Valvular Heart Disease And Anaesthesia: Quiz

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Quizzes Created: 28 | Total Attempts: 60,100

Questions: 54 | Attempts: 621 | Updated: Mar 18, 2023

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Valvular Heart Disease And Anaesthesia: Quiz - Quiz

Valvular heart disease and anaesthesia: quiz. Vascular heart disease is basically the presence of issues with parts of the heart which cause a problem when it comes to blood flow. It is necessary for people undergoing surgery to be sedated during the process. In this quiz, you will get to test out just how much you know about the characteristics one will exhibit and knowing which ones are expected and how to take care of the patient.

Questions and Answers

1.

During Carotid vascular surgery, BP should be maintained…
- A.
  
  Slightly above pre-op levels
- B.
  
  Slightly below pre-op levels
- C.
  
  Equal to pre-op levels
- D.
  
  Ummm, there is no BP on bypass.
Correct Answer
A. Slightly above pre-op levels

Explanation
During Carotid vascular surgery, maintaining blood pressure slightly above pre-operative levels is important to ensure adequate blood flow to the brain. This is because carotid arteries supply blood to the brain, and any decrease in blood pressure during surgery can lead to a decrease in cerebral perfusion and potential brain damage. By keeping blood pressure slightly above pre-operative levels, the surgeon can help maintain sufficient blood flow to the brain and minimize the risk of complications.

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2.

Which of the following is not necessary for an ASA 3 pt undergoing an Aorta-life bypass?
- A.
  
  Serial H&H and ABG’s
- B.
  
  Bair Hugger for lower extremities
- C.
  
  A-Line
- D.
  
  Fluid Warmer
Correct Answer
B. Bair Hugger for lower extremities

Explanation
In an ASA 3 patient undergoing an Aorta-life bypass, a Bair Hugger for lower extremities is not necessary. A Bair Hugger is a device used to maintain the patient's body temperature during surgery. However, in an Aorta-life bypass procedure, the lower extremities are not directly involved or exposed, so there is no need for a Bair Hugger specifically for the lower extremities. Other measures such as serial H&H and ABG's, an A-Line for continuous blood pressure monitoring, and a fluid warmer may be necessary for the procedure.

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3.

90-95% of AAA’s involve which part of the abdominal aorta?
- A.
  
  Suprarenal
- B.
  
  Juxtarenal
- C.
  
  Infrarenal
- D.
  
  Pararenal
Correct Answer
C. Infrarenal

Explanation
Infrarenal refers to the portion of the abdominal aorta that is located below the renal arteries. AAA (abdominal aortic aneurysm) is a condition characterized by the enlargement or ballooning of the abdominal aorta. The majority of AAA cases, around 90-95%, occur in the infrarenal region of the abdominal aorta. This means that the aneurysm is located below the renal arteries, which are the arteries that supply blood to the kidneys.

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4.

Which of the following disease is not commonly associated with pts undergoing CEA?
- A.
  
  CAD
- B.
  
  Diabetes
- C.
  
  CVA
- D.
  
  Liver dx
Correct Answer
D. Liver dx

Explanation
Liver disease is not commonly associated with patients undergoing carotid endarterectomy (CEA). CEA is a surgical procedure performed to remove plaque buildup from the carotid arteries in order to prevent stroke. Commonly associated diseases with CEA include coronary artery disease (CAD), diabetes, and cerebrovascular accident (CVA) as these conditions often coexist with carotid artery stenosis. However, liver disease is not typically linked to carotid artery disease and therefore not commonly associated with patients undergoing CEA.

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5.

Which of the following is not true regarding the management of a pt undergoing AAA repair?
- A.
  
  During cross-clamp, vasoconstrict to keep BP slightly elevated and restrict fluids
- B.
  
  You should have a central line, A-line, and large bore IV’s
- C.
  
  During cross clamp you should turn off heating blankets
- D.
  
  All the above are true
Correct Answer
A. During cross-clamp, vasoconstrict to keep BP slightly elevated and restrict fluids

Explanation
During cross-clamp, it is important to vasoconstrict to keep the blood pressure slightly elevated and restrict fluids. This is necessary to minimize the risk of bleeding and maintain hemodynamic stability during the procedure. Having a central line, A-line, and large bore IVs is also important to monitor and manage the patient's fluid status and administer medications as needed. Additionally, turning off heating blankets during cross-clamp helps prevent hypothermia, which can have negative effects on the patient's physiology. Therefore, all the statements provided are true except for the statement that says vasoconstriction and fluid restriction should not be done during cross-clamp.

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6.

Which of the following is not an indication to perform endovascular grafting procedure?
- A.
  
  Active Infection
- B.
  
  AAA rupture
- C.
  
  Severe COPD
- D.
  
  Severe cardiac Disease
Correct Answer
B. AAA rupture

Explanation
Performing endovascular grafting procedure is contraindicated in cases of AAA rupture. This is because AAA rupture is a life-threatening emergency that requires immediate surgical intervention, such as open repair or endovascular repair with a stent graft. Endovascular grafting is not suitable for ruptured AAA as it may not provide adequate sealing and may not be able to control bleeding effectively. Therefore, AAA rupture is not an indication for endovascular grafting procedure.

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7.

Which of the following is not a necessity to monitor a pt undergoing a right CEA?
- A.
  
  Left A-line
- B.
  
  Femoral Central catheter
- C.
  
  Large bore IV’s
- D.
  
  Serial ABG’s
Correct Answer
B. Femoral Central catheter

Explanation
A femoral central catheter is not a necessity to monitor a patient undergoing a right CEA. Monitoring a patient undergoing a right CEA typically involves the placement of an arterial line (A-line) in the left arm to monitor blood pressure, large bore IVs for fluid administration, and serial arterial blood gas (ABG) measurements to assess oxygen and carbon dioxide levels. The femoral central catheter is not directly related to the monitoring of a patient undergoing a right CEA procedure.

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8.

What changes would you expect to see in your pt following the release of the aortic cross-clamp?
- A.
  
  Alkalotic ABG
- B.
  
  Sudden increase in SVR
- C.
  
  A sudden increase in ETCO2
- D.
  
  Need for NTG drip
Correct Answer
C. A sudden increase in ETCO2

Explanation
Following the release of the aortic cross-clamp, a sudden increase in end-tidal carbon dioxide (ETCO2) levels would be expected. This is because the release of the cross-clamp allows for improved blood flow and oxygenation to the tissues, leading to increased carbon dioxide production and subsequent elimination. Therefore, the sudden increase in ETCO2 indicates improved tissue perfusion and ventilation.

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9.

Prior to aortic cross-clamp, you administered 7,500 units of heparin to your pt. It has now been one hour and the surgeon is asking you to give protamine. How much should you give?
- A.
  
  26 mg
- B.
  
  75 mg
- C.
  
  90 mg
- D.
  
  38 mg
Correct Answer
D. 38 mg

Explanation
The correct answer is 38 mg. Protamine is a medication used to reverse the anticoagulant effects of heparin. The general guideline for protamine administration is to give 1 mg of protamine for every 100 units of heparin previously administered. In this case, 7,500 units of heparin were given, so the appropriate dose of protamine would be 75 mg (7,500 units divided by 100). However, since it has been one hour since heparin administration, some of the heparin may have already been metabolized. Therefore, a slightly lower dose of protamine, such as 38 mg, may be appropriate.

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1
10.

What is the most common side effect associated with the administration of protamine?
- A.
  
  Hypotension
- B.
  
  Bradycardia
- C.
  
  Hemorrhage
- D.
  
  Allergic reaction
Correct Answer
A. Hypotension

Explanation
The most common side effect associated with the administration of protamine is hypotension. Protamine is a medication used to reverse the effects of heparin, which is commonly used as an anticoagulant. Hypotension refers to low blood pressure, and it can occur as a result of protamine administration due to its vasodilatory effects. This can lead to a decrease in blood flow and oxygen delivery to tissues, potentially causing symptoms such as dizziness, lightheadedness, and fainting. Monitoring blood pressure and providing supportive care are important in managing this side effect.

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11.

At what level should you seek to maintain your ETCO2 waveform on the anesthesia monitor during a CEA?
- A.
  
  ETCO2 27
- B.
  
  ETCO2 36
- C.
  
  ETCO2 48
- D.
  
  Wherever the pt tolerates best
Correct Answer
B. ETCO2 36

Explanation
During a carotid endarterectomy (CEA), it is important to maintain the end-tidal carbon dioxide (ETCO2) waveform on the anesthesia monitor at a level of 36. This value indicates the amount of carbon dioxide present at the end of exhalation and is used as an indicator of effective ventilation and perfusion. Keeping the ETCO2 at 36 ensures proper gas exchange and adequate oxygenation during the procedure.

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12.

What is the most common hemodynamic response following CEA?
- A.
  
  Hypotension
- B.
  
  Myocardial Ischemia
- C.
  
  Hypertension
- D.
  
  Pulmonary HTN
Correct Answer
C. Hypertension

Explanation
Following carotid endarterectomy (CEA), the most common hemodynamic response is hypertension. This is because during CEA, the carotid artery is manipulated, leading to increased blood flow to the brain. This increased blood flow triggers a reflex response in the body, causing an increase in systemic blood pressure. Hypertension following CEA is a normal physiological response and is typically transient, resolving within a few hours after the surgery.

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13.

Which of the following does not typify the response expected when managing a pt with HTN?
- A.
  
  Exaggerated hypotensive response to induction
- B.
  
  Hypertension upon intubation of pt
- C.
  
  Chronic volume depletion requiring fluid boluses during surgery
- D.
  
  Resistance to vasoactive medications, requiring higher doses
Correct Answer
D. Resistance to vasoactive medications, requiring higher doses

Explanation
Resistance to vasoactive medications, requiring higher doses does not typify the response expected when managing a patient with hypertension. In patients with hypertension, vasoactive medications are commonly used to lower blood pressure. However, resistance to these medications, requiring higher doses, is not a typical response. Instead, the expected response would include an exaggerated hypotensive response to induction, hypertension upon intubation of the patient, and chronic volume depletion requiring fluid boluses during surgery.

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14.

During anesthetic management of a pt with HTN, you should seek to keep the intra-op BP within _____ of your baseline BP.
- A.
  
  You should seek to reduce BP to normal range.
- B.
  
  10%
- C.
  
  5%
- D.
  
  20%
Correct Answer
D. 20%

Explanation
During anesthetic management of a patient with hypertension, it is important to keep the intraoperative blood pressure within 20% of the baseline blood pressure. This means that the blood pressure should not deviate more than 20% from the patient's normal baseline reading. This allows for a controlled and safe management of the patient's hypertension during the procedure.

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15.

At what stage of hypertension would a patient begin to experience renal dysfunction?
- A.
  
  Stage 4
- B.
  
  Stage 3
- C.
  
  Stage 2
- D.
  
  Stage 1
Correct Answer
B. Stage 3

Explanation
At stage 3 of hypertension, a patient would begin to experience renal dysfunction. This is because hypertension can lead to damage and narrowing of the blood vessels in the kidneys, reducing their ability to function properly. This can result in decreased urine output, increased protein in the urine, and other signs of kidney dysfunction. Stage 3 hypertension is characterized by a systolic blood pressure of 180 mmHg or higher or a diastolic blood pressure of 110 mmHg or higher.

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16.

Which of the following two-valve disorder are classified as Pressure Overload disorders?
- A.
  
  Aortic Stenosis
- B.
  
  Aortic Regurge
- C.
  
  Mitral Stenosis
- D.
  
  Mitral Regurge
Correct Answer(s)
A. Aortic Stenosis
C. Mitral Stenosis

Explanation
Aortic Stenosis and Mitral Stenosis are classified as Pressure Overload disorders because both conditions involve narrowing or obstruction of the valves, leading to increased pressure within the affected chambers of the heart. In Aortic Stenosis, the aortic valve becomes narrowed, causing the left ventricle to work harder to pump blood out of the heart. Similarly, in Mitral Stenosis, the mitral valve becomes narrowed, resulting in increased pressure in the left atrium. Both conditions lead to pressure overload on the affected valves and chambers, ultimately affecting the heart's ability to efficiently pump blood.

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17.

Which of the following two-valve disorder are classified as Volume Overload disorders?
- A.
  
  Aortic Stenosis
- B.
  
  Aortic Regurge
- C.
  
  Mitral Stenosis
- D.
  
  Mitral Regurge
Correct Answer(s)
B. Aortic Regurge
D. Mitral Regurge

Explanation
Aortic regurgitation and mitral regurgitation are classified as volume overload disorders. In aortic regurgitation, the aortic valve does not close properly, leading to the backflow of blood from the aorta into the left ventricle during diastole. This increases the volume of blood in the left ventricle, causing volume overload. Similarly, in mitral regurgitation, the mitral valve fails to close properly, resulting in the backflow of blood from the left ventricle into the left atrium during systole. This also leads to volume overload in the left ventricle.

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18.

A pt with Aortic stenosis is most likely to experience which of the following?
- A.
  
  Concentric Hypertrophy
- B.
  
  Ischemic Cardiomyopathy
- C.
  
  Eccentric Hypertrophy
- D.
  
  Tamponade
Correct Answer
A. Concentric Hypertrophy

Explanation
Aortic stenosis is a condition where the aortic valve narrows, causing obstruction of blood flow from the heart to the rest of the body. This obstruction leads to an increased workload on the left ventricle of the heart. In response to this increased workload, the left ventricle undergoes hypertrophy, which is the thickening of the heart muscle. Concentric hypertrophy refers to the thickening of the heart muscle without any dilation of the ventricular chamber. Therefore, it is the most likely outcome for a patient with aortic stenosis as it is a compensatory mechanism to overcome the obstruction and maintain cardiac output.

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19.

What is the most common cause of Mitral Stenosis?
- A.
  
  Hypertension
- B.
  
  Aortic Regurge
- C.
  
  Left Ventricular Hypertrophy
- D.
  
  Rheumatic Fever
Correct Answer
D. Rheumatic Fever

Explanation
Rheumatic fever is the most common cause of Mitral Stenosis. Rheumatic fever is an inflammatory disease that can occur after an untreated streptococcal throat infection. It can cause damage to the heart valves, particularly the mitral valve, leading to stenosis. This occurs when the valve becomes stiff and narrowed, reducing the flow of blood from the left atrium to the left ventricle. Hypertension, aortic regurgitation, and left ventricular hypertrophy are not typically associated with the development of mitral stenosis.

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20.

Where should you keep the HR on a pt with Mitral stenosis?
- A.
  
  Equal to or slightly below baseline
- B.
  
  Keep HR elevated above baseline
- C.
  
  Aim for a HR >80 bpm
- D.
  
  Aim for HR
Correct Answer
A. Equal to or slightly below baseline

Explanation
In patients with mitral stenosis, the narrowing of the mitral valve obstructs blood flow from the left atrium to the left ventricle. This can lead to increased pressure in the left atrium and congestion in the lungs. Keeping the heart rate equal to or slightly below baseline helps to maintain adequate filling time for the left ventricle, allowing for optimal cardiac output and reducing the risk of pulmonary congestion. Elevating the heart rate above baseline can decrease the diastolic filling time and worsen symptoms. Aim for a heart rate above 80 bpm or aiming for heart rate are not recommended strategies for managing mitral stenosis.

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21.

Which of the following is not true regarding pts with Mitral Stenosis?
- A.
  
  These patients are more prone to a-fib
- B.
  
  Pavulon is a good choice for facilitating intubation
- C.
  
  Sedative drugs should be given at a reduced dose, due to increased risk for ventilator depression
- D.
  
  Use caution with fluid therapy as these pts are more prone to fluid overload
Correct Answer
B. Pavulon is a good choice for facilitating intubation

Explanation
The statement that Pavulon is a good choice for facilitating intubation is not true regarding patients with Mitral Stenosis. Pavulon is a neuromuscular blocking agent that can cause muscle relaxation, but it does not provide any airway protection or sedation, which are important considerations during intubation in these patients. Therefore, other medications or techniques should be used for facilitating intubation in patients with Mitral Stenosis.

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22.

Which of the following is true regarding anesthetic management of a pt with Mitral Stenosis?
- A.
  
  Ketamine is drug of choice for induction of pts with severe MS
- B.
  
  Narcotics and propofol infusions should be avoided due to myocardial suppression
- C.
  
  Rocuronium or Sux would be drugs of choice for intubation of MS pts
- D.
  
  Aggressive fluid therapy is necessary due to chronic fluid depleted state and risk for hypotension
Correct Answer
C. Rocuronium or Sux would be drugs of choice for intubation of MS pts

Explanation
Rocuronium or Sux (succinylcholine) would be the drugs of choice for intubation of patients with Mitral Stenosis (MS) because these medications provide rapid onset and short duration of muscle relaxation, allowing for a smoother intubation process. Ketamine is not the drug of choice for induction in severe MS patients as it can cause an increase in heart rate and blood pressure. Narcotics and propofol infusions should be avoided due to their potential for myocardial suppression. Aggressive fluid therapy is not necessary in MS patients as they are typically in a chronic fluid-depleted state and at risk for hypotension.

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1
23.

How will Mitral stenosis affect the Wedge waveform on your Swan line?
- A.
  
  Prominent V wave
- B.
  
  Absent A wave
- C.
  
  Will show decrease wedge pressure
- D.
  
  Large A wave
Correct Answer
D. Large A wave

Explanation
Mitral stenosis refers to the narrowing of the mitral valve, which separates the left atrium and left ventricle of the heart. This condition obstructs the flow of blood from the left atrium to the left ventricle, causing an increase in pressure within the left atrium. As a result, the left atrium contracts more forcefully to overcome the obstruction, leading to a large A wave on the Wedge waveform. Therefore, the correct answer is a large A wave.

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24.

Acute mitral regurge is most commonly due to…
- A.
  
  Myocardial Infarction
- B.
  
  Rheumatic fever
- C.
  
  Mitral Stenosis
- D.
  
  Severe hypertensive episodes
Correct Answer
A. Myocardial Infarction

Explanation
Acute mitral regurgitation is most commonly caused by a myocardial infarction. During a heart attack, the blood supply to a part of the heart muscle is blocked, leading to damage or death of that muscle tissue. This can weaken the heart muscle, including the muscles that support the mitral valve. As a result, the mitral valve may not close properly, causing blood to flow backward into the left atrium. This backward flow of blood is known as mitral regurgitation. Therefore, myocardial infarction is the most likely cause of acute mitral regurgitation.

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25.

Which of the following is not true regarding patients with Mitral Regurgitation?
- A.
  
  Ketamine may be used for induction of MR patients
- B.
  
  Decreases in SVR should be avoided
- C.
  
  Decreases in HR should be avoided
- D.
  
  Reversal of NMB may be done as usual
Correct Answer
B. Decreases in SVR should be avoided

Explanation
In patients with Mitral Regurgitation, decreases in systemic vascular resistance (SVR) should be avoided. This is because MR is characterized by the backflow of blood from the left ventricle into the left atrium during systole, leading to decreased forward flow and decreased cardiac output. To compensate for this, the body increases SVR to maintain adequate blood pressure and perfusion. Decreases in SVR can further decrease forward flow and worsen the symptoms of MR. Therefore, it is important to avoid interventions or medications that can cause a decrease in SVR in these patients.

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26.

How will Mitral regurge affect the Wedge waveform on your Swan line?
- A.
  
  Absent A wave
- B.
  
  Will show decrease wedge pressure
- C.
  
  Prominent V wave
- D.
  
  Large A wave
Correct Answer
C. Prominent V wave

Explanation
Mitral regurge refers to the backward flow of blood from the left ventricle into the left atrium during systole. This causes an increase in pressure in the left atrium, which is reflected in the waveform on the Swan line. A prominent V wave is seen in the waveform when there is regurgitation because the increased pressure in the left atrium leads to a larger V wave. Therefore, the correct answer is that Mitral regurge will result in a prominent V wave in the Wedge waveform on the Swan line.

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27.

Which of the following is not required for symptomatic Aortic Stenosis pts?
- A.
  
  Swan Ganz line
- B.
  
  A-Line
- C.
  
  Large Bore IV’s
- D.
  
  All the above are required
Correct Answer
D. All the above are required

Explanation
All of the options listed (Swan Ganz line, A-Line, Large Bore IV's) are required for symptomatic Aortic Stenosis patients. This means that none of the options are not required, hence the correct answer is "All the above are required".

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28.

Which of the following would you choose for the induction of a patient with severe aortic stenosis?
- A.
  
  Inhalational induction with desflurane
- B.
  
  Ketamine IV induction
- C.
  
  Propofol IV Induction
- D.
  
  High dose fentanyl induction
Correct Answer
D. High dose fentanyl induction

Explanation
A patient with severe aortic stenosis may be at risk for hemodynamic instability during induction of anesthesia. High dose fentanyl induction may be chosen because it provides analgesia and sedation without causing significant cardiovascular depression. This allows for a smoother induction process and minimizes the risk of hemodynamic compromise in the patient with aortic stenosis.

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29.

Which of the following is not true of patients with Aortic Stenosis?
- A.
  
  Sudden decreases in SVR should be avoided
- B.
  
  For reversal, Atropine is preferred over Robinul
- C.
  
  There is an increase in myocardial O2 demand
- D.
  
  Maintenance is preferable with N2O and high dose narcotic
Correct Answer
B. For reversal, Atropine is preferred over Robinul

Explanation
In patients with Aortic Stenosis, sudden decreases in systemic vascular resistance (SVR) should be avoided because it can lead to a decrease in blood pressure and compromise cardiac output. There is an increase in myocardial oxygen demand in patients with Aortic Stenosis due to the narrowing of the aortic valve, which causes the heart to work harder to pump blood through the narrowed valve. Maintenance anesthesia is preferable with nitrous oxide (N2O) and high dose narcotic in patients with Aortic Stenosis because these agents help maintain hemodynamic stability. Atropine is not preferred over Robinul for reversal in patients with Aortic Stenosis because Robinul, a vagolytic agent, is more effective in increasing heart rate and improving cardiac output in these patients.

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30.

Which of the following is the least dangerous of valvular disorders?
- A.
  
  Aortic Stenosis
- B.
  
  Mitral Regurge
- C.
  
  Aortic Regurge
- D.
  
  Mitral Stenosis
Correct Answer
C. Aortic Regurge

Explanation
Aortic regurgitation is the least dangerous of valvular disorders because it involves the backflow of blood from the aorta into the left ventricle during diastole. While it can lead to symptoms such as fatigue and shortness of breath, it often progresses slowly and may not require immediate intervention. In contrast, aortic stenosis, mitral regurgitation, and mitral stenosis can all have more severe consequences and may require more urgent treatment.

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31.

Where would you listen for a murmur on a patient with Mitral Regurge?
- A.
  
  1
- B.
  
  2
- C.
  
  3
- D.
  
  4
- E.
  
  5
Correct Answer
E. 5

Explanation
In a patient with Mitral Regurge, a murmur would be heard on the fifth intercostal space, which is located at the left midclavicular line. This is because the mitral valve is located between the left atrium and the left ventricle, and when there is regurgitation of blood from the left ventricle back into the left atrium, a murmur can be heard in this area.

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32.

Hemodynamic goals for a CEA are:
- A.
  
  Hypotension to prevent blood loss within the surgical field
- B.
  
  Hypertension and tachycardia to maintain CPP
- C.
  
  High-normal BP range to maintain CPP
- D.
  
  No blood pressure concerns
Correct Answer
C. High-normal BP range to maintain CPP

Explanation
The hemodynamic goals for a carotid endarterectomy (CEA) are to maintain cerebral perfusion pressure (CPP) at a high-normal blood pressure (BP) range. This is because maintaining a high-normal BP helps ensure adequate blood flow to the brain during the surgery. Hypotension can lead to decreased blood flow and increased risk of ischemia, while hypertension and tachycardia can increase the risk of bleeding within the surgical field. Therefore, the goal is to keep the BP within a high-normal range to optimize cerebral perfusion while minimizing the risk of complications.

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33.

Appropriate interventions with surgical traction on the carotid sinus include:
- A.
  
  Atropine
- B.
  
  Infiltration with local anesthestic
- C.
  
  Release of traction by surgeon
- D.
  
  All the above are acceptable interventions
Correct Answer
D. All the above are acceptable interventions

Explanation
The correct answer is that all of the above interventions are acceptable. Atropine can be used to counteract any vagal response that may occur during the surgical traction on the carotid sinus. Infiltration with local anesthetic is important to minimize pain and discomfort during the procedure. Finally, the release of traction by the surgeon is necessary to ensure that the procedure is completed safely. Therefore, all of these interventions are appropriate in this context.

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34.

Regional anesthesia is sometimes preferred when performing a CEA primarily because:
- A.
  
  Less post-op complications
- B.
  
  Continuous neurological assessment
- C.
  
  Less incidence of transient ischemia
- D.
  
  Less hemodynamic fluctuations
Correct Answer
B. Continuous neurological assessment

Explanation
Regional anesthesia is sometimes preferred when performing a CEA primarily because it allows for continuous neurological assessment. With regional anesthesia, the patient remains awake during the procedure, allowing the healthcare team to monitor their neurological status throughout. This is important in carotid endarterectomy (CEA) surgeries as it involves the removal of plaque from the carotid artery, which can potentially lead to neurological complications. By continuously assessing the patient's neurological function, any changes or signs of ischemia can be detected early and appropriate interventions can be taken.

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35.

Your patient is having a left-sided CEA, the A-line should be placed:
- A.
  
  On the right side because in case occlusion to left occurs
- B.
  
  In femoral site due to risk of occluding the innominate
- C.
  
  On the left side because you want to know how well the operative side is perfusing
- D.
  
  Either side is acceptable
Correct Answer
A. On the right side because in case occlusion to left occurs

Explanation
The correct answer is "On the right side because in case occlusion to left occurs." This is because if there is an occlusion on the left side during the procedure, the A-line on the right side will still provide continuous monitoring of the patient's blood pressure and allow for appropriate interventions to be taken. Placing the A-line on the left side may not provide accurate information about the perfusion of the operative side.

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36.

All of the following are post-op complications related to CEA except:
- A.
  
  Hemorrhage
- B.
  
  HTN due to denervation of carotid baroreceptors
- C.
  
  Injury to RLN
- D.
  
  Injury to the optic nerve due to hypoperfusion
Correct Answer
D. Injury to the optic nerve due to hypoperfusion

Explanation
Injury to the optic nerve due to hypoperfusion is not a post-operative complication related to carotid endarterectomy (CEA). CEA is a surgical procedure performed to remove plaque buildup in the carotid artery, which can improve blood flow to the brain and reduce the risk of stroke. Common post-operative complications include hemorrhage, hypertension due to denervation of carotid baroreceptors, and injury to the recurrent laryngeal nerve (RLN). However, injury to the optic nerve due to hypoperfusion is not directly associated with CEA.

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37.

Appropriate interventions to counteract the effects of “unclamping” are all of the following except:
- A.
  
  Vasodilators
- B.
  
  Increase minute ventilation
- C.
  
  Calcium Chloride
- D.
  
  Sodium Bicarb
Correct Answer
A. Vasodilators

Explanation
Vasodilators are not appropriate interventions to counteract the effects of "unclamping" because they would further relax and dilate blood vessels, potentially exacerbating the problem. "Unclamping" typically refers to the release of a clamp on a blood vessel, which can lead to decreased blood flow and oxygen supply to tissues. To counteract this, interventions such as increasing minute ventilation, administering calcium chloride, or using sodium bicarbonate can be used to improve blood flow and restore normal physiological functions.

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38.

What is the primary effect of aortic cross-clamping?
- A.
  
  Decrease in preload
- B.
  
  Increase in contractility
- C.
  
  Increase in afterload
- D.
  
  Mitral regurgitation
Correct Answer
C. Increase in afterload

Explanation
Aortic cross-clamping refers to the temporary occlusion of the aorta during certain surgical procedures. This procedure increases the afterload, which is the resistance against which the heart must pump blood. By clamping the aorta, the blood flow is restricted, causing an increase in pressure within the arterial system. This increased pressure increases the workload of the heart, leading to an increase in afterload. Therefore, the primary effect of aortic cross-clamping is an increase in afterload.

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39.

The most effective method to preserve renal function during aortic cross-clamping is:
- A.
  
  Mannitol
- B.
  
  Lasix
- C.
  
  Fenoldopam
- D.
  
  Hydration
Correct Answer
D. Hydration

Explanation
Hydration is the most effective method to preserve renal function during aortic cross-clamping. Aortic cross-clamping can lead to reduced blood flow to the kidneys, which can cause renal dysfunction. By maintaining adequate hydration, blood volume and perfusion to the kidneys can be optimized, reducing the risk of renal injury. Hydration helps to maintain renal blood flow and glomerular filtration rate, preventing ischemic damage to the kidneys. Mannitol, Lasix, and Fenoldopam are not specifically indicated for preserving renal function during aortic cross-clamping.

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40.

Surgery on the ascending aorta involves:
- A.
  
  Median sternotomy and CPB
- B.
  
  Median sternontomy with deep hypothermic circulatory arrest
- C.
  
  Cross clamping with thoractomy using OLV
- D.
  
  Cross clamping using retroperitoneal approach
Correct Answer
A. Median sternotomy and CPB

Explanation
Surgery on the ascending aorta typically involves a median sternotomy, which is a surgical incision made along the sternum to access the heart and aorta. CPB, or cardiopulmonary bypass, is also used during this procedure. CPB involves diverting blood flow away from the heart and lungs, allowing the surgeon to operate on a still, bloodless field. This is done by connecting the patient to a heart-lung machine, which takes over the functions of the heart and lungs during the surgery.

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41.

Surgery on the transverse aorta involves:
- A.
  
  Median sternotomy and CPB
- B.
  
  Median sternontomy with deep hypothermic circulatory arrest
- C.
  
  Cross clamping with thoractomy using OLV
- D.
  
  Cross clamping using retroperitoneal approach
Correct Answer
B. Median sternontomy with deep hypothermic circulatory arrest

Explanation
Surgery on the transverse aorta involves performing a median sternotomy, which is a surgical procedure that involves making an incision down the middle of the chest. This approach provides access to the aorta for the surgery. Additionally, deep hypothermic circulatory arrest is used, which involves lowering the patient's body temperature to a very low level and stopping the circulation of blood during the surgery. This is done to protect the brain and other vital organs from damage during the procedure.

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42.

Surgery on the descending aorta involves:
- A.
  
  Median sternotomy and CPB
- B.
  
  Median sternontomy with deep hypothermic circulatory arrest
- C.
  
  Cross clamping with thoractomy using OLV
- D.
  
  Cross clamping using retroperitoneal approach
Correct Answer
C. Cross clamping with thoractomy using OLV

Explanation
The correct answer is cross clamping with thoracotomy using OLV. This is because surgery on the descending aorta typically requires accessing the aorta through a thoracotomy, which involves making an incision in the chest wall. Cross clamping refers to temporarily blocking the blood flow in the aorta to perform the necessary repairs. OLV (one-lung ventilation) is used during thoracotomy to collapse one lung and provide better exposure and access to the surgical site.

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43.

A patient with critical mitral stenosis develops atrial fibrillation with an uncontrolled ventricular rate averaging 150 beats per minute and pulmonary edema. Which of the following courses of action would be most appropriate?
- A.
  
  Administer a diuretic
- B.
  
  Administer a positive inotropic agent
- C.
  
  Administer a positive inotropic agent in combination with vasodilator
- D.
  
  Administer a negative chronotropic agent
Correct Answer
D. Administer a negative chronotropic agent

Explanation
Administering a negative chronotropic agent would be the most appropriate course of action in this scenario. Atrial fibrillation with an uncontrolled ventricular rate can worsen symptoms in a patient with critical mitral stenosis, leading to pulmonary edema. A negative chronotropic agent, such as a beta-blocker, can slow down the heart rate and improve symptoms by reducing the workload on the heart. This can help alleviate the pulmonary edema and improve the patient's condition.

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44.

The most common arrhythmia seen in rheumatic mitral valve disease associated with left atrial enlargement is:
- A.
  
  Atrial flutter
- B.
  
  Atrial tachycardia
- C.
  
  Atrial fibrillation
- D.
  
  Paroxysmal atrial tachycardia
Correct Answer
C. Atrial fibrillation

Explanation
In rheumatic mitral valve disease, left atrial enlargement can lead to the development of atrial fibrillation. Atrial fibrillation is characterized by rapid and irregular electrical impulses in the atria, resulting in an irregular and often fast heart rate. This arrhythmia is commonly seen in patients with rheumatic mitral valve disease due to the structural changes and increased pressure in the left atrium. Atrial flutter, atrial tachycardia, and paroxysmal atrial tachycardia may also occur in these patients, but atrial fibrillation is the most common arrhythmia associated with left atrial enlargement in rheumatic mitral valve disease.

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45.

A rumbling diastolic murmur heard at the apex of the heart is characteristic of which of the valvular lesions?
- A.
  
  Mitral stenosis
- B.
  
  Mitral regurgitation
- C.
  
  Aortic stenosis
- D.
  
  Aortic regurgitation
Correct Answer
A. Mitral stenosis

Explanation
A rumbling diastolic murmur heard at the apex of the heart is characteristic of mitral stenosis. Mitral stenosis is a condition where the mitral valve, which separates the left atrium and the left ventricle, becomes narrowed, causing blood flow obstruction from the left atrium to the left ventricle. This narrowing leads to turbulent blood flow, resulting in the characteristic rumbling murmur. The murmur is heard during diastole, when the heart is relaxed and filling with blood.

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46.

A systolic murmur auscultated at 2^nd intercostal space is typical for which type of valvular heart lesion?
- A.
  
  Mitral stenosis
- B.
  
  Aortic stenosis
- C.
  
  Mitral prolapse
- D.
  
  Aortic regurgitation
Correct Answer
B. Aortic stenosis

Explanation
A systolic murmur auscultated at the 2nd intercostal space is typical for aortic stenosis. This is because aortic stenosis is characterized by narrowing or obstruction of the aortic valve, which leads to turbulent blood flow during systole. This turbulent flow produces a murmur that can be heard best at the 2nd intercostal space, which is the location where the aortic valve is most easily heard. Mitral stenosis, mitral prolapse, and aortic regurgitation would typically present with different types of murmurs and would not be expected to be heard at the 2nd intercostal space.

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47.

Lactic acid build-up distal to the aortic clamp will cause:
- A.
  
  Vasodilation
- B.
  
  Bronchodilation
- C.
  
  Vasoconstriction
- D.
  
  Myocardial stimulation
Correct Answer
A. Vasodilation

Explanation
Lactic acid build-up distal to the aortic clamp will cause vasodilation. Lactic acid is produced when there is insufficient oxygen supply to tissues, such as during ischemia. This lactic acid can cause the blood vessels in the affected area to dilate, leading to increased blood flow. Vasodilation helps to deliver more oxygen and nutrients to the tissues, aiding in their recovery.

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48.

In which condition would sodium nitroprusside be the MOST beneficial to increase cardiac output?
- A.
  
  Mitral stenosis
- B.
  
  Aortic stenosis
- C.
  
  Aortic regurgitation
- D.
  
  Coronary artery disease
Correct Answer
C. Aortic regurgitation

Explanation
Sodium nitroprusside is a potent vasodilator that can decrease systemic vascular resistance and increase cardiac output. In aortic regurgitation, the aortic valve does not close properly, causing blood to flow back into the left ventricle during diastole. This leads to increased volume overload and decreased forward flow. By dilating the systemic vasculature, sodium nitroprusside can help to decrease the regurgitant volume and improve forward flow, thereby increasing cardiac output. Therefore, sodium nitroprusside would be most beneficial in aortic regurgitation to enhance cardiac output.

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49.

All of the following hemodynamic changes should be anticipated during aortic cross-clamping in a patient with normal left ventricular function except:
- A.
  
  Increased SVR
- B.
  
  Increased MAP
- C.
  
  Increased CO
- D.
  
  Decreased EF%
Correct Answer
C. Increased CO

Explanation
During aortic cross-clamping, the aorta is temporarily blocked to allow for surgical procedures. This leads to an increase in systemic vascular resistance (SVR) and mean arterial pressure (MAP) due to the obstruction of blood flow. Additionally, the left ventricle compensates for the increased afterload by increasing its contractility, resulting in an increased cardiac output (CO). However, the ejection fraction (EF%) is a measure of the percentage of blood pumped out of the left ventricle with each contraction and is not directly affected by aortic cross-clamping. Therefore, the correct answer is increased CO, as it is an expected hemodynamic change during aortic cross-clamping in a patient with normal left ventricular function.

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50.

The most common cause of postoperative mortality associated with AAA repair is
- A.
  
  CVA
- B.
  
  Mesenteric thrombosis
- C.
  
  Acute renal failure
- D.
  
  MI
Correct Answer
D. MI

Explanation
Postoperative mortality refers to death that occurs within a certain period after a surgical procedure. In the case of AAA repair (abdominal aortic aneurysm repair), the most common cause of postoperative mortality is myocardial infarction (MI), also known as a heart attack. This is because AAA repair is a major surgical procedure that can put stress on the cardiovascular system. The surgery itself and the manipulation of the aorta can potentially lead to complications such as blood clot formation, which can block the blood flow to the heart and cause a heart attack. Therefore, MI is the most likely cause of postoperative mortality in AAA repair patients.

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Aug 01, 2009

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Valvular Heart Disease And Anaesthesia: Quiz

During Carotid vascular surgery, BP should be maintained…

Which of the following is not necessary for an ASA 3 pt undergoing an Aorta-life bypass?

90-95% of AAA’s involve which part of the abdominal aorta?

Which of the following disease is not commonly associated with pts undergoing CEA?

Which of the following is not true regarding the management of a pt undergoing AAA repair?

Which of the following is not an indication to perform endovascular grafting procedure?

Which of the following is not a necessity to monitor a pt undergoing a right CEA?

What changes would you expect to see in your pt following the release of the aortic cross-clamp?

Prior to aortic cross-clamp, you administered 7,500 units of heparin to your pt. It has now been one hour and the surgeon is asking you to give protamine. How much should you give?

What is the most common side effect associated with the administration of protamine?

At what level should you seek to maintain your ETCO2 waveform on the anesthesia monitor during a CEA?

What is the most common hemodynamic response following CEA?

Which of the following does not typify the response expected when managing a pt with HTN?

During anesthetic management of a pt with HTN, you should seek to keep the intra-op BP within _____ of your baseline BP.

At what stage of hypertension would a patient begin to experience renal dysfunction?

Which of the following two-valve disorder are classified as Pressure Overload disorders?

Which of the following two-valve disorder are classified as Volume Overload disorders?

A pt with Aortic stenosis is most likely to experience which of the following?

What is the most common cause of Mitral Stenosis?

Where should you keep the HR on a pt with Mitral stenosis?

Which of the following is not true regarding pts with Mitral Stenosis?

Which of the following is true regarding anesthetic management of a pt with Mitral Stenosis?

How will Mitral stenosis affect the Wedge waveform on your Swan line?

Acute mitral regurge is most commonly due to…

Which of the following is not true regarding patients with Mitral Regurgitation?

How will Mitral regurge affect the Wedge waveform on your Swan line?

Which of the following is not required for symptomatic Aortic Stenosis pts?

Which of the following would you choose for the induction of a patient with severe aortic stenosis?

Which of the following is not true of patients with Aortic Stenosis?

Which of the following is the least dangerous of valvular disorders?

Where would you listen for a murmur on a patient with Mitral Regurge?

Hemodynamic goals for a CEA are:

Appropriate interventions with surgical traction on the carotid sinus include:

Regional anesthesia is sometimes preferred when performing a CEA primarily because:

Your patient is having a left-sided CEA, the A-line should be placed:

All of the following are post-op complications related to CEA except:

Appropriate interventions to counteract the effects of “unclamping” are all of the following except:

What is the primary effect of aortic cross-clamping?

The most effective method to preserve renal function during aortic cross-clamping is:

Surgery on the ascending aorta involves:

Surgery on the transverse aorta involves:

Surgery on the descending aorta involves:

A patient with critical mitral stenosis develops atrial fibrillation with an uncontrolled ventricular rate averaging 150 beats per minute and pulmonary edema. Which of the following courses of action would be most appropriate?

The most common arrhythmia seen in rheumatic mitral valve disease associated with left atrial enlargement is:

A rumbling diastolic murmur heard at the apex of the heart is characteristic of which of the valvular lesions?

A systolic murmur auscultated at 2nd intercostal space is typical for which type of valvular heart lesion?

Lactic acid build-up distal to the aortic clamp will cause:

In which condition would sodium nitroprusside be the MOST beneficial to increase cardiac output?

All of the following hemodynamic changes should be anticipated during aortic cross-clamping in a patient with normal left ventricular function except:

The most common cause of postoperative mortality associated with AAA repair is

A systolic murmur auscultated at 2^nd intercostal space is typical for which type of valvular heart lesion?