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WorksheetsCo-Existing Disease Review
Total questions: 65
Worksheet time: 1hrs 4mins
During anesthesia for a 5-year-old with a mild URI, which of the following strategies would BEST reduce the risk of perioperative respiratory adverse events?
Use an ETT instead of LMA and perform rapid extubation
Administer minimal fluids and use high inspiratory pressures
Limit airway manipulations, consider LMA over ETT, maintain hydration
Proceed with standard induction without airway precautions
Which pathophysiological mechanism is most prominent during an acute asthma attack?
Airway hyperresponsiveness with smooth muscle constriction
Destruction of alveolar walls
Fibrotic remodeling of the alveoli
Loss of surfactant production
Which of the following best explains the mechanism behind post-obstructive (negative pressure) pulmonary edema?
Alveolar damage caused by aspiration of gastric contents
Increased alveolo-capillary permeability from histamine release
High negative intrathoracic pressure increasing venous return and hydrostatic gradient
Fluid overload from excessive IV fluids during airway obstruction
Why does residual volume increase in COPD?
Airway narrowing during inspiration traps more air
Early airway collapse during exhalation prevents full emptying of the lungs
Patient breathes more rapidly
Diaphragmatic strength is increased, trapping air
A 68-year-old man with severe COPD undergoes GA for a laparoscopic cholecystectomy. Mechanical ventilation is set with a tidal volume of 8 mL/kg and a rate of 16/min. After 20 minutes, the patient develops hypotension, rising peak airway pressures, and a prolonged expiratory phase with a noticeable plateau on capnograph. Which of the following is the most appropriate immediate intervention?
Increase tidal volume to 12 mL/kg to improve ventilation
Administer N2O to reduce airway resistance
Disconnect ventilator to allow trapped gas to escape
Increase PEEP to recruit alveoli
A 28-year-old woman with moderate persistent asthma is scheduled for elective laparoscopic cholecystectomy. She uses an albuterol inhaler as needed and an inhaled corticosteroid daily. During induction, she develops wheezing and increasing peak airway pressures after endotracheal intubation. Which of the following is the most appropriate next step?
Administer IV corticosteroids immediately and continue surgery
Deepen anesthesia and administer a short-acting inhaled bronchodilator
Extubate and postpone the procedure
Increase tidal volume to improve ventilation
A patient has the following preop PFTs: FEV1: 60% predicted FVC: 80% predicted FEV1:FVC ratio: 0.55 Which of the following statements is most accurate?
Both FEV1 and FVC are within normal limits; PFTs are unremarkable
This pattern suggests obstructive lung disease
This pattern suggests restrictive lung disease
This pattern indicates neuromuscular weakness
A 55-year-old patient with severe bronchiectasis is recovering from a thoracotomy. The patient has copious purulent sputum, a weak cough, and mild hypoxemia (SpO2 91% on 2L oxygen). Which of the following interventions is most effective in preventing postop pulmonary complications?
Early extubation and supplemental oxygen only
High FiO2 therapy without airway clearance
Incentive spirometry combined with chest physiotherapy and airway suctioning as needed
Nebulized bronchodilators only
A 62-year-old man with GOLD stage III COPD presents for an elective laparoscopic cholecystectomy. He continues to smoke and has dyspnea on exertion. Preop evaluation reveals FEV1 40% of predicted and PaCO2 of 50. Which ventilation strategy is best to minimize hyperinflation and auto-PEEP?
Increase respiratory rate with low tidal volume
Use prolonged expiratory time with low respiratory rate
Add PEEP to offset auto-PEEP
Use a large tidal volume to ensure adequate ventilation
A 16-year-old patient with a history of CF presents for an emergent laparoscopic appendectomy. The patient has thick pulmonary secretions and decreased breath sounds bilaterally. The anesthesia plan of care includes GA with ETT. Which of the following medications should the CRNA avoid administering during this case?
Fentanyl
Rocuronium
Glycopyrrolate
Ondansetron
Your patient with severe COPD comes in for a laparoscopic appendectomy. The patient is sedated with GA and an ETT is placed. During the case, you notice that your peak and plateau pressures are rising and your waveform is not returning to baseline. What action(s) should you take? Select all that apply.
Increase the respiratory rate
Change I:E ratio from 1:2 to 1:3
Disconnect the patient circuit from the ventilator
Increase tidal volume
A 45-year-old man with a history of asthma undergoes GA for an inguinal hernia repair. During the case, peak airway pressures suddenly rise, the capnography tracing shows an upsloping EtCO2 waveform, and wheezing is heard on auscultation. Which of the following is the most appropriate initial management step?
Administer IV corticosteroids
Deepen the level of anesthesia
Give IV magnesium sulfate
Administer epinephrine
A 62-year-old man with a history of idiopathic pulmonary fibrosis presents for preoperative evaluation before elective knee replacement. He reports progressive shortness of breath on exertion. PFTs show the following: TLC 55% of predicted FEV1 65% of predicted FVC 60% of predicted FEV1/FVC ratio 1.08 DLCO reduced A flow-volume loop is performed and shows a small sharply peaked curve. Which of the following best describes the characteristic changes in restrictive lung disease and differentiates it from obstructive lung disease?
Reduced lung volumes, preserved flow shape, scooped out expiratory limb
Reduced lung volumes, preserved flow shape, sharp peak expiratory flow
Increased residual volume, scooped out expiratory limb, left-shifted loop
Flattened inspiratory limb, normal expiratory limb
A 68-year-old woman with history of hypertension and diastolic heart failure presents to the ED with sudden onset shortness of breath. She reports difficulty breathing when lying flat. On exam, she is tachycardic, hypertensive, and diaphoretic. Lung auscultation reveals bilateral crackles. Chest x-ray demonstrates symmetric perihilar opacities. Which of the following best explains the pathophysiology of her pulmonary edema?
Alveolar flooding due to increased pulmonary capillary hydrostatic pressure from LV dysfunction
Alveolar flooding due to increased alveolar-capillary permeability from diffuse alveolar damage
Airway collapse during expiration leading to impaired ventilation and hypoxia
Decreased surfactant production resulting in alveolar collapse and impaired gas exchange
A 22-year-old woman with a history of moderate asthma undergoes an uncomplicated appendectomy under GA. She is extubated awake in the OR. Minutes later, she develops stridor, agitation, and desats to 88% on supplemental O2. She is making vigorous inspiratory efforts against a partially obstructed airway. Auscultation reveals bilateral crackles. Which of the following best describes the pathophysiology of her pulmonary edema?
LV dysfunction causing increased pulmonary capillary hydrostatic pressure
Alveolar flooding due to increased capillary permeability from ARDS
Vigorous inspiratory effort against an obstructed airway generating high negative intrathoracic pressure, increasing transcapillary gradient
Surfactant deficiency leading to alveolar collapse and hypoxemia
A 42-year-old man undergoes emergency craniotomy for a subdural hematoma. Within 2 hours postop, he develops acute dyspnea, hypoxemia, and bilateral pulmonary infiltrates on CXR. Blood pressure is elevated and echo shows normal LV function.
Increased capillary permeability due to direct alveolar injury
LV systolic dysfunction from catecholamine surge
Sympathetic-mediated pulmonary vasoconstriction causing increased pulmonary capillary pressure
Aspiration of gastric contents inducing inflammation
A 32-year-old mountaineer rapidly ascends to 4000 meters and develops progressive dyspnea, fatigue, and dry cough over the next 48 hours. XR reveals bilateral patchy infiltrations. Oxygen sat is 82% on room air. Which of the following best explains the underlying mechanism contributing to his pulmonary edema?
LV dysfunction leading to elevated pulmonary capillary wedge pressure
Aspiration of gastric contents resulting in localized inflammatory edema
Direct alveolar injury for viral infection causing increased capillary permeability
Widespread alveolar hypoxia causing pulmonary vasoconstriction
A 67-year-old man presents to the preop area for incarcerated inguinal hernia repair. An HPI reveals that he underwent an upper esophageal resection with end-to-end anastomosis several weeks ago, complicated by a leak, which now appears to have healed. He admits to eating a sandwich 4 hours ago. Shortly after the interview, he is actively vomiting. What is the most appropriate strategy for intubating him?
Awake FOI to maintain appropriate airway reflexes
RSI with appropriate positioning
Wait 6 hours and perform RSI with appropriate positioning
Place an NG tube before transport to the OR, and then perform RSI with appropriate positioning
A 55-year-old man presents for urgent cystoscopy due to bleeding. His PMH includes hypertension, obesity, T2DM, and chronic pain. His medications include insulin, gabapentin, lisinopril, and oxycodone. He has been NPO for the last 8 hours. Which 3 of the following factors increase this patient's risk of pulmonary aspiration during anesthesia?
Gabapentin use
Obesity
Lithotomy position
Urgent surgery
NPO for 8 hours
A 56-year-old patient is on mechanical ventilation in the ICU following abdominal surgery. The ventilator is set to deliver a set number of breaths per minute, each with a fixed tidal volume. When the patient initiates a spontaneous breath, the ventilator provides additional pressure support to reduce their work of breathing. Which mode is this?
Assist control + PEEP
CPAP with PEEP
Pressure Support Ventilation with PEEP
SIMV with pressure support
A 78-year-old patient is scheduled for elective hip replacement. PFTs show mild decrease in FEV1 and FC with preserved FEV1/FVC ratio. The patient has noticeable kyphosis and reports exertional dyspnea. Which of the following physiologic changes is most consistent with age-related restrictive lung disease?
Increased chest wall compliance and decreased residual volume
Decreased elastic recoil with increased residual volume
Obstruction of small airways leading to increased FEV1/FVC ratio
Normal FRC with increased vital capacity
A 70-year-old woman with idiopathic pulmonary fibrosis, kyphosis, and a history of sarcoidosis presents for elective laparoscopic cholecystotomy. She reports progressive dyspnea on exertion, but no recent infections. PFTs show restrictive pattern with reduced FVC and FEV1 and a DLCO at 50% of predicted. Which of the following statements regarding perioperative management is most appropriate?
Preoxygenation is optional because restrictive physiology patients maintain normal FRC
High tidal volumes should be used to overcome decreased lung compliance
Use low tidal volumes, moderate PEEP, minimize peak airway pressures, and optimize oxygenation preop
NMBs should be avoided entirely in patients with LAM or sarcoidosis due to the risk of lung collapse
An 82-year-old woman with kyphosis and mild age-related restrictive lung disease is scheduled for laparoscopic cholecystectomy under GA. Preop PFTs show a mild reduction in FEV1 and FVC with preserved FEV1/FVC ratio. Which of the following ventilation strategies is most appropriate intraop to minimize the risk of hypoxemia and VILI?
Avoid preoxygenation to reduce oxygen toxicity and allow spontaneous breathing with no ventilatory support
Moderate tidal volumes with permissive hypercapnia to maximize alveolar recruitment
High tidal volumes with zero PEEP to overcome decreased chest wall compliance
Moderate tidal volumes with moderate PEEP, careful monitoring of peak airway pressures, and preoxygenation
Which of the following features best distinguishes neurogenic pulmonary edema from aspiration pneumonitis in the postop period?
Presence of bilateral infiltrates on imaging
Association with massive sympathetic outflow
Need for mechanical ventilation
Development of secondary bacterial pneumonia
A 55-year-old male with a history of idiopathic pulmonary fibrosis presents for elective hernia repair. Preop testing shows: PFT: TLC 48% predicted, FVC 50% predicted, FEV1/FVC ratio 0.85. ABG on room air: PaO2 60, PaCO2 38. Exam: Bibasilar crackles, SpO2 96%. Which of the following is the most important anesthetic management strategy for this patient?
Use high tidal volumes to ensure adequate ventilation
Apply low tidal volumes with moderate PEEP to optimize oxygenation
Liberal fluid administration to prevent intraop hypotension
Avoid preoxygenation to reduce risk of absorption atelectasis
A 25-year-old healthy male undergoes shoulder arthroscopy. Right after extubating, he develops acute upper airway obstruction due to laryngospasm. Less than 5 minutes, he is hypoxemic with pink frothy sputum. Chest x-ray results show bilateral pulmonary infiltrates. Which of the following is the most likely diagnosis?
Cardiogenic pulmonary edema
Aspiration pneumonitis
Negative pressure pulmonary edema
Acute respiratory distress syndrome
Which of the following best describes the normal function of the pericardium?
Provides electrical insulation between atria and ventricles
Limits acute cardiac dilation
Maintains constant coronary blood flow
Enhances ventricular compliance
A 24-year-old man presents with chest pain that is sharp, worse with inspiration, and improved when sitting forward. His ECG shows diffuse ST elevation and PR depression. Which of the following confirms the diagnosis of acute pericarditis?
Elevated troponin
Reciprocal ST depression
Coronary CTA
Pericardial friction rub
Which of the following findings best distinguishes acute pericarditis from MI?
Chest pain relieved by leaning forward
Elevated troponin
ST segment elevation
Chest pain radiating to the right arm
On TTE, which finding helps distinguish pericardial effusion from pleural effusion?
Electrical alternans on ECG
Left atrial enlargement
Presence of fluid posterior to the descending aorta
PR segment depression
A 56-year-old man with a history of metastatic lung cancer presents with progressive dyspnea and chest discomfort. On exam, his BP is 84/52, HR is 122, and SpO2 is 93% on room air. JVD is noted and heart sounds are muffled. Lungs are clear to auscultation. Which of the following additional findings would most strongly support the diagnosis in this patient?
Fixed splitting of the second heart sound
Systolic BP that increases during inspiration
Decrease in systolic BP > 10 mmHg during inspiration
Pericardial knock on auscultation
A 55-year-old man with a large pericardial effusion presents for emergent pericardial window. Which induction agent is most appropriate?
Propofol
Etomidate
Thiopental
Midazolam
Which intraoperative management strategy is most appropriate for a patient with cardiac tamponade?
Controlled ventilation with high tidal volumes and PEEP
Induction with ketamine, maintain spontaneous ventilation
Large fluid boluses to maintain preload
Avoid vasopressors at all costs
A 55-year-old man presents with progressive abdominal distension, peripheral edema, and exertional dyspnea. On exam, he has elevated JVP that rises with inspiration, ascites, hepatomegaly, and lower extremity edema. A high-pitched early diastolic sound is heard shortly after S2. Echo shows preserved systolic function with abnormal septal motion that varies with respiration. What is the diagnosis?
Restrictive cardiomyopathy
Constrictive pericarditis
Dilated cardiomyopathy
Cardiac tamponade
A 56-year-old man presents with progressive dyspnea, ascites, and lower extremity edema. On exam, he has elevated JVP with a lack of inspiratory decline, consistent with Kussmaul’s sign. Which of the following best explains the underlying pathophysiology of his condition?
Systolic dysfunction due to dilated cardiomyopathy
Impaired ventricular filling due to a rigid pericardium
Increased pulmonary venous compliance due to left atrial enlargement
Increased myocardial contractility due to sympathetic activation
A 32-year-old man presents after a high-speed MVC. He is hemodynamically stable. ECG shows new RBBB. Troponin is elevated. Which of the following is the most likely diagnosis?
MI
Cardiac concussion
Myocardial contusion
Aortic dissection
What is the most common site of blunt traumatic aortic injury?
Aortic arch at the origin of the left subclavian artery (isthmus)
Ascending aorta
Descending thoracic aorta at the diaphragm
Abdominal aorta just above the renal arteries
Which of the following is not a modifiable risk factor of ischemic heart disease?
DM
Age
Smoking
Hypercholesterolemia
Which Canadian Cardiovascular Society class is defined by angina with walking 1-2 blocks on the flat or 1 flight of stairs at normal pace?
Class I
Class II
Class III
Class IV
Which of the following meds prolong survival in patients with chronic stable angina?
Nitrates
BBs
CCBs
ACEi
A 65-year-old man with exertional chest pain undergoes coronary angiography showing 75% stenosis of the left main coronary artery. Which therapy is most appropriate?
PCI with stent
CABG
Nitrates and BB only
Ranolazine
A patient develops Dressler’s syndrome 6 weeks after MI. What is the best management?
IV steroids immediately
Aspirin
Nitrates and BB
High-dose NSAIDs or corticosteroids
A 68-year-old woman with peripheral vascular disease undergoes urgent femoral endarterectomy. On postop day 2, troponin is elevated with new ST-segment depression but she has no chest pain. Which is the most likely mechanism?
Plaque rupture with thrombus formation
Coronary artery embolism
Oxygen supply-demand mismatch
Coronary vasospasm
During laryngoscopy in a patient with known CAD, which hemodynamic response is most concerning?
Transient bradycardia
Transient tachycardia
Mild hypotension
Mild hypoventilation
A 65-year-old man with poorly controlled hypertension is scheduled for elective hernia repair. His preop BP in clinic is 178/96. He denies chest pain, dyspnea, or neuro symptoms. What is the best course of action?
Cancel surgery and refer for patient BP optimization
Administer IV labetalol to normalize BP before induction
Delay surgery until BP is consistent <140/90
Proceed with surgery as there is no evidence of end-organ damage
A 70-year-old woman with longstanding hypertension is scheduled for colectomy. Which two antihypertensive meds should definitely be continued on the day of surgery to avoid rebound complications?
Clonidine
Labetalol
Hydrochlorothiazide
Lisinopril
A 48-year-old woman with idiopathic pulmonary hypertension is on continuous IV Flolan therapy. She presents for elective cholecystectomy. Which of the following is the most important periop consideration regarding her medication?
The infusion must never be interrupted
It should be stopped the night before surgery
It should be transitioned to oral therapy for convenience
It can be restarted after extubation if needed
A 52-year-old woman with idiopathic pulmonary hypertension presents for elective lap chole. Which intraop factor poses the greatest risk of worsening her pulmonary hypertension and precipitating RV failure?
Use of volatiles
Administration of propofol at induction
Creation of CO2 pneumoperitoneum in Trendelenburg position
Insertion of a CVC
A 65-year-old man with severe AS presents for elective hip arthroplasty. His echo shows concentric LVH and preserved EF. Which statement best describes his reliance on the Frank-Starling mechanism?
Increasing preload will reliably increase SV, even in advanced pressure overload
The ventricle’s ability to augment SV with preload is limited due to diastolic dysfunction
SV is primarily maintained by afterload reduction rather than preload dependence
The Frank-Starling mechanism is irrelevant once concentric hypertrophy develops
A 54-year-old woman with chronic severe MR presents for mitral valve repair. Which best explains how the Frank-Starling mechanism contributes to her clinical presentation?
Chronic volume overload causes eccentric hypertrophy, which enhances SV indefinitely.
The Frank-Starling relationship is preserved because regurgitant flow decreases LV afterload
SV is primarily maintained by tachycardia, not preload responsiveness
Increased preload initially augments forward SV, but progressive dilation reduces efficiency
A 72-year-old man with known AS presents for hip fracture repair. Which anesthetic management principle is MOST important?
Maintain rapid heart rate
Avoid afterload reduction
Reduce preload to prevent congestion
Use nitroglycerin to reduce wall stress
A 22-year-old woman with a history of congenital heart disease presents for elective lap chole. Her condition is characterized by apical displacement of the septal leaflet of the tricuspid valve, leading to arterialization of the RV. Which of the following anesthetic considerations is MOST appropriate for this patient?
Avoiding agents that increase PVR to prevent right-to-left shunting
Hyperventilation and high FiO2 should be avoided to prevent systemic vasoconstriction
Bradycardia is well tolerated because of preserved atrial contraction
Volatile anesthetics should always be avoided due to risk of tricuspid regurgitation
Which of the following agents that increase PVR to prevent right-to-left shunting?
Avoiding agents that increase PVR to prevent right-to-left shunting
Hyperventilation and high FiO2 should be avoided to prevent systemic vasoconstriction
Bradycardia is well tolerated because of preserved atrial contraction
Volatile anesthetics should always be avoided due to risk of tricuspid regurgitation
Which of the following best differentiates HFpEF from HFrEF?
Reduced cardiac output
Ventricular stiffness during diastole
Pulmonary congestion symptoms
Elevated filling pressures
A 72-year-old man with longstanding hypertension and preserved EF presents for elective hip replacement. Echo shows concentric LVH, enlarged LA, and impaired relaxation on Doppler. Which of the following findings is most consistent with diastolic dysfunction?
Increased ESPVR slope
Increased slope of EDPVR slope
Increased LV compliance
Reduced EF (<40%)
A 66-year-old man with EF 30% is scheduled for colectomy under GA. During epidural placement, BP drops from 125/70 to 85/50. Which is the best initial management?
Rapid 1L bolus
Administer phenylephrine 100 mcg IV
Begin dopamine infusion
Give 20 mg furosemide IV
Which of the following hemodynamic changes will worsen LVOTO in hypertrophic cardiomyopathy?
Increased afterload
Decreased contractility
Decreased preload
Bradycardia
A 60-year-old man with severe COPD and chronic hypoxemia presents for lap chole. He has JVD, pitting edema, and a loud P2. Which intraoperative event would most likely precipitate acute RV failure?
PaCO2 95, EtCO2 35, normothermia
Administration of low-dose phenylephrine
Maintenance of sinus rhythm at HR 85
Increase in PEEP from 5 to 12
A 55-year-old man with HCM develops hypotension after induction. Which intervention will most effectively improve his hemodynamics?
Ephedrine 10 mg IV
Phenylephrine 100 mcg IV
Dobutamine infusion
Large fluid bolus
A 68-year-old woman with restrictive CMP from amyloidosis develops new-onset AFib during lap chole. BP drops to 70/40. What is the most appropriate next step?
Increase volatile
Administer phenylephrine
Immediate synchronized cardioversion
Give esmolol for rate control
A 65-year-old man with severe COPD and cor pulmonale becomes hypotensive after induction. Which finding would suggest the cause is increased PVR?
EtCO2 32, PaO2 95
PaCO2 65, pH 7.28
HR 55, CVP 4
MAP 90, PAP 20
Which phase of the cardiac action potential is primarily responsible for triggering myocardial contraction?
Phase 0
Phase 1
Phase 2
Phase 3
During anesthesia, a patient receiving amiodarone develops QT prolongation. Which ionic current is most likely affected?
Na influx during Phase 0
Ca influx during Phase 2
K efflux during Phase 3
Na/K ATPase during Phase 4
A 42-year-old otherwise healthy patient develops severe bradycardia (HR 28) and hypotension (BP 60/30) approximately 45 minutes after receiving a spinal anesthetic for a hernia repair. Oxygen saturation remains normal, and there are no signs of high spinal blockade. Which of the following mechanisms most likely explains this event?
Unopposed sympathetic stimulation of the SA node
Direct myocardial depression from LAST
Activation of the Bezold-Jarisch reflex due to decreased venous return
Blockade of parasympathetic fibers in the cervical ganglia
A 72-year-old man with a DDD pacemaker presents for open abdominal surgery under general anesthesia. The surgeon will be using monopolar electrocautery near the upper abdomen. Which of the following best describes the expected pacemaker response when a magnet is applied over the device?
Inhibition of pacing output to prevent oversensing
Conversion to asynchronous pacing (DOO) at a fixed rate
Triggers of pacing output in response to intrinsic P waves
Deactivation of both sensing and pacing functions
