Bioscience Quiz 2

1. Which of the following is not one of the layers of blood vessels?

Tunica Intima

Tunica Media

Tunica Externa

Tunica Venosum

2. Through what artery is blood supplied to the brain?

External Carotid

External Jugular

Internal Carotid

Internal Jugular

3. Atherosclerosis is usually considered to be a localized process and will not affect other portions of the arterial system.

True

False

4. You are doing a pre-op for a pt who will be coming in next Tuesday for spinal surgery. This patient has a history of HTN and wants to know when he should stop taking his medication for the surgery. What do you say?

Take your last dose the night before since you must remain NPO for 8 hours prior to surgery.

Take a double dose of medication the night before, this way it will last until surgery.

Wait until you come to the hospital that morning, then take your medication only after we have measured your BP.

Take your morning pill as scheduled with a small sip of water in the AM.

5. Where can the point of maximal impulse (and best auscultation of S1) be found on a normal patient?

4th right intercostals space

3rd left intercostals space

5th left intercostals space

3rd right intercostals space

6. After perfusing the myocardium, blood returns to the right atrium via the…

Coronary Sinus

Internodal Pathways

Left circumflex artery

Sinus of Vasalva

7. COMIC RELIEF: From the wonderful world of nature...

I never knew Spiders could 'pop a cap' in someones ass.

Ha ha ha ha!!!! I like Caffeine Spider!

Nice web Mr.Crack spider

All the Above

8. Which of the following would be a normal cardiac output?

3 L/min

950 dynes

6 L/min

10 L/min

9. The more distal the aortic cross clamp, the fewer side effects (such as decreased CO) you will have

True

False

10. The cells of the heart are self-excitatory in nature, and thus make the heart a highly efficient pump.

True

False

11. Collateral circulation temporarily allows adequate circulation to the tissues to occur and is important in disease states such as PVD.

True

False

12. Atrial kick contributes how much to ventricular filling?

10-15%

40-50%

20-30%

35-40%

13. Which of the following is not one of the pathphysiologic processes that affect arteries?

Plaque formation

Thrombosis

Aneurysm formation

Neuropathy

14. What effect will drainage of CSF have on post-op risk of paraplegia following aortic aneurysm repair?

Increase risk by removing nutrients contained in CSF

Risk will not change

Decrease risk by increasing perfusion pressure

15. For a patient with aortic stenosis, would you want a slower or faster heart rate?

Faster

Slower

Maintain baseline heart rate

16. Which of the following slows down conduction of electrical activity across the heart and thus allow for ‘atrial kick’?

AV node

SA node

Purkinje Fibers

Internodal Pathway

17. The only direct connection between the atria and ventricles is the…

SA Node

AV node

Sinus of Valsava

Purkinje Fibers

18. Which of the following has the thickest myocardial layer?

Left ventricle

Right Ventricle

Left Atria

Right Atria

19. Where does exchange of fluids, nutrients and electrolytes occur between cells?

Arterioles

Capillaries

Venules

All the above

20. Immediately following extubation of a pt who required general anesthesia for a carotid endarterectomy, what should you do?

Start fluid replacement, as post-op requirements are increased

Perform neuro assessment

Assess peripheral pulses

21. Will a patient with tricuspid valve area of 7cm² exhibit any signs of tricuspid insufficiency?

No, because that’s the normal area

No, not enough narrowing to exhibit symptoms yet

Yes

22. How would Aortic stenosis effect cardiac output?

Decrease CO by increasing afterload

Increase CO through incomplete closure of valve

No change on CO

Decrease CO through decrease in preload

23. The venous system contains approximately how much of the total blood volume?

20%

50%

60%

40%

24. The internal and external jugular veins drain blood from which part of the body?

Head and Neck

Upper Extremities

Thorax

All the above

25. The abdominal aorta terminates at…

Common Iliac arteries

Femoral Arteries

Gastroduodenal Arteries

Renal Arteries

26. Which of the following results in acute ischemia?

Plaque formation

Thrombosis

Aneurysm formation

Neuropathy

27. Which of the following vascular procedures most likely will not require an A-line for BP monitoring?

Fem pop bypass

Endovascular AAA repair

Insertion of AV fistula

Carotid endarterectomy

28. Postoperative renal failure is most correlated to which of the following?

Presence of atherosclerotic disease

The level of cross clamping of the aorta

Pre-op renal dysfunction

Pre-op cardiac function

29. The AV node receives its blood supply from what artery in the majority of patients?

Left Anterior descending artery

Right Coronary Artery

Circumflex Artery

Coronary Sinus

30. An increase in myocardial oxygen demand will have what effect on heart rate?

No effect, as myocardium can extract more oxygen from hemoglobin

Increased heart rate to increase coronary blood flow

Decrease heart rate to allow greater filling time

All the above are possible

31. You are SRNA for Ms. Tathum who came in after a MVA. She had trauma to her chest and is coming in for an emergent procedure. She already has an A-line and central line in place, but you are taking a quick peek at her before the procedure. She is currently hypotensive and the SBP goes even lower with inspiration (by 15 mm Hg). You see she has JVD and her heart sounds are muffled., while her CXR shows an enlarged cardiac silhouette. What is Ms. Tathum’s diagnosis?

Acute Pericarditis

Cardiomyopathy

Cardiac ischemia

Cardiac Tamponade

32. A patient will generally have symptoms of mitral stenosis once the valve surface area has been reduced to…

2 cm2

6 cm2

8 cm2

4 cm2

33. Volatile anesthetic agents will cause coronary vasoconstriction and decrease myocardial oxygen demand.

True

False

34. With any type of valvular regurgitation you want your HR to be ______ while with any type of stenosis your want you HR to ______.

Slow, Fast

Equivalent to baseline, rapid

Fast, Slow

Rapid, equivalent to baseline

35. Where would be optimal placement of an A-line for a patient having surgery on the descending aorta?

Right Radial A-line

Femoral A-line

Left Radial A-line

Wherever the heck you can get it.

36. At what level would you wish to maintain ETCO2 during carotid endarterectomy?

Normocapnic

Hypocapnic

Hypercapnic

37. Which layer of the cardiac musculature provides strength during contraction?

Epicardium

Endocardium

Myocardium

Pericardium

38. Acute ETOH intoxication will have what effect on ventricular performance?

Increase contractility

Decrease contractility

Cause irregular ventricular rate

Decrease heart rate

39. What would be an appropriate dose of heparin to give to a 60 kg pt prior to cross clamping of the aorta?

18,000 units, followed by an ACT

2,500 units

5,000 units

Infusion of 100 u/kg/hr to run while aorta is clamped

40. Which of the following does not directly affect ventricular performance?

Preload

Afterload

Heart Rate

Coronary Perfusion

41. What type of anesthetic management would you choose for a patient with severe CAD and an EF of 20%, this patient is having removal of a lung mass?

Volatile anesthetic based technique, to maintain favorable myocardial supply-demand.

Manage with opiod based anesthetic due to depressed ventricular function.

Perform regional anesthesia with moderate sedation

Cancel the case.

42. Aortic cross clamping may have all of the following side effects except for what?

RV failure

Increased LV afterload

Severe HTN

Paraplegia

43. Which of the following would not be considered mandatory for most aortic surgeries?

Insertion of an A-line

Double Lumen ETT

PAP monitoring

Foley Catheter

44. Which layer of the cardiac musculature consists of an endothelium and a layer of connective tissue?

Epicardium

Pericardium

Myocardium

Endocardium

45. Prior to cross clamping of the suprarenal aorta, which of the following drugs would be useful in helping to prevent renal failure?

Mannitol

Heparin

Dopamine

Neosynephrine

46. You are caring for Mr. Tisci today. He came in several days and was diagnosed with an acute MI. He was treated in cath lab and is now a patient on your floor. Within the past day he has developed and just now started complaining of chest pain. He says it came on suddenly and is frightened he is having another heart attack, he is currently sitting up in bed and leaning forward which he states helps some. You auscultate his chest and hear a creaking, scratching noise in his chest. His ECG shows ST elevation in the precordial leads, but when you send cardiac enzymes they come back normal. What do you think is wrong with Mr. Tisci?

Acute Pericarditis

Cardiac tamponade

Acute heart failure

Early phase of new MI

47. Which of the following has the greatest effect on SVR?

Constriction of arterioles

Constriction of veins

Constriction of capillaries

Constriction of conducting arteries

48. Aortic Aneuryms most commonly involve which part of the aorta?

Ascending

Descending

Aortic Arch

Abdominal

49. Ischemic cerebrovascular disease accounts for what percentage of strokes?

80%

50%

60%

95%

50. A patient with aortic stenosis (but not CHF) will generally have all of the following except what?

Dyspnea on exertion

A-fibrillation

Left Ventricular hypertrophy

Angina

51. Which of the following is not one of three major venous drainage routes in the heart?

Coronary Sinus

Anterior Cardiac Veins

Obtuse marginal vein

Thebesian veins

52. Hypertension is a significant cause of cardiomyopathy and CHF due to increased…

Atherosclerosis

Afterload

Preload

Cardiac Output

53. After giving 5,000 units of heparin to a 50 kg at 8:30 am, the surgeon now tells you he is ready for you to give protamine. It is currently 9:30 am, what is an appropriate dose of protamine to give?

Do not give, Heparin should be out of the pts system

50 mg

100 mg

25 mg

54. Which of the following pts would be a good candidate for endovascular aortic aneurysm repair with neuraxial blockade?

Mr. A with a transverse aortic aneurysm

Mrs. B with a descending aortic aneurysm

Mr. C with an abdominal aortic aneurysm

Mrs. D with an ascending aortic aneurysm

55. A patient who has arteriosclerosis is also likely to be more prone to all of the following except what?

Arrythmias

HTN

Insufficient perfusion to tissues

Aneurysms

56. Which of the following would be a normal surface area for the mitral valve?

7 cm2

5 cm2

3 cm2

8 cm2

57. Surgery to correct a lesion in which of the following locations would require cardiopulmonary bypass?

Descending Aorta

Abdominal aorta

Transverse aorta

All the above

58. You are having a bad dream tonight… your dreaming of school related material!! In your dream you are an ICU nurse again and are receiving a pt from the ER with a distal aortic dissection. The Dr. wants the pt to be managed in the ICU prior to stent placement. The Dr. forgets to write Blood Pressure parameters for this pt… but since you are smart you know you want your systolic BP where?

70-90

90- 120

120-140

Within 10% of pts baseline pressure, as any changes may effect progression of aneurysm.

59. Which of the following is more likely to cause symptoms with a smaller fluid volume?

Chronic constrictive percarditis

Acute pericarditis

Both conditions require only a small amount of excess fluid to cause symptoms

60. Which of the following is not a true of anesthetic management for a patient with Mitral Stenosis?

Avoid hypovolemia

Epidural is preferable to regional anesthesia

Avoid giving too much fluid

Ideal HR is 80-100 bpm.

61. Which of the following will not effect the movement of fluid volume in the microcirculation?

Interstitial fluid pressure

Intracellular fluid pressure

Capillary pressure

Plasma colloid osmotic pressure

62. Extent of disability associated with PVD is influenced most by…

Amount of collateral blood flow

Severity of stenosis within arteries

Presence of aneurysms

Fluid volume status

63. Why would you be cautious when treating hypertension associated with aortic cross clamping?

You may increase risk for post-op renal failure

Pt needs high BP in order to maintain adequate perfusion to spinal cord

You may cause severe hypotension below the level of the clamp

You will increase risk of intra-op MI

64. Which of the following is not true regarding post-op considerations for the patient undergoing aortic surgery?

These patients will most likely remain intubated post op

Need for pain control is minimal as hypotension should be avoided and pts remain intuabted

There is an increased need for maintenance fluids in post-op period

Initial post-op emphasis should be on maintaining hemodynamic stability

65. You are caring for a pt with CAD and are asked what muscle relaxant would be a good choice for this patient. How do you respond?

Vecuronium would be a good choice

Succinylcholine would be a good choice

Choice of muscle relaxants does not matter

Muscle relaxants are contraindicated due to pt condition

66. Which of the following would not be helpful to prevent severe hypotension following release of aortic cross clamp?

Volume Loading

Administration of Sodium Bicarb

Partial or slow release of cross clamp

Decreasing anesthetic depth

67. A patient with pulmonary hypertension may also experience ________ due to increased resistance to blood flow.

Left ventricular hypertrophy

Right ventricular hypertrophy

Left Atrial thickening

None of above

68. Which of the following patients is not eligible to undergo an elective arthroscopy?

Mrs. F who had an MI 3 months ago

Mr. H who has a history of CHF, but is currently well controlled

Mrs. E who has severe aortic stenosis

Mr. Q who is currently in a-fib

69. Where would be optimal placement of an A-line for a patient having surgery on the ascending aorta?

Right Radial A-line

Femoral A-line

Left Radial A-line

Wherever the heck you can get it.

70. What is the function of the sinus of Valsalva?

It is a Specialized conduction pathways readily spreads electrical activity from one atrium to the other

Acts as a reservoir for oxygenated blood from pulmonary veins

Allows aortic valve to open fully without compromising blood flow to myocardium.

71. You are caring for 19 yr old Mr. Gerrad today who has a past history of heart transplantation at age 5. During surgery he becomes slightly bradycardic. Which of the following medication would be best to increase his HR?

Phenylephrine

Atropine

Glycopyrolate

Isuprel

72. Weakening of the vessel walls may result in which of the following?

Plaque formation

Thrombosis

Aneurysm formation

All of the above

73. Which of the following is not an advantage of endovascular repair of aortic aneurysm?

Decreased incidence of renal dysfunction

Improved hemodynamic stability

Decreased post-op discomfort

Decreased incidence of lower extremity ischemia

74. When monitoring pts who have vascular disease we are most concerned with early detection of…

Hypoxia

Atrial Arrythmias

Poor peripheral perfusion

Cardiac Ischemia

75. You are the SRNA today for Mrs. Issary who has a PMH of Shoulder sx, knee sx, and Marfan’s syndrome. Your preceptor decides to pimp you and asks you what condition this pt would be at an increases risk for. Your answer is?

Myocardial Infarction

Valvular regurgitation

Thrombosis

Aortic aneurysm

76. What is the fixation point for cardiac musculature?

Coronary Sulcus

Chordea tendonae

Annulus Fibrosis

Endocardium

77. End diastolic left ventricular volume is also known as what?

Preload

Afterload

SVR

Cardiac Index

78. Which of the following would not help to decrease the risk of neurological injury and deficits post op for a patient undergoing a carotid endarterectomy?

Decreasing pre-op hypertension

Maintenance fluid with D5W

Maintaining normocapnia

All above help to reduce post-op deficits

79. Which of the following is not a compensatory mechanism associated with Heart failure?

Decreased preload

Increased sympathetic tone

Increased afterload due to release of AVP

Ventricular hypertrophy

80. What are the two most important preoperative risk factors for predicting CV complications following noncardiac surgery? (two answers)

History of DVT or PE

History of recent MI

Uncontrolled HTN

Evidence of CHF

Submit

81. Which layer of the blood vessel walls contains smooth muscle and is able to contract and dilate?

Tunica Intima

Tunica Media

Tunica Externa

Tunica Venosum

82. A patient with decreased diastolic BP may experience which of the following?

Supraventricular tachycardia

Decreased right ventricular perfusion

Increased aortic pressure

Decreased left ventricular perfusion

83. You are the SRNA for Mr. Cora today who has a past history of HTN, CHF, CAD, PVD, Bil BKA, and DM. When inducing this patient your preceptor asks you how the anesthesia will affect this pt. What do you say?

This pt may have an exaggerated response to induction agents and to stimulation

This pt has a low cardiac output which will only be worsened when anesthesia decreases the preload and afterload

Anesthesia can cause a decrease in circulating catecholamine and this may lead to acute cardiac decompensation.

Be a super star and say all the above.

84. Congestive heart failure may result in what type of displacement of the point of maximal impulse?

No displacement at all

Right displacement

Cephalad displacement

Lateral displacement

85. How would Mitral valve stenosis affect cardiac output?

Decrease CO by increasing afterload

Increase CO through incomplete closure of valve

No change on CO

Decrease CO through decrease in preload

86. Which of the following is not true regarding anesthetic management of a patient chronic constrictive pericarditis who is going in for pericardiectomy?

You should have an A-line or large bore IV for these pts

Positive pressure ventilation is contraindicated for these patients

The patient should be given metoprolol prior to surgery to decrease HR and preload

CABG pump should be ready and on stand-by during procedure

87. Unstable angina frequently occurs after an MI.

True

False

88. Which of the following will not increase the incidence of post-op renal failure following aortic surgery?

Prolonged cross clamp time

Pre-op renal dysfunction

Emergency procedure

Prolonged Hypertension

89. Which of the following properly describes a pseudoaneurysm?

Thickening of all layers of vessel walls, giving appearance of a distended aorta but without an actual aneurysm being present.

Results from thromboembolic occlusion of the aorta

90. You are the SRNA for a pt about to undergo repair of a L wrist fracture. This pt has a past history of HTN and after you have induced the pt becomes profoundly hypotensive. You are at a little over MAC on sevoflurane. The surgeon will make his incision in about 5 minutes, what do you do?

Just wait, hypotension for a few minutes wont hurt

Turn down your VAA, to help bring up the pressure

Give some pressors for now but maintain VAA at current level

Turn to your preceptor and beg for help… making decisions is stressful!

you don’t want to turn down VAA prior to incision as this is most common event precipitating intra-op HTN. Just give pressors and after incision if BP does not go up turn down gas.

Explanation

you don’t want to turn down VAA prior to incision as this is most common event precipitating intra-op HTN. Just give pressors and after incision if BP does not go up turn down gas.

91. Surgery on which part of the aorta will most likely require use of a double lumen ETT?

Ascending

Descending

Aortic Arch

Abdominal

92. Long rewarming periods associated with aortic arch surgeries may lead to which of the following?

Increased blood loss

Decreased drug requirements

Increased risk of arrhythmias

All the above

93. Which layer of the cardiac musculature is most vulnerable to ischemia during episodes of decreased coronary perfusion?

Endocardium

Myocardium

Epicardium

Pericardium

94. What would be an appropriate amount of fluid replacement for insensible loss for a 70 kg male undergoing repair of an AAA?

700 ml/hr

110 ml hr

350 ml/hr

200 ml/hr

95. Which of the following would provide an alternative blood return route to the SVC if the IVC is obstructed?

Brachiocephalic Veins

Azygos System

Internal Iliac veins

Sagittal Sinuses

96. You are the SRNA for a pt who is having surger to repair an aneurysm on the aortic arch. You are excited because this is a big procedure! You are reviewing special considerations for cases like this and would expect to do all of the following interventions, except for what?

After pt is on CPB, pack the pt in ice

Start a thiopental infusion

Administer Dexamethasone

Use a double lumen ETT

97. Which of the following is not a branch of the descending thoracic aorta?

Bronchial Arteries

SubCostal Arteries

Pericardial Arteries

Splenic Artery

98. What is the function of the pericardium?

To protect heart against inflammation and infection

Is highly vascularized and provides bloodflow to coronary arteries

Provides ‘atrial kick’ to the ventricles

Stabilizes heart to its anatomic position

99. Which of the following will not help reduce the incidence of post-op paraplegia following aortic surgies?

Monitoring SSEP’s

Giving Mannitol

Administratin of thiopental infusion

Draining CSF through lumbar catheter

100. The idea that vessels will dilate, or release substances to cause dilation, in response to hypoxemia is states by which theory of capillary blood flow?

Oxygen Demand Theory

Capillary response theory

Vasodilator theory

Collateral circulation theory

101. A patient with acute aortic regurge is likely to have all of the following except:

Decreased Stroke Volume

Pulm Edema

Eccentric Hypertrophy

Low SVR

102. You are the SRNA for Mr. Tory today. He is just post-op from a surgery to repair an abdominal aortic aneurysm. His urine output has been pretty low and the nurses are asking you for something to help. Which of the following medication would be the best choice?

Mannitol

Dopamine

Fenoldopam

Furosemide