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The signs and symptoms of heart failure include:
- A. Polyphagia and polydipsia.
- B. Orthopnoea and gastrointestinal disruption.
- C. Urinary frequency and acute pulmonary oedema.
- D. Dyspnoea and peripheral oedema.
Correct Answer: D
Rationale: Heart failure (HF) manifests through circulatory and fluid overload effects. Polyphagia and polydipsia align with diabetes, not HF. Orthopnoea (breathlessness lying flat) is HF-specific, but gastrointestinal disruption (e.g., nausea) is secondary, less hallmark. Urinary frequency occurs nocturnally in HF (nocturia), but acute pulmonary edema is an acute crisis, not a chronic sign. Dyspnoea (shortness of breath) from pulmonary congestion and peripheral edema (swelling) from venous backup are classic, per Farrell (2017) reflecting left and right HF respectively. These stem from reduced cardiac output and fluid retention (e.g., elevated jugular venous pressure), driving clinical presentation. Dyspnoea limits activity, edema signals systemic impact, making them definitive over less specific or acute-only symptoms.
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Which of the following appropriately describes diastolic dysfunction?
- A. The rate of filling of the ventricles during diastole is slowed
- B. The left ventricle is dilated
- C. The preload (end ventricular diastolic volume) is increased
- D. The left ventricular ejection fraction is decreased
Correct Answer: A
Rationale: Diastolic dysfunction stiffens ventricles slowed filling in diastole nails it, as relaxation flops, hiking pressure. Dilated LV or high preload fits systolic; low EF's not here preserved in HFpEF. Dyssynchrony's another beast. Clinicians peg this slow fill, a chronic heart kink distinct from pump fail.
A government initiative to reduce the effects of fatigue in the workforce has recently been rolled out. As anaesthetic lead, you are asked by the chief executive of your institution to develop strategies to reduce fatigue in your department. Appropriate strategies are likely to include:
- A. Changing the frequency of night shifts on the on-call rota from every 3 days to every 2 weeks.
- B. Including a section in the trainee's handbook on the signs of fatigue, along with prevention and management strategies.
- C. Acquiring a departmental exercise bike.
- D. Reducing the number of night shifts worked by colleagues over 55 years of age.
Correct Answer: A
Rationale: Fatigue mitigation in anaesthesia enhances safety. Reducing night shift frequency from every 3 days to every 2 weeks allows recovery (per sleep science, 48-72 hours post-night shift), significantly cutting cumulative fatigue versus less impactful measures. A handbook educates on fatigue signs (e.g., yawning, errors) and strategies (naps, caffeine), but it's passive. An exercise bike offers minor alertness boosts but not sustained relief. Age-based shift reduction addresses older workers' recovery needs, yet evidence favors roster spacing for all. Refreshments help minimally. Frequent night shifts disrupt circadian rhythms and sleep homeostasis, amplifying error risk (e.g., medication misdosing); a 2-week gap aligns with occupational health guidelines for sustained performance.
Which of the following is the surgical treatment of choice for end-stage heart failure?
- A. Cardiac resynchronization therapy (CRT)
- B. Percutaneous angiogram
- C. Genetic counseling
- D. Ventricular assist devices (VADs)
Correct Answer: D
Rationale: End-stage heart failure, when drugs and pacing fail, leans on ventricular assist devices mechanical pumps aiding circulation, a bridge to transplant or destination therapy. CRT syncs ventricles, less invasive, but VADs tackle severe pump collapse. Angiograms diagnose, not treat; genetic counseling's irrelevant. Nurses prep for VADs, managing post-op risks, the go-to surgical fix in this terminal cardiac scenario.
In Home BP monitoring, which of the following readings show a normal night-time BP?
- A. 120/70 mmHg
- B. 135/85 mmHg
- C. 130/80 mmHg
- D. 125/75 mmHg
Correct Answer: A
Rationale: Home night BP 120/70 fits normal, not 130+ creepers. Nurses clock this chronic sleep dip.
Appropriate statements concerning intrathecal drug delivery systems include:
- A. In a patient with progressive cancer-related pain, a low-grade pelvic infection is an absolute contraindication for implanting either an intrathecal catheter or a pump, even under antibiotic cover.
- B. Intrathecally administered opioids circulate to the central neuraxis, including the brainstem, where they are likely to cause drowsiness and respiratory depression.
- C. In difficult cases, ziconotide can be administered with either an opioid or clonidine, or both.
- D. As a mixture of opioid and clonidine is expected to distribute throughout the cerebrospinal fluid, the level of the catheter in the intrathecal space is unlikely to be important.
Correct Answer: B
Rationale: Intrathecal drug delivery systems (IDDS) manage severe pain with nuances. A low-grade pelvic infection isn't an absolute contraindication; implantation may proceed with antibiotics if benefits outweigh risks (e.g., cancer palliation). Intrathecal opioids do reach the brainstem via cerebrospinal fluid, causing drowsiness and respiratory depression, though less than systemic routes due to lower doses still a key risk requiring monitoring. Ziconotide combines with opioids or clonidine for synergy in refractory pain, per clinical practice. Catheter tip position matters; drug distribution isn't uniform higher placement enhances rostral spread, affecting efficacy and side effects. MRI compatibility exists with most modern pumps. The brainstem effect of opioids underscores IDDS's potency and danger, necessitating careful titration and patient selection.