Portal Chunk 10

A) Proceed with cannulation immediately

B) Administer additional heparin and recheck the ACT

C) Give protamine and restart with bivalirudin

D) Delay and request haematology review

A) 4-6 mmol/L

B) 8-12 mmol/L

C) 16-30 mmol/L

D) 35-45 mmol/L

A) Reduced SVR

B) Tachycardia reducing diastolic filling and coronary perfusion

C) Increased RV afterload

D) Venodilation reducing preload

A) Systemic anticoagulation with warfarin

B) Infusion of cardioplegia into coronary ostia or aortic root

C) Elevation of perfusion pressure above 100 mmHg

D) Ventricular pacing at 60 bpm

A) HR 50-60 bpm, high SVR, high preload

B) HR 80-100 bpm, low-normal SVR, adequate preload

C) HR 80-100 bpm, high SVR, minimal preload

D) HR 50-60 bpm, low SVR, high preload

A) Heparin rebound syndrome

B) Catastrophic protamine reaction with pulmonary hypertension

C) Air embolism to coronary circulation

D) Acute RV failure from myocardial ischaemia

A) Peak of systolic upstroke

B) The dicrotic notch

C) Nadir of diastole

D) Onset of P wave on ECG

A) Halothane

B) Sevoflurane

C) Enflurane

D) Methoxyflurane

A) Convert to GA and continue

B) Release the cross-clamp and place an intraluminal shunt

C) Administer IV dexamethasone and proceed

D) Increase BP with phenylephrine and await improvement

A) Reduction in SVR

B) Acute increase in LV afterload and systemic hypertension

C) Decrease in venous return and hypotension

D) Bradycardia from baroreceptor activation

A) 32-34 C

B) 28-30 C

C) 18-20 C

D) 10-12 C

A) Pulmonary artery catheter

B) Transoesophageal echocardiography (TOE)

C) Cerebral near-infrared spectroscopy

D) Bispectral index monitoring

A) Noradrenaline infusion alone

B) Vasopressin bolus

C) Milrinone or dobutamine infusion

D) Phenylephrine infusion

A) Promote tachycardia to maintain CO

B) Maintain slow HR, sinus rhythm, and adequate preload

C) Aggressively reduce preload to prevent pulmonary oedema

D) Use vasodilators to reduce afterload

A) GA with intubation and TOE

B) Local anaesthesia with sedation, avoiding GA

C) Neuraxial anaesthesia with spinal block

D) High thoracic epidural with sedation

A) Lower endoleak rates requiring reintervention

B) Significantly reduced perioperative mortality and morbidity short-term

C) Eliminates need for postoperative surveillance imaging

D) Lower 10-year mortality than open repair

A) Deep hypothermia at 18 C throughout

B) Normothermia at 37 C throughout

C) Moderate hypothermia 28-32 C during bypass, then active rewarming

D) Hyperthermia at 38.5 C to increase metabolic rate

A) Avoid all volatile agents

B) Anticipate and prepare for adverse reaction to protamine

C) Avoid heparinisation and use alternative anticoagulation

D) Give prophylactic adrenaline before induction

A) Maintaining ACT above 480 seconds

B) Managing haemodynamic instability from cardiac displacement and compression

C) Preventing systemic air embolism from the open aorta

D) Maintaining hypothermia at 28 C throughout

A) High-dose fentanyl 50-100 mcg/kg as primary anaesthetic

B) Remifentanil infusion 0.05-0.5 mcg/kg/min with volatile agent

C) Morphine 1 mg/kg at induction

D) Methadone 0.3 mg/kg intraoperatively as sole opioid