Cardiovascular Physiology and
Anesthesia Answers with Explanation
at the end of every set
915. An oximetric pulmonary artery (PA) catheter is placed in a 69-year-old man
who is undergoing surgical repair of an abdominal aortic aneurysm under
general anesthesia. Before the aortic cross-clamp is placed, the mixed venous
O2 saturation decreases from 75% to 60%. Each of the following could
account for the decrease in mixed venous O2 saturation EXCEPT
A. Hypovolemia
B. Bleeding
C. Congestive heart failure (CHF)
D. Sepsis
916. Postoperatively a 64-year-old man develops heparin-induced
thrombocytopenia (HIT), type II (antibody proven), after anticoagulation for
aortic valve replacement with 25,000 units of heparin. The same patient
requires an elective tricuspid valve replacement soon thereafter because of
trauma from a transvenous pacemaker. The best option for cardiopulmonary
bypass anticoagulation for this patient with the second operation would be
A. Defer until disappearance of antibodies; use heparin
B. Cardiopulmonary bypass with lepirudin in place of heparin
C. Cardiopulmonary bypass with tirofiban in place of heparin
D. Anticoagulation with fondaparinux
917. Which of the following is the MOST sensitive indicator of left ventricular
myocardial ischemia?
A. Wall-motion abnormalities on the echocardiogram
B. ST segment changes in lead V5 of the electrocardiogram (ECG)
C. Appearance of V waves on the pulmonary capillary wedge
pressure tracing
D. Decrease in cardiac output as measured by the
thermodilution technique
,918. Oxygen consumption (Vo 2 ) is measured in a 70-kg subject on a treadmill at
2500 mL per minute. This corresponds to:
A. 1 metabolic equivalent (MET)
B. 5 METs
C. 10 METs
D. 15 METs
919. Accidental injection of air into a peripheral vein would be LEAST likely to
result in arterial air embolism in a patient with which of the following
anatomic cardiac defects?
A. Patent ductus arteriosus
B. Eisenmenger syndrome
C. Tetralogy of Fallot
D. Tricuspid atresia
920. Each of the following could be placed on the x-axis of the curve shown in the
figure EXCEPT
A. Stroke volume
B. Left ventricular end-diastolic pressure
C. Left ventricular end-diastolic volume
D. Left atrial pressure
921. The ECG rhythm strip below represents
, From Mark JB: Atlas of Cardiovascular Monitoring, New York, Churchill Livingstone,
1998.
A. Atrial flutter
B. Third-degree heart block
C. Sinus tachycardia second-degree heart block
D. Junctional rhythm
922. A 71-year-old man is undergoing revascularization of three coronary vessels
on cardiopulmonary bypass at 28° C. After the last graft is sewn into the
aorta, the arterial pressure measured from a left radial artery is 47 mm Hg
and the PA pressure is 6 mm Hg. Thirty minutes later, the arterial pressure is
52 mm Hg and PA pressure is 31 mm Hg. The MOST likely explanation for
this is
A. Malposition of the aortic cannula
B. Malposition of the venous cannula
C. Faulty ventricular venting
D. PA catheter migration
923. A 78-year-old patient is anesthetized for right hemicolectomy with isoflurane
and nitrous oxide. Vecuronium is administered to facilitate muscle relaxation.
At the end of the operation, the neuromuscular blockade is reversed with
neostigmine 4 mg and glycopyrrolate 0.8 mg. The rhythm below is noted
shortly after administration of these drugs. The patient’s blood pressure is
90/60. The MOST appropriate course of action at this point is
From Jackson JM, Thomas SJ, Lowenstein E: Anesthetic management of patients with
valvular heart disease, Semin Anesth 1:244, 1982.
, A. DC cardioversion
B. Isoproterenol drip
C. Atropine
D. Transcutaneous pacemaker
924. While on cardiopulmonary bypass during elective coronary artery
revascularization, the patient is noted to have bulging sclerae. Mean arterial
pressure (MAP) is 50 mm Hg, temperature is 28° C, and there is no ECG
activity. The MOST appropriate action to take at this time is to
A. Administer mannitol, 50 g IV
B. Decrease the cardiac index
C. Check the position of the aortic cannula
D. Check the position of the venous return cannula
925. The wave designated by the arrow is produced physiologically by
From Szocik J, Teig M, Tremper KK: Anesthetic monitoring. In: MC Pardo, RD Miller,
eds, Basics of Anesthesia, ed 7, Elsevier, 2018, p 355.
A. Atrial filling
B. Bulging of tricuspid valve into right atrium
Anesthesia Answers with Explanation
at the end of every set
915. An oximetric pulmonary artery (PA) catheter is placed in a 69-year-old man
who is undergoing surgical repair of an abdominal aortic aneurysm under
general anesthesia. Before the aortic cross-clamp is placed, the mixed venous
O2 saturation decreases from 75% to 60%. Each of the following could
account for the decrease in mixed venous O2 saturation EXCEPT
A. Hypovolemia
B. Bleeding
C. Congestive heart failure (CHF)
D. Sepsis
916. Postoperatively a 64-year-old man develops heparin-induced
thrombocytopenia (HIT), type II (antibody proven), after anticoagulation for
aortic valve replacement with 25,000 units of heparin. The same patient
requires an elective tricuspid valve replacement soon thereafter because of
trauma from a transvenous pacemaker. The best option for cardiopulmonary
bypass anticoagulation for this patient with the second operation would be
A. Defer until disappearance of antibodies; use heparin
B. Cardiopulmonary bypass with lepirudin in place of heparin
C. Cardiopulmonary bypass with tirofiban in place of heparin
D. Anticoagulation with fondaparinux
917. Which of the following is the MOST sensitive indicator of left ventricular
myocardial ischemia?
A. Wall-motion abnormalities on the echocardiogram
B. ST segment changes in lead V5 of the electrocardiogram (ECG)
C. Appearance of V waves on the pulmonary capillary wedge
pressure tracing
D. Decrease in cardiac output as measured by the
thermodilution technique
,918. Oxygen consumption (Vo 2 ) is measured in a 70-kg subject on a treadmill at
2500 mL per minute. This corresponds to:
A. 1 metabolic equivalent (MET)
B. 5 METs
C. 10 METs
D. 15 METs
919. Accidental injection of air into a peripheral vein would be LEAST likely to
result in arterial air embolism in a patient with which of the following
anatomic cardiac defects?
A. Patent ductus arteriosus
B. Eisenmenger syndrome
C. Tetralogy of Fallot
D. Tricuspid atresia
920. Each of the following could be placed on the x-axis of the curve shown in the
figure EXCEPT
A. Stroke volume
B. Left ventricular end-diastolic pressure
C. Left ventricular end-diastolic volume
D. Left atrial pressure
921. The ECG rhythm strip below represents
, From Mark JB: Atlas of Cardiovascular Monitoring, New York, Churchill Livingstone,
1998.
A. Atrial flutter
B. Third-degree heart block
C. Sinus tachycardia second-degree heart block
D. Junctional rhythm
922. A 71-year-old man is undergoing revascularization of three coronary vessels
on cardiopulmonary bypass at 28° C. After the last graft is sewn into the
aorta, the arterial pressure measured from a left radial artery is 47 mm Hg
and the PA pressure is 6 mm Hg. Thirty minutes later, the arterial pressure is
52 mm Hg and PA pressure is 31 mm Hg. The MOST likely explanation for
this is
A. Malposition of the aortic cannula
B. Malposition of the venous cannula
C. Faulty ventricular venting
D. PA catheter migration
923. A 78-year-old patient is anesthetized for right hemicolectomy with isoflurane
and nitrous oxide. Vecuronium is administered to facilitate muscle relaxation.
At the end of the operation, the neuromuscular blockade is reversed with
neostigmine 4 mg and glycopyrrolate 0.8 mg. The rhythm below is noted
shortly after administration of these drugs. The patient’s blood pressure is
90/60. The MOST appropriate course of action at this point is
From Jackson JM, Thomas SJ, Lowenstein E: Anesthetic management of patients with
valvular heart disease, Semin Anesth 1:244, 1982.
, A. DC cardioversion
B. Isoproterenol drip
C. Atropine
D. Transcutaneous pacemaker
924. While on cardiopulmonary bypass during elective coronary artery
revascularization, the patient is noted to have bulging sclerae. Mean arterial
pressure (MAP) is 50 mm Hg, temperature is 28° C, and there is no ECG
activity. The MOST appropriate action to take at this time is to
A. Administer mannitol, 50 g IV
B. Decrease the cardiac index
C. Check the position of the aortic cannula
D. Check the position of the venous return cannula
925. The wave designated by the arrow is produced physiologically by
From Szocik J, Teig M, Tremper KK: Anesthetic monitoring. In: MC Pardo, RD Miller,
eds, Basics of Anesthesia, ed 7, Elsevier, 2018, p 355.
A. Atrial filling
B. Bulging of tricuspid valve into right atrium
