BCA Fluid Management & Blood Transfusion 3

Question 1

Which coagulation test specifically reflects the function of the extrinsic pathway and is used to monitor warfarin therapy?

Accepted Answer

Prothrombin Time (PT/INR)

Answer

Activated Partial Thromboplastin Time (aPTT)

Answer

Thrombin Time (TT)

Answer

Platelet function analyzer (PFA-100)

Question 2

What is the primary clinical advantage of viscoelastic hemostatic assays (TEG/ROTEM) over conventional coagulation tests (PT/aPTT) in the perioperative setting?

Accepted Answer

Real-time point-of-care assessment of the entire clot formation, strength, and fibrinolysis process using whole blood

Answer

More accurate quantification of individual clotting factor levels

Answer

Superior prediction of postoperative bleeding compared to PT/INR in all patient populations

Answer

Ability to detect hypercoagulable states and thrombotic risk reliably

Question 3

During massive hemorrhage with dilutional coagulopathy, which coagulation factor reaches critically low levels first and is the most sensitive indicator of hemostatic impairment?

Accepted Answer

Fibrinogen

Answer

Factor VIII

Answer

Factor V

Answer

Factor VII

Question 4

What is the primary physiologic rationale for using albumin over crystalloids for volume resuscitation in patients with hypoalbuminemia?

Accepted Answer

Albumin restores oncotic pressure and expands intravascular volume with approximately 4-5 times less total infusion volume

Answer

Albumin is significantly less expensive and more widely available than crystalloids

Answer

Multiple large RCTs have demonstrated superior mortality with albumin over crystalloids in all ICU populations

Answer

Albumin prevents TRALI by replacing deficient plasma proteins

Question 5

Large-volume infusion of which intravenous fluid is most likely to cause hyperchloremic non-anion gap metabolic acidosis?

Accepted Answer

0.9% Normal Saline

Answer

Lactated Ringer's solution

Answer

Plasmalyte 148

Answer

5% Albumin in normal saline

Question 6

Intraoperative cell salvage (autotransfusion) is absolutely contraindicated in which clinical situation?

Accepted Answer

Surgery involving gross bacterial contamination of the operative field or resection of malignancy

Answer

Cardiac surgery requiring cardiopulmonary bypass

Answer

Major vascular surgery with anticipated large blood loss

Answer

Jehovah's Witness patients who have signed consent for closed-circuit autotransfusion

Question 7

What is the recommended hemoglobin transfusion threshold for patients with stable ischemic heart disease or known cardiovascular disease undergoing surgery?

Accepted Answer

Hemoglobin > 8 g/dL

Answer

Hemoglobin > 10 g/dL (liberal strategy)

Answer

Hemoglobin > 9 g/dL

Answer

Hemoglobin > 7 g/dL (same as general population)