BGHMC CV Module 2025 Quiz C

A 72-year-old with insulin-dependent diabetes, CKD (eGFR 30), prior MI, and poor METs (<4) is scheduled for open aortobifemoral bypass. Resting ECG is uninterpretable (paced rhythm). The result of preop testing will change management (revascularization vs proceed). Best noninvasive test?

• Exercise treadmill ECG

• Coronary calcium score

• Dobutamine stress echocardiography

• Vasodilator stress echo

• 6-minute walk test

A 63-year-old with moderate AS (mean gradient 30 mmHg) and stable angina requires urgent hemicolectomy for obstruction. Which intraop hemodynamic goal is most critical?

• Reduce afterload with nitroprusside

• Avoid tachycardia and maintain diastolic pressure

• Target low CVP to prevent edema

• Hyperventilate to PaCO2 25 mmHg

• Liberal PEEP to improve oxygenation

A 58-year-old with Chronic AF (rate 85) and severe MS presents for emergent laparotomy for peritonitis. Best induction plan?

• Ketamine 2 mg/kg + ephedrine as needed

• Etomidate/opioid blunting

• High-dose propofol bolus to blunt sympathetic tone

• Spinal anesthesia to avoid GA hemodynamics

• Remifentanil bolus followed by nitroglycerin

A 66-year-old with NSTEMI 5 days ago (no PCI) has bowel ischemia requiring OR now. Which monitor/adjunct most improves intraop ischemia detection/management?

• CVP

• Arterial line plus intraop TEE

• Pulmonary capillary wedge pressure

• End-tidal CO2 trends

• Pulse pressure variation

During carotid endarterectomy under GA, stump pressure is borderline and SSEPs fall after clamp. Best immediate intervention?

• Mannitol bolus

• Increase MAP ~20% above baseline

• Hyperventilate to PaCO2 25

• Give labetalol

• Start nitroprusside

In the PACU after CEA, patient becomes drowsy and hypotensive (MAP 55) with focal neurologic deficits. Neck is soft, no hematoma. Most likely cause needing treatment now?

• Cerebral hyperperfusion syndrome

• Watershed ischemia from hypotension

• Heparin rebound

• Intracerebral hemorrhage

• Embolism from clamp site

A 54-year-old with HOCM on metoprolol undergoes lap chole. Pneumoperitoneum + Trendelenburg causes hypotension and new systolic murmur. Best immediate step?

• Dobutamine infusion

• Phenylephrine bolus and reduce insufflation pressure

• Nitroglycerin infusion

• Esmolol bolus

• High PEEP to increase afterload

A patient with CRT-D (not pacer-dependent) presents for mastectomy with monopolar cautery. What does placing a magnet over the device typically do?

• Converts to asynchronous pacing and turns off shocks

• Disables ICD tachy therapies but may not affect pacing mode

• Increases pacing rate to 100 bpm

• Shuts the device off completely

• Has no effect if cautery is bipolar

A 68-year-old with severe AR, sinus rhythm 95, needs emergent colectomy for perforation. Suddenly BP falls to 80/40 after large phenylephrine bolus. Best next vasoactive?

• More phenylephrine

• Ephedrine or low-dose epinephrine

• Esmolol

• Vasopressin

• Nitroprusside

During thoracotomy with one-lung ventilation (FiO2 0.8), SpO2 drops from 96% to 88% despite recruitment and optimal positioning. Best maneuver next?

• Increase desflurane from 1.0 to 1.8 MAC

• Apply CPAP to non-dependent lung or add apneic oxygenation

• Add N2O

• Raise PEEP on dependent lung to 15 cmH2O without recruitment

• Start nitroprusside