Order previously Healthy Presents Discussion

Order previously Healthy Presents Discussion
Order previously Healthy Presents Discussion
1. A patient with asymptomatic, moderate aortic stenosis (Vmax = 3.7 m/s) is
presenting for elective laparoscopic colectomy for newly diagnosed colon
cancer. Within what time frame should an echocardiogram have been
performed before proceeding with elective surgery?
A. 3 months
B. 6-12 months
C. 1-2 years
D. 3-5 years
2. A 91-year-old woman presents to the emergency department with acute onset
of dyspnea and is found to have a harsh, late-peaking systolic murmur and
pulmonary edema on chest X-ray. Transthoracic echocardiography is
performed with the following findings:
Aortic valve area 0.8 cm2
Peak transaortic velocity (Vmax
) 3.4 m/s
Mean transaortic pressure gradient 36 mm Hg
Which of the following best describes the patient’s aortic stenosis (AS)?
A. Mild AS
B. Moderate AS
C. Severe high-gradient AS
D. Severe low-flow/low-gradient AS
3. Which one of the following patients should receive infective endocarditis (IE)
prophylaxis before undergoing his/her associated procedure?
A. A 61-year-old man with a mechanical mitral valve presenting for root canal
B. A 34-year-old woman with a history of repaired tetralogy of Fallot presenting for
dental cleaning
C. A 54-year-old woman after aortic valve replacement for bicuspid aortic valve
presenting for elective cystoscopy
D. A 28-year-old man with history of IE because of IV drug use presenting for
4. 24. A 71-year-old man is presenting for elective aortic valve replacement. His
transthoracic echocardiogram (TTE) shows a hypertrophic left ventricle (LV)
with preserved function and an aortic valve area = 1.4 cm2
, Vmax = 3.4 m/s, and
mean gradient = 37 mm Hg. He is currently asymptomatic and denies angina,
syncope, and dyspnea. Which of the following statements is correct regarding
his anesthetic management?
A. Phenylephrine infusion will decrease stroke volume because of increased
B. Atrial fibrillation will be poorly tolerated.
C. Heart rate between 80 and 100 beats per minute is ideal.
D. Dopamine is the inotrope of choice.
5. A 61-year-old man with moderate mitral regurgitation (MR) is presenting for
emergent exploratory laparotomy secondary to perforated bowel. Which of the
following goals is most critical in the anesthetic management of MR?
A. Target heart rates at the upper limit of normal (80-100 bpm).
B. Increase preload slightly.
C. Maintain sinus rhythm.
D. Reduce SVR.
Order previously Healthy Presents Discussion
6. A otherwise healthy 24-year-old man with hypertrophic cardiomyopathy
(HCM) is undergoing laparoscopic cholecystectomy for symptomatic
cholelithiasis. He becomes acutely hypotensive following insufflation of the
abdomen and positioning in the reverse Trendelenburg position. His blood
pressure is unchanged at 68/43 following a rapid bolus of IV fluids, lightening
the anesthetic and leveling the bed. Administration of which of the following
drugs is the most appropriate next step in management?
A. Epinephrine 10 µg IV
B. Ephedrine 5 mg IV
C. Norepinephrine 4 µg IV
D. Phenylephrine 100 µg IV
7. Which of the following statements is true with regard to anesthetic
management of patients with HCM?
A. Patients without outflow obstruction at rest are at low risk for dynamic
obstruction with administration of anesthetic agents.
B. Negative inotropic agents may be useful to attenuate sympathetic stimulation
C. Hypovolemia is better tolerated than hypervolemia.
D. Lethal arrhythmias do not occur in hypertrophic obstructive cardiomyopathy
patients without signs of inducible obstruction on echocardiography.
8. A 69-year-old woman becomes hypertensive to 207/109 upon emerging from a
general anesthetic for laparoscopic hysterectomy. She is subsequently hypoxic
and her endotracheal tube has frothy clear secretions. Which of the following is
the most likely diagnosis?
A. Volume overload
B. Negative pressure pulmonary edema
C. Flash pulmonary edema
D. Transfusion-associated circulatory overload
9. A 54-year-old woman who was previously healthy presents with severe malaise
and light-headedness 2 weeks after her husband died unexpectedly. Her
extremities are cool and clammy, she is found to be profoundly hypotensive, and
transthoracic echocardiogram shows global LV hypokinesis with apical
ballooning. Which of the following statements is correct about her condition?
A. Postmenopausal women are at highest risk for this condition.
B. ECG changes are uncommon at presentation.
C. This condition is unlikely to resolve over time.
D. Most patients affected by this condition have underlying coronary artery disease.
10. 30. A 74-year-old man with diabetes mellitus and poorly controlled
hypertension has undergone robotic prostatectomy over a course of 8 hours,
during which he received 4 L of Lactated Ringer and 500 cc of 5% albumin.
Blood loss was approximately 200 cc, and urine output was 320 cc. His oxygen
saturation is 93%-95% despite FiO2 of 100% and positive end-expiratory
pressure of 8 cm H2O. On auscultation, bibasilar crackles are present. Which of
the following is the best next step in management?
A. Emerge the patient and extubate to noninvasive positive pressure ventilation
(PPV) in the OR.
B. Keep the patient intubated and admit to the surgical intensive care unit.zzzz($zzzzzz
C. Administer a loop diuretic.
D. Initiate therapy with inhaled nitric oxide.
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