SEE Exam UPDATED Questions and
CORRECT Answers
During fetal monitoring, Type III decelerations are thought to be related to:
• head compression
• umbilical cord compression
• uteroplacental insufficiency
• placental abruption - CORRECT ANSWERS umbilical cord compression
Type III, or variable, decelerations are the most common type of decelerations. They are thought
to be related to umbilical cord compression and intermittent decreases in umbilical blood flow.
The arteria radicularis magna, or artery of Adamkiewicz, most commonly arises from:
• T4 - T8
• T8 - L2
• L2 - L4
• L4 - S1 - CORRECT ANSWERS T8 - L2.
A major complication of thoracic aortic surgery is paraplegia, occurring in up to 20% of elective
cases, and is secondary to spinal cord ischemia. The arteria radicularis magna supplies blood to
the anterior spinal artery. The arteria radicularis magna has a variable origin from aorta, arising
between T5 - T8 in 15%, between T9 - T12 in 60% and between L1 - L2 in 25% of individuals.
60. A 55-year-old woman with a history of congenital long QT syndrome is undergoing a
hysteroscopy for abnormal uterine bleeding. She had uneventful induction of general anesthesia
but after paracervical block with lidocaine develops ventricular tachycardia with morphological
appearance of torsades de pointe. Which of the following medications should be AVOIDED in
the treatment of her arrhythmia?
• Amiodarone
• Calcium chloride
• Esmolol
,• Magnesium sulfate - CORRECT ANSWERS 60. Amiodarone. Congenital long QT
syndrome may occur in conjunction with other hereditary syndromes, such as Jervell, Lange-
Nielsen or Romano-Ward syndrome, or acquired as a result of pharmacologic or metabolic
etiologies. It is an issue of cellular repolarization which precipitates tachyarrhythmias, most
commonly polymorphic ventricular tachycardia or torsades de pointe. There are multiple
subtypes that affect both potassium and/or sodium channels. The arrhythmias may be
precipitated by sympathetic activation, auditory stimuli or at rest. Family history may be positive
for sudden cardiac death and the ECG significant for prolonged corrected QT interval > 430ms
or bizarre odd-appearing T waves. Treatment includes magnesium for arrhythmias, possible
permanent pacemaker, or beta blockers for subtypes 1 and 2, but amiodarone is considered
contraindicated as it prolongs the QT interval.
59. A 76-year-old man is scheduled for a hemicolectomy. His past medical history is significant
for third degree heart block treated with a permanent pacemaker. Problems with electrocautery
use in this patient can be minimized by:
• placing the grounding pad near the pacemaker
• using infrequent bursts of longer duration
• the use of a bipolar cautery
• reducing the surface area of the return electrode - CORRECT ANSWERS 59. the use of a
bipolar cautery. Electrical interference from the electrocautery can be interpreted by the
pacemaker as myocardial activity and suppress pacemaker activity. These problems can be
minimized by limiting use to short bursts, placing the grounding pad as far from the pacemaker
as possible and using a bipolar cautery.
58. A 35-year-old woman who underwent orthotopic heart transplantation 2 years ago for
nonischemic cardiomyopathy presents after a motor vehicle accident for exploratory laparotomy
under general anesthesia. Intraoperatively, her blood pressure is 75/35 mmHg and heart rate is 90
bpm. After the administration of phenylephrine, which of the following hemodynamic responses
do you MOST expect?
• HR decreased, BP increased
• HR decreased, BP no change
• HR no change, BP increased
• HR no change, BP no change - CORRECT ANSWERS 58. HR no change, BP increased.
After heart transplantation, the heart is completely denervated. The normal resting heart rate is
relatively tachycardic at 90-100 bpm due to lack of vagal tone. Vagal bradycardic responses (to
,laryngoscopy, hypertension, carotid sinus massage) will also be absent. Over time, however,
many patients require permanent pacemaker placement for treatment of significant bradycardia.
After heart transplant, patients are not able to respond to demands for increased cardiac output
with increased heart rate. Thus in this situation of a trauma with potentially significant blood
loss, a normal patient would have tachycardia but a heart transplant patient has no change in
heart rate, only hypotension. Instead for heart transplant patients, cardiac output is augmented by
increased stroke volume. For this reason it is important to maintain adequate intravascular
volume. The transplanted heart is not able to respond to medications that block the
parasympathetic system. Bradycardia and hypotension have to be treated with medications that
have a direct effect such as epinephrine and isoproterenol. Phenylephrine will result in increased
blood pressure, but no change in heart rate. Indirect and mixed indirect/direct-acting drugs have
minimal effect or have the effect of their direct components.
57. The postretrobulbar block apnea syndrome:
• is likely secondary to intravascular injection
• most commonly occurs during or immediately after injection
• is associated with unconsciousness
• carries a high morbidity and mortality - CORRECT ANSWERS 57. is associated with
unconsciousness. The postretrobulbar block apnea syndrome is probably due to injection of local
anesthetic into the optic nerve sheath, with spread into the CSF. The CNS is exposed to high
concentrations of local anesthetic leading to apprehension and unconsciousness. Apnea occurs
within 20 minutes and resolves within an hour. Treatment is supportive.
56. A 75-year-old man is undergoing a mitral valve replacement via cardiopulmonary bypass.
The perfusionist is running bypass flows at > 2.5 liters/minute/m2. Which of the following is the
MOST likely adverse consequence of undergoing cardiopulmonary bypass at increased flow
rates?
• Increased trauma to blood elements
• Increased hypothermia
• Decreased blood flow to the brain
• Decreased myocardial blood flow - CORRECT ANSWERS 56. A. Increased trauma to
blood component: Cardiopulmonary bypass (CPB) does the work of the heart and lungs in order
to isolate those organs from blood flow such that surgery on the heart can occur in a relatively
bloodless fashion. Thus, the CPB circuit must oxygenate and ventilate the blood and then deliver
the oxygenated blood back to the body and end organs. It has long been debated whether
, maximal blood flow or pressure is more important in perfusion and homeostasis of the end
organs during bypass. Maximizing blood flow (generally considered to be flow at a cardiac index
of > 2 liters/minute/meter2) has been shown to increase hematologic trauma, increase the
magnitude of the stress or inflammatory response, cause strain on suture lines, increase shunting
of blood through the pulmonary system, increase washout of cardioplegia and not necessarily
lead to improved regional blood flow. The CPB machine can change total flow, but it cannot
adjust regional flows to the various end organ systems. Changes in blood pressure are currently
thought to be most effective for allowing adjustments to regional flow in organ systems as the
organs retain their regional vascular resistance capabilities. Thus conduct of CPB with an
optimal pressure (and potentially lower flows) may allow the individual organs to regionally
modulate their own flows. scheduled for ECT are routinely given anticholinergic medication
preoperatively.
55. Physiologic effects of electroconvulsive therapy (ECT) include an:
• initial sympathetic response with sustained tachycardia
• initial sympathetic discharge followed by a sustained parasympathetic response
• initial parasympathetic discharge followed by a sustained sympathetic response
• initial parasympathetic response with sustained bradycardia - CORRECT ANSWERS 55.
initial parasympathetic discharge followed by a sustained sympathetic response. An initial
parasympathetic discharge followed by a sustained sympathetic response is immediately seen
after the induction of a seizure. Marked bradycardia with increased secretions can occur, which is
then followed by hypertension and tachycardia. Patient
54. A 70-year-old man with a DDD-R pacemaker for a history of symptomatic bradycardiais
undergoing an anterior cervical discectomy and fusion with somatosensory evoked potential
(SSEP) and motor evoked potential (MEP) monitoring. The pacemaker should be reprogrammed
to which of the following?
• Discontinue R function
• Dual chamber asynchronous pacing
• No reprogramming
• Ventricular asynchronous pacing - CORRECT ANSWERS 54. "R" signifies rate
responsiveness in the fourth position of the pacemaker designation code. Patients who are
pacemaker-dependent are limited in their ability to exercise because of fixed rate (can't get their
heart rates up). "R" function allows a pacemaker to speed up to satisfy increased metabolic
demands (via motion, minute ventilation, temperature sensors) when the patient is exercising.
However, for patients who are pacemaker-dependent, rate responsiveness function may be
CORRECT Answers
During fetal monitoring, Type III decelerations are thought to be related to:
• head compression
• umbilical cord compression
• uteroplacental insufficiency
• placental abruption - CORRECT ANSWERS umbilical cord compression
Type III, or variable, decelerations are the most common type of decelerations. They are thought
to be related to umbilical cord compression and intermittent decreases in umbilical blood flow.
The arteria radicularis magna, or artery of Adamkiewicz, most commonly arises from:
• T4 - T8
• T8 - L2
• L2 - L4
• L4 - S1 - CORRECT ANSWERS T8 - L2.
A major complication of thoracic aortic surgery is paraplegia, occurring in up to 20% of elective
cases, and is secondary to spinal cord ischemia. The arteria radicularis magna supplies blood to
the anterior spinal artery. The arteria radicularis magna has a variable origin from aorta, arising
between T5 - T8 in 15%, between T9 - T12 in 60% and between L1 - L2 in 25% of individuals.
60. A 55-year-old woman with a history of congenital long QT syndrome is undergoing a
hysteroscopy for abnormal uterine bleeding. She had uneventful induction of general anesthesia
but after paracervical block with lidocaine develops ventricular tachycardia with morphological
appearance of torsades de pointe. Which of the following medications should be AVOIDED in
the treatment of her arrhythmia?
• Amiodarone
• Calcium chloride
• Esmolol
,• Magnesium sulfate - CORRECT ANSWERS 60. Amiodarone. Congenital long QT
syndrome may occur in conjunction with other hereditary syndromes, such as Jervell, Lange-
Nielsen or Romano-Ward syndrome, or acquired as a result of pharmacologic or metabolic
etiologies. It is an issue of cellular repolarization which precipitates tachyarrhythmias, most
commonly polymorphic ventricular tachycardia or torsades de pointe. There are multiple
subtypes that affect both potassium and/or sodium channels. The arrhythmias may be
precipitated by sympathetic activation, auditory stimuli or at rest. Family history may be positive
for sudden cardiac death and the ECG significant for prolonged corrected QT interval > 430ms
or bizarre odd-appearing T waves. Treatment includes magnesium for arrhythmias, possible
permanent pacemaker, or beta blockers for subtypes 1 and 2, but amiodarone is considered
contraindicated as it prolongs the QT interval.
59. A 76-year-old man is scheduled for a hemicolectomy. His past medical history is significant
for third degree heart block treated with a permanent pacemaker. Problems with electrocautery
use in this patient can be minimized by:
• placing the grounding pad near the pacemaker
• using infrequent bursts of longer duration
• the use of a bipolar cautery
• reducing the surface area of the return electrode - CORRECT ANSWERS 59. the use of a
bipolar cautery. Electrical interference from the electrocautery can be interpreted by the
pacemaker as myocardial activity and suppress pacemaker activity. These problems can be
minimized by limiting use to short bursts, placing the grounding pad as far from the pacemaker
as possible and using a bipolar cautery.
58. A 35-year-old woman who underwent orthotopic heart transplantation 2 years ago for
nonischemic cardiomyopathy presents after a motor vehicle accident for exploratory laparotomy
under general anesthesia. Intraoperatively, her blood pressure is 75/35 mmHg and heart rate is 90
bpm. After the administration of phenylephrine, which of the following hemodynamic responses
do you MOST expect?
• HR decreased, BP increased
• HR decreased, BP no change
• HR no change, BP increased
• HR no change, BP no change - CORRECT ANSWERS 58. HR no change, BP increased.
After heart transplantation, the heart is completely denervated. The normal resting heart rate is
relatively tachycardic at 90-100 bpm due to lack of vagal tone. Vagal bradycardic responses (to
,laryngoscopy, hypertension, carotid sinus massage) will also be absent. Over time, however,
many patients require permanent pacemaker placement for treatment of significant bradycardia.
After heart transplant, patients are not able to respond to demands for increased cardiac output
with increased heart rate. Thus in this situation of a trauma with potentially significant blood
loss, a normal patient would have tachycardia but a heart transplant patient has no change in
heart rate, only hypotension. Instead for heart transplant patients, cardiac output is augmented by
increased stroke volume. For this reason it is important to maintain adequate intravascular
volume. The transplanted heart is not able to respond to medications that block the
parasympathetic system. Bradycardia and hypotension have to be treated with medications that
have a direct effect such as epinephrine and isoproterenol. Phenylephrine will result in increased
blood pressure, but no change in heart rate. Indirect and mixed indirect/direct-acting drugs have
minimal effect or have the effect of their direct components.
57. The postretrobulbar block apnea syndrome:
• is likely secondary to intravascular injection
• most commonly occurs during or immediately after injection
• is associated with unconsciousness
• carries a high morbidity and mortality - CORRECT ANSWERS 57. is associated with
unconsciousness. The postretrobulbar block apnea syndrome is probably due to injection of local
anesthetic into the optic nerve sheath, with spread into the CSF. The CNS is exposed to high
concentrations of local anesthetic leading to apprehension and unconsciousness. Apnea occurs
within 20 minutes and resolves within an hour. Treatment is supportive.
56. A 75-year-old man is undergoing a mitral valve replacement via cardiopulmonary bypass.
The perfusionist is running bypass flows at > 2.5 liters/minute/m2. Which of the following is the
MOST likely adverse consequence of undergoing cardiopulmonary bypass at increased flow
rates?
• Increased trauma to blood elements
• Increased hypothermia
• Decreased blood flow to the brain
• Decreased myocardial blood flow - CORRECT ANSWERS 56. A. Increased trauma to
blood component: Cardiopulmonary bypass (CPB) does the work of the heart and lungs in order
to isolate those organs from blood flow such that surgery on the heart can occur in a relatively
bloodless fashion. Thus, the CPB circuit must oxygenate and ventilate the blood and then deliver
the oxygenated blood back to the body and end organs. It has long been debated whether
, maximal blood flow or pressure is more important in perfusion and homeostasis of the end
organs during bypass. Maximizing blood flow (generally considered to be flow at a cardiac index
of > 2 liters/minute/meter2) has been shown to increase hematologic trauma, increase the
magnitude of the stress or inflammatory response, cause strain on suture lines, increase shunting
of blood through the pulmonary system, increase washout of cardioplegia and not necessarily
lead to improved regional blood flow. The CPB machine can change total flow, but it cannot
adjust regional flows to the various end organ systems. Changes in blood pressure are currently
thought to be most effective for allowing adjustments to regional flow in organ systems as the
organs retain their regional vascular resistance capabilities. Thus conduct of CPB with an
optimal pressure (and potentially lower flows) may allow the individual organs to regionally
modulate their own flows. scheduled for ECT are routinely given anticholinergic medication
preoperatively.
55. Physiologic effects of electroconvulsive therapy (ECT) include an:
• initial sympathetic response with sustained tachycardia
• initial sympathetic discharge followed by a sustained parasympathetic response
• initial parasympathetic discharge followed by a sustained sympathetic response
• initial parasympathetic response with sustained bradycardia - CORRECT ANSWERS 55.
initial parasympathetic discharge followed by a sustained sympathetic response. An initial
parasympathetic discharge followed by a sustained sympathetic response is immediately seen
after the induction of a seizure. Marked bradycardia with increased secretions can occur, which is
then followed by hypertension and tachycardia. Patient
54. A 70-year-old man with a DDD-R pacemaker for a history of symptomatic bradycardiais
undergoing an anterior cervical discectomy and fusion with somatosensory evoked potential
(SSEP) and motor evoked potential (MEP) monitoring. The pacemaker should be reprogrammed
to which of the following?
• Discontinue R function
• Dual chamber asynchronous pacing
• No reprogramming
• Ventricular asynchronous pacing - CORRECT ANSWERS 54. "R" signifies rate
responsiveness in the fourth position of the pacemaker designation code. Patients who are
pacemaker-dependent are limited in their ability to exercise because of fixed rate (can't get their
heart rates up). "R" function allows a pacemaker to speed up to satisfy increased metabolic
demands (via motion, minute ventilation, temperature sensors) when the patient is exercising.
However, for patients who are pacemaker-dependent, rate responsiveness function may be
