoprecipitate in terms of:
A) Infection risk
B) Fibrinogen content
C) vWF content
D) Preparation method

Answer 182

In common preparation, the cryoprecipitate is not submitted to viral attenuation and, therefore, poses an increased risk of infection

Factor VIII concentrate is prepared from the pool of plasma from a large number of donors
It undergoes viral attenuation
Contains F VIII and vWF
Given preoperatively and during surgery

Question 183

What is the recommended time frame for DDAVP administration before surgery?
A) 15 minutes
B) 30 minutes
C) 45 minutes
D) 60 minutes

Answer 183

Answer: D) 60 minutes

Prior evaluation by a hematologist
When indicated, DDAVP should be infused 60 minutes before the surgery
Normalization of the bleeding time and improved levels of F VIII should be confirmed before the surgery in patients

Question 184

Why is general anesthesia a concern for patients with coagulopathies regarding specific blocks?
A) Risk of hematoma and neurological compression
B) Immediate allergic reactions
C) Ineffective pain management
D) Prolonged recovery time

Answer 184

Answer: A) Risk of hematoma and neurological compression

Patients with coagulopathies undergoing neuroaxial block = increased risk of developing a hematoma and compression of neurological structures

Question 185

In the context of anticoagulation and anesthesia, why should arterial punctures be avoided?
A) Risk of infection
B) Risk of hematoma formation
C) Inadequate blood withdrawal
D) Misinterpretation of arterial gases

Answer 185

Answer: B) Risk of hematoma formation

Avoid traumas during the anesthesia
Arterial puncture is not recommended
Laryngeal trauma during tracheal intubation may cause hematoma = postoperative obstruction of the airways
IM avoided

Question 186

Heparin’s anticoagulant effect can be neutralized by which substance?
A) Vitamin K
B) Protamine
C) Warfarin
D) DDAVP

Answer 186

Answer: B) Protamine

Monitor PTT and ACT
Heparin’s anticoagulant effect is rapidly reversible by protamine (+ polypeptide forming a stable complex neutralizing heparin)
LMWHs -effective at VTE prophylaxis compared to UFH
LMWHs have a more predictable pharmacokinetic response, fewer effects on platelet function, and a reduced risk for heparin-induced thrombocytopenia (HIT)
Monitoring of LMWHs is not performed routinely

Question 187

How does heparin primarily exert its anticoagulant effect?
A) Inhibiting vitamin K
B) Inhibiting Thrombin
C) Activating antithrombin III
D) Directly dissolving clots

Answer 187

B) Inhibiting Thrombin - Primarily

This should be b and c

Doesn’t work with anti-thrombin 3 deficiencies.. You can give FFP that has antithrombin 3 in it

Negatively charge, CHO containing glucuronic acid residues
Unfractionated heparin (UFH), LMWH
Heparin inhibits thrombin (thrombin needed to convert fibrinogen to fibrin)
Heparin derives its anticoagulant effect by activating antithrombin III

Question 188

What is the hallmark finding in heparin-induced thrombocytopenia (HIT)?
A) Platelet count < 150,000/mm³
B) Platelet count < 100,000/mm³
C) Increased PTT
D) Decreased fibrin degradation products
E) Increased ACT

Answer 188

Answer: B) Platelet count < 100,000/mm³

HIT describes an autoimmune-mediated drug reaction occurring in as many as 5% of patients after exposure to unfractionated heparin or (rare cases) LMWH
Thrombocytopenia occurring 5 -14 days after initial therapy
The hallmark of findings is a decrease in PLT < 100,000
HIT results in platelet activation and potential for venous and arterial thromboses

Question 189

In patients with vWD, what are the usual results of PT and aPTT tests?
A) Prolonged PT only
B) Prolonged aPTT only
C) Both prolonged PT and aPTT
D) Both are often normal

Answer 189

Answer: D) Both are often normal

PT and aPTT are often normal in patients with vWD
BT is prolonged
Hematologist to analyze labs

Question 190

What is the initial dose of DDAVP administered intravenously for vWD?
A) 0.1 µg/kg
B) 0.2 µg/kg
C) 0.3 µg/kg
D) 0.4 µg/kg

Answer 190

Answer: C) 0.3 µg/kg

A synthetic analogue of vasopressin and stimulates the release of vWF by endothelial cells
It can be administered intravenously at a dose of 0.3 µg/kg in 50 mL of normal saline over 15 to 20 minutes
The maximal effect in 30 minutes and lasts from 6 to 8 hours

Question 191

For how long should water intake be restricted after administering DDAVP to prevent water intoxication?
A) 1-2 hours
B) 2-4 hours
C) 4-6 hours
D) 6-8 hours

Answer 191

Answer: C) 4-6 hours

Question 192

What is the main risk associated with using cryoprecipitate in treating vWD?
A) Low fibrinogen increase
B) Increased risk of infection
C) Ineffective in Type 1 vWD
D) Causes hypernatremia

Answer 192

Answer: B) Increased risk of infection

Question 193

In the context of heparin-induced thrombocytopenia (HIT), what is the typical time frame for thrombocytopenia to occur after initial heparin therapy?
A) 1-3 days
B) 3-5 days
C) 5-14 days
D) 15-21 days

Answer 193

Answer: C) 5-14 days

Question 194

What is the main treatment strategy for HIT?
A) Continue heparin at a lower dose
B) Switch to warfarin immediately
C) Discontinue heparin and start a non-heparin anticoagulant
D) Administer vitamin K

Answer 194

Answer: C) Discontinue heparin and start a non-heparin anticoagulant

A diagnosis of HIT should be entertained for any patient experiencing thrombosis or thrombocytopenia during or after heparin administration
In suspected HIT cases, D/C heparin STAT (i.e., including unfractionated heparin, heparin-bonded catheters, heparin flushes, LMWH)
Alternative non-heparin anticoagulation must be administered concurrently
In most cases, a direct thrombin inhibitor (i.e., bivalirudin, lepirudin, argatroban) is substituted for heparin

Question 195

What factor does Fondaparinux target for anticoagulation?
A) Factor IIa (Thrombin)
B) Factor V
C) Factor VIII
D) Factor Xa

Answer 195

Answer: D) Factor Xa

Fondaparinaux - to treat VTE. Off labelled use. A synthetic Factor Xa inhibitor.

Question 196

What is the main clinical concern when using general anesthesia in patients with Factor V Leiden mutation?
A) Decreased risk of bleeding
B) Increased risk of developing DVT and PE
C) Reduced effect of local anesthetics
D) Enhanced sensitivity to anesthetics

Answer 196

Answer: B) Increased risk of developing DVT and PE

Factor V Leiden is associated with an increased risk of developing an episode of DVT (with or without a PE)
Because of high risks of DVT and PE, patients are on anticoagulants

Question 197

What is the standard treatment approach for a patient diagnosed with heparin-induced thrombocytopenia (HIT)?
A) Continue heparin but monitor platelet levels more frequently.
B) Switch to non-heparin anticoagulation such as bivalirudin, argatroban, or fondaparinux.
C) Increase the dose of unfractionated heparin.
D) Administer vitamin K antagonist.

Answer 197

Answer: B) Switch to non-heparin anticoagulation such as bivalirudin, argatroban, or fondaparinux.

Question 198

How does Desmopressin (DDAVP) act to correct bleeding disorders?
A) By converting fibrinogen to fibrin.
B) By inhibiting platelet function.
C) By stimulating the release of von Willebrand factor and factor VIII from endothelial cells.
D) By activating antithrombin III.

Answer 198

Answer: C) By stimulating the release of von Willebrand factor and factor VIII from endothelial cells.

Question 199

What is the primary action of unfractionated heparin in blood coagulation?
A) Converts prothrombin to thrombin.
B) Inhibits thrombin and factor Xa via antithrombin III activation.
C) Directly converts fibrinogen to fibrin.
D) Induces platelet aggregation.

Answer 199

Answer: B) Inhibits thrombin and factor Xa via antithrombin III activation.

Question 200

What is the consequence of administering heparin to a patient with antithrombin III deficiency?
A) Increased risk of bleeding.
B) No anticoagulant effect.
C) Enhanced anticoagulant effect.
D) Immediate reversal of anticoagulation.

Answer 200

Answer: B) No anticoagulant effect.
Give FFP first, has antithrombin 3 in it.

Question 201

How does von Willebrand factor (vWF) primarily function in hemostasis?
A) By degrading fibrinogen to prevent clot formation.
B) By facilitating platelet adhesion to damaged endothelium.
C) By activating factor X to convert prothrombin to thrombin.
D) By catalyzing the conversion of plasminogen to plasmin.

Answer 201

Answer: B) By facilitating platelet adhesion to damaged endothelium.

vWF critical role in platelet adherence/adhesion
Most common hereditary bleeding disorders
Clinical features varies
Different types and classification
Easy bruising
Recurrent epistaxis
Menorrhagia
Patients usually unaware until questionnaire/surgery

Question 202

Which statement best describes the management of disseminated intravascular coagulation (DIC)?
A) Primarily involves administering high-dose antifibrinolytics.
B) Focuses on treating the underlying cause and replacing consumed coagulation factors.
C) Involves lifelong administration of vitamin K antagonists.
D) Requires the exclusive use of unfractionated heparin.

Answer 202

Answer: B) Focuses on treating the underlying cause and replacing consumed coagulation factors.

Question 203

What is a common trigger for the development of disseminated intravascular coagulation (DIC)?
A) Chronic hypertension.
B) Mild allergic reactions.
C) Trauma, malignancy, sepsis, or amniotic fluid embolus.
D) Long term fibrinolytic use

Answer 203

C) Trauma, malignancy, sepsis, or amniotic fluid embolus.

Systemic activation of the coagulation system simultaneously leads to thrombus formation and exhaustion of platelets and coagulation factors
Numerous underlying disorders may precipitate DIC, including trauma, amniotic fluid embolus, malignancy, sepsis, or incompatible blood transfusions

Question 204

What lab findings are indicative of DIC?
A) Increased platelet count
B) Shortened PT/PTT
C) Reduction in platelets, prolonged PT/PTT
D) Elevated RBC count

Answer 204

Answer: C) Reduction in platelets, prolonged PT/PTT

Labs
Reductions in PLT, prolongation PT, PTT, and thrombin time (TT), and elevated concentrations of soluble fibrin degradation products
Management of DIC requires alleviating the underlying condition precipitating hemostatic activation
Treatment includes blood component transfusions to replete coagulation factors and platelets consumed in the process
Antifibrinolytic therapy generally is contraindicated in DIC owing to potential for catastrophic thrombotic complications

Question 205

The primary goal in the management of DIC is:
A) To start antifibrinolytic therapy immediately
B) To replace coagulation factors and platelets
C) To prescribe long-term anticoagulation therapy
D) To administer high doses of vitamin K

Answer 205

Answer: B) To replace coagulation factors and platelets

Question 206

Which is NOT a recommended treatment approach for DIC?
A) Blood component transfusions
B) Antifibrinolytic therapy
C) Immediate administration of heparin
D) Alleviating the underlying condition

Answer 206

Answer: B) Antifibrinolytic therapy

Antifibrinolytic agents–tranexamic acid, ε–aminocaproic acid, and aprotinin
inhibits the conversion of plasminogen to plasmin

Question 207

Factor V Leiden

Answer 207

Factor V Leiden is an abnormal version of factor V that is resistant to the action of activated protein C
Activated protein C cannot easily stop factor V Leiden from making more fibrin

Question 208

What is a common symptom of severe hyponatremia?
A) Hyperactivity
B) Seizures
C) Tachycardia
D) Hypertension

Answer 208

Answer: B) Seizures

Question 209

The treatment for acute symptomatic hyponatremia includes:
A) Administering hypotonic saline
B) Restricting fluid intake
C) Administering hypertonic saline
D) Increasing sodium intake orally

Answer 209

Answer: C) Administering hypertonic saline

Seizures, coma, death

NPO and hypertonic 3%- bag, bolus it in

Can give 23% syringe -

Question 210

What CNS changes are expected when the serum sodium level drops to 120 mEq/L?
A) Somnolence and Nausea
B) Seizures and Coma
C) Confusion and Restlessness
D) Headache and Dizziness

Answer 210

Answer: C) Confusion and Restlessness

Question 211

At which serum sodium level are elevated ST segments and widened QRS typically observed?
A) 120 mEq/L
B) 115 mEq/L
C) 110 mEq/L
D) 130 mEq/L

Answer 211

Answer: B) 115 mEq/L

Question 212

Severe hyponatremia is indicated by a serum sodium level of:
A) 120 mEq/L
B) 125 mEq/L
C) 110 mEq/L
D) 130 mEq/L

Answer 212

Answer: C) 110 mEq/L

Vtach or Vfib

Question 213

Which of the following ECG changes is not associated with a serum sodium level of 115 mEq/L?
A) Elevated ST segments
B) Narrow QRS
C) Vtach or Vfib
D) Normal sinus rhythm

Answer 213

A) Elevated ST segments
Also see a Widened QRS

Vtach or Vfib (This is associated with a serum sodium level of 110 mEq/L)

Question 214

What are the CNS changes associated with a serum sodium level of 110 mEq/L?
A) Confusion and Restlessness
B) Somnolence and Nausea
C) Seizures and Coma
D) Headache and Irritability

Answer 214

Answer: C) Seizures and Coma

Question 215

What is the correct sequence of exam procedures?

Answer 215

Inspection, palpation, percussion, auscultation

Question 216

Which of the following if considered allergic reaction to Lidocaine with Epi?

Answer 216

Pruritus (Tachycardia, HTN, and LA side effects not reactions)

Question 217

Late stage burn healing would be Ann example of what type of pain?

Answer 217

Inflammatory

Question 218

Acetaminophen- “tylenol”
IV (Ofirmev®) - Dose

Answer 218

Kid PO Tylenol 15 mg/kg

IV 15 mg/kg IV q 6 h or 12.5 mg/kg q4

Question 219

Tension Test with Edrophonium improves what type of crisis?

Answer 219

Myasthenic (gets worse w/ Cholinergic crisis)

Question 220

Rheumatoid Arthritis results inn increased pain at what time of day?

Answer 220

-Morning (OA is worse later in day)

Question 221

Airway concerns in RA include which of the following 2?

Answer 221

-Atlantoaxial subluxation & TMJ movement limitation (also decreased Cricoarytenoid Laxity)
*NO increased risk of aspiration

Question 222

Which off the following is not a common manifestation of SLE?

Answer 222

Asymmetric Arthritis

Question 223

The mortality rate of MH is?

Answer 223

-50%

Question 224

Which of the following agents are triggers for MH?

Answer 224

Isoflurane & Anectine (aka Succinylcholine)

Ryanodex is treatment

Question 225

Horners syndrome occurs as a result of which blockade?

Answer 225

Stellate Ganglion
-may be inadvertent d/t Scalene block

Question 226

Which of the following is the most sensitive indicator of left ventricular myocardial ischemia?

Answer 226

Wall motion abnormalities on the echo

Question 227

Cardiac Tamponade is associated with?

Answer 227

A: Pulsus paradoxus

Question 228

The MAP in a patient with a blood pressure of 180/60 mmHg is?

Answer 228

Dr. Schmidt Method: DBP + 1/3 (SBP- DBP)= 99.96

Question 229

Which of the following would be the best intraoperative TEE view to monitor for myocardial ischemia?

Answer 229

-A: Transgastric mid-papillary left ventricular short axis view

Question 230

Which of the following medications blocks angiotensin at the receptor?

Answer 230

Lorsartan (ARB)

Question 231

Sildenafil belongs to the same class of drug as which of the following?

Answer 231

-A: Milrinone

PDE3 inhibitor

Question 232

What is the minimum amount of time after angioplasty with a drug elut. Stent that DAPT is continued elective surgery?

Answer 232

-A: 1 yr.

Question 233

The effects of clopidogrel can be reversed with?

Answer 233

A: None of the above&raquo_space;> Plts.

Question 234

You made an infusion of dopamine with 200 mg dopamine in 250mL 800 mcg/mL. What is the rate for 5 mcg/kg/min in 70 kg pt?

Answer 234

A: 26 mL/hr

-(70 kg x 5 mcg/kg x 60 minutes)/ 800 mcg/mL

Question 235

Severe aortic stenosis is associated with a valve area less then __ cm2?

Answer 235

-A: 1 cm2

Question 236

What makes up the largest component of whole blood?

Answer 236

-A: Plasma

Question 237

Which is more predominant, Rh+ or Rh- ?

Answer 237

A: Rh+

Question 238

Von Willebrand disease could be treated (initial) with all of the following but?

Answer 238

Factor VIII

TREATMENT
Correct the deficiency of vWF
Using desmopressin
By the transfusion of the specific factor
Cryoprecipitate

Question 239

Patients with what factor deficiency may require FFP prior to Heparin administration?

Answer 239

A: ATIII

Question 240

Which blood type offers the most compatibility?

Answer 240

-A: O

Question 241

Which chemical is added to blood products as preservative?

Answer 241

A: CPDA-1

Question 242

Which product increases the O2 carrying capacity?

Answer 242

A: RBCs

Question 243

What is the standard dosing for plasma?

Answer 243

-A: 10-15 mL/kg

Question 244

One unit of platelets will increase your platelet count by?

Answer 244

A: 5-10K

Question 245

Which blood product is most likely to cause TRALI?

Answer 245

A: Plasma (high protein)

Question 246

What is the likely TEG result in a patient taking Plavix after cardiac stent placement?

Answer 246

-A: Normal TEG (doesn’t determine if Plt. Is functional itself —> use Plt. Mapping

Question 247

Which product contains the largest amount of Fibrinogen?

Answer 247

-A: Cryoprecipitate

Question 248

Administration of which product type may cause incompatibility later requiring treatment with Rhogram?

Answer 248

A: O+

Question 249

Which TEG measures fibrinolysis?

Answer 249

A: LY30

Question 250

Which product contain the most elemental calcium?

Answer 250

-A: Calcium Chloride

Question 251

What is the typical timing in the cardiac cycle for aortic stenosis?
A) Holosystolic
B) Midsystolic crescendo-decrescendo
C) Mid-diastolic
D) Early diastolic

Answer 251

B) Midsystolic crescendo-decrescendo

Systolic or midsystolic murmur – right upper sternal border
Crescendo–decrescendo pattern
Radiates to neck, mimics carotid bruit
Critical AS
Angina pectoris
Increased risk of peri-op mortality and MI
Syncope
Dyspnea on exertion

Symptoms correlate with an average time to death of 5, 3, and 2 years
75% of symptomatic pts die w/in 3 years w/o valve replacement

Question 251

Where is the murmur of mitral regurgitation best heard?
A) Right upper sternal border
B) Left sternal border
C) Apex
D) Lower left sternal border

Answer 251

C) Apex

Holosystolic murmur that is heard
Best at the apex and radiates to the axilla suggests mitral regurgitation

Question 252

Which of the following is a symptom of aortic stenosis?
A) Cyanosis
B) Orthopnea
C) Syncope
D) Palpitations

Answer 252

C) Syncope

Critical AS
Angina pectoris
Increased risk of peri-op mortality and MI
Syncope
Dyspnea on exertion

Question 253

What does the presence of a mid-systolic click indicate?
A) Mitral valve prolapse
B) Aortic regurgitation
C) Tricuspid stenosis
D) Mitral regurgitation

Answer 253

A) Mitral valve prolapse

Question 254

In which condition is the Valsalva maneuver likely to decrease the intensity of the murmur?
A) Hypertrophic cardiomyopathy
B) Mitral valve prolapse
C) Aortic stenosis
D) Tricuspid regurgitation

Answer 254

C) Aortic stenosis

Increases with squatting, decreases with Valsalva and standing

Question 255

What is the most common cause of mitral stenosis worldwide?
A) Infective endocarditis
B) Rheumatic heart disease
C) Degenerative disease
D) Congenital malformation

Answer 255

B) Rheumatic heart disease

Rare in the US
Rheumatic heart disease
Primarily affects women
Asymptomatic for 20-30 years

Question 256

Which of the following diagnostic tools is most useful for assessing valve areas and transvalvular pressure gradients?
A) EKG
B) Chest X-ray
C) Echocardiogram
D) MRI

Answer 256

C) Echocardiogram

Question 257

What is the main treatment approach for severe symptomatic aortic stenosis?
A) Beta-blockers
B) Valve repair
C) Transcatheter aortic valve replacement (TAVR)
D) Diuretics

Answer 257

C) Transcatheter aortic valve replacement (TAVR)

Prevention/avoidance of hypotension and decreased CO
Maintain NSR
Avoid bradycardia or tachycardia
Optimize intravascular fluid volume
Aggressive treatment of hypotension

CPR is typically not effective

Question 258

Which condition is characterized by a holosystolic murmur that increases with inspiration?
A) Mitral regurgitation
B) Tricuspid regurgitation
C) Aortic stenosis
D) Mitral valve prolapse

Answer 258

B) Tricuspid regurgitation

Prominent jugular venous distention, signs of right heart failure.

Question 259

What is the typical effect of exercise on functional murmurs?
A) Increase
B) Decrease
C) No change
D) Variable

Answer 259

A) Increase

Question 260

In which condition is the murmur best heard at the lower left sternal border?
A) Aortic stenosis
B) Mitral regurgitation
C) Tricuspid regurgitation
D) Mitral valve prolapse

Answer 260

C) Tricuspid regurgitation

Question 261

Which valve disorder is likely to show prominent jugular venous distension as an associated finding?
A) Mitral stenosis
B) Aortic regurgitation
C) Tricuspid regurgitation
D) Hypertrophic cardiomyopathy

Answer 261

C) Tricuspid regurgitation

Question 262

What is the initial medical treatment for mitral stenosis?
A) ACE inhibitors
B) Rate control with beta-blockers
C) Immediate surgery
D) High-dose diuretics

Answer 262

B) Rate control with beta-blockers

Rate control
β-blockers, calcium channel blockers, digoxin
Left atrial pressure
Diuretics
Anticoagulation - risk of stroke 7-15% per year
Arterial thromboembolism vs venous thrombosis
Surgical correction
Percutaneous valvotomy
Surgical commissurotomy
Valve replacement

Question 263

What is the risk of stroke per year without anticoagulation in mitral stenosis?
A) 1-3%
B) 7-15%
C) 20-25%
D) 30-35%

Answer 263

B) 7-15%

Question 264

Which murmur is described as “blowing” in character?
A) Aortic stenosis
B) Mitral regurgitation
C) Tricuspid stenosis
D) Mitral stenosis

Answer 264

A) Aortic stenosis

Question 265

What is the main concern with the use of mechanical valves in younger patients?
A) Durability
B) Risk of infection
C) Necessity for lifelong anticoagulation
D) High failure rate

Answer 265

C) Necessity for lifelong anticoagulation

Question 266

Which condition is associated with a midsystolic click followed by a late systolic murmur?
A) Aortic regurgitation
B) Mitral valve prolapse
C) Tricuspid regurgitation
D) Aortic stenosis

Answer 266

B) Mitral valve prolapse

Question 267

In which condition would you expect to find a diastolic decrescendo murmur?
A) Aortic regurgitation
B) Mitral stenosis
C) Tricuspid stenosis
D) Mitral regurgitation

Answer 267

A) Aortic regurgitation

Early diastole

Question 268

What diagnostic feature is most indicative of left atrial enlargement on an echocardiogram?
A) Notched T Wave
B) Elongated P Wave
C) Tall P Wave
D) Inverted T Wave

Answer 268

B) Elongated P Wave

Rumbling diastolic murmur at apex, radiates to left axilla

EKG
Notched P waves - longer
AF

Question 269

Which condition is often managed with diuretics to reduce left atrial pressure?
A) Aortic stenosis
B) Mitral regurgitation
C) Tricuspid stenosis
D) Mitral stenosis

Answer 269

D) Mitral stenosis

Left atrial pressure
Diuretics

Question 270

What is the main goal in the management of patients with aortic regurgitation?
A) Increase afterload
B) Decrease heart rate
C) Maintain forward flow
D) Reduce preload

Answer 270

C) Maintain forward flow

Goal: maintain forward LV SV
Avoid bradycardia
HR: > 80 bpm
Avoid increased SVR
Minimize myocardial depression
Vasodilator to reduce afterload
Inotrope to increase contractility

Question 271

Which 2 murmurs would likely increase with the handgrip maneuver or with a BP cuff?
A) Aortic stenosis
B) Mitral regurgitation
C) Aortic regurgitation
D) Tricuspid regurgitation

Answer 271

C) Aortic regurgitation
B) Mitral regurgitation

Question 272

In the context of valvular heart disease, what does the presence of an opening snap suggest?
A) Aortic stenosis
B) Mitral stenosis
C) Aortic regurgitation
D) Mitral regurgitation

Answer 272

B) Mitral stenosis

Opening snap after S2, Loud S1, radiation to left axilla

Question 273

What is the primary effect of tachycardia on aortic regurgitation?
A) Increases regurgitant volume
B) Decreases regurgitant volume
C) No effect on regurgitant volume
D) Increases forward flow

Answer 273

B) Decreases regurgitant volume

Decreased CO d/t regurgitant SV
Combined LV pressure and volume overload
Usually slow onset

Magnitude of regurgitation depends on:
Time available for regurgitant flow (HR)
Pressure gradient across the aortic valve (SVR)

Have an increased SV with a decreased EF

Question 274

Which is a common finding in patients with advanced mitral stenosis?
A) Atrial fibrillation
B) Ventricular tachycardia
C) Bradycardia
D) Complete heart block

Answer 274

A) Atrial fibrillation

MS: Symptoms
Dyspnea on exertion
Orthopnea
Paroxysmal nocturnal dyspnea
Pulmonary edema
Pulmonary HTN
Atrial fibrillation

Question 275

What is the incidence of valvular heart disease in the US population?
A) 1%
B) 2.5%
C) 5%
D) 10%

Answer 275

Answer: B) 2.5%

Question 276

Which condition is often associated with mitral regurgitation due to ischemic heart disease?
A) Aortic stenosis
B) Tricuspid regurgitation
C) Pulmonary hypertension
D) Increased mortality

Answer 276

Answer: D) Increased mortality

Valvular heart disease and ischemic heart disease frequently co-exist
50% of pt with aortic stenosis >50 years have ischemic heart disease
CAD pt with mitral or aortic valve disease worsens the long-term prognosis
Mitral regurgitation d/t ischemic heart disease > mortality

Question 277

What is the main compensatory mechanism in the presence of cardiac disease?
A) Decreased sympathetic nervous system activity
B) Myocardial atrophy
C) Increased sympathetic nervous system activity
D) Decreased heart rate

Answer 277

C) Increased sympathetic nervous system activity

Recognition of compensatory mechanisms for maintaining cardiac output, such as increased sympathetic nervous system activity and cardiac hypertrophy, as well as consideration of current drug therapy, are important

Question 278

What defines a functional murmur?
A) Results from structural heart disease
B) Primarily due to physiologic conditions outside the heart
C) Always pathologic
D) Causes decreased cardiac output

Answer 278

Answer: B) Primarily due to physiologic conditions outside the heart

Question 279

What is the normal mitral valve orifice area?
A) 1–2 cm²
B) 2–3 cm²
C) 4–6 cm²
D) 7–8 cm²

Answer 279

Answer: C) 4–6 cm²

Mechanical obstruction to LV filling d/t decrease in size of mitral valve orifice
Normal mitral valve orifice area is 4–6 cm2
Symptoms develop - < 2 cm2
Diffuse thickening and fibrosis of mitral leaflet cusps, subvalvular apparatus, and commissural fusion
Calcification of the annulus and leaflets

Left atrial volume and pressure
LV contractility
SV

Question 280

Which murmur is associated with stenosis of the aortic or pulmonic valves?
A) Diastolic murmur
B) Decrescendo murmur
C) Systolic murmur
D) Late systolic murmur

Answer 280

Answer: C) Systolic murmur

Stenosis of the aortic or pulmonic valves
Incompetence of the mitral or tricuspid valves

Midsystolic or holosystolic

Question 281

During which cardiac phase do the mitral and tricuspid valves open?
A) Systole
B) Diastole
C) Both A and B
D) Neither A nor B

Answer 281

Answer: B) Diastole

Question 282

What is the significance of a midsystolic murmur heard best at the right upper sternal border?
A) Mitral regurgitation
B) Tricuspid stenosis
C) Aortic stenosis
D) Pulmonic stenosis

Answer 282

C) Aortic stenosis

Systolic or midsystolic murmur – right upper sternal border
Crescendo–decrescendo pattern
Radiates to neck, mimics carotid bruit

Question 283

Which diagnostic tool is most useful for evaluating cardiomegaly?
A) EKG
B) CXR (Chest X-Ray)
C) MRI
D) Blood tests

Answer 283

Answer: B) CXR (Chest X-Ray)

Question 284

Which type of heart valve is very durable and lasts 20-30 years?
A) Biological
B) Mechanical
C) Homograft
D) Autograft

Answer 284

Answer: B) Mechanical

Mechanical
Metal or carbon alloy
Very durable… 20-30 years
Highly thrombogenic
Young pts

Bioprosthetic
Porcine or bovine
Shorter lasting… 10-15 years
Low thrombogenic potential
Elderly pts

Question 285

What is a key goal in the anesthetic management of patients with mitral stenosis?
A) Increase heart rate
B) Decrease systemic vascular resistance
C) Maintain normal heart rate
D) Increase preload

Answer 285

C) Maintain normal heart rate

Goal: normal HR, normal volume, normal afterload
Prevention and treatment of decreased cardiac output or pulmonary edema
Excessive pre-op IV fluid or trendelenburg position
Control HR
AF w/ RVR
Cardioversion or IV administration of amiodarone,β-blockers, or calcium channel blockers

Control of the heart rate is critical because tachycardia impairs left ventricular filling and increases left atrial pressure.

Question 286

What is the primary cause of mitral regurgitation in the US?
A) Infective endocarditis
B) Rheumatic heart disease
C) Mitral valve prolapse
D) Congenital mitral valve anomalies

Answer 286

Answer: C) Mitral valve prolapse

More common than MS
2% of the US population
Associated with
IHD
Ruptured papillary muscle
Endocarditis
Mitral valve prolapse
Cardiomyopathy

Question 287

What is a common cause of acute mitral regurgitation?
A) Degenerative valve disease
B) Calcification of the mitral valve
C) Ruptured papillary muscle
D) Aortic dissection

Answer 287

Answer: C) Ruptured papillary muscle

Question 288

What is the treatment of choice for severe mitral regurgitation when surgery is indicated?
A) Mitral valve repair
B) Balloon valvuloplasty
C) Mitral valve replacement
D) Transcatheter mitral valve repair (MitraClip)

Answer 288

Answer: A) Mitral valve repair

Asymptomatic vs symptomatic pts
MV repair > MV replacement
EF < 30% little improvement with surgery
Transcatheter mitral valve repair
MitraClip
Vasodilators, biventricular pacing
ACE-I, β-blockers (carvedilol)

Question 289

What is the primary goal in the management of aortic regurgitation?
A) Increase heart rate
B) Decrease afterload
C) Increase preload
D) Reduce regurgitant volume

Answer 289

Answer: B) Decrease afterload

A) is more important. Keeps pressure head moving forward

Goal: maintain forward LV SV
Avoid bradycardia
HR: > 80 bpm
Avoid increased SVR
Minimize myocardial depression
Vasodilator to reduce afterload
Inotrope to increase contractility

Question 290

What are the common symptoms of aortic stenosis?
A) Syncope, angina pectoris, and dyspnea on exertion
B) Fever, weight loss, and night sweats
C) Palpitations, flushing, and dizziness
D) Cough, frothy sputum, and wheezing

Answer 290

Answer: A) Syncope, angina pectoris, and dyspnea on exertion

Question 291

Which procedure is often performed simultaneously with aortic valve replacement in patients with significant coronary artery disease?
A) Coronary artery bypass grafting (CABG)
B) Mitral valve repair
C) Pulmonary thromboendarterectomy
D) Left ventricular assist device implantation

Answer 291

Answer: A) Coronary artery bypass grafting (CABG)

Question 292

The risk of sudden death is associated with which condition even when asymptomatic?
A) Mitral valve prolapse
B) Aortic stenosis
C) Tricuspid regurgitation
D) Pulmonary hypertension

Answer 292

Answer: B) Aortic stenosis

Question 293

What is the recommended heart rate for patients with aortic regurgitation under anesthesia?
A) Less than 60 bpm
B) 60-70 bpm
C) 70-80 bpm
D) More than 80 bpm

Answer 293

Answer: D) More than 80 bpm

Goal: maintain forward LV SV
Avoid bradycardia
HR: > 80 bpm
Avoid increased SVR
Minimize myocardial depression
Vasodilator to reduce afterload
Inotrope to increase contractility

Question 294

What is a key goal in the anesthetic management of patients with aortic stenosis?
A) Increase heart rate
B) Decrease heart rate
C) Maintain normal sinus rhythm
D) decrease preload

Answer 294

Answer: C) Maintain normal sinus rhythm

Prevention/avoidance of hypotension and decreased CO
Maintain NSR
Avoid bradycardia or tachycardia
Optimize intravascular fluid volume
Aggressive treatment of hypotension

CPR is typically not effective

Question 295

In patients with mitral stenosis, what condition increases the risk of arterial thromboembolism?
A) Increased Left Ventricle filling time
B) Decreased left atrial pressure
C) Stasis of blood in the distended left atrium
D) Increased turbulent flow across the stenotic valve.

Answer 295

C) Stasis of blood in the distended left atrium

Question 296

Which murmur is characterized by a low-pitched diastolic rumble at the left sternal border, also known as the Austin-Flint murmur?
A) Tricuspid Stenosis
B) Mitral Stenosis
C) Aortic Regurgitation
D) Pulmonic regurgitation

Answer 296

C) AR
Early or mid-diastolic murmur, at the left sternal border
Low-pitched diastolic rumble (Austin-Flint murmur)
Hyperdynamic circulation
Widened pulse pressure
Decreased DBP
Bounding pulses

LV failure (end stage)
Dyspnea, orthopnea, fatigue and coronary ischemia

Acute AR – severe LV volume overload
Coronary ischemia, rapid deterioration LV function, and HF

EKG and CXR
LV enlargement and hypertrophy

Echocardiogram
Leaflet prolapse or perforation
Associated aortic abnormalities

Question 297

What is the approximate specific gravity of red blood cells?
A) 1.08-1.09
B) 1.03-1.04
C) 1.00-1.01
D) 1.05-1.06

Answer 297

Answer: A) 1.08-1.09

Based on different specific gravities
RBC : 1.08-1.09
Platelet : 1.03-1.04

RBCs most dense, sink to bottom

Question 298

Fresh Frozen Plasma should be prepared from W.B within how many hours of collection?
A) 24 hours
B) 8 hours
C) 12 hours
D) 48 hours

Answer 298

B) 8 hours

Prepared by removing plasma from W.B w/in 8H of collection.
Source of antithrombin III
One bag = 200-250 mL
Expires 12 months after donation
Dose 10-15 mL/kg
Stored at –18C or below.
Each unit of FFP=increase the level of each clotting fx by 2-3% in adults.
Therapeutic dose: 10-15ml/kg.
Contains:
Water, carbohydrates, fats, minerals
Proteins(all labile & stable clotting fx).

Question 299

What is the primary reason for administering cryoprecipitate?
A) Increase oxygen-carrying capacity
B) Increase blood volume
C) Replace clotting factors
D) Counteract anticoagulation

Answer 299

C) Replace clotting factors

K time >3 : “Kinetic time” for fibrin cross linkage to reach 20 mm clot strength

Protein fraction taken off the top of the FFP when being thawed
Then refrozen for up to 1 year
Contains:
Factor VIII: C
Factor VIII: vWF
Factor XIII
Fibrinogen

Stored at –18C & below.

Question 300

Which of the following is a primary component of Cryoprecipitate?
A) Hemoglobin
B) Fibrinogen
C) Immunoglobulins
D) Albumin

Answer 300

B) Fibrinogen

Has the most
LTOWB-1000mg
FFP-400mg
Cryo-2500mg

Question 301

What is the typical storage temperature for whole blood?
A) 1-6°C
B) 10-15°C
C) 20-25°C
D) 30-35°C

Answer 301

Answer: A) 1-6°C

Question 302

The addition of which substance extends the storage time of blood from 21 to 35 days?
A) Glucose
B) Adenine
C) Calcium
D) Citrix acid

Answer 302

Answer: B) Adenine

Storage of blood is achieved by adding Citrate phosphate dextrose adenine (CPDA-1)
Citrate for chelation of calcium to prevent clotting
Phosphate as a buffer
Dextrose as a fuel source
Adenine as a substrate for the synthesis of ATP extending storage time from 21 to 35 days

Question 303

What does the transfusion of one unit of Packed Red Blood Cells typically increase?
A) Hemoglobin by 1g/dL
B) Platelet count by 50,000/mL
C) Hct 5%
D) Plasma volume

Answer 303

A) Hemoglobin by 1g/dL

Prepared by removing 200-250ml of plasma from a unit of W.B.
200-350 ml
Do not contain functional platelets or granulocytes
Have the same O2 carrying capacity with W.B
Intended to increase the O2 carrying capacity in anemic pt who require an increase in their red cell mass w/out increase in their blood volume.
1 unit: increase Hb level about 1g/dL (10g/L)& Hct by 3%.

Question 304

At what temperature should Fresh Frozen Plasma be stored?
A) Room temperature
B) 1-6°C
C) –18°C or below
D) 22-24°C

Answer 304

Answer: C) –18°C or below

Prepared by removing plasma from W.B w/in 8H of collection.
Source of antithrombin III
One bag = 200-250 mL
Expires 12 months after donation
Dose 10-15 mL/kg
Stored at –18C or below.
Each unit of FFP=increase the level of each clotting fx by 2-3% in adults.
Therapeutic dose: 10-15ml/kg.
Contains:
Water, carbohydrates, fats, minerals
Proteins(all labile & stable clotting fx).

Question 305

What is the typical dose of Fresh Frozen Plasma?
A) 5-10 mL/kg
B) 10-15 mL/kg
C) 20-25 mL/kg
D) 30-35 mL/kg

Answer 305

Answer: B) 10-15 mL/kg

Question 306

How does the storage of blood affect levels of 2,3-DPG?
A) Increases over time
B) Decreases over time
C) Remains constant
D) Initially decreases then increases

Answer 306

Answer: B) Decreases over time

The longer blood is stored, the lower are the levels of 2,3-DPG, shifting the oxyhemoglobin dissociation curve to the left, which impairs oxygen delivery
Packed red blood cells (PRBCs) are derived from whole blood from which the plasma has been removed
PRBCs contain leukocytes unless they have been specifically leukoreduced

Question 307

Which factor is primarily associated with Hemolytic Transfusion Reactions?
A) IgG antibodies
B) IgM antibodies
C) IgA antibodies
D) IgE antibodies

Answer 307

Answer: B) IgM antibodies

Hemolytic transfusion reactions
Mediators: IgM A/b (usually ABO), complement.
S/S: fever, chill, hemoglobinemia, hemoglobinuria, hypotension, dyspnea.
Treatment and Prevention: decrease opportunities for error, treat ARF & DIC.

Question 308

The TRALI syndrome is associated with which of the following components?
A) Red blood cells
B) Platelets
C) Fresh Frozen Plasma
D) All of the above

Answer 308

Answer: D) All of the above

It is typically associated with plasma components such as platelets and Fresh Frozen Plasma, though cases have been reported with packed red blood cells since there is some residual plasma in the packed cells.

Question 309

Which of the following is a common cause of post-transfusion purpura?
A) Platelet specific antibodies
B) Red blood cell antibodies
C) White blood cell antibodies
D) Plasma protein antibodies

Answer 309

Answer: A) Platelet specific antibodies

3 Post-transfusion purpura
MOA: platelet specific A/b.
S/S: thrombocytopenia, clinical bleeding.
Treatment and Prevention: IV Ig, plasma exchange, corticosteroids.

Question 310

Which component of blood is most likely to cause TRALI?
A) Cryoprecipitate
B) Packed Red Blood Cells
C) Platelets
D) Fresh Frozen Plasma

Answer 310

Answer: D) Fresh Frozen Plasma

Question 311

What is the standard ratio of blood components provided in the Massive Transfusion Protocol (MTP)?
A) 1:1:2 (Plasma:Platelets:RBCs)
B) 1:2:1 (Plasma:Platelets:RBCs)
C) 1:1:1 (Platelets:Plasma:RBCs)
D) 2:1:1 (Plasma:Platelets:RBCs)

Answer 311

Answer: C) 1:1:1 (Platelets:Plasma:RBCs)

Question 312

Which product is typically used to manage circulatory overload (TACO)?
A) Diuretics
B) Antihistamines
C) Corticosteroids
D) Calcium gluconate

Answer 312

Answer: A) Diuretics

Big difference is the circulatory overload and the fever..

2 Circulatory overload (TACO)
Mediators : fluid volume.
S/S: coughing, cyanosis, orthopnea, severe headache, peripheral edema, diff breathing.
Treatment and Prevention: administer subsequent Tx slowly & in a small volume.

Question 313

What is the main reason for leukoreducing blood products?
A) Increase oxygen capacity
B) Reduce risk of febrile non-hemolytic transfusion reactions
C) Increase platelet count
D) Reduce the risk of HIV transmission

Answer 313

B) Reduce risk of febrile non-hemolytic transfusion reactions

Nonhemolytic febrile transfusion reactions
Mediators: A/b to HLA Class I Ag.
S/S: fever, chill.
Treatment and Prevention: antipyretics, leukocyte reduced.

Question 314

In the setting of a massive transfusion, when is calcium typically replaced?
A) After 1 unit of blood has been transfused
B) After 2 units of blood have been transfused
C) After 4 units of blood have been transfused
D) Only if symptoms of hypocalcemia appear

Answer 314

Answer: C) After 4 units of blood have been transfused

CALCIUM: Hypocalcemia, long QTc, decreased cardiac output, coagulopathy, seizures, etc.
97.4% of trauma MTP patients hypocalcemic (<1.12mmol/L)
50-70% severe (<0.8-0.9mmol/L)
More coagulopathy
More blood transfused
Double mortality (49% vs. 24%)
Calcium replacement after 4U, but never resolved (still <1.12mmol/L)
One unit of citrated blood product drops iCa

Question 315

1 unit of Platelets will increase your count how much?
A) 5,000-7,000
B) 3,000-5,000
C) 5,000- 10,000
D) 250- 300

Answer 315

C) 5,000- 10,000

Prepared by cytapheresis/by separating PRP from a unit of W.B w/in 8H of collection & recentrifuged to remove plasma.
Contains PLT only
One bag = random value
One bag pheresis = 250-300 mL
One unit increases PLT by 5,000 - 10,000

Question 316

What is a critical variable in determining mortality in patients requiring massive transfusion?
A) Hypocalcemia
B) Hypernatremia
C) Hypokalemia
D) Hyponatremia

Answer 316

Answer: A) Hypocalcemia

Question 317

What is the threshold INR value for considering Fresh Frozen Plasma transfusion?
A) Greater than 1.2
B) Greater than 1.5
C) Greater than 1.8
D) Greater than 2.0

Answer 317

Answer: B) Greater than 1.5

Question 318

The transfusion of which component is usually indicated for treatment of a bleeding patient with a fibrinogen level below 100 mg/dL?
A) Platelets
B) Red Blood Cells
C) Fresh Frozen Plasma
D) Cryoprecipitate

Answer 318

Answer: D) Cryoprecipitate

Question 319

Which of the following best describes the effect of a long R time on a Thromboelastogram (TEG)?
A) Indicates a need for platelets
B) Suggests a deficit in clotting factors
C) Shows enhanced fibrinolysis
D) Represents accelerated clot formation

Answer 319

Answer: B) Suggests a deficit in clotting factors

“Reaction time” to initial fibrin formation
5.0 - 10.0 min

clotting factors (intrinsic pathway)

Long R time, give FFP

Question 320

When using a Massive Transfusion Protocol, what is a common trigger for initiating transfusion?
A) Hemoglobin less than 7 g/dL
B) Blood loss of 180 mL/min
C) Platelet count below 50,000/mL
D) Blood Loss of 15% Total Blood Volume

Answer 320

Answer: B) Blood loss of 180 mL/min

MTP in Adults
1) Total blood volume is replaced within 24 hours
2) 50% of total blood volume is replaced in 3 hours
3) Rapid bleeding rate = 4 units RBCS transfused within 4 hours or 150 mL/min blood loss
MTP in Children = >40 mL/kg transfusion

Current standard of care in level 1 trauma centers = balanced resuscitation
1:1:1 ratio (platelets:plasma:RBC)
Multiple blood components  ”reconstituted” whole blood

Actively bleeding pt>20% of body blood volume.

Question 321

What is the blood loss range for Class I Hemorrhage?
A) 0-750 ml
B) 750-1500 ml
C) 1500-2000 ml
D) >2000 ml

Answer 321

Answer: A) 0-750 ml

Question 322

In which class of hemorrhage does the pulse rate typically exceed 100 bpm?
A) Class I
B) Class II
C) Class III
D) Class IV

Answer 322

Answer: B) Class II

Question 323

Which class of hemorrhage is associated with a blood loss of more than 40% volume?
A) Class II
B) Class III
C) Class IV
D) None of the above

Answer 323

Answer: C) Class IV

Question 324

An R time of 8 minutes in a TEG suggests deficiency in:
A) Platelets
B) Clotting factors
C) Fibrinogen
D) None of the Above

Answer 324

D) None of the Above

Normal time : 5.0 - 10.0 min

Reaction time” to initial fibrin formation

clotting factors (intrinsic pathway)

Question 324

What is the normal range for the TEG-ACT value?
A) 50-70 sec
B) 80-140 sec
C) 5-10 min
D) 1-3 min

Answer 324

Answer: B) 80-140 sec

“Activated clotting time” to initial fibrin formation

Measures
clotting factors (extrinsic/intrinsic pathways

Question 325

Which TEG value indicates the need for Fresh Frozen Plasma (FFP) transfusion?
A) TEG-ACT > 140
B) MA < 50
C) LY30 > 3%
D) Alpha angle < 53

Answer 325

Answer: A) TEG-ACT > 140

MA < 50: Platelets
LY30 > 3%:Tranexamic Acid
Alpha angle < 53: Cryoprecipitate +/- Platelets

Question 326

The maximum amplitude (MA) in TEG reflects:
A) Clot lysis
B) Clotting factor activity
C) Platelet number and function
D) Fibrinolysis

Answer 326

Answer: C) Platelet number and function

Question 327

What does a MA amplitude of 80.0 mm on a TEG indicate?
A) Hypercoagulability
B) Hypocoagulability
C) Normal coagulation function
D) Platelet dysfunction

Answer 327

A) Hypercoagulability

MA
50.0 - 70.0 mm
Maximum amplitude of tracing
platelet number and function

Question 328

In the “Drinker’s Guide to Viscoelastic Testing”, what is recommended for a decreased LY 30 time?
A) FFP
B) Platelets
C) TXA
D) No action

Answer 328

Answer: C) TXA (Tranexamic Acid)

Normal: 0 - 3%

An increase in LY30 time in thromboelastography (TEG) analysis indicates more fibrinolysis than normal. The LY30 value measures the percentage of clot lysis 30 minutes after the maximum amplitude, reflecting the body’s natural process to break down blood clots. A higher LY30 value means there is more breakdown of the clot, which can indicate increased fibrinolytic activity.

Question 329

What is the fluid replacement strategy for Class I Hemorrhage?
A) Crystalloid and blood
B) Crystalloid only
C) Crystalloid (3:1 rule)
D) Blood only

Answer 329

Answer: C) Crystalloid (3:1 rule)

Question 330

A LY30 value greater than 3% in TEG analysis suggests treatment with:
A) FFP
B) Platelets
C) Cryoprecipitate
D) Tranexamic Acid

Answer 330

Answer: D) Tranexamic Acid

Question 331

At what percentage of blood volume loss does the heart rate typically begin to rise?
A) Up to 15%
B) 15%-30%
C) 30%-40%
D) >40%

Answer 331

Answer: B) 15%-30%

Question 332

The normal alpha angle in TEG, indicating clot strength, ranges between:
A) 20-40 degrees
B) 40-55 degrees
C) 53-72 degrees
D) 72-90 degrees

Answer 332

Answer: C) 53-72 degrees

a angle
53.0 - 72.0 degrees
Angle from baseline to slop of tracing that represents clot formation
fibrinogen, platelet number

Alpha angle <53
Cryoprecipitate +/- Platelets

Question 333

For which condition is cryoprecipitate transfusion recommended according to TEG?
A) TEG-ACT > 140
B) K time > 3
C) MA < 50
D) Alpha angle < 53

Answer 333

Answer: D) Alpha angle < 53

Question 334

The TEG value indicating entire coagulation cascade strength is:
A) Alpha angle
B) MA
C) G value
D) LY30

Answer 334

Answer: C) G value

G value
5.3 - 12.4 dynes/cm2
Calculated value of clot strength
entire coagulation cascade

Question 335

Hemodynamic instability due to hemorrhage generally starts in which class?
A) Class I
B) Class II
C) Class III
D) Class IV

Answer 335

Answer: C) Class III

Question 336

In a patient with an alpha angle less than 53 degrees, you would consider transfusing:
A) Platelets
B) FFP
C) Cryoprecipitate +/- Platelets
D) None of the above

Answer 336

Answer: C) Cryoprecipitate +/- Platelets

Question 337

In the context of hemorrhage, mental status changes to confusion or lethargy in which class?
A) Class I
B) Class II
C) Class III
D) Class IV

Answer 337

Answer: D) Class IV

Question 338

An MA value less than 50 mm in TEG suggests a requirement for:
A) Platelets
B) FFP
C) Cryoprecipitate
D) Tranexamic Acid

Answer 338

Answer: A) Platelets

Question 339

What TEG value assesses the clot lysis at 30 minutes?
A) MA
B) K time
C) LY30
D) Alpha angle

Answer 339

Answer: C) LY30

Question 340

What is the recommended treatment for a patient with a TEG K time greater than 3 minutes?
A) FFP
B) Platelets
C) Cryoprecipitate
D) Tranexamic Acid

Answer 340

Answer: C) Cryoprecipitate

K time
1.0 - 3.0 min
“Kinetic time” for fibrin cross linkage to reach 20 mm clot strength
fibrinogen, platelet number

K time >3
Cryoprecipitate