Fluid Management and Blood Transfusion

Fluid Management and Blood Transfusion

Rebecca Kalman and Edward Bittner

1. All of the following are signs of dehydration, except

A. Progressive metabolic acidosis

B. Urinary specific gravity > 1.010

C. Urine osmolality < 300 mOsm/kg

D. Urine sodium < 10 mEq/L

2. Regarding central venous pressure (CVP) monitoring

A. Low values of <5 mm Hg may be considered normal in the absence of other signs of hypovolemia

B. CVP readings can be interpreted independently of the clinical setting

C. CVP monitoring is never indicated in patients with normal cardiac and pulmonary function

D. In a patient with right ventricular dysfunction, a CVP of 10 mm Hg should be considered elevated

3. In healthy patients, the lactate in lactated Ringer solution

A. Causes a lactic acidosis

B. Is converted to bicarbonate by the liver

C. Is rapidly bound by albumin

D. Causes a hyperchloremic metabolic acidosis

4. All of the following fluids are generally considered to be isotonic, except

A. Lactated Ringer

B. Normal saline

C. D5 normal saline

D. D5¼ normal saline

5. All of the following statements regarding dextran solutions are true, except

A. Dextran 40 may improve blood flow through the microcirculation

B. Dextrans may have antiplatelet effects

C. Large-volume infusions of dextrans have been associated with renal failure

D. Dextran 40 is a better volume expander than dextran 70

6. Which of the following statements is true regarding fluid loss?

A. Substantial evaporative losses can be associated with large wounds and are directly proportionate to the surface area exposed

B. Internal redistribution of fluids, “third spacing,” cannot cause massive fluid shifts

C. Traumatized, inflamed, or infected tissues can only sequester minimal amounts of fluid in the interstitial space

D. Cellular dysfunction as a result of hypoxia usually produces a decrease in intracellular fluid volume

7. The probability of developing anti-D antibodies after a single exposure to the Rh antigen is

A. <1%

B. 5% to 10%

C. 50% to 70%

D. >80%

8. In a conventional crossmatch

A. Donor cells are mixed with recipient serum

B. Recipient cells are mixed with donor serum

C. Donor serum is tested against red cells of known antigenic composition

D. None of the above

9. A leftward shift of the oxyhemoglobin dissociation curve may be related to

A. Low levels of 2,3-DPG in packed red blood cells

B. Hypothermia resulting from transfusion of blood

C. Both A and B

D. None of the above

10. Which of the following statements regarding fresh-frozen plasma (FFP) is correct?

A. Contains all of the clotting factors except factor VIII

B. Should not be used in patients with antithrombin III deficiency

C. Carries the same infection risk as a unit of whole blood

D. Is contraindicated in the case of isolated-factor deficiencies

11. The most common cause of an acute hemolytic transfusion reaction is

A. An error during type and screen

B. An error during type and crossmatch

C. Misidentification of the patient, blood specimen, or transfusion unit

D. Defective blood filter

12. Evidence for the fact that leukocyte-containing blood products appear to be immunosuppressive includes all of the following, except

A. Preoperative blood transfusions appear to improve graft survival in renal transplant patients

B. Recurrence of malignant growths may be more likely in patients who receive a blood transfusion during surgery

C. Transfusion of allogeneic leukocytes can activate latent viruses in a recipient

D. Blood transfusion may decrease the incidence of serious infection following surgery or trauma

13. Bacterial infection due to a contaminated blood product is most likely with transfusion of

A. Packed red blood cells

B. Fresh-frozen plasma

C. Platelets

D. Cryoprecipitate

14. All of the following qualities are advantages of crystalloid solutions, except

A. Nontoxic

B. Reaction-free

C. Relatively inexpensive

D. Have the ability to remain in the intravascular space for a relatively long amount of time

15. Administration of large volumes of normal saline can lead to

A. A metabolic alkalosis

B. A hyperchloremic-induced nongap metabolic acidosis

C. An anion gap lactic acidosis

D. None of the above

16. All of the following solutions contain potassium, except

A. Lactated Ringer solution

B. PlasmaLyte

C. Hespan

D. Packed red blood cells

17. The storage time for packed red blood cells at temperatures of 1 to 6°C is

A. 7 to 10 days

B. 21 to 35 days

C. 60 to 80 days

D. 120 days

18. Which of the following statements regarding transfusion of packed red blood cells is most correct?

A. The hematocrit of 1 unit is usually 30% to 40%

B. Transfusion of a single unit will increase an adult’s hemoglobin concentration about 4 g/dL

C. May cause clotting if the transfused packed red blood cells are mixed with lactated Ringer solution

D. Their principle use as that of a volume expander

19. Blood products are tested for all of the following, except

A. Hepatitis C

B. HIV

C. West Nile virus

D. Herpes virus

20. Regarding assessment of surgical blood loss

A. Both surgeons and anesthesiologists tend to underestimate blood loss

B. Measurement of blood in the surgical suction container is all that is necessary to estimate blood loss

C. The use of irrigating solutions does not complicate assessment of blood loss

D. A soaked “lap” pad can hold 10 to 15 mL of blood

21. The most common nonhemolytic reaction to transfusion of blood products is

A. Allergic

B. Febrile

C. Anaphylactoid

D. Urticarial

22. Types of autologous blood transfusion include all of the following, except

A. Predeposited donation

B. Intraoperative blood salvage

C. Normovolemic hemodilution

D. Donor-directed transfusion

23. A patient with type O blood will have which of the following plasma antibodies?

A. Anti-A

B. Anti-B

C. Both anti-A and anti-B

D. None

24. After blood is collected, the preservative CPDA-1 is commonly added. This contains all of the following, except

A. Citrate

B. Phosphate

C. Dextrose

D. Potassium

25. A 51-year-old patient was an unrestrained driver in a motor vehicle crash in which he sustained multiple traumatic injuries. He is on mechanical ventilation, and has received 8 units of packed red blood cells, 4 units of fresh-frozen plasma, and 6 units of platelets. His arterial blood gas reveals a metabolic alkalosis. The most likely explanation for this finding is

A. Metabolism of citrate to bicarbonate

B. Under-resuscitation

C. Continued bleeding

D. Hypoventilation

26. A 70-year-old patient with chronic renal failure is in the operating room undergoing a kidney transplant. There has been more blood loss than expected, and he has received 6 units of packed red blood cells and 3 units of fresh-frozen plasma. The surgeons still complain that the patient “won’t clot.” All of the following are potential contributors to his coagulopathy, except

A. Temperature of 34.9°C

B. Uremia

C. Dilutional thrombocytopenia

D. Fibrinogen level of 250 mg/dL

27. The estimated maintenance fluid requirement for a 9-year-old, 35-kg patient is

A. 50 mL/h

B. 75 mL/h

C. 100 mL/h

D. 20 mL/h

28. Which of the following patients is least likely to need calcium supplementation due to citrate-induced hypocalcemia related to blood transfusion?

A. A 30-year-old trauma patient receiving massive blood transfusion through a rapid transfuser at a rate of 75 mL/min

B. A patient with end-stage liver disease undergoing a complicated open shunt procedure, who is hypothermic and has received greater than 2 blood volumes of transfusion

C. A neonate undergoing congenital diaphragmatic hernia repair

D. A 50-year-old patient with coronary artery disease undergoing an open femoral popliteal bypass procedure, who has received 3 units of packed red blood cells

29. A medical student asks you if “young” blood is better for critically ill patients. Which of the following statements regarding “young” blood is most correct?

A. Fresher blood has better ability to deliver oxygen to tissues

B. Blood from younger donors has lower risk of immunosuppression than blood donated by the elderly

C. Older blood has a lower potassium content

D. Fresher blood can be transfused more rapidly than older blood

30. You are caring for an 18-year-old female trauma patient who was emergently transported to the operating room for control of massive bleeding. Due to the acuteness of the patient’s bleeding, there was no time for blood typing and she has received 3 units of O-negative packed red blood cells. The blood bank notifies you that the patient’s blood type is A-positive. If the patient requires further transfusion, which of the following should be administered?

A. A-positive RBCs

B. A-negative RBCs

C. O-negative RBCs

D. RhoGAM

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