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

GDFT uses dynamic measures such as stroke volume optimization or stroke volume variation to individualize fluid administration and maximize cardiac output rather than targeting static filling pressures.

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

Permissive hypotension targets a systolic BP of 80-90 mmHg (MAP ~50-65 mmHg) to minimize ongoing hemorrhage by avoiding the hydraulic pressure that dislodges clots while maintaining minimum organ perfusion until surgical hemorrhage control.

Question 3

Hypocalcemia during rapid massive transfusion occurs primarily because:

Accepted Answer

Citrate anticoagulant in blood products chelates ionized calcium

Answer

Blood products are anticoagulated with citrate, which chelates ionized calcium; during massive transfusion, citrate accumulates faster than hepatic metabolism can clear it, leading to hypocalcemia that impairs cardiac contractility and enzymatic coagulation.

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

The lethal triad of hypothermia, acidosis, and coagulopathy is mutually reinforcing: hypothermia and acidosis impair enzyme function and platelet activity, worsening coagulopathy and hemorrhage, which deepens acidosis and heat loss.

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

The activated clotting time (ACT) is the standard intraoperative test for heparin monitoring during CPB, with a target of > 400-480 seconds to prevent circuit thrombosis; it provides rapid bedside results without laboratory processing.

MAC - Maintaining Anesthesia Certification Practice Test

MAC - Maintaining Anesthesia Certification Practice Test

MAC Fluid Management & Blood Products 3