Multiple Choice Questions (MCQ)

Quiz Categories Click to expand

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Cardiothoracic and Vascular Surgery
Page: 3

Question 11# Print Question

A 66-year-old female with a history of peripheral vascular disease, hypertension, prior stroke, and insulin-dependent diabetes is found to have expansion of her abdominal aortic aneurysm (AAA) on interval surveillance imaging and is scheduled for elective AAA open repair. As part of her preoperative workup, she has a positive nuclear stress test, leading to a cardiac catheterization showing 80% stenosis of the distal left anterior descending (LAD) artery. She undergoes elective AAA repair and is admitted to the ICU afterward. During her recovery, a family member is upset to learn that her coronary artery disease was not fixed before such a large surgery.

How do you answer?

A. This was a major oversight—coronary artery revascularization should be performed before most elective major vascular surgery, as this has been shown to decrease long-term mortality
B. Coronary artery revascularization should not be performed before major elective surgery as it has been shown to increase long-term mortality
C. Coronary artery revascularization should not be performed before major elective vascular surgery as it has not been shown to provide any long-term mortality benefit
D. There have not been any large clinical trials assessing coronary revascularization before elective major vascular surgery to help answer this family member’s question

Question 12# Print Question

A 63-year-old female who initially presented to the ED with chest pain radiating to her back was found to have a Stanford type B (descending only) aortic dissection and was admitted to the ICU for acute medical management. Her urine output is adequate (1 mL/kg/min), is neurologically intact, and has normal metabolic laboratories. To decrease the shear stress on her aortic dissection she was started on IV metoprolol and IV labetolol with good initial results. Her heart rate is 60 bpm, her blood pressure is 110/70, and she is pain-free. 

On her third ICU day she develops increasing pain and becomes progressively more hypertensive with BP 150/90, on metoprolol and labetolol. Considering her worsening condition, what course of therapy has been shown to most improve her overall survival?

A. Increase her antihypertensive medications with the addition of iv sodium nitroprusside
B. Proceed with endovascular aortic stent graft repair
C. Increase her pain medications to better control pain and associated hypertension
D. Proceed with emergent open repair of her type B dissection

Question 13# Print Question

You are called to the ED to evaluate a 54-year-old female who presented with sudden onset chest pain, which began while exercising at the gym, described as “tearing,” with radiation to her upper back. She is a former smoker with a history of hypertension, hyperlipidemia, and diabetes. On presentation her heart rate is 112 and blood pressure is 182/93; she is taking shallow breaths at 18 and her oxygenation saturation is 98% on 2 L NC. Physical examination is significant for a middle-aged woman, mildly diaphoretic, with a diastolic, decrescendo murmur, best heard at the left upper sternal border, and equal breath sounds with crackles at the bases. Chest CT shows an aortic dissection originating in the ascending aorta.

What is the next best step in her management?

A. Transesophageal echo
B. Start a nitroprusside infusion
C. Consult cardiology
D. Start an esmolol infusion

Question 14# Print Question

A 72-year-old male was brought into the ED with crushing substernal chest pain while mowing his lawn with EKG changes showing T-wave inversions and elevated serum troponins. His symptoms resolve with sublingual nitroglycerin, and he is hemodynamically stable throughout his workup. He undergoes cardiac catheterization shortly thereafter and is found to have multivessel coronary artery disease and is scheduled for coronaryartery bypass graft (CABG) surgery with the use of cardiopulmonary bypass (CPB) (on-pump) the next day. He is admitted to the ICU on a heparin infusion for closer monitoring.

Which of the following statements is correct with regard to off-pump versus on-pump CABG? 

A. Off-pump CABG decreases all-cause mortality compared with onpump CABG
B. Off-pump CABG increases all-cause mortality compared with onpump CABG
C. Across many clinical trials, no significant mortality differences have been shown between on-pump and off-pump CABG
D. There have not been adequate randomized clinical trials comparing off-pump versus on-pump CABG

Question 15# Print Question

A 59-year-old male who underwent an aortic valve replacement for congenital bicuspid aortic stenosis is admitted to the ICU post-op. The case went well, with a short bypass and cross-clamp time, minimal blood loss, and no blood products given. At the end of the case, an intraoperative TEE showed good biventricular function and a small amount of air in the apex of the left ventricle. For medications during the case, the patient received 1500 µg fentanyl; 100 mg of Propofol for induction; 100 mg of rocuronium, heparin, and protamine for bypass; and tranexamic acid for antifibrinolysis, and he was placed on dexmedetomidine post-op for sedation in the ICU.

He was extubated without difficulty 5 hours after his arrival from the operating room. Shortly after extubation, he had a witnessed generalized myoclonic seizure. The seizure was terminated within a few minutes after one dose of intravenous lorazepam. A stat head CT was obtained, which was read as normal with no acute changes. He was seen by neurology and had no further seizure activity throughout his hospital stay. Other than air from the surgical procedure, which of the following medications that the patient received are most likely associated with postoperative risk of seizure?

A. Propofol
B. Dexmedetomidine
C. Rocuronium
D. Tranexamic acid
E. Fentanyl

Category: Critical Care Medicine-Surgery, Trauma, and Transplantation--->Cardiothoracic and Vascular Surgery
Page: 3 of 3