MAC Fluid Management & Blood Products 3

Question 1

Goal-directed fluid therapy (GDFT) during major abdominal surgery primarily optimizes which hemodynamic endpoint?

Accepted Answer

Stroke volume or stroke volume variation

Answer

Central venous pressure (CVP) between 8-12 mmHg

Answer

Mean arterial pressure consistently > 75 mmHg

Answer

Urine output > 1.0 mL/kg/hr

Question 2

Permissive hypotension during damage control resuscitation for penetrating trauma targets which systolic blood pressure range in the absence of traumatic brain injury?

Accepted Answer

80-90 mmHg

Answer

50-60 mmHg

Answer

60-70 mmHg

Answer

100-110 mmHg

Question 3

Hypocalcemia during rapid massive transfusion occurs primarily because:

Accepted Answer

Citrate anticoagulant in blood products chelates ionized calcium

Answer

Stored red blood cells actively consume calcium during metabolism

Answer

Dilution of serum calcium by large crystalloid co-infusion

Answer

Activated clotting factors irreversibly bind calcium ions

Question 4

The 'lethal triad' in trauma resuscitation, which creates a self-perpetuating cycle of worsening coagulopathy, refers to:

Accepted Answer

Hypothermia, acidosis, and coagulopathy

Answer

Anemia, thrombocytopenia, and hypofibrinogenemia

Answer

Hypotension, tachycardia, and metabolic alkalosis

Answer

Hypovolemia, hypoxia, and hyperkalemia

Question 5

During cardiopulmonary bypass, which test is the standard point-of-care method for monitoring adequacy of heparin anticoagulation, and what is the target value?

Accepted Answer

Activated clotting time (ACT) > 480 seconds

Answer

aPTT > 70 seconds

Answer

Anti-Xa heparin level > 0.3 IU/mL

Answer

TEG R-time prolongation > 20 minutes

Question 6

Transfusion-associated graft-versus-host disease (TA-GvHD), a frequently fatal complication in immunocompromised patients, is prevented by:

Accepted Answer

Gamma irradiation of cellular blood products

Answer

Leukoreduction filtration of blood products

Answer

Use of CMV-seronegative blood products

Answer

Washing packed red blood cells before transfusion

Question 7

In a patient with end-stage liver disease undergoing major hepatic resection, which coagulation test provides the most comprehensive assessment of overall hemostatic balance?

Accepted Answer

Viscoelastic testing (TEG or ROTEM)

Answer

Prothrombin time (PT)

Answer

International Normalized Ratio (INR)

Answer

Activated partial thromboplastin time (aPTT)