APEX MOCK EXAM 1(Latest 2026/ 2027
Update) 100% Verified Questions &
Answers {Grade A}
All of the following confer protection to the spinal cord during ascending aortic
aneurysm repair, EXCEPT:
A. CSF drainage.
B. Normalization of serum glucose.
C. Induced hypertension during cross clamping
D. Avoidance of hypothermia - correct answer D. Avoidance of hypothermia
The spinal cord circulation consists of two posterior spinal arteries, and one anterior
spinal artery. The posterior spinal arteries arise from the cerebella arteries and supply
the dorsal sensory region of the cord. The anterior spinal artery arises from the
vertebral arteries and supplies the ventral motor region. Both arteries receive
collaterals from the intercostal arteries in the thorax in the lumbar arteries in the
abdomen. These radicular arteries arise from the descending aorta.
It is critical to understand that the spinal cord is perfuse at each segment, but not
necessarily along its length. This sets the stage for regional ischemia and infarction.
,The cervical cord receives most of its blood supply from the vertebral and radicular
arteries, while the thoracolumbar region of the cord receives its supply from the
radicular arteries. Therefore interruption of blood flow to any of these radicular
arteries can cause ischemia or infarction to the corresponding segments of the spinal
cord. The most notable of the radicular arteries is the artery of Adamkieeicz, which
typically arises from the segment between T9-T12 & more commonly on the left side.
An aortic cross clamp placed above the Adamkiewicz, may cause ischemia to the
lower portion of the anterior, spinal cord, resulting in anterior spinal artery syndrome,
or Beck's syndrome. This manifests as flaccid paralysis of the lower extremities,
coupled with bowel and bladder dysfunction and loss of temperature in pain sensation.
Sensation and proprioception remain intact.
Thoracic cross clamp times greater than 30 minutes pose a significant risk of court
ischemia and protective strategies should be employed. These include:
-Moderate hypothermia, 30-32°C
-CSF drainage— CSF shunting from the brain towards the spinal column during
Which factor is NOT affected by losartan administration?
,A. Fetal mortality
B. Lithium reabsorption
C. Angiotensin converting enzyme
D. Potassium - correct answer C. Angiotensin converting enzyme.
Losartan is an oral angiotensin II receptor antagonist. It combats hypertension by
antagonizing angiotensin II at the AT1 receptor. And it does not affect the activity of
angiotensin converting enzyme (ACE)
A potential side effects of losartan is hyperkalemia. The risk of increase in the patient
receiving potassium sparing diuretics.
Losartan increase lithium reabsorption by the kidneys, which can result in lithium
toxicity.
Losartan, an ACEIs increase maternal and fetal mortality. These drugs should also be
avoided in patients with renal artery stenosis.
ACEIs and losartan can cause post induction hypotension (vasoplegia). If vasoplegia is
resistant to common therapies (volume neo, epi, & NE), consider vasopressin (0.5-
1units) or methylene blue (1-2mg/kg).
, A patient developed atrial flutter and requires cardioversion. What is the appropriate
energy level that should be delivered during the first shock? - correct answer 50-100
joules.
Cardioversion is used to treat supraventricular and ventricular tachyarrhythmias
caused by reentry. It should not be used to treat tachyarrhythmias caused by an
increase in triggered activity (multifocal atrial tachycardia) or increased automaticity
(digitalis toxicity).
Indications for direct current cardioversion include :
Atrial flutter, atrial fibrillation, AV nodal, reentry, and tachycardia secondary to pre-
excitation syndrome
The appropriate dose of energy to be delivered during the first shock is 50-100 J
If unsuccessful, the energy is increased, incrementally to a maximum of 360 Jules. If
the paddles are applied directly to the myocardium, a substantial energy reduction is
required.
By delivering a shock synchronized to the R-wave, cardioversion is believed to correct
an excitable gap in the myocardium to restore electrical control to the conduction
Update) 100% Verified Questions &
Answers {Grade A}
All of the following confer protection to the spinal cord during ascending aortic
aneurysm repair, EXCEPT:
A. CSF drainage.
B. Normalization of serum glucose.
C. Induced hypertension during cross clamping
D. Avoidance of hypothermia - correct answer D. Avoidance of hypothermia
The spinal cord circulation consists of two posterior spinal arteries, and one anterior
spinal artery. The posterior spinal arteries arise from the cerebella arteries and supply
the dorsal sensory region of the cord. The anterior spinal artery arises from the
vertebral arteries and supplies the ventral motor region. Both arteries receive
collaterals from the intercostal arteries in the thorax in the lumbar arteries in the
abdomen. These radicular arteries arise from the descending aorta.
It is critical to understand that the spinal cord is perfuse at each segment, but not
necessarily along its length. This sets the stage for regional ischemia and infarction.
,The cervical cord receives most of its blood supply from the vertebral and radicular
arteries, while the thoracolumbar region of the cord receives its supply from the
radicular arteries. Therefore interruption of blood flow to any of these radicular
arteries can cause ischemia or infarction to the corresponding segments of the spinal
cord. The most notable of the radicular arteries is the artery of Adamkieeicz, which
typically arises from the segment between T9-T12 & more commonly on the left side.
An aortic cross clamp placed above the Adamkiewicz, may cause ischemia to the
lower portion of the anterior, spinal cord, resulting in anterior spinal artery syndrome,
or Beck's syndrome. This manifests as flaccid paralysis of the lower extremities,
coupled with bowel and bladder dysfunction and loss of temperature in pain sensation.
Sensation and proprioception remain intact.
Thoracic cross clamp times greater than 30 minutes pose a significant risk of court
ischemia and protective strategies should be employed. These include:
-Moderate hypothermia, 30-32°C
-CSF drainage— CSF shunting from the brain towards the spinal column during
Which factor is NOT affected by losartan administration?
,A. Fetal mortality
B. Lithium reabsorption
C. Angiotensin converting enzyme
D. Potassium - correct answer C. Angiotensin converting enzyme.
Losartan is an oral angiotensin II receptor antagonist. It combats hypertension by
antagonizing angiotensin II at the AT1 receptor. And it does not affect the activity of
angiotensin converting enzyme (ACE)
A potential side effects of losartan is hyperkalemia. The risk of increase in the patient
receiving potassium sparing diuretics.
Losartan increase lithium reabsorption by the kidneys, which can result in lithium
toxicity.
Losartan, an ACEIs increase maternal and fetal mortality. These drugs should also be
avoided in patients with renal artery stenosis.
ACEIs and losartan can cause post induction hypotension (vasoplegia). If vasoplegia is
resistant to common therapies (volume neo, epi, & NE), consider vasopressin (0.5-
1units) or methylene blue (1-2mg/kg).
, A patient developed atrial flutter and requires cardioversion. What is the appropriate
energy level that should be delivered during the first shock? - correct answer 50-100
joules.
Cardioversion is used to treat supraventricular and ventricular tachyarrhythmias
caused by reentry. It should not be used to treat tachyarrhythmias caused by an
increase in triggered activity (multifocal atrial tachycardia) or increased automaticity
(digitalis toxicity).
Indications for direct current cardioversion include :
Atrial flutter, atrial fibrillation, AV nodal, reentry, and tachycardia secondary to pre-
excitation syndrome
The appropriate dose of energy to be delivered during the first shock is 50-100 J
If unsuccessful, the energy is increased, incrementally to a maximum of 360 Jules. If
the paddles are applied directly to the myocardium, a substantial energy reduction is
required.
By delivering a shock synchronized to the R-wave, cardioversion is believed to correct
an excitable gap in the myocardium to restore electrical control to the conduction
