BCA Fluid Management & Blood Transfusion

Question 1

Which crystalloid solution most closely resembles plasma electrolyte composition and is considered a balanced isotonic solution?

Accepted Answer

Lactated Ringer's solution

Answer

Lactated Ringer's is a balanced isotonic solution containing sodium, chloride, potassium, calcium, and lactate in concentrations closest to plasma, making it a preferred choice for surgical fluid replacement.

Question 2

When comparing crystalloids to colloids for volume resuscitation, which statement best describes their volume distribution?

Accepted Answer

Crystalloids distribute throughout extracellular fluid requiring a 3:1 replacement ratio; colloids remain primarily intravascular

Answer

Crystalloids distribute throughout the extracellular fluid compartment (intravascular + interstitial), so approximately 3 mL of crystalloid is needed to replace 1 mL of blood loss, while colloids exert oncotic pressure keeping fluid intravascular.

Question 3

According to current restrictive transfusion guidelines, what is the hemoglobin trigger for red blood cell transfusion in a stable, non-cardiac patient?

Accepted Answer

Hemoglobin < 7 g/dL

Answer

Restrictive transfusion strategies supported by multiple RCTs recommend transfusion when hemoglobin falls below 7 g/dL in stable, non-cardiac patients, which has been shown to be non-inferior to liberal strategies.

Question 4

Transfusion-Related Acute Lung Injury (TRALI) is most commonly caused by which mechanism?

Accepted Answer

Donor antibodies against recipient HLA or neutrophil antigens causing neutrophil activation in the lungs

Answer

TRALI is most commonly caused by donor antibodies (anti-HLA or anti-neutrophil) that activate recipient neutrophils in pulmonary capillaries, leading to capillary leak and non-cardiogenic pulmonary edema within 6 hours of transfusion.

Question 5

Which colloid solution has been associated with increased renal dysfunction and mortality in critically ill septic patients, leading to restricted use in the ICU?

Accepted Answer

Hydroxyethyl starch (HES)

Answer

The 6S and CHEST trials demonstrated that hydroxyethyl starch (HES) solutions were associated with increased rates of acute kidney injury requiring renal replacement therapy and increased 90-day mortality in septic patients compared to crystalloids.

(BCA) Board of Certification in Anesthesiology Practice Test

(BCA) Board of Certification in Anesthesiology Practice Test

BCA Fluid Management & Blood Transfusion