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CSP Exam Study Guide _ Questions And Answers Rated 100- Correct.pdf
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8/30/24, 3:20 AMSEE practice review
Jeremiah
Terms in this set (248)
During fetal monitoring, Type III umbilical cord compression
decelerations are thought to be related to:
• head compression Type III, or variable, decelerations are the most common type of decelerations. They
• umbilical cord compression are thought to be related to umbilical cord compression and intermittent decreases in
• uteroplacental insufficiency umbilical blood flow.
• placental abruption
The arteria radicularis magna, or artery of T8 - L2.
Adamkiewicz, most commonly arises from: A major complication of thoracic aortic surgery is paraplegia, occurring in up to 20% of
• T4 - T8 elective cases, and is secondary to spinal cord ischemia. The arteria radicularis magna
• T8 - L2 supplies blood to the anterior spinal artery. The arteria radicularis magna has a variable
• L2 - L4 origin from aorta, arising between T5 - T8 in 15%, between T9 - T12 in 60% and between
• L4 - S1 L1 - L2 in 25% of individuals.
60. A 55-year-old woman with a history of 60. Amiodarone. Congenital long QT syndrome may occur in conjunction with other
congenital long QT syndrome is undergoing hereditary syndromes, such as Jervell, Lange-Nielsen or Romano-Ward syndrome, or
a hysteroscopy for abnormal uterine acquired as a result of pharmacologic or metabolic etiologies. It is an issue of cellular
bleeding. She had uneventful induction of repolarization which precipitates tachyarrhythmias, most commonly polymorphic
general anesthesia but after paracervical ventricular tachycardia or torsades de pointe. There are multiple subtypes that affect
block with lidocaine develops ventricular both potassium and/or sodium channels. The arrhythmias may be precipitated by
tachycardia with morphological appearance sympathetic activation, auditory stimuli or at rest. Family history may be positive for
of torsades de pointe. Which of the sudden cardiac death and the ECG significant for prolonged corrected QT interval >
following medications should be AVOIDED 430ms or bizarre odd-appearing T waves. Treatment includes magnesium for
in the treatment of her arrhythmia? arrhythmias, possible permanent pacemaker, or beta blockers for subtypes 1 and 2, but
• Amiodarone amiodarone is considered contraindicated as it prolongs the QT interval.
• Calcium chloride
• Esmolol
• Magnesium sulfate
SEE practice review
1/22
,8/30/24, 3:20 AM
59. A 76-year-old man is scheduled for a 59. the use of a bipolar cautery. Electrical interference from the electrocautery can be
hemicolectomy. His past medical history is interpreted by the pacemaker as myocardial activity and suppress pacemaker activity.
significant for third degree heart block These problems can be minimized by limiting use to short bursts, placing the grounding
treated with a permanent pacemaker. pad as far from the pacemaker as possible and using a bipolar cautery.
Problems with electrocautery use in this
patient can be minimized by:
• placing the grounding pad near the
pacemaker
• using infrequent bursts of longer duration
• the use of a bipolar cautery
• reducing the surface area of the return
electrode
58. HR no change, BP increased. After heart transplantation, the heart is completely
58. A 35-year-old woman who underwent
denervated. The normal resting heart rate is relatively tachycardic at 90-100 bpm due to
orthotopic heart transplantation 2 years ago
lack of vagal tone. Vagal bradycardic responses (to laryngoscopy, hypertension,
for nonischemic cardiomyopathy presents
carotid sinus massage) will also be absent. Over time, however, many patients require
after a motor vehicle accident for
permanent pacemaker placement for treatment of significant bradycardia. After heart
exploratory laparotomy under general
transplant, patients are not able to respond to demands for increased cardiac output
anesthesia. Intraoperatively, her blood
with increased heart rate. Thus in this situation of a trauma with potentially significant
pressure is 75/35 mmHg and heart rate is 90
blood loss, a normal patient would have tachycardia but a heart transplant patient has
bpm. After the administration of
no change in heart rate, only hypotension. Instead for heart transplant patients, cardiac
phenylephrine, which of the following
output is augmented by increased stroke volume. For this reason it is important to
hemodynamic responses do you MOST
maintain adequate intravascular volume. The transplanted heart is not able to respond
expect?
to medications that block the parasympathetic system. Bradycardia and hypotension
• HR decreased, BP increased
have to be treated with medications that have a direct effect such as epinephrine and
• HR decreased, BP no change
isoproterenol. Phenylephrine will result in increased blood pressure, but no change in
• HR no change, BP increased
heart rate. Indirect and mixed indirect/direct-acting drugs have minimal effect or have
• HR no change, BP no change
the effect of their direct components.
57. The postretrobulbar block apnea 57. is associated with unconsciousness. The postretrobulbar block apnea syndrome is
syndrome: probably due to injection of local anesthetic into the optic nerve sheath, with spread
• is likely secondary to intravascular injection into the CSF. The CNS is exposed to high concentrations of local anesthetic leading to
• most commonly occurs during or apprehension and unconsciousness. Apnea occurs within 20 minutes and resolves
immediately after injection within an hour. Treatment is supportive.
• is associated with unconsciousness
• carries a high morbidity and mortality
56. A. Increased trauma to blood component: Cardiopulmonary bypass (CPB) does the
work of the heart and lungs in order to isolate those organs from blood flow such that
surgery on the heart can occur in a relatively bloodless fashion. Thus, the CPB circuit
56. A 75-year-old man is undergoing a mitral
must oxygenate and ventilate the blood and then deliver the oxygenated blood back
valve replacement via cardiopulmonary
to the body and end organs. It has long been debated whether maximal blood flow or
bypass. The perfusionist is running bypass
pressure is more important in perfusion and homeostasis of the end organs during
flows at > 2.5 liters/minute/m2. Which of the
bypass. Maximizing blood flow (generally considered to be flow at a cardiac index of >
following is the MOST likely adverse
2 liters/minute/meter2) has been shown to increase hematologic trauma, increase the
consequence of undergoing
magnitude of the stress or inflammatory response, cause strain on suture lines, increase
cardiopulmonary bypass at increased flow
shunting of blood through the pulmonary system, increase washout of cardioplegia and
rates?
not necessarily lead to improved regional blood flow. The CPB machine can change
total flow, but it cannot adjust regional flows to the various end organ systems.
• Increased trauma to blood elements
Changes in blood pressure are currently thought to be most effective for allowing
• Increased hypothermia
adjustments to regional flow in organ systems as the organs retain their regional
• Decreased blood flow to the brain
vascular resistance capabilities. Thus conduct of CPB with an optimal pressure (and
• Decreased myocardial blood flow
potentially lower flows) may allow the individual organs to regionally modulate their
own flows. scheduled for ECT are routinely given anticholinergic medication
preoperatively.
SEE practice review
2/22
, 8/30/24, 3:20 AM
55. Physiologic effects of electroconvulsive 55. initial parasympathetic discharge followed by a sustained sympathetic response. An
therapy (ECT) include an: initial parasympathetic discharge followed by a sustained sympathetic response is
• initial sympathetic response with sustained immediately seen after the induction of a seizure. Marked bradycardia with increased
tachycardia secretions can occur, which is then followed by hypertension and tachycardia. Patient
• initial sympathetic discharge followed by a
sustained parasympathetic response
• initial parasympathetic discharge followed
by a sustained sympathetic response
• initial parasympathetic response with
sustained bradycardia
54. "R" signifies rate responsiveness in the fourth position of the pacemaker designation
code. Patients who are pacemaker-dependent are limited in their ability to exercise
because of fixed rate (can't get their heart rates up). "R" function allows a pacemaker to
54. A 70-year-old man with a DDD-R speed up to satisfy increased metabolic demands (via motion, minute ventilation,
pacemaker for a history of symptomatic temperature sensors) when the patient is exercising. However, for patients who are
bradycardiais undergoing an anterior pacemaker-dependent, rate responsiveness function may be activated by
cervical discectomy and fusion with perioperative events: fasciculations from succinylcholine, myoclonus from etomidate,
somatosensory evoked potential (SSEP) and vigorous surgical retraction, shivering, or SSEP/MEP neuromonitoring. This can cause
motor evoked potential (MEP) monitoring. undesired tachycardic pacing. So in cases like the one described, it is best to turn off
The pacemaker should be reprogrammed to the rate responsiveness function. Keeping the pacemaker in DDD is otherwise
which of the following? acceptable as long as a method of perfusion is assured, such as arterial blood pressure
• Discontinue R function or pulse oximetry. One concern is often that the pacemaker will interpret artifact or
• Dual chamber asynchronous pacing electromagnetic inference from the bovie cautery as native heart rhythm and not
• No reprogramming initiate pacing when it is indicated, leaving the patient at risk for profound bradycardia
• Ventricular asynchronous pacing or asystole. Placing the bovie pad away from the pacemaker generator and using
bipolar cautery if needed are options to deal with that type of interference.
Reprogramming to asynchronous mode risks R on T phenomenon (when the pacemaker
cannot discern between artifact and native heart rhythm).
53. Correct location of the catheter tip of a 53. superior vena cava. The CVP catheter tip should not be allowed to migrate into the
central venous line is in the: heart chamber to avoid arrhythmias and perforation.
• superior vena cava
• right atrium
• riht ventricle
• pulmonary artery
52. B. Salicylic acid produces its anti-inflammatory effects via suppressing the activity of
cyclooxygenase (COX). Unlike other NSAIDs, it does this not by direct inhibition of
COX, unlike most other non-steroidal anti-inflammatory drugs (NSAIDs), but instead by
52. Which of the following is NOT a potential suppression of the expression of the enzyme (via an un-elucidated mechanism).
treatment for salicylate poisoning? Salicylic acid is a non-reversible COX inhibitor. Salicylates produce epigastric pain,
• Activated charcoal nausea and vomiting, hyperventilation (respiratory alkalosis), and widely ranging
• Administration of a reversible COX-inhibitor neurologic signs and symptoms (tinnitus, delirium, coma, seizure) as well as a primary
• Hemodialysis metabolic acidosis (salicylic acid, lactic acid, and ketoacids). Treatment includes
• Sodium bicarbonate activated charcoal, alkalinization of blood and urine with IV sodium bicarbonate (pKa
3.5, thus salicylates can be "trapped" in the blood and urine, preventing movement into
tissues and enhancing excretion). Hemodialysis is considered for mental status changes,
severe acid-base disturbances, or serum concentrations > 100 mg/dL.
51. During pregnancy, the minimum alveolar 51. Decreases throughout pregnancy. The MAC progressively decreases during
concentration (MAC): pregnancy, at term by as much as 40%. MAC returns to normal by the third day after
delivery.
• decreases until the 20th week
• increases until the 20th week
• decreases throughout the pregnancy
• increases throughout the pregnancy
SEE practice review
3/22
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