Поздравляю всех с наступающими и прошедшими праздниками!
Надеюсь, что в Н.Г. отвечающих на вопросы станет больше (как минимум, на одного человека, по имени Юрий)
Женя, безусловно, у нас не "своя игра", однако, если задаваться целью сдавать какие-то тесты (европейские или другие), надо знать врагов в лицо. То есть, относиться к тестам как к тестам, где нужно выбрать один правильный ответ.
Кроме этого, я решил немного ускориться и увеличить количество вопросов.
Ответы:
#1. Correct Answer: B. Studies comparing the two types of oxygenators reveal less trauma to blood constituents with membrane oxygenators. Hemolysis and the resultant release of red cell debris is a potential problem associated with bubble oxygenators. Likewise, a decrease in platelet activity—resulting from platelet destruction, increased aggregation, and adherence to the oxygenator—may lead to impairment of postoperative hemostasis.
#2. Correct Answer: D. Mediastinoscopy is a means for assessing spread of lung carcinoma. Hemorrhage is a real risk and may be life threatening. Pressure on the innominate artery by the mediastinoscope has been thought to cause transient left hemiparesis; therefore, it is recommended that blood pressure be monitored in the left arm and that the right radial pulse be monitored continuously. A decrease in the right radial pulse would be an indication for repositioning the mediastinoscope. Recurrent laryngeal nerve injury may occur either secondary to damage by the mediastinoscope or involvement by the tumor. If both recurrent laryngeal nerves are damaged, upper airway obstruction may result. Mediastinoscopy may be performed under local anesthesia.
New:
#1. Which of the following may be effective therapy for the patient with severe, irreversible pulmonary hypertension?
1. Heterotopic heart transplant
2. Orthotopic heart transplant
3. Heart-lung transplant
4. Left ventricular assist device
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.
_________________________
#2. Which of the following statements is/are TRUE?
1. Parasympathetic stimulation to the heart decreases heart rate via muscarinic receptors, decreasing adrenergic receptor activation through G-protein–mediated pathways.
2. Sympathetic stimulation occurs via alpha-1, beta-1, and beta-22 receptors through G-protein–mediated pathways.
3. Chronotropic and inotropic effects of beta-1 activation results from increased numbers of calcium channels available for activation.
4. Sympathetic stimulation to the heart is via the stellate ganglia, with the right stellate having more chronotropic effect and the left stellate having more inotropic effect.
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.
_______________________
#3. Which of the following statements regarding bronchial blockers is/are TRUE?
1. They are effective in maintaining lung isolation despite surgical manipulation.
2. A Univent tube is useful for bilateral lung transplant cases.
3. Placement of an embolectomy catheter into the bronchus should be performed blindly.
4. Bronchial blockers may be used in children younger than 12 years.
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.
______________________
#4. Relatively strong indications for the perioperative placement of a pulmonary artery catheter in the patient undergoing cardiac surgery include:
1. procedures in which continuous retrograde cardioplegia is to be employed during cardiopulmonary bypass
2. a patient with moderate to severe pulmonary hypertension
3. access to central circulation for the infusion of vasoactive drugs
4. assistance in the management of the patient with impaired left ventricular function
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.
______________________
#5. In the lateral decubitus position:
A. Blood flow to the nondependent lung is significantly greater than it is to the dependent lung.
B. The distribution of blood flow is turned by 180 degrees compared to the supine position.
C. In the awake, spontaneously breathing patient, there is poor ventilation/perfusion matching in the dependent lung.
D. Controlled ventilation is required to ensure gas exchange and ventilation when a thoracotomy is performed.
E. The nondependent hemidiaphragm is pushed higher into the chest.