Bioscience Quiz 2
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Review of material for test 2 in bioscience covering the cardiovascular system.
- 1.The cells of the heart are self-excitatory in nature, and thus make the heart a highly efficient pump.
- A.
True
- B.
False
- 2.Which of the following slows down conduction of electrical activity across the heart and thus allow for ‘atrial kick’?
- A.
AV node
- B.
SA node
- C.
Purkinje Fibers
- D.
Internodal Pathway
- 3.The only direct connection between the atria and ventricles is the…
- A.
SA Node
- B.
AV node
- C.
Sinus of Valsava
- D.
Purkinje Fibers
- 4.Where can the point of maximal impulse (and best auscultation of S1) be found on a normal patient?
- A.
4th right intercostals space
- B.
3rd left intercostals space
- C.
5th left intercostals space
- D.
3rd right intercostals space
- 5.Congestive heart failure may result in what type of displacement of the point of maximal impulse?
- A.
No displacement at all
- B.
Right displacement
- C.
Cephalad displacement
- D.
Lateral displacement
- 6.Which of the following has the thickest myocardial layer?
- A.
Left ventricle
- B.
Right Ventricle
- C.
Left Atria
- D.
Right Atria
- 7.A patient with pulmonary hypertension may also experience ________ due to increased resistance to blood flow.
- A.
Left ventricular hypertrophy
- B.
Right ventricular hypertrophy
- C.
Left Atrial thickening
- D.
None of above
- 8.Which layer of the cardiac musculature provides strength during contraction?
- A.
Epicardium
- B.
Endocardium
- C.
Myocardium
- D.
Pericardium
- 9.Will a patient with tricuspid valve area of 7cm2 exhibit any signs of tricuspid insufficiency?
- A.
No, because that’s the normal area
- B.
No, not enough narrowing to exhibit symptoms yet
- C.
Yes
- 10.Which of the following would be a normal surface area for the mitral valve?
- A.
7 cm2
- B.
5 cm2
- C.
3 cm2
- D.
8 cm2
- 11.What is the function of the sinus of Valsalva?
- A.
It is a Specialized conduction pathways readily spreads electrical activity from one atrium to the other
- B.
It is the fixation point for cardiac musculature and plays an important role in the structure, function, and efficiency of the heart
- C.
Acts as a reservoir for oxygenated blood from pulmonary veins
- D.
Allows aortic valve to open fully without compromising blood flow to myocardium.
- 12.After perfusing the myocardium, blood returns to the right atrium via the…
- A.
Coronary Sinus
- B.
Internodal Pathways
- C.
Left circumflex artery
- D.
Sinus of Vasalva
- 13.The AV node receives its blood supply from what artery in the majority of patients?
- A.
Left Anterior descending artery
- B.
Right Coronary Artery
- C.
Circumflex Artery
- D.
Coronary Sinus
- 14.Which of the following is not one of three major venous drainage routes in the heart?
- A.
Coronary Sinus
- B.
Anterior Cardiac Veins
- C.
Obtuse marginal vein
- D.
Thebesian veins
- 15.A patient with decreased diastolic BP may experience which of the following?
- A.
Supraventricular tachycardia
- B.
Decreased right ventricular perfusion
- C.
Increased aortic pressure
- D.
Decreased left ventricular perfusion
- 16.Which layer of the cardiac musculature is most vulnerable to ischemia during episodes of decreased coronary perfusion?
- A.
Endocardium
- B.
Myocardium
- C.
Epicardium
- D.
Pericardium
- 17.An increase in myocardial oxygen demand will have what effect on heart rate?
- A.
No effect, as myocardium can extract more oxygen from hemoglobin
- B.
Increased heart rate to increase coronary blood flow
- C.
Decrease heart rate to allow greater filling time
- D.
All the above are possible
- 18.Volatile anesthetic agents will cause coronary vasoconstriction and decrease myocardial oxygen demand.
- A.
True
- B.
False
- 19.Atrial kick contributes how much to ventricular filling?
- A.
10-15%
- B.
40-50%
- C.
20-30%
- D.
35-40%
- 20.Which of the following does not directly affect ventricular performance?
- A.
Preload
- B.
Afterload
- C.
Heart Rate
- D.
Coronary Perfusion
- 21.End diastolic left ventricular volume is also known as what?
- A.
Preload
- B.
Afterload
- C.
SVR
- D.
Cardiac Index
- 22.Which of the following would be a normal cardiac output?
- A.
3 L/min
- B.
950 dynes
- C.
6 L/min
- D.
10 L/min
- 23.How would Mitral valve stenosis affect cardiac output?
- A.
Decrease CO by increasing afterload
- B.
Increase CO through incomplete closure of valve
- C.
No change on CO
- D.
Decrease CO through decrease in preload
- 24.How would Aortic stenosis effect cardiac output?
- A.
Decrease CO by increasing afterload
- B.
Increase CO through incomplete closure of valve
- C.
No change on CO
- D.
Decrease CO through decrease in preload
- 25.For a patient with aortic stenosis, would you want a slower or faster heart rate?
- A.
Faster
- B.
Slower
- C.
Maintain baseline heart rate
- 26.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?
- A.
This pt may have an exaggerated response to induction agents and to stimulation
- B.
This pt has a low cardiac output which will only be worsened when anesthesia decreases the preload and afterload
- C.
Anesthesia can cause a decrease in circulating catecholamine and this may lead to acute cardiac decompensation.
- D.
Be a super star and say all the above.
- 27.A patient who has arteriosclerosis is also likely to be more prone to all of the following except what?
- A.
Arrythmias
- B.
HTN
- C.
Insufficient perfusion to tissues
- D.
Aneurysms
- 28.Hypertension is a significant cause of cardiomyopathy and CHF due to increased…
- A.
Atherosclerosis
- B.
Afterload
- C.
Preload
- D.
Cardiac Output
- 29.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?
- A.
Take your last dose the night before since you must remain NPO for 8 hours prior to surgery.
- B.
Take a double dose of medication the night before, this way it will last until surgery.
- C.
Wait until you come to the hospital that morning, then take your medication only after we have measured your BP.
- D.
Take your morning pill as scheduled with a small sip of water in the AM.
- 30.You are about to wheel Mrs. Tennik back to the OR for a cholecystectomy and find her BP is currently 202/114. What do you do?
- A.
Administer esmolol prior to induction to help control BP during intubation
- B.
Take her back to room and induce her, this will drop her BP
- C.
Cancel the procedure
- D.
Administer labetolol prior to induction to control BP during procedure
- 31.What is your goal during maintenance of anesthesia of a pt with HTN?
- A.
To maintain normotension for majority of procedure
- B.
To maintain BP within 20% of normal mean pressure
- C.
To maintain a low HR in order to maintain CO
- D.
To maintain pt slightly more hypertensive in order to compensate for decreased circulation catecholamines.
- 32.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?
- A.
Just wait, hypotension for a few minutes wont hurt
- B.
Turn down your VAA, to help bring up the pressure
- C.
Give some pressors for now but maintain VAA at current level
- D.
Turn to your preceptor and beg for help… making decisions is stressful!
- 33.What is the function of the pericardium?
- A.
To protect heart against inflammation and infection
- B.
Is highly vascularized and provides bloodflow to coronary arteries
- C.
Provides ‘atrial kick’ to the ventricles
- D.
Stabilizes heart to its anatomic position
- 34.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?
- A.
Acute Pericarditis
- B.
Cardiac tamponade
- C.
Acute heart failure
- D.
Early phase of new MI
- 35.Which of the following is more likely to cause symptoms with a smaller fluid volume?
- A.
Chronic constrictive percarditis
- B.
Acute pericarditis
- C.
Both conditions require only a small amount of excess fluid to cause symptoms
- 36.Which of the following is not true regarding anesthetic management of a patient chronic constrictive pericarditis who is going in for pericardiectomy?
- A.
You should have an A-line or large bore IV for these pts
- B.
Positive pressure ventilation is contraindicated for these patients
- C.
The patient should be given metoprolol prior to surgery to decrease HR and preload
- D.
CABG pump should be ready and on stand-by during procedure
- 37.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?
- A.
Acute Pericarditis
- B.
Cardiomyopathy
- C.
Cardiac ischemia
- D.
Cardiac Tamponade
- 38.Which of the following is not a compensatory mechanism associated with Heart failure?
- A.
Decreased preload
- B.
Increased sympathetic tone
- C.
Increased afterload due to release of AVP
- D.
Ventricular hypertrophy
- 39.What are the two most important preoperative risk factors for predicting CV complications following noncardiac surgery? (two answers)
- A.
History of DVT or PE
- B.
History of recent MI
- C.
Uncontrolled HTN
- D.
Evidence of CHF
- 40.Which of the following patients is not eligible to undergo an elective arthroscopy?
- A.
Mrs. F who had an MI 3 months ago
- B.
Mr. H who has a history of CHF, but is currently well controlled
- C.
Mrs. E who has severe aortic stenosis
- D.
Mr. Q who is currently in a-fib
- 41.Unstable angina frequently occurs after an MI.
- A.
True
- B.
False
- 42.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?
- A.
Vecuronium would be a good choice
- B.
Succinylcholine would be a good choice
- C.
Choice of muscle relaxants does not matter
- D.
Muscle relaxants are contraindicated due to pt condition
- 43.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?
- A.
Volatile anesthetic based technique, to maintain favorable myocardial supply-demand.
- B.
Manage with opiod based anesthetic due to depressed ventricular function.
- C.
Perform regional anesthesia with moderate sedation
- D.
Cancel the case.
- 44.With any type of valvular regurgitation you want your HR to be ______ while with any type of stenosis your want you HR to ______.
- A.
Slow, Fast
- B.
Equivalent to baseline, rapid
- C.
Fast, Slow
- D.
Rapid, equivalent to baseline
- 45.Which of the following is not a true of anesthetic management for a patient with Mitral Stenosis?
- A.
Avoid hypovolemia
- B.
Epidural is preferable to regional anesthesia
- C.
Avoid giving too much fluid
- D.
Ideal HR is 80-100 bpm.
- 46.A patient will generally have symptoms of mitral stenosis once the valve surface area has been reduced to…
- A.
2 cm2
- B.
6 cm2
- C.
8 cm2
- D.
4 cm2
- 47.A patient with aortic stenosis (but not CHF) will generally have all of the following except what?
- A.
Dyspnea on exertion
- B.
A-fibrillation
- C.
Left Ventricular hypertrophy
- D.
Angina
- 48.A patient with acute aortic regurge is likely to have all of the following except:
- A.
Decreased Stroke Volume
- B.
Pulm Edema
- C.
Eccentric Hypertrophy
- D.
Low SVR
- 49.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?
- A.
Phenylephrine
- B.
Atropine
- C.
Glycopyrolate
- D.
Isuprel
- 50.Which of the following has the greatest effect on SVR?
- A.
Constriction of arterioles
- B.
Constriction of veins
- C.
Constriction of capillaries
- D.
Constriction of conducting arteries
- 51.Where does exchange of fluids, nutrients and electrolytes occur between cells?
- A.
Arterioles
- B.
Capillaries
- C.
Venules
- D.
All the above
- 52.The venous system contains approximately how much of the total blood volume?
- A.
20%
- B.
50%
- C.
60%
- D.
40%
- 53.Which layer of the blood vessel walls contains smooth muscle and is able to contract and dilate?
- A.
Tunica Intima
- B.
Tunica Media
- C.
Tunica Externa
- D.
Tunica Venosum
- 54.Which of the following is not one of the layers of blood vessels?
- A.
Tunica Intima
- B.
Tunica Media
- C.
Tunica Externa
- D.
Tunica Venosum
- 55.The internal and external jugular veins drain blood from which part of the body?
- A.
Head and Neck
- B.
Upper Extremities
- C.
Thorax
- D.
All the above
- 56.Which of the following would provide an alternative blood return route to the SVC if the IVC is obstructed?
- A.
Brachiocephalic Veins
- B.
Azygos System
- C.
Internal Iliac veins
- D.
Sagittal Sinuses
- 57.Which of the following is not a branch of the descending thoracic aorta?
- A.
Bronchial Arteries
- B.
SubCostal Arteries
- C.
Pericardial Arteries
- D.
Splenic Artery
- 58.The abdominal aorta terminates at…
- A.
Common Iliac arteries
- B.
Femoral Arteries
- C.
Gastroduodenal Arteries
- D.
Renal Arteries
- 59.Which of the following will not effect the movement of fluid volume in the microcirculation?
- A.
Interstitial fluid pressure
- B.
Intracellular fluid pressure
- C.
Capillary pressure
- D.
Plasma colloid osmotic pressure
- 60.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?
- A.
Oxygen Demand Theory
- B.
Capillary response theory
- C.
Vasodilator theory
- D.
Collateral circulation theory
- 61.Collateral circulation temporarily allows adequate circulation to the tissues to occur and is important in disease states such as PVD.
- A.
True
- B.
False
- 62.Which of the following is not one of the pathphysiologic processes that affect arteries?
- A.
Plaque formation
- B.
Thrombosis
- C.
Aneurysm formation
- D.
Neuropathy
- 63.Which of the following results in acute ischemia?
- A.
Plaque formation
- B.
Thrombosis
- C.
Aneurysm formation
- D.
Neuropathy
- 64.Extent of disability associated with PVD is influenced most by…
- A.
Amount of collateral blood flow
- B.
Severity of stenosis within arteries
- C.
Presence of aneurysms
- D.
Fluid volume status
- 65.Which of the following vascular procedures most likely will not require an A-line for BP monitoring?
- A.
Fem pop bypass
- B.
Endovascular AAA repair
- C.
Insertion of AV fistula
- D.
Carotid endarterectomy
- 66.When monitoring pts who have vascular disease we are most concerned with early detection of…
- A.
Hypoxia
- B.
Atrial Arrythmias
- C.
Poor peripheral perfusion
- D.
Cardiac Ischemia
- 67.Aortic cross clamping may have all of the following side effects except for what?
- A.
RV failure
- B.
Increased LV afterload
- C.
Severe HTN
- D.
Paraplegia
- 68.Surgery to correct a lesion in which of the following locations would require cardiopulmonary bypass?
- A.
Descending Aorta
- B.
Abdominal aorta
- C.
Transverse aorta
- D.
All the above
- 69.Weakening of the vessel walls may result in which of the following?
- A.
Plaque formation
- B.
Thrombosis
- C.
Aneurysm formation
- D.
All of the above
- 70.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?
- A.
Myocardial Infarction
- B.
Valvular regurgitation
- C.
Thrombosis
- D.
Aortic aneurysm
- 71.What is the most serious complication associated with an aortic dissection?
- A.
Aneurysm Rupture
- B.
Paraplegia
- C.
Renal failure
- D.
Left Ventricular Failure
- 72.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?
- A.
70-90
- B.
90- 120
- C.
120-140
- D.
Within 10% of pts baseline pressure, as any changes may effect progression of aneurysm.
- 73.Aortic Aneuryms most commonly involve which part of the aorta?
- A.
Ascending
- B.
Descending
- C.
Aortic Arch
- D.
Abdominal
- 74.Which of the following properly describes a pseudoaneurysm?
- A.
Thickening of all layers of vessel walls, giving appearance of a distended aorta but without an actual aneurysm being present.
- B.
Results from trauma to all layers of vessel wall resulting in only a blood clot forming the outer layer of the aorta
- C.
Results from cross clamping of the aorta which causes aortic area proximal to the clamp to become engorged with blood and increase risk of aortic rupture
- D.
Results from thromboembolic occlusion of the aorta
- 75.Atherosclerosis is usually considered to be a localized process and will not affect other portions of the arterial system.
- A.
True
- B.
False
- 76.Postoperative renal failure is most correlated to which of the following?
- A.
Presence of atherosclerotic disease
- B.
The level of cross clamping of the aorta
- C.
Pre-op renal dysfunction
- D.
Pre-op cardiac function
- 77.When assessing a pt with atherosclerotic disease, special attention should be paid to all of the following systems except for what?
- A.
Respiratory function
- B.
Cardiac Function
- C.
Neurologic Function
- D.
Renal function
- 78.Which of the following would not be considered mandatory for most aortic surgeries?
- A.
Insertion of an A-line
- B.
Double Lumen ETT
- C.
PAP monitoring
- D.
Foley Catheter
- 79.Where would be optimal placement of an A-line for a patient having surgery on the ascending aorta?
- A.
Right Radial A-line
- B.
Femoral A-line
- C.
Left Radial A-line
- D.
Wherever the heck you can get it.
- 80.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?
- A.
After pt is on CPB, pack the pt in ice
- B.
Start a thiopental infusion
- C.
Administer Dexamethasone
- D.
Use a double lumen ETT
- 81.Long rewarming periods associated with aortic arch surgeries may lead to which of the following?
- A.
Increased blood loss
- B.
Decreased drug requirements
- C.
Increased risk of arrhythmias
- D.
All the above
- 82.Surgery on which part of the aorta will most likely require use of a double lumen ETT?
- A.
Ascending
- B.
Descending
- C.
Aortic Arch
- D.
Abdominal
- 83.Why would you be cautious when treating hypertension associated with aortic cross clamping?
- A.
You may increase risk for post-op renal failure
- B.
Pt needs high BP in order to maintain adequate perfusion to spinal cord
- C.
You may cause severe hypotension below the level of the clamp
- D.
You will increase risk of intra-op MI
- 84.Where would be optimal placement of an A-line for a patient having surgery on the descending aorta?
- A.
Right Radial A-line
- B.
Femoral A-line
- C.
Left Radial A-line
- D.
Wherever the heck you can get it.
- 85.The more distal the aortic cross clamp, the fewer side effects (such as decreased CO) you will have
- A.
True
- B.
False
- 86.Which of the following would not be helpful to prevent severe hypotension following release of aortic cross clamp?
- A.
Volume Loading
- B.
Administration of Sodium Bicarb
- C.
Partial or slow release of cross clamp
- D.
Decreasing anesthetic depth
- 87.Which of the following will not help reduce the incidence of post-op paraplegia following aortic surgies?
- A.
Monitoring SSEP’s
- B.
Giving Mannitol
- C.
Administratin of thiopental infusion
- D.
Draining CSF through lumbar catheter
- 88.Which of the following will not increase the incidence of post-op renal failure following aortic surgery?
- A.
Prolonged cross clamp time
- B.
Pre-op renal dysfunction
- C.
Emergency procedure
- D.
Prolonged Hypertension
- 89.Prior to cross clamping of the suprarenal aorta, which of the following drugs would be useful in helping to prevent renal failure?
- A.
Mannitol
- B.
Heparin
- C.
Dopamine
- D.
Neosynephrine
- 90.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?
- A.
Mannitol
- B.
Dopamine
- C.
Fenoldopam
- D.
Furosemide
- 91.What would be an appropriate dose of heparin to give to a 60 kg pt prior to cross clamping of the aorta?
- A.
18,000 units, followed by an ACT
- B.
2,500 units
- C.
5,000 units
- D.
Infusion of 100 u/kg/hr to run while aorta is clamped
- 92.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?
- A.
Do not give, Heparin should be out of the pts system
- B.
50 mg
- C.
100 mg
- D.
25 mg
- 93.What would be an appropriate amount of fluid replacement for insensible loss for a 70 kg male undergoing repair of an AAA?
- A.
700 ml/hr
- B.
110 ml hr
- C.
350 ml/hr
- D.
200 ml/hr
- 94.Which of the following is not true regarding post-op considerations for the patient undergoing aortic surgery?
- A.
These patients will most likely remain intubated post op
- B.
Need for pain control is minimal as hypotension should be avoided and pts remain intuabted
- C.
There is an increased need for maintenance fluids in post-op period
- D.
Initial post-op emphasis should be on maintaining hemodynamic stability
- 95.Which of the following pts would be a good candidate for endovascular aortic aneurysm repair with neuraxial blockade?
- A.
Mr. A with a transverse aortic aneurysm
- B.
Mrs. B with a descending aortic aneurysm
- C.
Mr. C with an abdominal aortic aneurysm
- D.
Mrs. D with an ascending aortic aneurysm
- 96.Which of the following is not an advantage of endovascular repair of aortic aneurysm?
- A.
Decreased incidence of renal dysfunction
- B.
Improved hemodynamic stability
- C.
Decreased post-op discomfort
- D.
Decreased incidence of lower extremity ischemia
- 97.Ischemic cerebrovascular disease accounts for what percentage of strokes?
- A.
80%
- B.
50%
- C.
60%
- D.
95%
- 98.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?
- A.
Decreasing pre-op hypertension
- B.
Maintenance fluid with D5W
- C.
Maintaining normocapnia
- D.
All above help to reduce post-op deficits
- 99.What effect will drainage of CSF have on post-op risk of paraplegia following aortic aneurysm repair?
- A.
Increase risk by removing nutrients contained in CSF
- B.
Risk will not change
- C.
Decrease risk by increasing perfusion pressure
- 100.At what level would you wish to maintain ETCO2 during carotid endarterectomy?
- A.
Normocapnic
- B.
Hypocapnic
- C.
Hypercapnic
- 101.Immediately following extubation of a pt who required general anesthesia for a carotid endarterectomy, what should you do?
- A.
Start fluid replacement, as post-op requirements are increased
- B.
Perform neuro assessment
- C.
Assess peripheral pulses
- D.
Assess peripheral pulses
- 102.What is the fixation point for cardiac musculature?
- A.
Coronary Sulcus
- B.
Chordea tendonae
- C.
Annulus Fibrosis
- D.
Endocardium
- 103.COMIC RELIEF: From the wonderful world of nature...
- A.
I never knew Spiders could 'pop a cap' in someones ass.
- B.
Ha ha ha ha!!!! I like Caffeine Spider!
- C.
Nice web Mr. Crack spider
- D.
All the Above
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