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WorksheetsReview Cardiovascular anesthesia block
Total questions: 25
Worksheet time: 23mins
The mechanisms of depression of cardiac contractility by volatile anesthetics include all the following, except
They decrease the entry of calcium into cells during depolarization
They alter kinetics of calcium release
They decrease the sensitivity of contractile proteins to calcium
They affect only L-type calcium channels
The mechanism of “ x ” descent (descent between C and V waves) in the following right atrial tracing is
Downward movement of the atrioventricular (AV) valve cusps after ventricular
contraction
Relaxation of atrium after atrial systole
Decline in atrial pressure as the AV valves open
Pulling down of the atrium by ventricular contraction
The MOST important pathophysiologic difference between pericardial
effusion and cardiac tamponade is
Type of fluid (e.g., transudate, e xudate, blood)
Pressure
Inflammation
Quantity of fluid
Each of the following is a characteristic of cardiac and skeletal muscle fibers EXCEPT:
Mitochondria are highly abundant in both types of fibers.
Both sarcolemma contain Na
+
channels
Actin and myosin are the contractile proteins.
Impulses reach the myocytes through “T transverse tubules.”
When is the use of spironolactone possibly contraindicated?
In hypernatremic patients
In patients with refractory congestive heart failure
When also prescribing furosemide
In hyperkalemic patients
What is the primary mechanism of action and result of the Class III Antiarrhythmic
drugs (e.g. sotalol, amiodarone)?
Block potassium channels: prolong repolarization phase
Block fast Na channels: slows generation of action potential
Beta adrenergic receptor agonists: slow conduction through the heart
Calcium channel antagonists: vasodilation and increased heart rate
Significant intravenous absorption/inadvertent intravenous injection of bupivacaine can cause profound bradycardia and sinus node arrest. Which of the following best describes the mechanism of cardiac toxicity of bupivacaine?
Bupivacaine binds activated fast sodium channels and dissociates from them
slowly
Bupivacaine binds inactivated slow sodium channels and dissociates from them
slowly
Bupivacaine binds activated slow sodium channels and dissociates from them
slowly
Bupivacaine binds inactivated fast sodium channels and dissociates from them
slowly
Administration of protamine to a patient who has not received heparin can
result in
Profound bradycardia
Anticoagulation
Hypertension
Hypercoagulation
A 54- year-old patient is undergoing a three- vessel coronary artery bypass
graft (CABG) under general anesthesia. After induction, the pulmonary
capillary wedge pressure is 15 mmHg and PA pressures are 26/13 mmHg.
Suddenly, new 30-mmHg V waves appear on the monitor screen. Systemic
blood pressure is 120/70 mmHg, heart rate is 75 beats/min, and PA pressure
is 50/35 mmHg. Which of the following drugs should be administered to the patient ?
Esmolol
Dobutamine
Nitroglycerin
Nitroprusside
When performing the oscillometric method to measure blood pressure, for example, when you do not have a stethoscope or automated blood pressure cuff, it is important to remember that you will not be able to measure the
Mean arterial pressure
Systolic blood pressure
Diastolic or mean arterial blood pressure
Diastolic blood pressure
The O2 sensor location is on which part of the anesthesia circuit?
Fail-safe valve
Expiratory limb
Second-stage O2
pressure regulator
Inspiratory limb
The correct formula for determination of mean arterial pressure (MAP) based on systolic pressure (SP) and diastolic pressure (DP) is:
DP + 1/3(SP −DP)
DP −1/2(SP −DP)
(SP + DP)/3
SP −1/3(SP −DP)
Which of the following monitors is the most accurate indicator of left ventricular preload?
Mixed venous saturation
Central venous pressure (CVP) trends
Pulmonary capillary wedge pressure (PCWP)
Urine output
In a preoperative patient with tetralogy of Fallot, the best indicator of the magnitude of the average, chronic R->L shunt is the
arterial pO2.
hematocrit.
loudness and length of the systolic murmur.
pulmonary blood flow at catheterization.
ASD occurs in the basal portion of the interventricular septum in which of the following ?
Ostium secundum ASD
Sinus venosus ASD
Patent foramen ovale
Ostium primum ASD
Which of the following is a consequence of chronic hypoxemia in cyanotic CHD ?
Hyperviscosity
Secondary erythrocytosis
Abnormal hemostasis
All the above
The most common cyanotic congenital heart disease is
Tricuspid atresia
Transposition of the great arteries
Tetralogy of Fallot
Total anomalous pulmonary venous connection
A newborn infant is cyanotic at birth. You suspect transposition of the great arteries. A mixing lesion is necessary for life. Which of the following lesions would allow better mixing?
VSD
ASD
PDA
None of the above
Most neurologic deficits after carotid endarterectomy are thought to result from:
Prolonged carotid artery cross-clamp in the absence of shunt use
Perioperative vasospasm
Inadequate intraoperative carotid artery perfusion pressure
Thromboembolism
The most important factor shown to be of clinical importance in preserving renal function during aortic cross-clamping is:
Fenoldopam
Intravascular volume status
Mannitol
Dopamine
Potential advantages of a regional anesthetic technique over general anesthesia for lower extremity vascular bypass procedures include all of the following EXCEPT:
Reduced incidence of postoperative respiratory complications
Avoidance of hyperdynamic responses to tracheal intubation and extubation
A reduction in perioperative cardiac complications
Reduced postoperative hypercoagulability
The area of the myocardium most vulnerable to ischemia is the:
Right ventricle
Interventricular septum
Subendocardial region of the left ventricle
Apex of the left ventricle
Which of the following conditions best describes a physiologic change associated with mitral stenosis?
Left ventricular dysfunction resulting from chronic volume overload
Increased left atrial pressure and concomitant right ventricular hypertrophy
Decreased right ventricular pressure
Left ventricular outflow obstruction
The most common cause of persistent bleeding after heparin reversal in cardiac surgical patients is:
Reduced platelet count or function
Heparin rebound
Hypothermia
Diminished capillary integrity
Anesthetic considerations in a patient with mitral regurgitation include all the
following, except
Avoid sudden decreases in heart rate
Minimize drug-induced myocardial depression
Avoid sudden decreases in systemic vascular resistance (SVR)
Monitor the magnitude of the C wave of CVP as a reflection of mitral regurgitant flow
