MAC Fluid Management & Blood Products

Question 1

Which crystalloid solution is most appropriate for resuscitation in a patient at risk for hyperchloremic metabolic acidosis?

Accepted Answer

Lactated Ringer's solution

Answer

Lactated Ringer's is a balanced crystalloid with a chloride concentration closer to physiologic plasma levels, making it preferable to normal saline, which can cause hyperchloremic acidosis with large volumes.

Question 2

According to current evidence-based guidelines, what is the hemoglobin transfusion threshold for a hemodynamically stable, non-cardiac ICU patient without active ischemia?

Accepted Answer

Hgb < 7 g/dL

Answer

The TRICC trial and subsequent guidelines support a restrictive transfusion threshold of Hgb < 7 g/dL in stable non-cardiac ICU patients, as it does not worsen outcomes and reduces transfusion-related risks.

Question 3

Which dynamic parameter BEST predicts fluid responsiveness in a mechanically ventilated patient with regular cardiac rhythm?

Accepted Answer

Pulse pressure variation (PPV)

Answer

Pulse pressure variation > 13% in mechanically ventilated patients with regular rhythm reliably predicts volume responsiveness, unlike static preload markers such as CVP or PAOP.

Question 4

In a massive transfusion protocol (MTP) for hemorrhagic shock, what is the currently recommended ratio of packed red blood cells (pRBCs) to fresh frozen plasma (FFP) to platelets?

Accepted Answer

1:1:1

Answer

The PROPPR trial established that a balanced 1:1:1 ratio of pRBCs:FFP:platelets mimics whole blood, reduces dilutional coagulopathy, and improves 24-hour survival in massive hemorrhage.

Question 5

A patient develops acute hypoxemic respiratory failure with bilateral pulmonary infiltrates and PaO2/FiO2 ratio < 300 within 6 hours of transfusion, with no evidence of volume overload. This presentation is most consistent with:

Accepted Answer

Transfusion-related acute lung injury (TRALI)

Answer

TRALI is defined as new acute lung injury within 6 hours of transfusion with PaO2/FiO2 < 300 and bilateral infiltrates in the absence of circulatory overload, distinguishing it from TACO.

MAC - Maintaining Anesthesia Certification Practice Test

MAC - Maintaining Anesthesia Certification Practice Test

MAC Fluid Management & Blood Products