Cardiac 3, Cardiovascular Physiology And Anesthesia

Front 1

970. Useful therapy for hypercyanotic “tet spells” in patients with tetralogy of Fallot might include any of the following EXCEPT
...A. Esmolol
...B. Lactated Ringer’s solution bolus (5 mL/kg)
...C. Phenylephrine
...D. Isoproterenol
...E. Morphine

Back 1

970. (D)

Front 2

971. Sildenafil (Viagra) belongs to the same class of drugs as which of the following?
...A. Yohimbine
...B. Nitroglycerin
...C. Enalapril
...D. Milrinone
...E. Hydralazine

Back 2

971. (D)

Front 3

972. What is the minimal time after angioplasty & placement of a drug eluting stent that dual antiplatelet therapy should be continued before considering stopping it for elective surgery?
...A. 3 months
...B. 6 months
...C. 1 year
...D. 18 months
...E. Never

Back 3

972. (C)

Front 4

973. Hirudin is used in patients with
...A. Heparin resistance
...B. Protamine allergy
...C. Heparin induced thrombocytopenia type I
...D. Heparin induced thrombocytopenia type II
...E. Antithrombin deficiency

Back 4

973. (D)

Front 5

974. Which of the following anatomical sites is associated with the LEAST incidence of central line infection?
...A. Internal jugular vein
...B. External jugular vein
...C. Subclavian vein
...D. Femoral vein
...E. The incidence is roughly equal for all sites

Back 5

974. (C)

Front 6

975. The effects of clopidogrel (Plavix) can be reversed with
...A. Fresh frozen plasma
...B. Protamine
...C. Aprotinin
...D. Factor VIII concentrate
...E. None of the above

Back 6

975. (E)

Front 7

976. A disadvantage of port access coronary artery bypass surgery utilizing the da Vinci Robot versus “standard” coronary artery revascularization with cardiopulmonary bypass is
...A. Need for hypothermic cardiac arrest
...B. Greater incidence of intraoperative hypoxia
...C. Greater incidence of trauma to sternum
...D. Increased transfusion requirements
...E. Increased risk of neuropsychiatric deficits

Back 7

976. (B)

Front 8

977. A right sided double lumen tube will be used to separate ventilation of the right & left lungs for a left pneumonectomy. The plan for placement is to insert the distal tube into the trachea with a laryngoscope & then to advance the distal tube into the right mainstem bronchus under bronchoscopic guidance. After insertion of the tube with the laryngoscope, CO2 is seen on mass spectrometer & the scope is passed through bronchial port until it exits the tube inside the lumen of the patient’s airway. A structure is seen which appears to be the carina. The scope is then passed into the right branch & the structure in the picture below is visualized. The scope is located in the
...A. Right mainstem bronchus
...B. Left mainstem bronchus
...C. Lingular segment
...D. Right upper lobe
...E. Left upper lobe

Back 8

977. (D)

Front 9

978. Which of the following maneuvers (after assuring proper tube placement) is LEAST likely to raise the PaO2 during one-lung ventilation with a double lumen endotracheal tube?
...A. Continuous positive airway pressure (CPAP) to the non-dependent lung
...B. Positive end-expiratory pressure (PEEP) to the dependent lung
...C. Clamping the pulmonary artery by surgeon during pneumonectomy
...D. Raising mean arterial pressure from 60 to 85 mm Hg
...E. Continuous infusion of epoprostenol (Flolan) via central line

Back 9

978. (E)

Front 10

979. Which of the following drugs or interventions will cause the LEAST increase in heart rate in the transplanted denervated heart?
...A. Glucagon
...B. Atropine
...C. Isoproterenol
...D. Norepinephrine
...E. Pacemaker

Back 10

979. (B)

Front 11

980. A patient with known Wolff-Parkinson-White syndrome develops a wide complex tachycardia during a hernia operation under general anesthesia. Vital signs are stable & pharmacologic treatment is desired. Which of the following drugs is most likely to be successful in controlling heart rate in this patient?
...A. Verapamil
...B. Esmolol
...C. Adenosine
...D. Digoxin
...E. Procainamide

Back 11

980. (E)

Front 12

981. A 63-year-old patient with a DDD-R pacemaker is scheduled for right hemicolectomy. The indication for pacemaker implantation was sick sinus syndrome & the pacemaker has been reprogrammed to the asynchronous (DOO) mode at a rate of 70 for surgery. After induction, the patient’s native heart rate rises to 85 beats/min with blood pressure 130/90 mm Hg. Which of the following actions would be most appropriate?
...A. Turn off pacemaker for duration of case
...B. Administer lidocaine
...C. Administer esmolol
...D. Change volatile from isoflurane to desflurane & deepen anesthetic
...E. Observe

Back 12

981. (C)

Front 13

982. The main advantage of milrinone is that it lacks which side effect, compared with amrinone for long term use?
...A. Tachycardia
...B. Hypothyroidism
...C. Thrombocytopenia
...D. Hyperglycemia
...E. Pulmonary toxicity

Back 13

982. (C)

Front 14

983. Systemic inflammatory response syndrome (SIRS) differs from sepsis in that patients with SIRS have
...A. A normal temperature
...B. A heart rate less than 90 beats/min
...C. A normal white blood cell (WBC) count
...D. A normal Paco2 level
...E. No documented infection

Back 14

983. (E)

Front 15

984. Arrange the percutaneous insertion sites from nearest to farthest for placement of a pulmonary artery catheter.
...A. Left internal jugular, right internal jugular, antecubital, femoral
...B. Right internal jugular, left internal jugular, antecubital, femoral
...C. Right internal jugular, left internal jugular, femoral, antecubital
...D. Left internal jugular, right internal jugular, femoral, antecubital
...E. Right internal jugular, femoral, left internal jugular, antecubital

Back 15

984. (C)

Front 16

985. A pulmonary artery catheter capable of continuously monitoring is placed in a patient for coronary artery bypass surgery. Just before instituting cardiopulmonary bypass, the falls from 85% to 71%. Which of the following could account for this change in ?
...A. Cooling the patient to 27° C
...B. Transfusion of 2 units packed RBCs
...C. Epinephrine, 25 μg IV
...D. Myocardial ischemia
...E. Administration 1 g CaCl2

Back 16

985. (D)

Front 17

986. Which of the following terms refers to myocardial relaxation or diastole
...A. Inotropy
...B. Chronotropy
...C. Dromotropy
...D. Bathmotropy
...E. Lusitropy

Back 17

986. (E)

Front 18

987. A 31-year-old female with primary pulmonary hypertension is scheduled for a mastectomy. Pharmacologic agents that might be useful in reducing pulmonary vascular resistance include each of the following EXCEPT
...A. Prostaglandin I2 (epoprostenol)
...B. Oxygen
...C. Nitric oxide
...D. Milrinone
...E. Nitrous oxide

Back 18

987. (E)

Front 19

988. Pulmonary vascular resistance as a function of lung volume is the LEAST at which volume?
...A. Total lung volume
...B. Residual volume
...C. Functional residual capacity (FRC)
...D. Expiratory reserve volume
...E. Depends on the fluid volume status of the patient

Back 19

988. (C)

Front 20

989. A 45-year-old patient with hypertrophic cardiomyopathy is anesthetized for skin grafting after suffering third degree burns on his legs. As skin is being harvested from his back, his heart rate rises & his systolic blood pressure falls to 85 mm Hg. Which of the following interventions is LEAST likely to improve this patient’s hemodynamics?
...A. Administration of esmolol
...B. Fluid bolus
...C. Dobutamine infusion
...D. Administration of sufentanil
...E. Phenylephrine infusion

Back 20

989. (C)

Front 21

990. A 59-year-old patient is scheduled for right knee replacement. The patient has a long history of congestive heart failure (CHF) with room air O2 saturation of 87% in the holding area. Rales are audible throughout both lung fields with the patient upright. The most appropriate plan would be
...A. Arterial line & spinal with isobaric bupivacaine
...B. Arterial line, etomidate induction, sevoflurane, intraoperative TEE
...C. Arterial line, propofol induction, N2O, isoflurane, pulmonary artery catheter
...D. Arterial line, central venous pressure line (CVP) ketamine induction, N2O narcotic anesthetic, furosemide, milrinone
...E. Cancel the case

Back 21

990. (E)

Front 22

991. Which of the following drugs is LEAST likely to cause unfavorable hemodynamic changes in patients with severe mitral stenosis?
...A. Ketamine
...B. Remifentanil
...C. Pancuronium
...D. Desflurane
...E. Nitrous oxide

Back 22

991. (B)

Front 23

992. You made an infusion of dopamine by mixing 200 mg of dopamine in 250 mL of sodium chloride (NS) or 5% dextrose injection (D5W). What is the infusion pump rate when infusing dopamine at a rate of 5 μg/kg/min for this 70-kg patient?
...A. 6 mL/hr
...B. 10 mL/hr
...C. 16 mL/hr
...D. 20 mL/hr
...E. 26 mL/hr

Back 23

992. (E)

Front 24

993. The following are ideal parameters for the anesthetic management of high filling pressures, high systemic vascular resistance (SVR) & fast heart rate?
...A. Aortic stenosis
...B. Mitral stenosis
...C. Aortic insufficiency
...D. Cardiac tamponade
...E. Hypertrophic cardiomyopathy (HOCM)

Back 24

993. (D)

Front 25

994. Which of the following treatments would be the LEAST useful in treatment of the rhythm shown below?
...A. Procainamide
...B. Magnesium
...C. Overdrive pacing
...D. Unsynchronized cardioversion
...E. Isoproterenol infusion

Back 25

994. (A)

Front 26

995. P wave flattening, widening of the QRS complex, peaked T wave

DIRECTIONS: (Questions 995 through 997) each group of questions consists of several numbered statements followed by lettered headings. For each numbered statement select the ONE lettered heading that is most closely associated with it. Each letter heading may be selected once, more than once or not at all.

Back 26

995. (B)

Front 27

996. Depressed ST segments, flat T wave, U wave present

DIRECTIONS: (Questions 995 through 997) each group of questions consists of several numbered statements followed by lettered headings. For each numbered statement select the ONE lettered heading that is most closely associated with it. Each letter heading may be selected once, more than once or not at all.

Back 27

996. (A)

Front 28

997. Normal or increased PR interval, short QT interval
A. Hypokalemia
B. Hyperkalemia
C. Hyponatremia
D. Hypernatremia
E. Hypercalcemia

DIRECTIONS: (Questions 995 through 997) each group of questions consists of several numbered statements followed by lettered headings. For each numbered statement select the ONE lettered heading that is most closely associated with it. Each letter heading may be selected once, more than once or not at all.

Back 28

997. (E)