Cardiac Anesthesia Knowledge Assessment

01 Cardiopulmonary Bypass & Cardioprotection

Question 1

List 4 ways to provide cardio-protection during CPB.

ii.

iii.

iv.

Question 2

After going on pump you notice the patient's right side of face is stark white. What is the cause?

Question 3

After going on CPB you notice the head is bluish-purple. What should you do?

Question 4

During CPB utilizing femoral arterial cannulation, which arterial line placement ensures the entire aortic arch is perfused?

Question 5

Why is LV venting important? (2 reasons)

ii.

Question 6

Name 2 common ways to vent the LV.

ii.

02 Oxygen Delivery & Utilization

Question 7

Write out the Delivery of Oxygen (DO₂) equation.

Question 8

Write out the Oxygen Utilization (VO₂) equation.

Question 9

Why does SvO₂ decline between the OR and ICU? Describe factors influencing oxygen utilization.

Question 10

Nitrous Oxide improves cardiac output.

Nitrous oxide depresses myocardial function and does not improve cardiac output.

03 CPB Troubleshooting

Question 11

Patient is on full CPB flow, cross-clamp NOT applied, CVP and PA pressure are zero, yet the patient has a pulsatile arterial line. What is the diagnosis?

Question 12

During antegrade cardioplegia you notice a rise in PA pressure. What is the diagnosis?

Question 13

The most common reason for ST segment elevation post-CABG is:

Question 14

A common reason for sudden VFib while coming off pump is:

Question 15

Prior to removing the TEE probe, the ___________ should be assessed to help prevent sudden arrest on transport.

04 Hemodynamics & Equations

Question 16

What are the units for SVR?

b. Derive SVR (Hint: V = IR, Ohm's Law analogy)

Question 17

Write the complete SVR formula:

Question 18

Stroke Volume is dependent on: (3 factors)

ii.

iii.

Question 19

Define Cardiac Output:

Question 20

A Low CI automatically equates to low myocardial function (Low EF).

A low CI does not automatically mean low myocardial function — and a normal CI does not automatically mean normal function.

05 PA Catheter Interpretation

Question 21

What are the major assumptions when interpreting numbers on a PA Catheter?

ii.

Question 22

Reasons for PCWP being greater than PAD:

ii.

Question 23

A PAD greater than _____ mmHg from the PCWP implies intrinsic pulmonary artery pressure rather than LV volume.

Question 24

List 3 situations where PCWP is greater than LVEDP (overestimates filling):

ii.

iii.

Question 25

List 3 situations where PCWP is less than LVEDP (underestimates filling):

ii.

iii.

Question 26

In which West Lung Zone is PCWP NOT a reliable indicator of LVEDV?

Question 27

Cannon V waves correlate with:

Question 28

Cannon A waves correlate with:

Question 29

Thermodilution (non-oximetric) cardiac output is inaccurate in the following situations: (3)

ii.

iii.

Question 30

The focus of treatment for Right Heart Failure and Left Heart Failure are similar.

Right and left heart failure have fundamentally different treatment strategies.

06 Post-Bypass Management

Question 31

Which valve repair carries the highest level of concern for post-bypass troubles?

Question 32

Above what CVP does continued volume resuscitation become worrisome?

07 Heparin & Protamine

Question 33

How is heparin metabolized?

Question 34

Type 2 HIT occurs rapidly in onset and is associated with high mortality.

FALSE — Type 1 HIT occurs 2–5 days post-exposure and resolves without treatment. Type 2 HIT occurs days 5–9, carries 20% risk of thrombosis and 40% mortality.

Question 35

After giving 400 units/kg of heparin, the patient's ACT remains 300. Name the first and second treatments.

ii.

b. What patient population is at highest risk for being non-responsive?

Question 36

Protamine — answer the following:

a. How does protamine work?

b. Where else in medicine is protamine used?

c. Where does protamine come from?

d. Name 3 major reactions (i–iii) and 1 minor reaction (iv) to protamine:

ii.

iii.

iv.

08 Respiratory & Valvular Pathology

Question 37

List the 6 categorical reasons for Hypoxemia: 1 & 3 given

i.—

ii.

iii.—

iv.

vi.

Question 38

Mitral Valve Prolapse–related MR improves with full ventricular volumes, slow heart rates.

FALSE — MVP-related MR improves with full ventricular volumes and normal heart rates, not slow.

Question 39

AFib is well tolerated in patients with Mitral Stenosis.

FALSE — AFib is poorly tolerated in mitral stenosis; the atrial kick is critical and rate control is essential.

Question 40

In patients with Mitral Stenosis the atrial kick accounts for 35% of cardiac output.

TRUE — In mitral stenosis the atrial kick accounts for ~35% of cardiac output (vs ~20% in normal physiology).

Question 41

A patient receives a TEE under sedation and arrives in the OR appearing blue. Diagnosis and treatment?

Dx:

Tx:

b. Side effects of this medication: (any order)

ii.

c. Other time you'd use this in cardiac surgery?

d. Contraindicated in which patient population?

Question 42

Type A dissections need emergent cardiac intervention for 3 main reasons:

ii.

iii.

Question 43

Sickle Cell SS patient for emergent Type A dissection repair under deep hypothermic circulatory arrest. Anesthetic concerns?

09 Calculations

Question 44

Calculate the Aortic Valve Area — round to the nearest tenth:

Parameter	Value
VTI AV	20 cm
VTI LVOT	12 cm
Diameter LVOT	20 mm

Question 45

Aortic Valve Area Classification — fill in area and mean gradient thresholds:

Mild:

Moderate:

Severe:

10 TEE Safety

Question 46

What is the incidence of orogastric trauma from TEE probe?

Question 47

What is the incidence of perforation from TEE probe?

11 TEE Image Identification (complete by hand)

Label all structures indicated by arrows and name each view. Complete this section on a printed copy.

Page 1 — Views 1–6

Page 2 — Views 7–12

Reference views include: ME four chamber, ME two chamber, ME LAX, TG mid SAX, TG two chamber, TG basal SAX, ME mitral commissural, ME AV SAX, ME AV LAX, TG LAX, deep TG LAX, ME bicaval, ME RV inflow-outflow, TG RV inflow, ME asc aortic SAX/LAX, desc aortic SAX/LAX, UE aortic arch LAX/SAX

12 Coronary Artery Territory

Using the numbered myocardial segment diagrams, list the segment numbers each artery supplies. Any order is accepted.

RCA

LAD

13 Hemodynamic Scenarios

Question 48

For each hemodynamic scenario, identify the appropriate treatment.

CVP	BP	CI
5	80/45	1.8
15	90/60	1.8
15	140/85	1.8
18	80/50	1.4
10	120/80	2.0
12	85/50	3.2
12	85/50	1.5
6	100/65	2.2