Term Exam 2024 Paper: Cardiothoracic Anesthesia

School of Health Sciences PeshawarFinal Term Exam 2024 Paper: Cardiothoracic Anesthesia Name: __________________________ Discipline: ________________________ Note: Chose the correct answer. Note: cutting and duplication will cause no marking. Which of the following is a potential complication of protamine administration after cardiopulmonary bypass? What is the most common arrhythmia observed after cardiac surgery? During the preoperative evaluation, all of the following drugs should be discontinued before surgery except? A. Clopidogrel and prasugrel B. Diuretics and NSAIDs C. Statins and beta?blockers D. GP IIb/IIIa inhibitors What activated clotting time (ACT) range is generally considered safe during cardiopulmonary bypass? A. 100–200 seconds B. 200–300 seconds C. 400–480 seconds D. 600–700 seconds What is the usual initial dosage of heparin for achieving adequate anticoagulation prior to CPB? A. 50–100 u/kg B.150–200 u/kg C. 300–400 u/kg D. 500–600 u/kg Which of the following medications should be discontinued before cardiac surgery? Statins Beta-blockers Clopidogrel Nitrates Which of the following lead configurations provides improved sensitivity for detecting myocardial ischemia? 3-lead ECG 5-lead ECG Single-lead ECG \ 12-lead ECG Which of the following is a key characteristic of an ideal cardiac anesthetic agent? All of the following are part of the five "As" in cardiac anesthesia EXCEPT: Which test is used to confirm the adequacy of anticoagulation before CPB? Tranexamic acid is commonly dosed as: What is the recommended SBP range during aortic cannulation? D. 140–160 mmHg 13. All of the following are true regarding the initial bypass checklist, EXCEPT: 14. What Mean Arterial Pressure (MAP) is considered hypertension during cardiopulmonary bypass (CPB)? 15. What is the allowable hematocrit (HCT) range during cardiac surgery? 16. How many basic components are present in a cardiopulmonary bypass (CPB) circuit? 17. During a right pneumonectomy, the SpO? drops to 85% on OLV. What is the first intervention? A. Increase PEEP to 10 Cm H?O B. Switch to two-lung ventilation & administer O2 C. Administer vasodilators Decrease tidal volume to 5 ml/kg 18. What physiological mechanism helps reduce shunt flow during OLV? A. Hypoxic Pulmonary Vasoconstriction (HPV) B. Increased cardiac output C. Systemic vasodilation D. Bronchodilation 19.Which type of pump in the CPB circuit is more likely to cause RBC damage? 20. Which of the following metabolic changes is commonly seen in pediatric patient undergoing CPB? 21. Which of the following is a possible neurological complication of CPB? 22. Which of the following is an absolute indication for OLV? A. Upper lobectomy B. Bronchopleural fistula C. Thoracic spine surgery D. Minimal invasive cardiac surgery 23. Which factor can contribute to systemic inflammatory response syndrome (SIRS) after CPB? 24. Which test assesses the gas exchange capability of the lungs? A. FEV1 B. DLCO C. PEFR D. MVV 25. Which of the following drugs is used to reverse heparin after CPB? 26. Which electrolyte imbalance is commonly associated with CPB? 27. Which of the following is an advantage of centrifugal pumps over roller pumps in CPB? D. All the above 28. Which of the following anesthetic agents is most commonly used for induction in cardiac surgery? A. Propofol B. Etomidate C. Ketamine D. Midazolam Sodium 29. Which opioid is preferred in cardiac anesthesia due to its hemodynamic stability? A. Morphine Which metabolic change is commonly observed during CPB anesthesia ? A. Respiratory alkalosis B. Metabolic acidosis C. Hyperkalemia C. Hypernatremia Which muscle relaxant is preferred during induction for CPB surgery due to cardiovascular stability? A. Succinylcholine B. Pancuronium C. Vecuronium D. Atracurium De-airing of the heart is essential before removing the aortic cross-clamp to prevent: A. Arrhythmias B. Stroke C. Hypotension D. Cardiac hypertrophy Which of the following drugs is used for rapid control of intraoperative hypertension in cardiac anesthesia? A. Labetalol B. Esmolol C. Phenylephrine D. Atropine Which of the following agents is most commonly used for fast-track extubation after cardiac surgery? A. Sevoflurane B. Desflurane C. Isoflurane D. Propofol Which of the following muscle relaxants causes sinus tachycardia in cardiac anesthesia? Atracurium Vecuronium Pancuronium Vancuronium During cardiac surgery, which of the following is used to achieve cardioplegia? A. Magnesium sulfate B. Potassium chloride C. Sodium bicarbonate D. Epinephrine A 70-year-old man undergoing CABG is on CPB. After 2 hours, urine output drops to <0.5 mL/kg/hr. Likely cause? A. High CPB flow B. Excess protamine C. Renal hypoperfusion D. Excess oxygenation What is the common complication of prolonged CPB? A. Myocardial infarction B. Renal failure C. Liver cirrhosis D. Hypertension Which vessel is cannulated for venous drainage in a typical CPB procedure? A. Aort a B. Femoral artery C. Superior and inferior vena cava D. Pulmonary artery After childbirth What is the NYHA classification for a patient who experiences fatigue and shortness of breath during ordinary physical activity but has no symptoms at rest? Class I Class II Class III D. Class IV What is the NYHA Functional Class for a 70-year-old female with advanced heart failure who experiences shortness of breath at rest and is mostly bedbound? A. Class I B. Class II C. Class III D. Class IV Which test is traditionally used to assess collateral flow before radial artery cannulation? A. Doppler ultrasound B. Allen’s test C. Tilt table test D. Tourniquet test A delayed (>10 sec) return of color in Allen’s test suggests: A. Adequate collateral circulation B. Insufficient collateral circulation C. Normal vascular response D. Venous insufficiency Which artery in Arterial Cannulation is most associated with infectious complications and pseudoaneurysm formation? A. Brachial B. Femoral C. Radial D. Axillary Which of the following is NOT a complication of arterial catheterization? A 65-year-old female undergoing high-risk surgery requires tight BP control. Which site is best for beat-to-beat monitoring? Which technique is most commonly used for CVC placement? A patient develops sudden dyspnea and hypotension post-subclavian CVC placement. What is the most likely cause? What is the minimum preoperative FEV1% generally accepted for a pneumonectomy? Trepopnea refers to dyspnea that occurs: Which of the following is a sign of inadequate anticoagulation during CPB? Which of the following is a cause of coagulopathy post-CPB? What is the primary purpose of using antifibrinolytic agents (e.g., tranexamic acid) during cardiac surgery? Which receptor is primarily responsible for detecting changes in blood gases and triggering respiratory changes? A. Mechanoreceptors B. Juxtacapillary receptors C. Chemoreceptors D. Pain receptors The primary physiological cause of dyspnea is: A. Increased lung compliance B. Mismatch in brain's sensory and motor integration of breathing effort C. Overuse of diaphragm D. Excessive oxygen levels What is the normal range for ejection fraction (EF) in a healthy individual? a) 20%-30% b) 40%-50% c) 55%-65% d) 70%-80% Which of the following is a potential complication of arterial line placement? a) Hypertension b) Air or thromboembolism c) Hypoglycemia d) Improved peripheral perfusion What is a potential risk associated with angiography? a) Improved kidney function b) Severe allergic reaction to contrast dye c) Reduced blood pressure variability d) Increased bone density t he main advantage of using a left-sided DLT over a right-sided DLT is: A. Easier insertion B. Less risk of malposition due to anatomy C. Greater lumen size D. Better oxygenation One-lung ventilation with a DLT is likely to cause: A. Increased PaO ? B. Hypoxic pulmonary vasoconstriction C. Metabolic alkalosis D. Decreased CO? retention A patient requires vasopressor support post-CPB. Which agent provides both inotropic and vasopressor effects? A. Norepinephrine B. Dobutamine C. Nitroglycerin D. Esmolol Which drug is ideal for controlling intraoperative hypertension and is ultra-short-acting? A. Labetalol B. Esmolol C. Metoprolol D. Atenolol Which of the following antifibrinolytic agents is commonly used during cardiac surgery to reduce bleeding? A. Warfarin B. Tranexamic acid C. Protamine sulfate D. Atropine