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

The PT/INR measures the extrinsic pathway (tissue factor + factor VII) and the common pathway (factors X, V, II, fibrinogen); it is prolonged by warfarin because warfarin inhibits vitamin K-dependent factors including factor VII, which has the shortest half-life.

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

TEG/ROTEM provides dynamic assessment of the entire coagulation process from initial clot formation through clot strength and lysis using whole blood at the bedside within 30-60 minutes, enabling targeted hemostatic therapy compared to plasma-based conventional tests.

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

Fibrinogen (factor I) reaches critically low levels first during massive hemorrhage because it is consumed in clot formation and is present in lower plasma concentrations (~2-4 g/L) compared to other factors; a fibrinogen level < 1.5-2 g/L is associated with increased bleeding.

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, as an oncotic agent, expands plasma volume approximately 4-5 times more efficiently per mL administered than crystalloids by retaining fluid intravascularly through colloid osmotic pressure, reducing tissue edema from large-volume crystalloid resuscitation.

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

0.9% Normal Saline contains 154 mEq/L of chloride (supraphysiologic compared to plasma's 103 mEq/L); large volumes cause hyperchloremia that competitively inhibits bicarbonate reabsorption in the renal tubules, resulting in hyperchloremic metabolic acidosis.

(BCA) Board of Certification in Anesthesiology Practice Test

(BCA) Board of Certification in Anesthesiology Practice Test

BCA Fluid Management & Blood Transfusion 3