Cardiac 1, Cardiovascular Physiology And Anesthesia

Front 1

915. A 67-year-old man is to undergo a radical retropubic prostatectomy. He has aortic stenosis with a gradient of 37 mm Hg at rest. He has an allergy to penicillin. Which of the following is the best regimen for subacute bacterial endocarditis (SBE) prophylaxis in this patient?
...A. Ampicillin & gentamicin
...B. Vancomycin & gentamicin
...C. Clindamycin & gentamicin
...D. Clindamycin alone
...E. None of the above

Back 1

915. (E)

Front 2

916. A 68-year-old patient is undergoing elective coronary revascularization. Just before cardiopulmonary bypass, the hemoglobin concentration is 8.3 g/dL & platelet count is 253,000/mm3. After cardiopulmonary bypass is initiated, the patient is cooled to 20° C & 2 units of packed red blood cells (RBCs) are transfused because of bleeding. During bypass, the anesthesiologist notices that the platelet count is 10,000/mm3 & the hemoglobin concentration is 8 g/dL. The most likely cause of thrombocytopenia is
...A. Sequestration
...B. Hemolytic transfusion reaction
...C. Dilutional thrombocytopenia
...D. Disseminated intravascular coagulation
...E. Heparin-induced thrombocytopenia

Back 2

916. (A)

Front 3

917. Which of the following is the most sensitive indicator of left ventricular myocardial ischemia?
...A. Wall-motion abnormalities on the echocardiogram
...B. ST-segment changes in lead V5 of the electrocardiogram (ECG)
...C. Appearance of V waves on the pulmonary capillary wedge pressure tracing
...D. Elevation of the pulmonary capillary wedge pressure
...E. Decrease in cardiac output as measured by the thermodilution technique

Back 3

917. (A)

Front 4

918. Oxygen consumption (VO2) is measured in a 70-kg subject on a treadmill at 2500 mL per minute. This corresponds to:
...A. 1 metabolic equivalent (MET)
...B. 5 METs
...C. 10 METs
...D. 15 METs
...E. 20 METs

Back 4

918. (C)

Front 5

919. Accidental injection of air into a peripheral vein would be LEAST likely to result in arterial air embolism in a patient with which of the following anatomic cardiac defects?
...A. Patent ductus arteriosus
...B. Eisenmenger’s syndrome
...C. Teratology of Fallot
...D. Pulmonary atresia with ventricular septal defect
...E. Tricuspid atresia

Back 5

919. (A)

Front 6

920. Each of the following could be placed on the x-axis of the curve shown in the figure EXCEPT
...A. Stroke volume
...B. Left ventricular end-diastolic pressure
...C. Left ventricular end-diastolic volume
...D. Left atrial pressure
...E. Pulmonary artery occlusion pressure

Back 6

920. (A)

Front 7

921. The ECG rhythm strip below represents
...A. Atrial flutter
...B. Third-degree heart block
...C. Sinus tachycardia second-degree heart block
...D. Malfunctioning DDD pacemaker
...E. Junctional rhythm

Back 7

921. (A)

Front 8

922. A 71-year-old man is undergoing revascularization of three coronary vessels on cardiopulmonary bypass at 28° C. After the first graft is sewn into the aorta, the arterial pressure measured from a left radial artery is 47 mm Hg & the pulmonary artery pressure is 6 mm Hg. Thirty minutes later, the arterial pressure is 52 mm Hg & pulmonary artery pressure is 31 mm Hg. The most likely explanation for this is
...A. Malposition of the aortic cannula
...B. Malposition of the venous cannula
...C. Faulty ventricular venting
...D. Bypass associated sympathetic nervous system stimulation
...E. Pulmonary artery catheter migration

Back 8

922. (E)

Front 9

923. A78-year-old patient is anesthetized for right hemicolectomy with isoflurane & nitrous oxide. Vecuronium is administered to facilitate muscle relaxation. At the end of the operation, the neuromuscular blockade is reversed with neostigmine 4 mg & glycopyrrolate 0.8 mg. The rhythm below is noted shortly after administration of these drugs. The patient’s blood pressure is 90/60. The most appropriate course of action at this point is
...A. DC cardioversion
...B. Isoproterenol drip
...C. Atropine
...D. Transcutaneous pacemaker
...E. Begin chest compressions

Back 9

923. (C)

Front 10

924. While on cardiopulmonary bypass during elective coronary artery revascularization, the patient is noted to have bulging sclerae. Mean arterial pressure is 50 mm Hg, temperature is 28° C, & there is no ECG activity. The most appropriate action to take at this time is to
...A. Administer mannitol, 50 gm IV
...B. Administer furosemide, 20 mg IV
...C. Decrease the cardiac index
...D. Check the position of the aortic cannula
...E. Check the position of the venous return cannula

Back 10

924. (E)

Front 11

925. Which of the following correctly describes the effect of transposition of the great vessels on the rate of induction of anesthesia?
...A. Inhalation induction is faster than normal; intravenous induction is slower than normal
...B. Inhalation induction is slower than normal; intravenous induction is faster than normal
...C. Both inhalation & intravenous induction are faster than normal
...D. Both inhalation & intravenous induction are slower than normal
...E. Inhalation induction is normal; intravenous induction is faster than normal

Back 11

925. (B)

Front 12

926. Anastomosis of the right atrium to the pulmonary artery (Fontan procedure) is a useful surgical treatment for each of the following congenital cardiac defects EXCEPT
...A. Tricuspid atresia
...B. Hypoplastic left heart syndrome
...C. Pulmonary valve stenosis
...D. Truncus arteriosus
...E. Pulmonary artery atresia

Back 12

926. (D)

Front 13

927. By what percentage is tissue metabolic rate reduced during cardiopulmonary bypass at 30° C?
...A. 10%
...B. 25%
...C. 50%
...D. 75%
...E. 90%

Back 13

927. (C)

Front 14

928. Effective inflation of an intra-aortic balloon catheter should occur at which of the following times?
...A. Immediately after P wave on ECG
...B. Immediately after closure of aortic valve
...C. During opening of the aortic valve
...D. During systolic upstroke on arterial tracing
...E. At midpoint of QRS complex

Back 14

928. (B)

Front 15

929. Afterload reduction is beneficial during anesthesia for noncardiac surgery in patients with each of the following conditions EXCEPT
...A. Aortic insufficiency
...B. Mitral regurgitation
...C. Tetralogy of Fallot
...D. Congestive heart failure
...E. Patent ductus arteriosus

Back 15

929. (C)

Front 16

930. Administration of protamine to a patient who has not received heparin can result in
...A. Anticoagulation
...B. Hypercoagulation
...C. Profound bradycardia
...D. Seizure
...E. Hypertension

Back 16

930. (A)

Front 17

931. The primary determinants of myocardial O2 consumption, from most to least important, are
...A. Preload > afterload > heart rate
...B. Heart rate > preload > afterload
...C. Afterload > preload > heart rate
...D. Heart rate > afterload > preload
...E. Afterload > heart rate > preload

Back 17

931. (D)

Front 18

932. Cardiac tamponade is associated with
...A. Pulsus alternans
...B. Pulsus tardus
...C. Pulsus parvus
...D. Pulsus paradoxus
...E. Bisferiens pulse

Back 18

932. (D)

Front 19

933. Which of the following drugs should NOT be administered via an endotracheal tube?
...A. Lidocaine
...B. NaHCO3
...C. Atropine
...D. Naloxone
...E. Epinephrine

Back 19

933. (B)

Front 20

934. The mean arterial pressure in a patient with a blood pressure of 180/60 mm Hg is
...A. 90 mm Hg
...B. 100 mm Hg
...C. 110 mm Hg
...D. 120 mm Hg
...E. 130 mm Hg

Back 20

934. (B)

Front 21

935. Hypothyroidism & hyperthyroidism could develop in patients receiving which of the following antidysrhythmic drugs?
...A. Amiodarone
...B. Verapamil
...C. Phenytoin
...D. Lidocaine
...E. Procainamide

Back 21

935. (A)

Front 22

936. Calculate the systemic vascular resistance (in dynes/sec/cm–5) from the following data: cardiac output 5.0 L/min, central venous pressure 8 mm Hg, mean arterial blood pressure 86 mm Hg, mean pulmonary arterial blood pressure 20 mm Hg, pulmonary capillary wedge pressure 9 mm Hg, heart rate 85 beats/min, patient weight 100 kg.
...A. 750
...B. 1000
...C. 1250
...D. 1500
...E. Cannot be calculated

Back 22

936. (C)

Front 23

937. Which of the following is NOT included in tetralogy of Fallot?
...A. Patent ductus arteriosus
...B. Right ventricular hypertrophy
...C. Ventricular septal defect
...D. Overriding aorta
...E. Pulmonic stenosis

Back 23

937. (A)

Front 24

938. A 65-year-old female patient with sepsis is undergoing an emergency exploratory laparotomy. After induction of anesthesia & tracheal intubation, the patient’s blood pressure is noted to be 65 systolic with a heart rate of 120 beats/min. Cardiac output determined by a thermodilution pulmonary artery catheter is 13 L/min. Of the following vasopressors the LEAST appropriate choice would be
...A. Dobutamine
...B. Dopamine
...C. Norepinephrine
...D. Epinephrine
...E. Phenylephrine

Back 24

938. (A)

Front 25

939. Characteristics of ß2 stimulation include each of the following EXCEPT
...A. Inhibition of insulin secretion
...B. Glycogenolysis
...C. Gluconeogenesis
...D. Renin secretion
...E. Uterine relaxation

Back 25

939. (A)

Front 26

940. A 61-year-old male patient with hypertropic cardiomyopathy is scheduled for left ventricular myectomy under general anesthesia. Which of the following anesthetics would provide the most stable hemodynamics in this patient?
...A. N2O-narcotic
...B. Ketamine
...C. Halothane
...D. Sevoflurane
...E. Isoflurane

Back 26

940. (C)

Front 27

941. A healthy 59-year-old, 60-kg woman with a normal preoperative ECG develops wide complex tachycardia under general anesthesia for breast biopsy. Blood pressure is 81/47 mm Hg & heart rate is 220 beats/min & regular. The most appropriate therapy would be
...A. Electrical cardioversion
...B. Administration of lidocaine, 60 mg IV
...C. Administration of procainamide, 20 mg/min IV
...D. Administration of amiodarone, 300 mg IV
...E. Adenosine, 6 mg IV

Back 27

941. (A)