HFMA CRCR EXAM LATEST EXAM 2025\2026
PREPARATION QUESTIONS AND CORRECT
ANSWERS(VERIFIED ANSWERS)
spirnolactone act primarily on what segment of the renal tubule?
a. proximal
b.ascending limb of loop of henle
c. distal tubule
d. collecting duct
d. spirnolactone is a competitive aldosterone antagonist that works on the late distal
tubule and collecting duct (mostly the collecting duct). Increases sodium excretion and
potassium retention.
A 60-year-old man is undergoing a Type A aortic dissection repair under deep
hypothermic circulatory arrest. His current temperature is 24°C and his uncorrected
ABG shows pH 7.40, PaCO2 40 mmHg and PaO2 250 mmHg. Which of the following
changes would you MOST expect If you were to adjust his ABG to his core body
temperature of 24°C?
a. PaCO2 increased, PaO2 increased
b. PaCO2 decreased, PaO2 decreased
c. PaCO2 increased, PaO2 decreased
d. PaCO2 decreased, PaO2 increased
b. As the temperature of blood decreases, the solubility of gases increases such that the
partial pressure of CO2 and O2 decrease. Thus, a respiratory alkalosis develops as
temperature decreases. The ABG appears normal at the temperature at which it is
measured (37 °C) on the ABG machine; however, when corrected the patient's core
temperature of 24°C he will have a respiratory alkalosis with PaCO2 and PaO2 that are
decreased compared to the normal.
Actuation of the oxygen flush valve delivers 100% oxygen at a rate of:
a. 10 - 20 L/min
b. 20 - 30 L/min
c. 35 - 75 L/min
d. 80 - 100 L/min
-1-
,c. The oxygen flush valve delivers 100% oxygen at a rate of 35 - 75 L/min with a
pressure of 40 - 60 psi.
After a CABG, a 65-year-old man is hypotensive upon weaning from cardiopulmonary
bypass. The surgeon is considering insertion of an intraaortic balloon pump for
counterpulsation. Which of the following represents the MOST significant
contraindication to placement of an intraaortic balloon pump?
A. Aneurysm of left ventricle
B. Aortic atheroma
C. Aortic regurgitation
D. Aortic stenosis
C. Intraaortic balloon counterpulsation has been used for many years for patients with
left ventricular failure. Indications for its use have grown in recent years. Still, it is most
commonly used for patients in cardiogenic shock, post-myocardial infarction, severe
myocarditis, cardiomyopathy, unstable angina refractory to medications, high grade left
main coronary artery disease, failure to wean adequately from cardiopulmonary bypass,
low cardiac output syndrome and as a short-term bridge to heart transplant. There are
relatively few contraindications, including severe aortic regurgitation (AR) as the balloon
inflates during diastole and would worsen AR and not improve coronary flow during
diastole. Aortic dissection (difficult to place balloon in true lumen of aorta) and severe
aortoiliac occlusive disease or peripheral vascular disease (high risk of limb ischemia)
are also contraindications.
The incidence of headache with inadvertent dural puncture during epidural anesthesia is
decreased:
a. with decreasing age
b. by keeping the patient supine for more than 12 hours following puncture
c. with the use of fluid, instead of air, for loss of resistance
d. by inserting the needle with the bevel aligned perpendicular to the long axis of the
meninges
c. The use of fluid instead of air has been associated with a significant reduction in the
incidence of postdural puncture headache (PDPH). Other factors associated with a
reduced incidence of PDPH are: increasing age, insertion of the bevel aligned parallel to
the long axis of the meninges and the use of smaller needles. There is no evidence that
keeping the patient supine reduces the incidence of PDPH.
if somatosensory evoked potential monitoring suggests spinal cord damage, what
segment of the cord is involved?
-2-
,a. anterior
b. anterolateral
c. posterolateral
d. posterior
d. Posterior
Pain afferent nerve fibers enter the dorsal cord and scend or descend 1-3 segments in
what tract before entering and synpasing in the dosral horn?
a. dorsolateral tract
b. tract of lissauer
c. anterori cerebrospinal tract
d. lateral spinothalamic tract
b. Tract of lissauer
Pain transmitted from the periphery by A- delta fibers terminate primarily in Rexed's
lamina?
a. I and V
b. II and III
c. II and VI
d. III and IV
a. I and V
Identify the nuerotransmitters release from A-delta and C fibers?
A-delta C fibers
a. Enkephlain Acetylcholine
b. Acetylcholine Enkephalin
c. Substance P Glutamate
d. Glutamate Substance P
D. Glutamate and Substance P
Naltrexone is an opioid
a. agonist
b. antagonist
c. agonist/antagonist
d. selective mu-1 receptor antagonist
-3-
, b. antagonist
long acting and orally effective antagonist- has received attention b/c of its role in opioid
and alcohol addiction. Others include: naloxone (Narcan) and Nalmefene
what brain region contols events in the substantia gelatonisoa?
a. cerebral cortex
b. hypothalamus
c. periventricular/periaquaductal gray
d. basal ganglia
c. periventricular/periaquaductal gray
The minimum stump pressure demonstrating that the brain will be adequately perfused
during carotid endarterectomy is
a. 40 mm-Hg
b. 50 mm-Hg
c. 60 mm-Hg
d. 75 mm-Hg
c. 60 mm-Hg
A good stump pressure indicared that the brain will be perfused adequately during the
procedure. Recent studies indicate that stump pressures> 40 mm-Hg are as reliable as
EEG monitoring (gold standard) in predicting cerebral ischemia during cross-clamp
application in CEA and are more cost effective
cryoprecipitate contains what factors
factor VIII
vonWIllebrand
Factor I (fibrinogen)
Factor XIII
fibronectin
Heparin blocks what clotting pathways? (select 2)
- intrinsic
-extrinsic
-common
-platelet aggregation
-4-
PREPARATION QUESTIONS AND CORRECT
ANSWERS(VERIFIED ANSWERS)
spirnolactone act primarily on what segment of the renal tubule?
a. proximal
b.ascending limb of loop of henle
c. distal tubule
d. collecting duct
d. spirnolactone is a competitive aldosterone antagonist that works on the late distal
tubule and collecting duct (mostly the collecting duct). Increases sodium excretion and
potassium retention.
A 60-year-old man is undergoing a Type A aortic dissection repair under deep
hypothermic circulatory arrest. His current temperature is 24°C and his uncorrected
ABG shows pH 7.40, PaCO2 40 mmHg and PaO2 250 mmHg. Which of the following
changes would you MOST expect If you were to adjust his ABG to his core body
temperature of 24°C?
a. PaCO2 increased, PaO2 increased
b. PaCO2 decreased, PaO2 decreased
c. PaCO2 increased, PaO2 decreased
d. PaCO2 decreased, PaO2 increased
b. As the temperature of blood decreases, the solubility of gases increases such that the
partial pressure of CO2 and O2 decrease. Thus, a respiratory alkalosis develops as
temperature decreases. The ABG appears normal at the temperature at which it is
measured (37 °C) on the ABG machine; however, when corrected the patient's core
temperature of 24°C he will have a respiratory alkalosis with PaCO2 and PaO2 that are
decreased compared to the normal.
Actuation of the oxygen flush valve delivers 100% oxygen at a rate of:
a. 10 - 20 L/min
b. 20 - 30 L/min
c. 35 - 75 L/min
d. 80 - 100 L/min
-1-
,c. The oxygen flush valve delivers 100% oxygen at a rate of 35 - 75 L/min with a
pressure of 40 - 60 psi.
After a CABG, a 65-year-old man is hypotensive upon weaning from cardiopulmonary
bypass. The surgeon is considering insertion of an intraaortic balloon pump for
counterpulsation. Which of the following represents the MOST significant
contraindication to placement of an intraaortic balloon pump?
A. Aneurysm of left ventricle
B. Aortic atheroma
C. Aortic regurgitation
D. Aortic stenosis
C. Intraaortic balloon counterpulsation has been used for many years for patients with
left ventricular failure. Indications for its use have grown in recent years. Still, it is most
commonly used for patients in cardiogenic shock, post-myocardial infarction, severe
myocarditis, cardiomyopathy, unstable angina refractory to medications, high grade left
main coronary artery disease, failure to wean adequately from cardiopulmonary bypass,
low cardiac output syndrome and as a short-term bridge to heart transplant. There are
relatively few contraindications, including severe aortic regurgitation (AR) as the balloon
inflates during diastole and would worsen AR and not improve coronary flow during
diastole. Aortic dissection (difficult to place balloon in true lumen of aorta) and severe
aortoiliac occlusive disease or peripheral vascular disease (high risk of limb ischemia)
are also contraindications.
The incidence of headache with inadvertent dural puncture during epidural anesthesia is
decreased:
a. with decreasing age
b. by keeping the patient supine for more than 12 hours following puncture
c. with the use of fluid, instead of air, for loss of resistance
d. by inserting the needle with the bevel aligned perpendicular to the long axis of the
meninges
c. The use of fluid instead of air has been associated with a significant reduction in the
incidence of postdural puncture headache (PDPH). Other factors associated with a
reduced incidence of PDPH are: increasing age, insertion of the bevel aligned parallel to
the long axis of the meninges and the use of smaller needles. There is no evidence that
keeping the patient supine reduces the incidence of PDPH.
if somatosensory evoked potential monitoring suggests spinal cord damage, what
segment of the cord is involved?
-2-
,a. anterior
b. anterolateral
c. posterolateral
d. posterior
d. Posterior
Pain afferent nerve fibers enter the dorsal cord and scend or descend 1-3 segments in
what tract before entering and synpasing in the dosral horn?
a. dorsolateral tract
b. tract of lissauer
c. anterori cerebrospinal tract
d. lateral spinothalamic tract
b. Tract of lissauer
Pain transmitted from the periphery by A- delta fibers terminate primarily in Rexed's
lamina?
a. I and V
b. II and III
c. II and VI
d. III and IV
a. I and V
Identify the nuerotransmitters release from A-delta and C fibers?
A-delta C fibers
a. Enkephlain Acetylcholine
b. Acetylcholine Enkephalin
c. Substance P Glutamate
d. Glutamate Substance P
D. Glutamate and Substance P
Naltrexone is an opioid
a. agonist
b. antagonist
c. agonist/antagonist
d. selective mu-1 receptor antagonist
-3-
, b. antagonist
long acting and orally effective antagonist- has received attention b/c of its role in opioid
and alcohol addiction. Others include: naloxone (Narcan) and Nalmefene
what brain region contols events in the substantia gelatonisoa?
a. cerebral cortex
b. hypothalamus
c. periventricular/periaquaductal gray
d. basal ganglia
c. periventricular/periaquaductal gray
The minimum stump pressure demonstrating that the brain will be adequately perfused
during carotid endarterectomy is
a. 40 mm-Hg
b. 50 mm-Hg
c. 60 mm-Hg
d. 75 mm-Hg
c. 60 mm-Hg
A good stump pressure indicared that the brain will be perfused adequately during the
procedure. Recent studies indicate that stump pressures> 40 mm-Hg are as reliable as
EEG monitoring (gold standard) in predicting cerebral ischemia during cross-clamp
application in CEA and are more cost effective
cryoprecipitate contains what factors
factor VIII
vonWIllebrand
Factor I (fibrinogen)
Factor XIII
fibronectin
Heparin blocks what clotting pathways? (select 2)
- intrinsic
-extrinsic
-common
-platelet aggregation
-4-
