BCA Cardiovascular Anesthesia 3

Question 1

Which cardioplegia delivery method provides the most uniform myocardial protection in the presence of significant coronary artery disease?

Accepted Answer

Combined antegrade and retrograde delivery

Answer

Combined antegrade and retrograde delivery ensures distribution to areas that may not receive adequate cardioplegia through stenotic coronary arteries alone.

Question 2

The normal activated clotting time (ACT) target for full anticoagulation during cardiopulmonary bypass is:

Accepted Answer

>400 seconds

Answer

An ACT >400 seconds (some centers use >480 s) is required to prevent thrombus formation within the CPB circuit.

Question 3

A patient develops acute right heart failure immediately after separation from CPB following mitral valve repair. The FIRST intervention should be:

Accepted Answer

Administer inhaled nitric oxide to reduce PVR

Answer

Inhaled nitric oxide selectively reduces pulmonary vascular resistance, directly unloading the right ventricle without causing systemic hypotension.

Question 4

Which ECG finding during cardiac surgery indicates adequate diastolic arrest with cold potassium cardioplegia?

Accepted Answer

Flat isoelectric line (asystole)

Answer

Cardioplegia depolarizes myocardial cells by elevating extracellular potassium, causing diastolic arrest manifested as an isoelectric ECG.

Question 5

During aortic arch surgery with circulatory arrest, cerebral protection is best achieved by:

Accepted Answer

Antegrade selective cerebral perfusion with moderate hypothermia

Answer

Antegrade selective cerebral perfusion (ASCP) with moderate hypothermia (24-28°C) provides direct cerebral blood flow and metabolic suppression, offering superior neuroprotection.

(BCA) Board of Certification in Anesthesiology Practice Test

(BCA) Board of Certification in Anesthesiology Practice Test

BCA Cardiovascular Anesthesia 3