Анестезиология

[Евгений Хоменко]

Вот и ответы:

#3. Correct Answer: C. The Univent tube may be helpful for cases in which changing the double-lumen tube to a single lumen tube may be difficult (e.g., following bilateral lung transplant). It is a single lumen endotracheal tube with a movable endobronchial blocker. The bronchial blocker technique can be useful in achieving selective ventilation in adults and in children younger than 12 years, and it should be placed via bronchoscopic guidance. These tubes are not used very commonly because they are easily displaced.

Здесь бы я поспорил, т.к. билатеральная трансплантация подразумевает последовательное удаление и пересадку легкого, в случае с удалением правого легкого эндобронхиальный блокер в ПГБ может легко сместиться создав проблему, кроме того он может мешать при формировании бронхиального анастомоза, плюс невозможно селективно санировать и раздувать донорское легкое. Рекомендуется интубация левосторонней двухпросветной трубкой, т.к. ЛГБ длиннее и бронхиальный конец меньше будет мешать при формировании бронхиального анастомоза.

New:
#1. Which of the following statements about post–cardiac transplant patients is/are TRUE?
1. They are better able to increase heart rate than stroke volume.
2. Their resting stroke volume tends to be 50–60% of normal volume.
3. They are insensitive to circulating catecholamines.
4. They are preload dependent.

Choose A if 1, 2, and 3 are correct; B if 1 and 3; C if 2 and 4; D if 4; and E if all.

D.

#2. Regarding lung volume reduction surgery, all of the following are true EXCEPT:
A. This procedure is necessary in patients with end-stage emphysema.
B. Ventilation can usually be decreased after the chest is open.
C. Nitrous oxide should be avoided.
D. Pneumothorax may be difficult to diagnose.
E. Patients have a greater amount of functional lung tissue after surgery.

C.

#3. In patients presenting for vascular surgery, the incidence of significant coronary artery disease (stenosis >70%) detected by angiography in patients without any clinical symptoms of coronary stenosis is:
A. <1%
B. 11%
C. 37%
D. 78%
E. nearly universal

B.

#4. For patients undergoing vascular surgery, when is myocardial ischemia most likely to occur?
A. Preoperatively
B. During the induction of anesthesia
C. Intraoperatively, prior to revascularization
D. In the immediate postoperative period
E. 48–72 Hours postoperatively

D.

#5. Coronary sinus drainage includes all of the following EXCEPT:
A. great cardiac vein
B. middle cardiac vein
C. thebesian veins
D. posterior left ventricular vein
E. oblique vein of Marshall

C.

[Tsiklinskiy]

1."D"
2. "А"
3."В"
4."D"
5. "С"

[Alexey Dyachkov]

1. Correct Answer: D. Post–cardiac transplant patients have afferent and efferent autonomic denervation. Nevertheless, their resting stroke volume usually is normal or near normal so long as an adequate preload is maintained (preload dependence). They achieve immediate increases in cardiac output (as in response to exercise) by increasing stroke volume rather than heart rate. There is a delay in achieving maximal rate, which seems to correspond to the time required for secretion and circulation of adrenal catecholamines.
__________________

2. Correct Answer: B. Extensive bullae represent end-stage emphysematous destruction of the lung. Once the chest is open during lung volume reduction surgery, more of the tidal volume may enter the compliant bullae, which are no longer limited by chest-wall integrity, and an increase in ventilation is needed until the bullae are resected. Nitrous oxide should be avoided, because it can cause expansion of the bullae. The diagnosis of pneumothorax may be made by a unilateral decrease in breath sounds (which may be difficult to distinguish in a patient with bullous disease). Unlike most cases of pulmonary resection, patients following bullectomy are left with a greater amount of functional lung tissue than was previously available to them, and the mechanics of respiration are improved.
_________________

3. Correct Answer: C. Hertzer et al. performed coronary angiography in 1000 consecutive patients slated to undergo vascular surgery and identified significant coronary artery stenosis (>70% occlusion) in 37% of patients without any symptoms of coronary disease. These data indicate a high index of suspicion for coronary artery stenosis in patients presenting for vascular surgery, even in the absence of a prior history of cardiac disease.
_________________

4. Correct Answer: D. Patients undergoing vascular surgery are most likely to exhibit myocardial ischemia in the immediate postoperative period due to factors such as pain and adrenergic stress, hypercoagulability, and increased oxygen consumption associated with hypothermia and shivering. Landesburg et al. discovered that patients experienced twice as many episodes of myocardial ischemia after vascular surgery than preoperatively or intraoperatively. In fact, perioperative Holter monitoring indicates that the intraoperative period may be the period with the lowest incidence of ischemia.
________________

5. Correct Answer: C. The thebesian veins traverse the myocardium and drain into various cardiac chambers. The thebesian venous drainage, along with the bronchial and pleural venous drainage, contributes to the normal 1–3% arteriovenous shunt. The great, middle, posterior left ventricular veins, and the oblique vein of Marshall (vein of the left atrium) all drain into the coronary sinus.

[dcmikhaylov]

Даешь продолжение?!

[dcmikhaylov]

Или хотя бы можно выложить для скачивания тесты к board