diff --git "a/AnesBench.json" "b/AnesBench.json" new file mode 100644--- /dev/null +++ "b/AnesBench.json" @@ -0,0 +1,91260 @@ +[ + { + "id": "91b5e145-57f2-5307-99e4-eafd75643de4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The concentration of a specific gas in solution depends on which of the following?", + "A": "Temperature of the solution", + "B": "Volume of the system", + "C": "Solubility of the specific gas in that solution", + "D": "Molecular weight of the gas" + }, + "zh": { + "question": "溶液中某特定气体的浓度取决于以下哪项？", + "A": "溶液的温度", + "B": "系统的体积", + "C": "该气体在溶液中的溶解度", + "D": "气体的分子量" + } + }, + { + "id": "7b7f7b61-6bd1-500b-bfa7-dcef7ae8a213", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is true about the partial pressure of a gas at equilibrium?", + "A": "Directly proportional to its concentration of gas in solution", + "B": "Inversely proportional to its concentration of gas in solution", + "C": "Less than its concentration of gas in solution", + "D": "Greater than its concentration of gas in solution" + }, + "zh": { + "question": "关于气体在平衡时的分压，下列哪项陈述是正确的？", + "A": "与溶液中气体的浓度成正比", + "B": "与溶液中气体的浓度成反比", + "C": "小于溶液中气体的浓度", + "D": "大于溶液中气体的浓度" + } + }, + { + "id": "dd9833d1-8058-5dfc-a9d8-962d9f4c4590", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A vaporizer is mishandled and accidentally tipped on its side. Which of the following is the best course of action to take?", + "A": "Run high fresh gas flows with the dial set to a high concentration for 30 minutes.", + "B": "Run high fresh gas flows with the dial set to a low concentration for 30 minutes.", + "C": "Run low fresh gas flows with the dial set to a low concentration for 30 minutes.", + "D": "Run low fresh gas flows with the dial set to a high concentration for 30 minutes." + }, + "zh": { + "question": "一个蒸发器被误操作并意外倾倒在一侧。以下哪项是最佳的处理措施？", + "A": "将新鲜气体流量调高，并将刻度盘设置为高浓度，运行30分钟。", + "B": "将新鲜气体流量调高，并将刻度盘设置为低浓度，运行30分钟。", + "C": "将新鲜气体流量调低，并将刻度盘设置为低浓度，运行30分钟。", + "D": "将新鲜气体流量调低，并将刻度盘设置为高浓度，运行30分钟。" + } + }, + { + "id": "973f2910-489a-5526-9d89-4bc72a61abd5", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following would increase the output concentration of a volatile anesthetic from a vaporizer?", + "A": "Fresh gas flow rate of 100 mL/min", + "B": "Fresh gas flow rate of 20 L/min", + "C": "Decreased operating room temperature", + "D": "Significantly increasing the ratio of oxygen to nitrous oxide" + }, + "zh": { + "question": "以下哪项会增加挥发性麻醉剂从蒸发器输出的浓度？", + "A": "新鲜气体流速为100 mL/min", + "B": "新鲜气体流速为20 L/min", + "C": "手术室温度降低", + "D": "显著增加氧气与氧化亚氮的比例" + } + }, + { + "id": "b06f7854-4598-50c5-b336-2e7aa2245657", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "To decrease temperature fluctuations while delivering an anesthetic agent, manufacturers seek to use vaporizer materials that have which of the following properties?", + "A": "Low specific heat, high thermal conductivity", + "B": "Low specific heat, low thermal conductivity", + "C": "High specific heat, high thermal conductivity", + "D": "High specific heat, low thermal conductivity" + }, + "zh": { + "question": "为了减少在输送麻醉剂时的温度波动，制造商寻求使用具有以下哪些特性的蒸发器材料？", + "A": "低比热，高导热性", + "B": "低比热，低导热性", + "C": "高比热，高导热性", + "D": "高比热，低导热性" + } + }, + { + "id": "32890c9f-ed1d-53a6-a2bb-7aa6f8d1863c", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "6. A portable E-cylinder of oxygen has 1760 psig. In approximately what time frame will the cylinder be depleted if used at 8 L/min?", + "A": "30 minutes", + "B": "45 minutes", + "C": "60 minutes", + "D": "85 minutes" + }, + "zh": { + "question": "6. 一个便携式氧气E型钢瓶的压力为1760 psig。如果以8 L/min的速度使用，大约在什么时间范围内钢瓶会耗尽？", + "A": "30分钟", + "B": "45分钟", + "C": "60分钟", + "D": "85分钟" + } + }, + { + "id": "02200767-785c-5405-811c-45402a212a8c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements defines the critical temperature?", + "A": "The temperature at which a liquid will boil", + "B": "The highest temperature at which a gas can exist in liquid form", + "C": "The temperature at which a substance can exist as a gas or liquid", + "D": "The temperature at which a solid becomes a liquid" + }, + "zh": { + "question": "以下哪项陈述定义了临界温度？", + "A": "液体沸腾的温度", + "B": "气体可以以液态存在的最高温度", + "C": "物质可以以气态或液态存在的温度", + "D": "固体变为液体的温度" + } + }, + { + "id": "3ed86ad8-b15d-5ffb-8627-58d0fc19307e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following describes the partial pressure of inhaled anesthetics in the central nervous system (CNS), blood, and alveoli at equilibrium?", + "A": "CNS partial pressure (PCNS) = blood partial pressure (Pblood) = alveolar partial pressure (Palveolar)", + "B": "PCNS > Pblood = Palveolar", + "C": "PCNS < Pblood = Palveolar", + "D": "PCNS = Pblood < Palveolar" + }, + "zh": { + "question": "下列哪项描述了吸入麻醉剂在中枢神经系统（CNS）、血液和肺泡中的分压在平衡时的情况？", + "A": "CNS分压（PCNS）= 血液分压（Pblood）= 肺泡分压（Palveolar）", + "B": "PCNS > Pblood = Palveolar", + "C": "PCNS < Pblood = Palveolar", + "D": "PCNS = Pblood < Palveolar" + } + }, + { + "id": "56cca7ab-f77c-55dd-a356-be20fb69494d", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following would increase the rate of rise of Fa/Fi?", + "A": "A high blood:gas solubility", + "B": "A high cardiac output", + "C": "A low minute ventilation", + "D": "A high anesthetic concentration" + }, + "zh": { + "question": "下列哪项会增加Fa/Fi的上升速率？", + "A": "高血气溶解度", + "B": "高心输出量", + "C": "低分钟通气量", + "D": "高麻醉药浓度" + } + }, + { + "id": "5d35be6f-8e8f-57d8-9970-401c6ab6dbde", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "After an 8-hour general anesthetic case with volatile agents, which tissue group plays the greatest role in determining emergence time?", + "A": "Vessel-rich tissue", + "B": "Muscle", + "C": "Fat", + "D": "Each is equal" + }, + "zh": { + "question": "在使用挥发性药物进行8小时的全身麻醉后，哪个组织群在决定苏醒时间方面起到最大的作用？", + "A": "富血管组织", + "B": "肌肉", + "C": "脂肪", + "D": "各自相等" + } + }, + { + "id": "9c871117-866d-5180-b574-9d5a76869d09", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the purpose of the check valve on the anesthesia machine?", + "A": "To prevent hypoxic gas mixtures", + "B": "To prevent gas flow from the common gas outlet to the vaporizers", + "C": "To prevent overly high flows of oxygen", + "D": "To ensure adequate ratios of oxygen to nitrogen" + }, + "zh": { + "question": "以下哪项是麻醉机上止回阀的作用？", + "A": "防止低氧气体混合物", + "B": "防止气体从公共气体出口流向蒸发器", + "C": "防止氧气流量过高", + "D": "确保氧气与氮气的比例适当" + } + }, + { + "id": "153813d4-2c91-58f1-b2a9-bbc97b09b3c7", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following flowmeter arrangements would be the most likely to lead to a hypoxic gas mixture?", + "A": "N2O, Air, O2", + "B": "Air, N2O, O2", + "C": "N2O, O2 , Air", + "D": "O2 , Air, N2O" + }, + "zh": { + "question": "以下哪种流量计排列最有可能导致低氧气体混合物？", + "A": "N2O, 空气, O2", + "B": "空气, N2O, O2", + "C": "N2O, O2, 空气", + "D": "O2, 空气, N2O" + } + }, + { + "id": "63ae411c-c39b-5859-b15b-ae5a462a8de0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Standards for basic anesthetic monitoring during general anesthesia include which of the following?", + "A": "Continuous display of MAC", + "B": "Continuous display of electrocardiogram", + "C": "Continuous display of tidal volume", + "D": "Continuous display of temperature" + }, + "zh": { + "question": "全身麻醉期间基本麻醉监测标准包括以下哪项？", + "A": "持续显示MAC", + "B": "持续显示心电图", + "C": "持续显示潮气量", + "D": "持续显示体温" + } + }, + { + "id": "a6682a0f-c8d7-5a35-82af-6d86b6745c8b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "14. Which of the following would cause an abrupt decrease in the end-tidal CO2 (ETCO2 ) during general anesthesia?", + "A": "Hyperthermia", + "B": "Sepsis", + "C": "Shivering", + "D": "Pulmonary embolism" + }, + "zh": { + "question": "14. 以下哪项会导致全身麻醉期间呼气末二氧化碳（ETCO2）突然下降？", + "A": "高热", + "B": "败血症", + "C": "发抖", + "D": "肺栓塞" + } + }, + { + "id": "7b01c1e5-3864-5353-ac9a-c8cf239784f1", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "To mitigate the effects of attenuation during ultrasonography, an anesthesiologist would perform which of the following maneuvers?", + "A": "Use a low-frequency signal.", + "B": "Use a high-frequency signal.", + "C": "Increase the amplitude.", + "D": "Decrease the amplitude." + }, + "zh": { + "question": "为了减轻超声检查期间的衰减效应，麻醉医生会执行以下哪种操作？", + "A": "使用低频信号。", + "B": "使用高频信号。", + "C": "增加振幅。", + "D": "减少振幅。" + } + }, + { + "id": "d2d5b941-ade8-5cda-bc81-f8f75ee3fff0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "To maximize the axial resolution of an ultrasound image, an anesthesiologist would use which of the following?", + "A": "Long pulses of low frequency", + "B": "Long pulses of high frequency", + "C": "Short pulses of low frequency", + "D": "Short pulses of high frequency" + }, + "zh": { + "question": "为了最大化超声图像的轴向分辨率，麻醉医生会使用以下哪种方法？", + "A": "低频长脉冲", + "B": "高频长脉冲", + "C": "低频短脉冲", + "D": "高频短脉冲" + } + }, + { + "id": "f75f92fb-09ee-5221-ad78-a45b9843aa66", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Flow proportioning systems of anesthesia machines were designed to prevent which of the following?", + "A": "Inconsistent proportions of volatile anesthetic gases", + "B": "Hypoxic mixtures of nitrogen and oxygen", + "C": "Inaccurate proportions of gas flow to the common gas outlet", + "D": "Direct communication between the high-pressure and low-pressure circuits" + }, + "zh": { + "question": "麻醉机的流量比例系统设计是为了防止以下哪种情况？", + "A": "挥发性麻醉气体比例不一致", + "B": "氮气和氧气的低氧混合物", + "C": "气体流向公共气体出口的比例不准确", + "D": "高压回路和低压回路之间的直接通信" + } + }, + { + "id": "5e0e2fcf-3cbd-524e-b668-2227f04235dd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following devices prevents the delivery of a hypoxic mixture by ensuring appropriate connections from the hospitals' pipeline gas supply to the anesthesia machine?", + "A": "Second-stage oxygen pressure regulator", + "B": "Pin Index Safety System", + "C": "Diameter Index Safety System", + "D": "Check valve" + }, + "zh": { + "question": "以下哪种装置通过确保医院管道气体供应与麻醉机的适当连接来防止低氧混合物的输送？", + "A": "二级氧气压力调节器", + "B": "针式索引安全系统", + "C": "直径索引安全系统", + "D": "止回阀" + } + }, + { + "id": "3ef1ad1f-0ac0-5a9b-86db-276712ae597a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "An isolated power system (IPS) acts to prevent which of the following situations?", + "A": "Prevention of operating room power loss", + "B": "Prevention of an ungrounded operating room", + "C": "Prevention of macroshock", + "D": "Prevention of microshock" + }, + "zh": { + "question": "隔离电源系统（IPS）用于防止以下哪种情况？", + "A": "防止手术室断电", + "B": "防止手术室未接地", + "C": "防止宏电击", + "D": "防止微电击" + } + }, + { + "id": "1694adaa-ae5d-585d-a9fa-8e6e2ecb6a1d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are functions of the equipment ground wire EXCEPT which one?", + "A": "Provides a low-resistance path for fault currents to decrease the risk of macroshock.", + "B": "Minimizes leakage currents that may cause microshock in certain patients.", + "C": "Provides information to the line isolation monitor on the status of an ungroundedsystem.", + "D": "Acts to eliminate the need for ground fault circuit interrupters (GFCIs)." + }, + "zh": { + "question": "以下所有选项均为设备接地线的功能，除了哪一个？", + "A": "为故障电流提供低阻抗路径，以降低宏观电击的风险。", + "B": "减少可能在某些患者中引起微电击的漏电流。", + "C": "向线路隔离监测器提供有关未接地系统状态的信息。", + "D": "作用是消除对接地故障断路器（GFCI）的需求。" + } + }, + { + "id": "395ec59d-53f2-53ef-a6f1-bd06e381a35a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "When preparing to place a thoracic epidural, you palpate the inferior border of the scapula. This landmark corresponds to which level of the vertebral column?", + "A": "C7-T1", + "B": "T4-T6", + "C": "T10-T11", + "D": "T7-T8" + }, + "zh": { + "question": "在准备放置胸椎硬膜外导管时，你触摸到肩胛骨的下缘。这个标志对应于脊柱的哪个水平？", + "A": "C7-T1", + "B": "T4-T6", + "C": "T10-T11", + "D": "T7-T8" + } + }, + { + "id": "b0bdc414-3df4-5a76-82a9-402dc61685c9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Assuming normal anatomy, which of the following landmarks is appropriate for gaining subclavian venous access?", + "A": "Needle insertion medial to the sternocleidomastoid muscle, just medial to the carotid artery", + "B": "Needle insertion above the inguinal ligament, lateral to the femoral artery", + "C": "Needle insertion at the midpoint of the clavicle with the needle directed toward the suprasternal notch", + "D": "Needle insertion at the lateral border of the clavicular head of the sternocleidomastoid muscle in the interscalene groove" + }, + "zh": { + "question": "假设解剖结构正常，以下哪个标志适合获得锁骨下静脉通路？", + "A": "针头插入胸锁乳突肌内侧，颈动脉内侧", + "B": "针头插入腹股沟韧带上方，股动脉外侧", + "C": "针头插入锁骨中点，针头指向胸骨上切迹", + "D": "针头插入胸锁乳突肌锁骨头外侧缘，在斜角肌间沟内" + } + }, + { + "id": "85e6ea56-9a47-55c0-be3a-525ce8ca3849", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "While providing anesthesia for a 15-month-old, 5-kg girl undergoing strabismus surgery, you notice that the patient suddenly becomes hypotensive and bradycardic while the surgeons are applying direct pressure to the globe. Despite release of pressure, the patient continues to be hypotensive and bradycardic. After treatment with atropine, the patient becomes normotensive", + "A": "CN VII", + "B": "CN VI", + "C": "CN V", + "D": "CN III" + }, + "zh": { + "question": "在为一名15个月大、5公斤的女孩进行斜视手术提供麻醉时，你注意到在外科医生对眼球施加直接压力时，患者突然出现低血压和心动过缓。尽管压力已解除，患者仍然低血压和心动过缓。经过阿托品治疗后，患者恢复正常血压。以下哪个颅神经最可能与这种反应有关？", + "A": "CN VII", + "B": "CN VI", + "C": "CN V", + "D": "CN III" + } + }, + { + "id": "1bb76e22-6dbf-5b17-bbdf-0e6cde9f9440", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following treatments for glaucoma has been shown to increase the duration of action of succinylcholine?", + "A": "Echothiophate", + "B": "Dipivefrin", + "C": "Betaxolol", + "D": "Cyclopentolate" + }, + "zh": { + "question": "以下哪种青光眼治疗方法已被证明可以延长琥珀胆碱的作用时间？", + "A": "依可酰胺", + "B": "二磷酸腺苷", + "C": "贝他洛尔", + "D": "环戊醇胺" + } + }, + { + "id": "fac72e79-03f6-520b-94c2-4c09500cf391", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "5. The muscles of the larynx are innervated by the recurrent laryngeal nerve EXCEPT which of the following?", + "A": "Thyroarytenoid", + "B": "Thyroepiglotticus", + "C": "Cricothyroid", + "D": "Transverse arytenoids" + }, + "zh": { + "question": "5. 喉部肌肉由喉返神经支配，以下哪个除外？", + "A": "甲杓肌", + "B": "甲状会厌肌", + "C": "环甲肌", + "D": "横杓肌" + } + }, + { + "id": "f269a857-d01c-54fc-9dee-79434cd5ac5f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The glossopharyngeal nerve (CN IX) provides sensory innervation to all of the following structures EXCEPT which one?", + "A": "Posterior 1/3 of tongue", + "B": "Rostral epiglottis", + "C": "Pharynx", + "D": "Vocal cords" + }, + "zh": { + "question": "舌咽神经（CN IX）为以下所有结构提供感觉神经支配，除了哪一个？", + "A": "舌后1/3", + "B": "喉上部会厌", + "C": "咽", + "D": "声带" + } + }, + { + "id": "2815d069-33eb-5903-98fd-bba277c9880f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following structures would be effectively anesthetized by injection of lidocaine into the anterior tonsillar pillars bilaterally?", + "A": "Soft palate and oropharynx", + "B": "Anterior 2/3 of tongue", + "C": "Hypopharynx", + "D": "Vocal cords" + }, + "zh": { + "question": "将利多卡因注射到双侧前扁桃体柱可以有效麻醉以下哪个结构？", + "A": "软腭和口咽", + "B": "舌的前2/3", + "C": "下咽", + "D": "声带" + } + }, + { + "id": "e82630e5-5655-5e26-aceb-4ae986e17222", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following structures would be effectively anesthetized by injection of lidocaine inferior to the greater cornu of the hyoid bone?", + "A": "Recurrent laryngeal nerve", + "B": "Glossopharyngeal nerve", + "C": "Superior laryngeal nerve, internal branch", + "D": "Superior laryngeal nerve, external branch" + }, + "zh": { + "question": "以下哪种结构可以通过在舌骨大角下方注射利多卡因有效麻醉？", + "A": "喉返神经", + "B": "舌咽神经", + "C": "喉上神经内支", + "D": "喉上神经外支" + } + }, + { + "id": "3a35c4f4-622e-5782-867f-66a4f6360dd2", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "While performing a preoperative assessment of your patient, you note that on recent transthoracic echocardiogram (TTE) there was abnormal movement of the inferior wall with increased heart rates, whereas all other portions were noted to move normally. Which of the following arteries most likely has a stenotic lesion?", + "A": "Posterior descending artery", + "B": "Left circumflex artery", + "C": "Left anterior descending artery", + "D": "Right coronary artery" + }, + "zh": { + "question": "在对患者进行术前评估时，您注意到最近的经胸超声心动图（TTE）显示，心率增加时下壁运动异常，而其他部分运动正常。以下哪一条动脉最有可能存在狭窄病变？", + "A": "后降动脉", + "B": "左回旋动脉", + "C": "左前降动脉", + "D": "右冠状动脉" + } + }, + { + "id": "fe9576d7-21e1-5104-9404-571502b8ab06", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The leaflets of the aortic valve are named which of the following?", + "A": "Anterior and posterior", + "B": "Anterior, posterior, and septal", + "C": "Right coronary, left coronary, and noncoronary", + "D": "Right, left, and anterior" + }, + "zh": { + "question": "主动脉瓣的瓣叶被命名为以下哪一项？", + "A": "前叶和后叶", + "B": "前叶、后叶和隔叶", + "C": "右冠状、左冠状和无冠状", + "D": "右叶、左叶和前叶" + } + }, + { + "id": "af8092ac-0458-5cdb-9d74-b15e5cd49855", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The nipple line is at what dermatomal level?", + "A": "T2", + "B": "T4", + "C": "T6", + "D": "T8" + }, + "zh": { + "question": "乳头线位于哪个皮节水平？", + "A": "T2", + "B": "T4", + "C": "T6", + "D": "T8" + } + }, + { + "id": "d2f697e1-d0dd-59e9-8589-cfe77118d01b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "12. In regard to the trachea, all of the following are true EXCEPT which one?", + "A": "Normally half of the trachea is intrathoracic and half is extrathoracic.", + "B": "Normal tracheal movement in an adult can result in endotracheal movement of 4 cm with neck flexion and extension.", + "C": "The tracheal rings are located anteriorly.", + "D": "The trachea is the only part of the bronchial tree that does not participate in gas exchange." + }, + "zh": { + "question": "12. 关于气管，下列哪一项是错误的？", + "A": "正常情况下，气管一半在胸腔内，一半在胸腔外。", + "B": "成人正常的气管运动可导致颈部屈伸时气管内移动4厘米。", + "C": "气管环位于前方。", + "D": "气管是支气管树中唯一不参与气体交换的部分。" + } + }, + { + "id": "08775008-8a33-5102-8fa0-d6851bb113f9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "During bronchoscopy, where does the right upper lobe bronchus usually take off?", + "A": "5 cm past the carina", + "B": "Located farther away from the carina than the lingular bronchus on the left", + "C": "2.5 cm past the carina", + "D": "It has little anatomic variation" + }, + "zh": { + "question": "在支气管镜检查中，右上叶支气管通常在哪里起始？", + "A": "距隆突5厘米", + "B": "位于比左侧舌叶支气管更远的位置", + "C": "距隆突2.5厘米", + "D": "解剖变异很小" + } + }, + { + "id": "9e243fc2-c65a-5125-9b28-60ad4fef2afc", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "You are taking care of a 10-month-old boy presenting for bilateral orchiopexy. You plan to perform a caudal block for postoperative pain. All of the following", + "A": "Posterior superior iliac spines (PSISs)", + "B": "Sacral ala", + "C": "Sacral cornu", + "D": "Sacral hiatus" + }, + "zh": { + "question": "您正在照顾一名10个月大的男孩，他因双侧睾丸固定术入院。您计划进行尾部阻滞以缓解术后疼痛。以下所有选项中", + "A": "后上髂棘 (PSISs)", + "B": "骶翼", + "C": "骶角", + "D": "骶裂孔" + } + }, + { + "id": "736d2755-56de-5381-9dee-0d5c7b69801b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "When performing a single-shot caudal block, you must first pierce through which ligament?", + "A": "Sacrococcygeal", + "B": "Sacrotuberous", + "C": "Sacrospinous", + "D": "Sacroiliac" + }, + "zh": { + "question": "在进行单次骶管阻滞时，您必须首先穿过哪个韧带？", + "A": "骶尾韧带", + "B": "骶结节韧带", + "C": "骶棘韧带", + "D": "骶髂韧带" + } + }, + { + "id": "6192c7db-cbfe-5281-9fc2-809ecc0bfaab", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are true of the femoral triangle EXCEPT which one?", + "A": "Superior border: formed by the inguinal ligament", + "B": "Lateral border: formed by the medial border of the sartorius muscle", + "C": "Medial border: formed by the medial border of the adductor longus muscle", + "D": "Medial to lateral structures: femoral nerve, artery, vein, lymphatics" + }, + "zh": { + "question": "以下关于股三角的描述，除了哪一项外，其他都是正确的？", + "A": "上边界：由腹股沟韧带形成", + "B": "外侧边界：由缝匠肌内侧边界形成", + "C": "内侧边界：由长收肌内侧边界形成", + "D": "从内到外的结构：股神经、动脉、静脉、淋巴管" + } + }, + { + "id": "22f45e15-f332-5ee7-b53b-31f00d263e85", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A fracture of the proximal humerus can result in all of the following EXCEPT which one?", + "A": "Inability to abduct the arm at the shoulder", + "B": "Decreased sensation over the shoulder", + "C": "Wrist drop", + "D": "Atrophy of shoulder muscles" + }, + "zh": { + "question": "肱骨近端骨折可能导致以下所有情况，除了哪一个？", + "A": "无法在肩部外展手臂", + "B": "肩部感觉减退", + "C": "腕下垂", + "D": "肩部肌肉萎缩" + } + }, + { + "id": "6a4e87ba-ca75-5fec-bc7c-72be52fc70c9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the anatomic location of the cords of the brachial plexus?", + "A": "Above the clavicle, at the lateral border of the clavicular head of the sternocleidomastoid muscle", + "B": "At the clavicle, lateral to the subclavian artery", + "C": "Below the clavicle, closely related to the axillary artery", + "D": "Below the clavicle, closely related to the axillary vein" + }, + "zh": { + "question": "臂丛神经束的位置在哪里？", + "A": "在锁骨上方，位于胸锁乳突肌锁骨头的外侧边缘", + "B": "在锁骨处，位于锁骨下动脉的外侧", + "C": "在锁骨下方，与腋动脉紧密相关", + "D": "在锁骨下方，与腋静脉紧密相关" + } + }, + { + "id": "923b60a5-ccbe-5da1-92ff-37743121ba9f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "19. You are taking care of a 27-year-old G3P2 woman for whom you placed an epidural in early labor. Her labor has progressed slowly and she has been pushing for many hours. She ultimately has an unremarkable vaginal delivery of a health baby boy. The epidural is removed post delivery and she is eventually sent to the floor. During postdelivery rounds the next day, the patient complains of continued numbness on the anterolateral aspect of her thighs", + "A": "Obturator nerve", + "B": "Lateral femoral cutaneous nerve", + "C": "Femoral nerve", + "D": "Sciatic nerve" + }, + "zh": { + "question": "19. 您正在照顾一位27岁的G3P2女性，她在早期分娩时接受了硬膜外麻醉。她的分娩进展缓慢，已经推了很多小时。最终，她顺利地阴道分娩了一个健康的男婴。分娩后，硬膜外麻醉被移除，她最终被送到病房。第二天的产后查房时，患者抱怨大腿前外侧持续麻木", + "A": "闭孔神经", + "B": "股外侧皮神经", + "C": "股神经", + "D": "坐骨神经" + } + }, + { + "id": "cf7c7a94-baf5-5694-a608-a9418004cccc", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "While in preparation for placement of a central line, you perform ultrasonography on the patient's neck and notice the internal jugular vein (IJV) overlying the common carotid artery. Which of the following maneuvers will aid in decreasing the overlap between the IJV and the common carotid artery?", + "A": "Neck flexion", + "B": "Trendelenburg position", + "C": "Rotation of head 0°-45° to contralateral side", + "D": "Ultrasound probe placement toward clavicle" + }, + "zh": { + "question": "在准备放置中心静脉导管时，您对患者的颈部进行超声检查，发现颈内静脉（IJV）位于颈总动脉上方。以下哪种操作有助于减少IJV与颈总动脉之间的重叠？", + "A": "颈部屈曲", + "B": "特伦德伦堡体位", + "C": "头部旋转0°-45°至对侧", + "D": "超声探头朝锁骨方向放置" + } + }, + { + "id": "09fc3a23-8f56-5191-8781-bfae88b876e9", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "After performing an interscalene block, your patient complains of pain in his fourth and fifth digits. Which dermatomes are not adequately covered with an interscalene block?", + "A": "C5-C6", + "B": "C6-C7", + "C": "C7-C8", + "D": "C8-T1" + }, + "zh": { + "question": "在进行斜角肌间隙阻滞后，您的患者抱怨他的第四和第五指疼痛。哪些皮节没有被斜角肌间隙阻滞充分覆盖？", + "A": "C5-C6", + "B": "C6-C7", + "C": "C7-C8", + "D": "C8-T1" + } + }, + { + "id": "d3ff6708-11e5-58a5-b377-a2448ca5bd40", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "During neuraxial blockade, the level of sympathetic blockade is generally how far away from the sensory level?", + "A": "1-2 dermatomes above", + "B": "4-6 dermatomes above", + "C": "1-2 dermatomes below", + "D": "4-6 dermatomes below", + "E": "0 dermatome change" + }, + "zh": { + "question": "在神经轴阻滞期间，交感神经阻滞的水平通常与感觉水平相差多远？", + "A": "高出1-2个皮节", + "B": "高出4-6个皮节", + "C": "低于1-2个皮节", + "D": "低于4-6个皮节", + "E": "无皮节变化" + } + }, + { + "id": "29606f86-158c-5a24-86de-a1343e2ee011", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "During neuraxial blockade, the level of sensory blockade, in general, is how many dermatomes away from the level of motor blockade?", + "A": "0", + "B": "2", + "C": "4", + "D": "6", + "E": "8" + }, + "zh": { + "question": "在神经轴阻滞期间，感觉阻滞的水平通常与运动阻滞的水平相差多少个皮节？", + "A": "0", + "B": "2", + "C": "4", + "D": "6", + "E": "8" + } + }, + { + "id": "865af3ff-862c-5a85-9ef5-0c0cfc6b101d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Cutaneous infiltration of a local anesthetic to block the intercostobrachial nerve provides anesthesia to which dermatome(s)?", + "A": "C7", + "B": "C8", + "C": "T1", + "D": "T2" + }, + "zh": { + "question": "局部麻醉药的皮肤浸润阻断肋间臂神经可为哪个皮节提供麻醉？", + "A": "C7", + "B": "C8", + "C": "T1", + "D": "T2" + } + }, + { + "id": "35c554b2-cd69-5675-ba31-099039e4d867", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "5. Each respiratory center is correctly paired with its function EXCEPT which one of the following?", + "A": "Dorsal respiratory center: provides ventilatory rate", + "B": "Ventral respiratory center: coordinates exhalation", + "C": "Apneustic center: prolongs exhalation via signals to ventral respiratory center", + "D": "Pneumotaxic center: limits inspiration" + }, + "zh": { + "question": "5. 每个呼吸中枢都与其功能正确配对，除了以下哪一个？", + "A": "背侧呼吸中枢：提供通气频率", + "B": "腹侧呼吸中枢：协调呼气", + "C": "长吸中枢：通过信号传递给腹侧呼吸中枢来延长呼气", + "D": "呼吸调节中枢：限制吸气" + } + }, + { + "id": "2032b2c8-3eb2-54e0-8797-08534577715a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are examples of reflex or higher cortical structures that exert an influence on the respiratory centers/control of respiration EXCEPT which one?", + "A": "Cough reflex", + "B": "Hering-Breuer reflex", + "C": "Reticular activating system", + "D": "Bezold-Jarisch reflex" + }, + "zh": { + "question": "以下所有选项都是对呼吸中枢/呼吸控制产生影响的反射或高级皮层结构的例子，除了哪一个？", + "A": "咳嗽反射", + "B": "Hering-Breuer反射", + "C": "网状激活系统", + "D": "Bezold-Jarisch反射" + } + }, + { + "id": "97f809bf-a993-5342-9831-e9a9eae6485c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Carotid body chemoreceptors communicate with the respiratory centers via which nerve?", + "A": "Trigeminal", + "B": "Glossopharyngeal", + "C": "Vagus", + "D": "Hypoglossal" + }, + "zh": { + "question": "颈动脉体化学感受器通过哪条神经与呼吸中枢沟通？", + "A": "三叉神经", + "B": "舌咽神经", + "C": "迷走神经", + "D": "舌下神经" + } + }, + { + "id": "6995bf51-9581-51f7-ab1c-33b79e791702", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "An infarct involving the hypothalamus would most likely result from occlusion of which artery?", + "A": "Anterior spinal artery", + "B": "Vertebral artery", + "C": "Anterior cerebral artery", + "D": "Middle cerebral artery", + "E": "Posterior cerebral artery" + }, + "zh": { + "question": "下丘脑梗死最可能由哪条动脉闭塞引起？", + "A": "前脊髓动脉", + "B": "椎动脉", + "C": "前大脑动脉", + "D": "中大脑动脉", + "E": "后大脑动脉" + } + }, + { + "id": "74bd2e46-7993-5c35-9e9b-1a7f20d47e08", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Regarding the gray matter in the spinal cord, all of the following are correct EXCEPT which one?", + "A": "Consists of neurons, neuronal processes, and neuroglia", + "B": "Butterfly or H-shaped", + "C": "Categorized into columns and laminae", + "D": "Ratio of gray to white matter is least at the cervical and lumbar regions", + "E": "Each of the 10 Rexed laminae involved in sensory or motor pathways" + }, + "zh": { + "question": "关于脊髓中的灰质，以下哪一项是错误的？", + "A": "由神经元、神经元过程和神经胶质组成", + "B": "呈蝴蝶形或H形", + "C": "分为柱和层", + "D": "灰质与白质的比例在颈部和腰部区域最小", + "E": "10个Rexed层中的每一个都参与感觉或运动通路" + } + }, + { + "id": "126a46d7-fa30-512a-b2c3-cbef3adde1c6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following pathways carries fibers that control fine touch, vibration, proprioception, and pressure?", + "A": "Dorsal column", + "B": "Spinothalamic", + "C": "Corticospinal", + "D": "Reticulospinal" + }, + "zh": { + "question": "下列哪条通路携带控制精细触觉、振动、本体感觉和压力的纤维？", + "A": "背柱", + "B": "脊髓丘脑", + "C": "皮质脊髓", + "D": "网状脊髓" + } + }, + { + "id": "f30de17e-a6e8-520d-b339-f3b2cba25d6a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "All of the following are true regarding the descending motor tracts EXCEPT which one?", + "A": "They originate in either the cerebral cortex or brainstem.", + "B": "The pathways are generally made of a two-neuron system.", + "C": "The upper motor neuron fibers target lower motor neurons of the spinal cord or cranial nerves.", + "D": "They are involved in assisting with voluntary movement." + }, + "zh": { + "question": "以下关于下行运动束的描述，除了哪一项外，其他都是正确的？", + "A": "它们起源于大脑皮层或脑干。", + "B": "这些通路通常由一个两神经元系统组成。", + "C": "上运动神经元纤维以脊髓或脑神经的下运动神经元为目标。", + "D": "它们参与协助自愿运动。" + } + }, + { + "id": "e5e45454-6538-59cb-97e4-19d6427552e5", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "12. Which of the following pathways carries fibers that are involved in pain and temperature sensation?", + "A": "Dorsal column", + "B": "Spinothalamic", + "C": "Corticospinal", + "D": "Reticulospinal" + }, + "zh": { + "question": "12. 下列哪条通路携带与疼痛和温度感觉相关的纤维？", + "A": "背柱", + "B": "脊髓丘脑", + "C": "皮质脊髓", + "D": "网状脊髓" + } + }, + { + "id": "a6820714-00fb-546c-a5d2-248f8903545a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The main functions of the meninges include all of the following EXCEPT which one?", + "A": "Protecting the brain and spinal cord from mechanical injury", + "B": "Providing blood supply to the skull and to the hemispheres", + "C": "Providing a space for the flow of cerebrospinal fluid (CSF)", + "D": "Producing cerebral spinal fluid" + }, + "zh": { + "question": "脑膜的主要功能包括以下所有选项，除了哪一个？", + "A": "保护大脑和脊髓免受机械损伤", + "B": "为颅骨和大脑半球提供血液供应", + "C": "为脑脊液（CSF）的流动提供空间", + "D": "产生脑脊液" + } + }, + { + "id": "a1a6eb22-5b13-59e8-8642-763fb60c9dd4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which layer of the meninges is pain sensitive?", + "A": "Dura", + "B": "Pia", + "C": "Arachnoid", + "D": "Subarachnoid" + }, + "zh": { + "question": "哪一层脑膜对疼痛敏感？", + "A": "硬脑膜", + "B": "软脑膜", + "C": "蛛网膜", + "D": "蛛网膜下腔" + } + }, + { + "id": "570c8fe6-c573-5d23-9a4e-6dcf2e55b832", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the potential space between the arachnoid and pia mater?", + "A": "Epidural", + "B": "Subarachnoid", + "C": "Subdural", + "D": "Arachnoid" + }, + "zh": { + "question": "蛛网膜和软脑膜之间的潜在空间是什么？", + "A": "硬膜外", + "B": "蛛网膜下腔", + "C": "硬膜下", + "D": "蛛网膜" + } + }, + { + "id": "e3235d11-f2ab-552a-a6ce-d074d45645a6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the potential space between the dura and arachnoid mater?", + "A": "Epidural", + "B": "Subarachnoid", + "C": "Subdural", + "D": "Arachnoid" + }, + "zh": { + "question": "硬膜和蛛网膜之间的潜在空间是什么？", + "A": "硬膜外", + "B": "蛛网膜下腔", + "C": "硬膜下", + "D": "蛛网膜" + } + }, + { + "id": "c8d76b17-7cda-5d99-b7f0-98204bf38a06", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Cerebral perfusion pressure (CPP), in the absence of intracranial pathology, is MOST closely correlated with which parameter?", + "A": "Intracranial pressure (ICP)", + "B": "Central venous pressure (CVP)", + "C": "Cerebral blood volume (CBV)", + "D": "Mean arterial blood pressure (MAP)" + }, + "zh": { + "question": "在没有颅内病变的情况下，脑灌注压（CPP）与哪个参数最密切相关？", + "A": "颅内压（ICP）", + "B": "中心静脉压（CVP）", + "C": "脑血容量（CBV）", + "D": "平均动脉压（MAP）" + } + }, + { + "id": "00cbec32-84d9-5d6b-8c90-c0f29bcf6af1", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Which of the following situations has the least significant effect on cerebral blood flow (CBF)?", + "A": "PaCO2 of 80", + "B": "Temperature of 34°C", + "C": "Increased blood viscosity", + "D": "Acute metabolic acidosis" + }, + "zh": { + "question": "以下哪种情况对脑血流量（CBF）的影响最不显著？", + "A": "PaCO2为80", + "B": "温度为34°C", + "C": "血液粘度增加", + "D": "急性代谢性酸中毒" + } + }, + { + "id": "e148fa89-5803-5d0c-9dd2-6b316609b463", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "In regard to cerebral blood flow (CBF), cerebral metabolic rate (CMR), and volatile anesthetics, which of the following is a potential detrimental adverse effect?", + "A": "Increase in blood flow and a decrease in metabolic demand", + "B": "Increase in ICP", + "C": "Redistribution of blood flow away from ischemic areas of brain", + "D": "Decreased formation of cerebral spinal fluid" + }, + "zh": { + "question": "关于脑血流量（CBF）、脑代谢率（CMR）和挥发性麻醉剂，以下哪项是潜在的不利副作用？", + "A": "血流量增加和代谢需求减少", + "B": "颅内压增加", + "C": "血流重新分配远离脑缺血区域", + "D": "脑脊液生成减少" + } + }, + { + "id": "f66f0d22-a5d8-5c5f-82e5-c47be09d5f46", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following medications can be used to decrease elevated ICP EXCEPT which one?", + "A": "Hypertonic saline", + "B": "Furosemide", + "C": "Propofol", + "D": "Ketamine", + "E": "Acetazolamide" + }, + "zh": { + "question": "以下所有药物均可用于降低颅内压升高，除了哪一种？", + "A": "高渗盐水", + "B": "呋塞米", + "C": "丙泊酚", + "D": "氯胺酮", + "E": "乙酰唑胺" + } + }, + { + "id": "aed05d49-45a0-5065-9955-f73a29dbaf91", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following agents can cause an increase in CBF and CMRO2?", + "A": "Nitrous oxide", + "B": "Desflurane", + "C": "Halothane", + "D": "Sevoflurane" + }, + "zh": { + "question": "下列哪种药物可以导致脑血流量（CBF）和脑代谢率（CMRO2）的增加？", + "A": "一氧化二氮", + "B": "地氟烷", + "C": "氟烷", + "D": "七氟烷" + } + }, + { + "id": "dd131f4e-4745-54e1-be7b-6d4be7e5cdaf", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following inhalational agents facilitates CSF absorption?", + "A": "Halothane", + "B": "Isoflurane", + "C": "Sevoflurane", + "D": "Desflurane" + }, + "zh": { + "question": "下列哪种吸入性麻醉剂促进脑脊液的吸收？", + "A": "氟烷", + "B": "异氟醚", + "C": "七氟醚", + "D": "地氟醚" + } + }, + { + "id": "2c804769-637b-561f-b146-b26f5eb6792a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "24. Clinical goals for preventing or limiting neuronal tissue damage include all of the following EXCEPT which one?", + "A": "Optimizing CPP", + "B": "Decreasing metabolic requirements (basal and electrical)", + "C": "Limiting effects of mediators of cellular injury", + "D": "Tight glucose control" + }, + "zh": { + "question": "24. 预防或限制神经组织损伤的临床目标包括以下所有选项，除了哪一个？", + "A": "优化脑灌注压（CPP）", + "B": "降低代谢需求（基础和电活动）", + "C": "限制细胞损伤介质的影响", + "D": "严格控制血糖" + } + }, + { + "id": "5d482672-b41c-52fe-b3e7-0a93af667977", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the approximate total CSF volume?", + "A": "350-500 mL", + "B": "100-150 mL", + "C": "200-250 mL", + "D": "50-100 mL" + }, + "zh": { + "question": "脑脊液的总容量大约是多少？", + "A": "350-500 mL", + "B": "100-150 mL", + "C": "200-250 mL", + "D": "50-100 mL" + } + }, + { + "id": "b735c3f9-cb00-5741-ab8c-d9e95f162768", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following pairings is correct with respect to the production or absorption of CSF?", + "A": "Choroid plexus; cerebral venous sinuses", + "B": "Arachnoid villi; third ventricle", + "C": "Choroid plexus; subarachnoid space", + "D": "Choroid plexus; lateral ventricles", + "E": "Arachnoid villi; lateral ventricles" + }, + "zh": { + "question": "以下哪一对与脑脊液的产生或吸收有关的配对是正确的？", + "A": "脉络丛；大脑静脉窦", + "B": "蛛网膜绒毛；第三脑室", + "C": "脉络丛；蛛网膜下腔", + "D": "脉络丛；侧脑室", + "E": "蛛网膜绒毛；侧脑室" + } + }, + { + "id": "4b66a71e-bbc5-54c5-8861-f51a2ede0d18", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of these medications decrease CSF production EXCEPT which one?", + "A": "Acetazolamide", + "B": "Furosemide", + "C": "Thiopental", + "D": "Ketamine" + }, + "zh": { + "question": "以下哪种药物不会减少脑脊液的生成？", + "A": "乙酰唑胺", + "B": "呋塞米", + "C": "硫喷妥钠", + "D": "氯胺酮" + } + }, + { + "id": "14ebb09e-da7f-5465-8b88-fc78181c5fe0", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following inhalational agents impedes CSF absorption?", + "A": "Halothane", + "B": "Isoflurane", + "C": "Sevoflurane", + "D": "Desflurane" + }, + "zh": { + "question": "下列哪种吸入性麻醉剂会阻碍脑脊液的吸收？", + "A": "氟烷", + "B": "异氟醚", + "C": "七氟醚", + "D": "地氟醚" + } + }, + { + "id": "aa34c33f-3192-5ab5-ac02-52f206b67475", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which intravenous (IV) anesthetic has been shown to provide some protection against focal ischemia?", + "A": "Phenobarbital", + "B": "Propofol", + "C": "Etomidate", + "D": "Fentanyl", + "E": "Midazolam" + }, + "zh": { + "question": "哪种静脉麻醉药已被证明对局灶性缺血有一定的保护作用？", + "A": "苯巴比妥", + "B": "丙泊酚", + "C": "依托咪酯", + "D": "芬太尼", + "E": "咪达唑仑" + } + }, + { + "id": "0ba277bc-95e8-53a6-b5db-672860213bbd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "In patients undergoing neurosurgery, all of the following are acceptable ventilator strategies EXCEPT which one?", + "A": "Tidal volumes 6-8 cc/kg", + "B": "Peak pressure <30 cm H2O", + "C": "High positive end expiratory pressure", + "D": "Avoidance of hypoventilation" + }, + "zh": { + "question": "在接受神经外科手术的患者中，以下所有通气策略都是可接受的，除了哪一个？", + "A": "潮气量 6-8 cc/kg", + "B": "峰压 <30 cm H2O", + "C": "高呼气末正压", + "D": "避免低通气" + } + }, + { + "id": "b2b50b7d-017b-5d5d-aef5-e779d0a7b8f3", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "All of the following are acceptable ways to decrease elevated ICP EXCEPT which one?", + "A": "Total IV anesthesia", + "B": "Mannitol administration", + "C": "Opioid administration", + "D": "Elevation of the head of the bed" + }, + "zh": { + "question": "以下哪种方法不适合用于降低颅内压升高？", + "A": "全静脉麻醉", + "B": "甘露醇给药", + "C": "阿片类药物给药", + "D": "抬高床头" + } + }, + { + "id": "92d4161d-68d0-54c5-ab93-fb015e6af773", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "In regard to skeletal muscle contraction, all of the following are true EXCEPT which one?", + "A": "Calcium triggers contraction by reaction with regulatory proteins that, in the absence of calcium, prevent interaction of actin and myosin.", + "B": "Calcium entry into nerve terminals triggers the release of acetylcholine into the synaptic cleft.", + "C": "The binding of calcium to actin controls the movement of tropomyosin.", + "D": "Myosin head releases ADP and Pi and triggers the power stroke of muscle contraction." + }, + "zh": { + "question": "关于骨骼肌收缩，以下哪一项是错误的？", + "A": "钙通过与调节蛋白反应触发收缩，在没有钙的情况下，调节蛋白会阻止肌动蛋白和肌球蛋白的相互作用。", + "B": "钙进入神经末梢触发乙酰胆碱释放到突触间隙。", + "C": "钙与肌动蛋白结合控制原肌球蛋白的移动。", + "D": "肌球蛋白头部释放ADP和Pi并触发肌肉收缩的动力冲程。" + } + }, + { + "id": "d195090d-0375-5738-91fd-d492253a9c5a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are potential substrates for immediately replenishing ATP within the muscle fiber EXCEPT which one?", + "A": "Creatine phosphate", + "B": "Glycogen", + "C": "Free fatty acids (FFA)", + "D": "Lactate" + }, + "zh": { + "question": "以下所有选项都是肌肉纤维中立即补充ATP的潜在底物，除了哪一个？", + "A": "磷酸肌酸", + "B": "糖原", + "C": "游离脂肪酸 (FFA)", + "D": "乳酸" + } + }, + { + "id": "8e38fa1e-147c-59c1-9dbc-36a77ead502d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Binding of which molecule(s) is required for the myosin head to release its binding to actin?", + "A": "ATP", + "B": "GTP", + "C": "ADP", + "D": "cAMP" + }, + "zh": { + "question": "哪种分子结合是肌球蛋白头部释放其与肌动蛋白结合所必需的？", + "A": "ATP", + "B": "GTP", + "C": "ADP", + "D": "cAMP" + } + }, + { + "id": "59bf5fef-587d-547a-85d6-e2e4fc4b2cb1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Activation of which opioid receptor types can provide relief from opioidinduced itching?", + "A": "Mu", + "B": "Delta", + "C": "Sigma", + "D": "Kappa" + }, + "zh": { + "question": "激活哪种阿片受体类型可以缓解阿片类药物引起的瘙痒？", + "A": "Mu", + "B": "Delta", + "C": "Sigma", + "D": "Kappa" + } + }, + { + "id": "aa1c69a7-eccd-547e-8c53-ca507a1b9746", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following drugs does not exhibit N-methyl-D-aspartate (NMDA) receptor antagonism?", + "A": "Methadone", + "B": "Meperidine", + "C": "Ketamine", + "D": "Memantine" + }, + "zh": { + "question": "以下哪种药物不表现出N-甲基-D-天冬氨酸（NMDA）受体拮抗作用？", + "A": "美沙酮", + "B": "哌替啶", + "C": "氯胺酮", + "D": "美金刚" + } + }, + { + "id": "79ef2655-96ec-5188-a5e2-f30453b8b475", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following conditions describes the process of activation of Aβ fibers via tactile, nonnoxious stimuli causing inhibition of interneurons in the dorsal horn of the spinal cord, leading to inhibition of pain signals transmitted via C fibers?", + "A": "Stimulation produces analgesia", + "B": "Stress-induced analgesia", + "C": "Gate control theory", + "D": "Hyperanalgesia" + }, + "zh": { + "question": "下列哪种情况描述了通过触觉、非伤害性刺激激活Aβ纤维的过程，从而抑制脊髓后角的中间神经元，导致通过C纤维传递的疼痛信号被抑制？", + "A": "刺激产生镇痛", + "B": "压力诱导的镇痛", + "C": "闸门控制理论", + "D": "痛觉过敏" + } + }, + { + "id": "08fe1498-4d78-5063-bd67-353f8ece61d0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements is false with regard to the pain experience of elderly patients as compared with younger patients?", + "A": "Elderly patients may be undertreated because of stoicism or perceived different pain threshold.", + "B": "Elderly patients may be more likely to experience confusion and delirium from treatment with opioids.", + "C": "Elderly patients metabolize drugs more effectively than younger patients.", + "D": "Neuraxial techniques can help circumvent the use of systemic opioids." + }, + "zh": { + "question": "以下哪项关于老年患者与年轻患者疼痛体验的说法是错误的？", + "A": "由于坚忍或被认为不同的痛阈，老年患者可能治疗不足。", + "B": "老年患者在使用阿片类药物治疗时更容易出现混乱和谵妄。", + "C": "老年患者比年轻患者更有效地代谢药物。", + "D": "神经轴技术可以帮助避免使用全身性阿片类药物。" + } + }, + { + "id": "c2677c61-b853-511f-b616-e7a78ff05544", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "39. Which of the following statements most accurately describes the Monro-Kellie doctrine?", + "A": "Given the nondistensible cranial vault, the volume of blood, CSF, and brain tissue must be in equilibrium to maintain ICP and CPP.", + "B": "The cranial vault is distensible; therefore, there is adequate room for a spaceoccupying lesion without altering ICP.", + "C": "Given the nondistensible cranial vault, brain tissue and CSF must remain in equilibrium to maintain ICP. CSF volume has no impact.", + "D": "There is no relationship between brain tissue, CSF, and CBV and ICP." + }, + "zh": { + "question": "39. 以下哪项陈述最准确地描述了Monro-Kellie学说？", + "A": "鉴于颅腔不可扩张，血液、脑脊液和脑组织的体积必须保持平衡以维持颅内压和脑灌注压。", + "B": "颅腔是可扩张的；因此，有足够的空间容纳占位性病变而不改变颅内压。", + "C": "鉴于颅腔不可扩张，脑组织和脑脊液必须保持平衡以维持颅内压。脑脊液体积没有影响。", + "D": "脑组织、脑脊液、脑血容量与颅内压之间没有关系。" + } + }, + { + "id": "c9237784-9be5-5fb2-a239-fef05adb1a8f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the most ubiquitous material in the epidural space?", + "A": "Veins", + "B": "Arteries", + "C": "Fat", + "D": "Lymphatics" + }, + "zh": { + "question": "以下哪种是硬膜外腔中最常见的物质？", + "A": "静脉", + "B": "动脉", + "C": "脂肪", + "D": "淋巴管" + } + }, + { + "id": "1508a61e-f88d-5758-bb01-d0448cf55b3e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is a typical tidal volume (TV) range during quiet breathing?", + "A": "4-6 mL/kg", + "B": "6-8 mL/kg", + "C": "8-10 mL/kg", + "D": "10-12 mL/kg" + }, + "zh": { + "question": "以下哪一项是安静呼吸时的典型潮气量（TV）范围？", + "A": "4-6 mL/kg", + "B": "6-8 mL/kg", + "C": "8-10 mL/kg", + "D": "10-12 mL/kg" + } + }, + { + "id": "c320143f-956d-57fc-930c-5f5ce57a4f79", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Forced expiratory volume within the first second divided by forced vital capacity (FEV1/FVC) is typically greater than or equal to which one of the following?", + "A": "75%", + "B": "65%", + "C": "55%", + "D": "45%" + }, + "zh": { + "question": "第一秒的用力呼气量除以用力肺活量（FEV1/FVC）通常大于或等于以下哪一项？", + "A": "75%", + "B": "65%", + "C": "55%", + "D": "45%" + } + }, + { + "id": "468f58a5-5507-5678-9330-2bb12836095f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "FVC is normally equal to which one of the following?", + "A": "Inspiratory capacity (IC)", + "B": "Vital capacity (VC)", + "C": "Functional residual capacity (FRC)", + "D": "Total lung capacity (TLC)" + }, + "zh": { + "question": "FVC通常等于以下哪一项？", + "A": "吸气量 (IC)", + "B": "肺活量 (VC)", + "C": "功能残气量 (FRC)", + "D": "总肺容量 (TLC)" + } + }, + { + "id": "f45c2d64-8790-57dd-89bd-7dc73309cdb8", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which lung volume is the primary determinant of oxygen reserve when apnea", + "A": "Inspiratory capacity", + "B": "Vital capacity", + "C": "Functional residual capacity", + "D": "Total lung capacity" + }, + "zh": { + "question": "在呼吸暂停时，哪个肺容量是氧储备的主要决定因素", + "A": "吸气容量", + "B": "肺活量", + "C": "功能残气量", + "D": "肺总量" + } + }, + { + "id": "bce6237a-96f2-5338-a5e8-db4112de5b9f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the name of the lung volume at passive end expiration?", + "A": "Residual volume (RV)", + "B": "Expiratory reserve volume (ERV)", + "C": "Vital capacity (VC)", + "D": "Functional residual capacity (FRC)" + }, + "zh": { + "question": "在被动呼气末的肺容量叫什么？", + "A": "残气量 (RV)", + "B": "呼气储备量 (ERV)", + "C": "肺活量 (VC)", + "D": "功能残气量 (FRC)" + } + }, + { + "id": "a1a92318-3036-5e3e-91d6-e13d117760d5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "6. What volumes comprise TLC?", + "A": "Inspiratory reserve volume (IRV) + TV + ERV", + "B": "IRV + TV", + "C": "ERV + RV", + "D": "VC + RV" + }, + "zh": { + "question": "6. 总肺容量（TLC）包括哪些容量？", + "A": "补吸气量（IRV）+ 潮气量（TV）+ 补呼气量（ERV）", + "B": "补吸气量（IRV）+ 潮气量（TV）", + "C": "补呼气量（ERV）+ 残气量（RV）", + "D": "肺活量（VC）+ 残气量（RV）" + } + }, + { + "id": "de918ad8-d562-5617-aa56-8833e6486d65", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What volumes comprise IC?", + "A": "IRV + TV + ERV", + "B": "IRV + TV", + "C": "ERV + RV", + "D": "VC + RV" + }, + "zh": { + "question": "IC 包括哪些容量？", + "A": "IRV + TV + ERV", + "B": "IRV + TV", + "C": "ERV + RV", + "D": "VC + RV" + } + }, + { + "id": "23de4414-73eb-546c-b9e4-3a488905992b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What volumes comprise FRC?", + "A": "IRV + TV + ERV", + "B": "IRV + TV", + "C": "ERV + RV", + "D": "VC + RV" + }, + "zh": { + "question": "FRC由哪些容量组成？", + "A": "IRV + TV + ERV", + "B": "IRV + TV", + "C": "ERV + RV", + "D": "VC + RV" + } + }, + { + "id": "bb6afd84-ef43-5261-83ab-ae5ad2a90dc4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements is false regarding maximum voluntary ventilation (MVV)?", + "A": "MVV is the largest volume that can be breathed in 1 minute voluntarily.", + "B": "MVV measures the endurance of ventilatory muscles.", + "C": "MVV is increased in patients with restrictive disease.", + "D": "MVV is decreased in patients with obstructive disease." + }, + "zh": { + "question": "关于最大自主通气量（MVV），下列哪项陈述是错误的？", + "A": "MVV 是在 1 分钟内可以自愿呼吸的最大容量。", + "B": "MVV 测量通气肌肉的耐力。", + "C": "MVV 在限制性疾病患者中增加。", + "D": "MVV 在阻塞性疾病患者中减少。" + } + }, + { + "id": "cb0d389b-ebaa-5baf-9243-9e3791883dcc", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is false regarding FRC?", + "A": "FRC increases 10% when a healthy subject lies down.", + "B": "When FRC decreases, increased venous admixture results in arterial hypoxemia.", + "C": "The midportion of the pulmonary volume-pressure curve at FRC defines lung compliance.", + "D": "FRC may be used to quantify the degree of pulmonary restriction." + }, + "zh": { + "question": "关于FRC，下列哪项陈述是错误的？", + "A": "当健康个体躺下时，FRC增加10%。", + "B": "当FRC减少时，静脉混合增加导致动脉低氧血症。", + "C": "FRC时肺容量-压力曲线的中段定义了肺顺应性。", + "D": "FRC可用于量化肺部限制的程度。" + } + }, + { + "id": "67398cd4-f0b3-50e1-9ce1-26744ba4cf12", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The amount of net pressure required for inflation of an alveolus is dependent on which of the following?", + "A": "Surface tension", + "B": "Density of gas", + "C": "Radius of the alveolus", + "D": "A and C" + }, + "zh": { + "question": "充气肺泡所需的净压力量取决于以下哪项？", + "A": "表面张力", + "B": "气体密度", + "C": "肺泡半径", + "D": "A和C" + } + }, + { + "id": "6c963083-c759-53ba-9484-9b1b1f15e95d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following \"laws\" describes the pressure required within the alveolus to remain inflated?", + "A": "Laplace's law", + "B": "Boyle's law", + "C": "The ideal gas law", + "D": "Henry's law" + }, + "zh": { + "question": "下列哪个“定律”描述了肺泡内保持充气所需的压力？", + "A": "拉普拉斯定律", + "B": "波义耳定律", + "C": "理想气体定律", + "D": "亨利定律" + } + }, + { + "id": "91fe16ba-c5a4-5236-838c-fb845036eedd", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which type of alveolar cells produces surfactant?", + "A": "Type I", + "B": "Type II", + "C": "Type III", + "D": "Type IV" + }, + "zh": { + "question": "哪种类型的肺泡细胞产生表面活性剂？", + "A": "I型", + "B": "II型", + "C": "III型", + "D": "IV型" + } + }, + { + "id": "d1a16d6d-04b6-5a9c-85b6-1aaefa963037", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Type II alveolar cells:", + "A": "Produce surfactant in the lungs", + "B": "Modulate local electrolyte balance", + "C": "Provide for immunologic lung defense", + "D": "A and B", + "E": "All of the above" + }, + "zh": { + "question": "II型肺泡细胞：", + "A": "在肺中产生表面活性物质", + "B": "调节局部电解质平衡", + "C": "提供免疫性肺防御", + "D": "A和B", + "E": "以上全部" + } + }, + { + "id": "4adc80db-f79f-5763-8307-d7c5a4bebb4d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is/are depicted in a flow-volume loop?", + "A": "Total lung capacity", + "B": "Functional residual capacity", + "C": "Tidal volume", + "D": "All of the above" + }, + "zh": { + "question": "下列哪项在流量-容量环中被描绘？", + "A": "肺总容量", + "B": "功能残气量", + "C": "潮气量", + "D": "以上全部" + } + }, + { + "id": "43b27697-7fab-5d14-9d9b-cd35f63544d1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements about flow-volume loops is false?", + "A": "Shape and peak airflow rates during expiration at high lung volumes are effort dependent.", + "B": "Flow-volume loops provide more precise and useful information in the diagnosis of upper airway and extrathoracic obstruction compared with MRI.", + "C": "A flow-volume loop graphically demonstrates the flow generated during a forced expiratory maneuver followed by a forced inspiratory maneuver, plotted against the volume of gas expired.", + "D": "Flow-volume loops provide information about total lung volume, TV, FRC, and RV." + }, + "zh": { + "question": "以下关于流量-容量环的说法中哪一项是错误的？", + "A": "在高肺容量下，呼气时的形状和峰值气流速率依赖于努力程度。", + "B": "与MRI相比，流量-容量环在诊断上气道和胸外阻塞方面提供了更精确和有用的信息。", + "C": "流量-容量环以图形方式展示了在强制呼气动作后紧随的强制吸气动作中产生的流量，并与呼出气体的容量相对比。", + "D": "流量-容量环提供关于总肺容量、潮气量、功能残气量和残气量的信息。" + } + }, + { + "id": "f7e7cab0-7025-5119-b625-aa9fcf6414ba", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following pulmonary structures participates in gas exchange?", + "A": "Tnal bronchioles", + "B": "Alveoli", + "C": "Alveolar ducts", + "D": "A and B", + "E": "B and C" + }, + "zh": { + "question": "下列哪种肺部结构参与气体交换？", + "A": "终末细支气管", + "B": "肺泡", + "C": "肺泡管", + "D": "A 和 B", + "E": "B 和 C" + } + }, + { + "id": "8a7f4f56-f904-544b-a71f-ebdb49e8fbdf", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements regarding the distribution of ventilation in", + "A": "There is an alveolar pressure gradient in the lung.", + "B": "The negative intrapleural pressure results in more distended alveoli at the base of the lung.", + "C": "More ventilation is delivered to dependent pulmonary areas.", + "D": "The largest portion of TV reaches the apex of the lung." + }, + "zh": { + "question": "关于通气分布，下列哪项陈述是正确的？", + "A": "肺内存在肺泡压力梯度。", + "B": "负的胸膜内压导致肺底部的肺泡更膨胀。", + "C": "更多的通气输送到依赖的肺区。", + "D": "最大部分的潮气量到达肺尖。" + } + }, + { + "id": "8efe0c5c-710e-5d6e-b7ad-1bbf2e9c6d76", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements regarding the distribution of blood flow in the lung is false?", + "A": "Blood flow into the lung is mainly gravity dependent.", + "B": "West Zone 1 is the most gravity-dependent portion of the lung.", + "C": "Blood flow depends on the relationship between pulmonary artery pressure, alveolar pressure, and pulmonary venous pressure.", + "D": "West Zone 1 receives ventilation in the absence of perfusion." + }, + "zh": { + "question": "关于肺内血流分布的下列说法中哪一项是错误的？", + "A": "进入肺部的血流主要依赖于重力。", + "B": "West Zone 1 是肺部最依赖重力的部分。", + "C": "血流取决于肺动脉压、肺泡压和肺静脉压之间的关系。", + "D": "West Zone 1 在没有灌注的情况下接受通气。" + } + }, + { + "id": "791d9d32-2d41-518e-99ba-dd5f43326968", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Select the correct relationship between the pulmonary artery pressure (Ppa), alveolar pressure (PA), and pulmonary venous pressure (Ppv) in West Zone 3:", + "A": "Ppa > Ppv > PA", + "B": "Ppa = Ppv = PA", + "C": "Ppa > PA > Ppv", + "D": "PA > Ppa > Ppv" + }, + "zh": { + "question": "选择在 West Zone 3 中肺动脉压 (Ppa)、肺泡压 (PA) 和肺静脉压 (Ppv) 之间的正确关系：", + "A": "Ppa > Ppv > PA", + "B": "Ppa = Ppv = PA", + "C": "Ppa > PA > Ppv", + "D": "PA > Ppa > Ppv" + } + }, + { + "id": "7c7ab101-5a97-5fd5-8d2e-a3050b99683f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The ideal V/Q ratio of 1 is believed to occur at approximately the level of which one of the following?", + "A": "First rib", + "B": "Third rib", + "C": "Fifth rib", + "D": "Seventh rib" + }, + "zh": { + "question": "理想的通气/血流比值为1，通常被认为发生在以下哪个水平？", + "A": "第一根肋骨", + "B": "第三根肋骨", + "C": "第五根肋骨", + "D": "第七根肋骨" + } + }, + { + "id": "500db74c-4447-56d3-b56b-7864d821de6a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A V/Q ratio of 1:0 is known as which one of the following?", + "A": "Normal", + "B": "Dead space", + "C": "Shunt", + "D": "Silent unit" + }, + "zh": { + "question": "V/Q 比值为 1:0 被称为以下哪一项？", + "A": "正常", + "B": "无效腔", + "C": "分流", + "D": "静音单位" + } + }, + { + "id": "7cd97bc9-a105-5b0d-93df-9cf68cd64bb1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A V/Q ratio of 0:0 is known as which one of the following?", + "A": "Normal", + "B": "Dead space", + "C": "Shunt", + "D": "Silent unit" + }, + "zh": { + "question": "V/Q 比率为 0:0 被称为以下哪一项？", + "A": "正常", + "B": "无效腔", + "C": "分流", + "D": "静音单位" + } + }, + { + "id": "6aa7cf81-3f82-5d80-9601-1f3f9001f888", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A V/Q ratio of 0:1 is known as which one of the following?", + "A": "Normal", + "B": "Dead space", + "C": "Shunt", + "D": "Silent unit" + }, + "zh": { + "question": "V/Q 比值为 0:1 被称为以下哪一项？", + "A": "正常", + "B": "无效腔", + "C": "分流", + "D": "静音单位" + } + }, + { + "id": "dee78a7d-9068-5cca-838d-e32f851352f4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "29. Which of the following statements regarding hypoxic pulmonary vasoconstriction (HPV) is false?", + "A": "HPV leads to bronchiolar constriction.", + "B": "HPV is stimulated by alveolar hypoxia.", + "C": "HPV decreases blood flow.", + "D": "HPV causes areas that were previously shunted to effectively become silent units." + }, + "zh": { + "question": "29. 以下关于低氧性肺血管收缩（HPV）的说法哪一项是错误的？", + "A": "HPV导致细支气管收缩。", + "B": "HPV由肺泡低氧刺激。", + "C": "HPV减少血流。", + "D": "HPV使先前分流的区域有效地成为无声单位。" + } + }, + { + "id": "5ea2755f-c289-5768-b72c-743de2849f50", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is/are direct inhibitor(s) of HPV?", + "A": "Infection", + "B": "Vasodilator drugs", + "C": "Hypocarbia", + "D": "A and C", + "E": "All of the above" + }, + "zh": { + "question": "以下哪项是/直接抑制HPV的因素？", + "A": "感染", + "B": "血管扩张药物", + "C": "低碳酸血症", + "D": "A和C", + "E": "以上全部" + } + }, + { + "id": "245e9c49-eb8e-5e6c-a364-e802a1ae3b83", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following medical conditions shift(s) the oxyhemoglobin dissociation curve to the right?", + "A": "Hypocapnia", + "B": "Acidosis", + "C": "Hyperthermia", + "D": "B and C", + "E": "A and B" + }, + "zh": { + "question": "下列哪种医学状况会使氧合血红蛋白解离曲线右移？", + "A": "低碳酸血症", + "B": "酸中毒", + "C": "高热", + "D": "B 和 C", + "E": "A 和 B" + } + }, + { + "id": "a73f5302-16b8-5477-9de8-8891e00b6c18", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "In a normal patient, the Po2 drops from 100 to 40 mm Hg. What do you expect the pulse oximeter to read?", + "A": "99%", + "B": "95%", + "C": "85%", + "D": "<75%" + }, + "zh": { + "question": "在一个正常的病人中，Po2从100降到40 mm Hg。你预计脉搏血氧仪的读数是多少？", + "A": "99%", + "B": "95%", + "C": "85%", + "D": "<75%" + } + }, + { + "id": "c6a84037-19bf-583d-8570-e53a101dde94", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following medical conditions cause(s) a leftward shift to the oxyhemoglobin dissociation curve?", + "A": "Hypothermia", + "B": "Alkalosis", + "C": "Fetal hemoglobin", + "D": "All of the above" + }, + "zh": { + "question": "以下哪种医学状况会导致氧合血红蛋白解离曲线左移？", + "A": "低体温", + "B": "碱中毒", + "C": "胎儿血红蛋白", + "D": "以上所有" + } + }, + { + "id": "3e4772c4-e063-56e0-9773-169ec8e284ce", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements regarding respiratory acidosis is false?", + "A": "It is improved with laparoscopic procedures.", + "B": "It is always characterized by hypercarbia (PaCO2 > 45 mm Hg).", + "C": "It occurs because of a decrease in minute alveolar ventilation.", + "D": "It is usually characterized by a low pH (<7.35)." + }, + "zh": { + "question": "以下关于呼吸性酸中毒的说法中哪一项是错误的？", + "A": "腹腔镜手术可以改善这种情况。", + "B": "它总是以高碳酸血症（PaCO2 > 45 mm Hg）为特征。", + "C": "它是由于分钟肺泡通气量减少而发生的。", + "D": "它通常以低pH值（<7.35）为特征。" + } + }, + { + "id": "648a40ca-13c8-50e8-a1ec-5efd4aa0fc12", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements is/are true regarding systemic effects of hypercapnia?", + "A": "Arteriolar dilation", + "B": "Increased sympathetic output", + "C": "Pulmonary vasoconstriction", + "D": "All of the above" + }, + "zh": { + "question": "关于高碳酸血症的全身效应，下列哪项陈述是正确的？", + "A": "小动脉扩张", + "B": "交感神经输出增加", + "C": "肺血管收缩", + "D": "以上全部" + } + }, + { + "id": "53765e0a-d886-5522-8603-7d2f3f5196ce", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements is false regarding hyperoxia?", + "A": "It contributes to atelectasis.", + "B": "Prolonged exposure may increase the risk of secondary infections.", + "C": "It increases intracranial pressure.", + "D": "It increases systemic vascular resistance." + }, + "zh": { + "question": "以下关于高氧的说法哪一项是错误的？", + "A": "它有助于肺不张。", + "B": "长时间暴露可能增加继发感染的风险。", + "C": "它增加颅内压。", + "D": "它增加全身血管阻力。" + } + }, + { + "id": "f545b1ce-5532-5c13-af94-84c1b31a4036", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "37. Which of the following is/are the systemic effect(s) of hypoxia?", + "A": "Peripheral vessels dilate", + "B": "Increased ventilation", + "C": "Increased cardiac output", + "D": "All of the above" + }, + "zh": { + "question": "37. 以下哪项是缺氧的全身效应？", + "A": "外周血管扩张", + "B": "通气增加", + "C": "心输出量增加", + "D": "以上全部" + } + }, + { + "id": "0c325aa4-5589-51be-a451-5772e543582f", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Interpret this arterial blood gas (ABG): pH = 7.27, CO2 = 53, HCO2 = 24.", + "A": "Metabolic acidosis", + "B": "Metabolic alkalosis", + "C": "Respiratory acidosis", + "D": "Respiratory alkalosis" + }, + "zh": { + "question": "解释以下动脉血气（ABG）：pH = 7.27, CO2 = 53, HCO2 = 24。", + "A": "代谢性酸中毒", + "B": "代谢性碱中毒", + "C": "呼吸性酸中毒", + "D": "呼吸性碱中毒" + } + }, + { + "id": "daa73226-a6e0-5a2a-8840-e2b543f5f456", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Interpret this ABG: pH = 7.18, CO2 = 38, HCO3 = 16", + "A": "Metabolic acidosis", + "B": "Metabolic alkalosis", + "C": "Respiratory acidosis", + "D": "Respiratory alkalosis" + }, + "zh": { + "question": "解释这个动脉血气分析：pH = 7.18, CO2 = 38, HCO3 = 16", + "A": "代谢性酸中毒", + "B": "代谢性碱中毒", + "C": "呼吸性酸中毒", + "D": "呼吸性碱中毒" + } + }, + { + "id": "33df2df2-e193-53a3-bc1d-a39a59c295f6", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Interpret this ABG: pH = 7.60, CO2 = 37, HCO3 = 35", + "A": "Metabolic acidosis", + "B": "Metabolic alkalosis", + "C": "Respiratory acidosis", + "D": "Respiratory alkalosis" + }, + "zh": { + "question": "解释这个动脉血气分析：pH = 7.60, CO2 = 37, HCO3 = 35", + "A": "代谢性酸中毒", + "B": "代谢性碱中毒", + "C": "呼吸性酸中毒", + "D": "呼吸性碱中毒" + } + }, + { + "id": "c9d529b4-7d4f-5cd7-960d-f159c92a7f40", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The respiratory centers in the brain are located in which one of the following?", + "A": "Cerebrum", + "B": "Cerebellum", + "C": "Brainstem", + "D": "Spinal cord" + }, + "zh": { + "question": "大脑中的呼吸中枢位于以下哪个部位？", + "A": "大脑", + "B": "小脑", + "C": "脑干", + "D": "脊髓" + } + }, + { + "id": "2273a1a7-2dc9-5014-8071-86c87501b39d", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following structures comprise(s) the peripheral chemoreceptors?", + "A": "Carotid bodies", + "B": "Carotid sinus", + "C": "Aortic bodies", + "D": "A and C", + "E": "All of the above" + }, + "zh": { + "question": "以下哪种结构构成了外周化学感受器？", + "A": "颈动脉小球", + "B": "颈动脉窦", + "C": "主动脉小球", + "D": "A 和 C", + "E": "以上全部" + } + }, + { + "id": "02fec6f5-e07d-5db6-aca2-9a1cda5e7886", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Central chemoreceptors are primarily sensitive to changes in which one of the following?", + "A": "Carbon dioxide", + "B": "Hydrogen ion concentration", + "C": "Oxygen", + "D": "Bicarbonate" + }, + "zh": { + "question": "中枢化学感受器主要对以下哪一项的变化敏感？", + "A": "二氧化碳", + "B": "氢离子浓度", + "C": "氧气", + "D": "碳酸氢盐" + } + }, + { + "id": "45696ae6-6a1d-5d36-9f7a-6676f8884e85", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The sources of ventilatory rhythmicity are located in which one of the following?", + "A": "Dorsal respiratory group", + "B": "Ventral respiratory group", + "C": "Apneustic center", + "D": "Pneumotaxic respiratory center" + }, + "zh": { + "question": "通气���律的来源位于以下哪一项？", + "A": "背侧呼吸组", + "B": "腹侧呼吸组", + "C": "长吸中枢", + "D": "呼吸调节中枢" + } + }, + { + "id": "153a64aa-21e5-53fa-b68a-850407518850", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "45. Which of the following is/are known as cause(s) of true hyperventilation?", + "A": "Arterial hypoxemia", + "B": "Metabolic acidemia", + "C": "A and B", + "D": "None of the above", + "E": "All of the above" + }, + "zh": { + "question": "45. 以下哪项是已知的真正过度通气的原因？", + "A": "动脉低氧血症", + "B": "代谢性酸中毒", + "C": "A 和 B", + "D": "以上都不是", + "E": "以上所有" + } + }, + { + "id": "446e1b82-6738-5687-ba3f-07d07471b3a9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "At what level does PaO2 lack any influence on the carbon dioxide response curve?", + "A": "<65 mm Hg", + "B": "65 mm Hg", + "C": "85 mm Hg", + "D": "100 mm Hg" + }, + "zh": { + "question": "在什么水平上，PaO2 对二氧化碳反应曲线没有任何影响？", + "A": "<65 mm Hg", + "B": "65 mm Hg", + "C": "85 mm Hg", + "D": "100 mm Hg" + } + }, + { + "id": "b291a79f-1aa7-5605-b080-9aea3599a1bf", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Changes in physiology that can displace the carbon dioxide response curve to the right include which of the following?", + "A": "Normal sleep", + "B": "Opioids", + "C": "Inhaled anesthetics", + "D": "All of the above" + }, + "zh": { + "question": "可以使二氧化碳反应曲线右移的生理变化包括以下哪项？", + "A": "正常睡眠", + "B": "阿片类药物", + "C": "吸入麻醉剂", + "D": "以上所有选项" + } + }, + { + "id": "5de0c7a5-077c-5075-acb8-242bf65c3c54", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is true regarding the oxyhemoglobin", + "A": "Left shift leads to lower O2 affinity.", + "B": "Left shift leads to higher O2 affinity.", + "C": "Right shift leads to higher O2 affinity.", + "D": "None of the above." + }, + "zh": { + "question": "关于氧合血红蛋白，下列哪项陈述是正确的？", + "A": "左移导致氧气亲和力降低。", + "B": "左移导致氧气亲和力增加。", + "C": "右移导致氧气亲和力增加。", + "D": "以上都不是。" + } + }, + { + "id": "859b4e21-891a-57f0-8163-c75799c15cbd", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "50. How does fetal hemoglobin impact the hemoglobin dissociation curve?", + "A": "Shifts it to the left.", + "B": "Shifts it to the right.", + "C": "Shifts it up.", + "D": "Shifts it down." + }, + "zh": { + "question": "50. 胎儿血红蛋白如何影响血红蛋白解离曲线？", + "A": "使其向左移动。", + "B": "使其向右移动。", + "C": "使其向上移动。", + "D": "使其向下移动。" + } + }, + { + "id": "e3256784-65f3-554e-8b3f-16ea7603baf6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "With regards to smoking, which of the following statements is/are true?", + "A": "Smoking leads to V/Q mismatch, bronchitis, and airway hyperreactivity.", + "B": "Smoking leads to increased carboxyhemoglobin concentration.", + "C": "Smoking is one of the main risk factors associated with postoperative morbidity.", + "D": "All of the above." + }, + "zh": { + "question": "关于吸烟，下列哪项陈述是正确的？", + "A": "吸烟导致通气/血流比例失调、支气管炎和气道高反应性。", + "B": "吸烟导致碳氧血红蛋白浓度增加。", + "C": "吸烟是与术后发病率相关的主要风险因素之一。", + "D": "以上全部。" + } + }, + { + "id": "9377e3b9-e1c5-5307-b0e9-8c801d22932a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements about smoking cessation is true?", + "A": "Patients who quit smoking less than 8 weeks preoperatively have a significantly higher complication rate compared with those who quit more than 8 weeks preoperatively.", + "B": "Smokers who decrease cigarette consumption in an attempt to quit without nicotine replacement therapy decrease their nicotine intake.", + "C": "Smokers should be advised to stop smoking 3 months before elective operations to maximize the effect of smoking cessation.", + "D": "If smokers stop for at least 2 weeks preoperatively, they benefit from improved mucociliary function." + }, + "zh": { + "question": "以下关于戒烟的说法哪一项是正确的？", + "A": "与术前超过8周戒烟的患者相比，术前少于8周戒烟的患者并发症发生率显著更高。", + "B": "试图戒烟而不使用尼古丁替代疗法的吸烟者通过减少香烟消费来降低尼古丁摄入量。", + "C": "应建议吸烟者在择期手术前3个月停止吸烟，以最大化戒烟效果。", + "D": "如果吸烟者在术前至少2周停止吸烟，他们将受益于改善的纤毛功能。" + } + }, + { + "id": "1fa884b1-9eee-572a-88d7-99bf05267d17", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Bronchodilators, such as albuterol, act on which type of receptor?", + "A": "α1-Adrenergic", + "B": "α2-Adrenergic", + "C": "β1-Adrenergic", + "D": "β2-Adrenergic" + }, + "zh": { + "question": "支气管扩张剂，如沙丁胺醇，作用于哪种类型的受体？", + "A": "α1-肾上腺素能", + "B": "α2-肾上腺素能", + "C": "β1-肾上腺素能", + "D": "β2-肾上腺素能" + } + }, + { + "id": "a88329ab-fe85-51f1-9c0c-b8c09551feb1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "With regard to the action of anticholinergic bronchodilators, which of the following statements is/are true?", + "A": "They act to block nicotinic receptors.", + "B": "They block the formation of cyclic guanosine monophosphate.", + "C": "They are muscarinic agonists.", + "D": "B and C." + }, + "zh": { + "question": "关于抗胆碱能支气管扩张剂的作用，下列哪项陈述是正确的？", + "A": "它们通过阻断烟碱受体起作用。", + "B": "它们阻止环鸟苷酸的形成。", + "C": "它们是毒蕈碱受体激动剂。", + "D": "B 和 C。" + } + }, + { + "id": "1ce44eb6-14db-52ec-9807-24cd1291b059", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements describes the correct mechanism of action of β2-agonist bronchodilators?", + "A": "Receptor activation leads to increased production of cyclic guanosine monophosphate.", + "B": "Receptor activation leads to decreased production of cyclic guanosine monophosphate.", + "C": "Receptor activation leads to increased production of cyclic adenosine monophosphate (cAMP).", + "D": "Receptor activation leads to decreased production of cAMP." + }, + "zh": { + "question": "以下哪项陈述描述了β2-激动剂支气管扩张剂的正确作用机制？", + "A": "受体激活导致环鸟苷酸的生成增加。", + "B": "受体激活导致环鸟苷酸的生成减少。", + "C": "受体激活导致环腺苷酸（cAMP）的生成增加。", + "D": "受体激活导致cAMP的生成减少。" + } + }, + { + "id": "a233f290-b124-5f11-b0b5-c550e9333744", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is the mechanism of action of leukotriene modifiers?", + "A": "Decreasing the production of leukotrienes", + "B": "Increasing the production of leukotrienes", + "C": "Agonizing the leukotriene receptor agonist", + "D": "Antagonizing the leukotriene receptor antagonist" + }, + "zh": { + "question": "以下哪项是白三烯调节剂的作用机制？", + "A": "减少白三烯的生成", + "B": "增加白三烯的生成", + "C": "激动白三烯受体激动剂", + "D": "拮抗白三烯受体拮抗剂" + } + }, + { + "id": "5c92c38e-7c1e-5d9a-b9cc-0473f39f02cd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements is/are true regarding immunoglobulin E (IgE) blockers?", + "A": "They inhibit binding of IgE to the receptor on the surface of mast cells and basophils.", + "B": "One agent is a monoclonal antibody.", + "C": "They can be used for the treatment of asthma.", + "D": "All of the above." + }, + "zh": { + "question": "以下关于免疫球蛋白E（IgE）阻断剂的说法中，哪一项是正确的？", + "A": "它们抑制IgE与肥大细胞和嗜碱性粒细胞表面受体的结合。", + "B": "其中一种药物是单克隆抗体。", + "C": "它们可用于治疗哮喘。", + "D": "以上全部。" + } + }, + { + "id": "ffd67eb3-656e-54d0-8fcb-056e8cddb44e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "58. Which of the following is the mechanism of action of first-generation medications that target mast cells?", + "A": "Enhancement of mast cell chemical mediator release", + "B": "Stabilization of mast cells to inhibit release of chemical mediators", + "C": "Antagonizing the H1 receptor", + "D": "Agonizing the H1 receptor" + }, + "zh": { + "question": "58. 以下哪项是第一代靶向肥大细胞药物的作用机制？", + "A": "增强肥大细胞化学介质的释放", + "B": "稳定肥大细胞以抑制化学介质的释放", + "C": "拮抗H1受体", + "D": "激动H1受体" + } + }, + { + "id": "92b1d6fe-cea4-509e-8613-6fee0e4fcddd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements is/are true about the mechanism of action of exogenous glucocorticoids?", + "A": "They directly bind to glucocorticoid receptors to exert their action.", + "B": "They inhibit molecules such as cytokines, chemokines, and arachidonic acid metabolites.", + "C": "They upregulate anti-inflammatory mediators.", + "D": "All of the above." + }, + "zh": { + "question": "以下关于外源性糖皮质激素作用机制的说法中哪一项是正确的？", + "A": "它们直接与糖皮质激素受体结合以发挥作用。", + "B": "它们抑制细胞因子、趋化因子和花生四烯酸代谢物等分子。", + "C": "它们上调抗炎介质。", + "D": "以上全部。" + } + }, + { + "id": "7b84091c-17cd-5f26-a0f0-4c31e8d3fef9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Select the correct order of greatest to least anti-inflammatory properties of the following glucocorticoids:", + "A": "Hydrocortisone > prednisone > methylprednisolone > dexamethasone", + "B": "Dexamethasone > methylprednisolone > prednisone > hydrocortisone", + "C": "Dexamethasone > hydrocortisone > methylprednisolone > prednisone", + "D": "Hydrocortisone > dexamethasone > prednisone > methylprednisolone" + }, + "zh": { + "question": "选择以下糖皮质激素从强到弱的抗炎特性的正确顺序：", + "A": "氢化可的松 > 泼尼松 > 甲泼尼龙 > 地塞米松", + "B": "地塞米松 > 甲泼尼龙 > 泼尼松 > 氢化可的松", + "C": "地塞米松 > 氢化可的松 > 甲泼尼龙 > 泼尼松", + "D": "氢化可的松 > 地塞米松 > 泼尼松 > 甲泼尼龙" + } + }, + { + "id": "bbe09804-2f99-5a0f-a174-c30959336bb8", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which portion of the cardiac cycle has the highest myocardial oxygen consumption?", + "A": "Isovolumic relaxation period", + "B": "Ejection", + "C": "Diastasis", + "D": "Isovolumic contraction period" + }, + "zh": { + "question": "心动周期的哪个阶段心肌耗氧量最高？", + "A": "等容舒张期", + "B": "射血期", + "C": "舒张末期", + "D": "等容收缩期" + } + }, + { + "id": "446af164-074a-5304-8e9d-e9f130cae665", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following defines the Frank-Starling relationship?", + "A": "The relationship between preload (resting myocardial length) and contractile performance", + "B": "The relationship between the left ventricle (LV) pressure and wall stress", + "C": "The relationship between pressure, flow, and resistance", + "D": "The balance between hydrostatic pressure and oncotic pressure gradients across a membrane" + }, + "zh": { + "question": "以下哪项定义了Frank-Starling关系？", + "A": "前负荷（静息心肌长度）与收缩性能之间的关系", + "B": "左心室��LV）压力与壁应力之间的关系", + "C": "压力、流量和阻力之间的关系", + "D": "跨膜的静水压和胶体渗透压梯度之间的平衡" + } + }, + { + "id": "fa1bf99a-6af4-59f4-85ef-76407f733016", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the earliest indicator of myocardial ischemia?", + "A": "Increased left ventricle end-diastolic volume (LVEDV) and decreased compliance", + "B": "ECG abnormalities", + "C": "Wall motion abnormalities", + "D": "Congestive heart failure" + }, + "zh": { + "question": "以下哪项是心肌缺血的最早指征？", + "A": "左心室舒张末期容积（LVEDV）增加和顺应性降低", + "B": "心电图异常", + "C": "壁运动异常", + "D": "充血性心力衰竭" + } + }, + { + "id": "e87858f7-7eb2-5d7c-8330-dfaa24380369", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following contribute(s) to cardiac output?", + "A": "Heart rate", + "B": "Stroke volume", + "C": "Preload", + "D": "Afterload", + "E": "All of the above" + }, + "zh": { + "question": "以下哪项有助于心输出量？", + "A": "心率", + "B": "搏出量", + "C": "前负荷", + "D": "后负荷", + "E": "以上全部" + } + }, + { + "id": "97e55170-49b9-5d00-b9dd-bb393dfe93cb", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following factors will increase venous oxygen saturation measured in the pulmonary artery?", + "A": "Decreases in cardiac output", + "B": "Increases in oxygen consumption", + "C": "Decreased temperature", + "D": "Lower hemoglobin concentration" + }, + "zh": { + "question": "下列哪项因素会增加在肺动脉中测量的静脉氧饱和度？", + "A": "心输出量减少", + "B": "氧耗量增加", + "C": "温度降低", + "D": "血红蛋白浓度降低" + } + }, + { + "id": "b97511d5-bc4e-52b9-a670-d087e67fc0c2", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "6. Which of the following indicate(s) impaired diastolic function of the LV?", + "A": "Prolonged isovolumic relaxation time", + "B": "\"E\" wave to \"A\" wave ratio less than 1 (E/A <1)", + "C": "Prolonged time constant for LV relaxation measured at cardiac catheterization", + "D": "All of the above" + }, + "zh": { + "question": "6. 以下哪项表示左心室舒张功能受损？", + "A": "等容舒张时间延长", + "B": "“E”波与“A”波的比值小于1（E/A <1）", + "C": "心导管检查中测得的左心室舒张时间常数延长", + "D": "以上所有" + } + }, + { + "id": "153b74c5-e0b5-5714-9d93-6152cdbad46c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements is false concerning baroreceptor function?", + "A": "Pressure-sensitive stretch receptors are located in the carotid sinus and aortic arch.", + "B": "The effects of such stretch are to reduce heart rate at the sinoatrial node, as well as the atrioventricular node.", + "C": "The vagus nerve is the only nerve involved in the afferent limb of the baroreceptor response.", + "D": "Massage of the carotid artery will increase parasympathetic stimuli and can slow narrow complex supraventricular tachycardia." + }, + "zh": { + "question": "以下关于压力感受器功能的陈述中哪一项是错误的？", + "A": "压力敏感的牵张感受器位于颈动脉窦和主动脉弓。", + "B": "这种牵张的效果是降低窦房结和房室结的心率。", + "C": "迷走神经是压力感受器反应传入部分中唯一涉及的神经。", + "D": "颈动脉按摩会增加副交感神经刺激，并可减缓窄复合型室上性心动过速。" + } + }, + { + "id": "8e206f78-f505-524b-87c4-17d79b9e160f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is true regarding blood pressure in the arterial vascular tree?", + "A": "Pulse pressure is the difference between the systolic blood pressure (SBP) in the ventricle and the diastolic blood pressure (DBP) measured within the ventricle.", + "B": "Mean arterial blood pressure (MAP) = DBP + (0.33 * pulse pressure).", + "C": "The SBP measured in the femoral artery is lower than that measured in the aorta.", + "D": "The DBP is higher in the femoral artery than in the aorta." + }, + "zh": { + "question": "关于动脉血管树中的血压，下列哪项陈述是正确的？", + "A": "脉压是心室内收缩压（SBP）与心室内舒张压（DBP）之间的差值。", + "B": "平均动脉压（MAP）= DBP + (0.33 * 脉压)。", + "C": "股动脉测得的SBP低于主动脉测得的SBP。", + "D": "股动脉中的DBP高于主动脉中的DBP。" + } + }, + { + "id": "b7f73e08-2caa-53f1-9a7a-037bdfe47df6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Spontaneous respiration facilitates venous return primarily due to which of the following conditions?", + "A": "Thoracic expansion creates a slightly positive pressure in the chest.", + "B": "Mean intrathoracic pressure during spontaneous ventilation is slightly negative, facilitating venous return.", + "C": "Downward movement of the diaphragm reduces intra-abdominal pressure.", + "D": "Muscle contraction moves blood from the vasculature into muscles." + }, + "zh": { + "question": "自发呼吸主要通过以下哪种情况促进静脉回流？", + "A": "胸腔扩张在胸腔内产生轻微的正压。", + "B": "自发通气期间的平均胸腔内压略为负值，促进静脉回流。", + "C": "膈肌向下移动降低腹腔内压。", + "D": "肌肉收缩将血液从血管转移到肌肉中。" + } + }, + { + "id": "89aa5dc1-b5e8-5945-bfe0-e8c4f3fffae3", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Distribution of blood throughout the circulatory system is not uniform. Which of the following components of the tree has the largest blood volume?", + "A": "Venous system", + "B": "Arterial system", + "C": "Pulmonary vasculature", + "D": "Heart" + }, + "zh": { + "question": "血液在循环系统中的分布并不均匀。以下哪个部分的血容量最大？", + "A": "静脉系统", + "B": "动脉系统", + "C": "肺血管系统", + "D": "心脏" + } + }, + { + "id": "5d800ccd-f37e-5545-bfb2-e794d37fbb11", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is true?", + "A": "The arterial system has higher compliance than the venous system.", + "B": "The compliance of the venous system is 10-20 times greater than the arterial system.", + "C": "Small changes of blood within the venous system result in large changes in pressure.", + "D": "The cross-sectional area of the small and large arteries is larger than that of the corresponding veins." + }, + "zh": { + "question": "以下哪项陈述是正确的？", + "A": "动脉系统的顺应性比静脉系统高。", + "B": "静脉系统的顺应性是动脉系统的10-20倍。", + "C": "静脉系统内血液的微小变化会导致压力的巨大变化。", + "D": "小动脉和大动脉的横截面积大于相应静脉的横截面积。" + } + }, + { + "id": "5ae13f2d-2c5f-5762-aa77-c297b6d822e6", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Which of the following does NOT contribute to reduced cardiac output and blood pressure in the setting of acute massive pulmonary embolism?", + "A": "Tricuspid regurgitation", + "B": "Occlusion of the pulmonary arterial vasculature by thrombotic material", + "C": "Shift of the interventricular septum toward the left", + "D": "Hypokinesis of the LV" + }, + "zh": { + "question": "以下哪项不导致急性大面积肺栓塞时心输出量和血压的降低？", + "A": "三尖瓣返流", + "B": "血栓物质阻塞肺动脉血管", + "C": "室间隔向左移位", + "D": "左心室运动减弱" + } + }, + { + "id": "18ce551c-277c-55db-b94b-078b09da9083", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is/are the primate determinant(s) of capillary blood flow?", + "A": "Transmural pressure", + "B": "Oncotic pressure", + "C": "Contraction and relaxation of the precapillary and postcapillary sphincters", + "D": "A and C" + }, + "zh": { + "question": "以下哪项是毛细血管血流的主要决定因素？", + "A": "跨壁压", + "B": "胶体渗透压", + "C": "毛细血管前后括约肌的收缩和舒张", + "D": "A和C" + } + }, + { + "id": "2544d08e-68cd-52fe-b846-2f7796feab47", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "14. Blood flow through a tube is determined by several factors and explained by", + "A": "Blood flow is inversely proportional to the pressure gradient.", + "B": "Blood flow is proportional to the radius of the tube to the second power.", + "C": "Blood flow is proportional to the length of the tube.", + "D": "Blood flow is inversely proportional to the viscosity of the fluid." + }, + "zh": { + "question": "14. 血液通过管道的流动由几个因素决定，并由以下解释", + "A": "血流与压力梯度成反比。", + "B": "血流与管道半径的平方成正比。", + "C": "血流与管道的长度成正比。", + "D": "血流与液体的粘度成反比。" + } + }, + { + "id": "998fc416-51f3-5780-9a6f-5cb8f811459f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following tissues has the greatest capillary density?", + "A": "Fat", + "B": "Cartilage", + "C": "Bone", + "D": "Skeletal muscle" + }, + "zh": { + "question": "以下哪种组织的毛细血管密度最大？", + "A": "脂肪", + "B": "软骨", + "C": "骨骼", + "D": "骨骼肌" + } + }, + { + "id": "97e2be7f-20bf-54e9-a7a7-d799c0090ed5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Myocardial tissue has the highest oxygen extraction of any tissue. Which of the following statements is false concerning myocardial metabolism?", + "A": "Normal coronary blood flow is approximately 250 mL/min or 5% of cardiac output.", + "B": "Myocardial oxygen consumption is affected by heart rate, contractility, and wall stress.", + "C": "Coronary blood flow to both the right and left ventricles occurs exclusively during diastole.", + "D": "Venous oxygen saturation is higher in the right atrium than in the pulmonary artery." + }, + "zh": { + "question": "心肌组织的氧提取率是所有组织中最高的。以下关于心肌代谢的说法哪一项是错误的？", + "A": "正常冠状动脉血流量约为250 mL/min或心输出量的5%。", + "B": "心肌耗氧量受心率、收缩力和壁应力的影响。", + "C": "冠状动脉血流到达左右心室仅在舒张期发生。", + "D": "右心房的静脉氧饱和度高于肺动脉。" + } + }, + { + "id": "048e1af8-5265-5278-acbc-30dfa98fb719", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "All of the following concerning cerebral perfusion are true EXCEPT which one?", + "A": "Cerebral perfusion pressure is the difference between the MAP and the intracranial pressure or central venous pressure (CVP), whichever is higher.", + "B": "Cerebral blood flow (CBF) always varies consistently depending on the blood pressure.", + "C": "Blood carbon dioxide tension (PaCO2 ) plays a more important role in determining CBF than oxygen tension (PaO2 ).", + "D": "CBF remains constant if the MAP is between 60 and 160 mm Hg." + }, + "zh": { + "question": "以下关于脑灌注的描述中，除了哪一项外，其他都是正确的？", + "A": "脑灌注压是平均动脉压（MAP）与颅内压或中心静脉压（CVP）之间的差值，以较高者为准。", + "B": "脑血流量（CBF）总是随着血压的变化而一致变化。", + "C": "血液二氧化碳张力（PaCO2）在决定脑血流量方面比氧气张力（PaO2）起更重要的作用。", + "D": "如果平均动脉压在60到160 mm Hg之间，脑血流量保持不变。" + } + }, + { + "id": "f3dc9654-da12-5697-a994-088054719a5a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is false?", + "A": "There are 3 mechanisms whereby renal blood flow and glomerulofiltration rate are regulated: myogenic response, tubuloglomerular feedback, and sympathetic nervous system input.", + "B": "The renal system does not exhibit autoregulation.", + "C": "Sympathetic nervous system input results in constriction of all renal vessels.", + "D": "The myogenic response is an intrinsic action of vascular smooth muscle inresponse to increased transmural pressure." + }, + "zh": { + "question": "以下哪项陈述是错误的？", + "A": "肾血流和肾小球滤过率的调节机制有三种：肌源性反应、管球反馈和交感神经系统输入。", + "B": "肾脏系统不表现出自我调节。", + "C": "交感神经系统输入导致所有肾血管收缩。", + "D": "肌源性反应是血管平滑肌对增加的跨壁压力的内在反应。" + } + }, + { + "id": "b4c9c684-3125-574f-907d-98a7ba6197c4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Approximately what percentage of cardiac output goes to the liver?", + "A": "5%", + "B": "10%", + "C": "15%", + "D": "25%" + }, + "zh": { + "question": "大约多少百分比的心输出量流向肝脏？", + "A": "5%", + "B": "10%", + "C": "15%", + "D": "25%" + } + }, + { + "id": "d309139e-297c-55d1-84ae-39cdf6b8d559", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements describes coronary perfusion pressure?", + "A": "The difference between the pressures in the aorta during systole and diastole", + "B": "The difference between the pressure in the aorta and the mean arterial pressure", + "C": "The difference between the aortic root pressure and the left or right ventricular pressure", + "D": "The difference between the mean pulmonary pressure and the left atrial pressure (LAP)" + }, + "zh": { + "question": "以下哪项描述了冠状动脉灌注压？", + "A": "主动脉在收缩期和舒张期的压力差", + "B": "主动脉压力与平均动脉压之间的差异", + "C": "主动脉根部压力与左心室或右心室压力之间的差异", + "D": "平均肺动脉压与左心房压（LAP）之间的差异" + } + }, + { + "id": "94cac3af-5192-5e3f-bb63-5a9f6a90e163", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "21. A 73-year-old man complains of weakness and then falls to the ground. Cardiopulmonary resuscitation (CPR) including chest compressions is initiated. A monitor reveals that the patient is in ventricular fibrillation (VF). Defibrillation is performed, and the monitor reveals a wide complex rhythm at 90 beats per minute. Which of the following is appropriate?", + "A": "Continue CPR for 2 minutes.", + "B": "Cease CPR immediately.", + "C": "Administer sodium bicarbonate.", + "D": "Administer vasopressin." + }, + "zh": { + "question": "21. 一名73岁的男性抱怨无力，然后倒在地上。开始进行包括胸外按压在内的心肺复苏（CPR）。监护仪显示患者处于心室颤动（VF）。进行电除颤后，监护仪显示宽QRS波心律，心率为每分钟90次。以下哪项是合适的？", + "A": "继续进行2分钟的CPR。", + "B": "立即停止CPR。", + "C": "给予碳酸氢钠。", + "D": "给予加压素。" + } + }, + { + "id": "8c01f535-537b-5d48-a8e4-6b1a00324ea1", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following indicates adequacy of CPR during resuscitation?", + "A": "PETCO2 more than 10 mm Hg during CPR", + "B": "DBP less than 20 mm Hg", + "C": "PETCO2 less than 10 mm Hg", + "D": "Peripheral cyanosis" + }, + "zh": { + "question": "以下哪项表明在复苏期间心肺复苏术的充分性？", + "A": "心肺复苏期间PETCO2超过10 mm Hg", + "B": "舒张压低于20 mm Hg", + "C": "PETCO2低于10 mm Hg", + "D": "周围发绀" + } + }, + { + "id": "db7c5d8c-cb43-513a-b6a4-9aadd1db7b70", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient is found to be in cardiac arrest, and asystole is noted on the ECG. CPR is initiated, and venous access is established. Which of the following is the first medication indicated?", + "A": "Vasopressin 40 units", + "B": "Epinephrine 1 mg", + "C": "Amiodarone 300 mg", + "D": "Sodium bicarbonate 50 mEq" + }, + "zh": { + "question": "一名患者被发现心脏骤停，心电图显示心脏停搏。已开始心肺复苏，并建立静脉通路。以下哪种药物是首选？", + "A": "加压素 40 单位", + "B": "肾上腺素 1 毫克", + "C": "胺碘酮 300 毫克", + "D": "碳酸氢钠 50 毫当量" + } + }, + { + "id": "a6c6bc28-9872-58bc-9039-6140ce3c0f6d", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A young man is found lying down on the street unresponsive. He appears to be", + "A": "Initiate CPR and continue for 2 minutes.", + "B": "After 2 minutes of CPR if necessary, leave the patient and call 9-1-1.", + "C": "Administer naloxone.", + "D": "All of the above." + }, + "zh": { + "question": "一名年轻男子被发现躺在街上没有反应。他似乎是", + "A": "开始心肺复苏并持续2分钟。", + "B": "如果需要，在2分钟心肺复苏后，离开患者并拨打9-1-1。", + "C": "给予纳洛酮。", + "D": "以上所有。" + } + }, + { + "id": "95891ae5-2289-52e2-ace0-823b1dfb435f", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A patient is noted to have altered mental status and hypotension and complains of chest pain. The heart monitor shows a hear rate of 27 beats per minute. Blood pressure is 60/30 mm Hg. After administration of oxygen and lying the patient flat, atropine 0.5 mg is administered every 5 minutes for a total of 3 mg. No response is noted. Which of the following actions is next indicated?", + "A": "Amiodarone 300 mg IV (intravenous) over 10 minutes", + "B": "Additional atropine", + "C": "Vasopressin 40 units", + "D": "Dopamine infusion at 2-20 μg/kg/min" + }, + "zh": { + "question": "一名患者被发现有意识状态改变和低血压，并抱怨胸痛。心脏监护显示心率为每分钟27次。血压为60/30 mm Hg。在给予氧气并让患者平躺后，每5分钟给予0.5 mg阿托品，总计3 mg。未见反应。接下来应采取以下哪项措施？", + "A": "静脉注射300 mg胺碘酮，持续10分钟", + "B": "追加阿托品", + "C": "40单位加压素", + "D": "多巴胺以2-20 μg/kg/min的速度输注" + } + }, + { + "id": "fc463bc8-f1a4-57b9-90b1-28d2a6cbef24", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A patient is found to be in cardiac arrest. CPR is initiated, and IV access is established. After 2 minutes of CPR, VF is noted on the heart monitor. Epinephrine is administered, and CPR is resumed. VF is still noted. Which of the following is the next medication to be administered?", + "A": "Amiodarone 150 mg IV", + "B": "Amiodarone 300 mg IV", + "C": "Atropine 0.5 mg", + "D": "Vasopressin 40 units" + }, + "zh": { + "question": "一名患者被发现心脏骤停。开始进行心肺复苏术（CPR），并建立静脉通路。经过2分钟的CPR后，心脏监护仪上显示心室颤动（VF）。给予肾上腺素后继续CPR。VF仍然存在。以下哪种药物是接下来要给予的？", + "A": "胺碘酮 150 mg 静脉注射", + "B": "胺碘酮 300 mg 静脉注射", + "C": "阿托品 0.5 mg", + "D": "加压素 40 单位" + } + }, + { + "id": "1498476c-4b64-54e4-aef4-113844344be0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is true concerning alternative routes of drug administration?", + "A": "Interosseous (IO) access should not be attempted in children.", + "B": "The same drug dose should be administered via the endotracheal tube as via IV/IO.", + "C": "CPR does not need to be stopped when a medication is administered via the endotracheal route.", + "D": "When administering lidocaine, epinephrine, or vasopressin via the endotracheal tube, the dose should be diluted in 10 mL or normal saline or sterile water." + }, + "zh": { + "question": "关于药物给药的替代途径，下列哪项是正确的？", + "A": "不应在儿童中尝试骨内（IO）通路。", + "B": "通过气管插管给药时应与静脉/骨内给药相同剂量。", + "C": "通过气管插管给药时不需要停止心肺复苏（CPR）。", + "D": "通过气管插管给药利多卡因、肾上腺素或加压素时，剂量应稀释在10毫升生理盐水或无菌水中。" + } + }, + { + "id": "ed45e887-c68e-5caa-ba2a-83672bee4c4f", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "28. A patient presents with complaints of slight light-headedness as well as palpitations. ECG is obtained, and it is noted that he has a narrow complex (QRS <0.12 s), monomorphic, regular rhythm. Which of the following is/are indicated?", + "A": "Vagal maneuver", + "B": "β-Blocker or calcium channel blocker", + "C": "Adenosine", + "D": "All of the above" + }, + "zh": { + "question": "28. 一名患者出现轻微头晕和心悸的症状。进行心电图检查，发现他有窄QRS波群（QRS <0.12秒）、单形、规则的心律。以下哪项是适应症？", + "A": "迷走神经刺激", + "B": "β-受体阻滞剂或钙通道阻滞剂", + "C": "腺苷", + "D": "以上全部" + } + }, + { + "id": "59b5afe1-1627-50e8-833e-01d88eb45dbf", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are considered goals for in the management of acute coronary syndrome in the setting of ST-segment elevation myocardial infarction (STEMI) EXCEPT?", + "A": "Door-to-balloon time of 90 minutes for percutaneous coronary intervention (PCI)", + "B": "Door-to-needle time of 30 minutes when fibrinolysis is utilized", + "C": "Emergency room assessment of 10 minutes or less", + "D": "Complete stabilization within the emergency department before catheterization" + }, + "zh": { + "question": "在ST段抬高型心肌梗死（STEMI）情况下管理急性冠状动脉综合征的所有以下目标中，除了哪一个？", + "A": "经皮冠状动脉介入治疗（PCI）的门到球囊时间为90分钟", + "B": "使用纤溶治疗时的门到针时间为30分钟", + "C": "急诊室评估时间为10分钟或更短", + "D": "在导管插入前在急诊科内完全稳定" + } + }, + { + "id": "267908ff-fd3f-5062-8054-292434a39112", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is false regarding airway management during CPR?", + "A": "Cricoid pressure should always be applied throughout chest compressions.", + "B": "The oral pharyngeal size should be approximately the same as the distance from the tip of the patient's nose to the earlobe.", + "C": "An excessively long oropharyngeal airway (OPA) may enter the esophagus and may result in gastric distention with air during bag-mask ventilation.", + "D": "Ventilations during CPR should occur every 5-6 seconds." + }, + "zh": { + "question": "以下关于心肺复苏期间气道管理的说法中哪一项是错误的？", + "A": "在胸部按压期间应始终施加环状软骨压迫。", + "B": "口咽的大小应大致与从患者鼻尖到耳垂的距离相同。", + "C": "过长的口咽气道（OPA）可能进入食道，并可能在使用面罩通气时导致胃胀气。", + "D": "心肺复苏期间的通气应每5-6秒进行一次。" + } + }, + { + "id": "0f46c517-62f6-5b91-821c-5878734603a2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following coronary arteries is located in the posterior interventricular groove?", + "A": "Left anterior descending coronary artery", + "B": "Right coronary artery", + "C": "Posterior interventricular (descending) coronary artery (PDA)", + "D": "Left circumflex coronary artery" + }, + "zh": { + "question": "以下哪一条冠状动脉位于后室间沟？", + "A": "左前降支冠状动脉", + "B": "右冠状动脉", + "C": "后室间（降）冠状动脉（PDA）", + "D": "左回旋支冠状动脉" + } + }, + { + "id": "082a7c62-0413-5486-b7e7-4613c45f39da", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The aortic valve is composed of which of the following 3 leaflets?", + "A": "Right, left, and anterior", + "B": "Right, left, and noncoronary", + "C": "Anterior, posterior, and septal", + "D": "Anterolateral, posteromedial, and septal" + }, + "zh": { + "question": "主动脉瓣由以下哪三个瓣叶组成？", + "A": "右、左和前", + "B": "右、左和无冠", + "C": "前、后和隔", + "D": "前外侧、后内侧和隔" + } + }, + { + "id": "5d294523-9bc4-5b07-b8da-067a911fffee", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A patient presents with acute severe pulmonary edema and cardiogenic shock. Transesophageal echocardiography (TEE) demonstrates a ruptured papillary muscle. Which papillary muscle is most commonly affected?", + "A": "Posteromedial", + "B": "Septal", + "C": "Noncoronary", + "D": "Anterolateral" + }, + "zh": { + "question": "一名患者出现急性严重肺���肿和心源性休克。经食道超声心动图（TEE）显示乳头肌破裂。最常受影响的乳头肌是哪一个？", + "A": "后内侧", + "B": "间隔", + "C": "无冠状动脉", + "D": "前外侧" + } + }, + { + "id": "0206fffe-46dc-5330-90fc-532590eb7e02", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 55-year-old man is undergoing coronary artery bypass grafting. The TEE shows an enlarged coronary sinus. When saline is injected into an IV line in the left upper extremity, bubbles are noted, entering the left atrium (LA) near the inferior vena cava. Which of the following conditions most likely explains the findings?", + "A": "An aberrant right coronary artery", + "B": "Anomalous pulmonary venous return", + "C": "A left-sided superior vena cava (SVC)", + "D": "A patent foramen ovale" + }, + "zh": { + "question": "一名55岁的男性正在接受冠状动脉旁路移植术。经食道超声心动图显示冠状窦扩大。当盐水注入左上肢的静脉时，观察到气泡进入左心房（LA），靠近下腔静脉。以下哪种情况最可能解释这些发现？", + "A": "异常的右冠状动脉", + "B": "异常的肺静脉回流", + "C": "左侧上腔静脉（SVC）", + "D": "卵圆孔未闭" + } + }, + { + "id": "8329f640-2168-5f66-bfcc-db46c9b209ae", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "35. Which of the following structures is responsible for the conduction of impulses from the right atrium to the LA?", + "A": "Purkinje fibers", + "B": "Bundle of His", + "C": "Left bundle branch", + "D": "Bachmann bundle" + }, + "zh": { + "question": "35. 下列哪种结构负责将冲动从右心房传导到左心房？", + "A": "浦肯野纤维", + "B": "希氏束", + "C": "左束支", + "D": "巴赫曼束" + } + }, + { + "id": "1e0fc152-7550-5215-b072-00d46909a7ab", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 79-year-old man is scheduled to undergo lumbar laminectomy for spinal stenosis. His medical history is significant for aortic stenosis, with a valve area of 0.9 cm2 and a mean gradient of 45 mm Hg. Which of the following vasoactive agents would be most beneficial to this patient?", + "A": "Dopamine", + "B": "Phenylephrine", + "C": "Hydralazine", + "D": "Nitroglycerin" + }, + "zh": { + "question": "一名79岁的男性计划接受腰椎椎板切除术以治疗脊柱狭窄。他的病史中有主动脉瓣狭窄，瓣膜面积为0.9 cm²，平均梯度为45 mm Hg。以下哪种血管活性药物对该患者最有益？", + "A": "多巴胺", + "B": "去氧肾上腺素", + "C": "肼屈嗪", + "D": "硝酸甘油" + } + }, + { + "id": "58f4a919-b2da-549f-80ab-5c2e5e8fe285", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "41. Which of the following is the MOST accurate description of perfusion of the left and right sides of the heart in a normal healthy adult?", + "A": "Both the left and right sides of the heart are perfused during both systole and diastole.", + "B": "Both the left and right sides of the heart are perfused during diastole only.", + "C": "The left side of the heart is perfused during both systole and diastole; the right side of the heart is perfused during systole only.", + "D": "The left side of the heart is perfused during diastole only; the right side of the heart is perfused during both systole and diastole." + }, + "zh": { + "question": "41. 以下哪项是对正常健康成人心脏左右两侧灌注的最准确描述？", + "A": "心脏的左右两侧在收缩期和舒张期都得到灌注。", + "B": "心脏的左右两侧仅在舒张期得到灌注。", + "C": "心脏的左侧在收缩期和舒张期都得到灌注；心脏的右侧仅在收缩期得到灌注。", + "D": "心脏的左侧仅在舒张期得到灌注；心脏的右侧在收缩期和舒张期都得到灌注。" + } + }, + { + "id": "95722958-fb3d-5b11-b699-9b54b61d5e25", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "In a patient with severe pulmonary hypertension (HTN), use of which of the following agents would best preserve perfusion to the right side of the heart", + "A": "Milrinone", + "B": "Vasopressin", + "C": "Dobutamine", + "D": "Phenylephrine" + }, + "zh": { + "question": "在患有严重肺动脉高压（HTN）的患者中，使用以下哪种药物最能保持右心的灌注？", + "A": "米力农", + "B": "加压素", + "C": "多巴酚丁胺", + "D": "苯肾上腺素" + } + }, + { + "id": "acbc7677-9285-520c-adae-d9caf08b079f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "On a preoperative evaluation, the American College of Cardiology/American Heart Association (ACC/AHA) guidelines do NOT help direct your decisionmaking process with regard to which of the following ECG abnormalities?", + "A": "Left bundle branch block", + "B": "Atrial fibrillation with rapid ventricular response", + "C": "Mobitz type II block", + "D": "ST-elevation myocardial infarction" + }, + "zh": { + "question": "在术前评估中，美国心脏病学会/美国心脏协会（ACC/AHA）指南不帮助指导您对以下哪种心电图异常的决策过程？", + "A": "左束支传导阻滞", + "B": "伴快速心室反应的心房颤动", + "C": "莫氏II型阻滞", + "D": "ST段抬高型心肌梗死" + } + }, + { + "id": "cbfa8a95-cf2a-5285-8eb4-92d5a4bde7f9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following components of the cardiac conduction system has the FASTEST conduction velocity?", + "A": "SA node", + "B": "AV node", + "C": "His-Purkinje system", + "D": "Ventricular myocardium" + }, + "zh": { + "question": "以下哪一部分心脏传导系统的传导速度最快？", + "A": "窦房结", + "B": "房室结", + "C": "希氏-浦肯野系统", + "D": "心室肌" + } + }, + { + "id": "da551c17-2845-5cd6-8075-edb4aa0bc53f", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient who received a heart transplant 2 years ago presents for laparoscopic appendectomy. Which of the following medications should be avoided during this planned general anesthetic?", + "A": "Cisatracurium", + "B": "Vecuronium", + "C": "Neostigmine", + "D": "Glycopyrrolate" + }, + "zh": { + "question": "一名2年前接受心脏移植的患者因计划进行腹腔镜阑尾切除术就诊。在计划的全身麻醉中应避免使用以下哪种药物？", + "A": "顺式阿曲库铵", + "B": "维库溴铵", + "C": "新斯的明", + "D": "氢溴酸格隆溴铵" + } + }, + { + "id": "360b5ce7-467d-54aa-a2ac-81d7b1fe0905", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In a normal CVP tracing, where does the tricuspid valve close?", + "A": "Between the a-wave and c-wave", + "B": "At the peak of the c-wave", + "C": "Between the c-wave and x-descent", + "D": "Between the x-descent and v-wave" + }, + "zh": { + "question": "在正常的中心静脉压波形中，三尖瓣何时关闭？", + "A": "在a波和c波之间", + "B": "在c波的峰值处", + "C": "在c波和x下降之间", + "D": "在x下降和v波之间" + } + }, + { + "id": "30e0cf97-bd9e-5d9d-a5bf-ee9caf0fed0d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The V5 ECG lead is MOST SENSITIVE for detecting which of the following?", + "A": "Atrial fibrillation", + "B": "Anteroseptal ischemia", + "C": "Lateral wall ischemia", + "D": "Conduction abnormalities" + }, + "zh": { + "question": "V5导联的心电图最敏感于检测以下哪一项？", + "A": "心房颤动", + "B": "前间隔缺血", + "C": "侧壁缺血", + "D": "传导异常" + } + }, + { + "id": "a25c919c-0522-5a8f-9173-fd86626dbaf9", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following cardiac abnormalities would be MOST LIKELY to benefit from relative tachycardia?", + "A": "Aortic stenosis", + "B": "Mitral regurgitation", + "C": "Hypertrophic obstructive cardiomyopathy (HOCM)", + "D": "Unstable angina" + }, + "zh": { + "question": "以下哪种心脏异常最有可能从相对心动过速中受益？", + "A": "主动脉瓣狭窄", + "B": "二尖瓣返流", + "C": "肥厚型梗阻性心肌病 (HOCM)", + "D": "不稳定型��绞痛" + } + }, + { + "id": "934665f6-da70-53da-956a-12f0b0c526dd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is the \"agent of choice\" for treatment of tachyarrhythmias associated with Wolff-Parkinson-White?", + "A": "Metoprolol", + "B": "Verapamil", + "C": "Carvedilol", + "D": "Procainamide" + }, + "zh": { + "question": "以下哪种是治疗与沃尔夫-帕金森-怀特综合征相关的心动过速性心律失常的“首选药物”？", + "A": "美托洛尔", + "B": "维拉帕米", + "C": "卡维地洛", + "D": "普鲁卡因胺" + } + }, + { + "id": "ad85c279-eff1-59c5-a20d-be846fe2421f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is NOT considered a \"cyanotic\" heart lesion?", + "A": "Truncus arteriosus", + "B": "Pulmonic stenosis", + "C": "Tricuspid atresia", + "D": "Total anomalous pulmonary venous return" + }, + "zh": { + "question": "以下哪一项不被认为是“发绀型”心脏病变？", + "A": "动脉干", + "B": "肺动脉狭窄", + "C": "三尖瓣闭锁", + "D": "完全性肺静脉异位引流" + } + }, + { + "id": "abb8d19a-e997-500a-9cc5-edc588d54d3d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "52. Which of the following is LEAST LIKELY to be a complication of a transcatheter aortic valve replacement?", + "A": "Complete heart block", + "B": "Pneumothorax", + "C": "Cardiac tamponade", + "D": "Embolic stroke" + }, + "zh": { + "question": "52. 以下哪一项最不可能是经导管主动脉瓣置换术的并发症？", + "A": "完全性心脏传导阻滞", + "B": "气胸", + "C": "心脏压塞", + "D": "栓塞性中风" + } + }, + { + "id": "f8c71180-5d94-51fc-97c7-fbfc021e4d0f", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A patient with long-standing HTN and normally well-managed congestive heart failure is also found to have bilateral coarse rales on lung examination. He admits that he went to a wedding and had a dietary indiscretion, which is very rare for him. Which of the following is most likely true?", + "A": "| Volume overload | Transient | Noncompliant ventricle | Permanent |", + "B": "| Volume overload | Permanent | Noncompliant ventricle | Transient |", + "C": "| Noncompliant ventricle | Transient | Volume overload | Transient |", + "D": "| Noncompliant ventricle | Permanent | Volume overload | Permanent |" + }, + "zh": { + "question": "一位长期患有高血压且充血性心力衰竭通常控制良好的患者，在肺部检查中发现有双侧粗啰音。他承认自己参加了一场婚礼，并在饮食上有不当行为，这对他来说非常罕见。以下哪项最有可能是真的？", + "A": "| 容量超负荷 | 短暂的 | 不顺应的心室 | 永久的 |", + "B": "| 容量超负荷 | 永久的 | 不顺应的心室 | 短暂的 |", + "C": "| 不顺应的心室 | 短暂的 | 容量超负荷 | 短暂的 |", + "D": "| 不顺应的心室 | 永久的 | 容量超负荷 | 永久的 |" + } + }, + { + "id": "af6faa5c-f2ae-5320-85bc-30101b140df8", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is the MOST UNLIKELYcause of myocardial ischemia?", + "A": "Severe tachycardia", + "B": "Severe hypotension", + "C": "Severe anemia", + "D": "Severe hypokalemia" + }, + "zh": { + "question": "以下哪一项最不可能导致心肌缺血？", + "A": "严重的心动过速", + "B": "严重的低血压", + "C": "严重的贫血", + "D": "严重的低钾血症" + } + }, + { + "id": "9acac981-dc89-5da4-8383-e6ee53eba163", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is false regarding heart failure with preserved ejection fraction (HFpEF)?", + "A": "The most sensitive test of adequacy of tissue perfusion is mixed venous O2 saturation at rest.", + "B": "The most common causes of HFpEF in the United Sates are chronic HTN and aortic stenosis.", + "C": "Diagnosis of HFpEF requires echocardiography with Doppler.", + "D": "Atrial systole contributes relatively more to the left ventricular end diastolic volume (LVEDV) in patients with HFpEF than it does to those with normal ventricular function." + }, + "zh": { + "question": "以下关于射血分数保留的心力衰竭（HFpEF）的说法哪项是错误的？", + "A": "评估组织灌注充分性的最敏感测试是在静息状态下的混合静脉氧饱和度。", + "B": "在美国，HFpEF的最常见原因是慢性高血压和主动脉瓣狭窄。", + "C": "HFpEF的诊断需要使用多普勒超声心动图。", + "D": "在HFpEF患者中，心房收缩对左心室舒张末期容积（LVEDV）的贡献相对于正常心室功能的患者更大。" + } + }, + { + "id": "f7fdedcc-f38d-5074-9115-5d5650e399c1", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is false regarding heart rate in normal healthy adults?", + "A": "Cholinergic slowing of heart rate occurs via M2 muscarinic receptors.", + "B": "Factors that decrease the rate of SA node depolarization increase the likelihood that the pacemaker of the heart will become located at the AV junction.", + "C": "The normal intrinsic rate of the SA node increases over time.", + "D": "β1-Adrenergic stimulation increases the rate of phase 4 depolarization." + }, + "zh": { + "question": "以下关于正常健康成人心率的说法哪一项是错误的？", + "A": "通过M2毒蕈碱受体发生胆碱能心率减慢。", + "B": "降低窦房结去极化速率的因素增加了心脏起搏点位于房室交界处的可能性。", + "C": "窦房结的正常固有频率随时间增加。", + "D": "β1-肾上腺素能刺激增加第4相去极化的速率。" + } + }, + { + "id": "8b9c3fe4-42fe-5a37-903e-6f77a50dc1ef", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When the surgeon requests for the patient be placed in the \"reverse Trendelenburg\" position, which of the following is the PRIMARY parameter initially affected?", + "A": "Systemic afterload", + "B": "Venous return", + "C": "Myocardial inotropy", + "D": "Cerebral perfusion" + }, + "zh": { + "question": "当外科医生要求将患者置于“反Trendelenburg”体位时，以下哪一项是最初受到主要影响的参数？", + "A": "全身后负荷", + "B": "静脉回流", + "C": "心肌收缩力", + "D": "脑灌注" + } + }, + { + "id": "4425c3c4-f0ee-51b5-87df-209e85684de7", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "58. You are about to induce anesthesia in a 38-year-old man with HOCM. Which of the following options should be your goals with regard to preload, afterload, rate, rhythm, and contractility?", + "A": "| PRELOAD Increased | AFTERLOAD Increased | RATE Normal | RHYTHM Sinus | CONTRACTILITY Depressed |", + "B": "| PRELOAD Increased | AFTERLOAD Decreased | RATE Decreased | RHYTHM Sinus | CONTRACTILITY Increased |", + "C": "| PRELOAD Decreased | AFTERLOAD Increased | RATE Decreased | RHYTHM Sinus | CONTRACTILITY Depressed |", + "D": "| PRELOAD Decreased | AFTERLOAD Decreased | RATE Increased | RHYTHM Sinus | CONTRACTILITY Increased |" + }, + "zh": { + "question": "58. 你即将对一名38岁的HOCM男性患者进行麻醉诱导。以下选项中，哪一项应该是你在前负荷、后负荷、心率、心律和心肌收缩力方面的目标？", + "A": "| 前负荷 增加 | 后负荷 增加 | 心率 正常 | 心律 窦性 | 心肌收缩力 减弱 |", + "B": "| 前负荷 增加 | 后负荷 减少 | 心率 减慢 | 心律 窦性 | 心肌收缩力 增强 |", + "C": "| 前负荷 减少 | 后负荷 增加 | 心率 减慢 | 心律 窦性 | 心肌收缩力 减弱 |", + "D": "| 前负荷 减少 | 后负荷 减少 | 心率 增快 | 心律 窦性 | 心肌收缩力 增强 |" + } + }, + { + "id": "4ba8ba4d-c9c0-5299-9aea-05298f5e3f62", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Which of the following conditions is MOST sensitive to loss of the \"atrial kick\"?", + "A": "Mitral regurgitation", + "B": "Aortic insufficiency", + "C": "Mitral stenosis", + "D": "Diastolic dysfunction" + }, + "zh": { + "question": "以下哪种情况对“心房收缩”丧失最为敏感？", + "A": "二尖瓣关闭不全", + "B": "主动脉关闭不全", + "C": "二尖瓣狭窄", + "D": "舒张功能障碍" + } + }, + { + "id": "dd94d180-a557-58fd-b2cc-6ad87901c31a", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is false regarding mitral stenosis?", + "A": "Hyperdynamic states, such as sepsis, can lead to pulmonary edema.", + "B": "Pulmonary capillary wedge pressure approximates left ventricular end-diastolic pressure (LVEDP).", + "C": "The progression of disease includes right ventricular hypertrophy and dysfunction.", + "D": "Medical management of mitral stenosis includes use of β-blockers and calcium channel blockers." + }, + "zh": { + "question": "关于二尖瓣狭窄，下列哪项是错误的？", + "A": "高动力状态，如败血症，可导致肺水肿。", + "B": "肺毛细血管楔压接近左心室舒张末期压力（LVEDP）。", + "C": "疾病的进展包括右心室肥厚和功能障碍。", + "D": "二尖瓣狭窄的药物管理包括使用β受体阻滞剂和钙通道阻滞剂。" + } + }, + { + "id": "5802cac7-1dc7-5c41-aeb5-d876de59f9ab", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What percentage of hepatic blood flow comes from the portal vein?", + "A": "25%", + "B": "50%", + "C": "75%", + "D": "90%" + }, + "zh": { + "question": "肝脏血流量中有多少百分比来自门静脉？", + "A": "25%", + "B": "50%", + "C": "75%", + "D": "90%" + } + }, + { + "id": "c54e1f2b-bbce-57da-bbad-a608629561a4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What percentage of oxygen delivery to the liver comes from the hepatic artery?", + "A": "25%", + "B": "50%", + "C": "75%", + "D": "90%" + }, + "zh": { + "question": "肝动脉提供给肝脏的氧气占总氧气供应的百分比是多少？", + "A": "25%", + "B": "50%", + "C": "75%", + "D": "90%" + } + }, + { + "id": "a62536f1-8517-53c9-b5bc-ad57fd301975", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Hepatomegaly may be observed in all of the following conditions EXCEPT which one?", + "A": "Congestive heart failure", + "B": "Hypovolemic shock", + "C": "Leukemia", + "D": "Renal failure" + }, + "zh": { + "question": "下列哪种情况不会出现肝肿大？", + "A": "充血性心力衰竭", + "B": "低血容量性休克", + "C": "白血病", + "D": "肾衰竭" + } + }, + { + "id": "05ac8484-e000-5207-9231-5aee7b7a38bf", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The round ligament separates which 2 hepatic segments?", + "A": "1 and 2", + "B": "2 and 3", + "C": "3 and 4", + "D": "4 and 5" + }, + "zh": { + "question": "圆韧带分隔了哪两个肝段？", + "A": "1和2", + "B": "2和3", + "C": "3和4", + "D": "4和5" + } + }, + { + "id": "4a78dc65-d5d7-5755-b4a0-0fafb7020635", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following signaling factors is decreased in a cirrhotic liver?", + "A": "Nitric oxide", + "B": "Endothelin", + "C": "Norepinephrine", + "D": "Thromboxane A2" + }, + "zh": { + "question": "在肝硬化的肝脏中，以下哪种信号因子减少？", + "A": "一氧化氮", + "B": "内皮素", + "C": "去甲肾上腺素", + "D": "血栓素A2" + } + }, + { + "id": "d725bd35-f37d-57c9-925b-94cecc9758ad", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "6. Compared with the hepatic artery, which statement about portal vein is true?", + "A": "Portal vein supplies 50% of the liver's overall blood flow.", + "B": "Portal vein is a low-pressure/low-resistance system.", + "C": "Portal vein blood is richly oxygenated.", + "D": "Portal vein supplies 75% of the liver's overall oxygen delivery." + }, + "zh": { + "question": "6. 与肝动脉相比，关于门静脉的哪个说法是正确的？", + "A": "门静脉提供肝脏50%的总血流量。", + "B": "门静脉是一个低压/低阻力系统。", + "C": "门静脉血液富含氧气。", + "D": "门静脉提供肝脏75%的总氧气输送。" + } + }, + { + "id": "03287ed4-346a-5630-a319-ce084d8c4f12", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Increase in the serum level of which of the following may be observed in liver failure?", + "A": "IgG", + "B": "Factor VII", + "C": "Albumin", + "D": "Ammonia" + }, + "zh": { + "question": "在肝功能衰竭中，以下哪一项的血清水平可能会升高？", + "A": "IgG", + "B": "凝血因子VII", + "C": "白蛋白", + "D": "氨" + } + }, + { + "id": "e893eec1-777c-5c26-8d6c-d61c220f0254", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Glucose is synthesized in the liver as the result of all of the following processes EXCEPT which one?", + "A": "Glycogenolysis", + "B": "Gluconeogenesis", + "C": "Tricarboxylic acid cycle", + "D": "Oxidation of lactate" + }, + "zh": { + "question": "在肝脏中，葡萄糖的合成是以下所有过程的结果，除了哪一个？", + "A": "糖原分解", + "B": "糖异生", + "C": "三羧酸循环", + "D": "乳酸氧化" + } + }, + { + "id": "15cf3859-1f54-57fd-a79c-b5e99c04d636", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In the assessment of patient with liver failure, which parameter is used in the MELD (model for end-stage liver disease) scoring system but NOT the Child-Pugh scoring system?", + "A": "Creatinine", + "B": "International normalized ratio (INR)", + "C": "Bilirubin", + "D": "Albumin" + }, + "zh": { + "question": "在评估肝功能衰竭患者时，MELD（终末期肝病模型）评分系统使用了哪个参数，而Child-Pugh评分系统没有使用？", + "A": "肌酐", + "B": "国际标准化比值（INR）", + "C": "胆红素", + "D": "白蛋白" + } + }, + { + "id": "66e8a183-22ae-57b6-a950-2b68f3b45ff4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Elevation in the serum level of which factor is a specific marker of acute liver injury?", + "A": "Aspartate aminotransferase (AST)", + "B": "Alanine aminotransferase (ALT)", + "C": "Alkaline phosphatase", + "D": "Lactate dehydrogenase (LDH)" + }, + "zh": { + "question": "血清中哪种因子的升高是急性肝损伤的特异性标志？", + "A": "天冬氨酸氨基转移酶 (AST)", + "B": "丙氨酸氨基转移酶 (ALT)", + "C": "碱性磷酸酶", + "D": "乳酸脱氢酶 (LDH)" + } + }, + { + "id": "d099fe56-4855-5fdc-95b8-0bb18b951461", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which laboratory test is a sensitive indicator for decreased synthetic function of the liver?", + "A": "Aspartate aminotransferase", + "B": "Albumin", + "C": "International normalized ratio", + "D": "γ-Glutamyl transpeptidase (GGT)" + }, + "zh": { + "question": "哪项实验室检查是肝脏合成功能下降的敏感指标？", + "A": "天冬氨酸氨基转移酶", + "B": "白蛋白", + "C": "国际标准化比值", + "D": "γ-谷氨酰转肽酶（GGT）" + } + }, + { + "id": "5c22413b-0b8d-5825-b20f-8987f0f7be7b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A liver failure patient may show all of the following clinical signs EXCEPT which one?", + "A": "Jaundice", + "B": "Easy bruising", + "C": "Confusion", + "D": "Hyperglycemia" + }, + "zh": { + "question": "肝功能衰竭患者可能出现以下所有临床症状，除了哪一个？", + "A": "黄疸", + "B": "容易瘀伤", + "C": "意识混乱", + "D": "高血糖" + } + }, + { + "id": "21ad81ec-c414-5ff7-9084-7dcc69eca92c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The level of which coagulation factor may not be affected by advanced liver disease?", + "A": "II", + "B": "V", + "C": "VII", + "D": "VIII" + }, + "zh": { + "question": "哪种凝血因子的水平可能不受晚期肝病的影响？", + "A": "II", + "B": "V", + "C": "VII", + "D": "VIII" + } + }, + { + "id": "9cdc906d-1a75-5039-b7a9-cbb45dad5430", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "14. A patient with an elevated total serum bilirubin and an elevated indirect serum bilirubin may have which of the following conditions?", + "A": "Gilbert syndrome", + "B": "Primary biliary cirrhosis", + "C": "Primary sclerosing cholangitis", + "D": "Wilson disease" + }, + "zh": { + "question": "14. 一名患者的总血清胆红素升高和间接血清胆红素升高，可能患有以下哪种疾病？", + "A": "Gilbert 综合征", + "B": "原发性胆汁性肝硬化", + "C": "原发性硬化性胆管炎", + "D": "Wilson 病" + } + }, + { + "id": "d8931793-2391-54a9-a3ee-c57dac39cd10", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the mechanism by which lactulose relieves symptoms of hepatic encephalopathy?", + "A": "Inhibition of hepatic ammonia production", + "B": "Increasing the conversion of ammonia to urea", + "C": "Acidification of the colon", + "D": "Diuresis to decrease intracranial pressure" + }, + "zh": { + "question": "以下哪项是乳果糖缓解肝性脑病症状的机制？", + "A": "抑制肝脏氨的产生", + "B": "增加氨转化为尿素的过程", + "C": "结肠酸化", + "D": "利尿以降低颅内压" + } + }, + { + "id": "6765f344-32cf-5234-b788-62793909b5a1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Metabolism and clearance of morphine may be increased in which of the following situations?", + "A": "Congestive heart failure", + "B": "Inhaled anesthetics", + "C": "Intra-abdominal surgery", + "D": "Sepsis" + }, + "zh": { + "question": "在以下哪种情况下，吗啡的代谢和清除可能会增加？", + "A": "充血性心力衰竭", + "B": "吸入麻醉剂", + "C": "腹腔手术", + "D": "败血症" + } + }, + { + "id": "048cc8b5-4f65-5659-b039-b8efec3bd577", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The clearance of which of the following drugs through the liver is NOT dependent on liver blood flow?", + "A": "Propofol", + "B": "Morphine", + "C": "Fentanyl", + "D": "Midazolam" + }, + "zh": { + "question": "以下哪种药物通过肝脏的清除不依赖于肝血流？", + "A": "丙泊酚", + "B": "吗啡", + "C": "芬太尼", + "D": "咪达唑仑" + } + }, + { + "id": "e0408564-e497-5016-838a-d90a978ac5dd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Inducers of cytochrome P450 system include all of the following EXCEPT which one?", + "A": "Ethanol", + "B": "Phenytoin", + "C": "Isoniazid", + "D": "Rifampin" + }, + "zh": { + "question": "以下哪一项不是细胞色素P450系统的诱导剂？", + "A": "乙醇", + "B": "苯妥英", + "C": "异烟肼", + "D": "利福平" + } + }, + { + "id": "dfb63db2-dbd4-5129-8517-e2d714ad84e4", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 60-year-old man who has just been listed for a liver transplant remains overly sedated for 24 hours after being administered midazolam 4 mg IV. What other medication might he be taking at the same time?", + "A": "Erythromycin", + "B": "Penicillin", + "C": "Gentamicin", + "D": "Vancomycin" + }, + "zh": { + "question": "一名60岁的男性刚被列入肝移植名单，在静脉注射4毫克咪达唑仑后，过度镇静持续了24小时。他可能同时服用了哪种药物？", + "A": "红霉素", + "B": "青霉素", + "C": "庆大霉素", + "D": "万古霉素" + } + }, + { + "id": "28d37126-1d53-5a7b-8126-26acd2d5cf8d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A patient with deactivating mutation in the cytochrome P450 2D6 gene may have ineffective analgesia from which of the following opioids?", + "A": "Morphine", + "B": "Codeine", + "C": "Fentanyl", + "D": "Methadone" + }, + "zh": { + "question": "具有细胞色素P450 2D6基因失活突变的患者可能对以下哪种阿片类药物无效？", + "A": "吗啡", + "B": "可待因", + "C": "芬太尼", + "D": "美沙酮" + } + }, + { + "id": "67e06cd2-9541-5061-b81c-b7930cae2788", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the approximate glomerular filtration rate (GFR) in a patient with normal renal function?", + "A": "10 mL/min", + "B": "125 mL/min", + "C": "500 mL/min", + "D": "1000 mL/min" + }, + "zh": { + "question": "在肾功能正常的患者中，近似的肾小球滤过率（GFR）是多少？", + "A": "10 mL/min", + "B": "125 mL/min", + "C": "500 mL/min", + "D": "1000 mL/min" + } + }, + { + "id": "d47389af-bcc1-548b-af1b-3126a6317b01", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following tissues has the highest oxygen extraction ratio in the body?", + "A": "Renal medulla", + "B": "Cardiac myocytes", + "C": "Neurons", + "D": "Hepatocytes" + }, + "zh": { + "question": "以下哪种组织在体内具有最高的氧提取率？", + "A": "肾髓质", + "B": "心肌细胞", + "C": "神经元", + "D": "肝细胞" + } + }, + { + "id": "f1bb30d5-4b0c-51e5-bbf2-a33baf2be790", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following factors will increase sodium resorption in the proximal tubule?", + "A": "Increased blood pressure", + "B": "Increased extracellular volume", + "C": "High salt intake", + "D": "Angiotensin II" + }, + "zh": { + "question": "下列哪项因素会增加近端小管的钠重吸收？", + "A": "血压升高", + "B": "细胞外液量增加", + "C": "高盐摄入", + "D": "血管紧张素 II" + } + }, + { + "id": "f5c09835-f5b9-56f4-a0f9-1d4660c60744", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Sodium reabsorption in the distal nephron (connecting the segment and", + "A": "Aldosterone", + "B": "Angiotensin II", + "C": "Vasopressin", + "D": "Renin" + }, + "zh": { + "question": "远曲小管（连接段和）中的钠重吸收", + "A": "醛固酮", + "B": "血管紧张素 II", + "C": "加压素", + "D": "肾素" + } + }, + { + "id": "24df18b2-9733-5c85-8ae1-056b22d12d42", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "An increase in which of the following will decrease the GFR?", + "A": "Renal blood flow (RBF)", + "B": "Afferent arteriolar pressure", + "C": "Efferent arteriolar pressure", + "D": "Plasma osmotic pressure" + }, + "zh": { + "question": "以下哪项增加会降低肾小球滤过率（GFR）？", + "A": "肾血流量（RBF）", + "B": "入球小动脉压力", + "C": "出球小动脉压力", + "D": "血浆渗透压" + } + }, + { + "id": "bba94c6b-8526-5739-9abe-9d3bf315d15b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "6. Sympathetic stimulation increases sodium and water retention through which of the following mechanisms?", + "A": "Increased Na + /H2O reabsorption in the nephron", + "B": "Vasoconstriction leading to decreased net filtration", + "C": "Activation of the renin-angiotensin-aldosterone system (RAAS)", + "D": "All of the above" + }, + "zh": { + "question": "6. 交感神经刺激通过以下哪种机制增加钠和水的潴留？", + "A": "增加肾单位中的Na+/H2O重吸收", + "B": "血管收缩导致净滤过减少", + "C": "激活肾素-血管紧张素-醛固酮系统（RAAS）", + "D": "以上所有" + } + }, + { + "id": "e74d08cf-6cf0-5ece-b604-c443c92e2534", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is true of renal function and aging?", + "A": "Production of vitamin D is preserved in the aging kidney.", + "B": "Progressive decline in renal function begins to occur at 30-40 years of age.", + "C": "Serum creatinine tends to rise with age.", + "D": "GFR is preserved in healthy adults at the age of 80 years." + }, + "zh": { + "question": "以下关于肾功能���衰老的说法哪一项是正确的？", + "A": "老年肾脏的维生素D生成能力得以保留。", + "B": "肾功能的逐渐下降始于30-40岁。", + "C": "血清肌酐水平随着年龄增长而上升。", + "D": "健康成人在80岁时肾小球滤过率得以保留。" + } + }, + { + "id": "8d7ac41c-9c1b-57b1-a67f-2f2114d45c0f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following situations meets criteria for stage 3 acute kidney injury (AKI) according to the Acute Kidney Injury Network (AKIN) classifications?", + "A": "Creatinine rise from 0.8 to 1.5", + "B": "Creatinine rise from 4.1 to 4.3", + "C": "Commencement of renal replacement therapy", + "D": "Urine output of 40 mL/h for a 70-kg man" + }, + "zh": { + "question": "根据急性肾损伤网络（AKIN）分类，以下哪种情况符合3期急性肾损伤（AKI）的标准？", + "A": "肌酐从0.8升高到1.5", + "B": "肌酐从4.1升高到4.3", + "C": "开始肾脏替代治疗", + "D": "70公斤男性尿量为40毫升/小时" + } + }, + { + "id": "c13f75bb-cdca-5dce-80c5-9a886a338793", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "RBF represents what fraction of cardiac output?", + "A": "10%", + "B": "25%", + "C": "40%", + "D": "50%" + }, + "zh": { + "question": "RBF代表心输出量的多少百分比？", + "A": "10%", + "B": "25%", + "C": "40%", + "D": "50%" + } + }, + { + "id": "06348ebd-b381-5269-ad6c-a303ab46ae53", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following classes of drugs is known to raise serum creatinine by decreasing tubular secretion?", + "A": "Cimetidine", + "B": "Cephalosporins", + "C": "Vitamin D", + "D": "Aminoglycosides" + }, + "zh": { + "question": "以下哪类药物通过减少肾小管分泌而已知会升高血清肌酐？", + "A": "西咪替丁", + "B": "头孢菌素", + "C": "维生素D", + "D": "氨基糖苷类" + } + }, + { + "id": "7a3ce04e-5cb3-56f1-99ce-fc6acfcfc248", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A patient is admitted to the surgical ICU following a motor vehicle accident and is now status post an open splenectomy with massive hemorrhage. Which of the following sets of laboratory indices is most consistent with a diagnosis of prerenal AKI, assuming a serum sodium of 140 mEq/L and a urine creatinine of 50 mg/dL?", + "A": "| Cr 2.1(mg/dL) | BLOOD UREA NITROGEN 30(mg/dL) | Urine 40 + Na (mEq/L) | URINE OSMOLALITY 300(mOsm/L) |", + "B": "| Cr 2.1(mg/dL) | BLOOD UREA NITROGEN 45(mg/dL) | Urine 40 + Na (mEq/L) | URINE OSMOLALITY 200(mOsm/L) |", + "C": "| Cr 2.1(mg/dL) | BLOOD UREA NITROGEN 30(mg/dL) | Urine 14 + Na (mEq/L) | URINE OSMOLALITY 400(mOsm/L) |", + "D": "| Cr 2.1(mg/dL) | BLOOD UREA NITROGEN 45(mg/dL) | Urine 14 + Na (mEq/L) | URINE OSMOLALITY 800(mOsm/L) |" + }, + "zh": { + "question": "一名患者在发生机动车事故后被送入外科ICU，目前处于开放性脾切除术后伴有大量出血状态。假设血清钠为140 mEq/L，尿肌酐为50 mg/dL，以下哪组实验室指标最符合肾前性急性肾损伤的诊断？", + "A": "| Cr 2.1(mg/dL) | 血尿素氮 30(mg/dL) | 尿 40 + Na (mEq/L) | 尿渗透压 300(mOsm/L) |", + "B": "| Cr 2.1(mg/dL) | 血尿素氮 45(mg/dL) | 尿 40 + Na (mEq/L) | 尿渗透压 200(mOsm/L) |", + "C": "| Cr 2.1(mg/dL) | 血尿素氮 30(mg/dL) | 尿 14 + Na (mEq/L) | 尿渗透压 400(mOsm/L) |", + "D": "| Cr 2.1(mg/dL) | 血尿素氮 45(mg/dL) | 尿 14 + Na (mEq/L) | 尿渗透压 800(mOsm/L) |" + } + }, + { + "id": "8abf576f-873b-521b-8856-e78d29494f8d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "12. What percentage of the kidney's nephrons must be affected to see a rise in serum creatinine?", + "A": "25%", + "B": "50%", + "C": "75%", + "D": "90%" + }, + "zh": { + "question": "12. 肾脏多少百分比的肾单位受损会导致血清肌酐升高？", + "A": "25%", + "B": "50%", + "C": "75%", + "D": "90%" + } + }, + { + "id": "092ffc73-3572-5ef0-acc6-386caf36723f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Where is angiotensinogen produced?", + "A": "Kidney", + "B": "Lung", + "C": "Liver", + "D": "Muscle" + }, + "zh": { + "question": "血管紧张素原在哪里产生？", + "A": "肾脏", + "B": "肺", + "C": "肝脏", + "D": "肌肉" + } + }, + { + "id": "993619b7-a947-58ae-b287-3bcf58f5be87", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following substances is principally responsible for renal vasodilation in the face of surgical stress?", + "A": "Nitric oxide", + "B": "Prostaglandins", + "C": "Endothelial-derived hyperpolarizing factor", + "D": "Atrial natriuretic peptide (ANP)" + }, + "zh": { + "question": "以下哪种物质在手术应激时主要负责肾血管扩张？", + "A": "一氧化氮", + "B": "前列腺素", + "C": "内皮源性超极化因子", + "D": "心房利钠肽（ANP）" + } + }, + { + "id": "66490fcf-08ee-530c-989b-8ce53e15868b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Release of which of the following substances is most likely to lead to postoperative hyponatremia?", + "A": "Angiotensin II", + "B": "Aldosterone", + "C": "Renin", + "D": "Vasopressin" + }, + "zh": { + "question": "以下哪种物质的释放最有可能导致术后低钠血症？", + "A": "血管紧张素 II", + "B": "醛固酮", + "C": "肾素", + "D": "加压素" + } + }, + { + "id": "f8f9d032-eba2-5279-b717-0eb7b4612bf9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the net effect of angiotensin II on the glomerular arterioles and RBF?", + "A": "| AFFERENT ARTERIOLE Vasodilation | EFFERENT ARTERIOLE Vasodilation | RENAL BLOOD FLOW Increased |", + "B": "| AFFERENT ARTERIOLE Vasodilation | EFFERENT ARTERIOLE Vasoconstriction | RENAL BLOOD FLOW Increased |", + "C": "| AFFERENT ARTERIOLE Vasoconstriction | EFFERENT ARTERIOLE Vasodilation | RENAL BLOOD FLOW Decreased |", + "D": "| AFFERENT ARTERIOLE Vasoconstriction | EFFERENT ARTERIOLE Vasoconstriction | RENAL BLOOD FLOW Decreased |" + }, + "zh": { + "question": "血管紧张素II对肾小球动脉和肾血流量的净效应是什么？", + "A": "| 入球小动脉 扩张 | 出球小动脉 扩张 | 肾血流量 增加 |", + "B": "| 入球小动脉 扩张 | 出球小动脉 收缩 | 肾血流量 增加 |", + "C": "| 入球小动脉 收缩 | 出球小动脉 扩张 | 肾血流量 减少 |", + "D": "| 入球小动脉 收缩 | 出球小动脉 收缩 | 肾血流量 减少 |" + } + }, + { + "id": "52cf6ead-ad84-52ff-92aa-8d3642654b71", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the net effect of ANP on the glomerular arterioles, RBF, and GFR?", + "A": "| AFFERENT ARTERIOLE Vasodilation | EFFERENT ARTERIOLE Vasodilation | RENAL BLOOD FLOW Increased | RENAL BLOOD FLOW Unchanged |", + "B": "| AFFERENT ARTERIOLE Vasodilation | EFFERENT ARTERIOLE Vasoconstriction | RENAL BLOOD FLOW Increased | RENAL BLOOD FLOW Increased |", + "C": "| AFFERENT ARTERIOLE Vasoconstriction | EFFERENT ARTERIOLE Vasodilation | RENAL BLOOD FLOW Decreased | RENAL BLOOD FLOW Decreased |", + "D": "| AFFERENT ARTERIOLE Vasoconstriction | EFFERENT ARTERIOLE Vasoconstriction | RENAL BLOOD FLOW Decreased | RENAL BLOOD FLOW Unchanged |" + }, + "zh": { + "question": "ANP对肾小球动脉、肾血流量和肾小球滤过率的净效应是什么？", + "A": "| 入球小动脉扩张 | 出球小动脉扩张 | 肾血流量增加 | 肾血流量不变 |", + "B": "| 入球小动脉扩张 | 出球小动脉收缩 | 肾血流量增加 | 肾血流量增加 |", + "C": "| 入球小动脉收缩 | 出球小动脉扩张 | 肾血流量减少 | 肾血流量减少 |", + "D": "| 入球小动脉收缩 | 出球小动脉收缩 | 肾血流量减少 | 肾血流量不变 |" + } + }, + { + "id": "906e8f64-8d29-5046-98a2-f70a540129da", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "18. Which of the following is the treatment of choice for a patient who has acutely developed hypernatremia with a urine output of 600 cc/h in the postanesthesia care unit following transphenoidal resection of a pituitary adenoma?", + "A": "Normal saline", + "B": "Desmopressin", + "C": "Spironolactone", + "D": "Hydrocortisone" + }, + "zh": { + "question": "18. 下列哪项是经蝶窦垂体腺瘤切除术后在麻醉后监护室急性出现高钠血症且尿量为600 cc/h的患者的首选治疗？", + "A": "生理盐水", + "B": "去氨加压素", + "C": "螺内酯", + "D": "氢化可的松" + } + }, + { + "id": "003114ff-e336-514e-8621-519789052303", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following mechanisms primarily accounts for the normalization of arterial pH after prolonged hyperventilation in a patient with head injury?", + "A": "Increased renal excretion of bicarbonate ions", + "B": "Decreased RBF", + "C": "Decreased renal absorption of hydrogen ions", + "D": "Increased renal resorption of bicarbonate ions" + }, + "zh": { + "question": "以下哪种机制主要解释了头部损伤患者长期过度通气后动脉pH值的正常化？", + "A": "增加肾脏排泄碳酸氢根离子", + "B": "肾血流量减少", + "C": "减少肾脏对氢离子的吸收", + "D": "增加肾脏对碳酸氢根离子的重吸收" + } + }, + { + "id": "c0cc840f-8707-53b4-af5d-1fbe9e3b2c57", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "The following laboratory values are most consistent with which of the following acid-base disturbances?", + "A": "Anion gap acidosis", + "B": "Respiratory alkalosis with metabolic compensation", + "C": "Mixed anion gap and nonanion gap metabolic acidosis", + "D": "Combined metabolic and respiratory acidosis" + }, + "zh": { + "question": "以下实验室数值最符合下列哪种酸碱失衡？", + "A": "阴离子间隙性酸中毒", + "B": "代谢性代偿的呼吸性碱中毒", + "C": "混合阴离子间隙性和非阴离子间隙性代谢性酸中毒", + "D": "代谢性和呼吸性酸中毒的结合" + } + }, + { + "id": "2587235c-01d8-5930-b44a-aedab20adb63", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is a cause of metabolic alkalosis?", + "A": "Prolonged suction on nasogastric tube", + "B": "Administration of acetazolamide", + "C": "Diarrhea", + "D": "Ethylene glycol administration" + }, + "zh": { + "question": "以下哪项是代谢性碱中毒的原因？", + "A": "长时间使用鼻胃管吸引", + "B": "使用乙酰唑胺", + "C": "腹泻", + "D": "乙二醇的使用" + } + }, + { + "id": "aac0a4b5-8981-590a-83dc-1b04474788a6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "An increase in which of the following ions will decrease the strong ion difference (SID)?", + "A": "Calcium", + "B": "Sodium", + "C": "Chloride", + "D": "Magnesium" + }, + "zh": { + "question": "以下哪种离子的增加会降低强离子差（SID）？", + "A": "钙", + "B": "钠", + "C": "氯", + "D": "镁" + } + }, + { + "id": "caae5666-0a8b-5eaf-8220-988c64cef317", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "An anion gap metabolic acidosis with a normal osmolar gap is seen with ingestion of which of the following substances?", + "A": "Methanol", + "B": "Ethanol", + "C": "Ethylene glycol", + "D": "Aspirin" + }, + "zh": { + "question": "在摄入以下哪种物质时，会出现阴离子间隙代谢性酸中毒且渗透间隙正常？", + "A": "甲醇", + "B": "乙醇", + "C": "乙二醇", + "D": "阿司匹林" + } + }, + { + "id": "0abac0e5-de25-588d-b9a6-e551373ad5a5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "24. Which of the following best describes the acid-base disturbances seen with salicylate overdose?", + "A": "Anion gap metabolic acidosis with respiratory compensation", + "B": "Respiratory alkalosis with renal compensation", + "C": "Combined metabolic acidosis and respiratory alkalosis", + "D": "Combined metabolic and respiratory acidosis" + }, + "zh": { + "question": "24. 以下哪项最能描述水杨酸盐过量时的酸碱失衡？", + "A": "阴离子间隙代谢性酸中毒伴呼吸性代偿", + "B": "呼吸性碱中毒伴肾性代偿", + "C": "代谢性酸中毒和呼吸性碱中毒的结合", + "D": "代谢性和呼吸性酸中毒的结合" + } + }, + { + "id": "046f7b6d-20a3-58ee-8866-a7cb88dad61d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Excretion of which of the following intravenous anesthetics is unaffected in patients with end-stage renal disease (ESRD)?", + "A": "Propofol", + "B": "Ketamine", + "C": "Etomidate", + "D": "Thiopental" + }, + "zh": { + "question": "下列哪种静脉麻醉药的排泄在终末期肾病（ESRD）患者中不受影响？", + "A": "丙泊酚", + "B": "氯胺酮", + "C": "依托咪酯", + "D": "硫喷妥钠" + } + }, + { + "id": "718153ee-4dc4-53f5-b895-618674ee3671", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Increased levels of normeperidine, seen in patients with renal failure, are associated with what symptoms?", + "A": "Emesis", + "B": "Seizures", + "C": "Bradycardia", + "D": "Hypotension" + }, + "zh": { + "question": "在肾功能衰竭患者中，去甲哌啶水平升高与哪些症状相关？", + "A": "呕吐", + "B": "癫痫发作", + "C": "心动过缓", + "D": "低血压" + } + }, + { + "id": "b854966a-ce0a-5777-95b0-df69a347ddc9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following classes of drugs must be dosage-adjusted in patients with renal impairment?", + "A": "Phenothiazines (eg, promethazine)", + "B": "Antidopaminergics (eg, droperidol)", + "C": "H2 -receptor antagonists", + "D": "5-HT3 antagonists" + }, + "zh": { + "question": "以下哪类药物在肾功能不全的患者中需要调整剂量？", + "A": "吩噻嗪类（例如，异丙嗪）", + "B": "抗多巴胺药（例如，氟哌利多）", + "C": "H2受体拮抗剂", + "D": "5-HT3拮抗剂" + } + }, + { + "id": "936ad7b7-7147-5fb8-a247-5e4da776ccca", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which inhalation agent can react with barium hydroxide lime or soda lime to form compound A?", + "A": "Isoflurane", + "B": "Desflurane", + "C": "Sevoflurane", + "D": "Nitrous oxide" + }, + "zh": { + "question": "哪种吸入性麻醉剂可以与氢氧化钡石灰或苏打石灰反应形成化合物A？", + "A": "异氟醚", + "B": "地氟醚", + "C": "七氟醚", + "D": "一氧化二氮" + } + }, + { + "id": "6ffbe3f9-0aea-53c2-95ef-4abfa8af5dc5", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Approximately how much is potassium concentration elevated following administration of succinylcholine in patients with ESRD?", + "A": "0-0.2 mEq/L", + "B": "0.5-1 mEq/L", + "C": "1.0-1.5 mEq/L", + "D": "1.5-2 mEq/L" + }, + "zh": { + "question": "在终末期肾病（ESRD）患者中，给予琥珀胆碱后钾浓度大约升高多少？", + "A": "0-0.2 mEq/L", + "B": "0.5-1 mEq/L", + "C": "1.0-1.5 mEq/L", + "D": "1.5-2 mEq/L" + } + }, + { + "id": "e51a49f7-7756-54aa-bc8a-5386182071fc", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the primary form of elimination of vecuronium?", + "A": "Renal excretion", + "B": "Biliary excretion", + "C": "Degradation by nonspecific esterases", + "D": "Hoffman elimination" + }, + "zh": { + "question": "维库溴铵的主要消除形式是什么？", + "A": "肾脏排泄", + "B": "胆道排泄", + "C": "非特异性酯酶降解", + "D": "霍夫曼消除" + } + }, + { + "id": "9e589a44-7b04-5a41-99d3-0f409a4414a4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Cisatracurium is often used in patients with renal impairment. What is the primary mode of metabolism of cisatracurium?", + "A": "Renal excretion", + "B": "Biliary excretion", + "C": "Degradation by nonspecific esterases", + "D": "Hoffman elimination" + }, + "zh": { + "question": "西酰胺是一种常用于肾功能不全患者的药物。西酰胺的主要代谢方式是什么？", + "A": "肾脏排泄", + "B": "胆道排泄", + "C": "非特异性酯酶降解", + "D": "霍夫曼消除" + } + }, + { + "id": "d1754447-b9cb-52d8-b352-33e492f72de6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "32. Which of the following morphine metabolites can be responsible for delayed respiratory depression in patients with renal impairment?", + "A": "Morphine-3-glucuronide", + "B": "Morphine-6-glucuronide", + "C": "Normorphine", + "D": "Codeine" + }, + "zh": { + "question": "32. 以下哪种吗啡代谢产物可能导致肾功能不全患者的延迟性呼吸抑制？", + "A": "吗啡-3-葡萄糖醛酸苷", + "B": "吗啡-6-葡萄糖醛酸苷", + "C": "去甲吗啡", + "D": "可待因" + } + }, + { + "id": "901ebed5-ce68-5896-8197-f0c5adba1122", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "In what population has mannitol been shown to be protective against AKI?", + "A": "Patients undergoing laparoscopic partial nephrectomies", + "B": "Patients undergoing infrarenal abdominal aortic aneurysm repair", + "C": "Cadaveric kidney transplant recipients", + "D": "Patients with traumatic rhabdomyolysis" + }, + "zh": { + "question": "在什么人群中，甘露醇被证明对急性肾损伤（AKI）具有保护作用？", + "A": "接受腹腔镜部分肾切除术的患者", + "B": "接受肾下腹主动脉瘤修复术的患者", + "C": "尸体肾移植受者", + "D": "创伤性横纹肌溶解症患者" + } + }, + { + "id": "c8eddb3f-8985-56b6-9aa6-ebd833a568c4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements is true of eplerenone?", + "A": "It may cause gynecomastia in males.", + "B": "Hypokalemia is a common side effect.", + "C": "It acts in the distal convoluted tubule.", + "D": "It is indicated in patients with ascites due to end-stage liver disease." + }, + "zh": { + "question": "以下关于依普利酮的说法哪一项是正确的？", + "A": "它可能导致男性乳腺发育。", + "B": "低钾血症是常见的副作用。", + "C": "它作用于远曲小管。", + "D": "它适用于因终末期肝病导致腹水的患者。" + } + }, + { + "id": "3e6005a3-ca56-5777-81bb-2f72ef0b9217", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Nonsteroidal anti-inflammatory drugs (NSAIDs) most commonly contribute to what type of kidney injury?", + "A": "Prerenal", + "B": "Acute tubular necrosis", + "C": "Glomerulonephritis", + "D": "Postrenal obstruction" + }, + "zh": { + "question": "非甾体抗炎药（NSAIDs）最常导致哪种类型的肾损伤？", + "A": "肾前性", + "B": "急性肾小管坏死", + "C": "肾小球肾炎", + "D": "肾后性梗阻" + } + }, + { + "id": "848960df-c5f6-55c6-8e08-d8666d6cd558", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is true of fenoldopam?", + "A": "Rebound hypertension may occur when an infusion is discontinued.", + "B": "It is a nonselective α- and β-agonist.", + "C": "It is equipotent with dopamine.", + "D": "It is a selective DA1 receptor agonist." + }, + "zh": { + "question": "以下关于芬多拉姆的说法哪一项是正确的？", + "A": "停止输注时可能会出现反弹性高血压。", + "B": "它是非选择性的α和β激动剂。", + "C": "它与多巴胺效力相同。", + "D": "它是选择性的DA1受体激动剂。" + } + }, + { + "id": "f052ddd8-27e9-5960-b507-478325ca4194", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "On which part of the nephron do loop diuretics work?", + "A": "Proximal tubule", + "B": "Thick ascending limb", + "C": "Distal convoluted tubule", + "D": "Collecting duct" + }, + "zh": { + "question": "袢利尿剂作用于肾单位的哪个部分？", + "A": "近曲小管", + "B": "粗升支", + "C": "远曲小管", + "D": "集合管" + } + }, + { + "id": "0274741f-1505-5c71-a324-848eaa93b643", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the mechanism of action of acetazolamide?", + "A": "Inhibition of carbonic anhydrase", + "B": "Blockade of NaCl cotransporter in the distal convoluted tubule", + "C": "Increasing the oncotic pressure in tubular filtrate", + "D": "Inhibition of the Na-K-2Cl cotransporter in the thick ascending loop" + }, + "zh": { + "question": "以下哪项是乙酰唑胺的作用机制？", + "A": "抑制碳酸酐酶", + "B": "阻断远曲小管中的NaCl共转运体", + "C": "增加肾小管滤液中的胶体渗透压", + "D": "抑制粗升支袢中的Na-K-2Cl共转运体" + } + }, + { + "id": "9aae22b9-e40f-50da-89f6-372c346dcb54", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following electrolyte abnormalities is most likely to be seen with uremia?", + "A": "Hypokalemia", + "B": "Hypernatremia", + "C": "Hyperphosphatemia", + "D": "Hypomagnesemia" + }, + "zh": { + "question": "以下哪种电解质异常最有可能在尿毒症中出现？", + "A": "低钾血症", + "B": "高钠血症", + "C": "高磷血症", + "D": "低镁血症" + } + }, + { + "id": "a6d3842a-3d61-59c6-ba58-d10fbf0cb63c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "40. In a patient with a blood urea nitrogen (BUN) of 80 mg/dL, which of the following elements meets criteria for a diagnosis of uremia?", + "A": "Potassium of 6.1 mEq/L", + "B": "Serum creatinine of 4.5 mg/dL", + "C": "Urine output of 100 cc over a 24-hour period", + "D": "Asterixis and hiccups" + }, + "zh": { + "question": "40. 在一位血尿素氮（BUN）为80 mg/dL的患者中，下列哪一项符合尿毒症的诊断标准？", + "A": "钾为6.1 mEq/L", + "B": "血清肌酐为4.5 mg/dL", + "C": "24小时尿量为100 cc", + "D": "扑翼样震颤和打嗝" + } + }, + { + "id": "b19acb01-ab45-5e7d-8000-f087e7d36bc4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Clinical effects of unfractionated heparin (UFH) are best monitored by which of the following?", + "A": "Partial thromboplastin time (PTT)", + "B": "Prothrombin time (PT)", + "C": "International normalized ratio (INR)", + "D": "Antithrombin III (ATIII)" + }, + "zh": { + "question": "非分级肝素（UFH）的临床效果最好通过以下哪项进行监测？", + "A": "部分凝血活酶时间（PTT）", + "B": "凝血酶原时间（PT）", + "C": "国际标准化比值（INR）", + "D": "抗凝血酶III（ATIII）" + } + }, + { + "id": "7e3edd74-e1e5-5675-becf-598db4257243", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "With respect to reversal with protamine, which of the following statements is true when comparing UFH and low-molecular-weight heparin (LMWH)?", + "A": "UFH results in less predictable reversibility.", + "B": "UFH results in more predictable reversibility.", + "C": "Hypotension is less likely with UFH.", + "D": "Hypotension is more likely with UFH." + }, + "zh": { + "question": "关于使用鱼精蛋白逆转时，比较UFH和低分子量肝素（LMWH），以下哪项陈述是正确的？", + "A": "UFH的可逆性结果较不易预测。", + "B": "UFH的可逆性结果较易预测。", + "C": "使用UFH时低血压的可能性较小。", + "D": "使用UFH时低血压的可能性较大。" + } + }, + { + "id": "6538fe22-08cf-5fd7-8c2a-c0615ad1b2e5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Heparin-induced thrombocytopenia type 2 (HIT2) is mediated by which of the following?", + "A": "IgG antibodies binding to heparin-PF-4 complexes on the surface of red blood cells (RBCs)", + "B": "IgG antibodies binding to ATIII on the surface of RBCs", + "C": "IgG antibodies binding to heparin-PF-4 complexes on the surface of platelets", + "D": "IgG antibodies binding to ATIII on the surface of platelets" + }, + "zh": { + "question": "肝素诱导的血小板减少症2型（HIT2）是由以下哪种机制介导的？", + "A": "IgG抗体结合在红细胞（RBCs）表面的肝素-PF-4复合物", + "B": "IgG抗体结合在红细胞表面的ATIII", + "C": "IgG抗体结合在血小板表面的肝素-PF-4复合物", + "D": "IgG抗体结合在血小板表面的ATIII" + } + }, + { + "id": "8b4f9e88-6250-57f2-b156-bd50447b26fe", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "HIT typically presents in what period after the initiation of therapy?", + "A": "1-3 days", + "B": "3-5 days", + "C": "5-10 days", + "D": "10-15 days" + }, + "zh": { + "question": "HIT通常在治疗开始后的哪个时间段出现？", + "A": "1-3天", + "B": "3-5天", + "C": "5-10天", + "D": "10-15天" + } + }, + { + "id": "d23382d1-754b-5157-8f69-a7b9cca49431", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The mechanism of action of hirudin-derived compounds involves which of the following?", + "A": "Inhibition of vitamin K–derived clotting factors", + "B": "Inhibition of thrombin in its free and fibrin-bound states", + "C": "Potentiation of vitamin K–derived clotting factors", + "D": "Potentiation of thrombin in its free and fibrin-bound states" + }, + "zh": { + "question": "水蛭素衍生化合物的作用机制涉及以下哪一项？", + "A": "抑制维生素K衍生的凝血因子", + "B": "抑制游离和纤维蛋白结合状态的凝血酶", + "C": "增强维生素K衍生的凝血因子", + "D": "增强游离和纤维蛋白结合状态的凝血酶" + } + }, + { + "id": "f2e07e57-8540-5e1d-871a-22892b5a63ef", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "6. Warfarin's primary mechanism of action is inhibition of the synthesis of vitamin K–dependent clotting factors. These factors include which of the following?", + "A": "Factors II, VII, VIII, and X and protein C", + "B": "Factors II, VII, VIII, and XII and proteins C and S", + "C": "Factors VII, IX, X, and XII and protein S", + "D": "Factors II, VII, IX, and X and proteins C and S" + }, + "zh": { + "question": "6. 华法林的主要作用机制是抑制维生素K依赖性凝血因子的合成。这些因子包括以下哪项？", + "A": "因子II、VII、VIII和X以及蛋白C", + "B": "因子II、VII、VIII和XII以及蛋白C和S", + "C": "因子VII、IX、X和XII以及蛋白S", + "D": "因子II、VII、IX和X以及蛋白C和S" + } + }, + { + "id": "adbd859b-66df-5dd1-8aba-f1117e5d422e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Before undergoing a trigger finger release under local anesthesia at an orthopedic surgeon's office, a patient's dabigatran should be discontinued for what length of time?", + "A": "12 hours", + "B": "24 hours", + "C": "36 hours", + "D": "48 hours" + }, + "zh": { + "question": "在骨科医生办公室进行局部麻醉下的扳机指松解术之前，患者的达比加群应停用多长时间？", + "A": "12小时", + "B": "24小时", + "C": "36小时", + "D": "48小时" + } + }, + { + "id": "e2a2c722-d6b8-5089-b729-3a85d379aac8", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Tranexamic acid, a lysine analogue, acts by which of the following mechanisms?", + "A": "Reversibly binds to plasminogen, thereby preventing the degradation of fibrin", + "B": "Inhibition of COX-1 and COX-2", + "C": "Inhibition of vitamin K–dependent clotting factors", + "D": "Inhibition of glycoprotein (GP) IIb/IIIa expression on the surface of activated platelets" + }, + "zh": { + "question": "氨甲环酸，一种赖氨酸类似物，其作用机制是以下哪一种？", + "A": "可逆性结合纤溶酶原，从而防止纤维蛋白的降解", + "B": "抑制COX-1和COX-2", + "C": "抑制维生素K依赖的凝血因子", + "D": "抑制活化血小板表面的糖蛋白（GP）IIb/IIIa表达" + } + }, + { + "id": "0f4c02bf-29de-51f6-ac3b-45525895f2f3", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "When comparing prothrombin complex concentrates (PCCs) with fresh frozen plasma (FFP), which of the following is true?", + "A": "PCCs have a faster correction of coagulopathy.", + "B": "PCCs have a higher risk of infection.", + "C": "PCCs require a larger volume for administration.", + "D": "PCCs require a type and cross before administration." + }, + "zh": { + "question": "在比较凝血酶原复合物浓缩物（PCCs）与新鲜冰冻血浆（FFP）时，下列哪项是正确的？", + "A": "PCCs能更快纠正凝血功能障碍。", + "B": "PCCs有更高的感染风险。", + "C": "PCCs需要更大的给药体积。", + "D": "PCCs在给药前需要进行血型和交叉配型。" + } + }, + { + "id": "56f4a95c-4b5f-5f67-9601-6d1d675c355e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Fondaparinux exerts its effects by which of the following?", + "A": "Acting as an antagonist to free factor VII", + "B": "Acting as an antagonist to free factor IX", + "C": "Acting as an antagonist to free factor Xa", + "D": "Acting as an antagonist to the expression of GP IIb/IIIa" + }, + "zh": { + "question": "磺达肝癸钠通过以下哪种方式发挥作用？", + "A": "作为游离因子VII的拮抗剂", + "B": "作为游离因子IX的拮抗剂", + "C": "作为游离因子Xa的拮抗剂", + "D": "作为GP IIb/IIIa表达的拮抗剂" + } + }, + { + "id": "639ab579-0252-5ff6-bcce-f12c40842480", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The effects of aspirin therapy can be reversed by infusing which of the following products?", + "A": "Vitamin K", + "B": "Platelets", + "C": "Protamine", + "D": "von Willebrand factor" + }, + "zh": { + "question": "阿司匹林治疗的效果可以通过输注以下哪种产品来逆转？", + "A": "维生素K", + "B": "血小板", + "C": "鱼精蛋白", + "D": "血管性血友病因子" + } + }, + { + "id": "957b2369-ceb5-5fe0-856d-4fa34cc182f6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The effects of aspirin therapy rely primarily on the direct inhibition of which of the following?", + "A": "COX-1, TxA2", + "B": "COX-2, TxA1", + "C": "COX-1, COX-2", + "D": "COX-1 only" + }, + "zh": { + "question": "阿司匹林治疗的效果主要依赖于直接抑制以下哪一项？", + "A": "COX-1, TxA2", + "B": "COX-2, TxA1", + "C": "COX-1, COX-2", + "D": "仅 COX-1" + } + }, + { + "id": "deb6367a-356d-58c4-9574-4a9a08f8cf22", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "For patients on aspirin therapy at a high risk of cardiac events in the perioperative period, which of the following should be performed?", + "A": "Aspirin should be discontinued 24 hours before surgery and resumed after 6 weeks.", + "B": "Aspirin should be continued throughout the perioperative period.", + "C": "Aspirin should be discontinued at least 5 days (preferably 10 days) before surgery and resumed after 24 hours.", + "D": "Aspirin should be continued until surgery and discontinued for 6 weeks postoperatively." + }, + "zh": { + "question": "对于在围手术期有高心脏事件风险的阿司匹林治疗患者，应执行以下哪项措施？", + "A": "阿司匹林应在手术前24小时停用，并在6周后恢复。", + "B": "阿司匹林应在整个围手术期持续使用。", + "C": "阿司匹林应在手术前至少5天（最好10天）停用，并在24小时后恢复。", + "D": "阿司匹林应持续使用直到手术，并在术后停用6周。" + } + }, + { + "id": "ffa59f8e-77ab-5413-860b-fbe1428b7802", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "14. Which of the following is the mechanism of action of ADP receptor antagonists such as clopidogrel?", + "A": "Inhibition of GP IIb/IIIa expression on the surface of activated platelets", + "B": "Inhibition of the action of GP Ib", + "C": "Promotion of GP IIb/IIIa expression on the surface of activated platelets", + "D": "Promotion of the action of GP Ib" + }, + "zh": { + "question": "14. 以下哪项是ADP受体拮抗剂如氯吡格雷的作用机制？", + "A": "抑制活化血小板表面的GP IIb/IIIa表达", + "B": "抑制GP Ib的作用", + "C": "促进活化血小板表面的GP IIb/IIIa表达", + "D": "促进GP Ib的作用" + } + }, + { + "id": "2576f3bb-d3cd-5e8c-b74b-a77fddf5bf60", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Eptifibatide (integrellin) is an inhibitor of which of the following?", + "A": "Cyclooxygenase", + "B": "Phosphodiesterase", + "C": "ADP receptors", + "D": "GP IIb/IIIa receptors" + }, + "zh": { + "question": "Eptifibatide（Integrellin）是以下哪种物质的抑制剂？", + "A": "环氧合酶", + "B": "磷酸二酯酶", + "C": "ADP受体", + "D": "GP IIb/IIIa受体" + } + }, + { + "id": "240c6416-ab19-562e-936d-d06f583ef0f4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Autologous blood transfusion involves which 3 methods?", + "A": "Preoperative autologous blood donation, acute normovolemic hemodilution, and perioperative blood cell salvage", + "B": "Preoperative allogenic blood donation, acute normovolemic hemodilution, and perioperative blood cell salvage", + "C": "Preoperative autologous blood donation, acute hypervolemic hemodilution, and perioperative blood cell salvage", + "D": "Preoperative allogenic blood donation, acute hypovolemic hemodilution, and perioperative blood cell salvage" + }, + "zh": { + "question": "自体输血包括哪三种方法？", + "A": "术前自体献血、急性等容血液稀释和围手术期血液回收", + "B": "术前异体献血、急性等容血液稀释和围手术期血液回收", + "C": "术前自体献血、急性高容量血液稀释和围手术期血液回收", + "D": "术前异体献血、急性低容量血液稀释和围手术期血液回收" + } + }, + { + "id": "50568e83-8765-5e0e-affa-79c43ef8714f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "To increase the amount of times one may safely donate his/her own blood (autologous blood donation) for a future surgical procedure, which of the following may be administered to the patient before donation?", + "A": "Intravenous iron", + "B": "Oral iron", + "C": "Factor VIII concentrate", + "D": "Erythropoietin" + }, + "zh": { + "question": "为了增加一个人可以安全捐献自身血液（自体输血）用于未来的手术次数，以下哪种药物可以在捐献前给予患者？", + "A": "静脉注射铁剂", + "B": "口服铁剂", + "C": "第八因子浓缩物", + "D": "促红细胞生成素" + } + }, + { + "id": "279e7f30-b00b-5658-8c94-b3f871ceecfe", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following examples could be an indication for using the process known as \"acute normovolemic hemodilution\"?", + "A": "Congenital heart disease", + "B": "Refusal of allogenic blood products", + "C": "Anticipated blood loss of one-third of the patient's volume", + "D": "Preoperative anemia" + }, + "zh": { + "question": "以下哪种情况可能是使用“急性等容血液稀释”过程的指征？", + "A": "先天性心脏病", + "B": "拒绝异体血制品", + "C": "预计失血量为患者血容量的三分之一", + "D": "术前贫血" + } + }, + { + "id": "c1de9c0b-efd2-51a8-b1dc-c9984fd79081", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A primary concern with intraoperative blood cell salvage includes which of the following?", + "A": "Lack of validated evidence", + "B": "Increased rates of infection compared with allogenic blood products", + "C": "Dilutional coagulopathy", + "D": "Decreased stimulation of erythropoiesis" + }, + "zh": { + "question": "术中血液回收的主要关注点包括以下哪一项？", + "A": "缺乏验证的证据", + "B": "与异体血制品相比感染率增加", + "C": "稀释性凝血病", + "D": "促红细胞生成减少" + } + }, + { + "id": "a96f2832-8f0e-5717-bcb7-8b458abbfd31", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Perioperative blood salvage can be considered if the estimated blood loss will likely exceed which of the following?", + "A": "500 mL", + "B": "1000 mL", + "C": "1500 mL", + "D": "2000 mL" + }, + "zh": { + "question": "如果预计失血量可能超过以下哪一数值，可以考虑围手术期血液回收？", + "A": "500 毫升", + "B": "1000 毫升", + "C": "1500 毫升", + "D": "2000 毫升" + } + }, + { + "id": "b95ce0f1-be9e-5b6a-b793-a44fa8085017", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "21. Jehovah's Witnesses are a population whose beliefs lead to a refusal to accept blood products. Which of the following represents the best management of a conscious Jehovah's Witness patient who presents for emergency surgery with a high likelihood of significant blood loss?", + "A": "Transfuse blood products as clinically indicated.", + "B": "Refuse to transfuse blood products.", + "C": "Have a discussion with patients about their beliefs about blood products.", + "D": "Meet with hospital ethics team and legal counsel before surgery." + }, + "zh": { + "question": "21. 耶和华见证人是一个因信仰而拒绝接受血液制品的人群。以下哪项代表对一位意识清醒且因紧急手术而可能出现大量失血的耶和华见证人患者的最佳管理方式？", + "A": "根据临床指征输注血液制品。", + "B": "拒绝输注血液制品。", + "C": "与患者讨论他们对血液制品的信仰。", + "D": "在手术前与医院伦理团队和法律顾问会面。" + } + }, + { + "id": "03e59db0-b606-5279-adb7-b1b3ed0047a6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When an individual's hematocrit falls below a certain value, erythropoietin is released. Which of the following %is the \"critical\" value for its release?", + "A": "25%", + "B": "30%", + "C": "35%", + "D": "40%" + }, + "zh": { + "question": "当一个人的血细胞比容低于某个值时，会释放促红细胞生成素。以下哪个百分比是其释放的“临界”值？", + "A": "25%", + "B": "30%", + "C": "35%", + "D": "40%" + } + }, + { + "id": "ea6db718-69b2-542e-92f1-ca30a63a41d5", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 66-year-old man is scheduled to undergo a right total hip replacement and prefers a neuraxial technique. You note that he has a history of thrombocytopenia. Which of the following is the platelet transfusion threshold for patients undergoing neuraxial anesthesia?", + "A": "10 000", + "B": "50 000", + "C": "75 000", + "D": "100 000" + }, + "zh": { + "question": "一名66岁的男性计划进行右侧全髋关节置换术，他更倾向于使用神经轴技术。你注意到他有血小板减少的病史。以下哪项是接受神经轴麻醉的患者的血小板输注阈值？", + "A": "10 000", + "B": "50 000", + "C": "75 000", + "D": "100 000" + } + }, + { + "id": "9efd5ff2-da5f-57e2-857d-2769053f2c7b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Routine transfusion of packed red cells in a (stable) critically ill patient is NOT necessary unless the hemoglobin concentration is below which of the following?", + "A": "5.8 g/dL", + "B": "6.5 g/dL", + "C": "7 g/dL", + "D": "8.6 g/dL" + }, + "zh": { + "question": "对于（稳定的）危重病人，常规输注浓缩红细胞是不必要的，除非血红蛋白浓度低于以下哪个值？", + "A": "5.8 g/dL", + "B": "6.5 g/dL", + "C": "7 g/dL", + "D": "8.6 g/dL" + } + }, + { + "id": "5d0671ee-499b-5ca9-ae9c-50b957b6f06d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the most appropriate storage parameters for packed RBCs that LACK an additive solution?", + "A": "1°C-6°C for 21-35 days", + "B": "<−65°C for 10 years", + "C": "20°C-24°C for 5 days", + "D": "<−18°C for 1 year" + }, + "zh": { + "question": "对于缺乏添加剂溶液的浓缩红细胞，最合适的储存参数是什么？", + "A": "1°C-6°C，储存21-35天", + "B": "<−65°C，储存10年", + "C": "20°C-24°C，储存5天", + "D": "<−18°C，储存1年" + } + }, + { + "id": "7e2dcd0a-5198-5d1e-b9d1-0878bb8e5697", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Blood donors in the United States are required to have a minimum hemoglobin level of which of the following?", + "A": "7", + "B": "9.5", + "C": "11", + "D": "12.5" + }, + "zh": { + "question": "美国的献血者需要达到以下哪一项的最低血红蛋白水平？", + "A": "7", + "B": "9.5", + "C": "11", + "D": "12.5" + } + }, + { + "id": "fa13d773-3458-54a6-8cd6-7f60acfd0e38", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is true with regard to transfusing FFP?", + "A": "It contains all factors involved in hemostasis.", + "B": "It does not need to be ABO-compatible.", + "C": "It must be used within 1 year of collection.", + "D": "It carries no risk of transfusion-related acute lung injury (TRALI)." + }, + "zh": { + "question": "以下关于输注新鲜冰冻血浆（FFP）的说法中哪一项是正确的？", + "A": "它包含所有参与止血的因子。", + "B": "它不需要与ABO血型相容。", + "C": "它必须在采集后1年内使用。", + "D": "它没有输血相关急性肺损伤（TRALI）的风险。" + } + }, + { + "id": "546b6255-752b-5e6f-ac19-c2cad07129d6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "28. Cryoprecipitate contains all of the following factors EXCEPT which one?", + "A": "von Willebrand factor", + "B": "Factor VIII", + "C": "Factor IX", + "D": "Factor XIII" + }, + "zh": { + "question": "28. 冷沉淀含有以下所有因子，除了哪一个？", + "A": "von Willebrand 因子", + "B": "凝血因子 VIII", + "C": "凝血因子 IX", + "D": "凝血因子 XIII" + } + }, + { + "id": "c478f37e-b16d-5a26-ad9c-bae749d58211", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The most common reaction observed during transfusions of blood products is which of the following?", + "A": "An anaphylactoid reaction", + "B": "Febrile nonhemolytic transfusion reaction (FNHTR)", + "C": "Acute hemolytic transfusion reaction (AHTR)", + "D": "Delayed hemolytic transfusion reaction (DHTR)" + }, + "zh": { + "question": "在输注血液制品过程中观察到的最常见反应是以下哪一种？", + "A": "类过敏反应", + "B": "发热性非溶血性输血反应 (FNHTR)", + "C": "急性溶血性输血反应 (AHTR)", + "D": "延迟性溶血性输血反应 (DHTR)" + } + }, + { + "id": "bfabd796-9dfc-57b1-b9c0-a1b01d379c27", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Immediately following a blood transfusion in the PACU, a patient becomes tachycardic, hypotensive, and febrile, and his nurse notes that he appears to have blood leaking from his incision. After stopping the transfusion and administering IV fluids, which of the following is the most appropriate test to conduct?", + "A": "Tryptase", + "B": "Direct Coombs test", + "C": "Indirect Coombs test", + "D": "Caffeine-halothane contracture test" + }, + "zh": { + "question": "在恢复室输血后，患者出现心动过速、低血压和发热，护士注意到他的切口似乎有血液渗出。在停止输血并给予静脉输液后，以下哪项是最合适的检查？", + "A": "胰蛋白酶", + "B": "直接抗球蛋白试验", + "C": "间接抗球蛋白试验", + "D": "咖啡因-氟烷收缩试验" + } + }, + { + "id": "13295e24-70b5-5058-afc9-056bf9d508ec", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Seven days following embolization for an occult gastrointestinal (GI) bleed, a patient is noted to be jaundiced, in addition to having a mild fever and", + "A": "Liver biopsy", + "B": "Aspartate aminotransferase/alanine aminotransferase", + "C": "Prothrombin time/international normalized ratio", + "D": "IV fluids" + }, + "zh": { + "question": "在进行隐匿性胃肠道（GI）出血的栓塞术后七天，患者被发现出现黄疸，此外还有轻度发热和", + "A": "肝活检", + "B": "天冬氨酸氨基转移酶/丙氨酸氨基转移酶", + "C": "凝血酶原时间/国际标准化比值", + "D": "静脉输液" + } + }, + { + "id": "7071feb3-e583-5691-8595-f354e286cd52", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Allergic reactions to blood products in patients with a known IgA deficiency can be avoided by which of the following?", + "A": "Leukoreduction", + "B": "Washing", + "C": "Irradiation", + "D": "Premedication with acetaminophen" + }, + "zh": { + "question": "在已知IgA缺乏的患者中，过敏反应可以通过以下哪种方法避免？", + "A": "白细胞减少", + "B": "洗涤", + "C": "辐照", + "D": "用对乙酰氨基酚预处理" + } + }, + { + "id": "66ebc394-a304-5837-a8bd-70f5d8b1262c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is true about anaphylactoid responses to blood product tranfusions?", + "A": "They show evidence of anti-IgA antibodies.", + "B": "They are type I hypersensitivity IgE-mediated reactions.", + "C": "The majority occur secondary to IgM-mediated antibody-antigen complexes.", + "D": "They show evidence of IgG alloantibodies to Rh." + }, + "zh": { + "question": "以下哪项关于输血制品的类过敏反应是正确的？", + "A": "它们显示出抗IgA抗体的证据。", + "B": "它们是由IgE介导的I型超敏反应。", + "C": "大多数是由IgM介导的抗体-抗原复合物引起的。", + "D": "它们显示出对Rh的IgG同种抗体的证据。" + } + }, + { + "id": "c57e3e9c-5801-5243-baac-0621b1540c13", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "To decrease the risk of transfusion-related graft-versus-host disease (GVHD), cellular components of blood should undergo which of the following?", + "A": "Leukoreduction", + "B": "Washing", + "C": "Irradiation", + "D": "Preservation using citrate phosphate dextrose adenine (CDPA) solution" + }, + "zh": { + "question": "为了降低输血相关移植物抗宿主病（GVHD）的风险，血液的细胞成分应进行以下哪种处理？", + "A": "白细胞减少", + "B": "洗涤", + "C": "辐照", + "D": "使用柠檬酸磷酸葡萄糖腺苷（CDPA）溶液保存" + } + }, + { + "id": "b6e46dce-35fc-5290-9daa-e8e2a2245079", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "35. Following exploratory laparotomy for trauma in which a patient underwent a massive transfusion, the patient is noted to have twitching of the ipsilateral facial muscles when tapping on the face just below the zygomatic bone, as well as wrist flexion and hyperextension of the fingers when a blood pressure cuff is inflated above systolic blood pressure. Which of the following is the most likely cause for these symptoms?", + "A": "Hyperkalemia", + "B": "Hypokalemia", + "C": "Citrate toxicity", + "D": "Hypothermia" + }, + "zh": { + "question": "35. 在创伤性探查性剖腹手术后，患者接受了大量输血，发现当在颧骨下方轻拍面部时，患者同侧面部肌肉出现抽搐，以及当血压袖带充气至高于收缩压时，手腕屈曲和手指过度伸展。以下哪项最可能是这些症状的原因？", + "A": "高钾血症", + "B": "低钾血症", + "C": "枸橼酸盐中毒", + "D": "低体温" + } + }, + { + "id": "7ec7bae3-4d5f-5b55-9dbb-beeb0e0ec35a", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A patient received several units of blood products because of a massive GI hemorrhage. Which of the following sets of parameters is most concerning for", + "A": "Onset of shortness of breath 3 days after transfusion with chest X-ray (CXR) showing focal infiltrates in the right lower lobe", + "B": "Decreased lung compliance after induction of anesthesia with CXR showing no acute changes", + "C": "CXR showing pulmonary edema, elevated B-type natriuretic peptide, and transthoracic echocardiogram showing left atrial enlargement", + "D": "CXR showing pulmonary edema with acute bilateral infiltrates, PaO2 /FiO2 <300, SaO2 , 90% on room air, no evidence of left atrial hypertension" + }, + "zh": { + "question": "一名患者因大出血性胃肠道出血接受了几单位的血液制品。以下哪组参数最令人担忧？", + "A": "输血3天后出现呼吸急促，胸部X光片（CXR）显示右下叶局灶性浸润", + "B": "麻醉诱导后肺顺应性下降，CXR显示无急性变化", + "C": "CXR显示肺水肿，B型利钠肽升高，经胸超声心动图显示左心房扩大", + "D": "CXR显示肺水肿伴急性双侧浸润，PaO2/FiO2 <300，室内空气SaO2 90%，无左心房高血压证据" + } + }, + { + "id": "7082c677-c0d4-51cd-ad11-c5a46849cf50", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient received several units of blood products because of a massive GI hemorrhage. Which of the following sets of parameters is most concerning for transfusion-related acute cardiovascular overload (TACO)?", + "A": "Onset of shortness of breath 3 days after transfusion with CXR showing focal infiltrates in the right lower lobe", + "B": "Decreased lung compliance after induction of anesthesia with CXR showing no acute changes", + "C": "CXR showing bilateral pulmonary edema, elevated B-type natriuretic peptide, and transthoracic echocardiogram showing left atrial hypertension", + "D": "CXR showing pulmonary edema with acute bilateral infiltrates, PaO2 /FiO2 <300, SaO2 , 90% on room air, no evidence of left atrial hypertension" + }, + "zh": { + "question": "一名患者因大出血性胃肠道出血接受了多单位血液制品输注。以下哪组参数最令人担忧的是输血相关急性心血管超负荷（TACO）？", + "A": "输血后3天出现呼吸急促，胸片显示右下叶局灶性浸润", + "B": "麻醉诱导后肺顺应性下降，胸片无急性变化", + "C": "胸片显示双侧肺水肿，B型利钠肽升高，经胸超声心动图显示左心房高血压", + "D": "胸片显示肺水肿伴急性双侧浸润，PaO2/FiO2 <300，室内空气下SaO2 <90%，无左心房高血压证据" + } + }, + { + "id": "b145e766-ab15-5f31-91ba-ed52b52faf9d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following infections carries the highest residual risk post blood product transfusion in the United States?", + "A": "Human immunodeficiency virus (HIV)", + "B": "Hepatitis C virus", + "C": "Hepatitis B virus", + "D": "Cytomegalovirus (CMV)" + }, + "zh": { + "question": "以下哪种感染在美国输血后具有最高的残余风险？", + "A": "人类免疫缺陷病毒（HIV）", + "B": "丙型肝炎病毒", + "C": "乙型肝炎病毒", + "D": "巨细胞病毒（CMV）" + } + }, + { + "id": "eaf149d2-70ae-5bdf-8e5f-2aa9522fa5c8", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Transfusion of which of the following blood products has the highest rate of infection?", + "A": "Red blood cells", + "B": "Platelets", + "C": "Fresh frozen plasma", + "D": "Cryoprecipitate" + }, + "zh": { + "question": "输注以下哪种血液制品的感染率最高？", + "A": "红细胞", + "B": "血小板", + "C": "新鲜冰冻血浆", + "D": "冷沉淀" + } + }, + { + "id": "a1efff1d-18e9-555f-8271-fdcbce172d42", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Transfusion of blood products has been associated with which of the following?", + "A": "Increased flares in patients afflicted with Crohn disease", + "B": "Decreased rate of miscarriages in women with history of recurrent spontaneousabortion", + "C": "Decreased reactivation of latent tuberculosis", + "D": "Decreased rates of recurrent malignancies" + }, + "zh": { + "question": "输注血液制品与以下哪项有关？", + "A": "克罗恩病患者的发作次数增加", + "B": "有复发性自然流产史的女性流产率降低", + "C": "潜伏性结核病的再激活减少", + "D": "复发性恶性肿瘤的发生率降低" + } + }, + { + "id": "4d5f199d-9df8-51bf-9549-fc6e855f2d16", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "While performing a preoperative assessment on a patient with acromegaly, you note that his home medication list includes octreotide. Which of the following is the mechanism of action of octreotide?", + "A": "Competitive inhibition at the growth hormone (GH) receptor", + "B": "Inhibition of GH and IGF-1 secretion", + "C": "Stimulation of insulin secretion", + "D": "Agonism at the dopamine receptor" + }, + "zh": { + "question": "在对一名患有肢端肥大症的患者进行术前评估时，您注意到他的家庭用药清单中包括奥曲肽。以下哪项是奥曲肽的作用机制？", + "A": "在生长激素（GH）受体处的竞争性抑制", + "B": "抑制GH和IGF-1的分泌", + "C": "刺激胰岛素分泌", + "D": "在多巴胺受体处的激动作用" + } + }, + { + "id": "ff91e6d8-656c-580c-bcdb-8bafec24ae8e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following hormones is released from the posterior pituitary gland?", + "A": "Thyroid-stimulating hormone (TSH)", + "B": "Vasopressin (antidiuretic hormone [ADH])", + "C": "Corticotropin (adrenocorticotropic hormone [ACTH])", + "D": "Growth hormone" + }, + "zh": { + "question": "下列哪种激素是由后叶垂体释放的？", + "A": "促甲状腺激素 (TSH)", + "B": "加压素 (抗利尿激素 [ADH])", + "C": "促肾上腺皮质激素 (ACTH)", + "D": "生长激素" + } + }, + { + "id": "561314d4-fc38-5ef2-9a25-6980b1dcfe87", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements is true of the syndrome of inappropriate antidiuretic hormone (SIADH)?", + "A": "Chronic hyponatremia from SIADH should be corrected with hypertonic saline.", + "B": "Peripheral edema is a common physical exam finding.", + "C": "Most cases of SIADH are due to an intrinsic pituitary disorder.", + "D": "Demeclocycline may be used to treat SIADH." + }, + "zh": { + "question": "以下哪项陈述是关于抗利尿激素分泌异常综合征（SIADH）的正确描述？", + "A": "SIADH引起的慢性低钠血症应使用高渗盐水纠正。", + "B": "外周水肿是常见的体格检查发现。", + "C": "大多数SIADH病例是由于内在的垂体疾病引起的。", + "D": "去氯羟四环素可用于治疗SIADH。" + } + }, + { + "id": "e073e9bf-176e-57c3-bf43-c3c81e6afcac", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is true with regard to diabetes insipidus (DI)?", + "A": "Desmopressin administration can distinguish central versus nephrogenic DI.", + "B": "Patients with nephrogenic DI will increase urine osmolality in response to desmopressin.", + "C": "Thiazide diuretics may be used to treat central DI.", + "D": "Patients with central DI will fail to respond to exogenous desmopressin administration." + }, + "zh": { + "question": "以下关于尿崩症（DI）的说法哪一项是正确的？", + "A": "去氨加压素的使用可以区分中枢性和肾性尿崩症。", + "B": "肾性尿崩症患者在使用去氨加压素后尿液渗透压会增加。", + "C": "噻嗪类利尿剂可用于治疗中枢性尿崩症。", + "D": "中枢性尿崩症患者对外源性去氨加压素的使用无反应。" + } + }, + { + "id": "ce35483c-34ec-5993-aef6-6501116c139d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following features is more consistent with a diagnosis of a pituitary macroadenoma than that of a pituitary microadenoma?", + "A": "Galactorrhea", + "B": "Visual field deficit", + "C": "Thyrotoxicosis", + "D": "Cushing disease" + }, + "zh": { + "question": "以下哪一特征更符合垂体大腺瘤的诊断，而不是垂体小腺瘤？", + "A": "泌乳", + "B": "视野缺损", + "C": "甲状腺功能亢进", + "D": "库欣病" + } + }, + { + "id": "44e5e751-4398-5ecd-85f2-499868b933d0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements pertaining to thyroid storm is true?", + "A": "Atrial fibrillation is required for diagnosis.", + "B": "Mortality rate may exceed 20%.", + "C": "TSH levels are elevated.", + "D": "Hyperthermia is rare." + }, + "zh": { + "question": "以下关于甲状腺危象的陈述中哪一项是正确的？", + "A": "诊断需要心房颤动。", + "B": "死亡率可能超过20%。", + "C": "TSH水平升高。", + "D": "高热很少见。" + } + }, + { + "id": "b271a8c1-eeed-51b0-a2c9-1554f7a2a9a4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is likely to be seen when a patient with hypothyroidism is under general anesthesia?", + "A": "Hypotension", + "B": "Prolongation of nondepolarizing neuromuscular blockers", + "C": "Bradycardia", + "D": "Hyperglycemia" + }, + "zh": { + "question": "在甲状腺功能减退的患者接受全身麻醉时，以下哪种情况可能会出现？", + "A": "低血压", + "B": "非去极化肌松药作用时间延长", + "C": "心动过缓", + "D": "高血糖" + } + }, + { + "id": "5bf0bd53-fa49-53f4-bf80-7e469a3b923f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is true with regard to potential complications associated with thyroid surgery?", + "A": "Unilateral recurrent laryngeal nerve damage will cause aphonia.", + "B": "Unanticipated difficult airway is present in 5%-8% of thyroid cases.", + "C": "Retrosternal thyroid may cause airway obstruction with prone positioning.", + "D": "Postoperative hypocalcemia typically manifests immediately in the postanesthesia care unit." + }, + "zh": { + "question": "以下关于甲状腺手术相关潜在并发症的说法中哪一项是正确的？", + "A": "单侧喉返神经损伤会导致失音。", + "B": "5%-8%的甲状腺病例中存在意外的困难气道。", + "C": "胸骨后甲状腺可能在俯卧位时导致气道阻塞。", + "D": "术后低钙血症通常在麻醉后护理单元立即表现出来。" + } + }, + { + "id": "1f68d89a-1547-55d0-83a9-b413f23f8821", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following diagnostic results is consistent with a diagnosis of Grave disease?", + "A": "Elevated TSH", + "B": "Normal free T4", + "C": "Diffusely increased radioactive iodine uptake", + "D": "Decreased free T3" + }, + "zh": { + "question": "以下哪项诊断结果与Grave病的诊断一致？", + "A": "TSH升高", + "B": "游离T4正常", + "C": "放射性碘摄取弥漫性增加", + "D": "游离T3降低" + } + }, + { + "id": "09c55fbf-4272-5c1e-b52c-740fc738058e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which statement correctly describes one of the actions of parathyroid hormone (PTH)?", + "A": "PTH increases Ca 2+ resorption in the ascending loop of Henle, distal tubule, and collecting tubule of the kidney.", + "B": "PTH inhibits 1α-hydroxylase gene in renal cells.", + "C": "PTH promotes uptake of calcium by osteocytes.", + "D": "PTH increases the reabsorption of phosphate and bicarbonate in the nephron." + }, + "zh": { + "question": "哪项陈述正确描述了甲状旁腺激素（PTH）的一种作用？", + "A": "PTH增加肾脏亨利氏袢升支、远曲小管和集合小管中Ca 2+的重吸收。", + "B": "PTH抑制肾细胞中1α-羟化酶基因。", + "C": "PTH促进骨细胞对钙的摄取。", + "D": "PTH增加肾单位中磷酸盐和碳酸氢盐的重吸收。" + } + }, + { + "id": "c710469b-0b0c-5c2e-8df4-390943710671", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is the primary mechanism by which calcitonin reduces serum Ca 2+ levels?", + "A": "Increasing the renal excretion of phosphate", + "B": "Decreasing the intestinal absorption of calcium", + "C": "Promotion of osteoblastic activity to increase bone formation", + "D": "Inhibition of osteoclast activity to decrease bone resorption" + }, + "zh": { + "question": "以下哪项是降钙素降低血清钙离子水平的主要机制？", + "A": "增加磷酸盐的肾脏排泄", + "B": "减少钙的肠道吸收", + "C": "促进成骨细胞活动以增加骨形成", + "D": "抑制破骨细胞活动以减少骨吸收" + } + }, + { + "id": "1afd7adb-f5e3-51d1-8266-1ea89cfd9c6e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "13. What is the initial step in the management of a patient with symptomatic hypercalcemia?", + "A": "Calcitonin", + "B": "Furosemide", + "C": "Normal saline", + "D": "Pamidronate" + }, + "zh": { + "question": "13. 对于有症状的高钙血症患者，管理的初始步骤是什么？", + "A": "降钙素", + "B": "呋塞米", + "C": "生理盐水", + "D": "帕米膦酸钠" + } + }, + { + "id": "d7dd487e-acdc-583e-8df1-f7453f83051b", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What is the adjusted plasma calcium for a patient with end-stage liver disease who is hypoalbuminemic with the following laboratory values?", + "A": "5.7 mg/dL", + "B": "7.6 mg/dL", + "C": "9.5 mg/dL", + "D": "10 mg/dL" + }, + "zh": { + "question": "对于患有终末期���病且低白蛋白血症的患者，调整后的血浆钙是多少？", + "A": "5.7 mg/dL", + "B": "7.6 mg/dL", + "C": "9.5 mg/dL", + "D": "10 mg/dL" + } + }, + { + "id": "0a9092c4-cc37-5fdd-b315-594dff5c5a46", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following causes an increase in the ionized calcium concentration?", + "A": "Increased serum albumin", + "B": "Alkalosis", + "C": "Transfusion of fresh frozen plasma", + "D": "Acidosis" + }, + "zh": { + "question": "下列哪项会导致离子化钙浓度增加？", + "A": "血清白蛋白增加", + "B": "碱中毒", + "C": "输注新鲜冰冻血浆", + "D": "酸中毒" + } + }, + { + "id": "52342534-652b-5339-990b-8b89e2316044", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements is true regarding the preoperative preparation for a patient with pheochromocytoma?", + "A": "Selective α1 -blockers have a longer duration of action compared with phenoxybenzamine.", + "B": "β-Blockade should be initiated before α-blockade.", + "C": "Calcium channel blockers are contraindicated in patients with pheochromocytoma.", + "D": "The primary side effect of phenoxybenzamine is orthostatic hypotension." + }, + "zh": { + "question": "关于嗜铬细胞瘤患者的术前准备，下列哪项陈述是正确的？", + "A": "选择性α1-阻滞剂的作用时间比苯氧苄胺长。", + "B": "β-阻滞应在α-阻滞之前开始。", + "C": "钙通道阻滞剂在嗜铬细胞瘤患者中是禁忌的。", + "D": "苯氧苄胺的主要副作用是体位性低血压。" + } + }, + { + "id": "1b5ebcb5-efa9-5727-ab41-899046f7d0fb", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following steroids lacks mineralocorticoid activity?", + "A": "Hydrocortisone", + "B": "Dexamethasone", + "C": "Methylprednisolone", + "D": "Prednisone" + }, + "zh": { + "question": "下列哪种类固醇缺乏盐皮质激素活性？", + "A": "氢化可的松", + "B": "地塞米松", + "C": "甲泼尼龙", + "D": "泼尼松" + } + }, + { + "id": "423f2d0d-10b9-5550-b416-2050b7df9030", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "19. In which of the following patients is stress dose steroid administration", + "A": "A 67-year-old man on prednisone 10 mg daily for 5 days for chronic obstructive pulmonary disease exacerbation presenting for laparoscopic cholecystectomy", + "B": "A 40-year-old woman on prednisone 2.5 mg daily for 6 years for systemic lupus erythematosus presenting for total knee arthroplasty", + "C": "A 23-year-old man on prednisone 20 mg daily for ulcerative colitis presenting for subtotal colectomy", + "D": "A 56-year-old woman on prednisone 40 mg daily for rheumatoid arthritis presenting for superficial lymph node biopsy" + }, + "zh": { + "question": "19. 以下哪位患者需要应激剂量类固醇给药", + "A": "67岁男性，因慢性阻塞性肺病加重服用泼尼松10毫克每日5天，现准备进行腹腔镜胆囊切除术", + "B": "40岁女性，因系统性红斑狼疮服用泼尼松2.5毫克每日6年，现准备进行全膝关节置换术", + "C": "23岁男性，因溃疡性结肠炎服用泼尼松20毫克每日，现准备进行次全结肠切除术", + "D": "56岁女性，因类风湿性关节炎服用泼尼松40毫克每日，现准备进行浅表淋巴结活检" + } + }, + { + "id": "c1283ad7-42cd-55da-ab63-1adf7cdf3a78", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following correctly describes a physiologic effect of glucocorticoids?", + "A": "Increase in eosinophils and basophils", + "B": "Decreased protein catabolism", + "C": "Sensitization to insulin", + "D": "Promotion of gluconeogenesis" + }, + "zh": { + "question": "以下哪项正确描述了糖皮质激素的生理作用？", + "A": "嗜酸性粒细胞和嗜碱性粒细胞增加", + "B": "蛋白质分解代谢减少", + "C": "对胰岛素的敏感化", + "D": "促进糖异生" + } + }, + { + "id": "27f4d8a9-d0d4-5e5e-a5f3-cc08fd1a6248", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following characteristics is most consistent with nonketotic hyperosmolar coma?", + "A": "Metabolic acidosis", + "B": "Hypokalemia", + "C": "Skeletal muscle weakness", + "D": "Profound hyperglycemia >600 mg/dL" + }, + "zh": { + "question": "以下哪项特征最符合非酮症高渗性昏迷？", + "A": "代谢性酸中毒", + "B": "低钾血症", + "C": "骨骼肌无力", + "D": "严重高血糖 >600 mg/dL" + } + }, + { + "id": "65b1d2cd-e0e6-53f2-a9f3-190a5a4852f0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Long-term type 1 diabetes is associated with which of the following anesthetic complications?", + "A": "Malignant hyperthermia", + "B": "Difficult airway", + "C": "Pseudocholinesterase deficiency", + "D": "Anaphylaxis to local anesthetics" + }, + "zh": { + "question": "长期1型糖尿病与以下哪种麻醉并发症有关？", + "A": "恶性高热", + "B": "困难气道", + "C": "假性胆碱酯酶缺乏", + "D": "对局部麻醉药的过敏反应" + } + }, + { + "id": "66052a1c-f3fe-5c08-bede-5a36c94008f3", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is true of glucose metabolism in the perioperative period?", + "A": "Glucagon levels are decreased.", + "B": "Blood glucose levels in nondiabetic patients may rise as much as 60 mg/dL.", + "C": "Catecholamines inhibit gluconeogenesis.", + "D": "ACTH levels are decreased." + }, + "zh": { + "question": "以下哪项陈述是关于围手术期葡萄糖代谢的正确说法？", + "A": "胰高血糖素水平降低。", + "B": "非糖尿病患者的血糖水平可能上升至60 mg/dL。", + "C": "儿茶酚胺抑制糖异生。", + "D": "促肾上腺皮质激素（ACTH）水平降低。" + } + }, + { + "id": "32574c1c-4ccb-5b4f-b438-c38efefc3d07", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In which of the following scenarios is it acceptable to administer metformin therapy?", + "A": "The night before elective surgery", + "B": "In the presence of NYHA class II heart failure", + "C": "The morning a patient will undergo CT scan with IV contrast", + "D": "In a patient with pyelonephritis who remains normotensive" + }, + "zh": { + "question": "在以下哪种情况下可以接受使用二甲双胍治疗？", + "A": "择期手术前一晚", + "B": "存在NYHA II级心力衰竭", + "C": "患者将进行静脉注射造影剂的CT扫描当天早晨", + "D": "患有肾盂肾炎且保持正常血压的患者" + } + }, + { + "id": "97552047-84fc-58a6-9eec-987f550e94b4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is true regarding the cardiac risk in patients with diabetes mellitus?", + "A": "Diabetic patients reliably present with classic angina symptoms in the setting of acute myocardial infarction.", + "B": "Aspirin therapy is recommended for diabetic patients in the absence of known coronary disease.", + "C": "Routine stress testing is indicated for all diabetic patients to identify silent ischemia.", + "D": "ACE inhibitors should be avoided in diabetes because they are at risk of diabetic nephropathy." + }, + "zh": { + "question": "关于糖尿病患者的心脏风险，下列哪项陈述是正确的？", + "A": "糖尿病患者在急性心肌梗死的情况下通常会出现典型的心绞痛症状。", + "B": "在没有已知冠心病的情况下，建议糖尿病患者使用阿司匹林治疗。", + "C": "建议对所有糖尿病患者进行常规压力测试以识别无症状性缺血。", + "D": "应避免糖尿病患者使用ACE抑制剂，因为他们有患糖尿病肾病的风险。" + } + }, + { + "id": "557a70cc-1b04-5e62-bafd-a55444698b05", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The process of glycolysis converts glucose into what molecule?", + "A": "NADPH", + "B": "Acetyl-CoA", + "C": "Pyruvate", + "D": "Lactate" + }, + "zh": { + "question": "糖酵解过程将葡萄糖转化为什么分子？", + "A": "NADPH", + "B": "乙酰辅酶A", + "C": "丙酮酸", + "D": "乳酸" + } + }, + { + "id": "4bd79704-403b-5c05-a7ac-77885f031c2e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "27. Which molecule is common to carbohydrate, lipid, and amino acid metabolism and does directly enter the Krebs cycle for further metabolism?", + "A": "Acetyl-CoA", + "B": "Pyruvate", + "C": "Citrate", + "D": "Succinyl-CoA" + }, + "zh": { + "question": "27. 哪种分子在碳水化合物、脂类和氨基酸代谢中是共同的，并直接进入克雷布斯循环进行进一步代谢？", + "A": "乙酰辅酶A", + "B": "丙酮酸", + "C": "柠檬酸", + "D": "琥珀酰辅酶A" + } + }, + { + "id": "3fb44b19-d1f1-554b-bdb6-1d08ac1988d5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following molecules accelerates the Krebs cycle via activation of pyruvate dehydrogenase phosphatase?", + "A": "Citrate", + "B": "ATP", + "C": "NADH", + "D": "Calcium" + }, + "zh": { + "question": "以下哪种分子通过激活丙酮酸脱氢酶磷酸酶加速克雷布斯循环？", + "A": "柠檬酸", + "B": "ATP", + "C": "NADH", + "D": "钙" + } + }, + { + "id": "3d82c877-f973-5c93-8c17-521d663e2eb2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the final acceptor of electrons in the electron transport chain?", + "A": "NADH", + "B": "NAD+", + "C": "Oxygen", + "D": "FADH+" + }, + "zh": { + "question": "以下哪一项是电子传递链中电子的最终受体？", + "A": "NADH", + "B": "NAD+", + "C": "氧气", + "D": "FADH+" + } + }, + { + "id": "97cf3577-fecc-502d-b53c-758b27b77616", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following organs is/are responsible for gluconeogenesis?", + "A": "Liver only", + "B": "Kidney only", + "C": "Brain", + "D": "Liver and kidney" + }, + "zh": { + "question": "下列哪个器官负责糖异生？", + "A": "仅肝脏", + "B": "仅肾脏", + "C": "大脑", + "D": "肝脏和肾脏" + } + }, + { + "id": "9454e8ce-f874-52fe-833a-13e5ed9f6658", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the mechanism of action of simvastatin in lowering lipid levels?", + "A": "Prevention of intestinal absorption of triacylglycerides (TAGs)", + "B": "HMG-CoA reductase inhibition", + "C": "PCSK9 inhibition", + "D": "Upregulation of β-oxidation of fatty acids" + }, + "zh": { + "question": "下列哪项是辛伐他汀降低脂质水平的作用机制？", + "A": "防止三酰甘油（TAGs）的肠道吸收", + "B": "HMG-CoA还原酶抑制", + "C": "PCSK9抑制", + "D": "上调脂肪酸的β-氧化" + } + }, + { + "id": "5280a74b-c7d3-5e69-b08a-6a202ee89b2c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is true of lipid digestion?", + "A": "Cholecystokinin speeds gastric motility.", + "B": "TAGs are absorbed unchanged in the small intestine.", + "C": "Emulsification of lipids occurs primarily in the small intestine.", + "D": "Lipids diffuse into enterocytes unchanged because of their water solubility." + }, + "zh": { + "question": "以下哪项关于脂质消化的说法是正确的？", + "A": "胆囊收缩素加速胃动力。", + "B": "甘油三酯在小肠中不变地被吸收。", + "C": "脂质的乳化主要发生在小肠中。", + "D": "由于脂质的水溶性，它们不变地扩散进入肠上皮细胞。" + } + }, + { + "id": "08ab5d85-c1b3-54da-8e0b-7a967dcf1db2", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Patients with pancreatic exocrine insufficiency are at risk for which vitamin deficiency?", + "A": "Thiamine", + "B": "Pyridoxine", + "C": "Vitamin B12", + "D": "Vitamin D" + }, + "zh": { + "question": "胰腺外分泌功能不全的患者有缺乏哪种维生素的风险？", + "A": "硫胺素", + "B": "吡哆醇", + "C": "维生素B12", + "D": "维生素D" + } + }, + { + "id": "bfbc5d3d-9d6e-53d2-a0e0-1bbf5c40884f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is true with regard to lipid metabolism in the liver?", + "A": "The liver may package TAGs into very-low-density lipoproteins for transport to other tissues.", + "B": "The liver can extract energy from ketones via ketoacyl-CoA transferase.", + "C": "Insulin activates β-oxidation of fatty acids in the liver.", + "D": "When there is a deficiency in glycogen, the liver converts glucose to TAGs for storage." + }, + "zh": { + "question": "关于肝脏中的脂质代谢，下列哪项陈述是正确的？", + "A": "肝脏可以将三酰甘油包装成极低密度脂蛋白以运输到其他组织。", + "B": "肝脏可以通过酮酰辅酶A转移酶从酮体中提取能量。", + "C": "胰岛素激活肝脏中脂肪酸的β-氧化。", + "D": "当糖原缺乏时，肝脏将葡萄糖转化为三酰甘油以储存。" + } + }, + { + "id": "438c91a2-4cc8-5e9d-ae32-bec01b44c50b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "35. Which organ is unable to utilize fatty acid oxidation in times of starvation and thus relies primarily on ketone metabolism?", + "A": "Heart", + "B": "Liver", + "C": "Brain", + "D": "Muscle" + }, + "zh": { + "question": "35. 哪个器官在饥饿时无法利用脂肪酸氧化，因此主要依赖酮体代谢？", + "A": "心脏", + "B": "肝脏", + "C": "大脑", + "D": "肌肉" + } + }, + { + "id": "8cd5aa45-10fd-5749-800e-b594d0667cd3", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is true regarding cholesterol metabolism?", + "A": "Bile salts are recirculated through enterohepatic circulation several times a day.", + "B": "Cholesterol is converted into bile salts in the gall bladder.", + "C": "Bile salts are excreted into the colon.", + "D": "Cholesterols are hydrophilic molecules." + }, + "zh": { + "question": "关于胆固醇代谢，下列哪项陈述是正确的？", + "A": "胆盐通过肠肝循环每天多次循环。", + "B": "胆固醇在胆囊中转化为胆盐。", + "C": "胆盐被排泄到结肠中。", + "D": "胆固醇是亲水性分子。" + } + }, + { + "id": "fb56bf4b-7c88-5009-bc69-bec39627fd79", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the mechanism of action of ezetimibe in lowering lipid levels?", + "A": "Prevention of intestinal absorption of TAGs", + "B": "HMG-CoA reductase inhibition", + "C": "PCSK9 inhibition", + "D": "Upregulating β-oxidation of fatty acids" + }, + "zh": { + "question": "以下哪项是依折麦布降低脂质水平的作用机制？", + "A": "阻止肠道吸收甘油三酯", + "B": "抑制HMG-CoA还原酶", + "C": "抑制PCSK9", + "D": "上调脂肪酸的β-氧化" + } + }, + { + "id": "326875f7-9eb9-51b8-a1ec-019f1adf6050", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Inhaled nitric oxide (NO) produces pulmonary vasodilation via increased concentration of which of the following substances?", + "A": "Calcium", + "B": "Atrial natriuretic peptide", + "C": "Cyclic adenosine monophosphate (cAMP)", + "D": "Cyclic guanosine monophosphate (cGMP)" + }, + "zh": { + "question": "吸入一氧化氮（NO）通过增加以下哪种物质的浓度来产生肺血管扩张？", + "A": "钙", + "B": "心房钠尿肽", + "C": "环磷酸腺苷（cAMP）", + "D": "环磷酸鸟苷（cGMP)" + } + }, + { + "id": "77fc4e14-504c-5e92-aa58-495d1fca6b65", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Phosphodiesterase-5 inhibitors, such as sildenafil, will have which of the following effects?", + "A": "Increase the intracellular level of cAMP", + "B": "Increase the intracellular level of cGMP", + "C": "Decrease the intracellular level of cAMP", + "D": "Decrease the intracellular level of cGMP" + }, + "zh": { + "question": "磷酸二酯酶-5抑制剂，如西地那非，将产生以下哪种效果？", + "A": "增加细胞内cAMP水平", + "B": "增加细胞内cGMP水平", + "C": "降低细胞内cAMP水平", + "D": "降低细胞内cGMP水平" + } + }, + { + "id": "f4882c75-f69b-5ec5-8a79-ff7f104c3d53", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Activation of the β1 -adrenergic receptor will increase the concentration of which of the following secondary messengers?", + "A": "Cyclic guanosine monophosphate", + "B": "Cyclic adenosine monophosphate", + "C": "Ca 2+", + "D": "Inositol triphosphate (IP3 )" + }, + "zh": { + "question": "β1-肾上腺素能受体的激活会增加以下哪种次级信使的浓度？", + "A": "环鸟苷酸", + "B": "环腺苷酸", + "C": "Ca 2+", + "D": "肌醇三磷酸 (IP3)" + } + }, + { + "id": "d108d930-1daa-5af1-a350-2f67c2a42d04", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Acetylcholine (Ach) binds to which subunit of the nicotinic acetylcholine receptor (nAchR) on the skeletal muscle?", + "A": "α", + "B": "β", + "C": "γ", + "D": "δ" + }, + "zh": { + "question": "乙酰胆碱（Ach）与骨骼肌上的烟碱型乙酰胆碱受体（nAchR）的哪个亚基结合？", + "A": "α", + "B": "β", + "C": "γ", + "D": "δ" + } + }, + { + "id": "26147abf-0ab1-5b4b-b5bf-a9f0b4621856", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the correct sequence of signals, leading to skeletal muscle contraction?", + "A": "Release of Ach → ligand-gated Na + channels → motor nerve depolarization → voltage-gated Ca ++ channels → muscle depolarization", + "B": "Motor nerve depolarization → voltage-gated Ca ++ channels → release of Ach → ligand-gated Na + channels → muscle depolarization", + "C": "Motor nerve depolarization → ligand-gated Na + channels → release of Ach → voltage-gated Ca ++ channels → muscle depolarization", + "D": "Ligand-gated Na + channels → voltage-gated Ca ++ channels → release of Ach → motor nerve depolarization → muscle depolarization" + }, + "zh": { + "question": "以下哪项是导致骨骼肌收缩的信号正确顺序？", + "A": "释放Ach → 配体门控Na+通道 → 运动神经去极化 → 电压门控Ca++通道 → 肌肉去极化", + "B": "运动神经去极化 → 电压门控Ca++通道 → 释放Ach → 配体门控Na+通道 → 肌肉去极化", + "C": "运动神经去极化 → 配体门控Na+通道 → 释放Ach → 电压门控Ca++通道 → 肌肉去极化", + "D": "配体门控Na+通道 → 电压门控Ca++通道 → 释放Ach → 运动神经去极化 → 肌肉去极化" + } + }, + { + "id": "12b13e09-a62e-5aab-85f5-a76ca888fea3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following conditions may increase extrajunctional acetylcholine receptors (AchRs), EXCEPT which one?", + "A": "Severe burn", + "B": "Prolonged ICU stay", + "C": "Stroke", + "D": "Renal failure" + }, + "zh": { + "question": "以下所有情况均可能增加关节外乙酰胆碱受体（AchRs），除了哪一个？", + "A": "严重烧伤", + "B": "长期ICU住院", + "C": "中风", + "D": "肾衰竭" + } + }, + { + "id": "de45b5ba-54f6-5294-8195-34c3258a59e2", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The effect of Ach at the neuromuscular junction (NMJ) is terminated by which of the following mechanisms?", + "A": "Break down by acetylcholinesterase", + "B": "Break down by pseudocholinesterase", + "C": "Degradation by tissue esterase", + "D": "Reuptake into the nerve terminal" + }, + "zh": { + "question": "在神经肌肉接头（NMJ），Ach 的作用通过以下哪种机制终止？", + "A": "被乙酰胆碱酯酶分解", + "B": "被假性胆碱酯酶分解", + "C": "被组织酯酶降解", + "D": "重新摄取到神经末梢" + } + }, + { + "id": "0d3d9164-6e47-553b-bcd3-4026111d407c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "5. How many Ach molecules must bind to each postsynaptic receptor on muscle cells to induce conformational change?", + "A": "1", + "B": "2", + "C": "3", + "D": "4" + }, + "zh": { + "question": "5. 多少个乙酰胆碱分子必须结合到肌肉细胞上的每个突触后受体以引起构象变化？", + "A": "1", + "B": "2", + "C": "3", + "D": "4" + } + }, + { + "id": "6042e6a4-ad35-5994-a0e2-45b36a16d151", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following drugs inhibit nAchRs EXCEPT which one?", + "A": "α-Bungarotoxin", + "B": "Curare", + "C": "Pancuronium", + "D": "Atropine" + }, + "zh": { + "question": "以下所有药物均抑制nAchRs，除了哪一个？", + "A": "α-银环蛇毒素", + "B": "箭毒", + "C": "潘库溴铵", + "D": "阿托品" + } + }, + { + "id": "180544e1-cd65-5d0f-a468-2dd742a6b106", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Ca +2 binding to which component of the NMJ induces muscle contraction?", + "A": "Actin", + "B": "Thin filaments", + "C": "Troponin", + "D": "Nicotinic acetylcholine receptor" + }, + "zh": { + "question": "Ca +2 结合于神经肌肉接头的哪个成分引发肌肉收缩？", + "A": "肌动蛋白", + "B": "细肌丝", + "C": "肌钙蛋白", + "D": "烟碱型乙酰胆碱受体" + } + }, + { + "id": "d3883a5f-9946-5fd7-a142-d7862136c82c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following structures of the skeletal muscle does not change in length as the muscle contracts?", + "A": "A band", + "B": "I band", + "C": "H zone", + "D": "Z line" + }, + "zh": { + "question": "以下哪种骨骼肌结构在肌肉收缩时长度不变？", + "A": "A带", + "B": "I带", + "C": "H区", + "D": "Z线" + } + }, + { + "id": "53abfdd5-a5ab-5709-a190-b771b1a9a8eb", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which subunit of the nAchR is present in receptors located at the endplate", + "A": "β", + "B": "γ", + "C": "δ", + "D": "ε" + }, + "zh": { + "question": "在终板处的受体中存在的nAchR亚基是哪个？", + "A": "β", + "B": "γ", + "C": "δ", + "D": "ε" + } + }, + { + "id": "6a50e318-18ac-562c-ae52-a75978a23ec0", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the resting potential of the skeletal muscle cell?", + "A": "−90 mV", + "B": "−70 mV", + "C": "−50 mV", + "D": "0 mV" + }, + "zh": { + "question": "以下哪项是骨骼肌细胞的静息电位？", + "A": "−90 mV", + "B": "−70 mV", + "C": "−50 mV", + "D": "0 mV" + } + }, + { + "id": "d0b646aa-a0cf-577a-adba-aa26d8a6eaa5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following agents leads to an increase of Ach release from motor neuron terminals?", + "A": "Calcium channel blockers", + "B": "Magnesium", + "C": "Tetanus toxin", + "D": "Botulinum toxin" + }, + "zh": { + "question": "下列哪种药物会导致运动神经末梢释放乙酰胆碱增加？", + "A": "钙通道阻滞剂", + "B": "镁", + "C": "破伤风毒素", + "D": "肉毒毒素" + } + }, + { + "id": "20e6a087-b407-5a78-b42f-15ce68ef46b6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Synthesis of Ach is facilitated by which enzyme?", + "A": "Acetylcholinesterase", + "B": "Choline acetyltransferase", + "C": "Choline kinase", + "D": "Choline transporter" + }, + "zh": { + "question": "乙酰胆碱的合成由哪种酶促进？", + "A": "乙酰胆碱酯酶", + "B": "胆碱乙酰转移酶", + "C": "胆碱激酶", + "D": "胆碱转运蛋白" + } + }, + { + "id": "84207d85-73ae-5d2e-b7f6-d567129086e4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "13. Which of the following is the correct configuration of voltage-gated sodium channels in the repolarization phase immediately after the peak of an action potential?", + "A": "Activation and inactivation gates both open", + "B": "Activation gate open, inactivation gate closed", + "C": "Activation gate closed, inactivation gate open", + "D": "Activation and inactivation gates both closed" + }, + "zh": { + "question": "13. 以下哪项是动作电位峰值后复极化阶段电压门控钠通道的正确构型？", + "A": "激活门和失活门均打开", + "B": "激活门打开，失活门关闭", + "C": "激活门关闭，失活门打开", + "D": "激活门和失活门均关闭" + } + }, + { + "id": "dcf08f50-2b5c-5015-9e7c-52537651e43d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Tetanic fade following administration of nondepolarizing neuromuscular blockers (NMBs) indicates the inhibition of which group of receptors?", + "A": "Presynaptic nAchR", + "B": "Postsynaptic nAchR", + "C": "Presynaptic calcium channels", + "D": "Postsynaptic calcium channels" + }, + "zh": { + "question": "非去极化神经肌肉阻滞剂（NMBs）引起的强直衰退表明抑制了哪一组受体？", + "A": "突触前nAchR", + "B": "突触后nAchR", + "C": "突触前钙通道", + "D": "突触后钙通道" + } + }, + { + "id": "535013b0-01a0-5c1b-8b85-f1cbf168b3c1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Potential adverse effects of succinylcholine include all of the following", + "A": "Myalgia", + "B": "Aspiration", + "C": "Increased intraocular pressure", + "D": "Anaphylaxis" + }, + "zh": { + "question": "琥珀胆碱的潜在不良反应包括以下所有选项", + "A": "肌痛", + "B": "误吸", + "C": "眼内压升高", + "D": "过敏反应" + } + }, + { + "id": "b00a3661-34d8-5811-80e6-decf62f79ab7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements provides the most accurate explanation behind the \"faster onset\" of rocuronium as compared with cisatracurium?", + "A": "Rocuronium is less potent.", + "B": "Rocuronium is more potent.", + "C": "Rocuronium is ultrashort acting.", + "D": "Rocuronium is long acting." + }, + "zh": { + "question": "以下哪项陈述最准确地解释了罗库溴铵相比于西酰胺的“更快起效”原因？", + "A": "罗库溴铵效力较低。", + "B": "罗库溴铵效力较高。", + "C": "罗库溴铵是超短效药物。", + "D": "罗库溴铵是长效药物。" + } + }, + { + "id": "54cd671a-a918-5966-8fd9-9e18141dfdaf", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following agents belongs to the group of benzylisoquinolinium NMBs?", + "A": "Rocuronium", + "B": "Cisatracurium", + "C": "Vecuronium", + "D": "Succinylcholine" + }, + "zh": { + "question": "以下哪种药物属于苯基异喹啉类神经肌肉阻滞剂？", + "A": "罗库溴铵", + "B": "西酞曲溴铵", + "C": "维库溴铵", + "D": "琥珀胆碱" + } + }, + { + "id": "45ac23e4-707d-56b0-8201-2b05c045855c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Compared with its precursor atracurium, what is the main advantage of cisatracurium?", + "A": "Rapid, organ-independent degradation", + "B": "Faster onset", + "C": "Longer duration because of active metabolites", + "D": "Decreased histamine release" + }, + "zh": { + "question": "与其前体阿曲库铵相比，顺式阿曲库铵的主要优点是什么？", + "A": "快速、器官非依赖性降解", + "B": "起效更快", + "C": "由于活性代谢物而持续时间更长", + "D": "减少组胺释放" + } + }, + { + "id": "1dde24f4-41ab-55a6-94f8-ce1e221ca57e", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "When a long-duration depolarizing NMB (eg, pancuronium) is added at the end of an intermediate-duration NMB (eg, rocuronium) block, how will the recovery pattern change?", + "A": "Recovery will be similar to rocuronium.", + "B": "Recovery will be similar to pancuronium.", + "C": "Recovery will be synergistically prolonged, significantly longer than pancuronium.", + "D": "Recovery will be antagonistically shortened, significantly shorter than rocuronium." + }, + "zh": { + "question": "当在中等持续时间的去极化神经肌肉阻滞剂（如罗库溴铵）阻滞结束时加入长效去极化神经肌肉阻滞剂（如潘库溴铵）时，恢复模式将如何变化？", + "A": "恢复将类似于罗库溴铵。", + "B": "恢复将类似于潘库溴铵。", + "C": "恢复将协同延长，显著长于潘库溴铵。", + "D": "恢复将拮抗性缩短，显著短于罗库溴铵。" + } + }, + { + "id": "d44dfadd-73d3-552c-ab86-1d12904f6223", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Compared with the phase I block elicited by succinylcholine, the phase II block has which of the following characteristics?", + "A": "Same twitch strength with repetitive stimulation", + "B": "Posttetanic potentiation", + "C": "Similarity with depolarizing block", + "D": "Posttetanic depression" + }, + "zh": { + "question": "与琥珀胆碱引起的I期阻滞相比，II期阻滞具有以下哪种特征？", + "A": "重复刺激时相同的抽搐强度", + "B": "后强直性增强", + "C": "与去极化阻滞的相似性", + "D": "后强直性抑制" + } + }, + { + "id": "2f1ba421-ae99-558c-be7e-566bf0016105", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "21. Which statement regarding the phase II block that can be associated with succinylcholine administration is true?", + "A": "Phase II block occurs only after prolonged exposure to succinylcholine.", + "B": "Receptor desensitization is a mechanism responsible for phase II block.", + "C": "Inhalation anesthetics delay the onset of phase II block.", + "D": "Phase II block results in train-of-four (TOF) fade but not tetanic fade." + }, + "zh": { + "question": "21. 关于与琥珀胆碱给药相关的第二相阻滞，哪种说法是正确的？", + "A": "第二相阻滞仅在长时间暴露于琥珀胆碱后发生。", + "B": "受体脱敏是导致第二相阻滞的机制。", + "C": "吸入麻醉剂延迟第二相阻滞的发生。", + "D": "第二相阻滞导致四联刺激（TOF）衰减，但不导致强直衰减。" + } + }, + { + "id": "cf9d4ddd-5e1b-5db8-8650-52ba83021002", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A patient was maintained on a succinylcholine infusion for 8 hours during surgery and does not regain spontaneous ventilation 30 minutes after the infusion was discontinued. TOF yields 1 twitch. Which of the following is the best course of action?", + "A": "Give neostigmine.", + "B": "Send pseudocholinesterase activity test.", + "C": "Give naloxone.", + "D": "Wait for spontaneous recovery." + }, + "zh": { + "question": "一名患者在手术期间接受了8小时的琥珀胆碱输注，输注停止30分钟后仍未恢复自主呼吸。TOF显示1次抽搐。以下哪项是最佳处理方案？", + "A": "给予新斯的明。", + "B": "进行假性胆碱酯酶活性测试。", + "C": "给予纳洛酮。", + "D": "等待自主恢复。" + } + }, + { + "id": "c526c925-cd8f-5c88-bca3-39165f2825a0", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which mechanism best explains the fasciculations often seen preceding a phase I block by succinylcholine?", + "A": "Activation of presynaptic nAchR", + "B": "Activation of postsynaptic nAchR", + "C": "Prolonged muscle depolarization", + "D": "Prolonged muscle repolarization" + }, + "zh": { + "question": "哪种机制最能解释琥珀胆碱引起的I期阻滞前常见的肌束颤动？", + "A": "激活突触前nAchR", + "B": "激活突触后nAchR", + "C": "延长肌肉去极化", + "D": "延长肌肉复极化" + } + }, + { + "id": "d96f3a35-db60-5a4d-9888-75438d0b1847", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient on succinylcholine infusion has a TOF ratio of 0.3. What does this tell about the patient's degree of paralysis?", + "A": "Patient is in phase I block.", + "B": "Patient is in phase II block.", + "C": "Patient is recovering from block.", + "D": "Cannot tell from given information." + }, + "zh": { + "question": "一名患者正在接受琥珀胆碱输注，TOF比率为0.3。这说明了患者的麻痹程度如何？", + "A": "患者处于第一阶段阻滞。", + "B": "患者处于第二阶段阻滞。", + "C": "患者正在从阻滞中恢复。", + "D": "无法从给定信息中判断。" + } + }, + { + "id": "14f86c97-64ee-527f-b8d1-115f76c54b69", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Monitoring the TOF to assess the quality of a neuromuscular blockade offers what advantage over single twitch monitoring?", + "A": "TOF offers objective assessment of fade.", + "B": "TOF ratio correlates with the amount of stimulating current applied.", + "C": "TOF does not require baseline measurement.", + "D": "TOF is best at detecting the onset of neuromuscular blockade." + }, + "zh": { + "question": "监测TOF以评估神经肌肉阻滞的质量相比单次抽搐监测有什么优势？", + "A": "TOF提供了对衰减的客观评估。", + "B": "TOF比率与施加的刺激电流量相关。", + "C": "TOF不需要基线测量。", + "D": "TOF最适合检测神经肌肉阻滞的开始。" + } + }, + { + "id": "6132e1c3-39d2-5cbc-ae92-4343884d22dd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "When the TOF ratio is 0.7, what portion of the AchRs is still blocked?", + "A": "25%", + "B": "50%", + "C": "75%", + "D": "95%" + }, + "zh": { + "question": "当TOF比率为0.7时，仍有多少比例的AchRs被阻断？", + "A": "25%", + "B": "50%", + "C": "75%", + "D": "95%" + } + }, + { + "id": "4ff0e835-3552-5798-99d3-716a87b78538", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A TOF yields 0 twitch. Repeated 1 Hz stimulation following a 5-second 50 Hz tetanus produces 1 twitch. Assuming the patient was given an intermediateacting NMB, how much time is expected until recovery to TOF twitch count of 1?", + "A": "1-2 minutes", + "B": "5-10 minutes", + "C": "20-30 minutes", + "D": ">1 hour" + }, + "zh": { + "question": "TOF显示0次抽搐。5秒50 Hz强直刺激后进行1 Hz重复刺激产生1次抽搐。假设患者接受了中效NMB，预计需要多长时间才能恢复到TOF抽搐计数为1？", + "A": "1-2分钟", + "B": "5-10分钟", + "C": "20-30分钟", + "D": ">1小时" + } + }, + { + "id": "49ff5b5c-0de7-5f5e-a462-9eca8330aee3", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "28. Compared with TOF, what is an advantage of double-burst stimulation (DBS) for monitoring of neuromuscular blockade?", + "A": "Easier to detect fade", + "B": "Does not use tetanic stimuli", + "C": "Ability to immediately apply a repeat stimulus", + "D": "Smaller current" + }, + "zh": { + "question": "28. 与TOF相比，双重刺激（DBS）在监测神经肌肉阻滞方面的优势是什么？", + "A": "更容易检测到衰减", + "B": "不使用强直刺激", + "C": "能够立即应用重复刺激", + "D": "电流较小" + } + }, + { + "id": "384a4cb1-5c58-557a-9154-efac08b712a4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Side effects of neostigmine include all of the following EXCEPT which one?", + "A": "Salivation", + "B": "Tachycardia", + "C": "Nausea/vomiting", + "D": "Bowel motility" + }, + "zh": { + "question": "新斯的明的副作用包括以下所有选项，除了哪一个？", + "A": "流涎", + "B": "心动过速", + "C": "恶心/呕吐", + "D": "肠蠕动" + } + }, + { + "id": "c5685d82-1108-5503-827d-4dc7e5bafc47", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How long would a patient with a dibucaine number of 20 be expected to remain paralyzed after an intubating dose of succinylcholine?", + "A": "4 minutes", + "B": "40 minutes", + "C": "4 hours", + "D": "4 days" + }, + "zh": { + "question": "一名患者的地布卡因数为20，预计在接受琥珀胆碱插管剂量后会瘫痪多长时间？", + "A": "4分钟", + "B": "40分钟", + "C": "4小时", + "D": "4天" + } + }, + { + "id": "5fff6467-2f2a-5947-987f-ded6fcd05c8f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What differentiates Lambert-Eaton myasthenic syndrome (LEMS) from myasthenia gravis?", + "A": "Patients with LEMS often have autonomic dysfunction.", + "B": "LEMS results from autoantibodies to the postsynaptic AchRs.", + "C": "Patients with LEMS feel more proximal than distal weakness.", + "D": "Patients with LEMS get progressively fatigued with repetitive use of muscles." + }, + "zh": { + "question": "Lambert-Eaton肌无力综合征（LEMS）与重症肌无力有何区别？", + "A": "LEMS患者常有自主神经功能障碍。", + "B": "LEMS是由于针对突触后AchRs的自身抗体引起的。", + "C": "LEMS患者感到近端比远端更无力。", + "D": "LEMS患者在肌肉重复使用时会逐渐疲劳。" + } + }, + { + "id": "a0ebfcaf-6d6b-5f94-8aa2-fc2d600700f5", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "In patients with myasthenia gravis, which factor best predicts the risk of requiring prolonged intubation and mechanical ventilator support?", + "A": "Age of illness onset", + "B": "Involvement of muscle groups", + "C": "Dosage of acetylcholinesterase inhibitor at home", + "D": "Circulating autoantibody level" + }, + "zh": { + "question": "在重症肌无力患者中，哪个因素最能预测需要延长插管和机械通气支持的风险？", + "A": "疾病发作年龄", + "B": "肌肉群受累情况", + "C": "在家使用的乙酰胆碱酯酶抑制剂剂量", + "D": "循环自身抗体水平" + } + }, + { + "id": "a0a13a0b-de7e-519b-bf6a-da9578152d3f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How do patients with myasthenia gravis react to depolarizing NMBs and nondepolarizing NMBs?", + "A": "Sensitive to depolarizing, but insensitive to nondepolarizing NMBs", + "B": "Insensitive to depolarizing, but sensitive to nondepolarizing NMBs", + "C": "Sensitive to both depolarizing and nondepolarizing NMBs", + "D": "Insensitive to both depolarizing and nondepolarizing NMBs" + }, + "zh": { + "question": "重症肌无力患者对去极化型和非去极化型神经肌肉阻滞剂的反应如何？", + "A": "对去极化型敏感，但对非去极化型不敏感", + "B": "对去极化型不敏感，但对非去极化型敏感", + "C": "对去极化型和非去极化型都敏感", + "D": "对去极化型和非去极化型都不敏感" + } + }, + { + "id": "d66fb32e-6a02-565c-bbc9-1957c367b663", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A patient with myasthenia gravis presents with muscle weakness and respiratory failure. What is the best way to differentiate a myasthenia crisis from a cholinergic crisis?", + "A": "Presence or absence of GI symptoms", + "B": "Pupillary exam", + "C": "Tensilon test", + "D": "Excessive sweating" + }, + "zh": { + "question": "一名重症肌无力患者出现肌无力和呼吸衰竭。区分重症肌无力危象和胆碱能危象的最佳方法是什么？", + "A": "有无胃肠道症状", + "B": "瞳孔检查", + "C": "Tensilon试验", + "D": "过度出汗" + } + }, + { + "id": "7e29109e-a782-5049-af07-c3951d77a47d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the inheritance pattern of Duchenne muscular dystrophy (DMD)?", + "A": "Autosomal dominant", + "B": "Autosomal recessive", + "C": "X-linked dominant", + "D": "X-linked recessive" + }, + "zh": { + "question": "杜氏肌营养不良症（DMD）的遗传模式是什么？", + "A": "常染色体显性", + "B": "常染色体隐性", + "C": "X连锁显性", + "D": "X连锁隐性" + } + }, + { + "id": "804c4185-0303-5e8e-9415-715cd5536446", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "36. For patients with myotonic dystrophy, prolonged muscle contraction (myotonia) can be triggered by exposure to all of the following agents EXCEPT which one?", + "A": "Succinylcholine", + "B": "Rocuronium", + "C": "Potassium", + "D": "Neostigmine" + }, + "zh": { + "question": "36. 对于肌强直性营养不良患者，以下所有药��均可引发肌肉收缩延长（肌强直），除了哪一种？", + "A": "琥珀胆碱", + "B": "罗库溴铵", + "C": "钾", + "D": "新斯的明" + } + }, + { + "id": "60aaaed5-4bbe-591d-8ee2-c6e42f405391", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which intravenous anesthetic agent should be avoided in patients with mitochondrial myopathy?", + "A": "Propofol", + "B": "Etomidate", + "C": "Ketamine", + "D": "Dexmedetomidine" + }, + "zh": { + "question": "哪种静脉麻醉药应避免用于线粒体肌病患者？", + "A": "丙泊酚", + "B": "依托咪酯", + "C": "氯胺酮", + "D": "右美托咪定" + } + }, + { + "id": "72019bfe-9bec-5f04-9966-4d254d122ea7", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Malignant hyperthermia is a known risk for patients with the following conditions EXCEPT which one?", + "A": "King Denborough syndrome", + "B": "Multiminicore disease", + "C": "Central core disease", + "D": "Central cord syndrome" + }, + "zh": { + "question": "恶性高热是已知的风险，以下哪种情况的患者除外？", + "A": "King Denborough 综合征", + "B": "多微核病", + "C": "中央核心病", + "D": "中央脊髓综合征" + } + }, + { + "id": "15d89010-3b34-536b-985a-ec5ab970c575", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which intravenous fluid should be avoided in patients with mitochondrial disorder?", + "A": "Normal saline", + "B": "Lactated Ringer (LR)", + "C": "Dextrose", + "D": "Albumin" + }, + "zh": { + "question": "哪种静脉输液应避免用于线粒体疾病患者？", + "A": "生理盐水", + "B": "乳酸林格氏液 (LR)", + "C": "葡萄糖", + "D": "白蛋白" + } + }, + { + "id": "219b7490-11e7-52ad-9ed2-fddf2a75ef8c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Psuedocholinesterase activity is increased in which of the following conditions?", + "A": "Pregnancy", + "B": "Liver failure", + "C": "Obesity", + "D": "Malignancy" + }, + "zh": { + "question": "以下哪种情况会增加假性胆碱酯酶活性？", + "A": "妊娠", + "B": "肝功能衰竭", + "C": "肥胖", + "D": "恶性肿瘤" + } + }, + { + "id": "6865a162-81ed-58a8-86e5-0b0e240f17a5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A researcher designs a study examining the relationship between the gender of patients and the development of phantom limb pain. In this example, \"gender\" is best described as which of the following types of variables?", + "A": "Continuous", + "B": "Dichotomous", + "C": "Ordinal and dichotomous", + "D": "Nominal and dichotomous" + }, + "zh": { + "question": "一位研究人员设计了一项研究，调查患者性别与幻肢痛发展之间的关系。在这个例子中，“性别”最好被描述为以下哪种类型的变量？", + "A": "连续型", + "B": "二分型", + "C": "有序和二分型", + "D": "名义和二分型" + } + }, + { + "id": "3ba83abb-5b8d-5fca-aba7-4518ddc2267e", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A researcher designs a study with the purpose of investigating postoperative analgesic and blood pressure effects when acetaminophen was administered preoperatively. One hundred patients are randomized to receive either acetaminophen or a placebo pill. Systolic blood pressure measurements are recorded in each group, both before their operative procedure and postoperatively. What type of statistical test would be best utilized to analyze data for this study?", + "A": "Paired t-test", + "B": "Unpaired (Student) t-test", + "C": "Chi-squared", + "D": "ANOVA" + }, + "zh": { + "question": "一位研究人员设计了一项研究，目的是调查术前给予对乙酰氨基酚时的术后镇痛和血压效果。将一百名患者随机分为接受对乙酰氨基酚或安慰剂组。记录每组在手术前和术后收缩压的测量值。哪种统计检验最适合用于分析这项研究的数据？", + "A": "配对t检验", + "B": "非配对（学生）t检验", + "C": "卡方检验", + "D": "方差分析（ANOVA）" + } + }, + { + "id": "181a188e-7098-51b1-8b8e-2392099efa38", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A researcher designs a study that examines the relationship between red hair and postoperative nausea and vomiting. Which of the following statistical tests", + "A": "Paired t-test", + "B": "Unpaired (Student) t-test", + "C": "Chi-squared", + "D": "ANOVA" + }, + "zh": { + "question": "一位研究人员设计了一项研究，调查红头发与术后恶心呕吐之间的关系。以下哪种统计检验", + "A": "配对t检验", + "B": "非配对（学生）t检验", + "C": "卡方检验", + "D": "方差分析（ANOVA）" + } + }, + { + "id": "493bf095-37ca-5cb0-826e-236fa96be54c", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A researcher performs a study comparing the average heart rate of 4 groups of patients receiving different doses of a new β-blocker. Which of the following statistical tests is most appropriate to analyze the data from this study?", + "A": "Paired t-test", + "B": "Unpaired (Student) t-test", + "C": "Chi-squared", + "D": "ANOVA" + }, + "zh": { + "question": "一位研究人员进行了一项研究，比较接受不同剂量新型β受体阻滞剂的4组患者的平均心率。以下哪种统计检验最适合分析这项研究的数据？", + "A": "配对t检验", + "B": "独立（学生）t检验", + "C": "卡方检验", + "D": "方差分析（ANOVA）" + } + }, + { + "id": "43e9629d-7887-5cd7-a593-c7dc10db4fce", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "5. The probability of a newborn baby developing respiratory distress with a mother who is a smoker is 0.2 What are the odds of a newborn baby developing respiratory distress with a mother who is a smoker ?", + "A": "0.1", + "B": "0.25", + "C": "1", + "D": "4" + }, + "zh": { + "question": "5. 新生儿在母亲吸烟的情况下发生呼吸窘迫的概率是0.2。新生儿在母亲吸烟的情况下发生呼吸窘迫的赔率是多少？", + "A": "0.1", + "B": "0.25", + "C": "1", + "D": "4" + } + }, + { + "id": "f3aa37cd-7b28-589b-951c-34931037fa40", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A researcher describes a group of data as being positively skewed. In this data set which of the following statements is true?", + "A": "Population values are normally distributed.", + "B": "The tail of the data distribution extends to the right.", + "C": "The mean and median are equal.", + "D": "The mode is greater than the mean." + }, + "zh": { + "question": "一位研究人员描述一组数据为正偏态。在此数据集中，下列哪项陈述是正确的？", + "A": "总体值呈正态分布。", + "B": "数据分布的尾部向右延伸。", + "C": "均值和中位数相等。", + "D": "众数大于均值。" + } + }, + { + "id": "b6164e9e-c81d-5274-9ac6-dc0a43b8de55", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A highly sensitive test is defined as which of the following?", + "A": "A test that correctly classifies those with the disease", + "B": "A test that correctly excludes those without the disease", + "C": "A test that if negative indicates the true absence of the disease", + "D": "A test that if positive indicates the true presence of the disease" + }, + "zh": { + "question": "高度敏感的测试定义为以下哪一项？", + "A": "正确分类患有疾病的人的测试", + "B": "正确排除未患病的人的测试", + "C": "如果结果为阴性则表明真正没有疾病的测试", + "D": "如果结果为阳性则表明真正存在疾病的测试" + } + }, + { + "id": "57daf25f-78bd-53fa-ab9e-f2f26ceabdb1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A highly specific test is defined as which of the following?", + "A": "A test that correctly classifies those with the disease", + "B": "A test that correctly excludes those without the disease", + "C": "A test that if negative indicates the true absence of the disease", + "D": "A test that if positive indicates the true presence of the disease" + }, + "zh": { + "question": "高度特异性的测试定义为以下哪项？", + "A": "正确分类患有疾病者的测试", + "B": "正确排除未患病者的测试", + "C": "如果结果为阴性则表明真正没有疾病的测试", + "D": "如果结果为阳性则表明真正存在疾病的测试" + } + }, + { + "id": "94fc812f-25f7-58be-944f-f046b91db848", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A test with a high positive predictive value (PPV) is defined as which of the following?", + "A": "A test that correctly classifies those with the disease", + "B": "A test that correctly excludes those without the disease", + "C": "A test that if negative indicates the true absence of the disease", + "D": "A test that if positive indicates the true presence of the disease" + }, + "zh": { + "question": "高阳性预测值（PPV）的测试定义为以下哪一项？", + "A": "正确分类患有疾病的人的测试", + "B": "正确排除未患病的人的测试", + "C": "如果结果为阴性则表示真正没有疾病的测试", + "D": "如果结果为阳性则表示真正存在疾病的测试" + } + }, + { + "id": "657083d9-acc2-5152-89ac-ade610bbdf8a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A test with a high negative predictive value is best described as which of the following?", + "A": "A test that correctly classifies those with the disease", + "B": "A test that correctly excludes those without the disease", + "C": "A test that if negative indicates the true absence of the disease", + "D": "A test that if positive indicates the true presence of the disease" + }, + "zh": { + "question": "具有高阴性预测值的测试最好描述为以下哪一项？", + "A": "正确分类患有疾病的人的测试", + "B": "正确排除未患病的人的测试", + "C": "如果结果为阴性则表明真正没有疾病的测试", + "D": "如果结果为阳性则表明真正存在疾病的测试" + } + }, + { + "id": "4ffab09c-edf4-5368-ad56-9db9b8e799dd", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In which type of observational study are subjects chosen and followed over a period to observe the outcome of interest?", + "A": "Cohort", + "B": "Case-control studies", + "C": "Cross-sectional studies", + "D": "Case series" + }, + "zh": { + "question": "在哪种类型的观察性研究中，选择受试者并在一段时间内跟踪观察感兴趣的结果？", + "A": "队列研究", + "B": "病例对照研究", + "C": "横断面研究", + "D": "病例系列" + } + }, + { + "id": "2d85a6e9-3a47-512f-bc13-af62a46e200b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A survey is devised with the intent to compare patient satisfaction and anesthetic type (general or regional anesthesia). This inquiry is best described as which type of study design?", + "A": "Cohort", + "B": "Case-control", + "C": "Cross-sectional", + "D": "Randomized trial" + }, + "zh": { + "question": "一项调查旨在比较患者满意度和麻醉类型（全身麻醉或区域麻醉）。这种调查最适合描述为哪种研究设计？", + "A": "队列研究", + "B": "病例对照研究", + "C": "横断面研究", + "D": "随机试验" + } + }, + { + "id": "6f50d02f-773e-55fd-8692-2cca1a8e1f13", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "13. A type I error is defined as which of the following?", + "A": "Incorrectly rejecting the null hypothesis", + "B": "Correctly rejecting the null hypothesis", + "C": "Incorrectly accepting the null hypothesis", + "D": "Incorrectly rejecting the alternative hypothesis" + }, + "zh": { + "question": "13. I型错误定义为以下哪一项？", + "A": "错误地拒绝了原假设", + "B": "正确地拒绝了原假设", + "C": "错误地接受了原假设", + "D": "错误地拒绝了备择假设" + } + }, + { + "id": "7f3ada42-e493-56a2-adde-f739e200155e", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A study is being designed to examine the impact of a new analgesic on postoperative pain. Patients will be randomized to receive either the new analgesic or placebo, and average postoperative pain scores will be compared in the 2 patient groups. An increase in sample size will be required if which of the following factors is increased?", + "A": "Standard deviation", + "B": "α", + "C": "β", + "D": "Effect size" + }, + "zh": { + "question": "一项研究正在设计中，以检查一种新型镇痛药对术后疼痛的影响。患者将被随机分配接受新型镇痛药或安慰剂，并比较两组患者的平均术后疼痛评分。如果以下哪个因素增加，则需要增加样本量？", + "A": "标准差", + "B": "α", + "C": "β", + "D": "效应量" + } + }, + { + "id": "919dfe3f-395a-5869-9f76-6d1dd2de4395", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The number needed to treat (NNT) is defined as which of the following?", + "A": "The risk of the outcome in the experimental group", + "B": "The difference in risk in the treatment and control groups", + "C": "The number of patients who need to be treated to decrease the adverse outcome by 10%", + "D": "The number of patients who need to be treated to prevent 1 adverse outcome" + }, + "zh": { + "question": "需要治疗的人数（NNT）被定义为以下哪一项？", + "A": "实验组中结果的风险", + "B": "治疗组和对照组风险的差异", + "C": "需要治疗的患者人数以减少10%的不良结果", + "D": "需要治疗的患者人数以预防1个不良结果" + } + }, + { + "id": "d3ad971d-5514-59d6-88d9-e58447f3ae09", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements regarding the null hypothesis (H0 ) is most correct?", + "A": "It represents the absence of a difference between groups.", + "B": "It hypothesizes that there is a difference between test groups.", + "C": "If incorrectly rejected, it is referred to as a type II error.", + "D": "It is represented by the Greek letter α." + }, + "zh": { + "question": "以下关于原假设 (H0) 的陈述中哪一项是最正确的？", + "A": "它表示组间没有差异。", + "B": "它假设测试组之间存在差异。", + "C": "如果错误地拒绝它，则称为II型错误。", + "D": "它用希腊字母α表示。" + } + }, + { + "id": "bf9d10f6-d0b0-5910-b08b-50d8f8cabe71", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "An investigator is interested in comparing the differences in survival over time for patients who receive general anesthesia versus regional anesthesia for prostatectomies. Which of the following statistics would be most appropriate to analyze these data?", + "A": "Relative risk", + "B": "Hazard ratio (HR)", + "C": "Odds ratio", + "D": "Rate ratio" + }, + "zh": { + "question": "一位研究人员有兴趣比较接受全身麻醉与区域麻醉进行前列腺切除术的患者在生存时间上的差异。以下哪种统计方法最适合分析这些数据？", + "A": "相对风险", + "B": "风险比（HR）", + "C": "优势比", + "D": "比率比" + } + }, + { + "id": "74938152-3c98-56a5-8058-818e5e3b316b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "In a randomized control trial, the term \"crossover\" refers to which of the following?", + "A": "Patients who drop out of the trial", + "B": "Patients who do not receive treatment during the course of the trial", + "C": "Patients who receive a sequence of different treatments during the trial", + "D": "Patients who do not end up receiving an assigned treatment and instead are enrolled in another randomized control trial" + }, + "zh": { + "question": "在随机对照试验中，“交叉”一词是指以下哪项？", + "A": "退出试验的患者", + "B": "在试验过程中未接受治疗的患者", + "C": "在试验期间接受一系列不同治疗的患者", + "D": "未能接受指定治疗而被纳入另一项随机对照试验的患者" + } + }, + { + "id": "a9f0e0eb-75b2-5474-9228-eea3d0abe091", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In a single-blinded randomized control trial, the individuals being blinded to receiving treatment are which of the following?", + "A": "Subjects only", + "B": "Investigators only", + "C": "Statistician only", + "D": "Subjects and investigators" + }, + "zh": { + "question": "在单盲随机对照试验中，被蒙蔽接受治疗的是以下哪一项？", + "A": "仅受试者", + "B": "仅研究者", + "C": "仅统计学家", + "D": "受试者和研究者" + } + }, + { + "id": "b47851e4-ca76-5490-8f40-990b97328344", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "20. In statistical tests the P-value is defined as which of the following?", + "A": "The probability of rejecting the null hypothesis", + "B": "The probability of obtaining a test statistic value equal to or more extreme than the actual test statistics given the null hypothesis is true", + "C": "The probability of accepting the null hypothesis", + "D": "The probability of obtaining a test statistic value less extreme than the test statistics given the null hypothesis is true" + }, + "zh": { + "question": "20. 在统计检验中，P值被定义为以下哪一项？", + "A": "拒绝原假设的概率", + "B": "在原假设为真时，获得等于或更极端的检验统计量值的概率", + "C": "接受原假设的概率", + "D": "在原假设为真时，获得比检验统计量值更不极端的概率" + } + }, + { + "id": "3de2842f-5ac4-5fe7-bcc4-5f8304c7d626", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "You perform thromboelastography for your hemorrhaging patient who has sustained massive abdominal trauma and it reveals a prolonged R time. Which of the following is an appropriate initial therapy to manage the patient's suspected coagulopathy?", + "A": "Platelets", + "B": "Fresh frozen plasma", + "C": "Tranexamic acid", + "D": "Cryoprecipitate", + "E": "Packed red blood cells" + }, + "zh": { + "question": "您为一位遭受大面积腹部创伤的出血患者进行血栓弹力图检查，结果显示R时间延长。以下哪种是管理患者疑似凝血病的适当初始治疗？", + "A": "血小板", + "B": "新鲜冰冻血浆", + "C": "氨甲环酸", + "D": "冷沉淀", + "E": "浓缩红细胞" + } + }, + { + "id": "11fa4608-471d-56ec-adbd-49a7be88dbcd", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 26-year-old patient with autoimmune thrombocytopenic purpura and a platelet count of 51 000 per microliter is scheduled for urgent appendectomy. Which thromboelastographic parameter do you expect to be altered in this patient?", + "A": "Reaction (R) time", + "B": "Kinetic (K) time", + "C": "α angle", + "D": "Maximum amplitude (MA)", + "E": "Fibrinolysis (F)" + }, + "zh": { + "question": "一名26岁的自身免疫性血小板减少性紫癜患者，血小板计数为每微升51,000，计划进行紧急阑尾切除术。你预计该患者的哪一项血栓弹力图参数会发生改变？", + "A": "反应时间 (R)", + "B": "动力学时间 (K)", + "C": "α角", + "D": "最大振幅 (MA)", + "E": "纤溶 (F)" + } + }, + { + "id": "965eb423-d717-5a3f-91c1-867a7a438ed2", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "4. TEG is performed and reveals an increased R time and decreased MA. These abnormalities are most suggestive of which of the following coagulation deficits?", + "A": "Decreased platelets", + "B": "Decreased clotting factors", + "C": "Decreased fibrinogen", + "D": "Increased fibrinolysis", + "E": "Both decreased platelets and decreased clotting factors" + }, + "zh": { + "question": "4. TEG检查显示R时间延长和MA降低。这些异常最可能提示以下哪种凝血缺陷？", + "A": "血小板减少", + "B": "凝血因子减少", + "C": "纤维蛋白原减少", + "D": "纤维蛋白溶解增加", + "E": "血小板减少和凝血因子减少" + } + }, + { + "id": "0555dcfb-033b-5416-9bcd-24184aec7bdc", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A patient is receiving blood product transfusions after undergoing aortic valve replacement. Despite the transfusions, the surgeons still note that their field is very \"oozy.\" TEG is performed, which reveals a decreased α angle. Which blood product should be administered next?", + "A": "Platelets", + "B": "Fresh frozen plasma", + "C": "Tranexamic acid", + "D": "Cryoprecipitate", + "E": "Packed red blood cells" + }, + "zh": { + "question": "一名患者在接受主动脉瓣置换术后正在接受血液制品输注。尽管进行了输血，外科医生仍注意到手术区域出血较多。进行TEG检查，结果显示α角度降低。接下来应该输注哪种血液制品？", + "A": "血小板", + "B": "新鲜冰冻血浆", + "C": "氨甲环酸", + "D": "冷沉淀", + "E": "浓缩红细胞" + } + }, + { + "id": "2624a1d4-49ee-5f04-b0ff-645760f589c9", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The complication rate (vascular complications and nerve injuries) associated with insertion of arterial lines closest to which of the following?", + "A": "3-18 per 10 patients", + "B": "3-18 per 100 patients", + "C": "3-18 per 1000 patients", + "D": "3-18 per 10 000 patients", + "E": "3-18 per 100 000 patients" + }, + "zh": { + "question": "动脉导管插入相关的并发症发生率（血管并发症和神经损伤）最接近以下哪一项？", + "A": "每10名患者中有3-18例", + "B": "每100名患者中有3-18例", + "C": "每1000名患者中有3-18例", + "D": "每10 000名患者中有3-18例", + "E": "每100 000名患者中有3-18例" + } + }, + { + "id": "16c7afba-a36c-5819-8ac1-baa73775e6b7", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which nerve is at greatest risk of suffering an injury during arterial catheter insertion into the brachial artery?", + "A": "Median nerve", + "B": "Radial nerve", + "C": "Ulnar nerve", + "D": "Musculocutaneous nerve", + "E": "Axillary nerve" + }, + "zh": { + "question": "在将动脉导管插入肱动脉时，哪个神经最有可能受伤？", + "A": "正中神经", + "B": "桡神经", + "C": "尺神经", + "D": "肌皮神经", + "E": "腋神经" + } + }, + { + "id": "1fb3db44-d115-5ca7-9577-e5f3f9612bf5", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A \"flush test\" is performed to assess damping of an arterial line pressuremonitoring system. A system with an appropriate dynamic response will have which of the following responses to rapid flushing?", + "A": "One large oscillation before a return to baseline", + "B": "One large and 1 small oscillation before a return to baseline", + "C": "One large and 3 small oscillations before a return to baseline", + "D": "Several large and several small oscillations before a return to baseline", + "E": "A square wave" + }, + "zh": { + "question": "“冲洗测试”用于评估动脉导管压力监测系统的阻尼。具有适当动态响应的系统在快速冲洗时会有以下哪种反应？", + "A": "一个大振荡后回到基线", + "B": "一个大振荡和一个小振荡后回到基线", + "C": "一个大振荡和三个小振荡后回到基线", + "D": "几个大振荡和几个小振荡后回到基线", + "E": "一个方波" + } + }, + { + "id": "2f4afaab-46a5-50c2-bcf9-b9f8f003e942", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is most likely to produce underdamping in an arterial pressure monitoring system?", + "A": "Excessive tubing length", + "B": "Bubbles in the tubing system", + "C": "Kink in the arterial catheter", + "D": "Thrombus at the tip of the arterial catheter" + }, + "zh": { + "question": "以下哪项最有可能导致动脉压力监测系统的欠阻尼？", + "A": "过长的导管长度", + "B": "导管系统中的气泡", + "C": "动脉导管的扭曲", + "D": "动脉导管尖端的血栓" + } + }, + { + "id": "81a96f64-4cb6-5100-9460-690ca5c1eab3", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "10. How does the systolic pressure measured in the dorsalis pedis artery differ from that measured in the aorta?", + "A": "5 mm Hg lower than the aorta", + "B": "5 mm Hg higher than the aorta", + "C": "20 mm Hg higher than the aorta", + "D": "20 mm Hg lower than the aorta", + "E": "The same systolic pressure as the aorta" + }, + "zh": { + "question": "10. 足背动脉测得的收缩压与主动脉测得的收缩压有何不同？", + "A": "比主动脉低 5 mm Hg", + "B": "比主动脉高 5 mm Hg", + "C": "比主动脉高 20 mm Hg", + "D": "比主动脉低 20 mm Hg", + "E": "与主动脉的收缩压相同" + } + }, + { + "id": "849f9a29-8bc5-5ee2-8488-05fe97e4c009", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Which component of a central venous pressure (CVP) waveform is most likely to be absent in a patient with a junctional rhythm?", + "A": "a-wave", + "B": "x-descent", + "C": "c-wave", + "D": "Diastole descent", + "E": "v-wave" + }, + "zh": { + "question": "在具有交界性心律的患者中，中心静脉压（CVP）波形的哪个成分最有可能缺失？", + "A": "a波", + "B": "x下降", + "C": "c波", + "D": "舒张下降", + "E": "v波" + } + }, + { + "id": "2e6a9c77-7105-5cef-8b1c-900293a231cf", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A patient with severe tricuspid regurgitation would be expected to have which of the following CVP tracing abnormalities?", + "A": "Cannon a-wave", + "B": "Tall c-v wave, diastole", + "C": "Exaggerated x-descent", + "D": "Exaggerated y-descent" + }, + "zh": { + "question": "患有严重三尖瓣关闭不全的患者预期会出现以下哪种中心静脉压波形异常？", + "A": "巨大的a波", + "B": "高的c-v波，舒张期", + "C": "夸张的x下降", + "D": "夸张的y下降" + } + }, + { + "id": "cd453c90-5e98-5387-ba45-c4a2835c893d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Where is the right internal jugular vein typically located in relation to the right carotid artery in the lower neck?", + "A": "Posterior and medial", + "B": "Anterior and medial", + "C": "Posterior and lateral", + "D": "Anterior and lateral" + }, + "zh": { + "question": "在下颈部，右颈内静脉通常位于右颈动脉的哪个位置？", + "A": "后方和内侧", + "B": "前方和内侧", + "C": "后方和外侧", + "D": "前方和外侧" + } + }, + { + "id": "ad58e752-361a-5439-83a3-bf2136e6964b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "For insertion of a peripherally inserted central catheter, which vein is preferred, matched with its anatomical location?", + "A": "Cephalic vein, lateral", + "B": "Cephalic vein, medial", + "C": "Basilic vein, lateral", + "D": "Basilic vein, medial" + }, + "zh": { + "question": "对于外周插入中心静脉导管的插入，哪条静脉是首选，并与其解剖位置相匹配？", + "A": "头静脉，外侧", + "B": "头静脉，内侧", + "C": "贵要静脉，外侧", + "D": "贵要静脉，内侧" + } + }, + { + "id": "9afc5c67-415c-598c-8e8e-4aed27c060cb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the most common cause of death associated with iatrogenic pulmonary artery rupture (PAR)?", + "A": "Anoxia", + "B": "Hemorrhagic shock", + "C": "Cardiac tamponade", + "D": "Myocardial infarction" + }, + "zh": { + "question": "以下哪项是与医源性肺动脉破裂（PAR）相关的最常见死亡原因？", + "A": "缺氧", + "B": "失血性休克", + "C": "心脏压塞", + "D": "心肌梗死" + } + }, + { + "id": "96139dc6-342c-5a5b-bbc0-f4840d343ab8", + "choice_num": 6, + "answer": "A", + "level": 2, + "en": { + "question": "17. A 65-kg patient is receiving volume-controlled ventilation with a tidal volume of 400 mL and frequency of 14 breaths per minute. The measured peak airway pressure is 18 cm H2O, with a plateau pressure of 12 cm H2O, and the PEEP is 2 cm H2O. What is the static compliance of the patient's lung compliance?", + "A": "40 mL/cm H2O", + "B": "67 mL/cm H2O", + "C": "25 mL/cm H2O", + "D": "25 cm H2O/L", + "E": "15 cm H2O/L", + "F": "40 cm H2O/L" + }, + "zh": { + "question": "17. 一名65公斤的患者正在接受容量控制通气，潮气��为400毫升，呼吸频率为每分钟14次。测得的气道峰压为18 cm H2O，平台压为12 cm H2O，PEEP为2 cm H2O。患者的肺顺应性静态顺应性是多少？", + "A": "40 mL/cm H2O", + "B": "67 mL/cm H2O", + "C": "25 mL/cm H2O", + "D": "25 cm H2O/L", + "E": "15 cm H2O/L", + "F": "40 cm H2O/L" + } + }, + { + "id": "31e53e79-ac63-5544-92f0-5f2ce511382c", + "choice_num": 6, + "answer": "A", + "level": 3, + "en": { + "question": "For a euvolemic patient with normal lung compliance and cardiac function, delivery of positive pressure ventilation (PPV) would be most likely to have which of the following hemodynamic effects?", + "A": "Decreased preload, decreased afterload, and increased cardiac output", + "B": "Decreased preload, increased afterload, and decreased cardiac output", + "C": "Decreased preload, increased afterload, and increased cardiac output", + "D": "Increased preload, decreased afterload, and decreased cardiac output", + "E": "Increased preload, decreased afterload, and increased cardiac output", + "F": "Increased preload, increased afterload, and decreased cardiac output" + }, + "zh": { + "question": "对于一个血容量正常、肺顺应性和心功能正常的患者，给予正压通气（PPV）最可能产生以下哪种血流动力学效应？", + "A": "前负荷减少，后负荷减少，心输出量增加", + "B": "前负荷减少，后负荷增加，心输出量减少", + "C": "前负荷减少，后负荷增加，心输出量增加", + "D": "前负荷增加，后负荷减少，心输出量减少", + "E": "前负荷增加，后负荷减少，心输出量增加", + "F": "前负荷增加，后负荷增加，心输出量减少" + } + }, + { + "id": "2b38ad39-1833-5b4c-8814-79704fafd75b", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "21. A patient is breathing steadily at a minute ventilation of 10 L/min while receiving supplemental oxygen via nasal cannula at a rate of 6 L/min. What is the approximate FiO2 delivered to the patient during inspiration?", + "A": "0.15-0.21", + "B": "0.21-0.28", + "C": "0.28-0.38", + "D": "0.38-0.46", + "E": "0.46-0.52" + }, + "zh": { + "question": "21. 一名患者在每分钟通气量为10 L/min的情况下，通过鼻导管以6 L/min的速度吸入补充氧气。患者在吸气时接收到的FiO2大约是多少？", + "A": "0.15-0.21", + "B": "0.21-0.28", + "C": "0.28-0.38", + "D": "0.38-0.46", + "E": "0.46-0.52" + } + }, + { + "id": "b3c2b78f-27e0-549f-aab5-700d595a52a3", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements about the differences between a partial rebreather and a nonrebreather oxygen delivery mask is most correct?", + "A": "A nonrebreather can theoretically reach an Fio2 of 1.0, whereas a partial rebreather can reach an FiO2 of 0.7-0.8.", + "B": "A nonrebreather utilizes a large reservoir bag of 600-1000 mL, whereas a partial rebreather utilizes a smaller reservoir bag.", + "C": "A nonrebreather allows expired gases to enter the reservoir bag, whereas a partial rebreather has a 1-way valve that inhibits expired gases from entering the reservoir bag.", + "D": "A nonrebreather allows inhaled nebulized bronchodilator therapy to bedelivered, whereas a partial rebreather does not." + }, + "zh": { + "question": "以下关于部分重呼吸面罩和非重呼吸面罩之间差异的陈述中，哪一项是最正确的？", + "A": "非重呼吸面罩理论上可以达到1.0的吸入氧浓度（FiO2），而部分重呼吸面罩可以达到0.7-0.8的吸入氧浓度（FiO2）。", + "B": "非重呼吸面罩使用600-1000毫升的大储气袋，而部分重呼吸面罩使用较小的储气袋。", + "C": "非重呼吸面罩允许呼出的气体进入储气袋，而部分重呼吸面罩有一个单向阀，阻止呼出的气体进入储气袋。", + "D": "非重呼吸面罩允许吸入雾化支气管扩张剂治疗，而部分重呼吸面罩不允许。" + } + }, + { + "id": "23e4eda4-8077-5840-ac46-55fcac2c360e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is most correct regarding oxygen delivery to a patient wearing a Venturi mask?", + "A": "A variable FiO2 is delivered depending on the patient's minute ventilation.", + "B": "A fixed FiO2 is delivered based on the entrainment port size on the mask, independent of the patient's minute ventilation.", + "C": "A fixed FiO2 is delivered to the patient based on the oxygen flow rate to the mask, independent of the patient's minute ventilation.", + "D": "A variable FiO2 is delivered to the patient depending on the oxygen flow rate to the mask." + }, + "zh": { + "question": "关于佩戴文丘里面罩的患者的氧气输送，下列哪项陈述最正确？", + "A": "根据患者的每分钟通气量，提供可变的FiO2。", + "B": "根据面罩上的引流口大小，提供固定的FiO2，与患者的每分钟通气量无关。", + "C": "根据面罩的氧气流速，提供固定的FiO2，与患者的每分钟通气量无关。", + "D": "根据面罩的氧气流速，提供可变的FiO2。" + } + }, + { + "id": "2f805ed4-432d-55c0-9c29-68adfb4eec36", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements regarding the benefit of high-flow nasal cannula (HFNC) is/are most correct?", + "A": "HFNC can provide PEEP.", + "B": "HFNC can improve CO2 exchange.", + "C": "HFNC can achieve an FiO2 between 0.21 and 1.0 that is independent of patient respiratory effort.", + "D": "All of the above." + }, + "zh": { + "question": "以下关于高流量鼻导管（HFNC）益处的说法中，哪一项是最正确的？", + "A": "HFNC 可以提供呼气末正压（PEEP）。", + "B": "HFNC 可以改善二氧化碳交换。", + "C": "HFNC 可以实现 0.21 到 1.0 之间的吸入氧浓度（FiO2），且不依赖于患者的呼吸努力。", + "D": "以上全部。" + } + }, + { + "id": "1f398851-394c-5ba1-876b-3a132c6e65a6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A delivery system that allows for nitric oxide (NO) to have a long residence time in the ventilator circuit can lead to high concentrations of which of the following toxic metabolites?", + "A": "NO2", + "B": "NO", + "C": "N2O", + "D": "N2O2" + }, + "zh": { + "question": "一种使一氧化氮（NO）在呼吸机回路中停留时间较长的输送系统可能导致以下哪种有毒代谢物的高浓度？", + "A": "NO2", + "B": "NO", + "C": "N2O", + "D": "N2O2" + } + }, + { + "id": "396f454e-998b-5be9-8b47-d29badfa466c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following best describes the method for calculating of mean arterial pressure (MAP) using a noninvasive blood pressure monitor?", + "A": "Calculated from a proprietary algorithm based on systolic and diastolic blood pressure", + "B": "Inflation pressure at which maximum oscillometric pulse amplitude is detected", + "C": "Noninvasive blood pressure monitors do not give MAP", + "D": "Calculated using the equation, MAP = diastolic blood pressure + 1/3 (systolicdiastolic blood pressure)" + }, + "zh": { + "question": "以下哪项最能描述使用无创血压监测仪计算平均动脉压（MAP）的方法？", + "A": "根据收缩压和舒张压的专有算法计算", + "B": "检测到最大示波脉搏幅度的充气压力", + "C": "无创血压监测仪不提供MAP", + "D": "使用公式计算，MAP = 舒张压 + 1/3 (收缩压-舒张压)" + } + }, + { + "id": "cee831b2-724d-5fdc-8bd1-57d28cee546e", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A \"square wave\" test is performed to measure the dynamic response of a radial arterial line. Two oscillations are seen before the tracing returns to baseline. Which of the following best describes the state of the arterial pressure", + "A": "Underdamped", + "B": "Adequately damped", + "C": "Overdamped", + "D": "Cannot be determined" + }, + "zh": { + "question": "进行“方波”测试以测量桡动脉导管的动态响应。看到两个振荡后，波形回到基线。以下哪项最能描述动脉压力的状态？", + "A": "欠阻尼", + "B": "适度阻尼", + "C": "过度阻尼", + "D": "无法确定" + } + }, + { + "id": "7630e341-f885-5437-9b8a-76fee6e2fe4b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "33. You are called to evaluate a patient in the ICU who has an indwelling pulmonary artery catheter. The nurse states that the waveform (below) appears markedly changed from 30 minutes ago. Which of the following best explains the portion of the waveform indicated by the arrow?", + "A": "Pulmonary regurgitation", + "B": "Right ventricular diastole", + "C": "Right ventricular systole", + "D": "Intermittent wedging of the pulmonary artery catheter" + }, + "zh": { + "question": "33. 你被叫去评估一名在ICU的病人，他有一个留置的肺动脉导管。护士说波形（如下）与30分钟前相比有显著变化。以下哪一项最能解释箭头所指的波形部分？", + "A": "肺动脉返流", + "B": "右心室舒张期", + "C": "右心室收缩期", + "D": "肺动脉导管的间歇性楔入" + } + }, + { + "id": "fc17c02b-a78a-5abe-bac4-ca098cd019c5", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following conditions have the most insignificant effect on left ventricular end-diastolic pressure (LVEDP) estimation using a pulmonary artery catheter?", + "A": "Severe mitral regurgitation", + "B": "Tip of pulmonary artery catheter in West Zone I", + "C": "Severe tricuspid regurgitation", + "D": "Peak end-expiratory pressure at 15 cm H2O.", + "E": "Left atrial myxoma" + }, + "zh": { + "question": "以下哪种情况对使用肺动脉导管估算左心室舒张末期压（LVEDP）的影响最不显著？", + "A": "严重的二尖瓣返流", + "B": "肺动脉导管尖端位于 West Zone I", + "C": "严重的三尖瓣返流", + "D": "呼气末正压为 15 cm H2O", + "E": "左心房粘液瘤" + } + }, + { + "id": "dba08939-7f44-57e7-b847-b1034c180b6a", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Using the following measurements obtained from a patient with a pulmonary artery catheter that are listed below, what is the systemic vascular resistance (SVR) (in dynes/cm5 )?", + "A": "1003", + "B": "851", + "C": "673", + "D": "Cannot be calculated with the given information" + }, + "zh": { + "question": "使用从一位患者的肺动脉导管获得的以下测量值，系统血管阻力（SVR）（以dynes/cm5为单位）是多少？", + "A": "1003", + "B": "851", + "C": "673", + "D": "无法根据给定信息计算" + } + }, + { + "id": "87068bb2-34d3-5c75-978d-ec50fe32c0ea", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient is being monitored in the ICU using a noninvasive cardiac output monitoring device attached to radial arterial line. It uses arterial pressure contour for estimating stroke volume and cardiac output. In which of the following clinical scenarios would stroke volume estimated by this cardiac output monitor be most accurate?", + "A": "Rapid atrial fibrillation", + "B": "Acute aortic regurgitation", + "C": "During fluid resuscitation", + "D": "End-stage liver disease" + }, + "zh": { + "question": "一名患者在ICU中使用连接到桡动脉导管的无创心输出量监测设备进行监测。该设备使用动脉压力波形来估算每搏量和心输出量。在以下哪种临床情境中，该心输出量监测器估算的每搏量最为准确？", + "A": "快速心房颤动", + "B": "急性主动脉瓣关闭不全", + "C": "液体复苏期间", + "D": "终末期肝病" + } + }, + { + "id": "9d7e0ca7-cec5-5c8a-afc1-7abea44b8d07", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Based on the Stewart-Hamilton equation, the relationship between thermodilution-based cardiac output and area under the temperature curve is best characterized by which of the following?", + "A": "Directly proportional", + "B": "Inversely proportional", + "C": "Varies based on body surface area", + "D": "Not related" + }, + "zh": { + "question": "根据Stewart-Hamilton方程，基于热稀释的心输出量与温度曲线下面积之间的关系最好由以下哪一项描述？", + "A": "成正比", + "B": "成反比", + "C": "根据体表面积变化", + "D": "无关" + } + }, + { + "id": "1f51d995-5367-5e13-a279-a4976ecb1a70", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements regarding the Bispectral index (BIS) for monitoring depth of anesthesia is most correct?", + "A": "BIS is superior to end-tidal anesthetic gas monitoring in preventing awareness.", + "B": "BIS correlates with probability of patient movement to noxious stimuli.", + "C": "BIS is an American Society of Anesthesiology standard monitor.", + "D": "BIS is unreliable during total intravenous anesthesia." + }, + "zh": { + "question": "以下关于用于监测麻醉深度的双频谱指数（BIS）的陈述中，哪一项最正确？", + "A": "BIS在防止意识清醒方面优于呼气末麻醉气体监测。", + "B": "BIS与患者对有害刺激的运动概率相关。", + "C": "BIS是美国麻醉医师学会的标准监测仪。", + "D": "BIS在全静脉麻醉期间不可靠。" + } + }, + { + "id": "dc1d4d32-5993-5189-8ffc-5b97d75a3b1c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "An EEG monitor is being used to measure the depth of anesthesia for a patient receiving total intravenous anesthesia with propofol. Which of the following best describes the characteristics of an EEG in an awake patient and in a patient under general anesthesia?", + "A": "Awake: high frequency and high amplitude; general anesthesia: low frequency and low amplitude", + "B": "Awake: low frequency and low amplitude; general anesthesia: high frequency and high amplitude", + "C": "Awake: high frequency and low amplitude; general anesthesia: low frequency and high amplitude", + "D": "Awake: low frequency and high amplitude; general anesthesia: high frequency and low amplitude" + }, + "zh": { + "question": "正在使用脑电图监测仪测量接受丙泊酚全静脉麻醉患者的麻醉深度。以下哪项最能描述清醒患者和全身麻醉患者的脑电图特征？", + "A": "清醒：高频高幅；全身麻醉：低频低幅", + "B": "清醒：低频低幅；全身麻醉：高频高幅", + "C": "清醒：高频低幅；全身麻醉：低频高幅", + "D": "清醒：低频高幅；全身麻醉：高频低幅" + } + }, + { + "id": "aa5eb5df-b929-5bb7-a9eb-f55496b0c312", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "The velocity of blood through the middle cerebral artery, measured using transcranial Doppler (TCD), is likely to be elevated in all the following scenarios, EXCEPT which one?", + "A": "Increased cerebral perfusion pressure (CPP)", + "B": "Increased intracranial pressure", + "C": "Cerebral vasospasm", + "D": "Carotid artery stenosis" + }, + "zh": { + "question": "使用经颅多普勒（TCD）测量的中脑动脉血流速度在以下所有情况下可能升高，除了哪一种？", + "A": "脑灌注压（CPP）增加", + "B": "颅内压增加", + "C": "脑血管痉挛", + "D": "颈动脉狭窄" + } + }, + { + "id": "faa9eb64-1dec-5a3d-84cd-0b01917fe83e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following BEST represents the degree of influence of anesthetic agents on somatosensory evoked potential (SSEP) monitoring? (Arranged from most deleterious to the least deleterious agents.)", + "A": "Etomidate > isoflurane > propofol > opioids", + "B": "Isoflurane > propofol > opioids > etomidate", + "C": "Isoflurane > opioids > etomidate > propofol", + "D": "Propofol > isoflurane > opioids > etomidate" + }, + "zh": { + "question": "以下哪一项最能代表麻醉药物对体感诱发电位（SSEP）监测的影响程度？（从最有害到最不有害的药物排列。）", + "A": "依托咪酯 > 异氟醚 > 丙泊酚 > 阿片类药物", + "B": "异氟醚 > 丙泊酚 > 阿片类药物 > 依托咪酯", + "C": "异氟醚 > 阿片类药物 > 依托咪酯 > 丙泊酚", + "D": "丙泊酚 > 异氟醚 > 阿片类药物 > 依托咪酯" + } + }, + { + "id": "07cc97b0-102a-59df-afac-85d79f47361e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following modalities for monitoring evoked potentials (EPs) is least affected by inhalational anesthetics?", + "A": "Visual EP", + "B": "Somatosensory EP", + "C": "Motor EP", + "D": "Brainstem auditory EP" + }, + "zh": { + "question": "以下哪种诱发电位（EPs）监测方式最不受吸入麻醉药的影响？", + "A": "视觉诱发电位", + "B": "体感诱发电位", + "C": "运动诱发电位", + "D": "脑干听觉诱发电位" + } + }, + { + "id": "7d198112-7f21-519a-9857-ae939c257f5c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 67-year-old man is scheduled for a Whipple procedure and is offered an epidural for postoperative pain control. Which of the following is an absolute contraindication to placement of an epidural?", + "A": "Aortic stenosis with a valve area of 1.2 cm2", + "B": "Recent upper respiratory tract infection", + "C": "Patient refusal", + "D": "Scoliosis" + }, + "zh": { + "question": "一名67岁的男性计划进行胰十二指肠切除术，并被建议使用硬膜外麻醉进行术后疼痛控制。以下哪一项是硬膜外麻醉置入的绝对禁忌症？", + "A": "主动脉瓣狭窄，瓣膜面积为1.2 cm²", + "B": "近期上呼吸道感染", + "C": "患者拒绝", + "D": "脊柱侧弯" + } + }, + { + "id": "456258fb-2196-53d0-bea2-3fa5480c3501", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "You are called to the postanesthesia care unit because a patient with an epidural placed at T12-L1 is complaining of pain at the site of his lower abdominal incision but cannot move his legs. He was initially very comfortable. His motor examination has not changed since arrival in the postanesthesia care unit. Which of the following local anesthetics is most likely to have been used?", + "A": "Etidocaine 1.5%", + "B": "Lidocaine 2%", + "C": "Bupivacaine 0.5%", + "D": "Chloroprocaine 3%" + }, + "zh": { + "question": "你被叫到麻醉后护理单元，因为一名在T12-L1放置硬膜外导管的患者抱怨下腹部切口处疼痛，但无法移动双腿。他最初感觉很舒适。他的运动检查自到达麻醉后护理单元以来没有变化。以下哪种局部麻醉药最有可能被使用？", + "A": "1.5% 依替卡因", + "B": "2% 利多卡因", + "C": "0.5% 布比卡因", + "D": "3% 氯普鲁卡因" + } + }, + { + "id": "c1ea6d13-a4da-5366-aa5a-6ae430d5cc62", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 67-year-old woman is on the first postoperative day following a Whipple procedure. She has a thoracic epidural in place and is receiving a mix of bupivacaine and dilaudid. She reports good pain relief but states that she is incredibly itchy, especially in her face and on her nose. Which of the following is", + "A": "Naloxone", + "B": "Propofol", + "C": "Diphenhydramine", + "D": "Elimination of opioids from epidural mix" + }, + "zh": { + "question": "一名67岁的女性在Whipple手术后的第一天。她有一个胸段硬膜外导管，并正在接受布比卡因和氢吗啡酮的混合物。她报告疼痛缓解良好，但表示她感到非常痒，尤其是在脸上和鼻子上。以下哪项是", + "A": "纳洛酮", + "B": "丙泊酚", + "C": "苯海拉明", + "D": "去除硬膜外混合物中的阿片类药物" + } + }, + { + "id": "28e40994-7e57-5f91-bbe6-3080b23448bb", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A 100-kg, 71-year-old man with a history of asthma, snoring, and emphysema undergoes thoracotomy and wedge resection for removal of a lung tumor. Which of the following treatments would be most effective to control his pain postoperatively while also maintaining adequate ventilation?", + "A": "Thoracic epidural with a continuous infusion of bupivacaine and hydromorphone", + "B": "As-needed doses of hydromorphone administered by the nurse", + "C": "Patient-controlled analgesia (PCA) with hydromorphone", + "D": "Lumbar epidural with a continuous infusion of bupivacaine and hydromorphone" + }, + "zh": { + "question": "一名100公斤、71岁的男性，有哮喘、打鼾和肺气肿病史，接受开胸手术和楔形切除以去除肺部肿瘤。以下哪种治疗方法最有效地控制他的术后疼痛，同时保持足够的通气？", + "A": "胸段硬膜外麻醉，持续输注布比卡因和氢吗啡酮", + "B": "由护士按需给予氢吗啡酮", + "C": "患者自控镇痛（PCA）使用氢吗啡酮", + "D": "腰段硬膜外麻醉，持续输注布比卡因和氢吗啡酮" + } + }, + { + "id": "a1d1d855-79b4-5ee2-8928-9ad4240eb1c8", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "5. A 67-year-old woman who is 9 hours status post gastrectomy is noted to have a respiratory rate of 6 and is also somewhat somnolent. Which of the following neuraxial medications or combinations of medications would be predicted to cause respiratory depression within 6-12 hours of exposure?", + "A": "Morphine", + "B": "Fentanyl", + "C": "Bupivacaine", + "D": "Bupivacaine plus sufentanil" + }, + "zh": { + "question": "5. 一名67岁的女性在胃切除术后9小时被发现呼吸频率为6，并且有些嗜睡。以下哪种神经轴药物或药物组合预计会在接触后6-12小时内导致呼吸抑制？", + "A": "吗啡", + "B": "芬太尼", + "C": "布比卡因", + "D": "布比卡因加舒芬太尼" + } + }, + { + "id": "2d48433e-3ccf-5f6b-808f-e59d1657edda", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with a single epidural dose of morphine, a single epidural dose of fentanyl has a longer half-time in the epidural space secondary to which of the following properties?", + "A": "Lipid solubility", + "B": "Ionization state", + "C": "Molecular size", + "D": "Molecular weight" + }, + "zh": { + "question": "与单次硬膜外注射吗啡相比，单次硬膜外注射芬太尼在硬膜外腔中的半衰期较长，这主要是由于以下哪种特性？", + "A": "脂溶性", + "B": "电离状态", + "C": "分子大小", + "D": "分子量" + } + }, + { + "id": "ebfa64d4-525a-5671-9c0e-b3bbb2cd446b", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 42-year-old woman undergoes total colectomy under general anesthesia with a thoracic epidural (T10-T11) in place. At the conclusion of the procedure, she receives an infusion of bupivacaine 0.1% and hydromorphone 20 μg/mL at 6 mL/h through her epidural catheter. You are called to see her 8 hours postoperatively and find that she is complaining of pain at the site of her incision. Her heart rate is 100 beats per minute and her blood pressure is 160/92 mm Hg. What is the most appropriate next step to manage this patient's pain?", + "A": "Administer a bolus of 5 cc of 1.5% lidocaine with epinephrine 1:200 000 through her epidural catheter.", + "B": "Add PCA with hydromorphone to her current regimen.", + "C": "Add Toradol to her current regimen.", + "D": "Check a serum bupivacaine level." + }, + "zh": { + "question": "一名42岁的女性在全身麻醉下接受了全结肠切除术，并置入了胸段硬膜外导管（T10-T11）。手术结束时，她通过硬膜外导管接受了0.1%布比卡因和20 μg/mL氢吗啡酮以6 mL/h的速度输注。术后8小时，你被叫去看她，发现她抱怨切口处疼痛。她的心率为每分钟100次，血压为160/92 mm Hg。管理该患者疼痛的最合适的下一步措施是什么？", + "A": "通过她的硬膜外导管给予5 cc 1.5%利多卡因和1:200 000肾上腺素的推注。", + "B": "在她目前的方案中加入氢吗啡酮的PCA。", + "C": "在她目前的方案中加入托拉塞米。", + "D": "检查血清布比卡因水平。" + } + }, + { + "id": "6d35883d-ce9f-5fc3-8bf3-8d3eb44abc69", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "You are caring for a 77-year-old man with no significant medical history who underwent an L5-S1 fusion yesterday for spinal stenosis. He was taking oxycodone at home for his chronic back pain, and you decide to write him for a PCA. Which of the following medications should be avoided?", + "A": "Hydromorphone", + "B": "Morphine", + "C": "Meperidine", + "D": "Fentanyl" + }, + "zh": { + "question": "您正在照顾一位77岁的男性患者，他没有显著的病史，昨天因脊柱狭窄进行了L5-S1融合手术。他在家中因慢性背痛服用羟考酮，您决定为他开一个PCA。以下哪种药物应避免使用？", + "A": "氢吗啡酮", + "B": "吗啡", + "C": "哌替啶", + "D": "芬太尼" + } + }, + { + "id": "bd4d3267-d8af-5e47-b848-171d39c32f42", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following settings is not recommended for a PCA pump using hydromorphone for an opioid-naive patient in the postoperative period?", + "A": "Continuous background infusion", + "B": "Initial lockout interval of 10 minutes", + "C": "Initial hourly dose limit of 1-2 mg", + "D": "Addition of opioid-sparing medications to the analgesic regimen" + }, + "zh": { + "question": "以下哪种设置不建议用于术后期间使用氢吗啡酮的PCA泵在阿片类药物初次使用患者中？", + "A": "持续背景输注", + "B": "初始锁定间隔为10分钟", + "C": "初始每小时剂量限制为1-2毫克", + "D": "在镇痛方案中添加阿片类药物节省药物" + } + }, + { + "id": "66dc6c0a-cb3b-589f-ab33-392d32a67739", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 65-year-old woman with Parkinson disease and esophageal cancer is receiving an intravenous PCA with hydromorphone after undergoing Ivor Lewis esophagectomy. She reports excellent pain control but is experiencing nausea. Which of the following antiemetics is the most appropriate selection for this patient?", + "A": "Ondansetron", + "B": "Haldol", + "C": "Promethazine", + "D": "Droperidol" + }, + "zh": { + "question": "一名65岁的女性患有帕金森病和食道癌，在接受Ivor Lewis食管切除术后，正在使用静脉PCA与氢吗啡酮。她报告疼痛控制良好，但出现了恶心。以下哪种止吐药是该患者最合适的选择？", + "A": "昂丹司琼", + "B": "氟哌啶醇", + "C": "异丙嗪", + "D": "氟哌利多" + } + }, + { + "id": "3be699df-499d-5bda-9411-a2a846c15c91", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "11. Which of the following best describes the mechanism of acetaminophen?", + "A": "Central inhibition of cyclooxygenase (COX) activation", + "B": "Inhibition of lipoxygenase activation", + "C": "Activation of lipoxygenase central a2 receptors", + "D": "Activation of GABA receptors" + }, + "zh": { + "question": "11. 以下哪项最能描述对乙酰氨基酚的作用机制？", + "A": "中枢抑制环氧合酶（COX）激活", + "B": "抑制脂氧合酶激活", + "C": "激活脂氧合酶中枢α2受体", + "D": "激活GABA受体" + } + }, + { + "id": "ca047e42-8f34-58b8-8f0d-33865c012b3b", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "You are consulted on a patient with a history of chronic back pain who is now on the first postoperative day from a L4-L5 fusion surgery. He tells you that he", + "A": "Ketamine", + "B": "Hydromorphone", + "C": "Tizanidine", + "D": "Tylenol" + }, + "zh": { + "question": "您被咨询了一位有慢性背痛病史的患者，他现在是L4-L5融合手术后的第一天。他告诉你他", + "A": "氯胺酮", + "B": "氢吗啡酮", + "C": "替扎尼定", + "D": "泰诺" + } + }, + { + "id": "9bd0b727-6186-5853-bfda-11551de0c271", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following agents or drugs is most likely to have a similar mechanism of action to ketamine?", + "A": "Sevoflurane", + "B": "Nitrous oxide", + "C": "Midazolam", + "D": "Clonidine" + }, + "zh": { + "question": "以下哪种药物或药剂的作用机制最有可能与氯胺酮相似？", + "A": "七氟醚", + "B": "一氧化二氮", + "C": "咪达唑仑", + "D": "可乐定" + } + }, + { + "id": "d535a56b-3d41-5b90-9b6a-769430a16d53", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 60-year-old man with bilateral radicular pain in his legs presents 4 weeks after implantation of a spinal cord stimulator (SCS) with dual percutaneous leads. He had reported greater than 50% pain relief with his SCS trial and also reports feeling well after implantation of his SCS. He has therefore greatly increased his daily activity. He now complains of paresthesias in his lower abdominal region and worsening pain in his legs. His neurologic exam is unremarkable. There is no pain on palpation of his lower back. His incision site is clean, dry, and intact and he is afebrile. Which of the following most likely explains this presentation?", + "A": "Epidural abscess", + "B": "Migration of leads", + "C": "Disc herniation", + "D": "Infection of the SCS leads" + }, + "zh": { + "question": "一名60岁的男性在植入双经皮导线的脊髓刺激器（SCS）4周后出现双侧腿部根性疼痛。他在SCS试验中报告疼痛缓解超过50%，并且在植入SCS后感觉良好。因此，他大大增加了日常活动量。现在他抱怨下腹部区域有感觉异常，并且腿部疼痛加重。他的神经系统检查无异常。触诊下背部无疼痛。他的切口部位清洁、干燥且完整，并且无发热。以下哪项最可能解释这种表现？", + "A": "硬膜外脓肿", + "B": "导线移位", + "C": "椎间盘突出", + "D": "SCS导线感染" + } + }, + { + "id": "b28ca67d-279b-5348-b23d-3bf82681febf", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following areas is targeted by SCSs?", + "A": "Dorsal columns", + "B": "Lateral corticospinal tract", + "C": "Botzinger complex", + "D": "Peripheral nerves" + }, + "zh": { + "question": "以下哪个区域是SCSs的目标？", + "A": "背柱", + "B": "侧皮质脊髓束", + "C": "Botzinger复合体", + "D": "周围神经" + } + }, + { + "id": "36d8e04b-0c78-5c3c-9db0-983be7440eb5", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient with a history of unresectable pancreatic cancer presents to your office because his current pain control regimen, Tylenol and hydromorphone (2- 4 mg every 4 h as needed), is no longer sufficient. He reports that when he", + "A": "Opioid-induced hyperalgesia (OIH)", + "B": "Pseudotolerance", + "C": "Drug-seeking behavior", + "D": "Addiction" + }, + "zh": { + "question": "一名有不可切除胰腺癌病史的患者来到您的办公室，因为他目前的疼痛控制方案（泰诺和氢吗啡酮，每4小时2-4毫克按需服用）已不再足够。他报告说，当他", + "A": "阿片类药物诱导的痛觉过敏（OIH）", + "B": "假耐受性", + "C": "药物寻求行为", + "D": "成瘾" + } + }, + { + "id": "e5a9b617-9172-5863-a319-fa4a9b457973", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "17. A patient with a history of prostate cancer with metastases to his spine causing back pain presents to your office. You have been managing his opioid prescriptions for over a year, and during that time he has required increasing doses of hydromorphone to treat his back pain. He currently takes 8-10 mg of dilaudid every 3 hours. When questioned about his pain, he describes a diffuse pain that affects his arms and legs. His back pain is also present. Which of the following receptors or family of receptors is thought to be involved in this phenomenon?", + "A": "GABA-A", + "B": "NMDA", + "C": "GABA-B", + "D": "Dopamine-2" + }, + "zh": { + "question": "17. 一名有前列腺癌病史并转移至脊柱导致背痛的患者来到您的诊所。您已经管理他的阿片类药物处方超过一年，在此期间他需要增加氢吗啡酮的剂量来治疗背痛。他目前每3小时服用8-10毫克的氢吗啡酮。当被问及他的疼痛时，他描述了一种影响手臂和腿的弥漫性疼痛。他的背痛也存在。以下哪种受体或受体家族被认为与这种现象有关？", + "A": "GABA-A", + "B": "NMDA", + "C": "GABA-B", + "D": "多巴胺-2" + } + }, + { + "id": "79575af3-9282-5407-803f-38efd5384065", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In the perioperative period, patients maintained on Suboxone will most likely experience which of the following?", + "A": "Increased postoperative opioid requirements", + "B": "Increased sensitivity to opioids", + "C": "Withdrawal symptoms within 24 hours of discontinuing Suboxone", + "D": "Increased risk of postoperative delirium" + }, + "zh": { + "question": "在围手术期，使用Suboxone维持的患者最有可能经历以下哪种情况？", + "A": "术后阿片类药物需求增加", + "B": "对阿片类药物的敏感性增加", + "C": "停用Suboxone后24小时内出现戒断症状", + "D": "术后谵妄风险增加" + } + }, + { + "id": "dc4195a9-9b9c-56dc-bf01-cd684b66df31", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following effects would be likely to occur after parenteral injection of Suboxone in a patient actively taking heroin?", + "A": "Respiratory depression", + "B": "Withdrawal", + "C": "Euphoria", + "D": "Miosis" + }, + "zh": { + "question": "在正在服用海洛因的患者中，注射Suboxone后可能会出现以下哪种效果？", + "A": "呼吸抑制", + "B": "戒断反应", + "C": "欣快感", + "D": "瞳孔缩小" + } + }, + { + "id": "f0845d9b-300d-5502-9249-c79d2e76f557", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 76-year-old man with pancreatic cancer and chronic abdominal pain admits to his pain specialist that he has been giving his son, who has chronic back pain, some of his oxycodone pills. Which of the following terms best characterizes", + "A": "Abuse", + "B": "Misuse", + "C": "Pseudoaddiction", + "D": "Addiction" + }, + "zh": { + "question": "一名76岁的男性患有胰腺癌和慢性腹痛，他向他的疼痛专科医生承认，他一直在给患有慢性背痛的儿子一些他的羟考酮药片。以下哪个术语最能描述这种行为？", + "A": "滥用", + "B": "误用", + "C": "伪成瘾", + "D": "成瘾" + } + }, + { + "id": "6f3ba33d-56eb-53e3-8e46-e28d6fef4bae", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient with metastatic prostate cancer complains of back pain. He is found to have metastases to his vertebral bodies. He has no neurologic deficits. Which of the following is the first-line definitive treatment for this pain?", + "A": "Physical therapy", + "B": "Glucocorticoids", + "C": "Radiation therapy", + "D": "Surgical decompression" + }, + "zh": { + "question": "一名患有转移性前列腺癌的患者抱怨背痛。他被发现椎体有转移。他没有神经功能缺损。以下哪项是这种疼痛的一线根本治疗方法？", + "A": "物理治疗", + "B": "糖皮质激素", + "C": "放射治疗", + "D": "外科减压" + } + }, + { + "id": "59d5f9af-f03c-5751-a624-22acfcc80c2d", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Which of the following would you expect to see in a patient receiving continuous thoracic epidural analgesia as compared with one receiving PCA with morphine after undergoing open nephrectomy?", + "A": "Faster return of bowel function", + "B": "Comparable requirements for antiemetic medications", + "C": "Inferior pain control at the surgical site", + "D": "Similar patient satisfaction" + }, + "zh": { + "question": "与接受吗啡PCA的患者相比，接受连续胸段硬膜外镇痛的患者在开放性肾切除术后，您预计会看到以下哪种情况？", + "A": "肠功能更快恢复", + "B": "对止吐药物的需求相当", + "C": "手术部位的疼痛控制较差", + "D": "患者满意度相似" + } + }, + { + "id": "1821b106-2db3-53f1-80c8-3ae17810686d", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "23. An immunocompromised patient undergoing treatment for lymphoma presents to the emergency department with altered mental status. He has recently tested positive for coccidiomycosis, and there is a concern that he has a disseminated infection. He undergoes a lumbar puncture, which is negative. His mental status clears later that night, but 2 days later he returns to the emergency department with a positional headache, consistent with a postdural puncture headache (PDPH). Every time he sits up, he reports severe pain and nausea. He fails treatment with rest, intravenous fluids, and medications. Which of the following epidural injections is most appropriate?", + "A": "Normal saline", + "B": "Autologous blood", + "C": "Allogeneic blood", + "D": "Autologous blood with fibrin glue" + }, + "zh": { + "question": "23. 一名免疫功能低下的患者正在接受淋巴瘤治疗，他因精神状态改变来到急诊科。他最近被检测出球孢子菌病阳性，担心他有播散性感染。他接受了腰椎穿刺，结果为阴性。当天晚上他的精神状态恢复正常，但两天后他因体位性头痛再次来到急诊科，这与硬膜穿刺后头痛（PDPH）一致。每次他坐起来时，他都报告有剧烈的疼痛和恶心。他在休息、静脉输液和药物治疗后无效。以下哪种硬膜外注射最合适？", + "A": "生理盐水", + "B": "自体血", + "C": "异体血", + "D": "自体血与纤维蛋白胶" + } + }, + { + "id": "13b35c56-d551-56b7-8df4-3162aa1c6562", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A patient with unresectable pancreatic cancer presents for a celiac plexus block. Which of the following organs or structures does not receive innervation from the celiac plexus?", + "A": "Biliary tract", + "B": "Mesentery", + "C": "Descending colon", + "D": "Adrenal glands" + }, + "zh": { + "question": "一名无法切除的胰腺癌患者前来进行腹腔神经丛阻滞。以下��个器官或结构不接受腹腔神经丛的支配？", + "A": "胆道", + "B": "肠系膜", + "C": "降结肠", + "D": "肾上腺" + } + }, + { + "id": "8ffcf6d7-8375-5e6d-a59c-1864ea4b81d7", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A patient with unresectable pancreatic cancer presents for celiac plexus neurolysis via a posterior approach. He asks what the risks of the procedure are. Which of the following is the most common complications?", + "A": "Constipation", + "B": "Lower-extremity paralysis", + "C": "Anterior abdominal pain", + "D": "Orthostatic hypotension" + }, + "zh": { + "question": "一名无法切除的胰腺癌患者前来接受通过后路进行的腹腔神经丛神经溶解术。他询问该手术的风险是什么。以下哪项是最常见的并发症？", + "A": "便秘", + "B": "下肢瘫痪", + "C": "前腹痛", + "D": "体位性低血压" + } + }, + { + "id": "cf79ad7e-e318-51d8-8a7e-42b58cbbd8e2", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "When used for neurolytic blocks, compared with ethanol, which of the following is true about phenol?", + "A": "Painless on injection", + "B": "More effective", + "C": "Provides a longer duration of block", + "D": "More likely to cause hypotension" + }, + "zh": { + "question": "在用于神经溶解阻滞时，与乙醇相比，关于苯酚以下哪项是正确的？", + "A": "注射时无痛", + "B": "更有效", + "C": "提供更长时间的阻滞", + "D": "更可能导致低血压" + } + }, + { + "id": "3d0fe68e-b6d2-5e57-994b-b8f60b7ce900", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "According to the World Health Organization (WHO) pain ladder, what is the next treatment step for a patient who has inadequate pain control for back pain secondary to metastatic prostate cancer after trying Tylenol, ibuprofen, aspirin as well as multiple nonnarcotic adjuvant pain medications such as gabapentin, tizanidine, and lidocaine patches?", + "A": "Paracetamol", + "B": "Fentanyl patch", + "C": "Tramadol", + "D": "Morphine" + }, + "zh": { + "question": "根据世界卫生组织（WHO）疼痛阶梯，对于一名在尝试了泰诺、布洛芬、阿司匹林以及多种非麻醉性辅助止痛药如加巴喷丁、替扎尼定和利多卡因贴片后，仍然无法有效控制因前列腺癌转移引起的背痛的患者，下一步的治疗措施是什么？", + "A": "对乙酰氨基酚", + "B": "芬太尼贴片", + "C": "曲马多", + "D": "吗啡" + } + }, + { + "id": "3d317223-0b00-59dc-81a7-72d0e1de4267", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is most consistent with the WHO pain ladder?", + "A": "The oral form of analgesics should be used over other forms whenever possible.", + "B": "Analgesics should be given only as needed.", + "C": "Standardized dosing of opioids should be used for adult patients.", + "D": "Treatment of cancer pain should begin with an opioid medication." + }, + "zh": { + "question": "以下哪项陈述最符合WHO疼痛阶梯？", + "A": "应尽可能使用口服形式的镇痛药，而不是其他形式。", + "B": "镇痛药应仅在需要时给予。", + "C": "成人患者应使用标准化的阿片类药物剂量。", + "D": "癌痛治疗应从阿片类药物开始。" + } + }, + { + "id": "094663f7-8328-53ee-b206-413d78293c2f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "29. All of the following are part of the diagnostic criteria for fibromyalgia EXCEPT which one?", + "A": "Allodynia to digital pressure at 11 or more of 18 anatomically defined tender points", + "B": "A history of widespread pain for at least 3 months", + "C": "A history of sleep disturbance", + "D": "A history of radicular pain in both arms and legs" + }, + "zh": { + "question": "29. 以下哪一项不属于纤维肌痛的诊断标准？", + "A": "在18个解剖学定义的压痛点中，11个或更多点对数字压力的异常痛觉", + "B": "至少3个月的广泛疼痛史", + "C": "睡眠障碍史", + "D": "双臂和双腿的根性疼痛史" + } + }, + { + "id": "b5adba46-2e7d-5265-85c4-bc935af52943", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following medications has been shown to be efficacious in the treatment of fibromyalgia?", + "A": "Duloxetine", + "B": "Amitriptyline", + "C": "Pregabalin", + "D": "Hydrocodone" + }, + "zh": { + "question": "以下哪种药物已被证明对治疗纤维肌痛有效？", + "A": "度洛西汀", + "B": "阿米替林", + "C": "普瑞巴林", + "D": "氢可酮" + } + }, + { + "id": "ec4db7a2-6149-5db7-9ee5-c0555176302f", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following scenarios is suggestive of complex regional pain syndrome (CRPS) type II?", + "A": "A patient burns his right foot and develops pain, hyperalgesia, and allodynia in his right lower leg that continues more than 6 months after his burn. His right foot is noted to be shiny and without hair.", + "B": "A patient's right forearm is crushed by a falling object. She reports pain, hyperalgesia, and allodynia of the forearm more than a year later. Her forearm is noted to be shiny and without hair.", + "C": "A patient's left forearm is crushed by a falling object. She reports pain, hyperalgesia, and allodynia of the forearm more than a year later. Atrophy of the muscles of the forearm is noted.", + "D": "After surgery, a patient develops numbness over his right lateral thigh. He reports pain, hyperalgesia, and allodynia of the lateral thigh more than a year later. The area is noted to be shiny and without hair." + }, + "zh": { + "question": "以下哪种情况提示复杂性区域疼痛综合征（CRPS）II型？", + "A": "一名患者右脚被烧伤，出现疼痛、痛觉过敏和异常痛觉，持续超过6个月。其右脚被观察到发亮且无毛发。", + "B": "一名患者的右前臂被坠落物体压伤。她报告前臂的疼痛、痛觉过敏和异常痛觉超过一年。其前臂被观察到发亮且无毛发。", + "C": "一名患者的左前臂被坠落物体压伤。她报告前臂的疼痛、痛觉过敏和异常痛觉超过一年。观察到前臂肌肉萎缩。", + "D": "手术后，一名患者右侧大腿外侧出现麻木。他报告大腿外侧的疼痛、痛觉过敏和异常痛觉超过一年。该区域被观察到发亮且无毛发。" + } + }, + { + "id": "f2144623-db6d-5262-8a59-56fd9842f1ae", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the greatest risk factor for the development of postherpetic neuralgia (PHN)?", + "A": "Increasing age", + "B": "Male sex", + "C": "Lack of a prodrome", + "D": "Use of antiviral agents during acute herpes zoster infection" + }, + "zh": { + "question": "带状疱疹后神经痛（PHN）发展的最大风险因素是什么？", + "A": "年龄增加", + "B": "男性", + "C": "缺乏前驱症状", + "D": "在急性带状疱疹感染期间使用抗病毒药物" + } + }, + { + "id": "5b1207ed-673c-5753-bd89-239ab967a3a9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "All of the following are risk factors for the development of phantom limb pain EXCEPT which one?", + "A": "Preamputation pain", + "B": "Depression", + "C": "Distal amputation", + "D": "Proximal amputation" + }, + "zh": { + "question": "以下哪一项不是幻肢痛发展的风险因素？", + "A": "截肢前疼痛", + "B": "抑郁", + "C": "远端截肢", + "D": "近端截肢" + } + }, + { + "id": "7b49ee47-4064-5909-b992-b3588e8521ff", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is most characteristic with facetogenic back pain?", + "A": "Pain in the low back that radiates to the ipsilateral posterior thigh", + "B": "Nonradiating pain in the low back", + "C": "Pain in the ipsilateral buttocks", + "D": "Numbness over the lower back" + }, + "zh": { + "question": "以下哪项最能表征关节突源性背痛？", + "A": "下背部疼痛放射至同侧后大腿", + "B": "下背部非放射性疼痛", + "C": "同侧臀部疼痛", + "D": "下背部麻木" + } + }, + { + "id": "6d569186-da48-5cda-8c82-c646487f6d0f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A patient with a history of pain in the lower back that radiates to his ipsilateral thigh presents to a pain clinic for a facet joint injection. Which nerve fibers innervate the facet joints?", + "A": "Medial branch of the dorsal ramus of spinal nerve", + "B": "Lateral branch of the dorsal ramus of spinal nerve", + "C": "Lateral branch of the posterior cutaneous branch of the dorsal ramus", + "D": "Medial branch of the posterior cutaneous branch of the dorsal ramus" + }, + "zh": { + "question": "一名有下背部疼痛病史的患者，疼痛放射至同侧大腿，来到疼痛诊所进行小关节注射。哪些神经纤维支配小关节？", + "A": "脊神经背支的内侧支", + "B": "脊神经背支的外侧支", + "C": "背支后皮神经支的外侧支", + "D": "背支后皮神经支的内侧支" + } + }, + { + "id": "0f4f642e-de0f-5fa9-aee3-a54447857675", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "36. Which of the following would you expect to find in a patient who presents with pain originating from the sacroiliac joint?", + "A": "Back pain that radiates to the ipsilateral buttocks", + "B": "Back pain accompanied by pain extending down the ipsilateral leg when the ipsilateral leg is passively raised straight in the air up to 60°", + "C": "Numbness of the anterolateral thigh", + "D": "Back pain accompanied by a leg length discrepancy" + }, + "zh": { + "question": "36. 患者出现来源于骶髂关节的疼痛时，您期望发现以下哪种情况？", + "A": "放射至同侧臀部的背部疼痛", + "B": "伴随疼痛的背部疼痛，当同侧腿被动抬高至60°时疼痛延伸至同侧腿", + "C": "前外侧大腿的麻木", + "D": "伴随腿长差异的背部疼痛" + } + }, + { + "id": "9f883f21-29c0-588d-96cd-c12594340b28", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A patient presents with pain in the left buttock. He reports that he frequently carries his wallet in the left pocket and that his wallet is quite large. Furthermore, he sits on the wallet throughout most of the day at a desk job. You suspect piriformis syndrome and plan to inject a combination of local anesthetic and steroid. Which anatomic relationship between the piriformis muscle and the sciatic nerve is most common?", + "A": "The undivided sciatic nerve passes below the piriformis muscle.", + "B": "The divided sciatic nerve passes through and below the piriformis muscle.", + "C": "The divided sciatic nerve passes through and above the piriformis muscle.", + "D": "The undivided nerve passes through the piriformis muscle." + }, + "zh": { + "question": "一名患者出现左侧臀部疼痛。他报告说经常把钱包放在左边口袋里，而且钱包很大。此外，他在办公桌工作时大部分时间都坐在钱包上。你怀疑是梨状肌综合征，并计划注射局部麻醉剂和类固醇的组合。梨状肌与坐骨神经之间最常见的解剖关系是什么？", + "A": "未分开的坐骨神经经过梨状肌下方。", + "B": "分开的坐骨神经穿过并经过梨状肌下方。", + "C": "分开的坐骨神经穿过并经过梨状肌上方。", + "D": "未分开的神经穿过梨状肌。" + } + }, + { + "id": "af21ea2e-c242-5b01-8790-e3fcc1417539", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 56-year-old man with a history of hypertension, chronic obstructive pulmonary disease, and diabetes presents for a lumbar epidural steroid injection (ESI) for lower-back pain that radiates into his right leg. He receives an injection of methylprednisone and lidocaine. Which of the following is most likely to occur after he receives this injection?", + "A": "Arachnoiditis", + "B": "Headache", + "C": "Infection", + "D": "Hyperglycemia" + }, + "zh": { + "question": "一名56岁的男性，有高血压、慢性阻塞性肺病和糖尿病病史，因下背部疼痛放射至右腿而接受腰椎硬膜外类固醇注射（ESI）。他接受了甲基泼尼松龙和利多卡因的注射。在他接受注射后，以下哪种情况最有可能发生？", + "A": "蛛网膜炎", + "B": "头痛", + "C": "感染", + "D": "高血糖" + } + }, + { + "id": "0ea3218a-2cd3-5223-b99b-28bcf73cf77d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements about new, acute onset low-back pain is most accurate?", + "A": "Bed rest is recommended for up to 1 week.", + "B": "In the absence of \"red flag\" symptoms, imaging is not indicated in the acute setting.", + "C": "Opioids are the first-line therapy for this type of pain.", + "D": "A short course of oral steroids may be helpful in treating this pain." + }, + "zh": { + "question": "以下关于新发急性下背痛的陈述中哪一项最准确？", + "A": "建议卧床休息长达1周。", + "B": "如果没有“红旗”症状，急性情况下不需要影像检查。", + "C": "阿片类药物是这种疼痛的一线治疗。", + "D": "短期口服类固醇可能有助于治疗这种疼痛。" + } + }, + { + "id": "15705985-4e9b-5052-83ad-4226def8b51d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A patient presents to you with pain on the left side of her face. She states that the pain began a month ago and that chewing food is excruciating. She also notes the sensation of \"shooting\" pain on the left side of her face. Which of the following statements about this condition is most likely true?", + "A": "Pain on the left side of the face is more common than the right side.", + "B": "Involvement of the V1 distribution is uncommon.", + "C": "Autonomic symptoms such as tearing or nasal discharge are common.", + "D": "The most common first-line drug is oxycodone." + }, + "zh": { + "question": "一名患者向您诉说左侧面部疼痛。她表示疼痛始于一个月前，咀嚼食物时疼痛难忍。她还注意到左侧面部有“电击”样疼痛感。关于这种情况，下列哪项陈述最有可能是正确的？", + "A": "左侧面部疼痛比右侧更常见。", + "B": "V1分布的受累不常见。", + "C": "自主神经症状如流泪或流鼻涕很常见。", + "D": "最常用的一线药物是羟考酮。" + } + }, + { + "id": "57420f6d-1618-5dd8-8d2c-fa431ca5a1cc", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 38-year-old man with a history of HIV well managed on antiretroviral agents presents with painful neuropathy in both feet. He describes the pain as burning and constant. It gets worse when he does his job as a postal carrier. Initially he responded to tramadol but no longer finds it helpful. Which of the following is the next most appropriate step to manage this patient's foot pain?", + "A": "Further evaluate the patient's antiviral regimen.", + "B": "Initiate antiepileptic therapy.", + "C": "Perform an ESI.", + "D": "Initiate oxycontin." + }, + "zh": { + "question": "一名38岁的男性患者，既往有HIV病史，抗逆转录病毒药物控制良好，现出现双足疼痛性神经病变。他描述疼痛为烧灼感且持续存在。在从事邮递员工作时疼痛加重。最初他对曲马多有反应，但现在不再觉得有帮助。以下哪一项是管理该患者足部疼痛的下一个最合适的步骤？", + "A": "进一步评估患者的抗病毒方案。", + "B": "开始抗癫痫治疗。", + "C": "进行硬膜外类固醇注射。", + "D": "开始使用奥施康定。" + } + }, + { + "id": "f64f766d-abaf-5ac7-b306-cf6f0c39e490", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "42. In a patient taking methadone, which of the following is most likely to contribute to development of torsades de pointes?", + "A": "Methadone dose of 10 mg a day", + "B": "HIV", + "C": "Male sex", + "D": "Obesity" + }, + "zh": { + "question": "42. 在服用美沙酮的患者中，下列哪项最有可能导致尖端扭转型室性心动过速的发展？", + "A": "每天10毫克的美沙酮剂量", + "B": "艾滋病毒", + "C": "男性", + "D": "肥胖" + } + }, + { + "id": "549f1e72-f698-5e64-b18b-ad6f96ab6053", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A lumbar sympathetic block is appropriate for diagnosis and/or treatment of all the following conditions EXCEPT which one?", + "A": "CRPS type I of the right calf", + "B": "Phantom limb pain of the left lower extremity", + "C": "PHN of the right thigh", + "D": "Coccydynia" + }, + "zh": { + "question": "腰交感神经阻滞适用于诊断和/或治疗以下所有情况，除了哪一种？", + "A": "右小腿的CRPS I型", + "B": "左下肢的幻肢痛", + "C": "右大腿的PHN", + "D": "尾骨痛" + } + }, + { + "id": "4626a62e-c709-588f-ac8f-35c085126cd6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the most likely cause of a \"failed\" spinal?", + "A": "Resistance to local anesthetics", + "B": "Displacement of the tip of a pencil-point needle", + "C": "Dural ectasia", + "D": "Use of lidocaine instead of bupivacaine" + }, + "zh": { + "question": "以下哪项最有可能导致“失败”的脊髓麻醉？", + "A": "对局部麻醉药的抵抗", + "B": "铅笔尖针头的尖端移位", + "C": "硬膜外膨出", + "D": "使用利多卡因代替布比卡因" + } + }, + { + "id": "702bbfa5-8a77-585e-bbc2-604af4c81492", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "An otherwise healthy 42-year-old patient who has received a spinal anesthetic for outpatient total knee arthroplasty reports severe pain in his legs and buttocks. The pain began a few hours after surgery and has persisted on the first postoperative day. Which medication was most likely used for the spinal anesthetic?", + "A": "Bupivacaine", + "B": "Lidocaine", + "C": "Bupivacaine and fentanyl", + "D": "2-Chloroprocaine" + }, + "zh": { + "question": "一名42岁健康患者在门诊全膝关节置换术中接受了脊髓麻醉，术后报告腿部和臀部剧烈疼痛。疼痛在手术后几小时开始，并持续到术后第一天。最有可能用于脊髓麻醉的药物是哪种？", + "A": "布比卡因", + "B": "利多卡因", + "C": "布比卡因和芬太尼", + "D": "2-氯普鲁卡因" + } + }, + { + "id": "69732d9c-fea6-5958-8ecc-7b326d8fd40d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Six months after undergoing a right inguinal hernia repair, a 27-year-old man presents to your office with continuing pain in the groin. He describes the pain as a constant burning sensation that is also occasionally sharp. He has seen his surgeon and does not have a recurrence of his hernia. Which of the following nerve blocks might be helpful in diagnosing this condition?", + "A": "Genitofemoral nerve block", + "B": "Pudendal nerve block", + "C": "Transversus abdominus plane (TAP) block", + "D": "Lateral femoral cutaneous nerve (LFCN) block" + }, + "zh": { + "question": "在接受右侧腹股沟疝修补术六个月后，一名27岁的男性来到您的诊所，抱怨腹股沟持续疼痛。他描述这种疼痛为持续的烧灼感，有时也会感到尖锐疼痛。他已经看过他的外科医生，并没有疝气复发。以下哪种神经阻滞可能有助于诊断这种情况？", + "A": "生殖股神经阻滞", + "B": "阴部神经阻滞", + "C": "腹横肌平面（TAP）阻滞", + "D": "股外侧皮神经（LFCN）阻滞" + } + }, + { + "id": "ea295afb-f89c-5889-9e3a-dd7498446130", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The pudendal nerve can become entrapped at all the following locations EXCEPT which one?", + "A": "Inside the Alcock canal", + "B": "Between the sacrospinous and sacrotuberous ligaments", + "C": "Across the inner margin of the falciform process of the sacrotuberous ligament", + "D": "Inside the deep inguinal ring" + }, + "zh": { + "question": "阴部神经可能在以下所有位置受压，除了哪一个？", + "A": "在Alcock管内", + "B": "在骶棘韧带和骶结节韧带之间", + "C": "跨过骶结节韧带的镰状突内缘", + "D": "在深腹股沟环内" + } + }, + { + "id": "e7200a91-dcae-555a-b288-d3c14a0edd8e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following nerve blocks is associated with a nearly 100% chance of ipsilateral diaphragmatic palsy?", + "A": "Superficial cervical plexus block", + "B": "Infraclavicular block", + "C": "Greater auricular nerve block", + "D": "Axillary nerve block" + }, + "zh": { + "question": "以下哪种神经阻滞与几乎100%的同侧膈肌麻痹有关？", + "A": "浅颈丛阻滞", + "B": "锁骨下阻滞", + "C": "大耳神经阻滞", + "D": "腋神经阻滞" + } + }, + { + "id": "44c53a0b-b837-5e63-afa7-a9aaa745f040", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "49. Which one of the following is the benefit of transcutaneous electrical stimulation (TENS)?", + "A": "It can be applied by the patient at home.", + "B": "It has shown to be effective for chronic pain management.", + "C": "It is cost-effective.", + "D": "It improves the level of disability due to back pain." + }, + "zh": { + "question": "49. 以下哪一项是经皮电刺激（TENS）的好处？", + "A": "患者可以在家中自行使用。", + "B": "已被证明对慢性疼痛管理有效。", + "C": "具有成本效益。", + "D": "改善因背痛导致的残疾程度。" + } + }, + { + "id": "cc880b64-ca00-5e77-ad82-bd6d7611b8ba", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 56-year-old type 1 diabetic man comes to your office to complaining of bilateral \"stocking distribution\" neuropathy. When questioned about his glucose control, the patient states that he normally maintains tight glucose control and he follows a strict low-carbohydrate diet. Which of the following is not a risk factor for development of peripheral neuropathy?", + "A": "Poorly controlled blood glucose", + "B": "Duration of diabetes", + "C": "Gender", + "D": "Patient age" + }, + "zh": { + "question": "一名56岁的1型糖尿病男性来到您的诊所，抱怨双侧“袜子分布”型神经病变。当询问他的血糖控制情况时，患者表示他通常保持严格的血糖控制，并遵循严格的低碳水化合物饮食。以下哪一项不是周围神经病变发展的风险因素？", + "A": "血糖控制不佳", + "B": "糖尿病病程", + "C": "性别", + "D": "患者年龄" + } + }, + { + "id": "2a963f14-08c2-57f0-a04a-394fa0e4583c", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 42-day-old infant is brought to the operating room (OR) for repair of hypertrophic pyloric stenosis. After appropriate rapid sequence induction and intubation of the trachea, the surgeons begin the procedure. One hour into the procedure you notice that the infant's body temperature has dropped from 37°C to 35.5°C. Which of the following is the LEAST effective method of maintaining thermal homeostasis in an infant?", + "A": "Raising the room temperature from 24°C to 29°C", + "B": "Running maintenance IV fluids through a fluid warmer", + "C": "Wrapping the infant's head in plastic", + "D": "Applying a forced-air warming device to exposed body areas", + "E": "Using a circulating warm-water mattress" + }, + "zh": { + "question": "一名42天大的婴儿被送到手术室进行肥厚性幽门狭窄的修复手术。在适当的快速序贯诱导和气管插管后，外科医生开始手术。手术进行一小时后，你注意到婴儿的体温从37°C下降到35.5°C。以下哪种方法是维持婴儿热平衡最不有效的方法？", + "A": "将室温从24°C提高到29°C", + "B": "通过液体加温器加热维持静脉输液", + "C": "用塑料包裹婴儿的头部", + "D": "在暴露的身体部位使用强制空气加热装置", + "E": "使用循环温水床垫" + } + }, + { + "id": "671ebcfb-737e-5c8c-913d-0a801b24b412", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "When considering premedication with midazolam in the pediatric patient, all of the following are true EXCEPT which one?", + "A": "Midazolam's fast onset of action is due to its water insolubility.", + "B": "Midazolam can be administered via the oral, nasal, intramuscular (IM), buccal, intravenous (IV), and rectal routes.", + "C": "As age decreases, required midazolam dose in mg/kg for effective anxiolysis increases.", + "D": "Oral midazolam has a bioavailability of 30% compared with IV administration.", + "E": "Time to peak plasma concentration of rectally administered midazolam is 15-20 minutes." + }, + "zh": { + "question": "在考虑对儿科患者使用咪达唑仑作为术前用药时，以下哪一项是错误的？", + "A": "咪达唑仑的快速起效是由于其不溶于水。", + "B": "咪达唑仑可以通过口服、鼻腔、肌肉注射（IM）、颊部、静脉注射（IV）和直肠途径给药。", + "C": "随着年龄的减小，为达到有效的抗焦虑效果所需的咪达唑仑剂量（mg/kg）增加。", + "D": "口服咪达唑仑的生物利用度为静脉注射的30%。", + "E": "直肠给药的咪达唑仑达到血浆峰浓度的时间为15-20分钟。" + } + }, + { + "id": "e381e427-f640-59b2-b905-b9ababa26d5b", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Of the various types of Mapleson circuits, which one has the fresh gas inflow furthest from the patient/T-piece?", + "A": "Mapleson A", + "B": "Mapleson B", + "C": "Mapleson C", + "D": "Mapleson D", + "E": "Mapleson E" + }, + "zh": { + "question": "在各种类型的Mapleson回路中，哪一种的新鲜气体流入点距离患者/T型管最远？", + "A": "Mapleson A", + "B": "Mapleson B", + "C": "Mapleson C", + "D": "Mapleson D", + "E": "Mapleson E" + } + }, + { + "id": "3e5f393d-c1e2-5e90-951b-3b50eceaac8b", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Of the various types of Mapleson circuits, which has a spring-loaded pop-off valve located at the distal end of the circuit (furthest from the patient/Tpiece?)", + "A": "Mapleson A", + "B": "Mapleson B", + "C": "Mapleson C", + "D": "Mapleson D", + "E": "Mapleson E" + }, + "zh": { + "question": "在各种类型的Mapleson回路中，哪一种在回路的远端（离患者/T型管最远处）有一个弹簧加载的排气阀？", + "A": "Mapleson A", + "B": "Mapleson B", + "C": "Mapleson C", + "D": "Mapleson D", + "E": "Mapleson E" + } + }, + { + "id": "e53f568e-d77c-5d97-b666-be967cf74f30", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "5. The Bain modification is a coaxial circuit where fresh gas flows through an inner tube through the corrugated reservoir tubing of which Mapleson circuit?", + "A": "Mapleson A", + "B": "Mapleson B", + "C": "Mapleson C", + "D": "Mapleson D", + "E": "Mapleson E" + }, + "zh": { + "question": "5. Bain改良型是一种同轴回路，其中新鲜气体通过内管流经哪种Mapleson回路的波纹储气管？", + "A": "Mapleson A", + "B": "Mapleson B", + "C": "Mapleson C", + "D": "Mapleson D", + "E": "Mapleson E" + } + }, + { + "id": "a0f4806b-c919-584b-834e-71bacdfcdde6", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are acceptable agents for induction of anesthesia in children EXCEPT which one?", + "A": "Sevoflurane", + "B": "Ketamine", + "C": "Halothane", + "D": "Desflurane", + "E": "Methohexital" + }, + "zh": { + "question": "以下哪一种不是儿童麻醉诱导的可接受药物？", + "A": "七氟醚", + "B": "氯胺酮", + "C": "氟烷", + "D": "地氟醚", + "E": "甲氧己妥" + } + }, + { + "id": "e71f8351-55a7-5521-8f3f-dd4a859784e1", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "When evaluating a 4-month-old for elective circumcision revision in the preoperative area, the patient's mother tells you that she fed the child expressed breastmilk fortified with formula powder 3.5 hours ago. According to the ASA NPO status guidelines, how many hours must pass between this feeding and the induction of general anesthesia?", + "A": "2 hours", + "B": "4 hours", + "C": "6 hours", + "D": "8 hours", + "E": "12 hours# The following vignette applies to questions 8, 9, and 10.A 2-year-old, 12.5-kg girl with history of a ventriculoperitoneal shunt that was placed in infancy for congenital aqueductal stenosis presents to your OR for emergent shunt revision in the setting of lethargy, vomiting, and irritability. Her parents tell you she \"ate some crackers\" 2 hours ago. The patient is otherwise healthy with no known drug allergies." + }, + "zh": { + "question": "在术前区域为一名4个月大的婴儿评估择期包皮环切术修正时，患者的母亲告诉你，她在3.5小时前给孩子喂了用配方奶粉强化的母乳。根据ASA禁食状态指南，从这次喂食到全身麻醉诱导之间必须间隔多少小时？", + "A": "2小时", + "B": "4小时", + "C": "6小时", + "D": "8小时", + "E": "12小时# 以下情境适用于问题8、9和10。一名2岁、12.5公斤的女孩有婴儿期因先天性导水管狭窄而放置脑室腹腔分流管的病史，因嗜睡、呕吐和易怒的情况来到你的手术室进行紧急分流管修正。她的父母告诉你，她在2小时前“吃了一些饼干”。患者其他方面健康，无已知药物过敏。" + } + }, + { + "id": "3a3c9610-7da0-5c19-b581-6729697733a4", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "The MOST appropriate medication and dosage for neuromuscular blockade for rapid sequence intubation in this patient is which of the following?", + "A": "Rocuronium 10 mg IV", + "B": "Rocuronium 25 mg IV", + "C": "Succinylcholine 12.5 mg IV", + "D": "Succinylcholine 25 mg IV", + "E": "Succinylcholine 25 mg IM" + }, + "zh": { + "question": "在该患者的快速序贯插管中，最合适的神经肌肉阻滞药物及剂量是以下哪一项？", + "A": "罗库溴铵 10 mg 静脉注射", + "B": "罗库溴铵 25 mg 静脉注射", + "C": "琥珀胆碱 12.5 mg 静脉注射", + "D": "琥珀胆碱 25 mg 静脉注射", + "E": "琥珀胆碱 25 mg 肌肉注射" + } + }, + { + "id": "664227d1-ec09-5093-bb43-b1f461b45da8", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "The MOST appropriate blade and endotracheal tube for this patient would be which of the following?", + "A": "Miller 1 blade, size 4.0 uncuffed endotracheal tube", + "B": "Miller 1 blade, size 4.0 cuffed endotracheal tube", + "C": "Miller 1 blade, size 4.5 cuffed endotracheal tube", + "D": "Wis-Hipple 1.5 blade, size 4.0 cuffed endotracheal tube", + "E": "Wis-Hipple 1.5 blade, size 5.0 uncuffed endotracheal tube" + }, + "zh": { + "question": "对于该患者，最合适的喉镜片和气管导管是以下哪一种？", + "A": "Miller 1号喉镜片，4.0号无袖套气管导管", + "B": "Miller 1号喉镜片，4.0号有袖套气管导管", + "C": "Miller 1号喉镜片，4.5号有袖套气管导管", + "D": "Wis-Hipple 1.5号喉镜片，4.0号有袖套气管导管", + "E": "Wis-Hipple 1.5号喉镜片，5.0号无袖套气管导管" + } + }, + { + "id": "de9b812a-8b70-51d9-aaa1-dcd49045d801", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "After successful intubation and initiation of general anesthesia, you decide you would like to attempt to decrease the patient's chance of emergence excitation. With that in mind, which of the following would be the least appropriate choice for maintenance anesthesia?", + "A": "Desflurane at 0.5 minimum alveolar concentration (MAC), dexmedetomidine infusion at 0.5 μg/kg/h", + "B": "Propofol and fentanyl total IV anesthesia", + "C": "Sevoflurane at 1.0 MAC, oxygen, and air", + "D": "Isoflurane at 1.0 MAC, oxygen, and air", + "E": "Ketamine infusion, 50% nitrous oxide/50% oxygen" + }, + "zh": { + "question": "在成功插管并开始全身麻醉后，你决定尝试减少患者出现苏醒激动的几率。考虑到这一点，以下哪种维持麻醉的选择最不合适？", + "A": "0.5最低肺泡浓度（MAC）的地氟醚，0.5 μg/kg/h的右美托咪定输注", + "B": "丙泊酚和芬太尼全静脉麻醉", + "C": "1.0 MAC的七氟醚、氧气和空气", + "D": "1.0 MAC的异氟醚、氧气和空气", + "E": "氯胺酮输注，50%一氧化二氮/50%氧气" + } + }, + { + "id": "76ad2271-407e-530e-94ae-6137ab60861d", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "At what age is MAC of isoflurane the highest?", + "A": "Newborn", + "B": "6 months of age", + "C": "12 months of age", + "D": "2 years of age", + "E": "5 years of age" + }, + "zh": { + "question": "异氟醚的最低肺泡浓度（MAC）在什么年龄最高？", + "A": "新生儿", + "B": "6个月大", + "C": "12个月大", + "D": "2岁大", + "E": "5岁大" + } + }, + { + "id": "1ad7d2a8-7aa5-521b-bbfe-cc1df4271fab", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "One MAC of isoflurane in a neonate equates to what percentage of end-tidal isoflurane concentration?", + "A": "0.9", + "B": "1.1", + "C": "1.3", + "D": "1.6", + "E": "2.2" + }, + "zh": { + "question": "新生儿中一MAC的异氟醚相当于多少百分比的呼气末异氟醚浓度？", + "A": "0.9", + "B": "1.1", + "C": "1.3", + "D": "1.6", + "E": "2.2" + } + }, + { + "id": "23fcaf3d-b966-55b2-b14b-7d667b8e784e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "When considering the relative ED95 in μg/kg of nondepolarizing neuromuscular blocking drugs (NMBDs), the impact of age on relative pharmacodynamics is which of the following?", + "A": "Neonates require less than children who require less than adults.", + "B": "Neonates require more than children who require more than adults.", + "C": "Neonates require more than children, but children require less than adults.", + "D": "Neonates require less than children, but children require more than adults." + }, + "zh": { + "question": "在考虑非去极化神经肌肉阻滞药（NMBDs）相对ED95（μg/kg）时，年龄对相对药效学的影响是以下哪项？", + "A": "新生儿所需剂量小于儿童，儿童所需剂量小于成人。", + "B": "新生儿所需剂量大于儿童，儿童所需剂量大于成人。", + "C": "新生儿所需剂量大于儿童，但儿童所需剂量小于成人。", + "D": "新生儿所需剂量小于儿童，但儿童所需剂量大于成人。" + } + }, + { + "id": "53dd6d04-80a2-5a8a-8fa0-10063b96f01d", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "The estimated circulating blood volume of a 4-kg, full-term neonate is which of the following?", + "A": "200 mL", + "B": "240 mL", + "C": "340 mL", + "D": "420 mL", + "E": "480 mL" + }, + "zh": { + "question": "4公斤足月新生儿的估计循环血容量是以下哪一项？", + "A": "200毫升", + "B": "240毫升", + "C": "340毫升", + "D": "420毫升", + "E": "480毫升" + } + }, + { + "id": "6a087fa5-28a3-5012-ab0b-4351f9baecf3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The benefits of leukoreduction of donor blood products include all of the following EXCEPT which one?", + "A": "Prevention of cytomegalovirus transmission", + "B": "Prevention of nonhemolytic febrile transfusion reactions", + "C": "Prevention of graft-versus-host disease", + "D": "Prevention of human leukocyte antigen alloimmunization" + }, + "zh": { + "question": "供体血液产品的白细胞去除的好处包括以下所有选项，除了哪一个？", + "A": "预防巨细胞病毒传播", + "B": "预防非溶血性发热性输血反应", + "C": "预防移植物抗宿主病", + "D": "预防人类白细胞抗原同种免疫" + } + }, + { + "id": "cc965c1c-6450-51d5-b4e0-c9c9d87c18b9", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 2500-g infant is born at approximately 35 weeks' gestation to a woman who had received minimal prenatal care. Shortly after birth, the infant is noted to be tachypneic with respiratory rates in the 60s, an SpO2 of 85%, and a heart rate", + "A": "Application of continuous positive airway pressure (CPAP), with ventilation goals titrated to an ETCO2 of 35-40 mm Hg", + "B": "Application of CPAP, with ventilation goals titrated to an ET CO2 of 40-45 mm Hg", + "C": "Intubation and pressure control ventilation, with ventilation goals titrated to ETCO2 of 40-45 mm Hg", + "D": "Intubation and pressure support ventilation with permissive hypercapnia and peak inspiratory pressures <25 cm H20", + "E": "Spontaneous ventilation with high-flow oxygen therapy via nasal cannula#### The following vignette applies to questions 17, 18, and 19.A 37-week infant is born uneventfully to a 39-year-old G3P2002 mother via normal spontaneous vaginal delivery. He is noted to have small palpebral fissures and mild hypotonia. 24 hours after birth, the infant has repeated vomiting of bilious emesis." + }, + "zh": { + "question": "一名2500克的婴儿在大约35周的妊娠期出生，其母亲接受的产前护理很少。出生后不久，婴儿被发现呼吸急促，呼吸频率在60次左右，SpO2为85%，心率", + "A": "应用持续气道正压通气（CPAP），通气目标调整为ETCO2 35-40 mm Hg", + "B": "应用CPAP，通气目标调整为ETCO2 40-45 mm Hg", + "C": "插管和压力控制通气，通气目标调整为ETCO2 40-45 mm Hg", + "D": "插管和压力支持通气，允许性高碳酸血症，峰值吸气压<25 cm H2O", + "E": "通过鼻导管进行高流量氧疗的自发通气" + } + }, + { + "id": "72155fef-1b52-58cf-95a0-24003eb9027d", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "17. Which of the following is the most likely cause of the emesis?", + "A": "Pyloric stenosis", + "B": "Duodenal atresia", + "C": "Choanal atresia", + "D": "Necrotizing enterocolitis", + "E": "Intussusception" + }, + "zh": { + "question": "17. 以下哪一项最有可能是呕吐的原因？", + "A": "幽门狭窄", + "B": "十二指肠闭锁", + "C": "后鼻孔闭锁", + "D": "坏死性小肠结肠炎", + "E": "肠套叠" + } + }, + { + "id": "5bd10b71-3dda-5346-8225-e8121694f394", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is the most common radiologic finding that would be seen in this infant during workup for bilious emesis?", + "A": "Gastric bubble above the diaphragm", + "B": "Multiple dilated loops of bowel", + "C": "Pneumatosis", + "D": "\"Double-bubble\" sign on X-ray", + "E": "Target sign on abdominal ultrasonography" + }, + "zh": { + "question": "在对该婴儿进行胆汁性呕吐的检查中，以下哪项是最常见的放射学发现？", + "A": "膈肌上方的胃泡", + "B": "多处肠管扩张", + "C": "肠壁积气", + "D": "X光片上的“双泡”征", + "E": "腹部超声上的靶征" + } + }, + { + "id": "8bc9fcb7-9320-5516-95d1-aa254d4f7541", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "The patient undergoes successful surgical repair in the neonatal period. At 6 months of age he returns for an esophagogastroduodenoscopy. He has appropriately fasted, and an inhalational induction is planned. While your resident is managing the airway, you attempt to place an IV. The patient slightly withdraws to the needle, so your resident increases the inhaled sevoflurane concentration from 4% to 8% to aid with depth of anesthesia. The", + "A": "Hypotension", + "B": "Tachycardia", + "C": "Bradycardia", + "D": "Decreased respiratory rate", + "E": "Increased tidal volume" + }, + "zh": { + "question": "患者在新生儿期成功接受了手术修复。在6个月大时，他返回进行食管胃十二指肠镜检查。他已适当禁食，计划进行吸入诱导。当您的住院医生管理气道时，您尝试放置静脉注射。患者对针头稍微退缩，因此您的住院医生将吸入的七氟醚浓度从4%增加到8%以帮助加深麻醉深度。", + "A": "低血压", + "B": "心动过速", + "C": "心动过缓", + "D": "呼吸频率降低", + "E": "潮气量增加" + } + }, + { + "id": "36d3e605-7377-5e69-a804-6134489c7316", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Compared with adults, infants desaturate more quickly during induction of anesthesia because of which of the following?", + "A": "Increased respiratory rate", + "B": "Increased cardiac output in mL/kg/min", + "C": "Decreased O2 consumption in mL/kg/min compared with adults", + "D": "Decreased closing capacity", + "E": "Decreased functional residual capacity (FRC) in mL/kg" + }, + "zh": { + "question": "与成人相比，婴儿在麻醉诱导期间更快脱饱和是由于以下哪一项？", + "A": "呼吸频率增加", + "B": "每公斤体重每分钟的心输出量增加", + "C": "与成人相比，每公斤体重每分钟的氧气消耗减少", + "D": "闭合容量减少", + "E": "每公斤体重的功能残气量（FRC）减少" + } + }, + { + "id": "295c1a77-a534-5cbe-bfc9-e2eddad416e5", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 14-week-old infant, who was born at 36 weeks' gestational age, presents for elective repair of a right-sided inguinal hernia. He is otherwise healthy and does not have any known allergies, and his parents have not noted any symptoms that would indicate a recent upper respiratory tract infection. The infant did not spend any time in the NICU and has never had an apneic or bradycardic spell. The surgeon asks you about the patient's disposition after surgery. Which of the following is true?", + "A": "Preterm infants who are less than 60 weeks' postconceptual age (PCA) need to undergo extended apnea monitoring after general anesthesia but not after light sedation with a natural airway.", + "B": "This patient does not have a history of apnea or bradycardia and therefore does not meet criteria for postanesthetic admission for apnea monitoring.", + "C": "This patient will need to be admitted for apnea monitoring after general anesthesia with the requirement that 24 hours of apnea-free time elapse before discharge.", + "D": "Spinal and regional anesthesia without supplemental sedation does not abolish the need for postoperative apnea monitoring in former preterm infants less than 60 weeks' PCA.", + "E": "Prophylactic administration of caffeine is recommended for this patient after general anesthesia to prevent apnea." + }, + "zh": { + "question": "一名14周大的婴儿，出生时孕龄为36周，现准备进行右侧腹股沟疝的择期修复手术。婴儿身体健康，无已知过敏，其父母未注意到任何表明近期上呼吸道感染的症状。婴儿未曾在新生儿重症监护室（NICU）停留过，也从未有过呼吸暂停或心动过缓的发作。外科医生询问您关于患者术后处理的意见。以下哪项是正确的？", + "A": "胎龄小于60周的早产婴儿在全身麻醉后需要进行延长的呼吸暂停监测，但在自然气道的轻度镇静后则不需要。", + "B": "该患者没有呼吸暂停或心动过缓的病史，因此不符合术后入院进行呼吸暂停监测的标准。", + "C": "该患者在全身麻醉后需要入院进行呼吸暂停监测，并要求在出院前有24小时无呼吸暂停的时间。", + "D": "在胎龄小于60周的早产婴儿中，单纯使用脊髓和区域麻醉而不辅以镇静并不能免除术后呼吸暂停监测的需要。", + "E": "建议在全身麻醉后为该患者预防性使用咖啡因以防止呼吸暂停。" + } + }, + { + "id": "c846e5f9-1434-57c2-ad29-7e10184e012c", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Of the following pediatric surgical patients, which one would have the lowest risk of postoperative nausea and vomiting (PONV)?", + "A": "A 3-year-old undergoing open reduction of a radial fracture", + "B": "A 16-year-old undergoing hernia repair", + "C": "A 5-year-old undergoing strabismus repair", + "D": "An 8-year-old undergoing tonsillectomy", + "E": "A 12-year-old undergoing orchiopexy" + }, + "zh": { + "question": "在以下小儿外科手术患者中，哪一位的术后恶心呕吐（PONV）风险最低？", + "A": "3岁儿童接受桡骨骨折切开复位术", + "B": "16岁青少年接受疝修补术", + "C": "5岁儿童接受斜视矫正术", + "D": "8岁儿童接受扁桃体切除术", + "E": "12岁儿童接受隐睾固定术" + } + }, + { + "id": "a8a5b497-2309-51f3-8cc7-00efad9cc289", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "All of the following are efficacious in preventing and managing PONV in children EXCEPT which one?", + "A": "Intraoperative fluid restriction", + "B": "Ondansetron", + "C": "Dexamethasone", + "D": "Total IV anesthesia with propofol", + "E": "Postoperative oral fluid restriction" + }, + "zh": { + "question": "以下哪一项在预防和管理儿童术后恶心呕吐（PONV）方面无效？", + "A": "术中限制液体摄入", + "B": "昂丹司琼", + "C": "地塞米松", + "D": "丙泊酚全静脉麻醉", + "E": "术后限制口服液体摄入" + } + }, + { + "id": "1bc479c5-c92b-5020-86a8-0362582e7607", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Considerations in anesthetizing a neonate with meningomyelocele include which of the following?", + "A": "It is necessary to avoid succinylcholine because these patients are at higher risk for hyperkalemia.", + "B": "There is high likelihood of a difficult airway.", + "C": "Evaporative heat and fluid loss through the defect results in hypothermia and hypovolemia.", + "D": "Defect should be repaired within 12 hours of birth to avoid infection and worsening neurologic damage.", + "E": "Cardiac anomalies are commonly present." + }, + "zh": { + "question": "在对患有脊髓脊膜膨出的新生儿进行麻醉时需要考虑以下哪些因素？", + "A": "有必要避免使用琥珀胆碱，因为这些患者有较高的高钾血症风险。", + "B": "很可能会遇到困难的气道。", + "C": "通过缺损的蒸发性热量和液体损失会导致体温过低和低血容量。", + "D": "为了避免感染和神经损伤恶化，缺损应在出生后12小时内修复。", + "E": "常见心脏异常。" + } + }, + { + "id": "d5b1846d-23a7-528a-9e20-3ac4fdbb5101", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 12-day-old, 875-g infant born at 25 weeks' gestational age is brought to the OR for exploratory laparotomy for concern for necrotizing enterocolitis. The patient's vital signs on entry to the OR are notable for HR 160, RR 40, SPO2 of 98%, and BP 70/40. The patient has appropriate IV access, and the decision is made to do an awake intubation after administration of 1 µg/kg of fentanyl. The laryngoscopy is more difficult than anticipated, but successful tracheal intubation occurs within 60 seconds. Despite this, the infant desaturates during laryngoscopy from 98% to 65%. The SpO2 recovers with gentle positive pressure ventilation. With regard to the respiratory mechanics and anatomy of the newborn as compared with adults, which of the following is false?", + "A": "Tidal volumes in mL/kg are decreased compared with adults.", + "B": "FRC is equal in neonates and adults.", + "C": "Neonates have a higher rate of O2 consumption in mL/kg/min.", + "D": "Neonates have a higher closing capacity than adults.", + "E": "Neonates have a decreased total lung capacity (TLC) in mL/kg compared withadults.# The following vignette pertains to questions 26 and 27.A 3-year-old, 16-kg unvaccinated child presents to the emergency department with fever, dysphagia, and drooling. His parents attempted herbal remedies for his fever and sought medical evaluation once he started drooling out of fear that he had been accidentally poisoned by the herbs. Vital signs include HR 120, BP 90/50, RR 40, SpO2 98%, and T 39.8°C. On examination the patient is in visible respiratory distress, drooling, and sitting leaning forward on one arm." + }, + "zh": { + "question": "一名12天大的婴儿，体重875克，出生时胎龄为25周，被送到手术室进行探查性剖腹手术，因担心坏死性小肠结肠炎。患者进入手术室时的生命体征显示心率160次/分，呼吸频率40次/分，血氧饱和度98%，血压70/40。患者有合适的静脉通路，决定在给予1 µg/kg芬太尼后进行清醒插管。喉镜检查比预期更困难，但在60秒内成功进行了气管插管。尽管如此，婴儿在喉镜检查期间血氧饱和度从98%下降到65%。通过轻柔的正压通气，血氧饱和度恢复。关于新生儿与成人相比的呼吸力学和解剖结构，下列哪项是错误的？", + "A": "与成人相比，潮气量（mL/kg）减少。", + "B": "新生儿和成人的功能残气量（FRC）相等。", + "C": "新生儿的氧气消耗率（mL/kg/min）更高。", + "D": "新生儿的闭合容量比成人高。", + "E": "与成人相比，新生儿的总肺容量（TLC，mL/kg）减少。" + } + }, + { + "id": "f2731419-9b20-57e3-9393-46091f83a013", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "26. Which of the following is the most likely diagnosis?", + "A": "Fifth disease", + "B": "Pneumonia", + "C": "Foreign body ingestion", + "D": "Epiglottitis", + "E": "Coxsackie virus" + }, + "zh": { + "question": "26. 以下哪一项是最可能的诊断？", + "A": "第五病", + "B": "肺炎", + "C": "异物吞咽", + "D": "会厌炎", + "E": "柯萨奇病毒" + } + }, + { + "id": "159c9ce3-8c5c-59b2-b780-02aeac60a4fa", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "27. The emergency department physicians decide that the child needs a secure airway, given that he is rapidly decompensating from a respiratory standpoint. The best strategy for airway management in this patient would be which of the following?", + "A": "Immediate placement of an IV in the emergency department followed by rapid sequence intubation with pediatric anesthesia on standby", + "B": "IM ketamine and glycopyrrolate, followed by IV placement and intubation in the emergency department with pediatric anesthesiology on standby", + "C": "Expedited transfer to the OR with pediatric anesthesiologists followed by rapid sequence intubation with succinylcholine, propofol, and fentanyl", + "D": "Expedited transfer to the OR, inhalational induction, and direct laryngoscopy with rigid bronchoscope and surgical personnel present on standby" + }, + "zh": { + "question": "27. 急诊科医生决定，由于孩子的呼吸状况迅速恶化，需要确保气道安全。对于该患者，气道管理的最佳策略是哪一项？", + "A": "在急诊科立即放置静脉通路，然后在儿科麻醉师待命的情况下进行快速序贯插管", + "B": "肌肉注射氯胺酮和东莨菪碱，然后在急诊科放置静脉通路并在儿科麻醉师待命的情况下进行插管", + "C": "快速转移到手术室，由儿科麻醉师进行快速序贯插管，使用琥珀胆碱、丙泊酚和芬太尼", + "D": "快速转移到手术室，进行吸入诱导，并在硬质支气管镜和外科人员待命的情况下进行直接喉镜检查" + } + }, + { + "id": "7868657c-40bc-5013-8e72-c3969930699a", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 7-day-old, 3.5-kg neonate with severe coarctation of the aorta has failed percutaneously repair in the catheterization laboratory and comes to the OR for an open repair. In addition to placing noninvasive blood pressure cuffs on both upper and lower extremities to monitor precoarctation and postcoarctation blood pressures, where should the pulse oximeter probe be placed in this patient?", + "A": "Right upper extremity", + "B": "Right lower extremity", + "C": "Left upper extremity", + "D": "Left lower extremity" + }, + "zh": { + "question": "一名7天大的3.5公斤新生儿患有严重的主动脉缩窄，在导管室的经皮修复失败后，来到手术室进行开放修复。除了在上下肢放置无创血压袖带以监测缩窄前和缩窄后的血压外，该患者的脉搏血氧仪探头应放置在哪里？", + "A": "右上肢", + "B": "右下肢", + "C": "左上肢", + "D": "左下肢" + } + }, + { + "id": "3f6aceb3-ea06-5a68-bd20-03f33122f62c", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "An 18-month-old, 12-kg child with hypoplastic left heart syndrome is following a", + "A": "10 mL/kg crystalloid bolus", + "B": "Hypoventilation, 100% oxygen", + "C": "Transfusion of whole blood to achieve hematocrit of 39% from 33%", + "D": "Hyperventilation with 100% oxygen" + }, + "zh": { + "question": "一名18个月大、12公斤的患有左心发育不全综合征的儿童正在接受以下哪种治疗？", + "A": "10 mL/kg的晶体液推注", + "B": "低通气，100%氧气", + "C": "输注全血以将血细胞比容从33%提高到39%", + "D": "用100%氧气进行过度通气" + } + }, + { + "id": "2ce7f3dd-d4a3-58b3-a8cc-8b4bebd5dcbe", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A 3-year-old, 16-kg boy with unrepaired tetralogy of Fallot is presenting to the OR for repair. Preinduction vitals are BP 88/52, HR 100, and SpO2 90%. He receives sevoflurane and nitrous oxide for induction of anesthesia, followed by IV placement and rocuronium. Airway placement is unexpectedly difficult, and the patient's vitals after successful intubation are BP 69/40, HR 135, and SpO2 60% and falling, despite confirmation of ETCO2 and bilateral breath sounds. Which of the following would be an appropriate pharmacologic intervention?", + "A": "Phenylephrine", + "B": "Ephedrine", + "C": "Lasix", + "D": "Epinephrine" + }, + "zh": { + "question": "一名3岁、16公斤的男孩患有未修复的法洛四联症，现准备在手术室进行修复手术。诱导前生命体征为血压88/52，心率100，血氧饱和度90%。他接受了七氟醚和氧化亚氮进行麻醉诱导，随后进行静脉置管和注射罗库溴铵。气道置管意外困难，成功插管后患者的生命体征为血压69/40，心率135，血氧饱和度60%并下降，尽管已确认ETCO2和双侧呼吸音。以下哪种药物干预是合适的？", + "A": "去氧肾上腺素", + "B": "麻黄碱", + "C": "呋塞米", + "D": "肾上腺素" + } + }, + { + "id": "15369de9-60dd-5319-8e04-9626c96b93eb", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following conditions seen in pediatric patients confers the lowest risk for development of hyperkalemia after succinylcholine administration?", + "A": "Central core disease", + "B": "Duchenne muscular dystrophy", + "C": "Spastic paraplegia", + "D": "10% total-body surface area burns", + "E": "Werdnig-Hoffman syndrome (spinal muscular atrophy type 1)" + }, + "zh": { + "question": "以下哪种在儿科患者中出现的情况在琥珀胆碱给药后发展为高钾血症的风险最低？", + "A": "中央核心病", + "B": "杜氏肌营养不良", + "C": "痉挛性截瘫", + "D": "10% 全身表面积烧伤", + "E": "Werdnig-Hoffman 综合征（脊髓性肌萎缩症1型）" + } + }, + { + "id": "c0f185cf-860a-5d65-bf4d-5585546333c6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "32. A 5-year-old, 20-kg boy comes to the OR for laparoscopic appendectomy in the setting of acute appendicitis. He is otherwise healthy with no known allergies, and he takes no medications. Surgery is uneventful, and before emergence you administer 10 mg of ketorolac and 2 mg of morphine IV for analgesia. Compared with an adult, the clearance of morphine in this patient is which of the following?", + "A": "Less", + "B": "Equal", + "C": "Greater", + "D": "Cannot be determined" + }, + "zh": { + "question": "32. 一名5岁、20公斤的男孩因急性阑尾炎来到手术室进行腹腔镜阑尾切除术。他身体健康，无已知过敏史，也不服用任何药物。手术顺利，在苏醒前你给予10毫克酮咯酸和2毫克吗啡静脉注射用于镇痛。与成人相比，这名患者的吗啡清除率是以下哪种情况？", + "A": "更低", + "B": "相等", + "C": "更高", + "D": "无法确定" + } + }, + { + "id": "dc00b397-1639-5976-93ba-efaedfcbecd2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 6-month-old male infant, who was born healthy at full term, is presenting for bilateral herniorrhaphy. His parents have read recent warnings about exposure to general anesthesia in infants and inquire about other anesthetic techniques available for this procedure. You decide to administer a spinal anesthetic. In infants, the spinal cord terminates at which of the following?", + "A": "T12", + "B": "L1", + "C": "L3", + "D": "L4" + }, + "zh": { + "question": "一名6个月大的男性婴儿，足月健康出生，现准备进行双侧疝修补术。他的父母读到了关于婴儿全身麻醉暴露的最新警告，并询问该手术可用的其他麻醉技术。您决定实施脊髓麻醉。在婴儿中，脊髓终止于以下哪个位置？", + "A": "T12", + "B": "L1", + "C": "L3", + "D": "L4" + } + }, + { + "id": "a7b67b6f-d3d0-524b-8fbe-61c219e5c731", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "You are administering anesthesia to a healthy 14-month-old girl for an inguinal herniorrhaphy. You decide to perform a caudal epidural block for postoperative analgesia. The proper level of needle entry for a caudal block is which of the following?", + "A": "At the center of a line drawn connecting the posterior-superior iliac spines", + "B": "At the cornua of the sacral hiatus", + "C": "Between the sacrum and coccyx, piercing the sacrococcygeal ligament", + "D": "1 cm above the crease of the buttocks" + }, + "zh": { + "question": "您正在为一名健康的14个月大的女孩进行腹股沟疝修补术的麻醉。您决定进行尾部硬膜外阻滞以提供术后镇痛。尾部阻滞的正确针刺进入水平是以下哪一项？", + "A": "在连接后上髂棘的线的中心", + "B": "在骶裂孔的角上", + "C": "在骶骨和尾骨之间，穿过骶尾韧带", + "D": "在臀部褶皱上方1厘米" + } + }, + { + "id": "9990ebbb-bb9e-5882-9168-510d40602fa7", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "According to ASA practice guidelines, all of the following are required before discharge to home from the postanesthesia care unit (PACU) EXCEPT which one?", + "A": "Return to baseline level of consciousness", + "B": "Nausea/vomiting adequately controlled", + "C": "Pain adequately controlled with oral analgesics", + "D": "Patient's ability to void", + "E": "Stable blood pressure and heart rate" + }, + "zh": { + "question": "根据ASA实践指南，以下所有条件在从麻醉后护理单元（PACU）出院回家前都是必需的，除了哪一项？", + "A": "恢复到基线意识水平", + "B": "恶心/呕吐得到充分控制", + "C": "疼痛通过口服镇痛药得到充分控制", + "D": "患者能够排尿", + "E": "血压和心率稳定" + } + }, + { + "id": "1e8b7948-c561-5c77-a883-8177ab1088b0", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "You are caring for an ex-25-week, 1-kg premature infant at 6 days of life who has necrotizing enterocolitis. You are concerned about the risk for retinopathy of prematurity in this very premature infant. To reduce his risk of developing this complication, your goals for management of his vital signs include which of the following?", + "A": "SpO2 > 94% with no greater than 50% FiO2", + "B": "SpO2 90%-94% with the minimum FiO2 necessary to achieve stable SpO2", + "C": "Permissive hypercapnia with ETCO2 goals of 42-47 mm Hg", + "D": "Normotension, mean arterial pressure > 60 mm Hg", + "E": "Normotension, mean arterial pressure > 50 mm Hg" + }, + "zh": { + "question": "您正在照顾一名出生25周、体重1公斤的早产儿，目前出生6天，患有坏死性小肠结肠炎。您担心这名极早产儿患上早产儿视网膜病变的风险。为了降低他发生这种并发症的风险，您对其生命体征管理的目标包括以下哪一项？", + "A": "SpO2 > 94%，FiO2不超过50%", + "B": "SpO2 90%-94%，使用最低的FiO2以达到稳定的SpO2", + "C": "允许性高碳酸血症，ETCO2目标为42-47 mm Hg", + "D": "正常血压，平均动脉压 > 60 mm Hg", + "E": "正常血压，平均动脉压 > 50 mm Hg" + } + }, + { + "id": "17c9fb48-688e-5fea-aeb2-66f762b1f655", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "An infant is born at 38 weeks with omphalocele and macroglossia. Birth weight is 4500 g. Which of the following is the most likely diagnosis?", + "A": "Beckwith-Wiedemann syndrome", + "B": "Angelman syndrome", + "C": "Treacher-Collins syndrome", + "D": "Hurler syndrome", + "E": "Trisomy 21" + }, + "zh": { + "question": "一名婴儿在38周时出生，伴有脐膨出和巨舌症。出生体重为4500克。以下哪项是最可能的诊断？", + "A": "Beckwith-Wiedemann 综合征", + "B": "Angelman 综合征", + "C": "Treacher-Collins 综合征", + "D": "Hurler 综合征", + "E": "21三体综合征" + } + }, + { + "id": "ceca468b-7685-5366-85be-948934e975bc", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 1-year-old child has mandibular hypoplasia, macrostomia, and cleft palate. His airway is expected to become more difficult with age. Which of the following is the most likely diagnosis?", + "A": "Beckwith-Wiedemann syndrome", + "B": "Angelman syndrome", + "C": "Treacher-Collins syndrome", + "D": "Hurler syndrome", + "E": "Trisomy 21" + }, + "zh": { + "question": "一名1岁儿童有下颌发育不全、大口畸形和腭裂。随着年龄的增长，他的气道预计会变得更加困难。以下哪项是最可能的诊断？", + "A": "Beckwith-Wiedemann综合征", + "B": "Angelman综合征", + "C": "Treacher-Collins综合征", + "D": "Hurler综合征", + "E": "21三体综合征" + } + }, + { + "id": "4c5b320b-023d-54aa-9b23-14ce311e6a6d", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Of the following syndromes, which one typically causes cognitive impairment, skeletal abnormalities, short stature, cardiac disease, and restrictive lung disease and is considered to present one of the greatest airway challenges in pediatric anesthesia because of the progressive craniofacial anomalies that can make both intubation and mask ventilation extremely challenging?", + "A": "Beckwith-Wiedemann syndrome", + "B": "Angelman syndrome", + "C": "Treacher-Collins syndrome", + "D": "Hurler syndrome", + "E": "Trisomy 21" + }, + "zh": { + "question": "在以下综合征中，哪一种通常会导致认知障碍、骨骼异常、身材矮小、心脏病和限制性肺病，并且由于进行性颅面异常使插管和面罩通气极具挑战性，被认为是小儿麻醉中最大的气道挑战之一？", + "A": "Beckwith-Wiedemann 综合征", + "B": "Angelman 综合征", + "C": "Treacher-Collins 综合征", + "D": "Hurler 综合征", + "E": "21 三体综合征" + } + }, + { + "id": "9b6fd654-97e2-52e3-92b5-e721cbdc63eb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the most common type of tracheoesophageal fistula (TEF) seen in neonates?", + "A": "Esophageal atresia with a blind esophageal pouch and a distal TEF", + "B": "TEF in the absence of esophageal atresia", + "C": "Proximal TEF with proximal esophageal pouch ending distal to the fistula", + "D": "Esophageal atresia with 2 TEFs, one each between the proximal and distal esophagus and the trachea" + }, + "zh": { + "question": "以下哪种是新生儿中最常见的气管食管瘘（TEF）类型？", + "A": "食管闭锁伴盲端食管囊和远端气管食管瘘", + "B": "无食管闭锁的气管食管瘘", + "C": "近端气管食管瘘伴近端食管囊末端位于瘘远端", + "D": "食管闭锁伴2个气管食管瘘，一个在近端食��和气管之间，另一个在远端食管和气管之间" + } + }, + { + "id": "4130d7ce-7d15-596d-91b1-8ae4303cbcf4", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following scenarios would be least appropriate for a parentpresent induction of anesthesia?", + "A": "An anxious 4-year-old girl here for tonsillectomy with her mother, who is tearful but cooperative", + "B": "A crying 7-year-old for unilateral orchiopexy here with his father, who states he prefers to be with his son when he goes to sleep", + "C": "A 5-month-old girl for diagnostic MRI under general anesthesia here with her mother, who is an anesthesiologist", + "D": "A 17-year-old boy with Down syndrome for general anesthesia in the cardiac catheterization suite here with his mother, who attends all of his medical appointments" + }, + "zh": { + "question": "以下哪种情况最不适合父母在场的麻醉诱导？", + "A": "一个焦虑的4岁女孩在母亲的陪同下进行扁桃体切除术，母亲虽然流泪但很配合", + "B": "一个哭泣的7岁男孩在父亲的陪同下进行单侧隐睾固定术，父亲表示希望在儿子入睡时陪伴", + "C": "一个5个月大的女孩在母亲的陪同下进行全身麻醉下的诊断性MRI，母亲是一名麻醉师", + "D": "一个17岁患有唐氏综合症的男孩在母亲的陪同下在心脏导管插入室进行全身麻醉，母亲参加了他的所有医疗预约" + } + }, + { + "id": "b7013e2b-f325-5bba-8afe-7bc4ff9767e7", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A woman who has received little prenatal care presents in labor with a frank breech fetus. Fetal age is estimated by ultrasonography to be 33 weeks. Her labor proves unstoppable and she undergoes an emergency cesarean delivery. A live-born, 2-kg female infant is delivered. Shortly after the birth, the infant is noted to have grunting, nasal flaring, and retractions. Cardiac examination is within normal limits. There are no structural abnormalities noted, and oral secretions are of the usual amount. Which of the following radiologic findings is/are most likely on chest X-ray of this infant?", + "A": "Lung hyperinflation with diaphragmatic flattening and layering of fluid in horizontal lung fissures", + "B": "Diffuse ground-glass opacities and reduced lung volumes", + "C": "Loops of bowel in the left thorax with mediastinal shift to the right", + "D": "Right-sided pneumothorax", + "E": "Pulmonary edema" + }, + "zh": { + "question": "一名孕期护理不足的女性在分娩时出现臀位胎儿。通过超声波估计胎龄为33周。她的分娩无法停止，进行紧急剖宫产。分娩出一名活产的2公斤女婴。出生后不久，婴儿出现呻吟、鼻翼扇动和胸廓回缩。心脏检查在正常范围内。未发现结构异常，口腔分泌物量正常。以下哪项是该婴儿胸部X光片上最可能的放射学发现？", + "A": "肺过度充气伴膈肌扁平和水平肺裂中的液体分层", + "B": "弥漫性磨玻璃样阴影和肺容量减少", + "C": "左侧胸腔内有肠袢，纵隔向右移位", + "D": "右侧气胸", + "E": "肺水肿" + } + }, + { + "id": "144a7b6c-681b-53fc-9e0c-322a3a5ad396", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "43. An 8-year-old, 45-kg girl with severe obstructive sleep apnea (OSA) presents for tonsillectomy and adenoidectomy. She has an uneventful inhalational induction and is intubated after IV placement and administration of propofol, rocuronium, and 50 µg of fentanyl. Intraoperatively, she receives 500 mg of IV Tylenol and 2 mg of IV morphine. At the end of her procedure she is extubated uneventfully and brought to the recovery room. Approximately 2 hours later, she begins to complain of pain. Which of the following is the most appropriate analgesic choice for her?", + "A": "500 mg of PO Tylenol elixir", + "B": "30 mg of IV ketorolac", + "C": "25 µg of IV fentanyl", + "D": "5 mg of IV morphine", + "E": "1 mg of IV hydromorphone" + }, + "zh": { + "question": "43. 一名8岁、45公斤的女孩患有严重的阻塞性睡眠呼吸暂停（OSA），前来进行扁桃体切除术和腺样体切除术。她顺利地进行了吸入诱导，并在静脉置管后给予丙泊酚、罗库溴铵和50微克芬太尼后插管。在手术过程中，她接受了500毫克的静脉注射泰诺和2毫克的静脉注射吗啡。在手术结束时，她顺利拔管并被送到恢复室。大约2小时后，她开始抱怨疼痛。以下哪种是最适合她的镇痛选择？", + "A": "500毫克口服泰诺糖浆", + "B": "30毫克静脉注射酮咯酸", + "C": "25微克静脉注射芬太尼", + "D": "5毫克静脉注射吗啡", + "E": "1毫克静脉注射氢吗啡酮" + } + }, + { + "id": "48a280c8-2eee-5fbc-8bd6-c89e1f015212", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The P50 of fetal hemoglobin is which of the following?", + "A": "15", + "B": "20", + "C": "27", + "D": "32" + }, + "zh": { + "question": "胎儿血红蛋白的P50是以下哪一项？", + "A": "15", + "B": "20", + "C": "27", + "D": "32" + } + }, + { + "id": "b12a7975-b8f8-5652-92ba-c07fb0f3f37c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "With regard to the fetal circulatory system, which of the following sites will possess the most oxygenated blood?", + "A": "The inferior vena cava (IVC)", + "B": "The superior vena cava (SVC)", + "C": "The right atrium", + "D": "The left atrium", + "E": "The aorta" + }, + "zh": { + "question": "关于胎儿循环系统，下列哪个部位含有最多的氧合血？", + "A": "下腔静脉 (IVC)", + "B": "上腔静脉 (SVC)", + "C": "右心房", + "D": "左心房", + "E": "主动脉" + } + }, + { + "id": "71beac74-7b21-5388-a3e4-de91dc989cb5", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 6-year-old girl who has been diagnosed with a Wilms tumor presents to the OR for resection. You obtain consent from the parents for epidural placement to aid with postoperative analgesia. The safest technique for placement of a thoracic epidural in this age group is which of the following?", + "A": "Awake with minimal sedation, in the seated position, using the paramedian approach", + "B": "Under general anesthesia, in the right lateral decubitus position, using the paramedian approach", + "C": "Awake with moderate sedation, in the seated position, using the midline approach", + "D": "Under general anesthesia, in the right lateral decubitus position, using the midline approach" + }, + "zh": { + "question": "一名6岁女孩被诊断为肾母细胞瘤，现准备在手术室进行切除手术。您已获得父母同意进行硬膜外麻醉，以帮助术后镇痛。在这个年龄组中，放置胸椎硬膜外麻醉的最安全技术是哪一种？", + "A": "清醒状态下，轻度镇静，坐位，使用旁正中入路", + "B": "全身麻醉下，右侧卧位，使用旁正中入路", + "C": "清醒状态下，中度镇静，坐位，使用正中入路", + "D": "全身麻醉下，右侧卧位，使用正中入路" + } + }, + { + "id": "a8518751-83e6-551d-b350-f0ba02a28dea", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 10-year-old, 40-kg boy is involved in a motor vehicle accident along with his parents. He is transported by ambulance to the emergency department after intubation in the field for decreased level of consciousness and hypotension. He is found in the emergency department to have a rigid abdomen concerning for intra-abdominal hemorrhage and is brought emergently to the OR for exploratory laparotomy. His father, who was injured minorly in the crash, accompanies him to the preoperative area and says to you as you take the patient into the OR, \"We are Jehovah's Witnesses. He is not to receive blood transfusions.\" During the case, the patient is hypotensive with BP 60/30, HR 130, and SpO2 94%. Upon entry to the abdomen, 500 mL of frank blood is appreciated. An arterial blood gas is obtained, which shows a hematocrit of 20% with ongoing blood loss. The most appropriate course of action in this case is which of the following?", + "A": "Begin fluid resuscitation with nonblood products, including crystalloid and nonhuman colloid.", + "B": "Call the hospital lawyer to obtain an emergency court order to transfuse blood.", + "C": "Consult the hospital Ethics Committee.", + "D": "Transfuse blood.", + "E": "Ask a colleague to go discuss with the parents that without permitting blood transfusion, their child will die." + }, + "zh": { + "question": "一名10岁、40公斤的男孩与父母一起发生了机动车事故。在现场因意识水平下降和低血压被插管后，他被救护车送到急诊科。在急诊科发现他有腹部僵硬，怀疑是腹腔内出血，并紧急送往手术室进行探查性剖腹手术。他的父亲在事故中受了轻伤，陪同他来到术前区域，并在你将患者带入手术室时对你说：“我们是耶和华见证人。他不能接受输血。”在手术过程中，患者出现低血压，血压为60/30，心率为130，血氧饱和度为94%。进入腹腔时，发现有500毫升的鲜血。动脉血气分析显示，血细胞比容为20%，并有持续的失血。在这种情况下，最合适的处理措施是以下哪一项？", + "A": "开始使用非血液制品进行液体复苏，包括晶体液和非人类胶体。", + "B": "联系医院律师以获得紧急法庭命令进行输血。", + "C": "咨询医院伦理委员会。", + "D": "输血。", + "E": "请同事与父母讨论，如果不允许输血，他们的孩子将会死亡。" + } + }, + { + "id": "662bb979-77eb-526d-bbfc-ddcd49ecf918", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "48. Differences in required dosing of propofol between children and adults can be attributed to which of the following?", + "A": "Increased clearance of propofol in children", + "B": "Larger volume of distribution in children", + "C": "More rapid redistribution of propofol from vessel-rich organs in children", + "D": "A and B", + "E": "B and C" + }, + "zh": { + "question": "48. 丙泊酚在儿童和成人之间所需剂量的差异可以归因于以下哪一项？", + "A": "儿童丙泊酚的清除率增加", + "B": "儿童的分布容积较大", + "C": "丙泊酚从儿童富血管器官的再分布更快", + "D": "A 和 B", + "E": "B 和 C" + } + }, + { + "id": "73f23b78-cfb9-5324-941a-92f54cdeffcd", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Dexmedetomidine can be safely used in children for all of the following situations EXCEPT which one?", + "A": "Prevention of emergence delirium", + "B": "Treatment of opioid withdrawal", + "C": "As an analgesic adjunct", + "D": "Induction of general anesthesia with a loading dose of 2-4 μg/kg over 10 minutes", + "E": "Procedural sedation" + }, + "zh": { + "question": "右美托咪定可以安全用于儿童的所有以下情况，除了哪一种？", + "A": "预防苏醒期谵妄", + "B": "治疗阿片类药物戒断", + "C": "作为镇痛辅助药", + "D": "以2-4 μg/kg的负荷剂量在10分钟内诱导全身麻醉", + "E": "程序性镇静" + } + }, + { + "id": "7bfb30ac-f0bf-5059-8c90-dc6bafd2cf29", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "When administering sedation outside the OR, which of the following corresponds to a plane of moderate sedation?", + "A": "Normal response to verbal stimuli; patent-unassisted airway", + "B": "Responsive to touch or verbal stimuli; may require assistance to maintain patency of airway", + "C": "Responsive to touch or verbal stimuli; patent-unassisted airway", + "D": "Purposeful response to painful stimuli but not verbal stimuli; patent-unassisted airway", + "E": "No response to painful stimuli; requires assistance to maintain patency of airway" + }, + "zh": { + "question": "在手术室外进行镇静时，下列哪项对应于中度镇静的状态？", + "A": "对语言刺激有正常反应；气道通畅且无需辅助", + "B": "对触摸或语言刺激有反应；可能需要协助以保持气道通畅", + "C": "对触摸或语言刺激有反应；气道通畅且无需辅助", + "D": "对疼痛刺激有目的性反应但对语言刺激无反应；气道通畅且无需辅助", + "E": "对疼痛刺激无反应；需要协助以保持气道通畅" + } + }, + { + "id": "91c3ad56-2e52-5d63-bd22-550f81b7a339", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following cardiovascular parameters increases with pregnancy?", + "A": "Left ventricular end-systolic volume", + "B": "Left ventricular end-diastolic volume", + "C": "Central venous pressure", + "D": "Pulmonary artery diastolic pressure", + "E": "Pulmonary vascular resistance" + }, + "zh": { + "question": "以下哪项心血管参数在妊娠期间增加？", + "A": "左心室收缩末期容积", + "B": "左心室舒张末期容积", + "C": "中心静脉压", + "D": "肺动脉舒张压", + "E": "肺血管阻力" + } + }, + { + "id": "143a02dc-cd1d-5715-a192-3b15e40e178b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is NOT consistent with supine hypotensive syndrome of pregnancy?", + "A": "Bradycardia", + "B": "Decreased right atrial filling pressure", + "C": "Normal blood flow in the upper extremities", + "D": "Increased femoral vein velocity" + }, + "zh": { + "question": "以下哪项与妊娠仰卧位低血压综合征不一致？", + "A": "心动过缓", + "B": "右心房充盈压降低", + "C": "上肢血流正常", + "D": "股静脉流速增加" + } + }, + { + "id": "0290ee29-306e-5a3b-9173-3f1283858a16", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following characteristics of local anesthetic administration for spinal anesthesia is more common in a parturient than in a nonpregnant patient?", + "A": "Increased dose requirement for the same level and duration of block", + "B": "Slower onset of neuraxial blockade", + "C": "Longer duration of neuraxial blockade", + "D": "Decreased neural sensitivity to local anesthetics", + "E": "Increased risk of local anesthetic systemic toxicity" + }, + "zh": { + "question": "以下哪项关于脊髓麻醉中局部麻醉药使用的特征在产妇中比在非孕患者中更常见？", + "A": "达到相同阻滞水平和持续时间所需剂量增加", + "B": "神经轴阻滞起效较慢", + "C": "神经轴阻滞持续时间更长", + "D": "对局部麻醉药的神经敏感性降低", + "E": "局部麻醉药全身毒性风险增加" + } + }, + { + "id": "8c0dd17f-a6e3-51f2-86cd-70b33645dc3c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following pharmacokinetic physiologic changes in drug metabolism do you anticipate in a pregnant woman at term?", + "A": "Decreased requirement of isoflurane for maintenance of general anesthesia", + "B": "Slower increase in alveolar concentration of inhaled anesthetics due to increased cardiac output", + "C": "Increased susceptibility to propofol induction", + "D": "Prolonged paralysis after succinylcholine administration", + "E": "Increased dose requirements for aminosteroidal neuromuscular blockers (such as vecuronium and rocuronium)" + }, + "zh": { + "question": "在足月妊娠的孕妇中，您预期以下哪种药物代谢的药代动力学生理变化？", + "A": "减少异氟醚用于维持全身麻醉的需求", + "B": "由于心输出量增加，吸入麻醉剂的肺泡浓度增加速度减慢", + "C": "对丙泊酚诱导的敏感性增加", + "D": "琥珀胆碱给药后麻痹时间延长", + "E": "对氨类类固醇神经肌肉阻滞剂（如维库溴铵和罗库溴铵）的剂量需求增加" + } + }, + { + "id": "d1f29e72-3289-5223-be22-2de8478b5d44", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "5. During which time period of a normal pregnancy does the PaCO2 decrease to reach a level of 30 mm Hg?", + "A": "8 weeks", + "B": "12 weeks", + "C": "20 weeks", + "D": "28 weeks" + }, + "zh": { + "question": "5. 在正常妊娠的哪个时间段，PaCO2 降低到 30 mm Hg 的水平？", + "A": "8 周", + "B": "12 周", + "C": "20 周", + "D": "28 周" + } + }, + { + "id": "7fce1074-8403-54d0-8f60-f7ff60fc47a8", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following changes in lung volume occurs in a pregnant patient at term compared with prepregnancy?", + "A": "Increased functional residual capacity (FRC)", + "B": "Increased vital capacity", + "C": "Decreased inspiratory capacity", + "D": "Decreased expiratory reserve volume", + "E": "Decreased inspiratory reserve volume" + }, + "zh": { + "question": "与怀孕前相比，足月孕妇的肺容量发生了以下哪种变化？", + "A": "功能残气量（FRC）增加", + "B": "肺活量增加", + "C": "吸气容量减少", + "D": "呼气储备容量减少", + "E": "吸气储备容量减少" + } + }, + { + "id": "f39189cf-a820-55b8-a922-a13f4b69a915", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following renal physiologic adaptations is NOT commonly seen in pregnancy?", + "A": "Increased creatinine clearance", + "B": "Increased glomerular filtration rate", + "C": "Increased protein excretion", + "D": "Decreased serum bicarbonate", + "E": "Decreased glucose excretion" + }, + "zh": { + "question": "以下哪项肾脏生理适应在妊娠期不常见？", + "A": "肌酐清除率增加", + "B": "肾小球滤过率增加", + "C": "蛋白质排泄增加", + "D": "血清碳酸氢盐减少", + "E": "葡萄糖排泄减少" + } + }, + { + "id": "cb25967b-3c34-50d3-be34-8524b8e04dc0", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is correct regarding biliary disease during pregnancy?", + "A": "Hormonal changes in pregnancy account for altered bile acid content.", + "B": "Alkaline phosphatase (AP) levels increase during pregnancy because of biliary stasis.", + "C": "Intrahepatic cholestasis of pregnancy is a normal phenomenon that is not associated with increased risk to the fetus.", + "D": "Computerized tomography is the gold standard for diagnosis of gallstones in pregnancy.", + "E": "Laparoscopic surgery is significantly safer during pregnancy in reducing fetal loss as compared with open cholecystectomy." + }, + "zh": { + "question": "关于妊娠期胆道疾病，下列哪项陈述是正确的？", + "A": "妊娠期的激素变化导致胆汁酸含量的改变。", + "B": "碱性磷酸酶（AP）水平在妊娠期增加是由于胆汁淤积。", + "C": "妊娠期肝内胆汁淤积是一种正常现象，与胎儿风险增加无关。", + "D": "计算机断层扫描是妊娠期胆结石诊断的金标准。", + "E": "与开放性胆囊切除术相比，腹腔镜手术在妊娠期显著降低胎儿流失的风险。" + } + }, + { + "id": "aaf2856d-cc60-519c-92f8-cc4de2aa2ebc", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements regarding gastrointestinal (GI) changes during pregnancy is true?", + "A": "Gastroesophageal reflux disease is common, and lower esophageal sphincter pressures are significantly reduced during the first trimester.", + "B": "Gastric emptying becomes progressively more delayed during the later trimesters of pregnancy.", + "C": "Preoperative fasting guidelines for scheduled cesarean section required increased fasting periods compared with other surgical procedures.", + "D": "Intestinal transit and peristalsis are slowed during pregnancy, resulting in constipation.", + "E": "The use of nonparticulate antacids to increase gastric pH has demonstrated a significant decrease in clinical aspiration events." + }, + "zh": { + "question": "以下关于妊娠期间胃肠道（GI）变化的说法中哪一项是正确的？", + "A": "胃食管反流病很常见，并且在妊娠的第一孕期下食管括约肌压力显著降低。", + "B": "胃排空在妊娠后期逐渐变得更加延迟。", + "C": "计划剖宫产的术前禁食指南要求比其他手术程序更长的禁食时间。", + "D": "妊娠期间肠道转运和蠕动减慢，导致便秘。", + "E": "使用非颗粒性抗酸剂来增加胃pH值已显示出临床吸入事件显著减少。" + } + }, + { + "id": "ff3e02be-95fb-5aa6-81bf-538f17c8b71f", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements regarding hematologic changes during pregnancy is false?", + "A": "Plasma volume increases more in pregnancy than red blood cell (RBC) volume, resulting in a physiologic anemia of pregnancy.", + "B": "There is increased fibrinolytic activity during pregnancy, resulting in elevated fibrin degradation products.", + "C": "Procoagulant proteins including factors I, VII, VIII, IX, and X are increased during pregnancy, resulting in a prothrombotic state.", + "D": "White blood cell function is impaired during pregnancy.", + "E": "Platelet consumption during pregnancy is unchanged compared with that during prepregnancy." + }, + "zh": { + "question": "以下关于妊娠期血液学变化的陈述中哪一项是错误的？", + "A": "妊娠期血浆容量增加比红细胞（RBC）容量增加更多，导致妊娠期生理性贫血。", + "B": "妊娠期纤溶活性增加，导致纤维蛋白降解产物升高。", + "C": "妊娠期促凝血蛋白包括因子I、VII、VIII、IX和X增加，导致促凝状态。", + "D": "妊娠期白细胞功能受损。", + "E": "妊娠期血小板消耗与妊娠前相比没有变化。" + } + }, + { + "id": "5bb35384-1164-5b16-9064-d8903b2b2828", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "11. Which of the following drugs when administered to the mother is least likely to have clinical effects on the neonate?", + "A": "Vecuronium", + "B": "Propofol", + "C": "Morphine", + "D": "Diazepam", + "E": "Ketamine" + }, + "zh": { + "question": "11. 以下哪种药物给母亲使用后最不可能对新生儿产生临床影响？", + "A": "维库溴铵", + "B": "丙泊酚", + "C": "吗啡", + "D": "地西泮", + "E": "氯胺酮" + } + }, + { + "id": "223e0e26-1ee2-5841-a3cd-7aee55f8ecc2", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following drugs administered for postpartum hemorrhage (PPH) is incorrectly paired with a commonly associated side effect?", + "A": "Carbetocin—hypotension", + "B": "Oxytocin—hypernatremia", + "C": "Misoprostol—fever", + "D": "Methylprostaglandin—bronchoconstriction", + "E": "Methylergonovine—arteriolar constriction" + }, + "zh": { + "question": "以下哪种用于产后出血（PPH）的药物与其常见的副作用配对错误？", + "A": "卡贝缩宫素—低血压", + "B": "催产素—高钠血症", + "C": "米索前列醇—发热", + "D": "甲基前列腺素—支气管收缩", + "E": "麦角新碱—小动脉收缩" + } + }, + { + "id": "d720b6c5-5f5b-5b29-a753-9fd679f0476a", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following drugs administered to reduce preterm labor is least likely to reduce preterm birth?", + "A": "β-Adrenergic agonists", + "B": "Magnesium sulfate", + "C": "Progesterone", + "D": "Calcium channel blockers", + "E": "Indomethacin" + }, + "zh": { + "question": "以下哪种药物用于减少早产的效果最不明显？", + "A": "β-肾上腺素能激动剂", + "B": "硫酸镁", + "C": "孕激素", + "D": "钙通道阻滞剂", + "E": "吲哚美辛" + } + }, + { + "id": "fc646010-a555-5ad5-bb2e-72e8d0f624eb", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 22-year-old G2P1 is seen preoperatively for an anesthesia consultation at 32 weeks. She has a history of complex partial seizures since the age of 8 years and has been maintained on carbamazepine for the last several years with good control, and her last seizure was 19 months ago. Which of the following is NOT a common perinatal consequence of maternal antiepileptic drug use?", + "A": "Small for gestational age", + "B": "Decreased Apgar scores", + "C": "Thromboembolic events", + "D": "Admission to NICU", + "E": "Preterm delivery" + }, + "zh": { + "question": "一名22岁的G2P1孕妇在32周时进行术前麻醉咨询。她自8岁起有复杂部分性癫痫病史，过去几年一直服用卡马西平，控制良好，最近一次发作是在19个月前。以下哪一项不是母亲使用抗癫痫药物的常见围产期后果？", + "A": "胎儿小于孕龄", + "B": "Apgar评分降低", + "C": "血栓栓塞事件", + "D": "入住新生儿重症监护室", + "E": "早产" + } + }, + { + "id": "0a26c3e0-5d9e-5763-acf7-455d70fedd67", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "You are called to assist with an emergent general anesthesia for a 34-year-old G1P0 for nonreassuring fetal heart tones and persistent fetal bradycardia. During induction, you give propofol, succinylcholine, and fentanyl intravenously. Which of the following pharmacologic drug characteristics is most likely to be associated with an increased transfer of drugs across the placental membrane?", + "A": "Lipophilic substances", + "B": "Charged molecules", + "C": "Molecular weight >1000 Da", + "D": "Low free drug fraction", + "E": "α-1-Acid glycoprotein binding" + }, + "zh": { + "question": "你被叫去协助一名34岁G1P0孕妇进行紧急全身麻醉，因为胎心音不佳和持续的胎儿心动过缓。在诱导过程中，你静脉注射了丙泊酚、琥珀胆碱和芬太尼。以下哪种药物特性最可能与药物通过胎盘膜的转运增加有关？", + "A": "脂溶性物质", + "B": "带电分子", + "C": "分子量>1000 Da", + "D": "低游离药物比例", + "E": "α-1-酸性糖蛋白结合" + } + }, + { + "id": "22a9228f-f15d-5ab1-8713-92c825edbbcb", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements comparing chorionic villus sampling (CVS) with amniocentesis is most accurate?", + "A": "Amniocentesis is associated with a risk of Rh isoimmunization; however, CVS is not.", + "B": "CVS is safer than amniocentesis before 15 weeks of gestation.", + "C": "Pregnancy loss following CVS and amniocentesis is directly related to provider experience.", + "D": "Both techniques evaluate amniotic fluid and desquamated fetal cells (amniocytes) to perform genetic analysis.", + "E": "Amniocentesis is contraindicated in patients with a history of pregnancy loss." + }, + "zh": { + "question": "以下哪项关于绒毛膜绒毛取样（CVS）与羊膜穿刺术比较的陈述最准确？", + "A": "羊膜穿刺术与Rh同种免疫化风险相关；然而，CVS则不然。", + "B": "在妊娠15周前，CVS比羊膜穿刺术更安全。", + "C": "CVS和羊膜穿刺术后的妊娠丢失与提供者的经验直接相关。", + "D": "这两种技术都评估羊水和脱落的胎儿细胞（羊膜细胞）以进行遗传分析。", + "E": "羊膜穿刺术在有妊娠丢失史的患者中禁忌。" + } + }, + { + "id": "dfe78e90-01ec-5b32-9b52-33f8868582bd", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "17. Which of the following statements regarding oligohydramnios is most accurate?", + "A": "The amniotic fluid volume can be influenced by acute fetal hypoxia or acute fetal CNS dysfunction.", + "B": "Oligohydramnios secondary to amniocentesis carries a worse prognosis than other causes and rarely reverts to normal volumes of amniotic fluid.", + "C": "The most common cause of oligohydramnios is fetal anomalies.", + "D": "Uteroplacental insufficiency is not associated with oligohydramnios.", + "E": "Hydrops fetalis is classically associated with oligohydramnios." + }, + "zh": { + "question": "17. 以下关于羊水过少的说法中哪一项最准确？", + "A": "羊水量可以受到急性胎儿缺氧或急性胎儿中枢神经系统功能障碍的影响。", + "B": "羊膜穿刺术引起的羊水过少预后比其他原因更差，且很少恢复到正常羊水量。", + "C": "羊水过少最常见的原因是胎儿畸形。", + "D": "子宫胎盘功能不全与羊水过少无关。", + "E": "胎儿水肿通常与羊水过少有关。" + } + }, + { + "id": "88647bbc-c04d-5a6a-8a16-a841cf4b5d2b", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements regarding the etiology of hydrops fetalis is most correct?", + "A": "Since the introduction of Rho(D) immune globulin, the most common causes of hydrops fetalis are nonimmune.", + "B": "Maternal viral infections are not associated with hydrops fetalis.", + "C": "Although the etiology of this condition must be addressed after delivery, the overall perinatal mortality associated with hydrops fetalis is <10%.", + "D": "Non-ABO RBC antigens such as Kell, Rh(E), Rh(c), and Duffy are not associated with severe immune hydrops.", + "E": "Isolated blunt abdominal trauma to a pregnant woman is not an indication for Rho(D) immune globulin." + }, + "zh": { + "question": "关于胎儿水肿病因的以下哪项陈述最正确？", + "A": "自从引入Rho(D)免疫球蛋白以来，胎儿水肿的最常见原因是非免疫性的。", + "B": "母体病毒感染与胎儿水肿无关。", + "C": "虽然这种情况的病因必须在分娩后处理，但与胎儿水肿相关的围产期总死亡率小于10%。", + "D": "非ABO红细胞抗原如Kell、Rh(E)、Rh(c)和Duffy与严重的免疫性胎儿水肿无关。", + "E": "孕妇单纯的钝性腹部创伤不是Rho(D)免疫球蛋白的适应症。" + } + }, + { + "id": "5f357a70-2a73-531b-9de4-2938e2134f45", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following variables is NOT included in a biophysical profile (BPP)?", + "A": "Fetal limb movements", + "B": "Fetal breathing movements", + "C": "Fetal response to stimulation", + "D": "Qualitative amniotic fluid volume", + "E": "Fetal body movements" + }, + "zh": { + "question": "以下哪项变量��包括在生物物理评分（BPP）中？", + "A": "胎儿肢体运动", + "B": "胎儿呼吸运动", + "C": "胎儿对刺激的反应", + "D": "羊水量的定性评估", + "E": "胎儿身体运动" + } + }, + { + "id": "d3c8f1b5-316a-5e9e-8b87-f7740fa90aef", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A 23-year-old G2P0 undergoes ultrasound at 38 weeks, which demonstrates an estimated fetal weight (EFW) of 4850 g. Which of the following statements is the correct statement regarding fetal macrosomia?", + "A": "An EFW greater than 4500 g in a nondiabetic woman or greater than 5000 g in a diabetic woman may warrant an elective cesarean delivery.", + "B": "Fetal macrosomia is associated with an increased risk of cesarean and instrumental vaginal delivery.", + "C": "Fetal macrosomia is more accurately predicted by ultrasound than by Leopold maneuvers.", + "D": "Induction of labor at 38 weeks for suspected fetal macrosomia is associated with improved maternal and fetal outcomes.", + "E": "The risk of PPH is unchanged by the presence of fetal macrosomia." + }, + "zh": { + "question": "一名23岁的G2P0孕妇在38周进行超声检查，显示估计胎儿体重（EFW）为4850克。以下哪项陈述是关于胎儿巨大症的正确陈述？", + "A": "在非糖尿病女性中，EFW大于4500克或在糖尿病女性中大于5000克可能需要选择性剖宫产。", + "B": "胎儿巨大症与剖宫产和器械辅助阴道分娩的风险增加有关。", + "C": "胎儿巨大症通过超声比通过Leopold触诊更准确地预测。", + "D": "在38周因怀疑胎儿巨大症而引产与改善母婴结局有关。", + "E": "胎儿巨大症的存在不会改变产后出血的风险。" + } + }, + { + "id": "96afea9c-4b55-5fa5-940f-c8d194dd3c9c", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "For which of the following urgent obstetric conditions would it be considered most appropriate to perform neuraxial anesthesia?", + "A": "Placenta previa", + "B": "Preterm footling breech", + "C": "Uterine rupture with hemodynamic compromise", + "D": "Severe obstetric hemorrhage", + "E": "Profound fetal bradycardia" + }, + "zh": { + "question": "在以下哪种紧急产科情况中，最适合进行椎管内麻醉？", + "A": "前置胎盘", + "B": "早产足先露", + "C": "伴随血流动力学不稳定的子宫破裂", + "D": "严重产科出血", + "E": "严重胎儿心动过缓" + } + }, + { + "id": "a88ab7c9-555c-51bd-b956-09c3c8a1c9ce", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following symptoms is not consistent with a postdural puncture headache (PDPH)?", + "A": "Improves with lying flat, worsened by sitting or standing", + "B": "Neck stiffness", + "C": "Tinnitus", + "D": "Bifrontal distribution", + "E": "Scalp tenderness" + }, + "zh": { + "question": "以下哪项症状与硬膜穿刺后头痛（PDPH）不一致？", + "A": "平躺时改善，坐或站时加重", + "B": "颈部僵硬", + "C": "耳鸣", + "D": "额部双侧分布", + "E": "头皮压痛" + } + }, + { + "id": "2b6d7784-f7c1-5970-a682-8b34e7aa1b2b", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "23. What is the anticipated change in oxygen consumption during a normal second stage of labor?", + "A": "Unchanged", + "B": "Increased by 20%", + "C": "Increased by 50%", + "D": "Increased by 70%", + "E": "Increased by 100%" + }, + "zh": { + "question": "23. 在正常的第二产程中，预期氧气消耗的变化是什么？", + "A": "不变", + "B": "增加20%", + "C": "增加50%", + "D": "增加70%", + "E": "增加100%" + } + }, + { + "id": "4b9ad33c-25a9-5273-99fb-9daf6a4d7c14", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "You are participating in the care of a complex obstetric patient who has a history of severe pulmonary arterial hypertension and is undergoing induction of labor. She is a G3P2 at 37 weeks with 2 prior vaginal deliveries and has had progressive dyspnea over the last month, and a multidisciplinary discussion with her cardiologist, maternal fetal medicine specialist, and anesthesia team took place before her admission. She has an epidural in place and is now fully dilated", + "A": "At the beginning of the first stage of labor (onset of contractions, cervical dilation <5 cm)", + "B": "At the end of the first stage of labor (full cervical dilation)", + "C": "At the end of the second stage of labor (immediate postpartum period)", + "D": "At the end of 24 hours after delivery", + "E": "At the end of 72 hours after delivery" + }, + "zh": { + "question": "您正在参与一位复杂的产科患者的护理，该患者有严重的肺动脉高压病史，正在进行引产。她是G3P2，怀孕37周，之前有2次阴道分娩，过去一个月出现进行性呼吸困难，并在入院前与她的心脏病专家、母胎医学专家和麻醉团队进行了多学科讨论。她已经放置了硬膜外麻醉，现在宫口已完全扩张。", + "A": "在分娩第一阶段开始时（宫缩开始，宫颈扩张<5厘米）", + "B": "在分娩第一阶段结束时（宫颈完全扩张）", + "C": "在分娩第二阶段结束时（产后立即）", + "D": "在分娩后24小时结束时", + "E": "在分娩后72小时结束时" + } + }, + { + "id": "2a7e4f74-197c-5770-9d86-580772e8e565", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A 23-year-old G1P0 woman with an uncomplicated pregnancy is now beginning the second stage of labor. Which of the following changes in respiratory physiology would be expected for this patient compared with prepregnancy?", + "A": "Decreased tidal volume and increased respiratory rate", + "B": "Increased tidal volume and increased minute ventilation", + "C": "Decreased tidal volume and increased minute ventilation", + "D": "Increased tidal volume and decreased respiratory rate", + "E": "Increased tidal volume and decreased minute ventilation" + }, + "zh": { + "question": "一名23岁的G1P0女性，怀孕过程顺利，现在开始进入分娩的第二阶段。与怀孕前相比，该患者的呼吸生理会出现以下哪种变化？", + "A": "潮气量减少，呼吸频率增加", + "B": "潮气量增加，分钟通气量增加", + "C": "潮气量减少，分钟通气量增加", + "D": "潮气量增加，呼吸频率减少", + "E": "潮气量增加，分钟通气量减少" + } + }, + { + "id": "c272098e-4ce3-541a-a36b-31b38270a19a", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements regarding the effect of combined spinal epidural (CSE) anesthesia on progress of labor is most correct?", + "A": "CSE anesthesia techniques accelerate the progress of the second stage of labor.", + "B": "CSE anesthesia techniques increase the rate of instrumental vaginal delivery.", + "C": "Early placement CSE anesthesia increases the risk of cesarean delivery when compared with later placement.", + "D": "CSE anesthesia has no greater effect on the progress of labor than epidural anesthesia.", + "E": "CSE has been shown to increase the risk of requiring a cesarean delivery compared with epidural anesthesia alone." + }, + "zh": { + "question": "关于联合脊椎硬膜外（CSE）麻醉对分娩进程影响的以下哪项陈述最正确？", + "A": "CSE麻醉技术加速分娩第二阶段的进程。", + "B": "CSE麻醉技术增加器械辅助阴道分娩的发生率。", + "C": "与后期放置相比，早期放置CSE麻醉增加剖宫产的风险。", + "D": "CSE麻醉对分娩进程的影响不大于硬膜外麻醉。", + "E": "研究表明，与单纯硬膜外麻醉相比，CSE增加了需要剖宫产的风险。" + } + }, + { + "id": "5ece50d2-33c4-5760-a459-bf67e0fe9637", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A 31-year-old G2P0 woman with an epidural in place for labor analgesia has been actively pushing for the last 2 hours and 15 minutes. Her partner inquires whether this is a concerning duration of time. What would be considered a prolonged second stage of labor in this patient?", + "A": "Second stage lasting more than 1 hour with neuraxial anesthesia", + "B": "Second stage lasting more than 1 hour without neuraxial anesthesia", + "C": "Second stage lasting more than 2 hours with neuraxial anesthesia", + "D": "Second stage lasting more than 3 hours with neuraxial anesthesia", + "E": "Second stage lasting more than 4 hours with neuraxial anesthesia" + }, + "zh": { + "question": "一名31岁的G2P0女性在分娩镇痛中使用硬膜外麻醉，已经积极用力推了2小时15分钟。她的伴侣询问这是否是一个令人担忧的时间长度。在这位患者中，什么情况被认为是第二产程延长？", + "A": "第二产程在神经轴麻醉下持续超过1小时", + "B": "第二产程在没有神经轴麻醉的情况下持续超过1小时", + "C": "第二产程在神经轴麻醉下持续超过2小时", + "D": "第二产程在神经轴麻醉下持续超过3小时", + "E": "第二产程在神经轴麻醉下持续超过4小时" + } + }, + { + "id": "9249243e-eb12-5204-8432-eed4bad30447", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is not a strong indication for cesarean delivery?", + "A": "Previous Pfannenstiel incision cesarean delivery", + "B": "Placenta previa", + "C": "Breech presentation", + "D": "Prolapsed umbilical cord", + "E": "Prior myomectomy" + }, + "zh": { + "question": "以下哪项不是剖宫产的强指征？", + "A": "既往Pfannenstiel切口剖宫产", + "B": "前置胎盘", + "C": "臀位", + "D": "脐带脱垂", + "E": "既往子宫肌瘤切除术" + } + }, + { + "id": "ef59cab2-de2b-53ec-aba3-85e63358029f", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "29. For which of the following conditions would general anesthesia be considered the preferred technique for a cesarean delivery?", + "A": "High body mass index (BMI)/obesity", + "B": "History of malignant hyperthermia", + "C": "Severe psychiatric disorder", + "D": "History of pulmonary disease", + "E": "History of difficult intubation" + }, + "zh": { + "question": "29. 以下哪种情况剖宫产时全身麻醉被认为是首选技术？", + "A": "高体重指数（BMI）/肥胖", + "B": "恶性高热病史", + "C": "严重的精神障碍", + "D": "肺部疾病史", + "E": "困难插管史" + } + }, + { + "id": "2f2bf7db-fe39-5cda-a1eb-975e172b55d3", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Which of the following pregnancy-related changes is least likely to contribute to airway complications during intubation?", + "A": "Presence of a Mallampati class III or IV airway", + "B": "Friable oral mucosa", + "C": "Increased metabolic need and oxygen consumption", + "D": "Decreased lower esophageal sphincter tone", + "E": "Decreased duration of paralysis following succinylcholine administration" + }, + "zh": { + "question": "以下哪种与妊娠相关的变化最不可能导致插管时的气道并发症？", + "A": "存在 Mallampati III 或 IV 级气道", + "B": "脆弱的口腔黏膜", + "C": "代谢需求和氧气消耗增加", + "D": "下食道括约肌张力降低", + "E": "琥珀胆碱给药后麻痹持续时间缩短" + } + }, + { + "id": "cf1b4f4e-dfa0-58f8-9ea8-2a3a4c024f91", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "You are asked to provide an anesthesia consultation for a 33-year-old G1P0 with a medical history significant for relapsing and remitting multiple sclerosis that was diagnosed 4 years before this pregnancy. She is currently not taking any medications, and her last relapse was 15 months ago. Her physical examination is significant only for right foot drop. Which of the following is the most appropriate management for her obstetric anesthesia?", + "A": "Spinal and epidural analgesia are contraindicated for labor.", + "B": "Spinal techniques are significantly safer than epidural techniques and are preferred for analgesia or anesthesia.", + "C": "Epidural techniques are significantly safer than spinal techniques and are preferred for analgesia or anesthesia.", + "D": "Spinal and epidural techniques are both considered to be safe and can be pursued for analgesia or anesthesia.", + "E": "General anesthesia has been implicated in relapses of multiple sclerosis and should be avoided." + }, + "zh": { + "question": "您被要求为一名33岁的G1P0患者提供麻醉咨询，该患者有复发和缓解型多发性硬化病史，该病是在本次妊娠前4年确诊的。她目前没有服用任何药物，最后一次复发是在15个月前。她的体格检查仅显示右足下垂。以下哪项是她产科麻醉的最合适管理？", + "A": "椎管内和硬膜外镇痛在分娩时是禁忌的。", + "B": "椎管内技术明显比硬膜外技术更安全，优先用于镇痛��麻醉。", + "C": "硬膜外技术明显比椎管内技术更安全，优先用于镇痛或麻醉。", + "D": "椎管内和硬膜外技术都被认为是安全的，可以用于镇痛或麻醉。", + "E": "全身麻醉可能导致多发性硬化复发，应避免使用。" + } + }, + { + "id": "77119422-7141-5769-8cce-eca2c3026482", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "A 24-year-old G2P0 woman, 7 weeks pregnant based on the last menstrual period, presents to the ED with right lower quadrant pain, tachycardia, and", + "A": "If on physical examination she has cervical dilation without fetal or placental expulsion, this would be considered a threatened abortion.", + "B": "Spontaneous abortions are most commonly related to maternal immunologic phenomena.", + "C": "Methotrexate may be used to treat this patient with suspected ectopic pregnancy.", + "D": "The rate of serum β-hCG concentration rise is not reliable for the diagnosis of ectopic pregnancies.", + "E": "Transvaginal ultrasound is the best modality to image if an ectopic pregnancy is suspected." + }, + "zh": { + "question": "一名24岁的G2P0女性，根据最后一次月经推算怀孕7周，因右下腹痛、心动过速来到急诊科，", + "A": "如果在体格检查中发现宫颈扩张但没有胎儿或胎盘排出，这将被视为先兆流产。", + "B": "自然流产最常与母体免疫现象有关。", + "C": "甲氨蝶呤可用于治疗疑似异位妊娠的患者。", + "D": "血清β-hCG浓度上升的速度对于诊断异位妊娠不可靠。", + "E": "如果怀疑异位妊娠，经阴道超声是最佳的成像方式。" + } + }, + { + "id": "fae4f6a3-fc2b-53b1-96eb-25d45fd3e369", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements is not true regarding systemic lupus erythematosus (SLE) in pregnancy?", + "A": "Patients with SLE have an increased risk of preterm delivery.", + "B": "The presence of atypical blood antibodies may make it challenging to obtain a blood type and crossmatch.", + "C": "The presence of lupus anticoagulant increases the patient's risk of bleeding complications from neuraxial anesthesia.", + "D": "Patients with SLE are at risk of pericarditis and cardiac tamponade.", + "E": "Infants born to mothers with SLE may be born with congenital heart block." + }, + "zh": { + "question": "关于妊娠期系统性红斑狼疮（SLE），以下哪项陈述是不正确的？", + "A": "SLE患者早产的风险增加。", + "B": "非典型血液抗体的存在可能使获得血型和交叉配对变得困难。", + "C": "狼疮抗凝剂的存在增加了患者因椎管内麻醉而出现出血并发症的风险。", + "D": "SLE患者有心包炎和心脏压塞的风险。", + "E": "SLE母亲所生的婴儿可能会患有先天性心脏传导阻滞。" + } + }, + { + "id": "93d0fc02-aef4-5cd7-af05-5f3cdeb70159", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "34. Which of the following hematologic disorders is not associated with an increased risk of thrombotic events in pregnancy?", + "A": "Protein C deficiency", + "B": "Antithrombin III deficiency", + "C": "Disseminated intravascular coagulation", + "D": "Von Willebrand disease", + "E": "Antiphospholipid syndrome" + }, + "zh": { + "question": "34. 以下哪种血液病在妊娠期与血栓事件的风险增加无关？", + "A": "蛋白C缺乏", + "B": "抗凝血酶III缺乏", + "C": "弥散性血管内凝血", + "D": "血友病", + "E": "抗磷脂综合征" + } + }, + { + "id": "dbc39872-e445-557b-b0a5-afaae47438f2", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements regarding management of a parturient with mitral stenosis is most correct?", + "A": "Percutaneous mitral balloon valvuloplasty may be considered during pregnancy in patients with severe disease who are refractory to medical management.", + "B": "The physiologic changes of pregnancy are well tolerated with the peak period of symptoms in the first trimester that typically improves throughout gestation.", + "C": "Peripartum β-blockers may be used but have been associated with worse maternal outcomes.", + "D": "Percutaneous valvuloplasty should be performed postconception in patients withmoderate or severe mitral stenosis, as the clinical course during pregnancy is widely variable.", + "E": "Epidural labor analgesia is not recommended given the risk of cardiovascular collapse." + }, + "zh": { + "question": "关于二尖瓣狭窄产妇管理，下列哪项陈述最正确？", + "A": "对于严重疾病且对药物治疗无反应的患者，可以考虑在妊娠期间进行经皮二尖瓣球囊成形术。", + "B": "妊娠的生理变化通常能很好地耐受，症状高峰期在第一孕期，通常在整个妊娠期会有所改善。", + "C": "围产期可以使用β-受体阻滞剂，但已与较差的母体结局相关。", + "D": "对于中度或重度二尖瓣狭窄的患者，应在妊娠后进行经皮瓣膜成形术，因为妊娠期间的临床过程变化很大。", + "E": "不推荐硬膜外分娩镇痛，因为存在心血管崩溃的风险。" + } + }, + { + "id": "ec1570ce-e82a-51a6-95af-951fda634026", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following associations between findings from fetal heart rate (FHR) monitoring and their causes is most accurately paired?", + "A": "Early decelerations—umbilical cord compression", + "B": "Variable decelerations—fetal head compression", + "C": "Late decelerations—umbilical cord compression", + "D": "Sinusoidal pattern—fetal anemia", + "E": "Accelerations—fetal distress" + }, + "zh": { + "question": "以下哪一项关于胎心率（FHR）监测结果与其原因的关联最为准确？", + "A": "早期减速—脐带受压", + "B": "变异减速—胎头受压", + "C": "晚期减速—脐带受压", + "D": "正弦波模式—胎儿贫血", + "E": "加速—胎儿窘迫" + } + }, + { + "id": "91ac74d5-ef6b-5a26-8ad7-332e9b192593", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 36-year-old G1P0 at 37 weeks' gestation presents to triage complaining of a severe headache and blurry vision. Her vital signs include T 37.8, HR 84, RR 28, and BP 190/114. Her laboratory evaluation is significant for proteinuria and shows a platelet count of 86 000/mm3 with normal coagulation studies. Which of the following steps of management is inappropriate?", + "A": "Treatment of hypertension to a goal of 15%-25% reduction in mean arterial pressure with intravenous (IV) hydralazine", + "B": "Initiating seizure prophylaxis with magnesium sulfate", + "C": "Performing an epidural for labor analgesia", + "D": "Placement of a radial arterial blood pressure catheter", + "E": "Platelet transfusion to achieve a platelet count of >100 000 mm3 before performing neuraxial anesthesia" + }, + "zh": { + "question": "一名36岁的G1P0孕妇在妊娠37周时因严重头痛和视力模糊到急诊就诊。她的生命体征包括体温37.8°C，心率84次/分，呼吸频率28次/分，血压190/114 mmHg。实验室检查显示蛋白尿，血小板计数为86,000/mm3，凝血功能正常。以下哪项管理步骤是不合适的？", + "A": "使用静脉注射肼屈嗪治疗高血压，目标是平均动脉压降低15%-25%", + "B": "开始使用硫酸镁进行癫痫预防", + "C": "进行硬膜外麻醉以缓解分娩疼痛", + "D": "放置桡动脉血压导管", + "E": "在进行神经轴麻醉前输注血小板以使血小板计数达到>100,000/mm3" + } + }, + { + "id": "34a55d3e-6c05-58f9-955f-3df9ada40412", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "A 42-year-old G1P0 woman complains of shortness of breath 3 hours after undergoing cesarean delivery of a term infant. She was initially admitted for preeclampsia and had a prolonged induction during which time she received 5 L of crystalloid infusions. Which of the following is the most likely etiology of her hypoxemia?", + "A": "Pulmonary embolism", + "B": "Pulmonary edema", + "C": "Spontaneous pneumothorax", + "D": "Atelectasis", + "E": "Pneumonia" + }, + "zh": { + "question": "一名42岁的G1P0女性在足月婴儿剖宫产术后3小时抱怨呼吸急促。她最初因子痫前期入院，并在长时间的引产过程中接受了5升晶体液输注。以下哪一项是她低氧血症最可能的病因？", + "A": "肺栓塞", + "B": "肺水肿", + "C": "自发性气胸", + "D": "肺不张", + "E": "肺炎" + } + }, + { + "id": "23b633ac-c8ee-59ff-8a45-a9fa225d630a", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "39. Which of the following statements is most correct regarding umbilical cord prolapse during labor?", + "A": "Vaginal delivery may be attempted if the diagnosis is made during the first stageof labor; however, if diagnosed in the second stage, then cesarean delivery should be performed.", + "B": "Manual elevation of the presenting limb is contraindicated.", + "C": "Neuraxial anesthesia should be attempted before the use of general anesthesia.", + "D": "Macrosomia is associated with an increased risk of umbilical cord prolapse.", + "E": "The risk of complications is decreased with a shorter interval from diagnosis to delivery." + }, + "zh": { + "question": "39. 关于分娩时脐带脱垂，下列哪项陈述最正确？", + "A": "如果在分娩第一阶段诊断出脐带脱垂，可以尝试阴道分娩；然而，如果在第二阶段诊断出，则应进行剖宫产。", + "B": "禁忌手动抬高先露肢体。", + "C": "在使用全身麻醉之前应尝试神经轴麻醉。", + "D": "巨大胎儿与脐带脱垂的风险增加有关。", + "E": "从诊断到分娩的间隔时间越短，合并症的风险越低。" + } + }, + { + "id": "364c3087-0fa0-506f-84ee-c4d8a292296d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following interventions is not recommended for aspiration prophylaxis in pregnant patients?", + "A": "Ondansetron", + "B": "Metoclopramide", + "C": "H2 -receptor antagonists", + "D": "Nonparticulate antacids", + "E": "Avoidance of solid foods during labor" + }, + "zh": { + "question": "以下哪项干预措施不推荐用于孕妇的误吸预防？", + "A": "昂丹司琼", + "B": "甲氧氯普胺", + "C": "H2受体拮抗剂", + "D": "非颗粒性抗酸剂", + "E": "分娩期间避免固体食物" + } + }, + { + "id": "5c12121d-baba-57aa-8bf7-a35cb9ca3592", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 23-year-old G1P0 woman who just had a successful vaginal delivery with epidural analgesia now has persistent bleeding suspected to be related to retained placenta. Which of the following actions is the least appropriate to pursue for this patient's anesthetic management?", + "A": "Use of oxytocin for increased uterine tone after manual removal of the placenta", + "B": "Neuraxial anesthesia to achieve a block height of T6", + "C": "Intermittent boluses of ketamine to facilitate extraction", + "D": "Administering nitroglycerin spray to the mother", + "E": "Transport to OR and induction of general anesthesia with 1.5-2 MAC (minimum alveolar concentration) of volatile anesthetic" + }, + "zh": { + "question": "一名23岁的G1P0女性刚刚成功进行了硬膜外镇痛下的阴道分娩，现在持续出血，怀疑与胎盘滞留有关。以下哪项措施对于该患者的麻醉管理最不合适？", + "A": "在手动取出胎盘后使用催产素以增加子宫张力", + "B": "使用神经轴麻醉达到T6的阻滞高度", + "C": "间歇性推注氯胺酮以促进取出", + "D": "给母亲喷射硝酸甘油", + "E": "转运至手术室并以1.5-2 MAC（最低肺泡浓度）的挥发性麻醉剂诱导全身麻醉" + } + }, + { + "id": "3e0cbedb-de04-5605-91e5-f719ba0406f0", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "You are called to the bedside to evaluate a 31-year-old G2P1 at term who is attempting a trial of labor after cesarean (TOLAC) and is complaining of abrupt onset of abdominal pain despite previously adequate epidural analgesia. She has a history of a prior cesarean delivery for arrest of descent at 39 weeks. Which of the following statements regarding TOLAC and vaginal birth after cesarean (VBAC) is false?", + "A": "Contraindications to VBAC include a previous classic incision uterine surgery.", + "B": "Risk of uterine rupture is significantly increased in patients attempting a TOLAC.", + "C": "The risk of maternal mortality is less in a TOLAC than that in an elective cesarean section.", + "D": "Gestation beyond 40 weeks carries a higher risk of uterine rupture in an attempted TOLAC.", + "E": "Increased BMI (>30) significantly decreases the likelihood of a successful VBAC." + }, + "zh": { + "question": "你被叫到床边评估一位31岁的G2P1足月产妇，她正在尝试剖宫产后的试产（TOLAC），并抱怨尽管之前硬膜外镇痛效果良好，但突然出现腹痛。她有39周因胎头下降停滞而进行剖宫产的病史。以下关于TOLAC和剖宫产���阴道分娩（VBAC）的陈述中哪一项是错误的？", + "A": "VBAC的禁忌症包括既往经典切口的子宫手术。", + "B": "尝试TOLAC的患者子宫破裂的风险显著增加。", + "C": "TOLAC的孕产妇死亡率风险低于选择性剖宫产。", + "D": "妊娠超过40周在尝试TOLAC时子宫破裂的风险更高。", + "E": "较高的BMI（>30）显著降低成功VBAC的可能性。" + } + }, + { + "id": "45939f65-726a-5bda-98ae-e2b4aeb0cdcf", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "A 24-year-old G1P0 patient at 33 weeks' gestation with twins presents to triage with uterine contractions and a concern for preterm premature rupture of membranes. Which of the following complications of pregnancy is not consistently associated with multiple gestations?", + "A": "Preterm labor", + "B": "Acute fatty liver of pregnancy", + "C": "Placental abruption", + "D": "Postpartum hemorrhage", + "E": "Gestational diabetes" + }, + "zh": { + "question": "一位24岁的G1P0孕妇，怀孕33周，怀有双胞胎，因子宫收缩和担心胎膜早破而到急诊。以下哪种妊娠并发症与多胎妊娠不一致相关？", + "A": "早产", + "B": "妊娠急性脂肪肝", + "C": "胎盘早剥", + "D": "产后出血", + "E": "妊娠糖尿病" + } + }, + { + "id": "2e447d47-78be-55ff-bc0e-abe3b752234a", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the statements below regarding preterm labor is most correct?", + "A": "Preterm labor complicates roughly 5% of all pregnancies in the United States.", + "B": "Birth weight of preterm neonates does not correlate with morbidity and mortality.", + "C": "Urinary tract infections may predispose patients to preterm labor.", + "D": "Neonatal benefits of maternal administration of corticosteroids in preterm labor are limited to pulmonary maturation.", + "E": "Magnesium sulfate is preferred as a first-line agent for tocolysis in preterm labor." + }, + "zh": { + "question": "以下关于早产的陈述中哪一项是最正确的？", + "A": "早产大约影响美国5%的妊娠。", + "B": "早产新生儿的出生体重与发病率和死亡率无关。", + "C": "尿路感染可能使患者易于发生早产。", + "D": "母体使用皮质类固醇对早产的胎儿益处仅限于肺部成熟。", + "E": "硫酸镁是早产中首选的抑制宫缩药物。" + } + }, + { + "id": "1b8f385c-f168-54e0-b75f-fcec9cd9f56b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "45. Which of the following statements is false regarding breech presentation and delivery?", + "A": "External cephalic version is more likely to be successful if performed with general anesthesia.", + "B": "Perinatal morbidity and mortality are greater in planned cesarean delivery than those in planned vaginal delivery.", + "C": "Maternal morbidity is lower in planned cesarean delivery than that in planned vaginal delivery.", + "D": "Institutional protocols for vaginal breech delivery to select appropriate candidates and labor management may be appropriate.", + "E": "Fetal head entrapment during delivery may require administration of nitroglycerin to the mother." + }, + "zh": { + "question": "45. 关于臀位分娩，下列哪项陈述是错误的？", + "A": "在全身麻醉下进行外倒转术更有可能成功。", + "B": "计划剖宫产的围产期发病率和死亡率高于计划阴道分娩。", + "C": "计划剖宫产的母体发病率低于计划阴道分娩。", + "D": "为选择合适的候选者和分娩管理而制定的阴道臀位分娩机构协议可能是合适的。", + "E": "分娩过程中胎头被卡住可能需要给母亲使用硝酸甘油。" + } + }, + { + "id": "50d82b12-6876-5bf9-a843-da17ea50bf24", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A neonate, born with a heart rate of 109 beats per minute, is taking gasping irregular breaths, appears cyanotic, grimaces to stimulation, and flexes the extremities. Which of the following is the infant's Apgar score?", + "A": "2", + "B": "4", + "C": "5", + "D": "7", + "E": "8" + }, + "zh": { + "question": "一名新生儿出生时心率为每分钟109次，呼吸不规则且呈喘息状，出现紫绀，对刺激有痛苦表情，四肢屈曲。以下哪项是婴儿的阿普加评分？", + "A": "2", + "B": "4", + "C": "5", + "D": "7", + "E": "8" + } + }, + { + "id": "c84fa092-43e4-5a8f-be14-a8dea81a9773", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A neonate is delivered at 38 weeks via cesarean section after a failed induction for intrauterine growth restriction. Which of the following is most likely to be associated with increased neonatal morbidity?", + "A": "Two separate episodes of FHR late decelerations each lasting 90 seconds", + "B": "An Apgar score of 6 at 1 minute after delivery", + "C": "Umbilical artery pH of 7.18 and base deficit of 10 mmol/L", + "D": "Umbilical artery pH less than 7.0 and base deficit of 14 mmol/L", + "E": "Stage I hypoxic-ischemic encephalopathy" + }, + "zh": { + "question": "一名新生儿在38周时因宫内生长受限诱导失败后通过剖宫产分娩。以下哪项最有可能与新生儿发病率增加有关？", + "A": "两次胎心率晚期减速发作，每次持续90秒", + "B": "出生后1分钟的阿普加评分为6", + "C": "脐动脉pH值为7.18，碱缺失为10 mmol/L", + "D": "脐动脉pH值小于7.0，碱缺失为14 mmol/L", + "E": "I期缺氧缺血性脑病" + } + }, + { + "id": "fa0c4a80-a347-5122-8330-97cb2cf5b6d0", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A neonate is delivered at 35 weeks via an emergent cesarean section and is noted to have rapid shallow gasping, appears cyanotic, and has a heart rate of 110 beats per minute. Which of the following is the most appropriate next step in fetal resuscitation?", + "A": "Continue to observe.", + "B": "Provide positive pressure ventilation.", + "C": "Provide blow-by supplementary oxygen.", + "D": "Administer epinephrine.", + "E": "Begin chest compressions." + }, + "zh": { + "question": "一名新生儿在35周时通过紧急剖宫产分娩，发现其呼吸急促浅表，出现发绀，心率为每分钟110次。以下哪项是胎儿复苏的最适当下一步措施？", + "A": "继续观察。", + "B": "提供正压通气。", + "C": "提供旁路补充氧气。", + "D": "给予肾上腺素。", + "E": "开始胸外按压。" + } + }, + { + "id": "59a0bda3-f4ef-5334-b9d1-d370ab2d9dff", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "You are caring for a 29-year-old G2P1 at 28 weeks' gestation with the pregnancy complicated by a fetal sacrococcygeal teratoma, who is presenting for an intrauterine surgical intervention. Which of the following statements is NOT true regarding intrauterine surgery?", + "A": "Volatile anesthetic agents are used at 2-3 MAC for maintenance of anesthesia.", + "B": "Magnesium and nitroglycerin may be used to provide tocolysis.", + "C": "Maternal administration of paralytic agents is needed to ensure maternal and fetal immobility.", + "D": "Vasopressor use to maintain placental perfusion is frequently required.", + "E": "Subsequent pregnancies should be delivered via cesarean section rather than allowing labor." + }, + "zh": { + "question": "您正在照顾一位29岁的G2P1孕妇，怀孕28周，因胎儿骶尾部畸胎瘤而需要进行宫内手术干预。关于宫内手术，下列哪项陈述是不正确的？", + "A": "挥发性麻醉剂以2-3 MAC用于麻醉维持。", + "B": "镁和硝酸甘油可用于提供宫缩抑制。", + "C": "需要给予母体麻痹剂以确保母体和胎儿不动。", + "D": "通常需要使用升压药来维持胎盘灌注。", + "E": "后续的妊娠应通过剖宫产分娩，而不是允许自然分娩。" + } + }, + { + "id": "ca75dbd4-a6be-586f-9bfc-0f921d5ee1a5", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A healthy 24-year-old G2P1 at term with an epidural in place for analgesia who is currently at 7 cm cervical dilatation develops a late deceleration in the FHR tracing. Her current heart rate is 108 beats per minute, blood pressure is 80/47 mm Hg, and oxygen saturation is 97%on room air. Which of the following interventions is least likely to be beneficial for correction of fetal distress?", + "A": "IV fluid bolus", + "B": "IV bolus of phenylephrine", + "C": "Terbutaline", + "D": "Maternal repositioning", + "E": "Maternal oxygen supplementation" + }, + "zh": { + "question": "一名健康的24岁G2P1足月产妇，正在使用硬膜外麻醉���行镇痛，目前宫颈扩张7厘米，胎心率监测出现晚期减速。她目前的心率为108次/分钟，血压为80/47 mm Hg，室内空气下的氧饱和度为97%。以下哪项干预措施最不可能有助于纠正胎儿窘迫？", + "A": "静脉输液推注", + "B": "静脉推注去氧肾上腺素", + "C": "特布他林", + "D": "母体体位调整", + "E": "母体氧气补充" + } + }, + { + "id": "d79cadc3-15b6-5f21-b399-e2e22114f5d9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 64-year-old man with a medical history significant for Mobitz type II seconddegree heart block after permanent pacemaker (PPM) placement presents for video-assisted right upper lobe wedge resection for a pulmonary nodule. Which of the following intraoperative issues is unlikely to occur from electromagnetic interference (EMI)?", + "A": "Increase in ventricular thresholds", + "B": "Inhibition of pacemaker by EMI", + "C": "Pacemaker battery failure", + "D": "Transient or permanent loss of capture" + }, + "zh": { + "question": "一名64岁的男性，病史中有永久性心脏起搏器（PPM）植入后的Mobitz II型二度房室传导阻滞，现因肺结节需进行视频辅助右上叶楔形切除术。以下哪项术中问题不太可能由电磁干扰（EMI）引起？", + "A": "心室阈值增加", + "B": "起搏器被EMI抑制", + "C": "起搏器电池故障", + "D": "暂时或永久性失去捕获" + } + }, + { + "id": "78f47e09-9b94-5431-a66c-4bc8ad932266", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following codes correctly describes a pacemaker that utilizes synchronous, dual-chamber pacing and is rate-responsive?", + "A": "DOOR", + "B": "DDDO", + "C": "VVIR", + "D": "DDIR" + }, + "zh": { + "question": "以下哪种代码正确描述了使用同步双腔起搏并具有速率响应功能的起搏器？", + "A": "DOOR", + "B": "DDDO", + "C": "VVIR", + "D": "DDIR" + } + }, + { + "id": "157201a3-b2cf-5534-b129-d25587b7e167", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "8. A 74-year-old man is 3 weeks after pulmonary vein isolation for atrial fibrillation and presents to the emergency department with fever, chills, and dysphagia. He is found to be hypotensive and anemic. Which of the following complications from pulmonary vein isolation commonly presents during this period?", + "A": "Atrial-esophageal fistula (AEF)", + "B": "Complete heart block", + "C": "Cardiac tamponade", + "D": "Phrenic nerve injury" + }, + "zh": { + "question": "8. 一名74岁男性在进行肺静脉隔离术治疗心房颤动3周后，因发热、寒战和吞咽困难来到急诊科。他被发现有低血压和贫血。以下哪种肺静脉隔离术的并发症常在此期间出现？", + "A": "心房-食管瘘（AEF）", + "B": "完全性心脏传导阻滞", + "C": "心脏压塞", + "D": "膈神经损伤" + } + }, + { + "id": "5f162bdd-6680-5783-8131-138d0ca0373e", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "An otherwise healthy 26-year-old woman undergoing laparoscopic myomectomy develops intraoperative narrow-complex tachycardia at a rate of 170 beats per minute, with loss of P wave. Her blood pressure quickly drops to 55/30. Which of the following is the correct next step in treatment?", + "A": "Diltiazem", + "B": "Adenosine", + "C": "Metoprolol", + "D": "Synchronized cardioversion" + }, + "zh": { + "question": "一名26岁健康女性在进行腹腔镜子宫肌瘤切除术时，术中出现窄复合波心动过速，心率为每分钟170次，P波消失。她的血压迅速下降到55/30。以下哪项是正确的下一步治疗措施？", + "A": "地尔硫卓", + "B": "腺苷", + "C": "美托洛尔", + "D": "同步电复律" + } + }, + { + "id": "78d1bb52-b5d9-5c3b-a160-00753dbf29a7", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 58-year-old woman one day after catheter ablation for atrial fibrillation complains of shortness of breath. Vital signs are as follows: 36.8°C | 74 | 134/68 | 26 | 98% on room air. ECG shows restoration of normal sinus rhythm. Chest Xray demonstrates an elevated right hemidiaphragm. Which of the following procedural complications is the most likely source of her dyspnea?", + "A": "Volume overload", + "B": "Phrenic nerve injury", + "C": "Atrial-esophageal fistula", + "D": "Cardiac tamponade" + }, + "zh": { + "question": "一名58岁的女性在进行房颤导管消融术后一天，抱怨呼吸急促。生命体征如下：36.8°C | 74 | 134/68 | 26 | 室内空气中氧饱和度98%。心电图显示恢复正常窦性心律。胸部X光显示右侧膈肌抬高。以下哪种手术并发症最可能是她呼吸困难的原因？", + "A": "容量超负荷", + "B": "膈神经损伤", + "C": "心房-食管瘘", + "D": "心脏压塞" + } + }, + { + "id": "56ba7314-388f-5951-a4cd-08b39afb751d", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "Which of the following patients should undergo additional cardiac testing before proceeding for an intraoperative surgical procedure?", + "A": "A 71-year-old man with known untreated 3-vessel coronary disease presenting for exploratory laparotomy for perforated bowel", + "B": "An 81-year-old woman with chronic kidney disease (creatinine 2.3 mg/dL) and prior ischemic stroke presenting for lumpectomy for breast cancer", + "C": "A 68-year-old man with type 2 diabetes mellitus and prior ischemic strokepresenting for revascularization procedure for peripheral arterial disease, which limits his exercise capacity", + "D": "An otherwise healthy 48-year-old man presenting for median sternotomy for thymoma resection" + }, + "zh": { + "question": "以下哪位患者在进行术中手术程序前应接受额外的心脏检查？", + "A": "71岁男性，已知未治疗的3支冠状动脉疾病，因肠穿孔需进行探查性剖腹手术", + "B": "81岁女性，慢性肾病（肌酐2.3 mg/dL）和既往缺血性中风史，因乳腺癌需进行乳房肿块切除术", + "C": "68岁男性，2型糖尿病和既往缺血性中风史，因外周动脉疾病需进行血管重建手术，影响其运动能力", + "D": "48岁健康男性，因胸腺瘤切除需进行正中胸骨切开术" + } + }, + { + "id": "3b80ebd2-bab9-5660-9031-9a78418f5cd6", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A patient with type 1 diabetes mellitus and chronic kidney disease, stage III (Cr 2.5 mg/dL) presents for a video-assisted right upper lobe wedge resection for pulmonary nodule. Which of the following medications is appropriate to initiate preoperatively?", + "A": "Metoprolol", + "B": "Lisinopril", + "C": "Amlodipine", + "D": "Aspirin" + }, + "zh": { + "question": "一名患有1型糖尿病和慢性肾病III期（肌酐2.5 mg/dL）的患者前来进行视频辅助的右上叶楔形切除术以切除肺结节。以下哪种药物适合在术前开始使用？", + "A": "美托洛尔", + "B": "赖诺普利", + "C": "氨氯地平", + "D": "阿司匹林" + } + }, + { + "id": "1d97bff8-af4f-522e-b418-e0b7010df2f2", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "When used alone, which ECG lead will most likely detect intraoperative myocardial ischemia?", + "A": "aVL", + "B": "II", + "C": "V4", + "D": "V5" + }, + "zh": { + "question": "单独使用时，哪个心电图导联最有可能检测到术中心肌缺血？", + "A": "aVL", + "B": "II", + "C": "V4", + "D": "V5" + } + }, + { + "id": "d316e6c7-fd64-5487-8d7f-f365e7b77a3d", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "14. A 59-year-old man with a suspected bowel perforation is scheduled to undergo exploratory laparotomy. His vitals are as follows: 38.2°C | 122 | 81/43 | 24 | 97% on 3 L nasal cannula. Laboratory analysis is notable for troponin of 0.12 ng/mL, and ECG shows ST depressions in leads V4 -V6 . Which of the following is the most appropriate diagnosis?", + "A": "Unstable angina", + "B": "Non-ST elevation myocardial infarction (MI), type I", + "C": "Non-ST elevation MI, type II", + "D": "ST elevation MI" + }, + "zh": { + "question": "14. 一名59岁男性疑似肠穿孔，计划进行探查性剖腹手术。他的生命体征如下：38.2°C | 122 | 81/43 | 24 | 3升鼻导管吸氧时血氧饱和度97%。实验室分析显示肌钙蛋白为0.12 ng/mL，心电图显示V4-V6导联ST段压低。以下哪项是最合适的诊断？", + "A": "不稳定型心绞痛", + "B": "非ST段抬高型心肌梗死（MI），I型", + "C": "非ST段抬高型心肌梗���，II型", + "D": "ST段抬高型心肌梗死" + } + }, + { + "id": "5f8d574f-60cb-5e25-9171-1909181ce8cc", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 49-year-old man is undergoing retroperitoneal sarcoma resection, which has been complicated by an injury to the inferior vena cava (IVC) and substantial blood loss. You note ST depressions in lead II and send an arterial blood gas revealing the following information:", + "A": "Increasing FiO2", + "B": "Transfusion of 2 units of packed red blood cells", + "C": "Administering rectal aspirin", + "D": "Increasing phenylephrine infusion" + }, + "zh": { + "question": "一名49岁的男性正在接受腹膜后肉瘤切除术，手术过程中发生了下腔静脉（IVC）损伤和大量失血。你注意到II导联的ST段压低，并送去动脉血气分析，结果如下：", + "A": "增加吸入氧浓度（FiO2）", + "B": "输注2个单位的浓缩红细胞", + "C": "给予直肠阿司匹林", + "D": "增加去氧肾上腺素的输注" + } + }, + { + "id": "b4e84e23-7570-5708-a6a7-6012fe9af85f", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following statements is true concerning patients with ventricular assist devices (VADs) presenting for noncardiac surgery?", + "A": "Noninvasive blood pressure cuffs will not function correctly in a patient with a VAD.", + "B": "Anticoagulation should be held for at least 48 hours before proceeding to the operating room (OR).", + "C": "Implantation of a VAD may delay gastric emptying and necessitate a rapid sequence induction.", + "D": "Regional anesthesia should be utilized whenever possible for VAD patients." + }, + "zh": { + "question": "关于接受非心脏手术的心室辅助装置（VAD）患者，下列哪项陈述是正确的？", + "A": "非侵入性血压袖带在VAD患者中无法正常工作。", + "B": "在进入手术室（OR）前，抗凝治疗应至少暂停48小时。", + "C": "VAD的植入可能会延迟胃排空，并需要快速序列诱导。", + "D": "应尽可能对VAD患者使用区域麻醉。" + } + }, + { + "id": "f9f44cc8-2710-572b-b681-b5d11efc657c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements is true with respect to extracorporeal membrane oxygenation (ECMO) as compared with cardiopulmonary bypass (CPB)?", + "A": "Arterial line tracing for both ECMO and CPB will lack pulsatility.", + "B": "The membrane oxygenator in CPB is designed for longer-term use compared with ECMO.", + "C": "The heart is stopped in both ECMO and CPB.", + "D": "Lower flow rates are used in CPB, necessitating a greater degree of anticoagulation." + }, + "zh": { + "question": "与体外循环（CPB）相比，以下关于体外膜氧合（ECMO）的说法哪一项是正确的？", + "A": "ECMO和CPB的动脉线波形都缺乏脉动性。", + "B": "CPB中的膜氧合器设计用于比ECMO更长时间的使用。", + "C": "在ECMO和CPB中，心脏都被停止。", + "D": "CPB使用较低的流速，因此需要更高程度的抗凝。" + } + }, + { + "id": "560d3ed0-d42e-590d-a328-5fd67db5edd0", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following factors places a patient at increased risk of anaphylaxis to protamine during reversal of heparin following CPB?", + "A": "Prior exposure to protamine", + "B": "Diabetes treated with metformin", + "C": "History of atopy (asthma, eczema)", + "D": "Prolonged heparin time" + }, + "zh": { + "question": "以下哪种因素会使患者在体外循环（CPB）后逆转肝素时对鱼精蛋白发生过敏反应的风险增加？", + "A": "之前接触过鱼精蛋白", + "B": "使用二甲双胍治疗的糖尿病", + "C": "有特应性病史（哮喘、湿疹）", + "D": "肝素时间延长" + } + }, + { + "id": "1e5c7646-839c-54af-92c6-292536382b76", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "19. Which of the following is an advantage of traditional, on-pump coronary artery bypass grafting (CABG) as compared with off-pump coronary artery bypass grafting (OPCABG)?", + "A": "Lower intraoperative blood loss", + "B": "Reduced risk of postoperative cognitive dysfunction", + "C": "Higher rates of graft patency", + "D": "Reduced risk of thrombotic events" + }, + "zh": { + "question": "19. 以下哪项是传统体外循环冠状动脉旁路移植术（CABG）相比于非体外循环冠状动脉旁路移植术（OPCABG）的优势？", + "A": "术中失血量较少", + "B": "降低术后认知功能障碍的风险", + "C": "更高的移植通畅率", + "D": "降低血栓事件的风险" + } + }, + { + "id": "e6447c4b-c1c7-5a1d-82ca-97cd1282551f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following correctly describes the appropriate timing of inflation of an intra-aortic balloon pump?", + "A": "Just after the dicrotic notch", + "B": "At the onset of ventricular systole", + "C": "When the P wave is seen on ECG", + "D": "During isovolumetric contraction" + }, + "zh": { + "question": "以下哪项正确描述了主动脉内球囊泵充气的适当时机？", + "A": "在重搏切迹之后", + "B": "在心室收缩开始时", + "C": "在心电图上看到P波时", + "D": "在等容收缩期间" + } + }, + { + "id": "e3934282-4f43-5a00-b816-4b2a8cdc6236", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient with asymptomatic, moderate aortic stenosis (Vmax = 3.7 m/s) is presenting for elective laparoscopic colectomy for newly diagnosed colon cancer. Within what time frame should an echocardiogram have been performed before proceeding with elective surgery?", + "A": "3 months", + "B": "6-12 months", + "C": "1-2 years", + "D": "3-5 years" + }, + "zh": { + "question": "一名患有无症状中度主动脉瓣狭窄（Vmax = 3.7 m/s）的患者因新诊断的结肠癌而准备进行择期腹腔镜结肠切除术。在进行择期手术之前，超声心动图应在什么时间范围内进行？", + "A": "3个月", + "B": "6-12个月", + "C": "1-2年", + "D": "3-5年" + } + }, + { + "id": "1dbc64d7-1531-55e6-b452-a32bbd3cc0b1", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 91-year-old woman presents to the emergency department with acute onset of dyspnea and is found to have a harsh, late-peaking systolic murmur and pulmonary edema on chest X-ray. Transthoracic echocardiography is performed with the following findings:", + "A": "Mild AS", + "B": "Moderate AS", + "C": "Severe high-gradient AS", + "D": "Severe low-flow/low-gradient AS" + }, + "zh": { + "question": "一名91岁的女性因急性呼吸困难到急诊科就诊，发现有粗糙的晚峰收缩期杂音和胸片显示肺水肿。进行了经胸超声心动图检查，结果如下：", + "A": "轻度主动脉瓣狭窄", + "B": "中度主动脉瓣狭窄", + "C": "重度高梯度主动脉瓣狭窄", + "D": "重度低流量/低梯度主动脉瓣狭窄" + } + }, + { + "id": "eeb42aa7-9f0a-58cc-9ef1-909c3124bec9", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Which one of the following patients should receive infective endocarditis (IE) prophylaxis before undergoing his/her associated procedure?", + "A": "A 61-year-old man with a mechanical mitral valve presenting for root canal", + "B": "A 34-year-old woman with a history of repaired tetralogy of Fallot presenting for dental cleaning", + "C": "A 54-year-old woman after aortic valve replacement for bicuspid aortic valvepresenting for elective cystoscopy", + "D": "A 28-year-old man with history of IE because of IV drug use presenting for esophagogastroduodenoscopy" + }, + "zh": { + "question": "以下哪位患者在进行相关手术前应接受感染性心内膜炎（IE）预防？", + "A": "61岁男性，机械二尖瓣，准备进行根管治疗", + "B": "34岁女性，法洛四联症修复史，准备进行牙齿清洁", + "C": "54岁女性，因二叶主动脉瓣进行主动脉瓣置换术后，准备进行择期膀胱镜检查", + "D": "28岁男性，因静脉药物使用史导致IE，准备进行食管胃十二指肠镜检查" + } + }, + { + "id": "a1d33b4e-25ab-5166-91ab-d698077064c8", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "24. A 71-year-old man is presenting for elective aortic valve replacement. His transthoracic echocardiogram (TTE) shows a hypertrophic left ventricle (LV) with preserved function and an aortic valve area = 1.4 cm2 , Vmax = 3.4 m/s, and mean gradient = 37 mm Hg. He is currently asymptomatic and denies angina, syncope, and dyspnea. Which of the following statements is correct regarding his anesthetic management?", + "A": "Phenylephrine infusion will decrease stroke volume because of increased afterload.", + "B": "Atrial fibrillation will be poorly tolerated.", + "C": "Heart rate between 80 and 100 beats per minute is ideal.", + "D": "Dopamine is the inotrope of choice." + }, + "zh": { + "question": "24. 一名71岁的男性正在接受择期主动脉瓣置换术。他的经胸超声心动图（TTE）显示左心室（LV）肥厚，功能保留，主动脉瓣面积=1.4 cm²，最大流速=3.4 m/s，平均梯度=37 mm Hg。目前他无症状，否认心绞痛、晕厥和呼吸困难。关于他的麻醉管理，下列哪项陈述是正确的？", + "A": "去氧肾上腺素输注会因后负荷增加而减少搏出量。", + "B": "心房颤动将难以耐受。", + "C": "心率在每分钟80到100次之间是理想的。", + "D": "多巴胺是首选的正性肌力药。" + } + }, + { + "id": "7ce216a5-450b-50fb-b1c2-4e6578445e60", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 61-year-old man with moderate mitral regurgitation (MR) is presenting for emergent exploratory laparotomy secondary to perforated bowel. Which of the following goals is most critical in the anesthetic management of MR?", + "A": "Target heart rates at the upper limit of normal (80-100 bpm).", + "B": "Increase preload slightly.", + "C": "Maintain sinus rhythm.", + "D": "Reduce SVR." + }, + "zh": { + "question": "一名61岁的男性患有中度二尖瓣返流（MR），因肠穿孔需进行紧急探查性剖腹手术。在MR的麻醉管理中，以下哪个目标最为关键？", + "A": "将心率控制在正常上限（80-100次/分钟）。", + "B": "略微增加前负荷。", + "C": "维持窦性心律。", + "D": "降低SVR。" + } + }, + { + "id": "6b28279d-9d1d-5064-84ac-cebd41de5cd7", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A otherwise healthy 24-year-old man with hypertrophic cardiomyopathy (HCM) is undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. He becomes acutely hypotensive following insufflation of the abdomen and positioning in the reverse Trendelenburg position. His blood pressure is unchanged at 68/43 following a rapid bolus of IV fluids, lightening the anesthetic and leveling the bed. Administration of which of the following drugs is the most appropriate next step in management?", + "A": "Epinephrine 10 µg IV", + "B": "Ephedrine 5 mg IV", + "C": "Norepinephrine 4 µg IV", + "D": "Phenylephrine 100 µg IV" + }, + "zh": { + "question": "一名24岁健康状况良好的男性患有肥厚型心肌病（HCM），因症状性胆石症正在接受腹腔镜胆囊切除术。在腹部充气和反向特伦德伦堡体位后，他出现急性低血压。在快速静脉输液、减轻麻醉和调整床位后，他的血压仍保持在68/43。以下哪种药物的使用是管理的最合适的下一步？", + "A": "肾上腺素 10 µg 静脉注射", + "B": "麻黄碱 5 mg 静脉注射", + "C": "去甲肾上腺素 4 µg 静脉注射", + "D": "苯肾上腺素 100 µg 静脉注射" + } + }, + { + "id": "491ee193-a732-5189-a24f-de27591ee8c4", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following statements is true with regard to anesthetic management of patients with HCM?", + "A": "Patients without outflow obstruction at rest are at low risk for dynamic obstruction with administration of anesthetic agents.", + "B": "Negative inotropic agents may be useful to attenuate sympathetic stimulation perioperatively.", + "C": "Hypovolemia is better tolerated than hypervolemia.", + "D": "Lethal arrhythmias do not occur in hypertrophic obstructive cardiomyopathy patients without signs of inducible obstruction on echocardiography." + }, + "zh": { + "question": "关于肥厚型心肌病患者的麻醉管理，下列哪项陈述是正确的？", + "A": "在静息状态下没有流出道梗阻的患者在使用麻醉药物时发生动态梗阻的风险较低。", + "B": "负性肌力药物可能有助于减轻围手术期的交感神经刺激。", + "C": "低血容量比高血容量更容易耐受。", + "D": "在超声心动图上没有诱发梗阻迹象的肥厚型梗阻性心肌病患者不会发生致命性心律失常。" + } + }, + { + "id": "ffa98143-17c7-51fa-9ad9-70fd65848de0", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 69-year-old woman becomes hypertensive to 207/109 upon emerging from a general anesthetic for laparoscopic hysterectomy. She is subsequently hypoxic and her endotracheal tube has frothy clear secretions. Which of the following is the most likely diagnosis?", + "A": "Volume overload", + "B": "Negative pressure pulmonary edema", + "C": "Flash pulmonary edema", + "D": "Transfusion-associated circulatory overload" + }, + "zh": { + "question": "一名69岁的女性在全身麻醉下进行腹腔镜子宫切除术后苏醒时血压升高至207/109。随后她出现低氧血症，气管插管中有泡沫状清晰分泌物。以下哪项是最可能的诊断？", + "A": "容量超负荷", + "B": "负压性肺水肿", + "C": "闪电性肺水肿", + "D": "输血相关循环超负荷" + } + }, + { + "id": "18d7b990-5550-5a2a-8d4a-4aa877b6f069", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 54-year-old woman who was previously healthy presents with severe malaise and light-headedness 2 weeks after her husband died unexpectedly. Her extremities are cool and clammy, she is found to be profoundly hypotensive, and transthoracic echocardiogram shows global LV hypokinesis with apical ballooning. Which of the following statements is correct about her condition?", + "A": "Postmenopausal women are at highest risk for this condition.", + "B": "ECG changes are uncommon at presentation.", + "C": "This condition is unlikely to resolve over time.", + "D": "Most patients affected by this condition have underlying coronary artery disease." + }, + "zh": { + "question": "一名54岁的女性，之前身体健康，在丈夫意外去世两周后出现严重的疲惫和头晕。她的四肢冰凉湿冷，被发现严重低血压，胸腔超声心动图显示左心室整体运动减弱伴有心尖部膨胀。关于她的病情，下列哪项陈述是正确的？", + "A": "绝经后的女性患此病的风险最高。", + "B": "在发病时，心电图变化不常见。", + "C": "这种情况不太可能随着时间的推移而改善。", + "D": "大多数患有这种疾病的患者都有潜在的冠状动脉疾病。" + } + }, + { + "id": "fde7962a-930b-57ac-96b1-764338e6e667", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "30. A 74-year-old man with diabetes mellitus and poorly controlled hypertension has undergone robotic prostatectomy over a course of 8 hours, during which he received 4 L of Lactated Ringer and 500 cc of 5% albumin. Blood loss was approximately 200 cc, and urine output was 320 cc. His oxygen saturation is 93%-95% despite FiO2 of 100% and positive end-expiratory pressure of 8 cm H2O. On auscultation, bibasilar crackles are present. Which of the following is the best next step in management?", + "A": "Emerge the patient and extubate to noninvasive positive pressure ventilation (PPV) in the OR.", + "B": "Keep the patient intubated and admit to the surgical intensive care unit.", + "C": "Administer a loop diuretic.", + "D": "Initiate therapy with inhaled nitric oxide." + }, + "zh": { + "question": "30. 一名74岁患有糖尿病和高血压控制不佳的男性接受了为期8小时的机器人前列腺切除术，在此期间他接受了4升乳酸林格氏液和500毫升5%白蛋白。失血量约为200毫升，尿量为320毫升。尽管吸入氧浓度为100%且呼气末正压为8 cm H2O，他的氧饱和度为93%-95%。听诊时，双侧基底部可闻及湿啰音。以下哪项是最佳的下一步处理措施？", + "A": "唤醒患者并在手术室内拔管至无创正压通气（PPV）。", + "B": "保持患者插管状态并送入外科重症监护病房。", + "C": "给予袢利尿剂。", + "D": "开始吸入一氧化氮治疗。" + } + }, + { + "id": "d2e1d308-7d3d-5e4d-8799-021db5c4636a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following signs or symptoms is more likely to be a presenting feature when cardiac tamponade develops chronically, rather than acutely?", + "A": "Hypotension", + "B": "Edema", + "C": "Light-headedness", + "D": "Cough" + }, + "zh": { + "question": "以下哪种体征或症状更可能是慢性而非急性心脏压塞发展的表现特征？", + "A": "低血压", + "B": "水肿", + "C": "头晕", + "D": "咳嗽" + } + }, + { + "id": "2b582a3d-ff9e-500a-8eb5-b28ca84c8cd4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following causes of cardiac tamponade is an indication for immediate surgical intervention?", + "A": "Viral pericarditis", + "B": "Metastatic lung cancer", + "C": "Free wall rupture following MI", + "D": "Systemic lupus erythematosus" + }, + "zh": { + "question": "以下哪种心脏压塞的原因需要立即进行手术干预？", + "A": "病毒性心包炎", + "B": "转移性肺癌", + "C": "心肌梗死后的游离壁破裂", + "D": "系统性红斑狼疮" + } + }, + { + "id": "9edb7abf-89c3-5ae0-b8d5-f6c86d2012e9", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following conditions will mask the pulsus paradoxus commonly seen in cardiac tamponade?", + "A": "Positive pressure ventilation", + "B": "Mucous plug", + "C": "Stridor", + "D": "Chronic obstructive pulmonary disease (COPD)" + }, + "zh": { + "question": "下列哪种情况会掩盖心脏压塞中常见的奇脉？", + "A": "正压通气", + "B": "粘液栓", + "C": "喘鸣", + "D": "慢性阻塞性肺疾病 (COPD)" + } + }, + { + "id": "d361dfe0-2565-56f7-a3c6-9db07e4beca4", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 67-year-old man presents with progressive dyspnea on exertion and intermittent positional chest discomfort. His past medical history is significant for coronary artery disease for which he underwent a 3-vessel CABG 2 years ago. Coronary catheterization shows patent grafts. Transthoracic echocardiography demonstrates evidence of increased ventricular interdependence and dissociation of intrathoracic-intracardiac pressures. Which of the following is the most likely cause of this patient's constrictive pericarditis (CP)?", + "A": "Tuberculosis", + "B": "Rheumatologic", + "C": "Postradiation", + "D": "Postcardiac surgical" + }, + "zh": { + "question": "一名67岁男性出现进行性劳力性呼吸困难和间歇性体位性胸部不适。他的病史中有冠状动脉疾病，两年前接受了三支血管的冠状动脉旁路移植术。冠状动脉造影显示移植物通畅。经胸超声心动图显示心室相互依赖性增加和胸腔内-心腔内压力分离的证据。以下哪项是该患者缩窄性心包炎（CP）的最可能原因？", + "A": "结核", + "B": "风湿性", + "C": "放射后", + "D": "心脏手术后" + } + }, + { + "id": "cba61d18-0a02-583f-8ffc-1fb090d9280e", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "The presence of which of the following findings is more consistent with a diagnosis of restrictive cardiomyopathy (RCM) as compared with CP?", + "A": "Expiratory flow reversal in the hepatic vein", + "B": "Respirophasic septal shift", + "C": "Moderate pulmonary hypertension", + "D": "Elevated medial mitral annulus velocity (e,) ≥ 8 cm/s" + }, + "zh": { + "question": "以下哪项发现更符合限制性心肌病（RCM）而非心包炎（CP）的诊断？", + "A": "肝静脉呼气期血流反转", + "B": "呼吸相间隔移位", + "C": "中度肺动脉高压", + "D": "内侧二尖瓣环速度（e,）≥ 8 cm/s" + } + }, + { + "id": "f575a4f4-9039-5720-b3fb-b413557cd49e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "36. Which of the following statements is true of perioperative venous", + "A": "Novel oral anticoagulants are more effective than once-daily enoxaparin in VTE prophylaxis without increased rates of postoperative bleeding.", + "B": "Major trauma increases VTE risk to a greater degree than postpartum status.", + "C": "The VTE prophylactic effects of aspirin and warfarin are synergistic.", + "D": "Neuraxial anesthesia initiated before surgical incision reduces rates of perioperative VTE." + }, + "zh": { + "question": "36. 以下哪项关于围手术期静脉血栓栓塞的说法是正确的？", + "A": "新型口服抗凝药在静脉血栓栓塞预防中比每日一次的依诺肝素更有效，并且不会增加术后出血率。", + "B": "重大创伤比产后状态更能增加静脉血栓栓塞的风险。", + "C": "阿司匹林和华法林的静脉血栓栓塞预防效果具有协同作用。", + "D": "在手���切口前开始的椎管内麻醉可降低围手术期静脉血栓栓塞的发生率。" + } + }, + { + "id": "97054359-6ab8-526b-bc0c-65839ca1417b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 48-year-old man presents for retroperitoneal sarcoma resection. Pharmacologic VTE prophylaxis should be continued postoperatively for what length of time?", + "A": "3 days", + "B": "14 days", + "C": "28 days", + "D": "60 days" + }, + "zh": { + "question": "一名48岁的男性接受后腹膜肉瘤切除术。术后应持续多长时间进行药物VTE预防？", + "A": "3天", + "B": "14天", + "C": "28天", + "D": "60天" + } + }, + { + "id": "ea276da0-28b5-50f3-b24f-c92c55858e8d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following pathophysiologic changes occurs with a pulmonary embolism?", + "A": "Increased dead space", + "B": "Increased shunt", + "C": "Reduced pulmonary vascular resistance", + "D": "Reflex bronchodilation" + }, + "zh": { + "question": "下列哪项病理生理变化发生在肺栓塞中？", + "A": "增加的无效腔", + "B": "增加的分流", + "C": "降低的肺血管阻力", + "D": "反射性支气管扩张" + } + }, + { + "id": "7b0e1ea1-18d4-581b-995e-3ea08520c51a", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following arterial blood gas results, on an FiO2 of 0.4, is most consistent with a diagnosis of acute, submassive pulmonary embolism?", + "A": "| pH 7.39 | PaCO2 44 | PaO2 90 | HCO3 26 |", + "B": "| pH 7.47 | PaCO2 40 | PaO2 74 | HCO3 28 |", + "C": "| pH 7.59 | PaCO2 28 | PaO2 90 | HCO3 26 |", + "D": "| pH 7.50 | PaCO2 32 | PaO2 74 | HCO3 24 |" + }, + "zh": { + "question": "在FiO2为0.4的情况下，以下哪项动脉血气结果最符合急性、亚大块肺栓塞的诊断？", + "A": "| pH 7.39 | PaCO2 44 | PaO2 90 | HCO3 26 |", + "B": "| pH 7.47 | PaCO2 40 | PaO2 74 | HCO3 28 |", + "C": "| pH 7.59 | PaCO2 28 | PaO2 90 | HCO3 26 |", + "D": "| pH 7.50 | PaCO2 32 | PaO2 74 | HCO3 24 |" + } + }, + { + "id": "8d05f78c-6eba-5231-b10c-821f718861ce", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following ECG findings is most sensitive for acute pulmonary embolus?", + "A": "Incomplete right bundle branch block", + "B": "Rightward axis", + "C": "Sinus tachycardia", + "D": "Large S wave in lead I, combined with Q wave and inverted T wave in lead III" + }, + "zh": { + "question": "以下哪项心电图发现对急性肺栓塞最敏感？", + "A": "不完全性右束支传导阻滞", + "B": "右偏轴", + "C": "窦性心动过速", + "D": "I导联大S波，III导联Q波和倒置T波的组合" + } + }, + { + "id": "236acb71-5de5-5419-8b82-68c16984c8de", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 59-year-old woman with a history of hypertension presents for total abdominal hysterectomy for endometrial cancer. She has continued her home amlodipine and metoprolol up until the day of surgery but has held her lisinopril for 2 days. In the preoperative day, she is very anxious and her blood pressure is 179/88. Which of the following is the most appropriate next step?", + "A": "Cancel the case.", + "B": "Administer home lisinopril dose.", + "C": "Proceed with the case and maintain blood pressure within high-normal range.", + "D": "Administer appropriate anxiolysis and reassess." + }, + "zh": { + "question": "一名59岁的女性有高血压病史，因子宫内膜癌需进行全腹子宫切除术。她在手术当天继续服用家中的氨氯地平和美托洛尔，但已经停用赖诺普利2天。在术前一天，她非常焦虑，血压为179/88。以下哪项是最合适的下一步措施？", + "A": "取消手术。", + "B": "给予家中的赖诺普利剂量。", + "C": "继续手术并将血压维持在高正常范围内。", + "D": "给予适当的抗焦虑药物并重新评估。" + } + }, + { + "id": "267ee312-185e-599d-87b0-3870db66530b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "42. Which of the following statements is true with respect to essential hypertension?", + "A": "Systolic dysfunction will precede diastolic dysfunction in the progression.", + "B": "LV eccentric hypertrophy is likely to occur.", + "C": "Essential hypertension accounts for >80% of all hypertension diagnoses.", + "D": "Cerebral autoregulation is unchanged with long-standing essential hypertension." + }, + "zh": { + "question": "42. 关于原发性高血压，下列哪项陈述是正确的？", + "A": "在进展过程中，收缩功能障碍将先于舒张功能障碍出现。", + "B": "可能发生左心室偏心性肥大。", + "C": "原发性高血压占所有高血压诊断的80%以上。", + "D": "长期原发性高血压患者的脑自动调节不变。" + } + }, + { + "id": "7f9598b0-ffb9-5a36-916c-025aca7ead3f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following antihypertensives should be held for 12-24 hours preoperatively?", + "A": "Captopril", + "B": "Labetalol", + "C": "Amlodipine", + "D": "Clonidine" + }, + "zh": { + "question": "以下哪种降压药应在术前12-24小时停用？", + "A": "卡托普利", + "B": "拉贝洛尔", + "C": "氨氯地平", + "D": "可乐定" + } + }, + { + "id": "c7516c0a-2568-54ec-a17c-944974bedb1a", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "In which of the following scenarios should a β-blocker be initiated preoperatively?", + "A": "A 60-year-old woman presenting for bilateral mastectomy with poorly controlled hypertension on lisinopril, amlodipine, and hydrochlorothiazide", + "B": "A 48-year-old man with 100-pack-year smoking history presenting for thoracoscopic lobectomy", + "C": "A 74-year-old man with coronary artery disease presenting for endovascular aortic aneurysm repair (EVAR)", + "D": "A 65-year-old woman with hypertension and hyperlipidemia presenting for laparoscopic cholecystectomy for acute cholecystitis" + }, + "zh": { + "question": "在以下哪种情况下应在术前开始使用β受体阻滞剂？", + "A": "一名60岁女性，准备进行双侧乳房切除术，服用赖诺普利、氨氯地平和氢氯噻嗪，但高血压控制不佳", + "B": "一名48岁男性，有100包年吸烟史，准备进行胸腔镜肺叶切除术", + "C": "一名74岁男性，有冠状动脉疾病，准备进行血管内主动脉瘤修复术（EVAR）", + "D": "一名65岁女性，有高血压和高脂血症，准备进行腹腔镜胆囊切除术以治疗急性胆囊炎" + } + }, + { + "id": "6251ac42-e118-52a1-8ece-8783767f8752", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Administration of which of the following drugs is most likely to resolve intraoperative hypotension refractory to phenylephrine in a patient who took lisinopril the morning of surgery?", + "A": "Ephedrine", + "B": "Methylene blue", + "C": "Norepinephrine", + "D": "Vasopressin" + }, + "zh": { + "question": "在手术当天早上服用赖诺普利的患者中，以下哪种药物的使用最有可能解决对苯肾上腺素无反应的术中低血压？", + "A": "麻黄碱", + "B": "亚甲蓝", + "C": "去甲肾上腺素", + "D": "加压素" + } + }, + { + "id": "40fd069a-c716-5de3-9843-9bfe04d694ac", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following monitoring modalities is the gold standard with which to assess cerebral ischemia during carotid cross-clamp for carotid endarterectomy (CEA) under general anesthesia?", + "A": "Somatosensory evoked potentials (SSEPs)", + "B": "Electroencephalography (EEG)", + "C": "Transcranial Dopplers (TCDs)", + "D": "Near-infrared spectroscopy" + }, + "zh": { + "question": "在全身麻醉下进行颈动脉内膜切除术（CEA）时，以下哪种监测方式是评估颈动脉夹闭期间脑缺血的金标准？", + "A": "体感诱发电位（SSEPs）", + "B": "脑电图（EEG）", + "C": "经颅多普勒（TCDs）", + "D": "近红外光谱" + } + }, + { + "id": "cba4bc9e-9d22-5b0e-8829-043ecb4e6a5a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is a class I recommendation for spinal cord protection during open and endovascular thoracic aortic aneurysm repair for patients at high risk of spinal cord ischemia?", + "A": "Cerebrospinal fluid drainage", + "B": "Systemic hypothermia", + "C": "Hyperventilation", + "D": "Hyperosmotic agents" + }, + "zh": { + "question": "以下哪项是对高风险脊髓缺血患者在开放和血管内胸主动脉瘤修复期间进行脊髓保护的I类推荐？", + "A": "脑脊液引流", + "B": "全身低温", + "C": "过度通气", + "D": "高渗透剂" + } + }, + { + "id": "495fae7a-db09-533e-aefb-92b9741a21e7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is true regarding the physiologic changes that ensue following release of the aortic cross-clamp during aortic surgery?", + "A": "Cardiac output increases.", + "B": "Venous return increases.", + "C": "Mixed venous oxygen saturation rapidly falls.", + "D": "PaCO2 abruptly falls." + }, + "zh": { + "question": "以下哪项关于主动脉手术中解除主动脉阻断后的生理变化是正确的？", + "A": "心输出量增加。", + "B": "静脉回流增加。", + "C": "混合静脉氧饱和度迅速下降。", + "D": "动脉二氧化碳分压突然下降。" + } + }, + { + "id": "c6ba1455-9287-5466-a759-8c66f137d796", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "49. Which of the following statements is true with respect to EVAR compared with open abdominal aortic aneurysm repair?", + "A": "Lower rate of operative survival with EVAR", + "B": "Increased hemodynamic shifts with EVAR", + "C": "Worsened intraoperative acid-base status with EVAR", + "D": "Higher rate of secondary interventions with EVAR at 6 years" + }, + "zh": { + "question": "49. 关于EVAR与开放性腹主动脉瘤修复术相比，下列哪项陈述是正确的？", + "A": "EVAR的手术生存率较低", + "B": "EVAR导致血流动力学变化增加", + "C": "EVAR导致术中酸碱状态恶化", + "D": "EVAR在6年内需要进行更多的二次干预" + } + }, + { + "id": "db51f659-2809-5e76-af93-cc5a0db40dbe", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 69-year-old man with type 2 diabetes mellitus, coronary artery disease after drug-eluting stent (28 months ago), COPD, and atrial fibrillation presents for lower limb revascularization for claudication. Which of the following is true with respect to timing of epidural placement as the primary anesthetic?", + "A": "Clopidogrel should be held for 5 days before epidural placement.", + "B": "The case should be canceled if the epidural placement is bloody.", + "C": "It is unnecessary to check platelet count before epidural removal.", + "D": "Systemic heparin may be administered 1 hour after epidural placement." + }, + "zh": { + "question": "一名69岁患有2型糖尿病、药物洗脱支架术后冠状动脉疾病（28个月前）、慢性阻塞性肺病和心房颤动的男性因跛行接受下肢血管重建术。关于硬膜外麻醉作为主要麻醉方式的时机，下列哪项是正确的？", + "A": "氯吡格雷应在硬膜外麻醉前停用5天。", + "B": "如果硬膜外麻醉穿刺出血，应取消手术。", + "C": "在移除硬膜外导管前无需检查血小板计数。", + "D": "硬膜外麻醉后1小时可以给予全身肝素。" + } + }, + { + "id": "0c114dca-492a-5a1f-a2c7-771c57af373b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "To decrease the risk of postoperative pulmonary complications associated with smoking, when should the patient stop smoking?", + "A": "48 hours", + "B": "1-2 weeks", + "C": "2-4 weeks", + "D": "4-6 weeks" + }, + "zh": { + "question": "为了减少与吸烟相关的术后肺部并发症风险，患者应在何时停止吸烟？", + "A": "48小时", + "B": "1-2周", + "C": "2-4周", + "D": "4-6周" + } + }, + { + "id": "87b802a3-5735-5d62-a891-36152fb76adf", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which one of the following is a risk for acute lung injury (ALI) postoperatively?", + "A": "Active ethanol abuse", + "B": "History of myocardial infarction", + "C": "History of peripheral vascular disease", + "D": "History of stroke" + }, + "zh": { + "question": "以下哪一项是术后急性肺损伤（ALI）的风���因素？", + "A": "活跃的乙醇滥用", + "B": "心肌梗死病史", + "C": "外周血管疾病病史", + "D": "中风病史" + } + }, + { + "id": "23b87228-ea5b-552c-a781-456bf501bf52", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 67-year-old woman presents for right lower lobe lobectomy. Which of the following results obtained via spirometry testing would place her at an increased risk for postoperative complications?", + "A": "Forced expiratory volume in 1 second (FEV1) of 1300 mL", + "B": "Predicted postoperative FEV1 70% of normal", + "C": "Maximum voluntary ventilation of 62% or predicted value", + "D": "Reserve volume (RV)/total lung capacity (TLC) of 57%" + }, + "zh": { + "question": "一名67岁的女性准备进行右下叶肺叶切除术。以下哪项通过肺活量测定获得的结果会使她术后并发症的风险增加？", + "A": "1秒用力呼气量（FEV1）为1300毫升", + "B": "预计术后FEV1为正常值的70%", + "C": "最大自主通气量为预测值的62%", + "D": "储备容量（RV）/总肺容量（TLC）为57%" + } + }, + { + "id": "c2916556-c89f-544c-9d62-0b0cdb9d995a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following symptoms is most consistent with theophylline toxicity?", + "A": "Tinnitus", + "B": "Itching", + "C": "Tachyarrhythmia", + "D": "Heart block" + }, + "zh": { + "question": "以下哪种症状最符合茶碱中毒？", + "A": "耳鸣", + "B": "瘙痒", + "C": "心动过速性心律失常", + "D": "心脏传导阻滞" + } + }, + { + "id": "118c591c-57c6-5fef-b330-ecfa0a12e21b", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following patients would have a low probability of developing postoperative respiratory complications?", + "A": "A 56-year-old man whose oxygen saturation drops 6% during exercise", + "B": "A 58-year-old woman who has a 6-minute walk distance of 610 m", + "C": "A 54-year-old woman who can climb 2 flights of stairs", + "D": "A 55-year-old man with a VO2 max of 12 mL/kg/min" + }, + "zh": { + "question": "以下哪位患者术后发生呼吸并发症的概率较低？", + "A": "一位56岁男性，运动时血氧饱和度下降6%", + "B": "一位58岁女性，6分钟步行距离为610米", + "C": "一位54岁女性，可以爬2层楼梯", + "D": "一位55岁男性，最大摄氧量为12 mL/kg/min" + } + }, + { + "id": "c7990cec-91ec-5739-81e9-aa08040a63ea", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "6. Which of the following is a predictor of desaturation during one-lung ventilation (OLV)?", + "A": "Left-sided thoracotomy", + "B": "Lateral position during surgery", + "C": "Normal preoperative spirometry", + "D": "Balanced perfusion on ventilation/perfusion (V/Q) imaging" + }, + "zh": { + "question": "6. 以下哪项是单肺通气（OLV）期间脱饱和的预测因素？", + "A": "左侧开胸术", + "B": "手术期间的侧卧位", + "C": "术前肺功能检查正常", + "D": "通气/灌注（V/Q）成像的灌注平衡" + } + }, + { + "id": "94a06bae-210f-5383-ab03-87280f04e989", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which patient is most likely to desaturate during OLV?", + "A": "A 68-year-old woman with a history of moderate chronic obstructive pulmonary disease (COPD) with a PaO2 : 481 mm Hg on 100% O2 before OLV", + "B": "A 72-year-old man undergoing thoracotomy for left lower lobe adenocarcinoma", + "C": "A 59-year-old man undergoing video-assisted thoracoscopic (VAT) resection of left upper lobe adenocarcinoma", + "D": "A 61-year-old man with a PaO2 of 187 mm Hg on 100% O2 before OLV" + }, + "zh": { + "question": "哪位患者在单肺通气期间最有可能出现血氧饱和度下降？", + "A": "一名68岁女性，既往有中度慢性阻塞性肺病（COPD）病史，单肺通气前在100%氧气下PaO2为481 mm Hg", + "B": "一名72岁男性，因左下叶腺癌接受开胸手术", + "C": "一名59岁男性，接受左上叶腺癌的胸腔镜辅助下切除术", + "D": "一名61岁男性，单肺通气前在100%氧气下PaO2为187 mm Hg" + } + }, + { + "id": "210800c0-cadd-502b-884b-424c3a93a866", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "For which of the following surgical procedures is a right-sided double-lumen tube (DLT) most likely indicated?", + "A": "Left lower lobectomy", + "B": "Bilateral lung transplantation", + "C": "Open thoracic aortic aneurysm repair", + "D": "Left sleeve resection with involvement of left mainstem" + }, + "zh": { + "question": "以下哪种手术最有可能需要使用右侧双腔管（DLT）？", + "A": "左下肺叶切除术", + "B": "双侧肺移植", + "C": "开放性胸主动脉瘤修复术", + "D": "涉及左主支气管的左袖状切除术" + } + }, + { + "id": "df03dfc7-23af-5eb5-86fb-25e9c93e2cca", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "During a routine right thoracotomy for tumor resection with peak airway pressures in the mid 40s cm H2O during OLV, the patient suddenly becomes hypotensive and hypoxic. End-tidal carbon dioxide drops precipitously. Which of the following is the next best step in management?", + "A": "Bronchoscopy", + "B": "Needle decompression of dependent lung", + "C": "Resumption of two-lung ventilation", + "D": "Application of continuous positive airway pressure (CPAP) to operative lung" + }, + "zh": { + "question": "在进行常规右侧开胸手术以切除肿瘤时，单肺通气期间气道峰压达到40多厘米水柱，患者突然出现低血压和低氧血症。呼气末二氧化碳急剧下降。以下哪项是管理的下一步最佳措施？", + "A": "支气管镜检查", + "B": "依赖肺的针刺减压", + "C": "恢复双肺通气", + "D": "对手术肺应用持续气道正压通气（CPAP）" + } + }, + { + "id": "829b4991-0e59-5917-b0ec-326e26cd62c6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is an absolute indication for OLV with a DLT as opposed to a bronchial blocker?", + "A": "Need for independent lung ventilation in a patient with severe unilateral rib fractures", + "B": "Wedge resection", + "C": "Pneumonectomy", + "D": "Lobectomy" + }, + "zh": { + "question": "以下哪项是使用双腔气管导管（DLT）进行单肺通气（OLV）而不是支气管阻塞器的绝对指征？", + "A": "需要对严重单侧肋骨骨折的患者进行独立的肺通气", + "B": "楔形切除术", + "C": "全肺切除术", + "D": "肺叶切除术" + } + }, + { + "id": "96e41ed8-720e-557f-b29f-2b575fb42758", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "During VAT wedge resection for a right lower lobe tumor with a bronchial blocker, the patient develops increased peak airway pressures, hypoxia, and a decreased end-tidal carbon dioxide. The surgeon reports good lung isolation in the field. Which of the following is the appropriate next step?", + "A": "Fiberoptic evaluation of the bronchial blocker", + "B": "Deflation of the bronchial blocker and ventilation of both lungs", + "C": "Needle decompression of dependent lung", + "D": "Application of CPAP to operative lung" + }, + "zh": { + "question": "在使用支气管封堵器进行右下叶肿瘤的胸腔镜楔形切除术期间，患者出现气道峰压升高、低氧血症和呼气末二氧化碳减少。外科医生报告术野中肺隔离良好。以下哪项是适当的下一步措施？", + "A": "纤维支气管镜检查支气管封堵器", + "B": "放气支气管封堵器并通气双肺", + "C": "对依赖肺进行针刺减压", + "D": "对手术肺应用持续气道正压通气" + } + }, + { + "id": "df67ec43-0358-5211-a5ce-216949df68f8", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "During right middle lobe resection for adenocarcinoma, you notice that your patient appears to be developing a mild acidosis on arterial blood gas. pH is 7.22, lactic acid is mildly elevated, hemoglobin is 10.1, urine output has been 0.5 mL/kg/h for the past 3 hours, and estimated blood loss is 150 mL. Which of the following is the best next step?", + "A": "Start low-dose inotropes.", + "B": "Give a fluid bolus of 10 mL/kg.", + "C": "Transfuse 1 unit of packed red blood cells.", + "D": "Increase minute ventilation to correct the acidosis." + }, + "zh": { + "question": "在进行右中叶腺癌切除术时，���注意到患者在动脉血气中出现轻度酸中毒。pH值为7.22，乳酸轻度升高，血红蛋白为10.1，尿量在过去3小时内为0.5 mL/kg/h，估计失血量为150 mL。以下哪项是最佳的下一步措施？", + "A": "开始低剂量正性肌力药物。", + "B": "给予10 mL/kg的液体推注。", + "C": "输注1单位的浓缩红细胞。", + "D": "增加分钟通气量以纠正酸中毒。" + } + }, + { + "id": "765b236b-470c-5e3d-ae7b-a5190f95e9e9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "13. Which level of oxygen saturation (SpO2 ) is acceptable for a patient undergoing OLV?", + "A": "92%", + "B": "90%", + "C": "80%", + "D": "76%" + }, + "zh": { + "question": "13. 对于正在进行单肺通气（OLV）的患者，哪一水平的血氧饱和度（SpO2）是可以接受的？", + "A": "92%", + "B": "90%", + "C": "80%", + "D": "76%" + } + }, + { + "id": "52fd4edd-a4d6-5d0f-8982-5b6fc8d29957", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which gas mixture is associated with the highest incidence of postthoracotomy atelectasis?", + "A": "98% O2 /2% sevoflurane", + "B": "60% O2 /33% air/7% desflurane", + "C": "50% O2 /49% air/2% isoflurane", + "D": "28% O2 /70% nitrous oxide/2% sevoflurane" + }, + "zh": { + "question": "哪种气体混合物与术后肺不张的发生率最高相关？", + "A": "98% O2 /2% 七氟醚", + "B": "60% O2 /33% 空气/7% 地氟醚", + "C": "50% O2 /49% 空气/2% 异氟醚", + "D": "28% O2 /70% 一氧化二氮/2% 七氟醚" + } + }, + { + "id": "82b71eec-a413-58eb-bbbf-62951dbb689c", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A patient who has a history of bleomycin chemotherapy for testicular cancer is undergoing a left VAT surgery for metastasis. The patient begins to desaturate to 88% with stable hemodynamics. Which of the following is the most appropriate next step?", + "A": "Attempt recruitment maneuver of dependent lung.", + "B": "Resume two-lung ventilation.", + "C": "Increase the fraction of inspired oxygen.", + "D": "Increase positive end-expiratory pressure (PEEP) of the dependent lung." + }, + "zh": { + "question": "一名有睾丸癌博来霉素化疗史的患者正在接受左侧VAT手术以治疗转移。患者开始脱饱和至88%，血流动力学稳定。以下哪项是最合适的下一步措施？", + "A": "尝试对依赖肺进行复张操作。", + "B": "恢复双肺通气。", + "C": "增加吸入氧浓度。", + "D": "增加依赖肺的呼气末正压（PEEP）。" + } + }, + { + "id": "30b57887-6b73-5b0f-9189-2f5be4eb510e", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient is undergoing surgery for correction of a bronchopleural fistula. A DLT has been placed without difficulty. During the procedure, the patient's oxygen saturation decreases to 85%. Which of the following is the most appropriate next step?", + "A": "Apply CPAP to the operative lung.", + "B": "Increase the fraction of inspired oxygen.", + "C": "Fiberoptic confirmation of DLT placement.", + "D": "Resume two-lung ventilation." + }, + "zh": { + "question": "一名患者正在接受手术以矫正支气管胸膜瘘。双腔气管导管已顺利置入。在手术过程中，患者的氧饱和度下降到85%。以下哪项是最合适的下一步措施？", + "A": "对手术侧肺应用持续气道正压通气（CPAP）。", + "B": "增加吸入氧浓度。", + "C": "纤维支气管镜确认双腔气管导管的位置。", + "D": "恢复双肺通气。" + } + }, + { + "id": "6e24a393-a581-5f6b-abb9-89f0804191c3", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A patient is scheduled to undergo a bilateral thoracoscopic MAZE procedure for chronic atrial fibrillation. The procedure is to be performed in the supine position. Which of the following interventions will reduce the likelihood of desaturation during OLV?", + "A": "Operating on the right side first", + "B": "Use of a total intravenous anesthetic", + "C": "Use of a right-sided DLT", + "D": "Use of a tidal volume of 10 mL/kg to maintain lung inflation" + }, + "zh": { + "question": "一名患者计划接受双侧胸腔镜MAZE手术以治疗��性心房颤动。手术将在仰卧位进行。以下哪项干预措施可以降低单肺通气期间脱饱和的可能性？", + "A": "先在右侧进行手术", + "B": "使用全静脉麻醉", + "C": "使用右侧双腔管", + "D": "使用10 mL/kg的潮气量以维持肺部充气" + } + }, + { + "id": "eb9959f2-c09a-5af5-9a66-1aeae3982a04", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient has persistent pain in the posterior and lateral aspects of the shoulder 10 days following thoracotomy. Which of the following positioning errors that can occur during the surgery is the most likely mechanism for this patient's pain?", + "A": "Inadequate padding of the dependent chest wall", + "B": "Lateral flexion of the cervical spine", + "C": "Placement of the axillary roll in the axilla", + "D": "Oversupination of the suspended arm" + }, + "zh": { + "question": "患者在开胸术后10天出现肩部后侧和外侧持续疼痛。以下哪种手术中可能发生的体位错误最有可能是导致该患者疼痛的机制？", + "A": "对依赖侧胸壁的衬垫不足", + "B": "颈椎的侧屈", + "C": "将腋下卷放置在腋窝中", + "D": "悬挂手臂的过度旋前" + } + }, + { + "id": "5e36b5ff-0da0-528b-9a6b-716965088d98", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "In which of the following patients would the administration of PEEP be expected to improve oxygenation during OLV?", + "A": "A 68-year-old man with severe emphysema on tiotropium undergoing lobectomy", + "B": "A 34-year-old man with α1 antitrypsin deficiency undergoing wedge resection", + "C": "A 51-year-old woman with moderate COPD on pulmonary function tests (PFTs) undergoing pleurectomy for mesothelioma", + "D": "A 42-year-old woman with interstitial lung disease undergoing VAT wedge resection" + }, + "zh": { + "question": "在以下哪位患者中，预计在单肺通气期间给予PEEP会改善氧合？", + "A": "68岁男性，患有严重肺气肿，正在使用噻托溴铵，接受肺叶切除术", + "B": "34岁男性，患有α1抗胰蛋白酶缺乏症，正在接受楔形切除术", + "C": "51岁女性，肺功能测试（PFTs）显示中度慢性阻塞性肺病（COPD），正在接受胸膜切除术以治疗间皮瘤", + "D": "42岁女性，患有间质性肺病，正在接受胸腔镜楔形切除术" + } + }, + { + "id": "af48a34a-61c6-5b47-8b45-7a35a7404c8d", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "20. A 70-kg, 1.8-m tall man is scheduled for open thoracotomy/sleeve resection for adenocarcinoma of the lung. Preoperative PFTs are within normal limits, and the patient denies any smoking history. A right-sided DLT is placed uneventfully after induction of anesthesia. Which of the following ventilation strategies is most appropriate?", + "A": "Volume control with a tidal volume of 700 mL, respiratory rate of 10, PEEP of 0", + "B": "Volume control with a tidal volume of 800 mL, respiratory rate of 8, PEEP of 5", + "C": "Volume control with a tidal volume of 450 mL, respiratory rate of 14, PEEP of 5", + "D": "Volume control with a tidal volume of 750 mL, respiratory rate of 12, PEEP of 8" + }, + "zh": { + "question": "20. 一名70公斤、1.8米高的男性计划进行肺腺癌的开胸手术/袖状切除术。术前肺功能检查在正常范围内，患者否认有吸烟史。麻醉诱导后顺利放置了右侧双腔管。以下哪种通气策略最为合适？", + "A": "容量控制，潮气量700毫升，呼吸频率10，PEEP为0", + "B": "容量控制，潮气量800毫升，呼吸频率8，PEEP为5", + "C": "容量控制，潮气量450毫升，呼吸频率14，PEEP为5", + "D": "容量控制，潮气量750毫升，呼吸频率12，PEEP为8" + } + }, + { + "id": "71b5191a-272d-529c-9ea9-66ef050aa02e", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 61-year-old man with a history of COPD, 40-pack-year smoking history, and hypertension is undergoing right lower lobe resection for primary lung cancer. While under OLV, he is ventilated with the following settings: assist control/pressure control inspiratory pressure: 20 cm H2O, PEEP: 5 cm H2O, inspiratory time: 0.8 seconds, and inspired oxygen: 70%. During the return to two-lung ventilation, which of the following parameters needs to be monitored very closely for sudden changes?", + "A": "Peak airway pressure", + "B": "Systolic blood pressure variability", + "C": "Tidal volume", + "D": "Heart rate" + }, + "zh": { + "question": "一名61岁男性，有COPD病史，40包年吸烟史和高血压，正在接受右下叶切除术以治疗原发性肺癌。在单肺通气期间，他的通气设置如下：辅助控制/压力控制吸气压：20 cm H2O，PEEP：5 cm H2O，吸气时间：0.8秒，吸入氧气：70%。在恢复双肺通气期间，以下哪个参数需要非常密切地监测以防突然变化？", + "A": "气道峰压", + "B": "收缩压变异性", + "C": "潮气量", + "D": "心率" + } + }, + { + "id": "b675d482-1f7f-55c5-b339-37357c49c04b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 47-year-old woman who is status post bilateral lung transplant is undergoing laparoscopic cholecystectomy. Which of the following is the benefit of pressure control ventilation in this patient?", + "A": "Reduced risk of lung injury from high airway pressures", + "B": "Better oxygenation", + "C": "Decreased risk of pulmonary edema", + "D": "Decreased risk of rejection" + }, + "zh": { + "question": "一名47岁的女性在双肺移植术后正在接受腹腔镜胆囊切除术。对于该患者，压力控制通气的好处是什么？", + "A": "降低因高气道压力导致肺损伤的风险", + "B": "更好的氧合", + "C": "降低肺水肿的风险", + "D": "降低排斥反应的风险" + } + }, + { + "id": "689454a4-ccc2-588c-9514-d0f36df9e2bd", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "For which of the following patients might pressure control ventilation be a", + "A": "A 67-year-old man having VAT bullae resection", + "B": "A 38-year-old man having VAT sympathectomy for hyperhidrosis", + "C": "A 71-year-old woman with coronary artery disease having thoracotomy for empyema decortication", + "D": "A 51-year-old woman undergoing thoracotomy for right lower lobe resection for adenocarcinoma" + }, + "zh": { + "question": "以下哪位患者可能适合使用压力控制通气？", + "A": "67岁男性，进行VAT肺大疱切除术", + "B": "38岁男性，进行VAT交感神经切除术以治疗多汗症", + "C": "71岁女性，患有冠状动脉疾病，进行胸廓切开术以清除脓胸", + "D": "51岁女性，进行胸廓切开术以切除腺癌的右下叶" + } + }, + { + "id": "9eb9e4c4-5dc2-5c2b-a6de-acd525457c4c", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 67-year-old woman with normal PFT (ideal body weight of 60 kg) is scheduled to undergo VAT lobectomy for adenocarcinoma. Which of the following ventilator settings is most optimal for lung ventilation in this patient?", + "A": "Tidal volume: 600 mL, PEEP: 0 cm H2O, respiratory rate: 13 breaths per minute, FiO2 : 0.8", + "B": "Tidal volume: 350 mL, PEEP: 0 cm H2O, respiratory rate: 12 breaths per minute, FiO2 : 0.8", + "C": "Tidal volume: 350 mL, PEEP: 5 cm H2O, respiratory rate: 14 breaths per minute, FiO2 : 0.8", + "D": "Tidal volume: 600 mL, PEEP: 5 cm H2O, respiratory rate: 11 breaths per minute, FiO2 : 0.8" + }, + "zh": { + "question": "一名67岁的女性，肺功能正常（理想体重为60公斤），计划进行腺癌的胸腔镜辅助肺叶切除术。以下哪种呼吸机设置最适合该患者的肺通气？", + "A": "潮气量：600 mL，PEEP：0 cm H2O，呼吸频率：13次/分钟，FiO2：0.8", + "B": "潮气量：350 mL，PEEP：0 cm H2O，呼吸频率：12次/分钟，FiO2：0.8", + "C": "潮气量：350 mL，PEEP：5 cm H2O，呼吸频率：14次/分钟，FiO2：0.8", + "D": "潮气量：600 mL，PEEP：5 cm H2O，呼吸频率：11次/分钟，FiO2：0.8" + } + }, + { + "id": "5be785f1-9571-5a46-82e4-9042a01a9817", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 28-year-old, 60-kg man with no significant medical history is undergoing VAT pleurodesis for spontaneous pneumothorax. While transitioning to OLV with a DLT, the peak airway pressure is noted to be 41 cm H2O. Current ventilator settings are as follows: tidal volume: 600 mL, PEEP: 5 cm H2O, respiratory rate: 14, FiO2 : 0.8. Bronchoscopy confirms proper tube position. Which of the following is the next most appropriate step?", + "A": "Decrease the PEEP from 5 cm H2O to 0 cm H2O.", + "B": "Increase the fraction of inspired oxygen to 100%.", + "C": "Decrease tidal volume.", + "D": "Increase the respiratory rate." + }, + "zh": { + "question": "一名28岁、60公斤的男性，无显著病史，正在接受VAT胸膜固定术以治疗自发性气胸。在使用双腔管过渡到单肺通气时，观察到峰值气道压为41 cm H2O。目前的呼吸机设置如下：潮气量：600 mL，PEEP：5 cm H2O，呼吸频率：14，FiO2：0.8。支气管镜检查确认管道位置正确。以下哪一项是下一个最合适的步骤？", + "A": "将PEEP从5 cm H2O减少到0 cm H2O。", + "B": "将吸入氧浓度增加到100%。", + "C": "减少潮气量。", + "D": "增加呼吸频率。" + } + }, + { + "id": "c3bc7b10-3906-5d03-a49d-a5f3b4399a34", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "26. A 47-year-old woman is undergoing rigid bronchoscopy with jet ventilation. Which of the following most likely represents the best anesthetic choice?", + "A": "Inhaled anesthetic with sevoflurane.", + "B": "Intravenous anesthetic using only propofol.", + "C": "Intravenous anesthetic using propofol and remifentanil.", + "D": "Inhaled anesthetic with desflurane." + }, + "zh": { + "question": "26. 一名47岁的女性正在接受使用喷射通气的硬质支气管镜检查。以下哪种最有可能代表最佳的麻醉选择？", + "A": "使用七氟醚的吸入麻醉。", + "B": "仅使用丙泊酚的静脉麻醉。", + "C": "使用丙泊酚和瑞芬太尼的静脉麻醉。", + "D": "使用地氟醚的吸入麻醉。" + } + }, + { + "id": "a533d626-6bab-5809-8e66-ae4365083c53", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 26-year-old man with no known medical history is status post an uneventful", + "A": "Administration of an albuterol nebulizer", + "B": "Chest X-ray", + "C": "Electrocardiogram and cardiac enzymes", + "D": "Transthoracic echocardiogram" + }, + "zh": { + "question": "一名26岁无已知病史的男性在术后状态良好", + "A": "给予沙丁胺醇雾化吸入", + "B": "胸部X光检查", + "C": "心电图和心脏酶检查", + "D": "经胸超声心动图" + } + }, + { + "id": "e799f24e-e1d5-5ffa-9ddd-07026c187501", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "High-frequency jet ventilation provides which of the following benefits when compared with traditional mechanical ventilation?", + "A": "Decreased risk of pneumothorax", + "B": "Faster onset of inhaled anesthetic", + "C": "Decreased diaphragmatic movement", + "D": "Improved postoperative pain scores" + }, + "zh": { + "question": "与传统机械通气相比，高频喷射通气提供了以下哪些好处？", + "A": "降低气胸风险", + "B": "吸入麻醉药物起效更快", + "C": "减少膈肌运动", + "D": "改善术后疼痛评分" + } + }, + { + "id": "90512188-7dbe-5581-989e-e867ca000a51", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is the most efficient way to reduce the incidence of airway fires?", + "A": "Handheld jet ventilation", + "B": "Lowest inspired oxygen level tolerated by the patient", + "C": "Use of a total intravenous anesthetic", + "D": "Preoperative administration of bronchodilators" + }, + "zh": { + "question": "以下哪种方法最有效减少气道火灾的发生率？", + "A": "手持喷射通气", + "B": "患者可耐受的最低吸入氧浓度", + "C": "使用全静脉麻醉", + "D": "术前给予支气管扩张剂" + } + }, + { + "id": "99fbdb25-bc1d-5882-9640-84c7f5f9eb71", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is a drawback when utilizing jet ventilation?", + "A": "Inability to monitor oxygenation", + "B": "Difficulty in monitoring adequacy of ventilation", + "C": "Poor surgical access to the airway because of extra equipment", + "D": "Increased risk of airway fires during laser procedures" + }, + "zh": { + "question": "以下哪项是使用喷射通气时的缺点？", + "A": "无法监测氧合", + "B": "难以监测通气的充分性", + "C": "由于额外设备导致手术通道不佳", + "D": "激光手术中增加气道火灾的风险" + } + }, + { + "id": "076d8674-35b5-5289-b090-58cd32eb0860", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A patient is scheduled to undergo right upper lobectomy. What is the predicted postoperative forced expired volume in 1 second (FEV1)? Preoperative FEV1 is 80%of predicted.", + "A": "69%", + "B": "64%", + "C": "59%", + "D": "72%" + }, + "zh": { + "question": "一名患者计划进行右上肺叶切除术。术后预计1秒钟用力呼气量（FEV1）是多少？术前FEV1为预测值的80%。", + "A": "69%", + "B": "64%", + "C": "59%", + "D": "72%" + } + }, + { + "id": "508376b4-20b3-5c66-82e9-e8bf9e57a003", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "During a double-lung transplant a patient has a saturation of 85% during OLV despite aggressive pulmonary toilet, 100% oxygen, and optimal recruitment maneuvers. Transesophageal echocardiography shows worsening right ventricular function, and pulmonary artery catheterization demonstrates", + "A": "CPAP to the operative lung", + "B": "Initiation of inotropes", + "C": "Immediate initiation of cardiopulmonary bypass or extracorporeal membrane oxygenation", + "D": "Diuresis to improve fluid status" + }, + "zh": { + "question": "在双肺移植过程中，尽管进行了积极的肺部清理、100%氧气和最佳复苏措施，患者在单肺通气时的饱和度为85%。经食道超声心动图显示右心室功能恶化，肺动脉导管检查显示", + "A": "对手术肺进行持续气道正压通气（CPAP）", + "B": "开始使用正性肌力药物", + "C": "立即启动体外循环或体外膜氧合（ECMO）", + "D": "通过利尿改善液体状态" + } + }, + { + "id": "701d502b-b952-5329-a6e6-e27e9b1d68fc", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "33. A patient presents for lobectomy for small cell lung cancer. He has a history of Lambert-Eaton syndrome. Which of the following symptoms would be expected on review of systems?", + "A": "Weakness in the distal muscles that worsens throughout the day", + "B": "Improvement in muscle function with repeated use", + "C": "Urinary incontinence", + "D": "Delayed gastric emptying" + }, + "zh": { + "question": "33. 一名患者因小细胞肺癌接受肺叶切除术。他有Lambert-Eaton综合征病史。在系统回顾中预期会出现以下哪种症状？", + "A": "远端肌肉无力，且随着一天的进展而加重", + "B": "肌肉功能在反复使用后改善", + "C": "尿失禁", + "D": "胃排空延迟" + } + }, + { + "id": "3dc10eda-eee1-555e-ad34-ccbbac2021d2", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A patient is undergoing left sleeve lobectomy for adenocarcinoma which is subsequently causing significant narrowing of the left mainstem bronchus. Which of the following lung isolation devices is most appropriate?", + "A": "Right-sided DLT", + "B": "Left-sided DLT", + "C": "EZ-Blocker", + "D": "Arndt bronchial blocker" + }, + "zh": { + "question": "一名患者正在接受左侧袖状肺叶切除术以治疗腺癌，导致左主支气管显著狭窄。以下哪种肺隔离装置最合适？", + "A": "右侧双腔管", + "B": "左侧双腔管", + "C": "EZ-Blocker", + "D": "Arndt支气管阻塞器" + } + }, + { + "id": "83088845-229f-5088-ab61-bcbedefe1b7c", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient post pneumonectomy is recovering in the surgical intensive care unit (ICU) when she suddenly develops hypotension and cardiovascular collapse. Pulmonary artery catheter demonstrates a pulmonary artery systolic pressure of 20 mm Hg (previously 42 mm Hg) and a CVP of 22 mm Hg (previously 8 mm Hg). Which of the following is the most likely cause of her acute event?", + "A": "Volume overload", + "B": "Right ventricular failure", + "C": "Postpneumonectomy herniation syndrome", + "D": "Mucous plugging" + }, + "zh": { + "question": "一名肺切除术后的患者正在外科重症监护病房（ICU）恢复，突然出现低血压和心血管崩溃。肺动脉导管显示肺动脉收缩压为20 mm Hg（之前为42 mm Hg），中心静脉压为22 mm Hg（之前为8 mm Hg）。以下哪项是她急性事件的最可能原因？", + "A": "容量超负荷", + "B": "右心室衰竭", + "C": "术后肺切除疝综合征", + "D": "粘液堵塞" + } + }, + { + "id": "fd104f59-7936-567d-8612-884ced590a6f", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 19-year-old man with no known medical history presents with a gunshot wound to the right chest. His vital signs are stable and he is brought to the operating room for repair of an open tibia fracture. After intubation and initiation of positive pressure ventilation, his blood pressure acutely drops and he loses his pulse. Which of the following is the next step in management?", + "A": "Transcutaneous pacing", + "B": "Needle thoracostomy", + "C": "Chest X-ray", + "D": "Initiation of dopamine infusion" + }, + "zh": { + "question": "一名19岁无已知病史的男性因右胸枪伤就诊。他的生命体征稳定，被送入手术室修复开放性胫骨骨折。插管和开始正压通气后，他的血压急剧下降并失去脉搏。以下哪项是下一步的处理措施？", + "A": "经皮起搏", + "B": "针刺胸腔减压", + "C": "胸部X光", + "D": "开始多巴胺输注" + } + }, + { + "id": "86f1d2c1-f18f-5e20-89b0-49ba82bb240f", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 68-year-old woman with a history of pulmonary embolism on therapeutic anticoagulation is admitted to the surgical ICU in profound shock. To guide management a pulmonary artery catheter is placed uneventfully. Four hours later you are called urgently to the bedside because the patient has had acutely worsening blood pressure and there is blood noted in the endotracheal tube. Which of the following is the next most appropriate step?", + "A": "Chest tube placement", + "B": "Isolation of the bleeding lung and emergent transport to endovascular therapy", + "C": "Inflation of the pulmonary catheter balloon and advancement to the wedge position", + "D": "Emergent bedside thoracotomy" + }, + "zh": { + "question": "一名68岁的女性，有肺栓塞病史，正在接受治疗性抗凝治疗，因严重休克被送入外科ICU。为了指导治疗，顺利放置了肺动脉导管。四小时后，由于患者血压急剧下降且气管插管中出现血液，您被紧急叫到床边。以下哪一项是下一个最合适的步骤？", + "A": "放置胸管", + "B": "隔离出血的肺并紧急转运至血管内治疗", + "C": "充气肺动脉导管球囊并推进至楔位", + "D": "紧急床边开胸术" + } + }, + { + "id": "d5bf6566-26d2-5f6b-b8c4-83c66bf5d452", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 47-year-old man who is status post left thoracotomy for esophageal rupture is doing well immediately postoperatively. On postoperative day 5 the patient is tolerating a regular diet when he develops progressive shortness of breath. Chest X-ray reveals a large left pleural effusion. A chest tube is placed, which drains white fluid. Which of the following is the most likely cause?", + "A": "Chylothorax", + "B": "Esophageal perforation", + "C": "Empyema", + "D": "Reactive effusion from esophageal rupture" + }, + "zh": { + "question": "一名47岁的男性在因食管破裂接受左侧开胸手术后状态良好。术后第5天，患者在能够耐受正常饮食时出现进行性呼吸困难。胸部X光显示左侧有大量胸腔积液。放置胸管后引流出白色液体。以下哪项是最可能的原因？", + "A": "乳糜胸", + "B": "食管穿孔", + "C": "脓胸", + "D": "食管破裂引起的反应性积液" + } + }, + { + "id": "e2eac625-0ee1-5420-a73f-6ed10d57d0af", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "39. A patient with a large left upper lobe abscess is scheduled for thoracotomy and drainage. Which of the following is the optimal lung isolation system?", + "A": "Left-sided DLT", + "B": "EZ-Blocker", + "C": "Mainstem intubation with a single-lumen tube", + "D": "Arndt bronchial blocker" + }, + "zh": { + "question": "39. 一名患者患有左上叶大脓肿，计划进行开胸手术和引流。以下哪种是最佳的肺隔离系统？", + "A": "左侧双腔管", + "B": "EZ-Blocker", + "C": "单腔管主支气管插管", + "D": "Arndt 支气管封堵器" + } + }, + { + "id": "858be2af-32ba-557d-b97d-73cb40e27ea2", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient is 6 days post right pneumonectomy for adenocarcinoma and is doing well on the ward. She develops progressive dyspnea and an increased oxygen requirement. Chest X-ray reveals a decreased fluid level on the right side. Which of the following is the most likely diagnosis?", + "A": "Mediastinal herniation", + "B": "Pneumonia", + "C": "Bronchopleural fistula", + "D": "Mucous plug" + }, + "zh": { + "question": "一名患者在右侧肺腺癌切除术后6天，病情在病房中稳定。她出现进行性呼吸困难和氧气需求增加。胸部X光显示右侧液体水平减少。以下哪项是最可能的诊断？", + "A": "纵隔疝", + "B": "肺炎", + "C": "支气管胸膜瘘", + "D": "粘液栓" + } + }, + { + "id": "d8e8db3c-d6c0-552f-868d-21d989284650", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 34-year-old, 140-kg, 160-cm woman is scheduled to undergo VAT resection of a hamartoma. Which of the following maneuvers is most effective at prolonging the time to desaturation in obese patients?", + "A": "Applying CPAP or PEEP during induction", + "B": "Applying cricoid pressure to reduce the chance of aspiration", + "C": "Using a video laryngoscope", + "D": "Using 50% FiO2 during induction to prevent absorption atelectasis" + }, + "zh": { + "question": "一名34岁，140公斤，160厘米的女性计划进行VAT切除错构瘤。以下哪种操作最能有效延长肥胖患者的脱饱和时间？", + "A": "在诱导期间应用CPAP或PEEP", + "B": "施加环状软骨压力以减少误吸的可能性", + "C": "使用视频喉镜", + "D": "在诱导期间使用50% FiO2以防止吸收性肺不张" + } + }, + { + "id": "b446e3e9-8edd-503f-a1e1-5c440b2a1615", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient with severe idiopathic pulmonary fibrosis is being evaluated before undergoing elective surgery. Which of the following clinical findings reflects impaired oxygen diffusion?", + "A": "Elevated PCO2 at rest", + "B": "Decreased PO2 with exercise", + "C": "Chronic respiratory acidosis with renal compensation", + "D": "Improved symptoms with inhaled bronchodilators" + }, + "zh": { + "question": "一名患有严重特发性肺纤维化的患者正在接受择期手术前的评估。以下哪项临床发现反映了氧气扩散受损？", + "A": "静息时PCO2升高", + "B": "运动时PO2降低", + "C": "慢性呼吸性酸中毒伴肾脏代偿", + "D": "吸入支气管扩张剂后症状改善" + } + }, + { + "id": "1427c4e1-ab27-55d6-932a-85c8ce6f8274", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 76-year-old woman with a history of COPD presents for preoperative evaluation before shoulder surgery. Which of the following tests is best able to identify CO2 retention?", + "A": "PFTs showing improvement in symptoms with bronchodilators", + "B": "PFTs showing a decreased diffusion capacity", + "C": "Arterial blood gas", + "D": "Exercise tolerance" + }, + "zh": { + "question": "一名76岁的女性，有慢性阻塞性肺病病史，现进行肩部手术前的术前评估。以下哪项检查最能识别二氧化碳潴留？", + "A": "肺功能测试显示使用支气管扩张剂后症状改善", + "B": "肺功能测试显示扩散能力下降", + "C": "动脉血气分析", + "D": "运动耐量" + } + }, + { + "id": "ce01b312-e119-556b-973d-27d6a4c0f06a", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A 68-year-old man with a history of severe COPD presents for urgent exploratory laparotomy for small bowel obstruction. A room air arterial blood gas reveals a PaO2 of 51 mm Hg, and brief history reveals noncompliance with prescribed oxygen therapy. On induction of anesthesia, the CVP rises from 14 to 26 mm Hg, and the patient becomes progressively hypotensive. Airway pressures are normal, ECG shows sinus bradycardia, and oxygen saturation is >90%. Which of the following is the most likely mechanism of this patient's hypotension?", + "A": "Right ventricular dysfunction", + "B": "Tension pneumothorax", + "C": "Acute blood loss", + "D": "Severe bronchospasm" + }, + "zh": { + "question": "一名68岁的男性，有严重COPD病史，因小肠梗阻需进行紧急探查性剖腹手术。室内空气动脉血气显示PaO2为51 mm Hg，简短病史显示患者未遵医嘱进行氧疗。在麻醉诱导时，CVP从14升至26 mm Hg，患者逐渐出现低血压。气道压力正常，心电图显示窦性心动过缓，氧饱和度>90%。以下哪种机制最可能导致该患者的低血压？", + "A": "右心室功能障碍", + "B": "张力性气胸", + "C": "急性失血", + "D": "严重支气管痉挛" + } + }, + { + "id": "85250317-88a1-5e27-b865-712028dd9e68", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "45. A 58-year-old woman with a 20-pack-year smoking history and severe", + "A": "Decreasing the respiratory rate", + "B": "Increasing the PEEP", + "C": "Administering IV fluid bolus", + "D": "Initiating a vasopressin infusion" + }, + "zh": { + "question": "45. 一名58岁的女性，有20包年吸烟史和严重的", + "A": "降低呼吸频率", + "B": "增加PEEP", + "C": "给予静脉输液推注", + "D": "开始使用加压素输注" + } + }, + { + "id": "6da8650c-82d0-5e4d-8091-2f00cfcefbd2", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 36-year-old man with severe scoliosis is scheduled to undergo operative repair. Which of the following best predicts postoperative ventilation need?", + "A": "A vital capacity <40% of normal", + "B": "A decreased DLCO", + "C": "A Cobb angle of 42°", + "D": "A lack of response to bronchodilators on PFT" + }, + "zh": { + "question": "一名36岁的严重脊柱侧弯男性计划进行手术修复。以下哪项最能预测术后通气需求？", + "A": "肺活量小于正常值的40%", + "B": "弥散能力降低", + "C": "Cobb角为42°", + "D": "肺功能测试中对支气管扩张剂无反应" + } + }, + { + "id": "92bc588a-cd71-513e-a907-b9154db9733a", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 48-year-old woman with small cell lung cancer presents for urgent angle incision and drainage after being bitten by a dog. In an abbreviated history, she describes increased fatigue in the mornings that improves as the day progresses. She denies any cardiac or neurologic history. Her preoperative coagulation panel, basic metabolic panel, and liver function panel are all normal. Before progression of her cancer, she had been very active. Her anesthetic is unremarkable with neuromuscular relaxation maintained with rocuronium. Despite appropriate reversal of neuromuscular blockade, she remains weak and requires postoperative mechanical ventilation. Which of the following is the most likely cause?", + "A": "Hypocalcemia", + "B": "Impaired acetylcholine release from nerve terminals", + "C": "Impaired pseudocholinesterase function", + "D": "Antibodies to acetylcholine receptors at the neuromuscular junction" + }, + "zh": { + "question": "一名48岁的女性患有小细胞肺癌，在被狗咬后需要紧急进行切口引流。在简要病史中，她描述了早晨疲劳增加，随着一天的进展而改善。她否认有任何心脏或神经系统病史。她的术前凝血功能检查、基础代谢面板和肝功能面板均正常。在癌症进展之前，她非常活跃。她的麻醉过程无异常，使用罗库溴铵维持神经肌肉松弛。尽管适当逆转了神经肌肉阻滞，她仍然虚弱，需要术后机械通气。以下哪项是最可能的原因？", + "A": "低钙血症", + "B": "神经末梢乙酰胆碱释放受损", + "C": "假性胆碱酯酶功能受损", + "D": "神经肌肉接头处乙酰胆碱受体抗体" + } + }, + { + "id": "b280df30-cfc7-5961-8e71-67955ab1f79b", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 27-year-old woman with a history of mild asthma is undergoing arthroscopic anterior cruciate ligament repair with a laryngeal mask airway. During incision, airway pressures increase significantly and bilateral wheezes are appreciated. Which of the following is the next step in management?", + "A": "Administer bolus propofol to deepen the anesthetic.", + "B": "Administer intravenous nitroglycerin.", + "C": "Increase the concentration of inhaled sevoflurane.", + "D": "Switch the patient to a volume-controlled mode of ventilation." + }, + "zh": { + "question": "一名27岁的女性，有轻度哮喘病史，正在接受喉罩下的关节镜前交叉韧带修复术。在切口过程中，气道压力显著增加，并出现双侧哮鸣音。以下哪项是下一步的处理措施？", + "A": "给予推注丙泊酚以加深麻醉。", + "B": "给予静脉注射硝��甘油。", + "C": "增加吸入七氟醚的浓度。", + "D": "将患者切换到容量控制通气模式。" + } + }, + { + "id": "eb7160fe-6b40-543d-8af0-ea7a26e10bda", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 34-year-old woman with a history of chronic bronchiectasis is scheduled for partial lung resection for recurrent pneumonia. Which of the following is an important consideration for patients with chronically infected lung tissue?", + "A": "Preincision coverage with cefazolin", + "B": "Ensuring there is adequate lung isolation before positioning", + "C": "Place a thoracic epidural for pain control", + "D": "Use of high PEEP to recruit bronchiectatic lung" + }, + "zh": { + "question": "一名34岁的女性有慢性支气管扩张病史，计划进行部分肺切除术以治疗复发性肺炎。对于慢性感染肺组织的患者，下列哪项是重要的考虑因素？", + "A": "切口前使用头孢唑林覆盖", + "B": "确保在定位前有足够的肺隔离", + "C": "放置胸椎硬膜外麻醉以控制疼痛", + "D": "使用高PEEP以招募支气管扩张的肺" + } + }, + { + "id": "e9c9a9bf-1992-5144-ac00-43519247e88e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is most concerning for vascular compression in a patient with a mediastinal mass?", + "A": "Supine presyncope", + "B": "Size of mass on chest X-ray", + "C": "Tachyarrhythmia", + "D": "Recent weight loss" + }, + "zh": { + "question": "以下哪项最令人担心纵隔肿块患者的血管受压？", + "A": "仰卧时的晕厥前状态", + "B": "胸部X光片上的肿块大小", + "C": "心动过速性心律失常", + "D": "近期体重减轻" + } + }, + { + "id": "65163e5a-dec9-5240-9ec8-856298521fe0", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following features of the infant airway compared with the adult airway is correct?", + "A": "Infants are obligate mouth breathers through the first several months of life.", + "B": "The infant larynx is more cephalad in the neck than the adult larynx.", + "C": "The infant epiglottis is shorter and broader than the adult epiglottis.", + "D": "The narrowest part of the upper airway in the infant is at the level of the vocal cords.", + "E": "The larger occiput of the infant requires extra elevation of the head to achieve an optimal \"sniffing\" position." + }, + "zh": { + "question": "以下关于婴儿气道与成人气道的比较，哪一项是正确的？", + "A": "婴儿在生命的最初几个月是强制性用口呼吸的。", + "B": "婴儿的喉部在颈部的位置比成人的更靠头侧。", + "C": "婴儿的会厌比成人的会厌更短更宽。", + "D": "婴儿上气道最狭窄的部分是在声带的水平。", + "E": "婴儿较大的枕骨需要额外抬高头部以达到最佳的“嗅探”位置。" + } + }, + { + "id": "44fc63a7-052c-5247-ad6b-65e3b6c3fbad", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is correct concerning airway innervation?", + "A": "The recurrent laryngeal nerve innervates all the intrinsic muscles of the larynx save the cricothyroid, which is innervated by the external branch of the superior laryngeal nerve.", + "B": "To numb sensation to the posterior third of the tongue and oropharynx, local anesthetic can be infiltrated into the base of the palatoglossal arch to block the lingual nerve.", + "C": "An inferior laryngeal nerve block is completed by injecting local anesthetic 1 cm below the greater cornu of the hyoid bone bilaterally.", + "D": "A transtracheal block, achieved by injecting local anesthetic through the cricoid membrane into the trachea, can serve as the sole anesthetic needed for an awake fiberoptic intubation.", + "E": "Numbing of the oropharynx through topical approaches is rarely effective, and direct injection of local anesthetics is usually required to achieve adequate numbing for an awake fiberoptic intubation." + }, + "zh": { + "question": "以下关于气道神经支配的说法哪一项是正确的？", + "A": "喉返神经支配喉部所有内在肌肉，除了由喉上神经外支支配的环甲肌。", + "B": "为了麻醉舌后1/3和口咽的感觉，可以在腭舌弓基部注射局部麻醉剂以阻断舌神经。", + "C": "通��在舌骨大角下1厘米处双侧注射局部麻醉剂来完成下喉神经阻滞。", + "D": "通过环状软骨膜注射局部麻醉剂进入气管的经气管阻滞可以作为清醒纤维支气管镜插管所需的唯一麻醉。", + "E": "通过局部方法麻醉口咽通常效果不佳，通常需要直接注射局部麻醉剂以达到清醒纤维支气管镜插管所需的充分麻醉。" + } + }, + { + "id": "d7ef5db5-59f9-5939-b547-9df4a5f63498", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "In the postanesthesia care unit (PACU), a patient develops hoarseness following surgical removal of the left lobe of the thyroid (without violation of the right neck), and you suspect a unilateral recurrent laryngeal nerve injury. You consult your ENT colleagues to help evaluate recurrent laryngeal nerve function. Which of the following appearances of the vocal cords would be expected from this proposed mechanism of injury?", + "A": "Immobile bilateral vocal cords, with an adequate glottic opening and no change during vocalization", + "B": "Immobile bilateral vocal cords, with a very small glottic opening", + "C": "Immobile left vocal cord and movement of the right vocal cord across midline during phonation", + "D": "Immobile right vocal cord and movement of the left vocal cord across midline during phonation", + "E": "Bilateral flaccid, partially abducted, immobile vocal cords" + }, + "zh": { + "question": "在麻醉后监护病房（PACU），一名患者在左侧甲状腺叶切除术后出现声音嘶哑（未涉及右侧颈部），你怀疑是单侧喉返神经损伤。你咨询了耳鼻喉科同事以帮助评估喉返神经功能。根据这种损伤机制，声带的哪种表现是可以预期的？", + "A": "双侧声带不动，声门开口足够，发声时无变化", + "B": "双侧声带不动，声门开口非常小", + "C": "左侧声带不动，发声时右侧声带越过中线移动", + "D": "右侧声带不动，发声时左侧声带越过中线移动", + "E": "双侧声带松弛，部分外展，不动" + } + }, + { + "id": "a7f960ed-3de3-509f-b32e-782df605c1a2", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "4. A 26-year-old professional singer is in your operating room (OR) undergoing suspension microlaryngoscopy for vocal cord polyps. Soon after induction and just after the surgeon places the patient into suspension, the heart rate drops from 85 to 30 beats per minute. Which of the following is the best initial course of action?", + "A": "Increase the depth of anesthetic.", + "B": "Administer an opioid.", + "C": "Administer glycopyrrolate.", + "D": "Continue to monitor the heart rate and cycle the blood pressure cuff with the knowledge that these parameters should recover, as the patient becomes accustomed to the positioning.", + "E": "Direct the surgeon to take the patient out of suspension and before proceeding with additional measures." + }, + "zh": { + "question": "4. 一名26岁的职业歌手在您的手术室（OR）接受声带息肉的悬吊显微喉镜检查。诱导后不久，外科医生将患者置于悬吊状态后，心率从85次/分钟降至30次/分钟。以下哪项是最佳的初步处理措施？", + "A": "加深麻醉深度。", + "B": "给予阿片类药物。", + "C": "给予氨甲酰胆碱。", + "D": "继续监测心率并循环血压袖带，了解这些参数应会恢复，因为患者会逐渐适应这种体位。", + "E": "指示外科医生将患者从悬吊状态中取出，然后再进行其他措施。" + } + }, + { + "id": "6b3c0ae9-a4f0-5b97-9073-479b107d5a4b", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "An ENT surgeon is planning microlaryngoscopy for laser ablation of vocal cord hemangiomas and asks that low-frequency jet ventilation be used so that \"the", + "A": "Care must be taken to allow passive exhalation and avoid breath stacking to limit the possibility of barotrauma.", + "B": "Reliable pulse oximetry is essential because jet ventilation relies on the venture effect and entrainment of room air, making the exact FiO2 challenging to measure.", + "C": "Total intravenous anesthesia is required.", + "D": "Pressure monitoring at the distal tip of the jet ventilation catheter is essential.", + "E": "The trigger pressure must be preset at a level to allow adequate synchronization between the jet ventilator and the patient's spontaneous breaths." + }, + "zh": { + "question": "一位耳鼻喉科外科医生计划进行激光消融声带血管瘤的显微喉镜检查，并要求使用低频喷射通气，以便", + "A": "必须小心允许被动呼气并避免呼吸堆积，以限制气压伤的可能性。", + "B": "可靠的脉搏血氧仪是必需的，因为喷射通气依赖于文丘里效应和室内空气的引入，使得确切的FiO2难以测量。", + "C": "需要全静脉麻醉。", + "D": "在喷射通气导管远端的压力监测是必不可少的。", + "E": "触发压力必须预设在一个水平，以允许喷射通气器与患者自发呼吸之间的充分同步。" + } + }, + { + "id": "28ef53de-b853-5489-aa3c-6bda92fdfc52", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "When considering the anesthetic management for a patient undergoing suspension microlaryngoscopy, which of the following is MOST important?", + "A": "Complete immobility during surgical manipulation of the larynx", + "B": "Light sedation so that the surgeon may observe vocal cord mobility during phonation", + "C": "Permissive hypotension to limit surgical bleeding", + "D": "Generous β-blockade to limit sympathetic discharge with suspension", + "E": "Long-acting opioids are the best agents to manage postoperative pain" + }, + "zh": { + "question": "在考虑为接受悬吊显微喉镜检查的患者进行麻醉管理时，以下哪项是最重要的？", + "A": "在喉部手术操作期间完全不动", + "B": "轻度镇静以便外科医生在发声时观察声带活动", + "C": "允许性低血压以减少手术出血", + "D": "大量使用β受体阻滞剂以限制悬吊时的交感神经放电", + "E": "长效阿片类药物是管理术后疼痛的最佳药物" + } + }, + { + "id": "5ea44ff8-664b-5350-9913-9ca49ceb3d36", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "You are caring for a patient in the intensive care unit (ICU) who remains intubated overnight following oromaxillofacial surgery procedure for irrigation and debridement of a submandibular abscess. The patient has a nasotracheal tube sutured in place and still has significant external facial swelling as well as discharge from the surgically placed drains. The patient has passed a spontaneous breathing trial and has a fully intact neurologic exam. Which of the following evaluations is likely to provide the best information regarding the patient's readiness for extubation?", + "A": "Upright X-ray of the neck", + "B": "CT of the neck", + "C": "Bedside cuff leak test", + "D": "Fiberoptic evaluation around the endotracheal tube (ETT) to visualize the posterior pharynx, larynx, and glottic aperture", + "E": "Fiberoptic evaluation through the ETT to visualize the trachea and proximal bronchi" + }, + "zh": { + "question": "您正在重症监护室（ICU）照顾一位患者，该患者在进行下颌下脓肿冲洗和清创的口颌面外科手术后，过夜仍需插管。患者的鼻气管插管已缝合固定，仍有明显的面部外部肿胀以及手术放置的引流管有分泌物。患者已通过自发呼吸试验，神经系统检查完全正常。以下哪项评估最有可能提供有关患者拔管准备情况的最佳信息？", + "A": "颈部直立X光片", + "B": "颈部CT", + "C": "床旁袖带漏气测试", + "D": "通过纤维镜在气管插管（ETT）周围进行评估，以观察后咽、喉和声门开口", + "E": "通过纤维镜在ETT内进行评估，以观察气管和近端支气管" + } + }, + { + "id": "e4dd83b9-905b-5439-a209-4e4c7ee66d9d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 35-year-old man with no significant medical history, with the exception of morbid obesity, is currently undergoing elective laparoscopic cholecystectomy for biliary cholic. Five minutes after a routine induction and a smooth", + "A": "A. Rocuronium", + "B": "Fentanyl", + "C": "Propofol", + "D": "Midazolam", + "E": "Lidocaine" + }, + "zh": { + "question": "一名35岁的男性，除了病态肥胖外，无其他显著病史，目前正在进行选择性腹腔镜胆囊切除术以治疗胆绞痛。在常规诱导和顺利进行五分钟后", + "A": "A. 罗库溴铵", + "B": "芬太尼", + "C": "丙泊酚", + "D": "咪达唑仑", + "E": "利多卡因" + } + }, + { + "id": "16c44888-a7cf-5198-b917-79016b8525ea", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 24-year-old woman with a medical history of exercise-induced asthma and subsequent use of an albuterol inhaler several times a week is currently undergoing urgent laparoscopic appendectomy. Several minutes after induction, you note increased peak inspiratory pressures and observe diffuse bilateral wheezes and a falling blood pressure. Which of the following is the best initial treatment?", + "A": "Spray albuterol into the breathing circuit with inspiration.", + "B": "Administer a corticosteroid such as hydrocortisone.", + "C": "Administer IV epinephrine 1 mg.", + "D": "Administer histamine blockers such as Benadryl and ranitidine.", + "E": "Administer IV epinephrine in 50-100 µg divided doses." + }, + "zh": { + "question": "一名24岁的女性，有运动诱发哮喘病史，每周多次使用沙丁胺醇吸入器，目前正在进行紧急腹腔镜阑尾切除术。诱导后几分钟，你注意到吸气峰压增加，观察到弥漫性双侧哮鸣音和血压下降。以下哪项是最佳的初始治疗？", + "A": "在吸气时将沙丁胺醇喷入呼吸回路。", + "B": "给予皮质类固醇，如氢化可的松。", + "C": "静脉注射1毫克肾上腺素。", + "D": "给予组胺阻滞剂，如苯海拉明和雷尼替丁。", + "E": "静脉注射50-100微克分次剂量的肾上腺素。" + } + }, + { + "id": "8d39ae9e-271e-50ef-a067-20924723bc1f", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A patient undergoing a routine elective inguinal hernia repair suffers from a suspected anaphylactic reaction, which is successfully treated with epinephrine, corticosteroids, and histamine blockers. However, at the end of the case, airway pressures remain elevated, there is evidence of swelling of the oral mucosa, and the decision is made to bring the patient into the ICU intubated. Upon admission to the ICU, the patient appears to be euvolemic by examination but remains hypotensive. After an additional dose of epinephrine, corticosteroids, and histamine blockers, which of the following would be the MOST appropriate next step?", + "A": "Proceed to extubation, as anaphylaxis rarely requires more than 2 treatments.", + "B": "Trend tryptase levels until they begin to downtrend, then consider extubation.", + "C": "Transition from crystalloid infusion to albumin, as capillary leak is likely to lead to pulmonary edema, which could delay extubation.", + "D": "Begin a low-dose epinephrine infusion and titrate to blood pressure and bronchospasm.", + "E": "Begin a low-dose norepinephrine infusion, as the continued symptoms demonstrate that they are refractory to epinephrine therapy." + }, + "zh": { + "question": "一名正在进行常规择期腹股沟疝修补术的患者出现疑似过敏性反应，成功用肾上腺素、皮质类固醇和组胺阻滞剂治疗。然而，在手术结束时，气道压力仍然升高，口腔黏膜有肿胀的迹象，决定将患者插管送入ICU。在ICU入院时，检查显示患者血容量正常，但仍然低血压。在额外给予一剂肾上腺素、皮质类固醇和组胺阻滞剂后，以下哪项是最合适的下一步措施？", + "A": "进行拔管，因为过敏反应很少需要超过2次治疗。", + "B": "监测胰蛋白酶水平，直到其开始下降，然后考虑拔管。", + "C": "从晶体液输注转为白蛋白，因为毛细血管渗漏可能导致肺水肿，从而延迟拔管。", + "D": "开始低剂量肾上腺素输注，并根据血压和支气管痉挛进行滴定。", + "E": "开始低剂量去甲肾上腺素输注，因为持续的症状表明对肾上腺素治疗无效。" + } + }, + { + "id": "35da10bb-c383-504c-94ce-3c97d253de5b", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements about anaphylaxis is MOST true?", + "A": "Elevated tryptase levels are pathognomonic of anaphylaxis.", + "B": "The level of severity of cutaneous reaction correlates with the severity of shock with anaphylaxis.", + "C": "The most common causes of intraoperative anaphylaxis are opioids and inhalational anesthetics.", + "D": "Patients suffering from an intraoperative anaphylactic reaction should be monitored in an inpatient unit for 24 hours.", + "E": "Prophylaxis against anaphylaxis allows for the repeated safe use of the offending agent." + }, + "zh": { + "question": "以下关于过敏性休克的陈述中哪一项最为正确？", + "A": "升高的胰蛋白酶水平是过敏性休克的特征性标志。", + "B": "皮肤反应的严重程度与过敏性休克的休克严重程度相关。", + "C": "术中过敏性休克最常见的原因是阿片类药物和吸入麻醉剂。", + "D": "术中发生过敏性休克反应的患者应在住院病房监测24小时。", + "E": "针对过敏性休克的预防措施可以安全地重复使用致病药物。" + } + }, + { + "id": "7dfd35e3-30d4-5a86-9dd2-1cea5511fe0e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 3-year-old child with fever, dysphagia, and drooling is brought to the emergency department (ED) by the caregiver. Lateral neck X-ray films reveal evidence of a \"thumbprint\" sign. Which of the following disorders is highest on your differential?", + "A": "Epiglottitis", + "B": "Croup", + "C": "Tracheal stenosis", + "D": "Tracheoesophageal fistula", + "E": "Tonsillitis" + }, + "zh": { + "question": "一名3岁儿童因发热、吞咽困难和流口水被看护人带到急诊科。侧颈X光片显示“拇指征”迹象。以下哪种疾病在你的鉴别诊断中最有可能？", + "A": "会厌炎", + "B": "哮吼", + "C": "气管狭窄", + "D": "气管食管瘘", + "E": "扁桃体炎" + } + }, + { + "id": "1a8a7991-76ee-588b-9f36-f8a7871294f0", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "13. Which organism is MOST associated with epiglottitis?", + "A": "Parainfluenza", + "B": "Haemophilus influenza", + "C": "Group A Streptococcus", + "D": "Group B Streptococcus", + "E": "Candida albicans" + }, + "zh": { + "question": "13. 哪种生物与会厌炎最相关？", + "A": "副流感病毒", + "B": "流感嗜血杆菌", + "C": "A组链球菌", + "D": "B组链球菌", + "E": "白色念珠菌" + } + }, + { + "id": "7e34fa18-a0e4-5219-9747-6241072f5cac", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "The 3-year-old patient from question 12, suffering from dysphagia and drooling, is now \"tripoding\" with increased work of breathing, and the decision is made to proceed to intubation. Which of the following is the safest method of securing the airway?", + "A": "Proceed to an immediate rapid sequence intubation in the ED via direct laryngoscopy.", + "B": "Proceed to an intravenous induction in the semirecumbent position in the ED via video laryngoscopy with fiberoptic backup.", + "C": "Move to an OR for emergent surgical airway.", + "D": "Proceed to an OR for an emergent rapid sequence intubation with surgeons at the bedside for possible rigid bronchoscopy or surgical airway.", + "E": "Proceed to an OR for an urgent inhalational induction in the seated position followed by laryngoscopy with surgeons at the bedside for possible rigid bronchoscopy or surgical airway." + }, + "zh": { + "question": "第12题中的3岁患者，患有吞咽困难和流口水，现在出现“三脚架”姿势并伴有呼吸困难，决定进行插管。以下哪种方法是确保气道安全的最安全方法？", + "A": "在急诊室通过直接喉镜进行立即快速序列插管。", + "B": "在急诊室通过视频喉镜进行半卧位静脉诱导，并备有纤维光学设备。", + "C": "转移到手术室进行紧急外科气道。", + "D": "转移到手术室进行紧急快速序列插管，外科医生在旁以备可能的硬质支气管镜检查或外科气道。", + "E": "转移到手术室进行紧急吸入诱导，坐姿后进行喉镜检查，外科医生在旁以备可能的硬质支气管镜检查或外科气道。" + } + }, + { + "id": "86cb27bc-5b5a-58b6-afa9-806f3ce01c9d", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "You are called to the ED to evaluate an 18-month-old child suffering from a suspected aspiration. The child's parents describe coughing, choking, and a slight bluish tinge to the lips after a meal, including pieces of corn and carrots, rushing to the hospital. The child is now quietly lying down without any outward signs of respiratory distress but with an O2 saturation of 92%. Which of the following is the MOST appropriate method of caring for this patient?", + "A": "Reassure the parents of the child that because it was only small pieces of vegetable and not a larger piece of meat or other protein, and the child is no longer actively coughing, no intervention is required and should simply be monitored in the ED until the O2 saturation normalizes.", + "B": "Advise that you are booking an OR for emergent bronchoscopic removal of the aspirate and oral midazolam should be administered immediately to ensure that the child remains calm and does not dislodge the aspirated material.", + "C": "Ask that antibiotics and steroids be started in the emergency department to be continued for only a 4-day course because this has been shown to be noninferior to a 7-day course.", + "D": "Take the patient to the OR emergently and complete a gentle inhaled induction to maintain spontaneous ventilation, place a laryngeal mask airway (LMA), and allow a surgeon to pass a flexible fiberoptic bronchoscope through the LMA to remove the aspirated particles.", + "E": "Take the child to the OR emergently, and after placing a peripheral IV under topical anesthesia with the child on the OR table, proceed with a rapid sequence intubation, securing the airway with an ETT before allowing the surgeon to proceed with flexible or rigid bronchoscopy." + }, + "zh": { + "question": "你被叫到急诊科评估一名18个月大的儿童，该儿童疑似吸入异物。孩子的父母描述说，孩子在进食包括玉米和胡萝卜的餐后出现咳嗽、窒息和嘴唇轻微发蓝的情况，并迅速赶往医院。孩子现在安静地躺着，没有明显的呼吸窘迫迹象，但氧饱和度为92%。以下哪种方法是对该患者最合适的护理方法？", + "A": "安抚孩子的父母，因为只是小块蔬菜而不是较大的肉块或其他蛋白质，并且孩子不再主动咳嗽，不需要干预，只需在急诊科监测直到氧饱和度正常化。", + "B": "建议预订手术室进行紧急支气管镜取出吸入物，并立即给予口服咪达唑仑，以确保孩子保持平静，不会使吸入物移位。", + "C": "要求在急诊科开始使用抗生素和类固醇，并仅持续4天的疗程，因为这已被证明不劣于7天的疗程。", + "D": "紧急将患者送至手术室，完成温和的吸入诱导以维持自主呼吸，放置喉罩（LMA），并允许外科医生通过LMA插入柔性纤维支气管镜以去除吸入的颗粒。", + "E": "紧急将孩子送至手术室，在手术台上用局部麻醉放置外周静脉后，进行快速序列插管，用气管导管（ETT）固定气道，然后允许外科医生进行柔性或刚性支气管镜检查。" + } + }, + { + "id": "243025fb-3e75-5876-8fd2-dcf93d1dae5e", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "You are called emergently to the bedside of a patient in the ICU after his nurse observed an acute desaturation event. You note the patient had a tracheostomy placed 6 days ago for chronic respiratory failure after a prolonged course of acute respiratory distress syndrome. You arrive at the patient's bedside to find an O2 saturation of 88%, the trach collar seated against the skin with the pilot balloon inflated, and the patient moving air very noisily through his mouth. The nurse describes that during a coughing fit his trach \"fell out, \" but she was able to push it back in. Which of the following would be the most inappropriate next move?", + "A": "Place an oxygen mask over the patient's mouth and nose.", + "B": "Attach an Ambu bag to the trach and support the patient's ventilation.", + "C": "Remove the trach and cover the ostomy site with a bandage.", + "D": "Call for a fiberoptic bronchoscope to interrogate the tracheostomy track.", + "E": "Attach an Ambu bag to a mask, place over the mouth and nose, and support the patient's ventilation." + }, + "zh": { + "question": "在ICU中，一名患者的护士观察到急性氧饱和度下降事件后，您被紧急叫到床边。您注意到患者在6天前因急性呼吸窘迫综合征的长期病程导致的慢性呼吸衰竭而进行了气管切开术。您到达患者床边时发现氧饱和度为88%，气管套管贴在皮肤上，导管球囊充气，患者通过嘴呼吸时发出很大的噪音。护士描述说，在咳嗽发作期间，气管套管“掉了出来”，但她能够将其推回去。以下哪项是最不合适的下一步措施？", + "A": "在患者的口鼻上放置氧气面罩。", + "B": "将Ambu气囊连接到气管套管上，支持患者的通气。", + "C": "移除气管套管，并用绷带覆盖造口部位。", + "D": "呼叫纤维支气管镜检查气管切开通道。", + "E": "将Ambu气囊连接到面罩上，放在口鼻上，支持患者的通气。" + } + }, + { + "id": "230cdc85-a96f-509e-8204-963dfa814dc5", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "17. According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following is the correct definition of a difficult airway?", + "A": "A clinical situation where a physician experiences difficulty with ventilation, intubation, or both.", + "B": "A clinical situation in which a conventionally trained anesthesiologist requires adjuncts for ventilation and/or advanced airway equipment for intubation.", + "C": "A clinical situation in which a conventionally trained anesthesiologist fails to ventilate and/or intubate a patient.", + "D": "A clinical situation in which a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both.", + "E": "A clinical situation in which a conventionally trained physician experiences difficulty with facemask ventilation, tracheal intubation, or both." + }, + "zh": { + "question": "17. 根据ASA困难气道管理实践指南，以下哪一项是困难气道的正确定义？", + "A": "医生在通气、插管或两者上遇到困难的临床情况。", + "B": "常规训练的麻醉医师在通气时需要辅助设备和/或在插管时需要高级气道设备的临床情况。", + "C": "常规训练的麻醉医师未能对患者进行通气和/或插管的临床情况。", + "D": "常规训练的麻醉医师在面罩通气上呼吸道、气管插管或两者上遇到困难的临床情况。", + "E": "常规训练的医生在面罩通气、气管插管或两者上遇到困难的临床情况。" + } + }, + { + "id": "fccfba93-df6a-5011-a741-63bebc0bfedb", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following has NOT been independently associated with challenging mask ventilation?", + "A": "Edentulousness", + "B": "Neck circumference >19 cm", + "C": "BMI >36 kg/m2", + "D": "Presence of a beard", + "E": "Snoring/obstructive sleep apnea (OSA) history" + }, + "zh": { + "question": "以下哪项未被独立关联为困难面罩通气的因素？", + "A": "无牙", + "B": "颈围 >19 厘米", + "C": "BMI >36 kg/m2", + "D": "有胡须", + "E": "打鼾/阻塞性睡眠呼吸暂停（OSA）病史" + } + }, + { + "id": "899e5902-a432-5b52-9cff-b01558c8509e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following components of the preoperative airway physical examination is correctly paired with a nonreassuring finding, as it relates to a potential difficult intubation?", + "A": "Relationship of maxillary and mandibular incisors during voluntary protrusion of the mandible: inability to bring mandibular incisors anterior to maxillary incisors", + "B": "Thyromental distance: four ordinary finger breaths", + "C": "Visibility of uvula: only upper third of uvula visible", + "D": "Range of motion of the head and neck: inability to rotate chin to each shoulder", + "E": "Interincisor distance: 5 cm" + }, + "zh": { + "question": "根据ASA困难气道管理实践指南，以下哪项术前气道体检的组成部分与可能的困难插管相关的不良发现正确配对？", + "A": "下颌自愿前突时上下门齿的关系：无法使下门齿前于上门齿", + "B": "甲颏距离：四个普通手指宽度", + "C": "悬雍垂的可见度：仅上三分之一的悬雍垂可见", + "D": "头颈的活动范围：无法将下巴旋转到每个肩膀", + "E": "门齿间距：5厘米" + } + }, + { + "id": "1b715f7b-3947-5fc5-a434-ec8429d1ab5b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "According to the Mallampati classification, if you are able to view the fauces,", + "A": "Class 0", + "B": "Class I", + "C": "Class II", + "D": "Class III", + "E": "Class IV" + }, + "zh": { + "question": "根据Mallampati分类，如果可以看到咽门，", + "A": "0级", + "B": "I级", + "C": "II级", + "D": "III级", + "E": "IV级" + } + }, + { + "id": "6f2ec914-392a-56c3-9912-eae0d217d8bc", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is MOST correct regarding the Mallampati classification system?", + "A": "The Mallampati score correlates well with difficulty of mask ventilation.", + "B": "Phonation increases the specificity of the Mallampati test.", + "C": "A Mallampati IV classification has a high positive predictive value of difficult direct laryngoscopy.", + "D": "Ability to visualize lingual tonsils requires a Mallampati IV score.", + "E": "Partial view of the glottis or arytenoids defines a Mallampati II score." + }, + "zh": { + "question": "以下关于Mallampati分类系统的描述中，哪一项是最正确的？", + "A": "Mallampati评分与面罩通气困难的相关性良好。", + "B": "发声增加了Mallampati测试的特异性。", + "C": "Mallampati IV级分类对困难直接喉镜检查具有很高的阳性预测值。", + "D": "可视化舌扁桃体需要Mallampati IV评分。", + "E": "部分可见声门或杓状软骨定义为Mallampati II评分。" + } + }, + { + "id": "b7a2720c-f56d-5bb9-9b5d-a834415a495c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "According to the ASA Difficult Airway Algorithm, which of the following is NOT included in the assessment of the likelihood of basic management problems?", + "A": "Difficulty with patient cooperation", + "B": "Difficult mask ventilation", + "C": "Difficult laryngoscopy", + "D": "Difficult intubation", + "E": "Difficult extubation" + }, + "zh": { + "question": "根据ASA困难气道算法，以下哪项不包括在基本管理问题可能性的评估中？", + "A": "患者配合困难", + "B": "面罩通气困难", + "C": "喉镜检查困难", + "D": "插管困难", + "E": "拔管困难" + } + }, + { + "id": "8c937a08-bb1a-5a64-bbc8-cd392878506c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "23. According to the ASA Difficult Airway Algorithm, which of the following correctly describes the pathway through the \"Awake Intubation\" Algorithm?", + "A": "The first decision to make is to determine whether invasive airway access or noninvasive intubation will be attempted.", + "B": "If noninvasive intubation fails, then progress to facemask ventilation.", + "C": "If noninvasive intubation fails, then consider waking the patient up and canceling the case.", + "D": "If invasive airway access fails, then consider canceling the case.", + "E": "If noninvasive intubation is successful, then the patient should be provided with a difficult airway note following the case." + }, + "zh": { + "question": "23. 根据ASA困难气道算法，以下哪项正确描述了“清醒插管”算法的路径？", + "A": "首先要做的决定是确定是尝试侵入性气道通路还是非侵入性插管。", + "B": "如果非侵入性插管失败，则进展到面罩通气。", + "C": "如果非侵入性插管失败，则考虑唤醒患者并取消手术。", + "D": "如果侵入性气道通路失败，则考虑取消手术。", + "E": "如果非侵入性插管成功，则在手术后应为患者提供困难气道说明。" + } + }, + { + "id": "7be41a97-1cc6-5930-b246-d1227e46d068", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following definitions is MOST correct?", + "A": "Failed intubation: inability to place an ETT after a single attempt", + "B": "Difficult laryngoscopy: failure of direct laryngoscopy and required use of videolaryngoscopy or fiberoptic bronchoscopy for successful intubation", + "C": "Difficult supraglottic airway placement: tracheal pathology making a supraglottic airway seal inadequate", + "D": "Difficult tracheal intubation: tracheal intubation requiring multiple attempts, with or without tracheal pathology", + "E": "Difficult facemask ventilation: use of airway adjuncts, including 2-handed mask and oral/nasal airways to achieve adequate ventilation" + }, + "zh": { + "question": "根据ASA困难气道管理实践指南，以下哪个定义是最正确的？", + "A": "插管失败：在一次尝试后无法放置气管导管", + "B": "困难喉镜检查：直接喉镜检查失败，需要使用视频喉镜或纤维支气管镜进行成功插管", + "C": "困难的声门上气道放置：气管病变导致声门上气道密封不充分", + "D": "困难的气管插管：气管插管需要多次尝试，无论是否存在气管病变", + "E": "困难的面罩通气：使用气道辅助工具，包括双手面罩和口/鼻气道以实现充分通气" + } + }, + { + "id": "4c31a850-8d20-57d7-8303-9afe490f0c80", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "According to the ASA Difficult Airway Algorithm for intubation after induction of general anesthesia, if initial intubation is unsuccessful and facemask ventilation is not adequate, then which of the following would be the best next step?", + "A": "Awaken the patient.", + "B": "Proceed to emergency invasive airway access.", + "C": "Proceed video-assisted or fiberoptic intubation.", + "D": "Cancel the case.", + "E": "Attempt supraglottic airway placement." + }, + "zh": { + "question": "根据ASA困难气道插管算法，在全身麻醉诱导后，如果初次插管不成功且面罩通气不充分，那么以下哪一项是最佳的下一步措施？", + "A": "唤醒患者。", + "B": "进行紧急侵入性气道通路。", + "C": "进行视频辅助或纤维光学插管。", + "D": "取消手术。", + "E": "尝试放置声门上气道。" + } + }, + { + "id": "c8ecbe29-17f8-5696-b89a-650c0189d578", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "According to the ASA Difficult Airway Algorithm, which of the following is NOT considered a noninvasive alternative in the difficult intubation approach?", + "A": "Light wand", + "B": "Intubating LMA", + "C": "Video-assisted laryngoscopy", + "D": "Percutaneous jet ventilation", + "E": "Blind nasal intubation" + }, + "zh": { + "question": "根据ASA困难气道算法，以下哪项不被视为困难插管方法中的非侵入性替代方案？", + "A": "光棒", + "B": "插管LMA", + "C": "视频辅助喉镜检查", + "D": "经皮喷射通气", + "E": "盲插鼻插管" + } + }, + { + "id": "81c93dc6-028b-5421-b844-99807bb64ce0", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following is NOT a recommended preformulated strategy for extubation of the difficult airway?", + "A": "Long-term intubation until the perioperative period is completed", + "B": "Short-term use of an airway exchange catheter", + "C": "Consideration of fully awake extubation", + "D": "Preparation for postextubation noninvasive ventilation or high-flow oxygen", + "E": "Extubation to an LMA" + }, + "zh": { + "question": "根据ASA困难气道管理指南，以下哪项不是困难气道拔管的推荐预先制定策略？", + "A": "长期插管直到围手术期结束", + "B": "短期使用气道交换导管", + "C": "考虑完全清醒拔管", + "D": "准备拔管后无创通气或高流量氧气", + "E": "拔管至喉罩" + } + }, + { + "id": "9ef53567-7fb5-5857-a601-20c710bcb1ef", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following symptoms is a major indication for tonsillectomy?", + "A": "Initial presentation with tonsillitis", + "B": "Children with valvular cardiac disease at first presentation with tonsillitis", + "C": "Severe OSA", + "D": "Recurrent step pharyngitis", + "E": "Presence of tonsillar stones" + }, + "zh": { + "question": "以下哪种症状是扁桃体切除术的主要指征？", + "A": "首次出现扁桃体炎", + "B": "首次出现扁桃体炎的心脏瓣膜病儿童", + "C": "严重的阻塞性睡眠呼吸暂停", + "D": "反复链球菌性咽炎", + "E": "存在扁桃体结石" + } + }, + { + "id": "290d59c3-0e85-590c-8da7-cf4965ec078d", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "29. According to the ASA Practice Guidelines for the Perioperative Management of Patients with OSA, which of the following is recommended for children undergoing tonsillectomy for OSA?", + "A": "Codeine is superior to nonsteroidal anti-inflammatory drugs for postoperative pain relief.", + "B": "Sleep studies should be obtained on all children undergoing elective tonsillectomy and/or adenoidectomy.", + "C": "For children undergoing tonsillectomy for OSA, the task force advises that opioid dosing should be decreased because repeated hypoxemia increases the sensitivity of µ-opioid receptors.", + "D": "All children undergoing tonsillectomy and/or adenoidectomy for OSA should be watched in a monitored setting for at least 24 hours following surgery.", + "E": "The ASA Practice Guidelines require the use of noninvasive CPAP in the immediate postoperative setting for all children undergoing tonsillectomy and/or adenoidectomy for OSA." + }, + "zh": { + "question": "29. 根据ASA关于OSA患者围手术期管理的实践指南，���下哪项是对接受扁桃体切除术的OSA儿童的推荐？", + "A": "可待因在术后疼痛缓解方面优于非甾体抗炎药。", + "B": "所有接受选择性扁桃体切除术和/或腺样体切除术的儿童都应进行睡眠研究。", + "C": "对于接受扁桃体切除术的OSA儿童，工作组建议减少阿片类药物的剂量，因为反复的低氧血症会增加µ-阿片受体的敏感性。", + "D": "所有接受扁桃体切除术和/或腺样体切除术的OSA儿童在术后至少24小时内应在监护环境中观察。", + "E": "ASA实践指南要求在术后立即为所有接受扁桃体切除术和/或腺样体切除术的OSA儿童使用无创CPAP。" + } + }, + { + "id": "cf1c71d1-569f-5981-be53-96727961da85", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Recent studies have shown that a single intraoperative dose of dexamethasone is associated with all the following EXCEPT which one?", + "A": "Decreased postoperative pain", + "B": "Decreased postoperative bleeding", + "C": "Decreased time to first oral intake", + "D": "Decreased postoperative nausea and vomiting in the immediate postoperative period", + "E": "Decreased postoperative nausea and vomiting in the first 24 hours" + }, + "zh": { + "question": "最近的研究表明，单次术中使用地塞米松与以下所有情况有关，除了哪一项？", + "A": "减少术后疼痛", + "B": "减少术后出血", + "C": "缩短首次口服摄入时间", + "D": "减少术后即刻的恶心和呕吐", + "E": "减少术后24小时内的恶心和呕吐" + } + }, + { + "id": "06363e4b-70ef-525c-909e-54ef9ac21ade", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is MOST correct regarding posttonsillectomy hemorrhage?", + "A": "Primary hemorrhage occurs during the tonsillectomy surgery itself, whereas secondary hemorrhage occurs within the first 24 hours.", + "B": "Posttonsillectomy hemorrhage is a common occurrence and should be treated with maintenance of NPO status and \"watchful waiting.\"", + "C": "Nearly half of patients suffering from posttonsillectomy hemorrhage have an undiagnosed coagulation disorder.", + "D": "Posttonsillectomy hemorrhage usually presents as brisk bleeding.", + "E": "Because of the friable nature of the tonsillar tissue, take-back surgeries for bleeding should be completed under moderate sedation." + }, + "zh": { + "question": "以下关于扁桃体切除术后出血的说法中，哪一项是最正确的？", + "A": "原发性出血发生在扁桃体切除手术过程中，而继发性出血发生在术后24小时内。", + "B": "扁桃体切除术后出血是常见现象，应通过保持禁食状态和“观察等待”来处理。", + "C": "几乎一半的扁桃体切除术后出血患者有未诊断的凝血障碍。", + "D": "扁桃体切除术后出血通常表现为急性出血。", + "E": "由于扁桃体组织易碎，止血的再次手术应在中度镇静下完成。" + } + }, + { + "id": "59c558b3-4afa-5210-9553-68c10b63947f", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 5-year-old child presents to the ED 12 hours posttonsillectomy with bleeding", + "A": "Proceed directly to the OR, induce via inhalation, secure IV access, and intubate.", + "B": "IV access should be secured in the ED with fluid resuscitation before proceeding to the OR.", + "C": "Proceed directly to the OR, secure IV access, and proceed with the least sedation necessary to allow for hemostasis through electrocautery.", + "D": "Consult interventional radiology for embolization of the external carotid artery on the side of bleeding.", + "E": "Manage the patient medically with volume resuscitation and reversal of coagulopathy." + }, + "zh": { + "question": "一名5岁儿童在扁桃体切除术后12小时出现出血，来到急诊科", + "A": "直接进入手术室，通过吸入麻醉诱导，建立静脉通路并插管。", + "B": "在急诊科建立静脉通路并进行液体复苏，然后再进入手术室。", + "C": "直接进入手术室，建立静脉通路，并在尽可能少的镇静下通过电灼止血。", + "D": "咨询介入放射科，进行出血侧颈外动脉的栓塞。", + "E": "通过容量复苏和逆转凝血功能障碍进行医学管理。" + } + }, + { + "id": "8991513d-7d0f-5bef-aac5-a030472b5b13", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following blocks is correctly matched with the anatomic location of injection of local anesthetic?", + "A": "Retrobulbar block: extraconal block outside the muscle cone formed by 4 recti muscles", + "B": "Peribulbar block: intraconal block in the middle of the muscle cone", + "C": "Median orbital block: in the space between the medial rectus muscle and the medial orbital wall", + "D": "Superior orbital block: medial to the supraorbital notch and advanced intraconal", + "E": "Subtenon block: in the space between the conjunctiva and subtenon capsule" + }, + "zh": { + "question": "以下哪种阻滞与局部麻醉药注射的解剖位置匹配正确？", + "A": "球后阻滞：肌锥外由4条直肌形成的锥外阻滞", + "B": "球周阻滞：肌锥中部的锥内阻滞", + "C": "中位眼眶阻滞：在内直肌和内侧眼眶壁之间的空间", + "D": "上眼眶阻滞：在眶上切迹内侧并向锥内推进", + "E": "筋膜下阻滞：在结膜和筋膜下囊之间的空间" + } + }, + { + "id": "212e824b-95fe-538f-b966-e48ff25ac209", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "34. Which of the following correctly describes the pathway involved with the oculocardiac reflex?", + "A": "Cranial nerve V → medulla → cranial nerve X", + "B": "Cranial nerve V → medulla → cardiac accelerator fibers", + "C": "Cranial nerve VII → midbrain → cervical parasympathetics", + "D": "Cranial nerve VII → medulla → cranial nerve V", + "E": "Cranial nerve V → pons → cervical parasympathetics" + }, + "zh": { + "question": "34. 以下哪项正确描述了眼心反射所涉及的通路？", + "A": "颅神经 V → 延髓 → 颅神经 X", + "B": "颅神经 V → 延髓 → 心脏加速纤维", + "C": "颅神经 VII → 中脑 → 颈部副交感神经", + "D": "颅神经 VII → 延髓 → 颅神经 V", + "E": "颅神经 V → 脑桥 → 颈部副交感神经" + } + }, + { + "id": "824e86b3-d6a0-568f-8130-a6bb8af95799", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following complications of ophthalmic regional anesthesia is correctly paired?", + "A": "Optic nerve sheath injection: retinal detachment/loss of vision", + "B": "Intra-arterial injection: loss of vision", + "C": "Globe penetration/injection: epidural injection", + "D": "Extraocular muscle injury: diplopia", + "E": "Trauma to the optic nerve: local anesthetic toxicity, seizure activity" + }, + "zh": { + "question": "以下哪种眼科区域麻醉的并发症配对正确？", + "A": "视神经鞘注射：视网膜脱离/视力丧失", + "B": "动脉内注射：视力丧失", + "C": "眼球穿透/注射：硬膜外注射", + "D": "眼外肌损伤：复视", + "E": "视神经损伤：局部麻醉药毒性，癫痫活动" + } + }, + { + "id": "102b0158-ccc9-567b-97ea-1f4fd0ff11ee", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following ophthalmic medications is correctly paired with its side", + "A": "Epinephrine topical solution: reflex bradycardia", + "B": "Echothiophate: increased longevity of succinylcholine", + "C": "Cyclopentolate: sedation", + "D": "Acetazolamide: metabolic alkalosis", + "E": "Sulfur hexafluoride: nitrous oxide is not contraindicated" + }, + "zh": { + "question": "以下哪种眼科药物与其副作用正确配对？", + "A": "外用肾上腺素溶液：反射性心动过缓", + "B": "依可硫酸：延长琥珀胆碱的作用时间", + "C": "环戊酸酯：镇静", + "D": "乙酰唑胺：代谢性碱中毒", + "E": "六氟化硫：一氧化二氮不禁忌" + } + }, + { + "id": "ba83765a-5bad-59a0-8589-84ea55705d37", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following ophthalmic medications is correctly paired with its side effect or anesthetic complication?", + "A": "Dipivefrin hydrochloride: trigger angle-closure glaucoma attack", + "B": "Phenylephrine topical solution: reflex tachycardia", + "C": "Timolol: meiosis", + "D": "Apraclonidine: agitation", + "E": "Scopolamine topical solution: sedation in the elderly" + }, + "zh": { + "question": "以下哪种眼科药物与其副作用或麻醉并发症正确配对？", + "A": "盐酸二磷酸肾上腺素：引发闭角型青光眼发作", + "B": "局部溶液去氧肾上腺素：反射性心动过速", + "C": "噻吗洛尔：缩瞳", + "D": "阿普拉克洛尼定：激动", + "E": "局部溶液东莨菪碱：老年人镇静" + } + }, + { + "id": "56512a8a-8ef3-5045-9f1b-592e72a01df8", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following medications, when administered intravenously, is MOST associated with increased ocular pressure?", + "A": "Midazolam", + "B": "Ketamine", + "C": "Propofol", + "D": "Dexmedetomidine", + "E": "Etomidate" + }, + "zh": { + "question": "以下哪种药物静脉注射时最容易导致眼压升高？", + "A": "咪达唑仑", + "B": "氯胺酮", + "C": "丙泊酚", + "D": "右美托咪定", + "E": "依托咪酯" + } + }, + { + "id": "ba65ed13-e863-532b-97cf-6bf92adeed2d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following can increase intraocular pressure (IOP)?", + "A": "Hypoxia", + "B": "Hypotension", + "C": "Hypothermia", + "D": "Hyperventilation", + "E": "Enhanced venous outflow" + }, + "zh": { + "question": "以下哪项可以增加眼内压（IOP）？", + "A": "缺氧", + "B": "低血压", + "C": "低体温", + "D": "过度通气", + "E": "增强静脉回流" + } + }, + { + "id": "3cafbea4-d51a-5d78-ab8d-80241357da5b", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 17-year-old boy presents to the ED with an open globe injury after being hit in the eye by a line drive while playing baseball. He had a hot dog just before sustaining his injury. Which of the following statements is MOST correct with regard to attempting to prevent increased ocular pressure with the induction of general anesthesia?", + "A": "A. Benzodiazepine premedication is contraindicated.", + "B": "Succinylcholine should be avoided at all cost.", + "C": "Awake fiberoptic intubation with minimal sedation or topicalization is the \"gold standard\" approach.", + "D": "Direct pressure to the globe by an assistant should be provided during directlaryngoscopy to limit any extrusion of vitreal contents.", + "E": "Every effort should be made to limit Valsalva or coughing during intubation." + }, + "zh": { + "question": "一名17岁男孩在打棒球时被直线球击中眼睛后，因开放性眼球损伤来到急诊室。他在受伤前刚吃了一个热狗。关于在全身麻醉诱导时尝试防止眼内压升高，下列哪项陈述是最正确的？", + "A": "A. 苯二氮䓬类药物的术前用药是禁忌的。", + "B": "无论如何都应避免使用琥珀胆碱。", + "C": "在清醒状态下进行纤维支气管镜插管并进行最小镇静或局部麻醉是“金标准”方法。", + "D": "在直接喉镜检查期间，助手应对眼球施加直接压力以限制玻璃体内容物的挤出。", + "E": "应尽一切努力限制插管期间的瓦尔萨尔瓦动作或咳嗽。" + } + }, + { + "id": "ef4aa316-c5e2-5e5f-bbd7-c651ec20dd20", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is MOST correct concerning the anesthetic implication of sulfur hexafluoride injection for retinal detachment?", + "A": "Nitrous oxide is contraindicated following injection with sulfur hexafluoride; however, it is safe to use with octafluoropropane.", + "B": "Nitrous oxide should be discontinued 15-20 minutes before injection of gas into the globe.", + "C": "At least a 30-day safety margin should be given before nitrous oxide is used for a patient who received an unknown intraocular gas injection.", + "D": "The worst complication of nitrous oxide use with an intraocular gas bubble is transient diplopia.", + "E": "At least a 15-day safety margin should be given before nitrous oxide is used for a patient who received an intraocular air injection." + }, + "zh": { + "question": "关于六氟化硫注射用于视网膜脱离的麻醉影响，下列哪项陈述是最正确的？", + "A": "注射六氟化硫后禁用氧化亚氮；然而，与八氟丙烷一起使用是安全的。", + "B": "在将气体注入眼球之前，应在15-20分钟内停止使用氧化亚氮。", + "C": "对于接受未知眼内气体注射的患者，在使用氧化亚氮之前应至少有30天的安全间隔。", + "D": "使用氧化亚氮与眼内气泡的最严重并发症是短暂复视。", + "E": "对于接受眼内空气注射的患者，在使用氧化亚氮之前应至少有15天的安全间隔。" + } + }, + { + "id": "24e0bdce-ecea-56e9-accc-65de6323f81f", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "When considering surgical placement of a cochlear implant, which of the following is MOST important regarding the anesthetic management?", + "A": "Nitrous oxide is absolutely contraindicated.", + "B": "Conscious sedation is the preferred technique.", + "C": "Regional block and local anesthetic infiltration provide superior surgical outcomes.", + "D": "Patient immobility is paramount.", + "E": "Mean arterial pressures should be maintained at greater than 65 mm Hg to ensure middle ear perfusion during mastoidotomy." + }, + "zh": { + "question": "在考虑人工耳蜗植入手术时，以下哪项对麻醉管理最重要？", + "A": "一氧化二氮绝对禁忌。", + "B": "意识镇静是首选技术。", + "C": "区域阻滞和局部麻醉浸润可提供更好的手术效果。", + "D": "患者不动是最重要的。", + "E": "平均动脉压应保持在65 mm Hg以上，以确保乳突切开术期间中耳的灌注。" + } + }, + { + "id": "5e9453bc-02a2-5564-9be5-1cdd222288bd", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 55-year-old woman is in the second hour of a middle ear exploration with eventual stapedotomy. Current vital signs are as follows: HR 85, BP 145/83, RR 16, SpO2 99%, and ETCO2 40 mm Hg. The current anesthetic is a propofol/remifentanil total IV anesthetic. The surgeon reports \"more bleeding\" than she expected and asks for your assistance in reducing the blood loss. Which of the following strategies is MOST likely to be effective in limiting surgical bleeding?", + "A": "Increase the respiratory rate on the ventilator to reduce PaCO2 .", + "B": "Add nitrous oxide to the anesthetic.", + "C": "Add paralytic to the anesthetic.", + "D": "Lower BP through deepening the plane of propofol anesthesia or adding an antihypertensive agent.", + "E": "Place the patient in Trendelenburg position." + }, + "zh": { + "question": "一名55岁的女性正在进行中耳探查手术，最终将进行镫骨切开术。当前生命体征如下：心率85，血压145/83，呼吸频率16，血氧饱和度99%，呼气末二氧化碳分压40 mm Hg。当前的麻醉是丙泊酚/瑞芬太尼全静脉麻醉。外科医生报告说出血比预期的多，并请求您协助减少失血。以下哪种策略最有可能有效地限制手术出血？", + "A": "增加呼吸机的呼吸频率以降低动脉二氧化碳分压。", + "B": "在麻醉中加入一氧化二氮。", + "C": "在麻醉中加入肌松药。", + "D": "通过加深丙泊酚麻醉深度或加入降压药来降低血压。", + "E": "将患者置于特伦德伦堡体位。" + } + }, + { + "id": "6cc4df1f-0c49-5e23-8551-1567e200dfe9", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "You are giving a lunch break for a fellow anesthesiologist who has been taking care of a 32-year-old otherwise healthy man who is undergoing functional endoscopic sinus surgery. About 10 minutes into the break, the surgeon notes that \"there is too much bleeding\" and places some fluid-saturated sponges into the nasal passage. Several minutes later, you note that the blood pressure cuff cycles several times before reading 220/110, the patient's heart rate has increased to 130 beats per minute, and there are depressions of the ST segments on the intraoperative ECG. Which of the following treatments is MOST likely to improve the patient's condition?", + "A": "Administration of Dantrolene 1 mg/kg bolus followed by 0/25 mg/kg/h infusion", + "B": "Administration of an intralipid 2.5 mg/kg bolus", + "C": "Transition from a propofol/remifentanil total IV anesthetic to inhalational anesthesia", + "D": "Administration of an intravenous β-blocker", + "E": "Deepening the plane of anesthesia" + }, + "zh": { + "question": "你正在为一位同事麻醉师提供午休，他一直在照顾一位32岁、身体健康的男性患者，该患者正在接受功能性内窥镜鼻窦手术。休息约10分钟后，外科医生注意到“出血过多”，并在鼻腔内放置了一些浸湿的海绵。几分钟后，你注意到血压袖带循环了几次后读数为220/110，患者的心率增加到��分钟130次，并且术中心电图上出现ST段压低。以下哪种治疗最有可能改善患者的状况？", + "A": "给予丹曲林1 mg/kg静脉推注，随后0.25 mg/kg/h输注", + "B": "给予脂肪乳剂2.5 mg/kg静脉推注", + "C": "从丙泊酚/瑞芬太尼全静脉麻醉转换为吸入麻醉", + "D": "给予静脉β受体阻滞剂", + "E": "加深麻醉深度" + } + }, + { + "id": "ab551b18-af7e-53a8-b68c-6fa201a1b064", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "45. Which of the following is an advantage of a deep extubation versus a normal emergence and extubation following fiberoptic endoscopic sinus surgery?", + "A": "There is a lower incidence of laryngospasm.", + "B": "Time to discharge is decreased.", + "C": "It is associated with decreased postoperative opioid use.", + "D": "It can facilitate extubation with minimal movement or bucking.", + "E": "It allows for less intensive postoperative nursing care." + }, + "zh": { + "question": "45. 以下哪项是深度拔管相比于纤维内窥镜鼻窦手术后的正常苏醒和拔管的优点？", + "A": "喉痉挛的发生率较低。", + "B": "出院时间缩短。", + "C": "与术后阿片类药物使用减少有关。", + "D": "可以在最小运动或呛咳的情况下促进拔管。", + "E": "允许较少的术后护理强度。" + } + }, + { + "id": "ffc65a4a-cf97-59c9-9f88-9e7335b4485b", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "You are assigned to give a break to another anesthesiologist just beginning a routine tonsillectomy for a 4-year-old child under general anesthesia with a cuff-less polyvinyl chloride (PVC) ETT. The surgeon is utilizing electrocautery, and you note that the FiO2 is still 95%. Which of the following is the best action to take?", + "A": "Immediately reduce the fresh gas flow to 2 L and turn off the sevoflurane inhalational anesthetic.", + "B": "Ask the surgeon to turn down the intensity of the electrocautery until the FiO2 is below 30%.", + "C": "Immediately tell the surgeon to cease using electrocautery until the FiO2 is below 30%.", + "D": "Allow the surgeon to continue, but turn the oxygen dial to 0 and increase the air dial to maximum, disconnect the circuit from the ETT, occlude the end of the circuit, and \"flush\" it with multiple manual compressions of the reservoir bag.", + "E": "Remove the PVC ETT and exchange it for an armored ETT." + }, + "zh": { + "question": "你被指派去接替另一位麻醉医生，他刚刚开始为一名4岁儿童进行常规扁桃体切除术，使用无袖套的聚氯乙烯（PVC）气管导管进行全身麻醉。外科医生正在使用电灼术，你注意到吸入氧浓度（FiO2）仍然是95%。以下哪项是最佳行动？", + "A": "立即将新鲜气体流量减少到2升，并关闭七氟醚吸入麻醉剂。", + "B": "要求外科医生降低电灼术的强度，直到FiO2低于30%。", + "C": "立即告诉外科医生停止使用电灼术，直到FiO2低于30%。", + "D": "允许外科医生继续，但将氧气旋钮调至0，并将空气旋钮调至最大，断开回路与气管导管的连接，封闭回路末端，并通过多次手动压缩储气袋来“冲洗”回路。", + "E": "移除PVC气管导管并更换为装甲气管导管。" + } + }, + { + "id": "3f1acaea-f0ae-560a-89c6-7ae1ca0d62d0", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "According to the American Society of Anesthesiologists Practice Advisory for the Prevention and Management of Operating Room Fires, the proper management of a nonairway fire includes all of the following EXCEPT which one?", + "A": "Remove the drapes and all burning and flammable materials from the patient.", + "B": "Stop the flow of all airway gases immediately.", + "C": "Remove the ETT.", + "D": "Extinguish flames by pouring saline or smothering.", + "E": "If burning persists, utilize a CO2 fire extinguisher." + }, + "zh": { + "question": "根据美国麻醉医师协会关于预防和管理手术室火灾的实践建议，非气道火灾的正确管理包括以下所有措施，除了哪一项？", + "A": "移除患者身上的手术单和所有燃烧及易燃材料。", + "B": "立即停止所有气道气体的流动。", + "C": "移除气管导管。", + "D": "通过倒生理盐水或覆盖来扑灭火焰。", + "E": "如果火焰持续燃烧，使用二氧化碳灭火器。" + } + }, + { + "id": "c18a4b0c-9fd4-566c-b6b4-0cbcfae04d83", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "An airway fire has just occurred in an adjacent OR where 100% O2 was being used for laser surgery of the vocal cords with a normal PVC ETT, and you are asked to provide assistance. When you arrive, the fire has been put out, there is a burnt and mangled ETT by the anesthesia machine, and the patient is being bag masked on room air. Which of the following describes the best immediate management for this patient?", + "A": "Order a STAT chest X-ray (CXR) in the OR to assess for inhalational injury.", + "B": "Travel to the CT scanner to assess for ETT remnants in the airway.", + "C": "Begin high-volume saline lavage of the lungs.", + "D": "Immediately switch to low FiO2 to avoid further oxygen toxicity.", + "E": "Proceed to rigid or flexible bronchoscopy to assess for plastic remnants and thermal or smoke injury." + }, + "zh": { + "question": "在相邻的手术室中，使用100%氧气进行声带激光手术时发生了气道火灾，使用的是普通PVC气管导管，你被要求提供帮助。当你到达时，火已经被扑灭，麻醉机旁有一个烧焦和扭曲的气管导管，患者正在使用室内空气进行面罩通气。以下哪项描述了对该患者的最佳即时处理？", + "A": "在手术室内紧急安排胸部X光检查（CXR）以评估吸入性损伤。", + "B": "前往CT扫描仪以评估气道内是否有气管导管残留物。", + "C": "开始对肺部进行大容量生理盐水冲洗。", + "D": "立即切换到低氧浓度以避免进一步的氧气毒性。", + "E": "进行硬性或柔性支气管镜检查以评估塑料残留物和热损伤或烟雾损伤。" + } + }, + { + "id": "afd3cf09-b2ec-58e8-b630-1fb2aa6cc406", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is MOST closely linked to OR fires caused by inhalational anesthetics?", + "A": "Use of xenon inhalational anesthesia", + "B": "Use of high FiO2", + "C": "A preceding period of ventilator inactivity", + "D": "High humidity in the breathing circuit", + "E": "Concomitant use of nitrous oxide" + }, + "zh": { + "question": "以下哪项与吸入麻醉剂引起的手术室火灾最密切相关？", + "A": "使用氙气吸入麻醉", + "B": "使用高氧浓度（高FiO2）", + "C": "通气机不活动的前期阶段", + "D": "呼吸回路中的高湿度", + "E": "同时使用一氧化二氮" + } + }, + { + "id": "2e206e86-a82a-57e7-876d-2d176b034f8e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "50. According to the American Society of Anesthesiologists: \"Practice advisory for the prevention and management of operating room fires, \" which of the following is considered a best practice?", + "A": "For every case the entire OR team should take part in determining whether a significant fire risk exists and should jointly take active roles in mitigating the risk of fire.", + "B": "High FiO2 at high flows should be used for sedation procedures to lessen the risk of oxygen accumulation under the drapes.", + "C": "Nitrous oxide should be used as an anesthetic adjunct to mitigate the fire risk of 100% FiO2 .", + "D": "Unipolar electrocautery should be used ahead of bipolar electrocautery to mitigate the risk of fire.", + "E": "If an airway fire is suspected, the ETT should be left in place until rigid bronchoscopy can be used to ensure that the tube is removed intact." + }, + "zh": { + "question": "50. 根据美国麻醉医师协会的建议：“手术室火灾的预防和管理实践指南”，以下哪项被认为是最佳实践？", + "A": "对于每个病例，整个手术室团队应参与确定是否存在重大火灾风险，并共同积极采取措施降低火灾风险。", + "B": "在镇静程序中应使用高流量的高氧浓度以减少氧气在手术单下积聚的风险。", + "C": "应使用氧化亚氮作为麻醉辅助剂以降低100%氧浓度的火灾风险。", + "D": "应优先使用单极电灼术而不是双极电灼术以降低火灾风险。", + "E": "如果怀疑气道火灾，应将气管导管留在原位，直到可以使用硬性支气管镜确保导管完整移除。" + } + }, + { + "id": "dd724951-886f-5c43-9dbc-f17bb24bb1eb", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following qualities make carbon dioxide a suitable gas for intraperitoneal insufflation EXCEPT which one?", + "A": "Noncombustible", + "B": "High blood solubility", + "C": "Clear and colorless", + "D": "Lack of cardiopulmonary effects" + }, + "zh": { + "question": "以下所有特性都使二氧化碳成为适合用于腹腔内充气的气体，除了哪一个？", + "A": "不可燃", + "B": "高血液溶解度", + "C": "透明无色", + "D": "无心肺影响" + } + }, + { + "id": "1db27046-6916-5749-b027-c65d4eb8f0bc", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "A 70-year-old woman is scheduled for total abdominal hysterectomy for endometrial cancer. Her medical history is significant ischemic cardiomyopathy with an ejection fraction of 25% and severe mitral regurgitation. Which of the following is a common effect of pneumoperitoneum seen with laparoscopic surgical procedures that would be least deleterious for her?", + "A": "Pneumoperitoneum-induced increase in systemic vascular resistance (SVR)", + "B": "Release of pneumoperitoneum-related decrease in SVR", + "C": "Hypercapnia-related decrease in arrhythmia threshold", + "D": "Hypercapnia-related increase in pulmonary vascular resistance (PVR)" + }, + "zh": { + "question": "一名70岁的女性计划进行全子宫切除术以治疗子宫内膜癌。她的病史显示显著的缺血性心肌病，射血分数为25%，并伴有严重的二尖瓣返流。以下哪项是腹腔镜手术中常见的气腹效应，对她的危害最小？", + "A": "气腹引起的全身血管阻力（SVR）增加", + "B": "解除气腹相关的SVR降低", + "C": "高碳酸血症相关的心律失常阈值降低", + "D": "高碳酸血症相关的肺血管阻力（PVR）增加" + } + }, + { + "id": "35c4d287-2829-5bed-8386-50f51b7a5149", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "Which of the following patients is likely to be the most negatively affected by", + "A": "A 78-year-old with severe COPD undergoing extraperitoneal laparoscopic inguinal lymph node dissection", + "B": "A 32-year-old with morbid obesity undergoing laparoscopic gastric bypass", + "C": "A 52-year-old with asthma undergoing laparoscopic appendectomy", + "D": "A 72-year-old with congestive heart failure undergoing laparoscopic Nissen fundoplication" + }, + "zh": { + "question": "以下哪位患者可能受到最负面的影响？", + "A": "78岁患有严重COPD的患者，正在接受腹膜外腹腔镜腹股沟淋巴结清扫术", + "B": "32岁患有病态肥胖的患者，正在接受腹腔镜胃旁路手术", + "C": "52岁患有哮喘的患者，正在接受腹腔镜阑尾切除术", + "D": "72岁患有充血性心力衰竭的患者，正在接受腹腔镜Nissen胃底折叠术" + } + }, + { + "id": "bf2bad8d-bedb-52c8-826f-6a736fcd37dc", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 62-year-old man is undergoing laparoscopic Nissen fundoplication. During the procedure, the patient becomes progressively hypoxemic with an oxygenation saturation that falls to 82%. You note a significant rise in end-tidal CO 2 despite hyperventilation, increased peak inspiratory pressure, and unequal chest expansion with ventilation. What should your first action be?", + "A": "Suction the endotracheal tube.", + "B": "Give albuterol.", + "C": "Change the CO2 absorbent.", + "D": "Stop the surgery and deflate the pneumoperitoneum." + }, + "zh": { + "question": "一名62岁的男性正在接受腹腔镜Nissen胃底折叠术。在手术过程中，患者逐渐出现低氧血症，氧饱和度下降至82%。尽管进行了过度通气，但你注意到呼气末二氧化碳显著升高，吸气峰压增加，通气时胸廓扩张不对称。你应该首先采取什么行动？", + "A": "吸引气管插管。", + "B": "给予沙丁胺醇。", + "C": "更换二氧化碳吸收剂。", + "D": "停止手术并放气腹腔。" + } + }, + { + "id": "f34e4f25-bf2f-5d2a-80cf-3f515f58f752", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "5. A 65-year-old woman with a history of hypertension and chronic kidney disease is undergoing a laparoscopic liver resection for hepatocellular carcinoma. You record 100 cc of urine output after positioning at the beginning of the case. Three hours into the procedure, you note the patient has not had any further urine output. The patient is hemodynamically stable, oxygenating and ventilating well, and has no pulse pressure variation in her arterial line tracing. Which of the following is most likely contributing to her low urine output?", + "A": "High central venous pressure", + "B": "Elevated intra-abdominal pressure (IAP) of 22 mm Hg", + "C": "Kinked foley catheter", + "D": "Reverse Trendelenburg position" + }, + "zh": { + "question": "5. 一名65岁的女性，有高血压和慢性肾病病史，正在接受肝细胞癌的腹腔镜肝切除术。在手术开始时定位后，你记录了100毫升的尿量。手术进行三个小时后，你注意到患者没有进一步的尿量。患者血流动力学稳定，氧合和通气良好，动脉线描记中没有脉压变化。以下哪项最有可能导致她尿量低？", + "A": "中心静脉压高", + "B": "腹内压（IAP）升高至22 mm Hg", + "C": "导尿管扭曲", + "D": "反向特伦德伦堡体位" + } + }, + { + "id": "cd1a78b8-4b3e-5b9f-a7ef-93c25b05b506", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 24-year-old woman is scheduled to undergo a laparoscopic appendectomy. The surgeon inserts the Veress needle and insufflates the abdomen to an IAP of 15 mm Hg without incident. As the surgeon proceeds with insertion of the other ports, you note the patients' blood pressure drops precipitously. The end-tidal CO2 remains stable at 38 mm Hg. Given this clinical scenario, what is the most likely cause of the hypotension?", + "A": "CO2 embolism", + "B": "Positioning", + "C": "Deep anesthesia", + "D": "Hemorrhage" + }, + "zh": { + "question": "一名24岁的女性计划进行腹腔镜阑尾切除术。外科医生插入Veress针并将腹腔充气至15 mm Hg的腹内压，未发生意外。当外科医生继续插入其他通道时，你注意到患者的血压急剧下降。呼气末二氧化碳保持在38 mm Hg稳定。在这种临床情况下，低血压最可能的原因是什么？", + "A": "CO2栓塞", + "B": "体位", + "C": "深麻醉", + "D": "出血" + } + }, + { + "id": "cb66d1a9-bc4c-5588-aafe-cb39068ed519", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "All of the following are benefits of laparoscopic versus open surgical procedures EXCEPT which one?", + "A": "Decrease in hypothermia", + "B": "Decrease in postoperative pain", + "C": "Decrease in time to ambulation", + "D": "Minimize surgical incision and stress response" + }, + "zh": { + "question": "以下哪一项不是腹腔镜手术相对于开放手术的优点？", + "A": "减少低体温", + "B": "减少术后疼痛", + "C": "减少术后活动时间", + "D": "减小手术切口和应激反应" + } + }, + { + "id": "bec075a4-5627-564c-a21d-62dac560b190", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 64-year-old woman with obesity and obstructive sleep apnea is undergoing a laparoscopic low anterior resection for colon cancer. Your anesthetic consists of 1.2 minimum alveolar concentration of sevoflurane. Three hours into the procedure, you note her blood pressure and heart rate start to rise. You treat this with 2 mg of hydromorphone. Thirty minutes later they are still elevated and you administer another 2 mg of hydromorphone. You are relieved for a lunch break, and when you return, your colleague tells you he gave another 2 mg of hydromorphone. The heart rate and blood pressure are not improved. Which of the following is the next best step?", + "A": "Increase the sevoflurane.", + "B": "Start a propofol infusion.", + "C": "Give 200 µg of fentanyl.", + "D": "Ensure adequate ventilation to maximize CO2 removal." + }, + "zh": { + "question": "一名64岁患有肥胖和阻塞性睡眠呼吸暂停的女性正在接受腹腔镜低位前切除术以治疗结肠癌。您的麻醉方案包括1.2最低肺泡浓度的七氟醚。手术进行到三个小时时，您注意到她的血压和心率开始上升。您用2毫克氢吗啡酮进行治疗。三十分钟后，它们仍然升高，您又给予了2毫克氢吗啡酮。您被替换去吃午餐，当您回来时，您的同事告诉您他又给了2毫克氢吗啡酮。心率和血压没有改善。以下哪项是下一步最佳措施？", + "A": "增加七氟醚。", + "B": "开始丙泊酚输注。", + "C": "给予200微克芬太尼。", + "D": "确保充分通气以最大化CO2的排出。" + } + }, + { + "id": "916d50f4-21d2-5846-8b75-1551370fae07", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Changes in pulmonary function during laparoscopic procedures include all of the following EXCEPT which one?", + "A": "Reduction in lung volume", + "B": "Reduction in lung compliance", + "C": "Reduction in ventilation-perfusion mismatch", + "D": "Increase in airway pressures" + }, + "zh": { + "question": "腹腔镜手术期间肺功能的变化包括以下所有情况，除了哪一项？", + "A": "肺容量减少", + "B": "肺顺应性降低", + "C": "通气-灌注不匹配减少", + "D": "气道压力增加" + } + }, + { + "id": "e26732a1-ca69-510c-8528-afc4755af021", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "10. A 64-year-old woman with a medical history significant for COPD, coronary artery disease, and diastolic congestive heart failure is undergoing laparoscopic lysis of adhesions and partial colectomy for recurrent colon cancer. You are assigned to take over the case, which has been going for over 8 hours. You find a woman in steep Trendelenburg position covered by drapes. Your colleague signs out that the patient developed a low-dose vasopressor requirement a half hour ago. Over the next hour, the patient becomes more hypotensive requiring increasing dose of vasopressor, and you note the end-tidal CO2 has continued to rise despite maximizing your ventilation strategy. Upon examination of the", + "A": "Treatment with sodium bicarbonate is appropriate.", + "B": "Prolonged operative times is a risk factor for developing subcutaneous emphysema.", + "C": "Subcutaneous emphysema does not have postoperative implications.", + "D": "Subcutaneous emphysema is assumed to be isolated to the chest and neck." + }, + "zh": { + "question": "10. 一名64岁的女性，病史包括慢性阻塞性肺病、冠状动脉疾病和舒张性充血性心力衰竭，正在接受腹腔镜粘连松解术和部分结肠切除术以治疗复发性结肠癌。你被指派接手这个已经进行了超过8小时的手术。你发现一名女性处于陡峭的Trendelenburg体位，被手术单覆盖。你的同事交接时提到患者在半小时前需要低剂量升压药。接下来的一小时内，患者变得更加低血压，需要增加升压药剂量，你注意到尽管最大化了通气策略，呼气末二氧化碳仍在上升。检查时发现", + "A": "使用碳酸氢钠治疗是合适的。", + "B": "手术时间过长是发生皮下气肿的风险因素。", + "C": "皮下气肿没有术后影响。", + "D": "皮下气肿被认为仅限于胸部和颈部。" + } + }, + { + "id": "2d914f3c-936e-523c-8fc0-0198fc6a6239", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Regarding robotic surgery, which of the following statements is false?", + "A": "Robotic surgery improves depth perception.", + "B": "One advantage of robotic surgery is that it broadens the application of minimally invasive surgery.", + "C": "Studies have shown that robotic surgery tends to have shorter operative times when compared with laparoscopic surgery.", + "D": "Robotic surgery enhances a surgeon's skills and can be utilized for technically challenging procedures." + }, + "zh": { + "question": "关于机器人手术，以下哪项陈述是错误的？", + "A": "机器人手术改善了深度感知。", + "B": "机器人手术的一个优点是它拓宽了微创手术的应用。", + "C": "研究表明，与腹腔镜手术相比，机器人手术的手术时间往往更短。", + "D": "机器人手术增强了外科医生的技能，并可用于技术上具有挑战性的手术。" + } + }, + { + "id": "579c3c66-ce6c-5cc4-a837-293f59c0f9b4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The da Vinci robotic surgical system is composed of which of the following?", + "A": "A control console, an equipment tower with an optical system, and a side cart with robotic arms", + "B": "A control console and a robotic platform", + "C": "An equipment tower, which includes equipment that allows the physician to control the robot utilizing any computer and a side car with robotic arms", + "D": "An equipment tower, which includes technology that allows the physician to control the robot utilizing any computer, a control console, and an anesthesia unit" + }, + "zh": { + "question": "达芬奇机器人手术系统由以下哪项组成？", + "A": "控制台、带有光学系统的设备塔和带有机械臂的侧车", + "B": "控制台和机器人平台", + "C": "设备塔，包括允许���生使用任何计算机控制机器人的设备和带有机械臂的侧车", + "D": "设备塔，包括允许医生使用任何计算机控制机器人的技术、控制台和麻醉单元" + } + }, + { + "id": "4149a052-36a8-5b04-a489-d9c8b990e5ea", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A healthy 52-year-old man is scheduled for a robotic prostatectomy. He tells you that he read on the Internet that robotic surgery can have negative impacts on his \"cardiac\" system and he is clearly concerned. Which of the following would be your most appropriate response?", + "A": "The Trendelenburg/head down tilt required for robotic prostatectomies does cause increased strain on the heart.", + "B": "Cardiac performance measures in healthy patients are maintained despite steep Trendelenburg position and pneumoperitoneum.", + "C": "Increased cardiac output in healthy patients has not been shown to increase overall cardiac risk.", + "D": "Increases in SVR can cause an increased cardiac risk even in healthy patients." + }, + "zh": { + "question": "一名健康的52岁男性计划进行机器人前列腺切除术。他告诉你，他在网上看到机器人手术可能对他的“心脏”系统产生负面影响，他显然很担心。以下哪项是你最合适的回应？", + "A": "机器人前列腺切除术所需的特伦德伦堡/头低位确实会对心脏造成更大压力。", + "B": "尽管处于陡峭的特伦德伦堡体位和气腹状态，健康患者的心脏功能指标仍能维持。", + "C": "在健康患者中，心输出量的增加尚未被证明会增加整体心脏风险。", + "D": "即使在健康患者中，SVR的增加也可能导致心脏风险增加。" + } + }, + { + "id": "9719ad1c-a679-53b3-b90e-aa1511f34fba", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "During a robotic surgical procedure, the surgeon tells you the patient is \"tight", + "A": "Additional paralytic is not needed for robotic surgical procedures.", + "B": "You will give additional paralytic, as muscle paralysis reduced IAP needed for the same degree of abdominal distension.", + "C": "Additional paralytic is not needed, as studies have not shown a correlation between the degree of muscle paralysis and surgeons' ability to perform the surgical procedure.", + "D": "You will give additional paralytic, as patient movement during robotic surgery can result in displacement of robotic arms, which can cause potential patient harm." + }, + "zh": { + "question": "在机器人手术过程中，外科医生告诉你病人“紧”", + "A": "机器人手术过程中不需要额外的麻痹药。", + "B": "你将给予额外的麻痹药，因为肌肉麻痹减少了相同程度腹部膨胀所需的腹内压。", + "C": "不需要额外的麻痹药，因为研究未显示肌肉麻痹程度与外科医生进行手术的能力之间的相关性。", + "D": "你将给予额外的麻痹药，因为患者在机器人手术中的移动可能导致机器人手臂移位，从而可能对患者造成伤害。" + } + }, + { + "id": "4fdb615d-c756-5831-83f5-aad573814b0d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "15. Following a laparoscopic cholecystectomy, a 67-year-old patient states that he can feel crackling when he touches his stomach and chest area. Which of the following is a risk for this specific complication following a laparoscopic procedure?", + "A": "Short surgery duration", + "B": "Patient age above 65 years", + "C": "Use of fewer surgical ports", + "D": "Laparoscopic cholecystectomy" + }, + "zh": { + "question": "15. 在腹腔镜胆囊切除术后，一名67岁的患者表示，当他触摸自己的腹部和胸部区域时，能感觉到有咔嚓声。以下哪项是腹腔镜手术后这种特定并发症的风险因素？", + "A": "手术时间短", + "B": "患者年龄超过65岁", + "C": "使用较少的手术通道", + "D": "腹腔镜胆囊切除术" + } + }, + { + "id": "96806999-ea41-5596-a969-911334ea3cee", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 36-year-old man is undergoing a laparoscopic appendectomy. Your anesthetic consists of isoflurane, oxygen, and air. You chose to avoid nitrous oxide secondary to which of the following?", + "A": "The ability of nitrous oxide to contribute significantly to postoperative nausea and vomiting", + "B": "The potential of nitrous oxide to build up in the lumen of bowel, causing distension and obscuring the view of the surgeon", + "C": "The increase in postoperative opioid requirements", + "D": "The increase in IAPs" + }, + "zh": { + "question": "一名36岁的男性正在接受腹腔镜阑尾切除术。您的麻醉方案包括异氟醚、氧气和空气。您选择避免使用氧化亚氮是由于以下哪一项原因？", + "A": "氧化亚氮显著增加术后恶心和呕吐的能力", + "B": "氧化亚氮在肠腔内积聚，导致肠胀气并遮挡外科医生视野的可能性", + "C": "术后阿片类药物需求的增加", + "D": "腹腔内压的增加" + } + }, + { + "id": "2610403e-8984-5f35-a848-721e1c1b8c61", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 63-year-old woman is undergoing a robotic hysterectomy for uterine cancer. The duration of the surgery is 6 hours, and despite aggressive warming maneuvers at the end of the procedure, the patient's core temperature is 35.8°C. Which of the following statements is true regarding the incidence of hypothermia following laparoscopic or robotic surgery?", + "A": "Extra heat loss is thought to occur via convection of cold gas in laparoscopic/robotic surgical procedures.", + "B": "Cold CO2 gas makes esophageal temperature probes inaccurate followinglaparoscopic/robotic procedures.", + "C": "Additional heat loss is thought to occur via radiation, as forced warming blankets can only be placed on a small percentage of body area in laparoscopic/robotic surgical procedures.", + "D": "Heat loss is transient and drastically improves upon cessation of the laparoscopic procedure without the use of additional heating equipment." + }, + "zh": { + "question": "一名63岁的女性正在接受机器人子宫切除术以治疗子宫癌。手术持续时间为6小时，尽管在手术结束时进行了积极的保暖措施，患者的核心体温仍为35.8°C。关于腹腔镜或机器人手术后低体温发生率，下列哪项陈述是正确的？", + "A": "在腹腔镜/机器人手术过程中，额外的热量损失被认为是通过冷气体的对流发生的。", + "B": "在腹腔镜/机器人手术后，冷的CO2气体会使食管温度探头不准确。", + "C": "额外的热量损失被认为是通过辐射发生的，因为在腹腔镜/机器人手术中，强制加热毯只能覆盖身体的一小部分区域。", + "D": "热量损失是暂时的，并且在腹腔镜手术停止后无需使用额外的加热设备就会显著改善。" + } + }, + { + "id": "c1bb6766-56c7-5284-bf80-a65cac35a596", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 61-year-old obese man is undergoing a robotic prostatectomy for prostate cancer. The surgery is technically difficult and lasts approximately 7 hours, most of which the patient is in a steep head down position. Which of the following positioning complications is not attributable to patient positioning in a robotic prostatectomy?", + "A": "Upper airway obstruction because of pharyngeal and laryngeal edema", + "B": "Blindness", + "C": "Numbness and burning of the lower ear lobe", + "D": "Corneal abrasions" + }, + "zh": { + "question": "一名61岁的肥胖男性正在接受机器人辅助前列腺切除术以治疗前列腺癌。手术技术难度大，持续约7小时，其中大部分时间患者处于陡峭的头低位。以下哪种定位并发症与机器人辅助前列腺切除术中的患者定位无关？", + "A": "由于咽喉水肿导致的上呼吸道阻塞", + "B": "失明", + "C": "下耳垂的麻木和灼烧感", + "D": "角膜擦伤" + } + }, + { + "id": "2a2c64e0-9ee8-58cf-9770-2b2cc8e1d849", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 22-year-old man is complaining of pain in both the right upper quadrant and right lower quadrant of his abdomen which he states is a 6/10 upon his arrival to the postoperative anesthesia recovery unit (PACU) following a laparoscopic appendectomy. Given the procedure that the patient underwent, the pain is likely classified as which type of pain?", + "A": "Parietal", + "B": "Referred", + "C": "Visceral", + "D": "Neuropathic" + }, + "zh": { + "question": "一名22岁的男性在腹腔镜阑尾切除术后到达术后麻醉恢复室（PACU）时，抱怨右上腹和右下腹的疼痛，他表示疼痛程度为6/10。鉴于患者所接受的手术，该疼痛可能被归类为哪种类型的疼痛？", + "A": "壁层痛", + "B": "牵涉痛", + "C": "内脏痛", + "D": "神经病理��疼痛" + } + }, + { + "id": "d222a5ac-774b-507d-b385-ee9f501e8cc1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "You are providing anesthesia for an in-office liposuction procedure that is utilizing a tumescent lidocaine technique. What is the maximum dose of lidocaine that can be safely utilized for this procedure?", + "A": "A. 5-7 mg/kg", + "B": "3-5 mg/kg", + "C": "15-25 mg/kg", + "D": "35-55 mg/kg" + }, + "zh": { + "question": "您正在为一项使用肿胀利多卡因技术的办公室抽脂手术提供麻醉。此手术中利多卡因的最大安全剂量是多少？", + "A": "A. 5-7 mg/kg", + "B": "B. 3-5 mg/kg", + "C": "C. 15-25 mg/kg", + "D": "D. 35-55 mg/kg" + } + }, + { + "id": "986c3518-f712-5828-9264-84b25d21bc8a", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "During a liposuction procedure that is utilizing the tumescent lidocaine technique, the patient begins to desaturate and reports feeling anxious. She begins to cough and you note she has almost pink, frothy sputum. You begin to suspect that the cause of her symptoms originates from which of the following?", + "A": "Pulmonary edema", + "B": "Pulmonary embolism", + "C": "Hemorrhage", + "D": "Abdominal viscous perforation" + }, + "zh": { + "question": "在使用肿胀利多卡因技术的抽脂手术中，患者开始出现氧饱和度下降并报告感到焦虑。她开始咳嗽，你注意到她有几乎粉红色的泡沫痰。你开始怀疑她的症状来源于以下哪种原因？", + "A": "肺水肿", + "B": "肺栓塞", + "C": "出血", + "D": "腹腔脏器穿孔" + } + }, + { + "id": "e88ca6f6-d4b7-54d6-b091-db984d7d22d2", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 28-year-old woman is undergoing a blepharoplasty under minimum alveolar concentration anesthesia. Before the start of the procedure, you give her a small amount of midazolam and place a nasal cannula with an FiO2 of 60%. After the surgeon injects a local anesthetic, it will be important for you to communicate the timing of which part of the procedure to prevent an adverse intraoperative event?", + "A": "Scalpel usage", + "B": "Need for additional local anesthetic", + "C": "Tissue removal", + "D": "Use of electrocautery" + }, + "zh": { + "question": "一名28岁的女性正在接受最低肺泡浓度麻醉下的眼睑成形术。在手术开始前，你给她少量咪达唑仑，并放置了氧浓度为60%的鼻导管。在外科医生注射局部麻醉剂后，为了防止术中不良事件，你需要沟通手术的哪个部分的时间？", + "A": "使用手术刀", + "B": "需要额外的局部麻醉剂", + "C": "组织切除", + "D": "使用电灼术" + } + }, + { + "id": "b6903688-0ca7-55d7-a61e-434244249c01", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "You are performing a preoperative interview with a 38-year-old woman just before the start of her planned procedure of a tissue graft to her right thigh for a scald injury. Which of the following is not considered to be a risk factor associated with poor wound healing?", + "A": "Smoking", + "B": "Marijuana use", + "C": "Poor nutrition", + "D": "Obesity" + }, + "zh": { + "question": "您正在为一名38岁女性进行术前访谈，她即将进行右大腿烫伤的组织移植手术。以下哪一项不被认为是与伤口愈合不良相关的风险因素？", + "A": "吸烟", + "B": "大麻使用", + "C": "营养不良", + "D": "肥胖" + } + }, + { + "id": "1f642da9-e1ca-50a7-8dbf-09f0306196dc", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "You are performing a laparoscopic cholecystectomy on a 49-year-old obese woman with a past medical/surgical history of a right-sided mastectomy and lymph node dissection for breast cancer, hepatitis C, and a remote history of IV drug abuse. As you attempt to place the IV, you note that the patient does not have many sites where an IV can be placed. Even after utilizing ultrasound, you can only see the median cubital vein clearly on the right. The patient tells you she has always been told to never let anyone place an IV on her right arm. Which of the following do you inform the patient?", + "A": "She may need central vascular access if no superficial cite can be found.", + "B": "The median cubital vein on the ipsilateral side of her previous surgical procedure should be utilized because there is poor evidence that needlesticks on the same side as a previous lymph node dissection contribute to lymphedema.", + "C": "Venous access on the ipsilateral side of her mastectomy and lymph node dissection is unlikely to cause lymphedema if good skin hygiene is utilized following the procedure.", + "D": "She should have a peripherally inserted central catheter line placed under fluoroscopy." + }, + "zh": { + "question": "您正在为一名49岁的肥胖女性进行腹腔镜胆囊切除术，该患者有右侧乳腺癌切除术和淋巴结清扫术的病史，丙型肝炎，以及静脉药物滥用的远期病史。当您尝试放置静脉注射时，您注意到患者没有很多可以放置静脉注射的部位。即使使用超声波，您也只能清楚地看到右侧的肘正中静脉。患者告诉您，她一直被告知绝不能让任何人在她的右臂上放置静脉注射。您会告知患者以下哪项？", + "A": "如果找不到浅表部位，她可能需要中心血管通路。", + "B": "应使用她先前手术程序同侧的肘正中静脉，因为缺乏证据表明在先前淋巴结清扫同侧进行针刺会导致淋巴水肿。", + "C": "如果在手术后保持良好的皮肤卫生，乳腺切除术和淋巴结清扫同侧的静脉通路不太可能导致淋巴水肿。", + "D": "应在透视下放置外周插入的中心静脉导管。" + } + }, + { + "id": "d0a49fec-5c1a-5e2e-a5b5-11bfb51d63b4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 25-year-old man is brought to the emergency department after being involved in an accident. All of his fingers have been amputated from his right hand, and digital reimplantation is planned. After a successful surgical procedure, the patient is brought to the PACU. Which of the following has not been shown to influence the viability of the reimplantation?", + "A": "Room temperature", + "B": "Pain control", + "C": "Hydration status", + "D": "Secure dressing" + }, + "zh": { + "question": "一名25岁的男子在发生事故后被送到急诊科。他右手的所有手指都被截断，计划进行手指再植术。手术成功后，患者被送到麻醉恢复室。以下哪项未被证明会影响再植的存活率？", + "A": "室温", + "B": "疼痛控制", + "C": "水合状态", + "D": "固定敷料" + } + }, + { + "id": "485fafbb-30d2-51d4-bb3f-8883d1d7cfb1", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A healthy 24-year-old man fell while he was snowboarding and was found to have a complete rotator cuff tear of his left shoulder. You would like to perform a peripheral nerve block under ultrasound guidance for intraoperative and postoperative analgesia. Which of the following is the most common complication for which you should counsel the patient?", + "A": "Ipsilateral pneumothorax", + "B": "Ipsilateral phrenic nerve paresis", + "C": "Infection at the site of the peripheral block", + "D": "Peripheral nerve block failure", + "E": "Ipsilateral Horner syndrome" + }, + "zh": { + "question": "一名健康的24岁男性在滑雪时摔倒，被发现左肩袖完全撕裂。您希望在超声引导下进行外周神经阻滞，以便术中和术后镇痛。以下哪项是您应告知患者的最常见并发症？", + "A": "同侧气胸", + "B": "同侧膈神经麻痹", + "C": "外周阻滞部位感染", + "D": "外周神经阻滞失败", + "E": "同侧霍纳综合征" + } + }, + { + "id": "1e33e94a-207c-547b-9681-d24902f6e671", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 35-year-old woman was involved in a motor vehicle accident and broke her right ulna. She reports using heroin daily. You have already performed an upper-extremity brachial plexus block, but she reports anesthesia in all digits except her fifth digit. The surgeon asks you to supplement her block. Where should you inject local anesthesia?", + "A": "Within the coracobrachialis muscle near its point of insertion on the humerus", + "B": "Medial to the brachial artery in the antecubital fossa", + "C": "Between the humeral and ulnar heads of the flexor carpi ulnaris muscle", + "D": "Posterior to the axillary artery in the axilla" + }, + "zh": { + "question": "一名35岁的女性卷入了一场机动车事故，右尺骨骨折。她报告每天使用海洛因。您已经进行了上肢臂丛神经阻滞，但她报告除了第五指外，其他手指都有麻醉。外科医生要求您补充她的阻滞。您应该在哪里注射局部麻醉药？", + "A": "在喙肱肌靠近其在肱骨上的插入点处", + "B": "在肘窝内侧靠近肱动脉", + "C": "在尺侧腕屈肌的肱骨头和尺骨头之间", + "D": "在腋窝内腋动脉的后方" + } + }, + { + "id": "e2fba263-af02-533b-85f2-dd240c5f2bf5", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "You are the anesthesiologist for a 19-year-old man who is scheduled to undergo", + "A": "Between the semimembranosus and biceps femoris muscles", + "B": "Between the greater trochanter and the ischial tuberosity", + "C": "Lateral to the femoral artery in the inguinal groove", + "D": "Deep to the sartorius muscle and medial to the vastus medialis muscle", + "E": "Between the adductor longus and adductor brevis muscles" + }, + "zh": { + "question": "您是一名麻醉师，负责为一名19岁的男性进行手术", + "A": "在半膜肌和股二头肌之间", + "B": "在大转子和坐骨结节之间", + "C": "在腹股沟沟的股动脉外侧", + "D": "在缝匠肌深处和股内侧肌内侧", + "E": "在长收肌和短收肌之间" + } + }, + { + "id": "afef10bb-fd3a-5dc3-b4ec-2056319069bd", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "A 68-year-old patient is scheduled to undergo a left total knee replacement. He has a history of hypertension and coronary artery disease and had drug-eluting stents placed 6 months ago. His daily medications include aspirin 81 mg (last taken 1 d ago), clopidogrel 75 mg (last taken 3 d ago), metoprolol 100 mg (last taken 1 d ago), and a multivitamin (last taken 1 d ago). You are counseling him", + "A": "Neuraxial anesthesia", + "B": "General anesthesia", + "C": "Femoral nerve block", + "D": "Sciatic nerve block", + "E": "Any are appropriate" + }, + "zh": { + "question": "一名68岁的患者计划进行左侧全膝关节置换术。他有高血压和冠状动脉疾病的病史，6个月前放置了药物洗脱支架。他的日常药物包括阿司匹林81 mg（最后一次服用是1天前）、氯吡格雷75 mg（最后一次服用是3天前）、美托洛尔100 mg（最后一次服用是1天前）和多种维生素（最后一次服用是1天前）。你正在为他提供咨询", + "A": "椎管内麻醉", + "B": "全身麻醉", + "C": "股神经阻滞", + "D": "坐骨神经阻滞", + "E": "任何一种都合适" + } + }, + { + "id": "72ad6636-088c-589a-82c5-7a94c173839b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "An 85-year-old patient with mild dementia, hypertension, paroxysmal atrial fibrillation on Coumadin, and chronic kidney disease fell and fractured her femoral shaft. The orthopedic surgeons need to place intramedullary nails. Her health care proxy is at bedside, and you discuss the risks and benefits of regional and general anesthesia with the health care proxy. Which of the following statements is correct?", + "A": "Provided her international neutralized ratio (INR) is less than 1.5, a neuraxial technique is safe.", + "B": "Provided her INR is less than 1.8, a neuraxial technique is safe.", + "C": "Provided her INR is less than 2.0, a neuraxial technique is safe.", + "D": "Provided her INR is less than 2.0, a neuraxial technique is safe if she receives 1 unit of fresh frozen plasma." + }, + "zh": { + "question": "一名85岁的患者患有轻度痴呆、高血压、服用华法林的阵发性房颤和慢性肾病，跌倒后股骨干骨折。骨科医生需要放置髓内钉。她的医疗代理在床边，你与医疗代理讨论了区域麻醉和全身麻醉的风险和收益。以下哪项陈述是正确的？", + "A": "如果她的国际标准化比值（INR）小于1.5，神经轴技术是安全的。", + "B": "如果她的INR小于1.8，神经轴技术是安全的。", + "C": "如果她的INR小于2.0，神经轴技术是安全的。", + "D": "如果她的INR小于2.0，并且她接受1单位的新鲜冰冻血浆，神经轴技术是安全的。" + } + }, + { + "id": "38f8e9ee-651d-5ece-bac3-72c01f8e0087", + "choice_num": 6, + "answer": "D", + "level": 1, + "en": { + "question": "A 22-year-old man severed his first and second digits. You elect to place an infraclavicular catheter for use intraoperatively and postoperatively. To provide adequate coverage, the cords that must be covered are:", + "A": "Lateral cord", + "B": "Medial cord", + "C": "Posterior cord", + "D": "A, B, and C", + "E": "A and B", + "F": "A and C" + }, + "zh": { + "question": "一名22岁的男子断了他的第一和第二指。您选择放置锁骨下导管以用于术中和术后。为了提供足够的覆盖，必须覆盖的神经束是：", + "A": "外侧束", + "B": "内侧束", + "C": "后束", + "D": "A、B和C", + "E": "A和B", + "F": "A和C" + } + }, + { + "id": "4bb8c513-0d8b-5809-bd42-d477390c7c50", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "8. While snowboarding, a 33-year-old man suffered a bimalleolar ankle fracture. You are planning a regional anesthetic technique as his primary anesthetic using nerve stimulation. You elicit a foot twitch of plantar flexion. This response means that your needle must be located:", + "A": "Medially, within the semitendinosus muscle, and the needle should be redirected laterally", + "B": "Laterally, eliciting stimulation of the biceps femoris muscle, and the needle should be redirected medially", + "C": "Near the common peroneal nerve, eliciting a foot twitch, and the needle shouldnot be redirected", + "D": "Near the tibial nerve, eliciting a foot twitch, and the needle should not be redirected" + }, + "zh": { + "question": "8. 在滑雪时，一名33岁的男子遭遇了双踝骨折。您计划使用神经刺激作为他的主要麻醉方法进行区域麻醉。您引发了足部跖屈的抽动。这一反应意味着您的针头必须位于：", + "A": "内侧，位于半腱肌内，针头应向外侧重新定向", + "B": "外侧，刺激股二头肌，针头应向内侧重新定向", + "C": "靠近腓总神经，引发足部抽动，针头不应重新定向", + "D": "靠近胫神经，引发足部抽动，针头不应重新定向" + } + }, + { + "id": "7807014f-2f42-51a4-8daa-ff6de9bde64a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Before confirmation of the anatomy with ultrasonography, you anticipate that the femoral nerve is located _____ and is responsible for _____.", + "A": "Lateral to the femoral artery; knee extension", + "B": "Medial to the femoral artery; hip flexion", + "C": "Medial to the femoral artery; knee flexion", + "D": "Lateral to the femoral artery; hip flexion" + }, + "zh": { + "question": "在用超声确认解剖结构之前，您预计股神经位于_____，负责_____。", + "A": "股动脉的外侧；膝关节伸展", + "B": "股动脉的内侧；髋关节屈曲", + "C": "股动脉的内侧；膝关节屈曲", + "D": "股动脉的外侧；髋关节屈曲" + } + }, + { + "id": "2bfeccc8-b49b-5d8f-ac37-1987a9ba9b1d", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 73-year-old man is scheduled for a right total knee arthroplasty for severe osteoarthritis. He has a history of aortic stenosis with an aortic valve area of 1.1 cm2 , hypertension, and chronic obstructive pulmonary disease. He takes lisinopril daily and is not on home oxygen. The surgeons are eager for him to engage in physical therapy on postoperative day 0. Consequently, you would like to minimize weakness of the quadriceps muscle. You believe the best anesthetic and analgesic plan for this patient is to:", + "A": "Offer a femoral nerve block and general anesthesia", + "B": "Offer a femoral nerve block and spinal anesthesia", + "C": "Offer a saphenous nerve block and general anesthesia", + "D": "Offer a saphenous nerve block and spinal anesthesia", + "E": "Forego a peripheral nerve block given his aortic stenosis and proceed with general anesthesia" + }, + "zh": { + "question": "一名73岁的男性计划进行右侧全膝关节置换术以治疗严重的骨关节炎。他有主动脉瓣狭窄（主动脉瓣面积为1.1 cm²）、高血压和慢性阻塞性肺病的病史。他每天服用赖诺普利，但不使用家庭氧疗。外科医生希望他在术后第0天进行物理治疗。因此，您希望尽量减少股四头肌的无力。您认为对该患者最佳的麻醉和镇痛方案是：", + "A": "提供股神经阻滞和全身麻醉", + "B": "提供股神经阻滞和脊髓麻醉", + "C": "提供隐神经阻滞和全身麻醉", + "D": "提供隐神经阻滞和脊髓麻醉", + "E": "考虑到他的主动脉瓣狭窄，放弃外周神经阻滞，进行全身麻醉" + } + }, + { + "id": "c3677a6a-f502-5e46-8ce1-f433edc86a10", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "12. A 81-year-old man presents for an open reduction and internal fixation of his distal tibial fracture after he suffered a mechanical fall at home. He currently takes clopidogrel 75 mg daily, hydrochlorothiazide 12.5 mg daily, and omeprazole. His family is very anxious about general anesthesia. You would like to offer a regional anesthetic and counsel him and his family that:", + "A": "Although there are small risks of bleeding, infection, and postdural puncture headache, you will proceed with neuraxial anesthesia.", + "B": "You can offer regional anesthesia if he has stopped his clopidogrel for 5 days.", + "C": "You can offer regional anesthesia if he has stopped his clopidogrel for 7 days.", + "D": "You can offer regional anesthesia if he has stopped his clopidogrel for 14 days.", + "E": "You can offer regional anesthesia if his INR is less than 1.5." + }, + "zh": { + "question": "12. 一名81岁的男性因在家中机械性跌倒后出现远端胫骨骨折，现需进行开放复位内固定手术。他目前每天服用75毫克氯吡格雷、12.5毫克氢氯噻嗪和奥美拉唑。他的家人对全身麻醉非常焦虑。您希望提供区域麻醉并告知他和他的家人：", + "A": "尽管存在小的出血、感染和硬膜穿刺后头痛的风险，您将进行椎管内麻醉。", + "B": "如果他停用氯吡格雷5天，可以提供区域麻醉。", + "C": "如果他停用氯吡格雷7天，可以提供区域麻醉。", + "D": "如果他停用氯吡格雷14天，可以提供区域麻醉。", + "E": "如果他的INR小于1.5，可以提供区域麻醉。" + } + }, + { + "id": "99b0b0f5-6981-5675-864d-e374b93d7b14", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 22-year-old incarcerated woman was involved in a fight and subsequently suffered a distal radius fracture. The surgeon informs you that the procedure will take under an hour, and he plans to use a tourniquet. You decide to offer the patient a regional anesthetic. You can offer her:", + "A": "Supraclavicular nerve block", + "B": "Infraclavicular nerve block with intercostobrachial nerve block", + "C": "Interscalene nerve block with intercostobrachial nerve block", + "D": "Paravertebral nerve block", + "E": "Regional anesthesia is inappropriate for this patient" + }, + "zh": { + "question": "一名22岁的被监禁女性参与了一场打斗，随后遭受了远端桡骨骨折。外科医生告知您手术将在一小时内完成，并计划使用止血带。您决定为患者提供区域麻醉。您可以为她提供：", + "A": "锁骨上神经阻滞", + "B": "锁骨下神经阻滞联合肋间臂神经阻滞", + "C": "斜角肌间神经阻滞联合肋间臂神经阻滞", + "D": "椎旁神经阻滞", + "E": "区域麻醉不适合该患者" + } + }, + { + "id": "856166f1-ef0f-5ae9-bbbe-280b0661e9fd", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 19-year-old baseball player is scheduled to undergo repair of his ulnar collateral ligament. He would like a peripheral nerve block. You choose to perform a(n):", + "A": "Interscalene nerve block", + "B": "Sciatic nerve block", + "C": "Femoral nerve block", + "D": "Supraclavicular nerve block" + }, + "zh": { + "question": "一名19岁的棒球运动员计划进行尺侧副韧带修复手术。他希望进行外周神经阻滞。你选择进行：", + "A": "斜角肌间神经阻滞", + "B": "坐骨神经阻滞", + "C": "股神经阻滞", + "D": "锁骨上神经阻滞" + } + }, + { + "id": "b673a421-fe2f-5276-ad46-58e0f6bedaa4", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 53-year-old woman with chronic obstructive pulmonary disease on 2 L of oxygen at baseline and end-stage renal disease is scheduled to undergo an arteriovenous fistula creation. The surgeon requests a regional anesthetic. You perform a peripheral nerve block, and intraoperatively, the surgeon complains that the patient does not have anesthesia on her lateral forearm. You fear that you may have missed the:", + "A": "Intercostobrachial nerve", + "B": "Lateral cord", + "C": "Musculocutaneous nerve", + "D": "Posterior cord", + "E": "Median nerve" + }, + "zh": { + "question": "一名53岁的女性，患有慢性阻塞性肺病，基础状态下使用2升氧气，并有终末期肾病，计划进行动静脉瘘的创建。外科医生要��进行区域麻醉。你进行了外周神经阻滞术，术中外科医生抱怨患者的外侧前臂没有麻醉。你担心可能遗漏了：", + "A": "肋间臂神经", + "B": "外侧束", + "C": "肌皮神经", + "D": "后束", + "E": "正中神经" + } + }, + { + "id": "98f7b24d-252d-5f6e-9b12-e6289489a62b", + "choice_num": 6, + "answer": "E", + "level": 1, + "en": { + "question": "The block identified in the question above targets which nerves?", + "A": "Ilioinguinal nerve", + "B": "Iliohypogastric nerve", + "C": "Intercostal nerve", + "D": "Subcostal nerve", + "E": "All of the above", + "F": "A and B- G. A, B, and D" + }, + "zh": { + "question": "上面问题中提到的阻滞针对哪些神经？", + "A": "髂腹股沟神经", + "B": "髂腹下神经", + "C": "肋间神经", + "D": "肋下神经", + "E": "以上所有", + "F": "A和B" + } + }, + { + "id": "78dd13e9-c9e5-5001-b89f-8c467867aeed", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 67-year-old man underwent a peripheral nerve block for his reverse total shoulder arthroplasty 1 week ago. On his follow-up visit, his wrist remains in flexion. You determine that he has suffered an injury to his:", + "A": "Radial nerve", + "B": "Median nerve", + "C": "Ulnar nerve", + "D": "Musculocutaneous nerve", + "E": "Axillary nerve" + }, + "zh": { + "question": "一名67岁的男性在1周前接受了反向全肩关节置换术的周围神经阻滞。在他的随访中，他的手腕仍然处于屈曲状态。您确定他受伤的是：", + "A": "桡神经", + "B": "正中神经", + "C": "尺神经", + "D": "肌皮神经", + "E": "腋神经" + } + }, + { + "id": "d3f5eaf4-754e-555a-99af-b8d5e96b887e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "19. A 27-year-old man who has a history of type 1 diabetes mellitus and recent intravenous heroin use presents for an amputation of his first 3 toes. To provide adequate anesthesia and analgesia, you need to block the:", + "A": "Femoral nerve, sural nerve, superficial peroneal nerve, deep peroneal nerve, posterior tibial nerve", + "B": "Saphenous nerve, sural nerve, common peroneal nerve, lateral femoral cutaneous nerve", + "C": "Femoral nerve, superficial peroneal nerve, deep peroneal nerve, posterior tibial nerve", + "D": "Saphenous nerve, sural nerve, femoral nerve, posterior tibial nerve" + }, + "zh": { + "question": "19. 一名27岁的男性，有1型糖尿病史和近期静脉注射海洛因史，现需进行前三个脚趾的截肢手术。为了提供足够的麻醉和镇痛，你需要阻滞：", + "A": "股神经、腓肠神经、浅腓神经、深腓神经、胫后神经", + "B": "隐神经、腓肠神经、腓总神经、股外侧皮神经", + "C": "股神经、浅腓神经、深腓神经、胫后神经", + "D": "隐神经、腓肠神经、股神经、胫后神经" + } + }, + { + "id": "2b52e399-0344-5c90-8a41-1c2835f8389e", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 16-year-old ice hockey player injured his right arm during a game. He is unable to abduct his fingers and exhibits a loss of sensation over his fourth and fifth digits. This injury may have occurred:", + "A": "Medial to the brachial artery in the antecubital fossa", + "B": "Medial aspect of the olecranon", + "C": "In the humeral groove", + "D": "Medial within the flexor retinaculum" + }, + "zh": { + "question": "一名16岁的冰球运动员在比赛中受伤了右臂。他无法外展手指，并且在第四和第五指上失去了感觉。该损伤可能发生在：", + "A": "肘窝内肱动脉的内侧", + "B": "鹰嘴的内侧", + "C": "肱骨沟内", + "D": "屈肌支持带的内侧" + } + }, + { + "id": "143d5705-5204-5efa-b23b-c07ce3e1bf09", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 20-kg, 5-year-old child suffered traumatic finger amputations of his left hand. You and your colleagues consent the parents for placement of an infraclavicular catheter. After the child is anesthetized, you place the catheter and bolus with 0.2%plain ropivacaine. The maximum dose of ropivacaine in this child is:", + "A": "40 mg", + "B": "60 mg", + "C": "100 mg", + "D": "120 mg", + "E": "140 mg" + }, + "zh": { + "question": "一名20公斤、5岁的儿童左手遭受创伤性手指截肢。你和你的同事征得父母同意后为其放置锁骨下导管。在孩子麻醉后，你放置导管并用0.2%无添加罗哌卡因进行推注。该儿童罗哌卡因的最大剂量是：", + "A": "40 mg", + "B": "60 mg", + "C": "100 mg", + "D": "120 mg", + "E": "140 mg" + } + }, + { + "id": "2ebfcaf3-38f6-5d41-8a40-461f7170c12f", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "In the child mentioned in question 21, the first sign of local anesthetic toxicity is:", + "A": "Bradycardia", + "B": "Hypotension", + "C": "Unresponsiveness", + "D": "Seizures", + "E": "Cardiac arrest" + }, + "zh": { + "question": "在第21题提到的儿童中，局部麻醉药毒性的第一个征兆是：", + "A": "心动过缓", + "B": "低血压", + "C": "无反应", + "D": "癫痫发作", + "E": "心脏骤停" + } + }, + { + "id": "7db19637-6e0e-5edd-9659-a557bb46087a", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The absorption of local anesthetic, from greatest to least, is:", + "A": "Intravenous > intercostal > supraclavicular > caudal > intrathecal", + "B": "Intercostal > caudal > brachial plexus > lumbar plexus > Intrathecal", + "C": "Intravenous > intercostal > caudal > epidural > brachial plexus", + "D": "Transtracheal > intercostal > epidural > brachial plexus > subcutaneous", + "E": "Intrathecal > epidural > sciatic > transtracheal > subcutaneous" + }, + "zh": { + "question": "局部麻醉药的吸收，从大到小，依次是：", + "A": "静脉 > 肋间 > 锁骨上 > 骶管 > 鞘内", + "B": "肋间 > 骶管 > 臂丛 > 腰丛 > 鞘内", + "C": "静脉 > 肋间 > 骶管 > 硬膜外 > 臂丛", + "D": "气管内 > 肋间 > 硬膜外 > 臂丛 > 皮下", + "E": "鞘内 > 硬膜外 > 坐骨 > 气管内 > 皮下" + } + }, + { + "id": "98f8384f-ba2f-5bca-b997-f8911e7f57bb", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Your surgical colleague inquires about performance of a nerve block for a coagulopathic gentleman with fulminant hepatic failure with a MELD score of 41. You educate your colleague that you would use _____ as it is metabolized by ____", + "A": "Lidocaine; pseudocholinesterase", + "B": "Chloroprocaine; pseudocholinesterase", + "C": "Mepivacaine; pseudocholinesterase", + "D": "Bupivacaine; pseudocholinesterase", + "E": "Prilocaine; pseudocholinesterase" + }, + "zh": { + "question": "您的外科同事询问关于为一位患有暴发性肝功能衰竭且MELD评分为41的凝血功能障碍患者进行神经阻滞的情况。您告知您的同事您会使用_____，因为它由____代谢", + "A": "利多卡因；假胆碱酯酶", + "B": "氯普鲁卡因；假胆碱酯酶", + "C": "甲哌卡因；假胆碱酯酶", + "D": "布比卡因；假胆碱酯酶", + "E": "丙胺卡因；假胆碱酯酶" + } + }, + { + "id": "ca83f284-8a9c-59f8-9c30-c70526f968b2", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "25. A patient experiences sudden restlessness, dizziness, tinnitus, and what appears to be rhythmic movements of her body following accidental release of an arm tourniquet 10 minutes after performing an intravenous Bier block. Which of the following medications is the most appropriate initial treatment?", + "A": "Physostigmine", + "B": "Phenytoin", + "C": "Midazolam", + "D": "Diphenhydramine", + "E": "Propofol" + }, + "zh": { + "question": "25. 一名患者在进行静脉Bier阻滞后10分钟意外释放手臂止血带，随后出现突然的烦躁不安、头晕、耳鸣以及看似有节律的身体运动。以下哪种药物是最合适的初始治疗？", + "A": "毒扁豆碱", + "B": "苯妥英钠", + "C": "咪达唑仑", + "D": "苯海拉明", + "E": "丙泊酚" + } + }, + { + "id": "aa63c406-c3c2-54ea-968c-9958094f9f96", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A 59-year-old man is undergoing debridement of a nonhealing foot ulcer. An ankle block was performed using a landmark technique. One hour following performance of the block, the surgeon makes incision, but the patient describes pain on the plantar surface of the foot. Failure to anesthetize which of the following nerves is responsible?", + "A": "Sural nerve", + "B": "Deep peroneal nerve", + "C": "Superficial peroneal nerve", + "D": "Posterior tibial nerve", + "E": "Saphenous nerve" + }, + "zh": { + "question": "一名59岁的男性正在进行难愈性足部溃疡的清创术。使用标志技术进行了踝阻滞。阻滞实施一小时后，外科医生进行切口，但患者描述足底表面有疼痛感。未能麻醉以下哪个神经是原因？", + "A": "腓肠神经", + "B": "深腓神经", + "C": "浅腓神经", + "D": "胫后神经", + "E": "隐神经" + } + }, + { + "id": "1d7b0f8b-818f-5469-b3ae-637471e0f44b", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "A 66-year-old man with a history of emphysema (on 2 L nasal cannula oxygen at night) and atrial fibrillation (on warfarin) had a witnessed fall while at home. He suffered a small subdural hematoma, left proximal humerus fracture, leftsided rib fractures (ribs 6-8), and a right-sided hemothorax. He is alert and oriented. Neurology recommended monitoring his subdural hematoma. He is saturating 93%on 3 L nasal cannula. The orthopedic surgeon plans to bring him to the operating room to perform a left total shoulder arthroplasty. You would like to perform a peripheral nerve block to help with postoperative pain control. You decide to perform:", + "A": "Axillary nerve block", + "B": "Suprascapular nerve block", + "C": "Interscalene nerve block", + "D": "Paravertebral nerve block", + "E": "Supraclavicular nerve block" + }, + "zh": { + "question": "一名66岁的男性，有肺气肿病史（夜间使用2升鼻导管氧气）和房颤病史（服用华法林），在家中被目击到摔倒。他患有小的硬膜下血肿、左侧近端肱骨骨折、左侧肋骨骨折（第6-8根肋骨）和右侧血胸。他神志清醒，定向力正常。神经科建议监测他的硬膜下血肿。他在3升鼻导管氧气下的血氧饱和度为93%。骨科医生计划将他送入手术室进行左侧全肩关节置换术。您希望进行外周神经阻滞以帮助术后疼痛控制。您决定进行：", + "A": "腋神经阻滞", + "B": "肩胛上神经阻滞", + "C": "斜角肌间神经阻滞", + "D": "椎旁神经阻滞", + "E": "锁骨上神经阻滞" + } + }, + { + "id": "c293a9ff-9737-5aa4-8fb5-1b5f19c55e13", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 31-year-old intravenous heroin user was involved in a motor vehicle accident and is scheduled for an open reduction and internal fixation of his left ankle. He has been on prophylactic enoxaparin. You should wait for how many hours before inserting a peripheral nerve catheter for postoperative pain control?", + "A": "2 hours", + "B": "8 hours", + "C": "12 hours", + "D": "24 hours", + "E": "72 hours" + }, + "zh": { + "question": "一名31岁的静脉注射海洛因使用者发生了一起机动车事故，计划进行左踝的切开复位内固定手术。他一直在使用预防性依诺肝素。在插入外周神经导管以控制术后疼痛之前，你应该等待多少小时？", + "A": "2小时", + "B": "8小时", + "C": "12小时", + "D": "24小时", + "E": "72小时" + } + }, + { + "id": "c2175a45-8899-5ff5-942e-52d059889388", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 56-year-old woman is scheduled to undergo operative fixation of a left distal humerus fracture. You are performing a supraclavicular nerve block for postoperative pain. You choose to use:", + "A": "20 cc of 0.5% bupivacaine", + "B": "10 cc of 1.5% mepivacaine", + "C": "40 cc of 0.2% ropivacaine", + "D": "30 cc of 0.25% bupivacaine" + }, + "zh": { + "question": "一名56岁的女性计划进行左侧远端肱骨骨折的手术固定。您正在进行锁骨上神经阻滞以缓解术后疼痛。您选择使用：", + "A": "20毫升0.5%布比卡因", + "B": "10毫升1.5%甲哌卡因", + "C": "40毫升0.2%罗哌卡因", + "D": "30毫升0.25%布比卡因" + } + }, + { + "id": "61c33532-9b20-51e1-af90-93691e4875bf", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 14-year-old, 40-kg girl presented to the emergency department as a pedestrian struck by a vehicle. She suffered a right wrist fracture with significant articular displacement necessitating an open reduction and internal fixation. You perform a supraclavicular block using 15 mL of 0.5% bupivacaine. The patient complains of full sensation of her fifth digit. You choose to supplement your block but cannot use more than:", + "A": "12 cc of 0.25% bupivacaine", + "B": "10 cc of 0.5% bupivacaine", + "C": "10 cc of 0.25% bupivacaine", + "D": "9 cc of 0.5% bupivacaine", + "E": "5 cc of 0.5% bupivacaine" + }, + "zh": { + "question": "一名14岁、40公斤的女孩作为行人被车辆撞到后被送到急诊科。她右手腕骨折，关节移位严重，需要进行切开复位和内固定。您使用15毫升0.5%布比卡因进行锁骨上神经阻滞。患者抱怨她的第五指有完全的感觉。您选择补充您的阻滞，但不能使用超过：", + "A": "12毫升0.25%布比卡因", + "B": "10毫升0.5%布比卡因", + "C": "10毫升0.25%布比卡因", + "D": "9毫升0.5%布比卡因", + "E": "5毫升0.5%布比卡因" + } + }, + { + "id": "0f71fb9c-037b-5e2f-b491-4e5b73192d6e", + "choice_num": 6, + "answer": "D", + "level": 2, + "en": { + "question": "A 25-year-old man sustained a pelvic fracture during a motor vehicle accident and has been receiving 5000 units of subcutaneous heparin 3 times daily to prevent deep venous thromboses. He desires an epidural for analgesia. Which of the following laboratory tests is most valuable before epidural placement?", + "A": "Bleeding time", + "B": "Anti-Xa level", + "C": "International neutralized ratio", + "D": "PTT (partial thromboplastin time)", + "E": "PT (prothrombin time)", + "F": "Platelet count" + }, + "zh": { + "question": "一名25岁的男性在一次机动车事故中遭受骨盆骨折，并一直每天3次接受5000单位的皮下注射肝素以预防深静脉血栓。他希望进行硬膜外麻醉以缓解疼痛。在进行硬膜外麻醉前，以下哪项实验室检查最有价值？", + "A": "出血时间", + "B": "抗Xa水平", + "C": "国际标准化比值", + "D": "PTT（部分凝血活酶时间）", + "E": "PT（凝血酶原时间）", + "F": "血小板计数" + } + }, + { + "id": "2407b0e6-37f0-57f1-9611-8e6bf131e958", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "33. A 36-year-old man is undergoing a lower-extremity orthopedic procedure under regional anesthesia. You note that his blood pressure continues to rise despite administration of β-blockers and intravenous opioids, and you suggest to the surgeon that the tourniquet should be deflated. You expect to observe all of the following hemodynamic responses EXCEPT a(n):", + "A": "Decrease in central venous pressure", + "B": "Increase in ETCO2", + "C": "Decrease in minute ventilation", + "D": "Decrease in temperature", + "E": "Decrease in mean arterial pressure" + }, + "zh": { + "question": "33. 一名36岁的男性正在接受下肢骨科手术，使用区域麻醉。尽管给予了β-受体阻滞剂和静脉注射阿片类药物，你注意到他的血压持续升高，并建议外科医生放气止血带。你预计会观察到以下所有血流动力学反应，除了：", + "A": "中心静脉压下降", + "B": "呼气末二氧化碳分压增加", + "C": "分钟通气量下降", + "D": "体温下降", + "E": "平均动脉压下降" + } + }, + { + "id": "7be7e60f-72b6-5964-b6d6-fa5e3bcac990", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 35-year-old man is scheduled to undergo a cubital tunnel release of the right upper extremity. The surgeon plans to use a tourniquet. The patient desires regional anesthesia with monitored anesthesia care. To use an axillary nerve block as your primary anesthetic, you must ensure all of the following nerves are covered EXCEPT:", + "A": "Ulnar nerve", + "B": "Median nerve", + "C": "Intercostobrachial nerve", + "D": "Radial nerve", + "E": "Suprascapular nerve" + }, + "zh": { + "question": "一名35岁的男性计划接受右上肢的肘管松解术。外科医生计划使用止血带。患者希望进行区域麻醉并监测麻醉护理。要使用腋神经阻滞作为主要麻醉，您必须确保覆盖以下所有神经，除了：", + "A": "尺神经", + "B": "正中神经", + "C": "肋间臂神经", + "D": "桡神经", + "E": "肩胛上神经" + } + }, + { + "id": "4957907d-82ed-50af-83c1-7ad636ec3157", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 62-year-old man is undergoing a right total hip replacement, and the surgeon mentions that the patient is continuing to \"ooze.\" You note that all of his laboratory values and coagulation factors are within normal limits. You suggest a dose of tranexamic acid because it has been shown to reduce bleeding during", + "A": "By potentiating the action of antithrombin II and inactivating thrombin to prevent the conversion of fibrinogen to fibrin", + "B": "By reversibly and noncompetitively binding the adenosine diphosphate receptor on the platelet surface to reduce platelet aggregation", + "C": "By forming a complex that displaces plasminogen from fibrin to block the conversion to plasmin", + "D": "By inhibiting vitamin K complexes and therefore reducing the synthesis of clotting factors" + }, + "zh": { + "question": "一名62岁的男性正在接受右侧全髋关节置换术，外科医生提到患者继续“渗血”。你注意到他的所有实验室值和凝血因子均在正常范围内。你建议使用一剂氨甲环酸，因为它已被证明可以减少手术中的出血", + "A": "通过增强抗凝血酶II的作用并使凝血酶失活以防止纤维蛋白原转化为纤维蛋白", + "B": "通过可逆且非竞争性地结合血小板表面的腺苷二磷酸受体以减少血小板聚集", + "C": "通过形成一个复合物，将纤维蛋白上的纤溶酶原置换出来以阻止其转化为纤溶酶", + "D": "通过抑制维生素K复合物，从而减少凝血因子的合成" + } + }, + { + "id": "b2c98963-45a5-5782-a103-f96721e45b75", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "An 18-year-old man undergoes open appendectomy, and you place a postoperative truncal regional block for pain control. You believe the most effective block involves placing local anesthesia:", + "A": "Superficial to the iliacus muscle", + "B": "Deep to the superior costotransverse ligament", + "C": "Between the rectus abdominis muscle and the posterior rectus sheath", + "D": "Superficial to the transversus abdominis muscle", + "E": "Deep to the ligamentum flavum" + }, + "zh": { + "question": "一名18岁的男性接受开放性阑尾切除术，你为疼痛控制放置了术后躯干区域阻滞。你认为最有效的阻滞涉及将局部麻醉剂放置在：", + "A": "髂肌浅表", + "B": "上肋横韧带深处", + "C": "腹直肌和后腹直肌鞘之间", + "D": "腹横肌浅表", + "E": "黄韧带深处" + } + }, + { + "id": "f8d7174b-b850-58ee-9765-7207757d7553", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A patient underwent an interscalene nerve block for his left total shoulder arthroplasty. Although nerve injury is uncommon, all of the following complications can occur, with the exception of:", + "A": "Left wrist drop", + "B": "Inability to abduct the left upper arm", + "C": "Inability to abduct the fingers of the left hand", + "D": "Inability to flex at the elbow joint", + "E": "Inability to extend at the elbow joint" + }, + "zh": { + "question": "一名患者接受了左侧全肩关节置换术的斜角肌间隙神经阻滞。虽然神经损伤不常见，但以下所有并发症都可能发生，除了：", + "A": "左侧腕下垂", + "B": "无法外展左上臂", + "C": "无法外展左手手指", + "D": "无法在肘关节处屈曲", + "E": "无法在肘关节处伸展" + } + }, + { + "id": "d815714d-5704-5e3f-a343-8aa7ae07fbe2", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "38. A 33-year-old patient with sickle cell disease is presenting for an orthopedic procedure, and the surgeon would like to use a tourniquet. You counsel the patient that:", + "A": "Tourniquet use in this patient population is not associated with increased complications.", + "B": "The tourniquet will be placed at the proximal part of the limb at the greatest circumference of the limb.", + "C": "Tourniquet use of longer than 2 hours increases the risk of compression neurapraxia.", + "D": "All of the above.", + "E": "None of the above." + }, + "zh": { + "question": "38. 一名33岁的镰状细胞病患者准备进行骨科手术，外科医生希望使用止血带。您告知患者：", + "A": "在这种患者群体中使用止血带与并发症增加无关。", + "B": "止血带将放置在肢体的近端，即肢体最大周长处。", + "C": "使用止血带超过2小时会增加压迫性神经麻痹的风险。", + "D": "以上全部。", + "E": "以上皆非。" + } + }, + { + "id": "357c1455-08b4-5eb5-a05b-f9acfb929491", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "You are taking care of an 18-year-old woman in the operating room. The tourniquet has been inflated for more than 90 minutes. The signs and symptoms that support your theory that her pain is secondary to the tourniquet inflation EXCEPT:", + "A": "Hypertension", + "B": "Tachycardia", + "C": "Hypoxia", + "D": "Diaphoresis" + }, + "zh": { + "question": "您正在手术室照顾一名18岁的女性。止血带已经充气超过90分钟。支持您认为她的疼痛是由于止血带充气引起的体征和症状，除了：", + "A": "高血压", + "B": "心动过速", + "C": "低氧血症", + "D": "出汗" + } + }, + { + "id": "258126fd-a384-53e7-8a6b-3529725ef069", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 25-year-old woman elects to have spinal anesthesia for her procedure on her right lower extremity. Following placement of her neuraxial anesthesia, she can move her toes but does not have sensation around her knee. This differential block is explained by:", + "A": "Sympathetic nerve fibers that are blocked at the lowest concentration of local anesthetic", + "B": "Motor nerve fibers that are sensitive to local anesthetic blockade", + "C": "An ineffective spinal anesthetic", + "D": "A subarachnoid block", + "E": "A slow-onset intrathecal block" + }, + "zh": { + "question": "一名25岁的女性选择为其右下肢手术进行脊髓麻醉。在进行椎管内麻醉后，她可以移动脚趾，但在膝盖周围没有感觉。这种差异性阻滞的解释是：", + "A": "交感神经纤维在最低浓度的局部麻醉药下被阻滞", + "B": "运动神经纤维对局部麻醉阻滞敏感", + "C": "无效的脊髓麻醉", + "D": "蛛网膜下腔阻滞", + "E": "缓慢起效的鞘内阻滞" + } + }, + { + "id": "2f26caef-3c34-5cde-b381-b18cf3b7abd7", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Following injection of local anesthetic, blood levels are highest for (from highest to lowest):", + "A": "Caudal > epidural > sciatic > brachial plexus > subcutaneous", + "B": "Intercostal > epidural > sciatic > brachial plexus > subcutaneous", + "C": "Intercostal > epidural > caudal > brachial plexus > subcutaneous", + "D": "Intercostal > caudal > epidural > brachial plexus > sciatic", + "E": "Epidural > caudal > sciatic > brachial plexus > subcutaneous" + }, + "zh": { + "question": "注射局部麻醉药后，血液浓度最高的顺序是（从高到低）：", + "A": "尾部 > 硬膜外 > 坐骨 > 臂丛 > 皮下", + "B": "肋间 > 硬膜外 > 坐骨 > 臂丛 > 皮下", + "C": "肋间 > 硬膜外 > 尾部 > 臂丛 > 皮下", + "D": "肋间 > 尾部 > 硬膜外 > 臂丛 > 坐骨", + "E": "硬膜外 > 尾部 > 坐骨 > 臂丛 > 皮下" + } + }, + { + "id": "34ce4a14-b161-51ae-a75d-d7c1f8c63607", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A lumbar epidural is placed for intraoperative anesthesia and postoperative analgesia. Epidurals may affect pulmonary function tests by causing a(n):", + "A": "Significant decrease in forced expiratory volume in 1 second", + "B": "Decrease in cough strength", + "C": "Increase in vital capacity", + "D": "Increase in residual volume", + "E": "Decrease in tidal volumes" + }, + "zh": { + "question": "腰椎硬膜外麻醉用于术中麻醉和术后镇痛。硬膜外麻醉可能通过以下方式影响肺功能测试：", + "A": "显著降低1秒钟用力呼气量", + "B": "降低咳嗽强度", + "C": "增加肺活量", + "D": "增加残气量", + "E": "降低潮气量" + } + }, + { + "id": "38dcb49e-9432-5cc8-ab34-4ef5c2c89443", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 46-year-old woman is presenting for a procedure on her left upper extremity. She has been on 120 mg of methadone daily for a history of opioid abuse.", + "A": "Discontinuation of methadone as it will make managing her pain postoperatively more difficult", + "B": "Changing her methadone to oxycodone that she should use the morning of surgery", + "C": "Discontinuation of methadone and performance of a left brachial plexus block", + "D": "Administration of intravenous methadone in addition to her oral morning dose", + "E": "Continuation of methadone perioperatively" + }, + "zh": { + "question": "一名46岁的女性因左上肢手术入院。她有阿片类药物滥用史，每天服用120毫克美沙酮。", + "A": "停用美沙酮，因为这会使术后疼痛管理更加困难", + "B": "将她的美沙酮换成羟考酮，并在手术当天早晨服用", + "C": "停用美沙酮并进行左侧臂丛神经阻滞", + "D": "在口服早晨剂量的基础上给予静脉注射美沙酮", + "E": "围手术期继续使用美沙酮" + } + }, + { + "id": "a0d72f69-9238-5717-85e9-9ec98bd8a8c5", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "44. A 64-year-old man is scheduled to undergo a left total shoulder arthroplasty. You are performing an interscalene block using nerve stimulation. You notice the patient begins to hiccup, so you decide to:", + "A": "Reposition the needle more anteriorly", + "B": "Withdraw your needle", + "C": "Reposition the needle more posteriorly", + "D": "Reposition the needle deep to this point of stimulation" + }, + "zh": { + "question": "44. 一名64岁的男性计划进行左侧全肩关节置换术。您正在使用神经刺激进行斜角肌间隙阻滞。您注意到患者开始打嗝，因此您决定：", + "A": "将针头向前重新定位", + "B": "撤回针头", + "C": "将针头向后重新定位", + "D": "将针头重新定位到此刺激点的深处" + } + }, + { + "id": "87610683-810b-5313-86fa-11e8bdb5e7d8", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A 33-year-old G3P1 woman who has been taking buprenorphine for a history of oxycodone abuse is scheduled to undergo a repeat cesarean section. Your colleague suggests performance of transversus abdominis plane (TAP) blocks to help with postoperative pain. Which of the following statements regarding TAP blocks is true?", + "A": "TAP blocks help with visceral and somatic pain.", + "B": "TAP blocks should be performed as laterally as possible on the trunk.", + "C": "TAP blocks involve injection of local anesthetic deep to the transversus abdominis muscle.", + "D": "TAP blocks cannot be performed if a patient is on buprenorphine.", + "E": "TAP block placement requires discontinuation of prophylactic heparin for at least 1 hour." + }, + "zh": { + "question": "一名33岁的G3P1女性因有羟考酮滥用史而服用丁丙诺啡，计划进行重复剖宫产。你的同事建议进行腹横肌平面（TAP）阻滞以帮助术后疼痛。以下关于TAP阻滞的说法哪一项是正确的？", + "A": "TAP阻滞有助于缓解内脏和躯体疼痛。", + "B": "TAP阻滞应尽可能在躯干的侧面进行。", + "C": "TAP阻滞涉及将局部麻醉剂注射到腹横肌深处。", + "D": "如果患者正在服用丁丙诺啡，则不能进行TAP阻滞。", + "E": "进行TAP阻滞需要至少停用1小时的预防性肝素。" + } + }, + { + "id": "4b1a2a77-eed7-582c-b20a-ed5d3831a25b", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A patient is undergoing surgery on her wrist and hand. Your colleague performs an axillary nerve block, but the patient can flex the wrist and has sensation over the lateral portion of the palm. To provide complete anesthesia, you need to supplement by ensuring blockade of which nerve?", + "A": "Ulnar nerve", + "B": "Radial nerve", + "C": "Median nerve", + "D": "Musculocutaneous nerve", + "E": "Axillary nerve" + }, + "zh": { + "question": "一名患者正在接受手腕和手部手术。您的同事进行了腋神经阻滞，但患者可以屈腕，并且在手掌的外侧部分有感觉。为了提供完全的麻醉，您需要补充阻滞哪个神经？", + "A": "尺神经", + "B": "桡神经", + "C": "正中神经", + "D": "肌皮神经", + "E": "腋神经" + } + }, + { + "id": "4a4a0859-1e82-5614-b0e8-97b9a8c50beb", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "In the patient mentioned in question 46, where should the supplemental nerve", + "A": "Medial to the brachial artery in the antecubital fossa", + "B": "Within the belly of the coracobrachialis muscle", + "C": "At the medial epicondyle of the humerus", + "D": "Within the radial groove of the humerus", + "E": "At the lateral epicondyle of the humerus" + }, + "zh": { + "question": "在问题46中提到的患者中，补充神经应该在哪里？", + "A": "肱动脉内侧，在肘窝处", + "B": "在喙肱肌的肌腹内", + "C": "在肱骨内上髁处", + "D": "在肱骨的桡神经沟内", + "E": "在肱骨外上髁处" + } + }, + { + "id": "feb8c651-f8ad-5316-aee1-da438a09ca6d", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 16-year-old man injured his ankle while skateboarding. You elect to perform a peripheral nerve block for intraoperative anesthesia and postoperative analgesia. You use a total of 18 mL of ropivacaine 0.2%, but the patient reports complete sensation of his lateral shin. You need to ensure adequate coverage of:", + "A": "Saphenous nerve", + "B": "Tibial nerve", + "C": "Common peroneal nerve", + "D": "Sural nerve", + "E": "Deep peroneal nerve" + }, + "zh": { + "question": "一名16岁男性在滑板时扭伤了脚踝。您选择进行外周神经阻滞以进行术中麻醉和术后镇痛。您使用了总共18毫升0.2%的罗哌卡因，但患者报告其小腿外侧完全有感觉。您需要确保充分覆盖：", + "A": "隐神经", + "B": "胫神经", + "C": "腓总神经", + "D": "腓肠神经", + "E": "腓深神经" + } + }, + { + "id": "1a77c115-410b-547a-9a59-d14ec4133112", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 35-year-old man is presenting for a procedure on his right elbow. You are deciding what type of block to perform. In discussions with your colleagues, you suggest:", + "A": "A supraclavicular block would be adequate for his elbow procedure and would cover the arm", + "B": "An interscalene block would be adequate for his elbow procedure and would provide anesthesia and analgesia up to the midforearm", + "C": "An infraclavicular block would be adequate for his elbow procedure and would provide anesthesia and analgesia up to the wrist", + "D": "An axillary nerve block would be adequate for his elbow procedure and would provide anesthesia and analgesia of his arm", + "E": "A targeted median and ulnar nerve block at the olecranon would be best to provide adequate anesthesia and analgesia of his elbow" + }, + "zh": { + "question": "一名35岁的男性需要进行右肘部的手术。您正在决定进行哪种类型的神经阻滞。在与同事讨论时，您建议：", + "A": "锁骨上神经阻滞足以满足他的肘部手术，并能覆盖手臂", + "B": "斜角肌间隙神经阻滞足以满足他的肘部手术，并能提供至前臂中部的麻醉和镇痛", + "C": "锁骨下神经阻滞足以满足他的肘部手术，并能提供至手腕的麻醉和镇痛", + "D": "腋神经阻滞足以满足他的肘部手术，并能提供手臂的麻醉和镇痛", + "E": "在鹰嘴处进行针对性正中神经和尺神经阻滞是提供其肘部充分麻醉和镇痛的最佳选择" + } + }, + { + "id": "ab48d31c-f127-5e7c-881c-f8141142299f", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 53-year-old woman victim of a high-speed motor vehicle accident has just arrived at the emergency department (ED). As the anesthesiologist, you are a member of the trauma team expected to provide initial care. First responders in the field report that the patient was an unrestrained driver in a head-on collision with a telephone pole around 25 minutes ago. The patient was the sole victim in the crash, and it is unclear whether alcohol contributed to the accident. En route, the patient's mental status steadily declined, and she remained hypotensive despite receiving 2 L of lactated ringers. Her current vital signs are: NIBP 81/53, RR 20, SPO2 96%, and T 36.2°F. What is the best initial step in the management of this patient?", + "A": "Obtain a brief medical history from the patient's next of kin.", + "B": "Assess the patient's airway and prepare to intubate as needed.", + "C": "Obtain a complete blood count for suspected hemorrhagic shock.", + "D": "Immediately transport the patient to CT scan.", + "E": "Place an arterial line to assess patient's oxygenation and ventilation with an arterial blood gas." + }, + "zh": { + "question": "一名53岁的女性在一起高速机动车事故中受伤，刚刚到达急诊科。作为麻醉���，您是创伤团队的一员，负责提供初步护理。现场的急救人员报告说，患者是在大约25分钟前与电线杆正面相撞的无约束驾驶员。患者是事故中的唯一受害者，目前尚不清楚酒精是否是事故的原因。在途中，患者的精神状态稳步下降，尽管接受了2升乳酸林格氏液，她仍然低血压。她目前的生命体征是：无创血压81/53，呼吸频率20，血氧饱和度96%，体温36.2°F。管理该患者的最佳初步步骤是什么？", + "A": "从患者的近亲处获取简要的病史。", + "B": "评估患者的气道并准备根据需要进行插管。", + "C": "获取全血细胞计数以怀疑失血性休克。", + "D": "立即将患者送往CT扫描。", + "E": "放置动脉导管以通过动脉血气评估患者的氧合和通气。" + } + }, + { + "id": "e8a1de9e-5d8b-5f29-b5c8-359d90d1b233", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "You are called to intubate a 17-year-old boy who was hit in the face with a baseball. You notice bilateral periorbital ecchymosis and swelling, a displaced nasal bridge, and a large soft tissue hematoma underneath his left maxilla. A", + "A": "Perform an awake fiberoptic intubation.", + "B": "Administer a short-acting opioid to facilitate tolerance of an awake fiberoptic intubation.", + "C": "Induce general anesthesia followed by bag mask ventilation (BVM) with cricoid pressure with subsequent orotracheal intubation.", + "D": "Induce general anesthesia followed by rapid sequence orotracheal intubation." + }, + "zh": { + "question": "你被叫去为一名17岁的男孩插管，他被棒球击中了脸部。你注意到双侧眶周瘀斑和肿胀，鼻梁移位，以及左上颌下方有一个大的软组织血肿。", + "A": "进行清醒纤维支气管镜插管。", + "B": "给予短效阿片类药物以促进对清醒纤维支气管镜插管的耐受。", + "C": "诱导全身麻醉后进行面罩通气（BVM）并施加环状软骨压迫，随后进行经口气管插管。", + "D": "诱导全身麻醉后进行快速序贯经口气管插管。" + } + }, + { + "id": "1b43cdfc-0c74-5f23-905a-fc6548597b98", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "A 39-year-old man who requires intubation has a potentially unstable cervical spine and Glasgow Coma Scale (GCS) of 7. Before induction of general anesthesia, you ask your surgical colleague to perform manual in-line stabilization (MILS) and your anesthesia colleague to apply cricoid pressure. Your first 2 attempts at indirect video laryngoscopy result in visualization of the epiglottis only, and the patient begins to desaturate. What is the next appropriate step in the management of this patient?", + "A": "Maintain MILS, and ask your anesthesia colleague to release cricoid pressure.", + "B": "Ask your surgical colleague to adjust MILS to improve airway view, and ask your anesthesia colleague to release cricoid pressure.", + "C": "Call for help and prepare to perform cricothyroidotomy.", + "D": "Wake the patient up." + }, + "zh": { + "question": "一名39岁的男性需要插管，他可能有不稳定的颈椎，格拉斯哥昏迷评分（GCS）为7。在诱导全身麻醉之前，你要求你的外科同事进行手动直线固定（MILS），并要求你的麻醉同事施加环状软骨压力。你前两次间接视频喉镜检查仅能看到会厌，患者开始出现氧饱和度下降。管理该患者的下一个适当步骤是什么？", + "A": "保持MILS，并要求你的麻醉同事释放环状软骨压力。", + "B": "要求你的外科同事调整MILS以改善气道视野，并要求你的麻醉同事释放环状软骨压力。", + "C": "呼叫支援并准备进行环甲膜切开术。", + "D": "唤醒患者。" + } + }, + { + "id": "590cfae8-4730-58a7-8ca2-443fb74f0642", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "4. A 68-year-old man who sustained an epidural hematoma after a fall while skiing is now being emergently taken to the operating room (OR) for decompression. Per the ED note, on physical examination the patient opens his eyes to sternal rub and grabs the hand used to perform the sternal rub. When asked where he is, the patient responds, \"Take the cat to the car.\" What is the patient's GCS score?", + "A": "5", + "B": "8", + "C": "10", + "D": "12", + "E": "15" + }, + "zh": { + "question": "4. 一名68岁的男子在滑雪时摔倒后出现硬膜外血肿，现在被紧急送往手术室进行减压。根据急诊科���记录，体格检查显示患者对胸骨摩擦睁眼，并抓住进行胸骨摩擦的手。当被问及他在哪里时，患者回答：“把猫带到车上。”患者的GCS评分是多少？", + "A": "5", + "B": "8", + "C": "10", + "D": "12", + "E": "15" + } + }, + { + "id": "1aee892f-8b9f-50d8-9495-5f40ba7b6cd6", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 23-year-old man is a victim of a high-speed all-terrain vehicle (ATV) accident. His vital signs in the ED are BP 80/65, HR 107, RR 14, and T 97.4°F, and he is noted to be mildly anxious with a GCS of 15. A primary survey reveals obvious swelling and ecchymosis over his bilateral thighs, and a portable plain", + "A": "A blood pressure of 80/40 mm Hg, which is tolerable in a young trauma patient who is otherwise healthy", + "B": "A systolic blood pressure (SBP) of >100 mm Hg", + "C": "A SBP of <100 mm Hg", + "D": "A mean arterial pressure (MAP) of >65 mm Hg", + "E": "Specific blood pressure goals in trauma resuscitation do not affect survival to hospital discharge" + }, + "zh": { + "question": "一名23岁的男性是高速全地形车（ATV）事故的受害者。他在急诊室的生命体征为血压80/65，心率107，呼吸频率14，体温97.4°F，并且被注意到轻度焦虑，格拉斯哥昏迷评分为15。初步检查显示双侧大腿明显肿胀和瘀斑，便携式平片显示", + "A": "80/40 mm Hg的血压，在其他健康的年轻创伤患者中是可以耐受的", + "B": "收缩压（SBP）>100 mm Hg", + "C": "收缩压（SBP）<100 mm Hg", + "D": "平均动脉压（MAP）>65 mm Hg", + "E": "创伤复苏中的特定血压目标不影响出院生存率" + } + }, + { + "id": "dc141cd6-51df-5631-a807-d2b9ce77acbf", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "An 18-year-old woman is an unrestrained victim of a high-speed motor vehicle collision. In the resuscitation bay of the ED, the patient appears confused and lethargic. Her initial vitals are BP 75/50, HR 144, and RR 32. Based on the Advanced Trauma Life Support (ATLS) classification of hemorrhagic shock, approximately what is this patient's estimated blood loss?", + "A": "<750 cc", + "B": "750-1500 cc", + "C": "1500-2000 cc", + "D": ">2000 cc" + }, + "zh": { + "question": "一名18岁的女性是一起高速机动车碰撞事故中未系安全带的受害者。在急诊室的复苏区，患者表现出困惑和嗜睡。她的初始生命体征为血压75/50，心率144，呼吸频率32。根据高级创伤生命支持（ATLS）对出血性休克的分类，该患者的估计失血量大约是多少？", + "A": "<750毫升", + "B": "750-1500毫升", + "C": "1500-2000毫升", + "D": ">2000毫升" + } + }, + { + "id": "866f1907-2822-51ad-a462-bfeecab8628a", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 24-year-old unseatbelted passenger who was involved in a motor vehicle collision is scheduled for an emergent exploratory laparotomy and external fixation of the pelvis. Her vitals in the ED are BP 85/60, HR 125, and RR 28 with a negative FAST exam. As you prepare the OR for her anesthesia, what should be your primary source of fluid for volume resuscitation in this patient?", + "A": "Hypotonic crystalloid", + "B": "Isotonic crystalloid", + "C": "5% albumin", + "D": "Blood and blood components" + }, + "zh": { + "question": "一名24岁的未系安全带的乘客在一起机动车碰撞事故中受伤，计划进行紧急探查性剖腹手术和骨盆外固定。在急诊室，她的生命体征为血压85/60，心率125，呼吸频率28，快速超声检查为阴性。在为她准备麻醉的手术室时，您应该选择哪种主要的液体作为该患者的容量复苏来源？", + "A": "低渗晶体液", + "B": "等渗晶体液", + "C": "5%白蛋白", + "D": "血液和血液成分" + } + }, + { + "id": "68782b66-1b7a-5cd7-965b-e268a377a04c", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "You are asked to help interpret an arterial blood gas test that was obtained by your colleague on one of her patients who is hemorrhaging in the OR. The values include pH 7.23, PaO2 415, PaCO2 41, FiO2 1.0, and base deficit 10.4. What degree of shock is this patient in?", + "A": "Mild shock", + "B": "Moderate shock", + "C": "Severe shock", + "D": "Not enough information to determine degree of shock" + }, + "zh": { + "question": "您被要求帮助解释一位同事在手术室中对其失血患者进行的动脉血气分析。数值包括 pH 7.23，PaO2 415，PaCO2 41，FiO2 1.0，碱剩余 10.4。该患者处于何种程度的休克？", + "A": "轻度休克", + "B": "中度休克", + "C": "重度休克", + "D": "信息不足以确定休克程度" + } + }, + { + "id": "ad053e89-995a-5ea7-ba49-a6644f54ef96", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 68-year-old woman with a history of hypertension, hyperlipidemia, coronary artery disease, atrial fibrillation on dabigatran, and type 2 diabetes is brought to the OR for an emergent decompressive craniectomy after sustaining a spontaneous intraparenchymal hemorrhage with midline shift. Vitals are BP 150/75, HR 72, and RR 14. The neurosurgeon asks if there is \"something you can give\" to reverse the anticoagulant effects of her dabigatran. You reach for which of the following?", + "A": "Idarucizumab", + "B": "Bebulin", + "C": "Pertuzumab", + "D": "Kcentra", + "E": "Fresh frozen plasma" + }, + "zh": { + "question": "一名68岁的女性，有高血压、高脂血症、冠状动脉疾病、服用达比加群的心房颤动和2型糖尿病病史，在发生自发性脑实质内出血伴正中线移位后被送到手术室进行紧急减压性颅骨切除术。生命体征为血压150/75，心率72，呼吸频率14。神经外科医生询问是否有“可以给的东西”来逆转她的达比加群的抗凝效果。你会选择以下哪种？", + "A": "伊达鲁单抗", + "B": "贝布林", + "C": "帕妥珠单抗", + "D": "Kcentra", + "E": "新鲜冰冻血浆" + } + }, + { + "id": "0b08453a-720c-51bb-ba66-ee983a484df6", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 29-year-old woman on warfarin for a history of an unprovoked pulmonary embolism is now undergoing an urgent open reduction and internal fixation for a right femur fracture sustained in a motorcycle crash. At the start of the case, she is transfused 2 units of FFP for significant oozing despite tourniquet use. Her anesthetic and surgical course are otherwise unremarkable. During surgical closure, the patient becomes acutely hypoxemic, febrile, and hypotensive, and pink froth is noted to be coming out of her endotracheal tube.", + "A": "Increased fraction of inspired oxygen", + "B": "Bolus of lactated ringers", + "C": "Initiation of phenylephrine", + "D": "Diuretic therapy" + }, + "zh": { + "question": "一名29岁的女性因既往无诱因的肺栓塞病史正在服用华法林，现在因在摩托车事故中右股骨骨折而进行紧急开放复位和内固定手术。在手术开始时，尽管使用了止血带，她因明显的渗血而输注了2个单位的新鲜冰冻血浆。她的麻醉和手术过程没有其他显著异常。在手术缝合期间，患者突然出现急性低氧血症、发热和低血压，并注意到她的气管插管中有粉红色泡沫流出。", + "A": "增加吸入氧浓度", + "B": "快速输注乳酸林格氏液", + "C": "开始使用去氧肾上腺素", + "D": "利尿治疗" + } + }, + { + "id": "dcd6076c-a9d8-5e2c-bedb-fb2c6233af36", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "12. A 32-year-old man is a helmeted victim in a car versus pole motor vehicle collision with prolonged extrication. He is found on secondary survey to have bilateral comminuted femur fractures and an open book pelvic fracture. He is brought emergently to the OR for external fixation. Before arrival to the OR, he has received 6 units of packed red blood cells and 4 units of FFP and remains hemodynamically unstable. His most recent laboratory test results include hemoglobin 6.9 mg/dL, platelets 150 000, INR 1.9, and fibrinogen 250 mg/dL. In addition to blood products, your colleague suggests administering tranexamic acid (TXA). Which of the following is your response?", + "A": "TXA given beyond 1 hour of injury may increase bleeding-related mortality.", + "B": "TXA given beyond 2 hours of injury may increase bleeding-related mortality.", + "C": "TXA given beyond 3 hours of injury may increase bleeding-related mortality.", + "D": "There is no difference in bleeding-related mortality in trauma patients given TXA." + }, + "zh": { + "question": "12. 一名32岁的男子在一场汽车与电线杆的碰撞事故中受伤，佩戴头盔，且被困时间较长。在二次检查中发现他有双侧粉碎性股骨骨折和开放性骨盆骨折。他被紧急送往手术室���行外固定。在到达手术室之前，他已经接受了6个单位的浓缩红细胞和4个单位的新鲜冰冻血浆，但仍然血流动力学不稳定。他最近的实验室检查结果包括血红蛋白6.9 mg/dL，血小板150,000，INR 1.9，纤维蛋白原250 mg/dL。除了血液制品外，你的同事建议给予氨甲环酸（TXA）。以下哪项是你的回应？", + "A": "在受伤1小时后给予TXA可能会增加与出血相关的死亡率。", + "B": "在受伤2小时后给予TXA可能会增加与出血相关的死亡率。", + "C": "在受伤3小时后给予TXA可能会增加与出血相关的死亡率。", + "D": "在创伤患者中给予TXA与出血相关的死亡率没有差异。" + } + }, + { + "id": "aba9ab9a-3eb2-576d-beda-53e92e305bd4", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 42-year-old otherwise healthy right-handed man is brought in by helicopter after falling approximately 50 feet while hiking. He was intubated in the field for a GCS of 7, and a CT scan of his head reveals right frontal and anterior temporal cortical contusions, with punctate hemorrhages at the gray-white junctions and hypodensities in the right frontal white matter. Vital signs include BP 90/50, HR 114 (sinus), T 35.9°C, and RR = 16 on volume control ventilation. Laboratory test results are significant for a hemoglobin of 9.2 mg/dL. Which of the following is the best fluid to use for initial volume resuscitation?", + "A": "Normal saline 0.9%", + "B": "5% dextrose in water", + "C": "Lactated ringers", + "D": "Albumin 5%", + "E": "Packed red blood cells" + }, + "zh": { + "question": "一名42岁身体健康的惯用右手的男性在徒步旅行时从大约50英尺的高度坠落后被直升机送来。他在现场因格拉斯哥昏迷评分为7而被插管，头部CT扫描显示右额叶和前颞叶皮质挫伤，灰白质交界处有点状出血，右额叶白质有低密度区。生命体征包括血压90/50，心率114（窦性），体温35.9°C，呼吸频率16次/分钟（容量控制通气）。实验室检查结果显示血红蛋白为9.2 mg/dL。以下哪种液体是初始容量复苏的最佳选择？", + "A": "0.9%生理盐水", + "B": "5%葡萄糖水", + "C": "乳酸林格氏液", + "D": "5%白蛋白", + "E": "浓缩红细胞" + } + }, + { + "id": "b433b7e2-0f52-5af0-983c-90faf9c78c22", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "15. A bedside Codman ICP Monitor (\"bolt\") is placed by your neurosurgical colleague in the OR after induction of anesthesia for a patient who suffered blunt trauma to the head and had a GCS of 8. The intracranial pressure (ICP) is found to be 35 mm Hg. Other vitals include BP 90/60, HR 84, and core T", + "A": "The patient's CPP is too high.", + "B": "The patient's CPP is too low.", + "C": "The patient's CPP is within the target range for TBI patients.", + "D": "There is no CPP target range for TBI patients." + }, + "zh": { + "question": "15. 在麻醉诱导后，您的神经外科同事在手术室为一名遭受钝性头部创伤且GCS为8的患者放置了床旁Codman颅内压监测仪（“螺栓”）。发现颅内压（ICP）为35 mm Hg。其他生命体征包括血压90/60，心率84，核心体温", + "A": "患者的CPP过高。", + "B": "患者的CPP过低。", + "C": "患者的CPP在TBI患者的目标范围内。", + "D": "TBI患者没有CPP目标范围。" + } + }, + { + "id": "63f824e6-f71b-59b9-bc6c-f430f8a83ec6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Mannitol is initiated to decrease a patient's ICP. Which of the following is the target ICP in TBI?", + "A": "<15 mm Hg", + "B": "<20-25 mm Hg", + "C": "<25-30 mm Hg", + "D": "<35 mm Hg" + }, + "zh": { + "question": "甘露醇用于降低患者的颅内压（ICP）。在创伤性脑损伤（TBI）中，以下哪项是目标颅内压？", + "A": "<15 mm Hg", + "B": "<20-25 mm Hg", + "C": "<25-30 mm Hg", + "D": "<35 mm Hg" + } + }, + { + "id": "9293fd9c-8238-5096-819c-d75be592409b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 24-year-old woman is admitted to the ICU postoperatively after surgical management of her traumatic right lower extremity amputation. To prevent venous thromboembolism (VTE), a sequential compression device is placed on her left lower extremity, and she is administered a daily prophylactic dose of low-molecular-weight heparin. On hospital day 4, she complains of left thigh pain, and a deep vein thrombosis (DVT) is found on duplex ultrasonography. All the following risk factors for VTE in blunt trauma victims have been shown to be refractory to well-established VTE prophylaxis clinical management guidelines EXCEPT which one?", + "A": "Pelvic ring injury", + "B": "Spinal cord injury", + "C": "Immobilization", + "D": ">3 days of mechanical ventilation" + }, + "zh": { + "question": "一名24岁的女性在手术后因创伤性右下肢截肢被送入ICU。为了预防静脉血栓栓塞（VTE），在她的左下肢放置了一个序贯压缩装置，并每天给予预防剂量的低分子量肝素。在住院第4天，她抱怨左大腿疼痛，双重超声检查发现深静脉血栓（DVT）。在钝性创伤患者中，以下所有VTE风险因素已被证明对已建立的VTE预防临床管理指南无效，除了哪一个？", + "A": "骨盆环损伤", + "B": "脊髓损伤", + "C": "固定不动", + "D": "机械通气超过3天" + } + }, + { + "id": "a10d669c-d0f0-505c-8939-b1b251f571b7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "An otherwise healthy 37-year-old man weighing 100 kg has burned 40% of his total body surface area (TBSA) in a construction accident. By current guidelines, which of the following is an acceptable range of crystalloid administration in the first 24 hours?", + "A": "4-8 L", + "B": "5-10 L", + "C": "8-16 L", + "D": "10-20 L" + }, + "zh": { + "question": "一名身体健康的37岁男性，体重100公斤，在一次建筑事故中烧伤了40%的体表面积（TBSA）。根据现行指南，以下哪一项是前24小时内晶体液输注的可接受范围？", + "A": "4-8升", + "B": "5-10升", + "C": "8-16升", + "D": "10-20升" + } + }, + { + "id": "1ed9e419-9a02-5230-9a30-55d58144da98", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 21-year-old otherwise healthy man is being taken emergently to the OR for an exploratory laparotomy with possible thoracotomy after sustaining multiple", + "A": ">34°C", + "B": ">35°C", + "C": ">36°C", + "D": ">37°C" + }, + "zh": { + "question": "一名21岁、身体健康的男性因遭受多处创伤，被紧急送往手术室进行探查性剖腹术，可能需要进行开胸手术。", + "A": ">34°C", + "B": ">35°C", + "C": ">36°C", + "D": ">37°C" + } + }, + { + "id": "19069c99-826c-5805-a54f-c59b69b717b4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 56-year-old man with a history of end-stage liver disease (ESLD) presents for liver transplant evaluation. His ESLD has been complicated by esophageal varices, recurrent gastrointestinal (GI) bleeds, and hepatorenal syndrome, and the MELD (Model for End-Stage Liver Disease) score is calculated to be 32 with a Child-Pugh score of 13. Which of the following is NOT included as a component when calculating the MELD score?", + "A": "Total bilirubin", + "B": "International normalized ratio (INR)", + "C": "Serum creatinine", + "D": "Partial thromboplastin time" + }, + "zh": { + "question": "一名56岁的男性有终末期肝病（ESLD）病史，前来进行肝移植评估。他的ESLD并发有食管静脉曲张、反复的胃肠道（GI）出血和肝肾综合征，MELD（终末期肝病模型）评分计算为32，Child-Pugh评分为13。以下哪一项不包括在计算MELD评分的成分中？", + "A": "总胆红素", + "B": "国际标准化比值（INR）", + "C": "血清肌酐", + "D": "部分凝血活酶时间" + } + }, + { + "id": "4a1f2432-c6c7-5953-9c66-9e6905428462", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 62-year-old woman with ESLD due to alcoholic cirrhosis is undergoing an orthotopic liver transplant. Her medical history is significant for paroxysmal atrial fibrillation, coronary artery disease, hypertension, and chronic kidney failure. The patient starts having frequent premature ventricular contractions, which progress into a sustained ventricular tachycardia causing hemodynamic instability after the surgeon releases the inferior vena cava (IVC) clamp. Of the following choices listed below, which would NOT be considered an appropriate choice for immediate therapy?", + "A": "Sodium bicarbonate infusion", + "B": "Low-dose epinephrine bolus", + "C": "Immediate synchronized cardioversion", + "D": "Calcium chloride injection" + }, + "zh": { + "question": "一名62岁的女性因酒精性肝硬化导致的终末期肝病正在接受原位肝移植。她的病史包括阵发性房颤、冠状动脉疾病、高血压和慢性肾功能衰竭。在外科医生释放下腔静脉（IVC）夹钳后，患者开始出现频繁的室性早搏，并进展为持续性室性心动过速，导致血流动力学不稳定。在以下列出的选项中，哪一项不被认为是立即治疗的合适选择？", + "A": "碳酸氢钠输注", + "B": "低剂量肾上腺素推注", + "C": "立即同步电复律", + "D": "氯化钙注射" + } + }, + { + "id": "c97cbf00-7e16-556a-ba85-db6bd28975c5", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "23. A 59-year-old man with ESLD complicated by portopulmonary hypertension (PPH), hepatorenal syndrome, and hepatic encephalopathy presents for an orthotopic liver transplant. Intraoperatively, the patient becomes progressively hypoxic despite adjustments to the ventilator. Of the following choices listed below, which would NOT be considered an appropriate INITIAL choice for therapeutic intervention to improve the patient's oxygenation status?", + "A": "Start milrinone.", + "B": "Start dobutamine.", + "C": "Start inhaled nitric oxide (iNO).", + "D": "Start dopamine." + }, + "zh": { + "question": "23. 一名59岁的男性患者患有终末期肝病（ESLD），并发有门肺高压（PPH）、肝肾综合征和肝性脑病，现准备进行原位肝移植。在手术过程中，尽管对呼吸机进行了调整，患者仍逐渐出现低氧血症。在以下选项中，哪一项不被视为改善患者氧合状态的适当初始治疗干预选择？", + "A": "开始使用米力农。", + "B": "开始使用多巴酚丁胺。", + "C": "开始使用吸入一氧化氮（iNO）。", + "D": "开始使用多巴胺。" + } + }, + { + "id": "3f7118ed-d6ea-595c-812f-57597f3a804e", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 48-year-old woman with end-stage renal disease secondary to severe hypertension presents for a renal transplant. Intraoperatively, you notice that the patient's urine output has dropped to less than 0.5 mL/h after the allograft kidney has been transplanted. The surgeon is requesting that you intervene to", + "A": "Dopamine", + "B": "Mannitol", + "C": "Albumin", + "D": "Norepinephrine" + }, + "zh": { + "question": "一名48岁的女性因严重高血压导致的终末期肾病，前来进行肾移植手术。在手术过程中，你注意到患者在移植异体肾后尿量下降到每小时少于0.5毫升。外科医生要求你进行干预以", + "A": "多巴胺", + "B": "甘露醇", + "C": "白蛋白", + "D": "去甲肾上腺素" + } + }, + { + "id": "7138a83d-e8cf-5fe4-9a57-8fe961ece74e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 72 year old man with a history of ESLD due to hepatitis C received an orthotopic liver transplant 2 months ago and is now presenting for a ventral hernia repair. Which of the following laboratory values is the best marker in assessing the patient's liver synthetic function posttransplant?", + "A": "Bilirubin", + "B": "AST/ALT (aspartate aminotransferase/alanine aminotransferase)", + "C": "International normalized ratio", + "D": "Albumin" + }, + "zh": { + "question": "一名72岁男性因丙型肝炎导致终末期肝病，2个月前接受了原位肝移植，现在前来进行腹壁疝修补术。以下哪项实验室指标是评估患者移植后肝脏合成功能的最佳标志？", + "A": "胆红素", + "B": "AST/ALT（天冬氨酸氨基转移酶/丙氨酸氨基转移酶）", + "C": "国际标准化比值", + "D": "白蛋白" + } + }, + { + "id": "5c779e95-f79c-564c-8fb6-cc0a77cb3a3f", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 71-year-old woman with a history of rheumatoid arthritis is scheduled for a left total knee arthroplasty. She has been taking prednisone 5 mg PO daily for the last 2 weeks to control her rheumatoid arthritis. Which of the following is the most appropriate perioperative steroid plan given her chronic steroid regimen?", + "A": "Recommend to the patient that she stop taking prednisone before the operation given the risk of intraoperative hyperglycemia.", + "B": "Recommend that she continues taking her home dose of prednisone up until the operation.", + "C": "Recommend that she doubles her dose of steroid on the morning of the operation.", + "D": "Recommend that she continue taking her home dose of prednisone up until the operation and give her an additional dose of hydrocortisone during the operation." + }, + "zh": { + "question": "一名71岁的女性有类风湿性关节炎病史，计划进行左侧全膝关节置换术。她在过去两周每天口服5毫克泼尼松来控制类风湿性关节炎。考虑到她的慢性类固醇方案，以下哪项是最合适的围手术期类固醇计划？", + "A": "建议患者在手术前停止服用泼尼松，因为存在术中高血糖的风险。", + "B": "建议她在手术前继续服用家中的泼尼松剂量。", + "C": "建议她在手术当天早晨将类固醇剂量加倍。", + "D": "建议她在手术前继续服用家中的泼尼松剂量，并在手术期间给予额外剂量的氢化可的松。" + } + }, + { + "id": "e8e04034-569f-55a8-89d5-d048d696cdb1", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 64-year-old woman with a 70-pack-year smoking history and hypertension was recently admitted to the hospital with a severe COPD exacerbation and is currently receiving 40 mg of prednisone daily. On hospital day 3 she begins to complain of abdominal pain and spikes a fever. Imaging demonstrates evidence of appendicitis, and she is scheduled for an urgent appendectomy. Throughout the procedure, you note that she is becoming gradually more hypotensive. You place a radial arterial catheter, and she is consistently in the 80s-90s/40s-50s. You decide to do which of the following?", + "A": "Start peripheral phenylephrine, place an nasogastric tube (NGT), and administer40 mg prednisone.", + "B": "Place a central venous catheter, and start norepinephrine.", + "C": "Administer 100 mg hydrocortisone IV (intravenously) in addition to placing an NGT and administering 40 mg prednisone.", + "D": "Administer 100 mg hydrocortisone IV, and start peripheral phenylephrine." + }, + "zh": { + "question": "一名64岁的女性，有70包年吸烟史和高血压，最近因严重的COPD加重住院，目前每天接受40毫克的泼尼松治疗。在住院第3天，她开始抱怨腹痛并发烧。影像学检查显示阑尾炎的证据，并计划进行紧急阑尾切除术。在手术过程中，你注意到她逐渐变得更加低血压。你放置了桡动脉导管，她的血压持续在80-90/40-50。你决定采取以下哪种措施？", + "A": "开始使用外周去氧肾上腺素，放置鼻胃管（NGT），并给予40毫克泼尼松。", + "B": "放置中心静脉导管，并开始使用去甲肾上腺素。", + "C": "静脉注射100毫克氢化可的松，此外放置NGT并给予40毫克泼尼松。", + "D": "静脉注射100毫克氢化可的松，并开始使用外周去氧肾上腺素。" + } + }, + { + "id": "db43f1b1-5fdb-5362-94b1-b8edf8910647", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "28. A 46-year-old man, with a history of IV drug use on chronic methadone therapy and hepatitis C, is 1 year post orthotopic liver transplant and is now scheduled for a ventral hernia repair. In an attempt to address his anticipated postoperative pain with nonopioid analgesia, you plan to give him IV ketorolac. Which of the following immunosuppressive agents, in combination with ketorolac, increases the risk for potential postoperative renal dysfunction?", + "A": "Tacrolimus", + "B": "Mycophenolate Mofetil", + "C": "Azathioprine", + "D": "Prednisone" + }, + "zh": { + "question": "28. 一名46岁的男性，有静脉药物使用史，正在接受慢性美沙酮治疗和丙型肝炎治疗，1年前接受了原位肝移植，现在计划进行腹壁疝修补术。为了用非阿片类镇痛药解决他预期的术后疼痛，你计划给他静脉注射酮咯酸。以下哪种免疫抑制剂与酮咯酸联合使用会增加术后肾功能障碍的风险？", + "A": "他克莫司", + "B": "吗替麦考酚酯", + "C": "硫唑嘌呤", + "D": "泼尼松" + } + }, + { + "id": "9cac743b-8bc8-5fbf-93ac-565377730f8d", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 55-year-old woman with a history of a kidney transplant has newly diagnosed lung cancer and presents for a right-sided thoracotomy. You plan to place a preoperative epidural. Which of the following immunosuppressive agents would raise concern for a possible increased risk of epidural hematoma?", + "A": "Azathioprine", + "B": "Cyclosporine", + "C": "Tacrolimus", + "D": "Prednisone" + }, + "zh": { + "question": "一名55岁的女性有肾移植史，最近被诊断出患有肺癌，并准备进行右侧开胸手术。您计划在术前放置硬膜外导管。以下哪种免疫抑制剂可能会增加硬膜外血肿的风险？", + "A": "硫唑嘌呤", + "B": "环孢素", + "C": "他克莫司", + "D": "泼尼松" + } + }, + { + "id": "fe1186ad-e97e-58f6-8170-4c3a354ac641", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Antithymocyte globulin (ATG) is given for acute rejection prevention during a kidney transplant. What is ATG's mechanism of action?", + "A": "Reduction in the demargination of neutrophils", + "B": "Depletion of B cells", + "C": "Inhibition of IL-1 receptors on B cells and T cells", + "D": "Depletion of T cells" + }, + "zh": { + "question": "抗胸腺细胞球蛋白（ATG）用于预防肾移植期间的急性排斥反应。ATG的作用机制是什么？", + "A": "减少中性粒细胞的边缘化", + "B": "消耗B细胞", + "C": "抑制B细胞和T细胞上的IL-1受体", + "D": "消耗T细胞" + } + }, + { + "id": "19dd6b84-f8f6-58f8-85c4-bacd481112de", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Compared with pulsatile left ventricular assist devices (LVADs), continuousflow LVAD therapy confers which of the following?", + "A": "Comparable risk of device-related infections", + "B": "A worse neurologic outcome", + "C": "Increased risk of GI bleeding", + "D": "Increased levels of circulating von Willebrand factor" + }, + "zh": { + "question": "与搏动式左心室辅助装置（LVAD）相比，连续流LVAD治疗具有以下哪种情况？", + "A": "设备相关感染的风险相当", + "B": "更差的神经系统结果", + "C": "增加胃肠道出血的风险", + "D": "循环中的von Willebrand因子水平增加" + } + }, + { + "id": "84d5dd0f-814d-5239-809f-b442803da65d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Regarding perioperative considerations for lung transplantation (LTx), which of the following statements are true?", + "A": "Compared with donation-after-brain-death LTx, donation-after-circulatory-death (DCD) LTx results in decreased graft survival.", + "B": "Perioperative hyperglycemia is associated with increased mortality in patients undergoing LTx.", + "C": "Use of lung protective ventilation strategies in organ donors with brain death has not increased the number of available donor lungs.", + "D": "Lung transplant using cardiopulmonary bypass (CPB) provides better long-term outcomes compared with off-pump LTx." + }, + "zh": { + "question": "关于肺移植（LTx）的围手术期考虑，下列哪项陈述是正确的？", + "A": "与脑死亡后捐献的肺移植相比，循环死亡后捐献（DCD）的肺移植导致移植物存活率降低。", + "B": "围手术期高血糖与接受肺移植患者的死亡率增加有关。", + "C": "在脑死亡器官捐献者中使用肺保护性通气策略并未增加可用捐献肺的数量。", + "D": "使用体外循环（CPB）进行的肺移植与非体外循环肺移植相比，提供了更好的长期结果。" + } + }, + { + "id": "18fb7b21-a4ee-5eeb-9888-3d2d3602c42d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "33. A 59-year-old man with a history of mild hypertension, hyperlipidemia, and B-cell lymphoma with doxorubicin-induced cardiomyopathy requiring orthotopic heart transplantation 5 years ago is brought in by EMS to the ED. His posttransplant course was complicated by postoperative renal failure with permanent need for dialysis. He presents now in shock. He does not follow a renal diet but has undergone a routine hemodialysis 2 days ago. \"He only takes tacrolimus and mycophenolate mofetil\" at home per EMS report. His vitals are HR 115, BP 74/41, RR 35, and O2 Sat 85% on 10 L FM. The patient's ECG shows ST elevations in multiple leads, his troponin I is 0.4, and serum lactate is 6. Before he can be brought to a heart catheterization laboratory, the patient passes away. Which of the following medications/intervention most likely would have helped prevent this situation?", + "A": "Pravastatin", + "B": "Aspirin", + "C": "Diltiazem", + "D": "Prophylactic coronary angioplasty with left main coronary artery stent deployment" + }, + "zh": { + "question": "33. 一名59岁男性，有轻度高血压��高脂血症和B细胞淋巴瘤病史，因阿霉素引起的心肌病需要在5年前进行原位心脏移植。EMS将他送到急诊室。他的移植后过程因术后肾衰竭而复杂化，需永久性透析。他现在表现为休克。他不遵循肾脏饮食，但在2天前进行了常规血液透析。根据EMS报告，他在家中只服用他克莫司和吗替麦考酚酯。他的生命体征为心率115，血压74/41，呼吸频率35，氧饱和度在10升面罩下为85%。患者的心电图显示多导联ST段抬高，肌钙蛋白I为0.4，血清乳酸为6。在他被送到心导管实验室之前，患者去世。以下哪种药物/干预最有可能帮助预防这种情况？", + "A": "普伐他汀", + "B": "阿司匹林", + "C": "地尔硫卓", + "D": "预防性冠状动脉成形术并植入左主冠状动脉支架" + } + }, + { + "id": "7b1c3fc4-6b75-5419-b804-b3857196662b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the statements regarding thyroid function and its impacts on cardiovascular pathophysiology is most likely true?", + "A": "Pulmonary hypertension is linked to hyper- and hypothyroidism.", + "B": "Hypothyroidism is associated with a slower progression of heart failure patients.", + "C": "Triiodothyronine (T3)/thyroxin (T4) therapy to the donor increases availability of thoracic donor organs but causes increased graft rejection after transplantation.", + "D": "T3 levels do not correlate with the presence of coronary artery disease." + }, + "zh": { + "question": "关于甲状腺功能及其对心血管病理生理影响的陈述中，哪一项最有可能是真的？", + "A": "肺动脉高压与甲亢和甲减有关。", + "B": "甲减与心力衰竭患者的病情进展较慢有关。", + "C": "给予供体三碘甲腺原氨酸（T3）/甲状腺素（T4）治疗增加了胸部供体器官的可用性，但在移植后导致移植物排斥增加。", + "D": "T3水平与冠状动脉疾病的存在无关。" + } + }, + { + "id": "ce572bfd-2619-53eb-a047-18436efe452f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Patients with end-stage heart failure pending heart transplantation may require", + "A": "Intra-aortic balloon pump (IABP) counterpulsation raises the effective cardiac output more than percutaneously inserted axial flow pumps (eg, Impella).", + "B": "Percutaneously inserted axial flow pumps (eg, Impella) generally do not require anticoagulation while inserted.", + "C": "Extracorporeal membrane oxygenation (ECMO) decreases left ventricular (LV) afterload less than IABP.", + "D": "It is recommended to continue supportive catecholamine infusions with indwelling percutaneously inserted axial flow pumps to enhance cardiac output." + }, + "zh": { + "question": "等待心脏移植的终末期心力衰竭患者可能需要", + "A": "主动脉内球囊反搏（IABP）比经皮插入的轴流泵（如Impella）更能提高有效心输出量。", + "B": "经皮插入的轴流泵（如Impella）在插入期间通常不需要抗凝。", + "C": "体外膜氧合（ECMO）减少左心室（LV）后负荷的效果不如IABP。", + "D": "建议在留置的经皮插入轴流泵的情况下继续支持性儿茶酚胺输注以增强心输出量。" + } + }, + { + "id": "58c46797-2e3f-5d10-abb9-5d5afd6ed050", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "You are taking care of an otherwise healthy 35-year-old man undergoing repair of his left anterior cruciate ligament. Shortly after induction, his heart rate increased from 70 to 110 beats per minute and his blood pressure drops to 60/40 mm Hg. You also notice an increase in his peak inspiratory pressure. Which of the following is your next step?", + "A": "Administer a 500-cc bolus of crystalloid, and turn down the concentration of volatile anesthetic.", + "B": "Start a phenylephrine infusion to target an MAP greater than 60 mm Hg.", + "C": "Call for help, give epinephrine 10-100 µg IV, and repeat or escalate dose every 1-2 minutes and titrate to effect.", + "D": "Call for help, and give epinephrine 1 mg IV." + }, + "zh": { + "question": "您正在照顾一名35岁健康男性，他正在进行左前交叉韧带修复手术。诱导后不久，他的心率从70次/分钟增加到110次/分钟，血压降至60/40 mm Hg。您还注意到他的吸气峰压增加。您接下来的步骤是什么？", + "A": "给予500毫升晶体液快速输注，并降低挥发性麻醉药的浓度。", + "B": "开始去氧肾上腺素输注，目标是平均动脉压大于60 mm Hg。", + "C": "呼叫支援，给予10-100微克肾上腺素静脉注射，每1-2分钟重复或增加剂量，并根据效果调整。", + "D": "呼叫支援，给予1毫克肾上腺素静脉注射。" + } + }, + { + "id": "936e2dca-930c-50f1-b4ea-d78f906d8fb0", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "37. The following scenario applies to the next 3 questions: You are asked to evaluate a 65-year-old 80-kg man in the postanesthesia care unit (PACU). He has just undergone a laser lithotripsy of a right ureteral stone. His temperature is 38.5°C, heart rate is 100 beats per minute, blood pressure is 83/55 mm Hg, and respiratory rate is 30 breaths per minute. He is arousable but confused. He has already received 2 L of crystalloid in the perioperative period. The most appropriate next step in management is administration of which of the following?", + "A": "Start norepinephrine infusion, and titrate to MAP >65 mm Hg.", + "B": "Start dopamine infusion, and titrate to MAP >65 mm Hg.", + "C": "Start phenylephrine infusion, and titrate to SBP >90 mm Hg.", + "D": "Give 250 cc of 5% albumin." + }, + "zh": { + "question": "37. 以下情境适用于接下来的3个问题：您被要求评估一名65岁、80公斤的男性，他在术后恢复室（PACU）中。他刚刚接受了右侧输尿管结石的激光碎石术。他的体温为38.5°C，心率为每分钟100次，血压为83/55 mm Hg，呼吸频率为每分钟30次。他可以被唤醒但有些困惑。他在围手术期已经接受了2升晶体液。最合适的下一步管理措施是给予以下哪种药物？", + "A": "开始去甲肾上腺素输注，并调整至平均动脉压（MAP）>65 mm Hg。", + "B": "开始多巴胺输注，并调整至平均动脉压（MAP）>65 mm Hg。", + "C": "开始去氧肾上腺素输注，并调整至收缩压（SBP）>90 mm Hg。", + "D": "给予250毫升5%白蛋白。" + } + }, + { + "id": "d4bac66d-36f5-528f-9ec9-276aae0c90b0", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "The patient is now on norepinephrine at 20 µg/min, and his MAP remains less than 65 mm Hg. The next appropriate step is which of the following?", + "A": "Add dopamine as a second vasopressor.", + "B": "Add phenylephrine as a second vasopressor.", + "C": "Add vasopressin as a second vasopressor.", + "D": "Decrease your MAP goal to 60 mm Hg, as his baseline pressure is usually low." + }, + "zh": { + "question": "患者目前正在使用去甲肾上腺素，剂量为20 µg/min，但其平均动脉压仍低于65 mm Hg。接下来的适当步骤是以下哪一项？", + "A": "添加多巴胺作为第二种血管加压药。", + "B": "添加苯肾上腺素作为第二种血管加压药。", + "C": "添加加压素作为第二种血管加压药。", + "D": "将平均动脉压目标降低到60 mm Hg，因为他的基线血压通常较低。" + } + }, + { + "id": "8606e961-5938-5adb-a3bc-74d0a4b586d7", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The patient has already received 2 L of crystalloid, but you want to determine if he remains intravascularly volume-depleted. How is \"fluid responsiveness\" defined?", + "A": "Decrease in heart rate", + "B": "Urine output", + "C": "Increase in SBP", + "D": "Increase in cardiac output" + }, + "zh": { + "question": "患者已经接受了2升晶体液，但您想确定他是否仍然存在血管内容量不足。如何定义“液体反应性”？", + "A": "心率下降", + "B": "尿量", + "C": "收缩压增加", + "D": "心输出量增加" + } + }, + { + "id": "3d463c35-f98e-5f1b-ab4b-b70f21daeb26", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 55-year old man is scheduled for elective colectomy. His medical history is significant for hypertension, which is controlled on lisinopril. Shortly after induction with propofol and rocuronium, his blood pressure decreases from 130/85 to 80/50 mm Hg. Administration of ephedrine 5 mg and phenylephrine 40 µg IV has no effect. The most appropriate treatment at this time is administration of which of the following?", + "A": "Vasopressin", + "B": "Epinephrine", + "C": "Phenylephrine", + "D": "Calcium chloride" + }, + "zh": { + "question": "一名55岁的男性计划进行选择性结肠切除术。他的病史中有高血压，服用赖诺普利控制。用丙泊酚和罗库溴铵诱导后不久���他的血压从130/85降至80/50 mm Hg。静脉注射5 mg麻黄碱和40 µg去氧肾上腺素无效。此时最合适的治疗是给予以下哪种药物？", + "A": "加压素", + "B": "肾上腺素", + "C": "去氧肾上腺素", + "D": "氯化钙" + } + }, + { + "id": "71430050-64c5-5033-b953-a02e515cea3c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following treatments for catecholamine-resistant vasoplegia does NOT inhibit nitric oxide?", + "A": "Methylene blue", + "B": "Hydroxocobalamin", + "C": "Vitamin C", + "D": "Angiotensin II" + }, + "zh": { + "question": "以下哪种治疗儿茶酚胺抵抗性血管麻痹的方法不抑制一氧化氮？", + "A": "亚甲蓝", + "B": "羟钴胺", + "C": "维生素C", + "D": "血管紧张素II" + } + }, + { + "id": "7c678657-e35a-58f4-a5a2-025207726feb", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 70-year-old man is in the ICU after undergoing a left upper lobectomy. He develops atrial fibrillation on the second postoperative day. His heart rate is 150 beats per minute and blood pressure is 85/50 mm Hg. Which of the following is the least appropriate treatment of his tachycardia?", + "A": "Phenylephrine", + "B": "Amiodarone", + "C": "Metoprolol", + "D": "Verapamil" + }, + "zh": { + "question": "一名70岁的男性在接受左上肺叶切除术后进入ICU。他在术后第二天出现心房颤动。心率为每分钟150次，血压为85/50 mm Hg。以下哪种治疗他的心动过速的方法最不合适？", + "A": "去氧肾上腺素", + "B": "胺碘酮", + "C": "美托洛尔", + "D": "维拉帕米" + } + }, + { + "id": "1f9a0312-4800-529a-ad9c-f5f67fba1b31", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "43. A 75-year-old man is admitted to the ICU with perforated diverticulitis and", + "A": "Mean arterial pressure >60 mm Hg", + "B": "Mean arterial pressure >65 mm Hg", + "C": "Mean arterial pressure >70 mm Hg", + "D": "Mean arterial pressure >80 mm Hg" + }, + "zh": { + "question": "43. 一名75岁男性因穿孔性憩室炎被送入ICU", + "A": "平均动脉压 >60 mm Hg", + "B": "平均动脉压 >65 mm Hg", + "C": "平均动脉压 >70 mm Hg", + "D": "平均动脉压 >80 mm Hg" + } + }, + { + "id": "9ceefb9b-f6fb-5477-8b3c-6d621486d219", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 63-year old man is admitted to the ICU with sepsis after abdominal surgery for perforated diverticulitis. After fluid resuscitation, he continues to require high doses of norepinephrine. Bedside echocardiography shows a dilated left ventricle with a reduced ejection fraction. Which of the following statements is true?", + "A": "The recommendation for use of dobutamine in patients with evidence of persistent hypoperfusion despite adequate fluid loading and vasopressor use is based on high-quality evidence.", + "B": "Milrinone is a phosphodiesterase inhibitor that increases contractility independent of β-adrenergic receptors.", + "C": "Levosimendan increases both inotropy and blood pressure.", + "D": "When compared with norepinephrine and dobutamine, epinephrine is associated with increased mortality." + }, + "zh": { + "question": "一名63岁的男性在因穿孔性憩室炎进行腹部手术后因败血症被送入ICU。液体复苏后，他仍需高剂量去甲肾上腺素。床旁超声心动图显示左心室扩张，射血分数降低。以下哪项陈述是正确的？", + "A": "在液体负荷和血管加压药使用充足的情况下，仍有持续低灌注证据的患者中使用多巴酚丁胺的推荐是基于高质量证据的。", + "B": "米力农是一种磷酸二酯酶抑制剂，可在不依赖β-肾上腺素能受体的情况下增加心肌收缩力。", + "C": "左西孟旦可同时增加心肌收缩力和血压。", + "D": "与去甲肾上腺素和多巴酚丁胺相比，肾上腺素与更高的死亡率相关。" + } + }, + { + "id": "cb4a4930-580d-5b44-b225-407a66ee5da0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 65-year-old man is admitted to the ICU after undergoing an uncomplicated 3 vessel coronary artery bypass graft (CABG × 3). His blood pressure is 185/95 mm Hg. Which of the following is false regarding clevidipine?", + "A": "It is contraindicated in patients with allergies to soybeans, soy products, eggs, or egg products.", + "B": "When compared with nitroprusside, clevidipine demonstrated a significant mortality advantage.", + "C": "Clevidipine is superior for blood pressure control when compared with nitroprusside, nitroglycerin, and nicardipine.", + "D": "Rebound hypertension can occur after discontinuation of clevidipine." + }, + "zh": { + "question": "一名65岁的男性在进行了一次无并发症的三支血管冠状动脉旁路移植术（CABG × 3）后被送入ICU。他的血压为185/95 mm Hg。关于克利维地平，下列哪项是错误的？", + "A": "对大豆、大豆制品、鸡蛋或蛋制品过敏的患者禁用。", + "B": "与硝普钠相比，克利维地平显示出显著的死亡率优势。", + "C": "与硝普钠、硝酸甘油和尼卡地平相比，克利维地平在血压控制方面更优。", + "D": "停用克利维地平后可能会出现反弹性高血压。" + } + }, + { + "id": "d4b9ebc3-96fa-5377-91f7-2e3c792e2003", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following agents is categorized as a Category A bioterrorism agent by the Centers for Disease Control and Prevention (CDC)?", + "A": "Ricin toxin", + "B": "Vibrio cholerae", + "C": "Yersinia pestis (plague)", + "D": "Hantavirus" + }, + "zh": { + "question": "以下哪种剂被美国疾病控制与预防中心（CDC）分类为A类生物恐怖主义剂？", + "A": "蓖麻毒素", + "B": "霍乱弧菌", + "C": "鼠疫耶尔森菌（鼠疫）", + "D": "汉坦病毒" + } + }, + { + "id": "2247ab44-ac2d-528e-86ee-225c27d60600", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "You are asked to evaluate several patients who presented with symptoms of mydriasis, ptosis, diplopia, dysphagia, dysarthria, and progressive, symmetric descending flaccid paralysis. The patients are conscious and have no cardiovascular perturbations. You hear from colleagues that there are several similar cases at area hospitals as well. You recommend which of the following?", + "A": "Treatment with plasmapheresis or IV immunoglobulin and close respiratory and cardiovascular monitoring", + "B": "Supportive care, close monitoring for respiratory failure and risk of aspiration, and administration of antitoxin", + "C": "Treatment with atropine, pralidoxime, anticonvulsants if seizures occur, and close monitoring for respiratory failure and risk of aspiration", + "D": "Thorough skin examination, removal of tick, and supportive care" + }, + "zh": { + "question": "你被要求评估几位出现瞳孔散大、上睑下垂、复视、吞咽困难、构音障碍以及进行性、对称性下降性弛缓性麻痹症状的患者。这些患者意识清醒且无心血管异常。你从同事那里得知，地区医院也有几例类似病例。你推荐以下哪种治疗方案？", + "A": "使用血浆置换或静脉注射免疫球蛋白进行治疗，并密切监测呼吸和心血管状况", + "B": "支持性护理，密切监测呼吸衰竭和误吸风险，并给予抗毒素", + "C": "使用阿托品、氯解磷定治疗，如发生癫痫则使用抗惊厥药，并密切监测呼吸衰竭和误吸风险", + "D": "彻底的皮肤检查，去除蜱虫，并进行支持性护理" + } + }, + { + "id": "47578365-9baa-5644-9a8a-bf53032483d1", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "48. Which of the following statements regarding smallpox is false?", + "A": "The incubation period for smallpox is 10-14 days.", + "B": "Smallpox is highly infective requiring exposure to only 10-100 organisms to be infected.", + "C": "The lesions of smallpox appear over the face and trunk and progress from macule to papule to vesicle to crust within 24-48 hours, and lesions at different stages can coexist on any 1 part of the body.", + "D": "The World Health Organization (WHO) recommends a surveillance and containment strategy for the management of smallpox." + }, + "zh": { + "question": "48. 以下关于天花的说法哪一项是错误的？", + "A": "天花的潜伏期为10-14天。", + "B": "天花具有高度传染性，仅需接触10-100个病原体即可感染。", + "C": "天花的皮损出现在面部和躯干，并在24-48小时内从斑疹发展为丘疹、疱疹到结痂，同一部位可同时存在不同阶段的皮损。", + "D": "世界卫生组织（WHO）建议采用监测和控��策略来管理天花。" + } + }, + { + "id": "ec2d84f4-e0ca-529b-9bd9-0ba40439628f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What are the 4 properties of hazards within the biological weapon spectrum?", + "A": "Toxicity, latency, persistency, and transmissibility", + "B": "Virulence, stability, endemic, and determination", + "C": "Toxicity, stability, transmissibility, and transitory", + "D": "Virulence, weaponization, toxicity, and transmissibility" + }, + "zh": { + "question": "生物武器谱系中危害的四个特性是什么？", + "A": "毒性、潜伏性、持久性和传播性", + "B": "毒力、稳定性、地方性和决断性", + "C": "毒性、稳定性、传播性和暂时性", + "D": "毒力、武器化、毒性和传播性" + } + }, + { + "id": "f4229d1e-3e9d-5cc2-b23a-5fe904631f1f", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "You are caring for a 35-year-old man with respiratory failure, fever, shock, and acidosis. He presented 3 days ago with nonspecific complaints of fever, cough, and malaise. His chest radiograph shows mediastinal widening and pleural effusions. Blood cultures are growing Bacillus anthracis. Which of the following is NOT part of his management?", + "A": "He should be started on an antibiotic with bactericidal activity such as a fluoroquinolone as well as a protein synthesis inhibitor such as clindamycin to reduce toxin production.", + "B": "He should be placed on airborne precautions in a negative pressure room.", + "C": "A lumbar puncture should be performed to evaluate for meningitis.", + "D": "He should be treated early with an anthrax antitoxin." + }, + "zh": { + "question": "您正在照顾一名35岁的男性患者，他患有呼吸衰竭、发热、休克和酸中毒。3天前，他因发热、咳嗽和不适等非特异性症状就诊。他的胸部X光片显示纵隔增宽和胸腔积液。血液培养显示生长有炭疽杆菌。以下哪项不属于他的管理措施？", + "A": "他应该开始使用具有杀菌活性的抗生素，如氟喹诺酮类药物，以及蛋白质合成抑制剂如克林霉素，以减少毒素的产生。", + "B": "他应该被安置在负压病房中进行空气隔离。", + "C": "应进行腰椎穿刺以评估是否存在脑膜炎。", + "D": "应及早使用炭疽抗毒素进行治疗。" + } + }, + { + "id": "f4443c9a-569f-5032-bbe3-1bd27de0c020", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 69-year-old woman presents to an outpatient surgical center for elbow arthroscopy under regional anesthesia. Her medical history is significant for well-controlled hypertension on 2 antihypertensive agents, type 2 diabetes on metformin with a most recent HbA1c of 6, and obesity with a body mass index of 35. During preoperative assessment, she reports a good functional capacity, able to carry heavy loads of laundry up and down stairs from the basement. When asked, she admits that she has been told she snores loudly, has had witnessed apneic episodes, and is frequently tired during the day. What should the attending anesthesiologist do?", + "A": "Cancel the surgery because she is at high risk for having obstructive sleep apnea (OSA) and refer her for a sleep study.", + "B": "Cancel the surgery because she is at high risk for having OSA and refer her to have to procedure done at an inpatient facility.", + "C": "Proceed with the surgery despite the fact that she is at high risk for having OSA because her comorbidities are well controlled and she will have a regional anesthetic.", + "D": "Proceed with the surgery, as she is not at high risk for having OSA.", + "E": "Cancel the surgery because of her obesity and hypertension." + }, + "zh": { + "question": "一名69岁的女性因肘关节镜检查在门诊手术中心接受区域麻醉。她的病史包括通过两种降压药物控制良好的高血压、服用二甲双胍的2型糖尿病，最近的糖化血红蛋白为6，以及体重指数为35的肥胖。在术前评估中，她报告说功能能力良好，能够从地下室上下楼搬运重物。当被问及时，她承认有人告诉她打鼾声很大，有目击的呼吸暂停发作，并且白天经常感到疲倦。麻醉师应该怎么做？", + "A": "取消手术，因为她有高风险患阻塞性睡眠呼吸暂停（OSA），并建议她进行睡眠研究。", + "B": "取消手术，因为她有高风险患OSA，并建议她在住院设施进行手术。", + "C": "尽管她有高风险患OSA，但由于她的合并症控制良好且将进行���域麻醉，因此继续手术。", + "D": "继续手术，因为她没有高风险患OSA。", + "E": "取消手术，因为她的肥胖和高血压。" + } + }, + { + "id": "d4e67ab9-2c1a-5f04-830b-d94c329fe393", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 22-year-old woman presents to the same-day surgery clinic for a rhinoplasty revision. Upon meeting her in the preoperative area, you note she is chewing gum. When you ask her about it, she immediately swallows the gum. Upon further questioning she admits that this is the fifth piece of gum she has chewed and swallowed this morning. Which of the following is the most appropriate action?", + "A": "Proceed with the surgery as scheduled because chewing gum has little effect on gastric volume or pH.", + "B": "Delay the surgery for 2 hours because chewing gum is considered similar to liquids according to ASA guidelines.", + "C": "Delay the surgery for 4 hours because chewing gum is considered similar to breast milk according to ASA guidelines.", + "D": "Delay the surgery for 6 hours because the gum she swallowed qualifies as a solid/light meal.", + "E": "Cancel the surgery because she did not follow directions." + }, + "zh": { + "question": "一名22岁的女性来到日间手术诊所进行鼻整形修复术。在术前区域见到她时，你注意到她正在嚼口香糖。当你询问她时，她立即吞下了口香糖。经过进一步询问，她承认这是她今天早上嚼过并吞下的第五块口香糖。以下哪项是最合适的行动？", + "A": "按计划进行手术，因为嚼口香糖对胃容量或pH值影响很小。", + "B": "将手术推迟2小时，因为根据ASA指南，嚼口香糖被视为类似于液体。", + "C": "将手术推迟4小时，因为根据ASA指南，嚼口香糖被视为类似于母乳。", + "D": "将手术推迟6小时，因为她吞下的口香糖被视为固体/轻食。", + "E": "取消手术，因为她没有遵循指示。" + } + }, + { + "id": "a5c07425-ccd8-50a0-97f0-b08b060c08a4", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "3. A nurse calls you from the preoperative area of an outpatient surgical center to tell you about a 35-year-old man with type 1 diabetes scheduled for knee arthroscopy. She notes he has vomited once, is tachycardic, and is constantly asking either to use the bathroom or to be able to drink water. He told her that he has not taken insulin in 2 days, so she took his blood glucose level and it is 467. Which of the following is the best course of action?", + "A": "Proceed with surgery and treat the hyperglycemia intraoperatively with IV regular insulin.", + "B": "Ask the nurse to give the patient his normal dose of NPH and proceed with surgery treating intraoperative hyperglycemia with IV regular insulin.", + "C": "Evaluate the patient yourself and proceed with surgery only if he understands how to treat his hyperglycemia postoperatively.", + "D": "Evaluate the patient yourself. Explain to him that you are concerned that he is showing signs and symptoms of diabetic ketoacidosis, cancel the surgery, draw appropriate laboratory test results, and send him to a tertiary care center for further evaluation and treatment.", + "E": "Counsel the nurse that she should not have checked the blood glucose level without discussing it with you first." + }, + "zh": { + "question": "3. 一名护士从门诊手术中心的术前区域打电话给你，告知一名35岁患有1型糖尿病的男性计划进行膝关节镜检查。她注意到他呕吐过一次，心动过速，并且不断要求要么上厕所，要么喝水。他告诉她他已经两天没有注射胰岛素了，所以她测了他的血糖，结果是467。以下哪项是最佳的处理方案？", + "A": "继续手术，并在术中用静脉注射常规胰岛素治疗高血糖。", + "B": "让护士给病人注射正常剂量的NPH，并继续手术，在术中用静脉注射常规胰岛素治疗高血糖。", + "C": "亲自评估病人，并仅在他了解如何在术后处理高血糖的情况下继续手术。", + "D": "亲自评估病人。向他解释你担心他表现出糖尿病酮症酸中毒的体征和症状，取消手术，进行适当的实验室检查，并将他送往三级护理中心进行进一步评估和治疗。", + "E": "建议护士在没有先与你讨论的情况下不应检查血糖水平。" + } + }, + { + "id": "6feeb5de-4fab-5a9a-8086-d16da3ac18da", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 23-year-old woman presents for same-day surgery for hysteroscopy for a misplaced intrauterine device. She is very anxious about anesthesia. On your preoperative assessment, you note she gets carsick frequently and is a", + "A": "Based on her Apfel score, she has 3 risk factors of PONV, giving her a 60% risk of PONV. A multimodal approach using antiemetics of 2 or 3 different classes is appropriate.", + "B": "Her anxiety confers additional risk for PONV.", + "C": "Both avoiding nitrous oxide and minimizing neostigmine dose can help reduce her risk of PONV.", + "D": "Scopolamine patch and ondansetron are most effective when administered before surgery.", + "E": "The use of haloperidol as an antiemetic requires doses the same as or higher than those that are used to treat psychiatric disorders." + }, + "zh": { + "question": "一名23岁的女性因宫内节育器移位而进行同日手术进行宫腔镜检查。她对麻醉非常焦虑。在术前评估中，你注意到她经常晕车，并且是一个", + "A": "根据她的Apfel评分，她有3个PONV的风险因素，给她带来60%的PONV风险。使用2或3种不同类别的止吐药的多模式方法是合适的。", + "B": "她的焦虑增加了PONV的额外风险。", + "C": "避免使用氧化亚氮和最小化新斯的明剂量都可以帮助降低她的PONV风险。", + "D": "东莨菪碱贴片和昂丹司琼在术前使用效果最佳。", + "E": "作为止吐药使用氟哌啶醇需要与治疗精神障碍相同或更高的剂量。" + } + }, + { + "id": "fcdcaa41-3e54-5d40-82fb-8d39c488aa2d", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 40-year-old woman presents to an ambulatory surgical center for knee arthroscopy. She tells you she needs to get home as soon as possible after the surgery because she has \"important things to take care of.\" What is the best anesthetic plan to ensure the shortest time from arrival to discharge?", + "A": "General anesthesia", + "B": "Regional anesthesia with a \"3-in-1\" block technique", + "C": "Spinal anesthesia", + "D": "All of the above techniques can be used to affect a short time to discharge", + "E": "Knee arthroscopy is not an appropriate surgery for an ambulatory center" + }, + "zh": { + "question": "一名40岁的女性来到门诊手术中心进行膝关节镜检查。她告诉你，她需要在手术后尽快回家，因为她有“重要的事情要处理”。为了确保从到达到出院的时间最短，最佳的麻醉计划是什么？", + "A": "全身麻醉", + "B": "使用“3合1”阻滞技术的区域麻醉", + "C": "脊髓麻醉", + "D": "以上所有技术都可以用于缩短出院时间", + "E": "膝关节镜检查不适合在门诊中心进行" + } + }, + { + "id": "5c74d1c5-8f38-58e7-99f1-7b67d5f5e83e", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 23-year-old woman is having nausea and vomiting in the postanesthesia care unit (PACU) after hysteroscopy. She was deemed to be at high risk for PONV and received dexamethasone, ondansetron, and haloperidol as PONV prophylaxis intraoperatively. Which of the following is the best next step in management?", + "A": "Repeat the same dose of ondansetron.", + "B": "Repeat the same dose of dexamethasone.", + "C": "Repeat the same dose of haloperidol.", + "D": "Give a higher dose of ondansetron.", + "E": "Administer perphenazine or promethazine." + }, + "zh": { + "question": "一名23岁的女性在子宫镜检查后出现恶心和呕吐，正在麻醉后恢复室（PACU）。她被认为是PONV的高风险患者，并在术中接受了地塞米松、昂丹司琼和氟哌啶醇作为PONV预防措施。以下哪项是管理的最佳下一步？", + "A": "重复相同剂量的昂丹司琼。", + "B": "重复相同剂量的地塞米松。", + "C": "重复相同剂量的氟哌啶醇。", + "D": "给予更高剂量的昂丹司琼。", + "E": "给予丙氟嗪或异丙嗪。" + } + }, + { + "id": "0a771324-6f44-5f74-9e13-63829aa786eb", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are common reasons for delay in ambulatory surgical patient discharge EXCEPT which one?", + "A": "Drowsiness", + "B": "Nausea", + "C": "Vomiting", + "D": "Anxiety", + "E": "Pain" + }, + "zh": { + "question": "以下哪一项不是导致门诊手术患者出院延迟的常见原因？", + "A": "嗜睡", + "B": "恶心", + "C": "呕吐", + "D": "焦虑", + "E": "疼痛" + } + }, + { + "id": "7a2a9b98-065f-528c-9ad8-1fe92a4d8bf6", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "8. A 31-year-old man complains of 7/10 pain in the PACU after hemorrhoidectomy under general anesthesia. Which is the most appropriate intervention to treat his pain and facilitate a shorter time to discharge home?", + "A": "Assume his complaint is due to discomfort from something else such as hypoxemia, hypercapnia, or full bladder rather than surgical pain.", + "B": "Administer IV hydromorphone.", + "C": "Administer IV morphine.", + "D": "Administer IV fentanyl.", + "E": "Evaluate for other sources of discomfort such as hypoxemia, hypercapnia, or full bladder. Once these are eliminated, administer IV fentanyl and a nonsteroidal anti-inflammatory drug." + }, + "zh": { + "question": "8. 一名31岁的男性在全身麻醉下进行痔疮切除术后，在PACU中抱怨7/10的疼痛。哪种干预措施最适合治疗他的疼痛并缩短出院时间？", + "A": "假设他的抱怨是由于其他不适引起的，例如低氧血症、高碳酸血症或膀胱充盈，而不是手术疼痛。", + "B": "给予静脉注射氢吗啡酮。", + "C": "给予静脉注射吗啡。", + "D": "给予静脉注射芬太尼。", + "E": "评估其他不适来源，如低氧血症、高碳酸血症或膀胱充盈。一旦排除这些因素，给予静脉注射芬太尼和非甾体抗炎药。" + } + }, + { + "id": "dae863f7-c037-5dc4-bb15-55ec6c3a0a8b", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 65-year-old man is recovering from general anesthesia for umbilical hernia repair. You go to evaluate him and note he is sleeping with an oxygen saturation of 94%on room air. When you call his name, he takes a deep breath, coughs, and yells at you for interrupting his nap. You note his blood pressure is 166/70. He kicks his blanket off and throws it at you, yelling \"that's what it always is!\"", + "A": "His modified Aldrete score is 5 and he is NOT ready for discharge.", + "B": "His modified Aldrete score is 9 and he is ready for discharge.", + "C": "He is hypertensive and therefore is not ready for discharge.", + "D": "He is angry and therefore is not ready for discharge.", + "E": "He was sleeping and therefore is not ready for discharge." + }, + "zh": { + "question": "一名65岁的男性在接受脐疝修补术的全身麻醉后正在恢复。你去评估他，注意到他在空气中氧饱和度为94%时正在睡觉。当你叫他的名字时，他深吸一口气，咳嗽，并对你打断他的午睡大喊大叫。你注意到他的血压是166/70。他踢掉毯子并扔向你，喊道“这就是它一直的样子！”", + "A": "他的改良Aldrete评分是5，他尚未准备好出院。", + "B": "他的改良Aldrete评分是9，他已准备好出院。", + "C": "他是高血压患者，因此尚未准备好出院。", + "D": "他很生气，因此尚未准备好出院。", + "E": "他在睡觉，因此尚未准备好出院。" + } + }, + { + "id": "1220665f-dcfd-58f7-8227-0b288a23ffc2", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 21-year-old man is in the PACU after receiving general anesthesia for excision and grafting of a small burn he sustained to his right lower extremity several days ago. He is demanding to be discharged home, but the nurse tells him he must urinate and eat crackers first. Which of the following is true regarding the need to void and eat/drink before discharge home?", + "A": "It is absolutely necessary for all patients to urinate and demonstrate that they can eat and drink before discharge home from the PACU.", + "B": "It is never necessary for patients to urinate and demonstrate that they can eat and drink before discharge home from the PACU.", + "C": "All patients who received general anesthesia need to demonstrate that they can eat and drink before discharge home. Only patients who had neuraxial blocks are required to urinate.", + "D": "Requiring all patients to void before discharge home is necessary from a medicolegal standpoint.", + "E": "Requiring patients who are at low risk to void and to eat and drink before discharge home is not necessary." + }, + "zh": { + "question": "一名21岁的男性在接受全身麻醉后正在PACU中，他几天前右下肢的小面积烧伤进行了切除和移植。他要求出院回家，但护士告诉他必须先排尿和吃饼干。关于出院前需要排尿和吃喝，下列哪项是正确的？", + "A": "所有患者在从PACU出院回家前���绝对有必要排尿并证明他们可以吃喝。", + "B": "患者在从PACU出院回家前，绝对不需要排尿并证明他们可以吃喝。", + "C": "所有接受全身麻醉的患者在出院前需要证明他们可以吃喝。只有接受神经轴阻滞的患者需要排尿。", + "D": "从医学法律的角度来看，要求所有患者在出院前排尿是必要的。", + "E": "对于低风险患者，要求他们在出院前排尿和吃喝是不必要的。" + } + }, + { + "id": "0c3dc24c-7028-5ef6-a0fa-eb9eaa639a87", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the expected physiologic response to electroconvulsive therapy (ECT), beginning with the electrical stimulus?", + "A": "Initial sympathetic discharge followed by parasympathetic response", + "B": "Initial parasympathetic discharge followed by sympathetic response", + "C": "Initial sympathetic discharge without parasympathetic response", + "D": "Initial prominent sympathetic discharge leading to arrhythmia", + "E": "No physiologic response" + }, + "zh": { + "question": "以下哪项是电休克疗法（ECT）从电刺激开始的预期生理反应？", + "A": "最初的交感神经放电，随后是副交感神经反应", + "B": "最初的副交感神经放电，随后是交感神经反应", + "C": "最初的交感神经放电，没有副交感神经反应", + "D": "最初显著的交感神经放电导致心律失常", + "E": "没有生理反应" + } + }, + { + "id": "374abd47-7a07-53fb-babe-c9c8194b525c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following agents CANNOT be used safely and effectively for induction of anesthesia for ECT?", + "A": "Methohexital", + "B": "Propofol", + "C": "Ketamine", + "D": "Etomidate", + "E": "None of the above, all can be used safely and effectively" + }, + "zh": { + "question": "以下哪种药物不能安全有效地用于电休克治疗的麻醉诱导？", + "A": "甲氧己妥", + "B": "丙泊酚", + "C": "氯胺酮", + "D": "依托咪酯", + "E": "以上都可以安全有效地使用" + } + }, + { + "id": "42c6c842-ccec-51c3-9bed-3435a5d12949", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "13. A 52-year-old woman presents for ECT for refractory depression. You note she is on multiple psychiatric medications, including a selective serotonin reuptake inhibitor, a tricyclic antidepressant, and a monoamine oxidase inhibitor (MAOI). Which of the following is false regarding MAOIs and ECT?", + "A": "Patient's taking MAOIs are at increased risk for hypertensive crisis if direct- or indirect-acting sympathomimetic drugs are given.", + "B": "If the decision is made to continue MAOI therapy, the patient should be on a stable dose before ECT.", + "C": "If the decision is made to discontinue the MAOI, it should be held for 3 days before ECT.", + "D": "If the decision is made to discontinue the MAOI, it should be held for 2 weeks before ECT.", + "E": "The decision to either stop or continue MAOIs for ECT should be made on an individual patient-by-patient basis." + }, + "zh": { + "question": "13. 一名52岁的女性因难治性抑郁症接受电休克疗法（ECT）。你注意到她正在服用多种精神药物，包括选择性5-羟色胺再摄取抑制剂、三环类抗抑郁药和单胺氧化酶抑制剂（MAOI）。关于MAOI和ECT，下列哪项是错误的？", + "A": "服用MAOI的患者如果给予直接或间接作用的拟交感神经药物，发生高血压危象的风险增加。", + "B": "如果决定继续MAOI治疗，患者在ECT前应保持稳定剂量。", + "C": "如果决定停用MAOI，应在ECT前停药3天。", + "D": "如果决定停用MAOI，应在ECT前停药2周。", + "E": "是否在ECT中停用或继续使用MAOI的决定应基于个体患者的情况。" + } + }, + { + "id": "ce28da7a-1860-550c-91bf-43718809b141", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "In which of the following patients would you be MOST concerned about ECT?", + "A": "A 55-year-old man who had a cerebral aneurysm coiled last year, stable on follow-up imaging.", + "B": "An 87-year-old woman with multivessel coronary artery disease and ejectionfraction on 35%", + "C": "A 41-year-old man with untreated pheochromocytoma", + "D": "A 71-year-old woman with severe osteoporosis", + "E": "A 65-year-old man with Parkinson disease" + }, + "zh": { + "question": "在以下哪位患者中，您最担心进行电休克疗法（ECT）？", + "A": "55岁男性，去年进行了脑动脉瘤栓塞术，随访影像显示稳定。", + "B": "87岁女性，患有多支冠状动脉疾病，射血分数为35%。", + "C": "41岁男性，未治疗的嗜铬细胞瘤。", + "D": "71岁女性，患有严重的骨质疏松症。", + "E": "65岁男性，患有帕金森病。" + } + }, + { + "id": "99a92e36-9c2e-5b3b-b185-f26e65b7a8ba", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 27-year-old woman with depression who has not responded well to medical management presents for ECT. You are about to go over the consent for anesthesia with her when a nurse tells you \"not to bother, \" consent is implied because she is depressed and therefore cannot consent for herself. Which of the following is the most appropriate response?", + "A": "Thank her for reminding you and do not consent the patient.", + "B": "Thank her for reminding you and call the patient's mother to obtain consent.", + "C": "Cancel the ECT.", + "D": "Assess the patient to evaluate if she understands the information relevant to consenting for anesthesia for ECT, and if she does, continue with the consent process." + }, + "zh": { + "question": "一名27岁的女性患有抑郁症，对药物治疗反应不佳，现准备接受电休克治疗。你正准备与她讨论麻醉同意书时，一名护士告诉你“别费心了”，因为她抑郁，所以无法为自己做出同意。以下哪项是最合适的回应？", + "A": "感谢她的提醒，并不为患者进行同意。", + "B": "感谢她的提醒，并打电话给患者的母亲以获得同意。", + "C": "取消电休克治疗。", + "D": "评估患者是否理解与电休克麻醉同意相关的信息，如果她理解，则继续进行同意过程。" + } + }, + { + "id": "ec191689-ff06-566e-b075-0b590bc4a98c", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are advantages of an office-based procedure EXCEPT which one?", + "A": "Cost containment", + "B": "Patient convenience", + "C": "Surgeon convenience", + "D": "Increased patient exposure to nosocomial infections", + "E": "Improved patient privacy" + }, + "zh": { + "question": "以下哪一项不是基于办公室的手术的优点？", + "A": "成本控制", + "B": "患者便利", + "C": "外科医生便利", + "D": "增加患者接触医院感染的风险", + "E": "改善患者隐私" + } + }, + { + "id": "2e426671-692b-517e-838b-055a029a09fb", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following equipment is NOT required to be available for the safe delivery of office-based anesthesia?", + "A": "Pulse oximeter", + "B": "Capnography", + "C": "Anesthesia machine", + "D": "Suction equipment", + "E": "Dantrolene and malignant hyperthermia supplies" + }, + "zh": { + "question": "以下哪种设备不是安全实施办公室麻醉所必需的？", + "A": "脉搏血氧仪", + "B": "呼气末二氧化碳监测仪", + "C": "麻醉机", + "D": "吸引设备", + "E": "丹曲林和恶性高热供应" + } + }, + { + "id": "22dc5452-9747-5d46-ba59-a76971b6a914", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "According to the ASA Closed Claims Project database, which of the following were the most common adverse events during office-based procedures?", + "A": "Respiratory events", + "B": "Cerebrovascular events", + "C": "Equipment-related injuries", + "D": "Gastrointestinal-related events", + "E": "Postanesthetic events" + }, + "zh": { + "question": "根据ASA关闭索赔项目数据库，以下哪项是办公室手术中最常见的不良事件？", + "A": "呼吸事件", + "B": "脑血管事件", + "C": "设备相关伤害", + "D": "胃肠道相关事件", + "E": "麻醉后事件" + } + }, + { + "id": "cea0c723-9183-5e4f-8151-1780bfd3b10a", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "19. All of the following patients are considered poor candidates for an officebased procedure EXCEPT which one?", + "A": "A 30-year-old woman with type 1 diabetes mellitus and HbA1c 9", + "B": "A 20-year-old man with history of intravenous drug use on Suboxone", + "C": "A 40-year-old woman with body mass index of 43", + "D": "A 70-year-old woman with osteoporosis", + "E": "A 50-year-old man without an escort" + }, + "zh": { + "question": "19. 以下哪位患者被认为不适合在诊所进行手术，除了哪一位？", + "A": "30岁女性，1型糖尿病，HbA1c 9", + "B": "20岁男性，有静脉药物使用史，正在服用Suboxone", + "C": "40岁女性，体重指数43", + "D": "70岁女性，患有骨质疏松症", + "E": "50岁男性，没有陪同人员" + } + }, + { + "id": "51371bd3-a373-554b-8ba2-74c5486eb876", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "The last patient of the day is recovering from her general anesthetic for liposuction at a plastic surgery office. The anesthesiologist and a medical assistant are the only people who remain in the office after a long day. The anesthesiologist tells the administrative assistant she has to leave and asks him if he can give the patient's escort the postoperative care instructions when he gets there. Which of the following statements is correct?", + "A": "This is inappropriate because the anesthesiologist must stay until the last patient has left the office.", + "B": "This is appropriate only if the medical assistant is ACLS/PALS-certified.", + "C": "This is appropriate because the anesthesiologist has to leave.", + "D": "This is inappropriate because the anesthesiologist is taking advantage of the medical assistant.", + "E": "This is inappropriate because the anesthesiologist should remain to answer the escort's questions about postsurgical care." + }, + "zh": { + "question": "今天最后一位患者正在整形外科诊所从吸脂手术的全身麻醉中恢复。麻醉师和一名医疗助理是经过漫长一天后办公室里仅剩的人。麻醉师告诉行政助理她必须离开，并询问他是否可以在患者的陪同人员到达时给他们提供术后护理说明。以下哪种说法是正确的？", + "A": "这是不合适的，因为麻醉师必须留到最后一位患者离开办公室。", + "B": "只有在医疗助理拥有ACLS/PALS认证时，这才是合适的。", + "C": "这是合适的，因为麻醉师必须离开。", + "D": "这是不合适的，因为麻醉师在利用医疗助理。", + "E": "这是不合适的，因为麻醉师应该留下来回答陪同人员关于术后护理的问题。" + } + }, + { + "id": "3d739736-6293-5065-a45b-32b921c665d1", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The 3-step paradigm to nonoperating room anesthesia describes a systematic approach that addresses which of the following?", + "A": "The patient, the procedure, and the environment", + "B": "The patient, the proceduralist, and the anesthesiologist", + "C": "The proceduralist, the anesthesiologist, and the ASA classification", + "D": "The anesthesiologist, the environment, and the equipment", + "E": "The proceduralist, the environment, and the equipment" + }, + "zh": { + "question": "非手术室麻醉的三步范式描述了一种系统的方法，该方法解决了以下哪些问题？", + "A": "患者、手术过程和环境", + "B": "患者、手术医生和麻醉师", + "C": "手术医生、麻醉师和ASA分级", + "D": "麻醉师、环境和设备", + "E": "手术医生、环境和设备" + } + }, + { + "id": "8beb395d-deea-5d6c-b039-0cc10f385ed8", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "You are delivering general anesthesia in the interventional radiology suite for fluoroscopy-guided radiofrequency ablation of hepatocellular carcinoma. All of the following steps can be taken to minimize exposure to radiation EXCEPT which one?", + "A": "Leaving the procedure room when active radiation is in use", + "B": "Wearing a lead-lined protective garment", + "C": "Working behind a lead-lined glass shield", + "D": "Working on the side of the table on which the X-ray source originates", + "E": "Limiting the length of time of the procedure" + }, + "zh": { + "question": "您正在介入放射科的手术室中进行肝细胞癌的透视引导射频消融术的全身麻醉。以下所有步骤都可以用来减少辐射暴露，除了哪一个？", + "A": "在使用主动辐射时离开手术室", + "B": "穿戴铅衬保护服", + "C": "在铅衬玻璃屏障后工作", + "D": "在X射线源发出的桌子一侧工作", + "E": "限制手术时间的长度" + } + }, + { + "id": "33a868f7-1285-5d6e-8971-6115b23d1297", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "You are performing a general anesthesia for a 4-year-old undergoing an MRI. After induction of anesthesia, you take all of the following steps to ensure safety in the MRI EXCEPT which one?", + "A": "Ear protection is placed in the patient's ears.", + "B": "IV tubing and cables are wound neatly in loops at the patient's skin.", + "C": "Ensure absence of ferromagnetic equipment such as IV poles, gas cylinders, and pens.", + "D": "The patient achieves adequate tidal volumes after moving into the scanner.", + "E": "The patient is adequately anesthetized." + }, + "zh": { + "question": "您正在为一名4岁的儿童进行全身麻醉以进行MRI。在麻醉诱导后，您采取以下所有步骤以确保MRI中的安全，除了哪一个？", + "A": "在患者的耳朵里放置耳部保护装置。", + "B": "将静脉输液管和电缆整齐地缠绕在患者的皮肤上。", + "C": "确保没有铁磁性设备，如静脉输液杆、气瓶和笔。", + "D": "患者在进入扫描仪后达到足够的潮气量。", + "E": "患者被充分麻醉。" + } + }, + { + "id": "88a6cb40-ece3-5ab3-a62e-d260e7b81972", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "After inducing general anesthesia, you observe your patient as she moves into the MRI scanner. After ensuring MRI safety standards have been met and she is adequately anesthetized and hemodynamically stable, you move to the monitoring room. When you are in the monitoring room, you are in which zone?", + "A": "Zone I", + "B": "Zone II", + "C": "Zone III", + "D": "Zone IV", + "E": "Zone V" + }, + "zh": { + "question": "在诱导全身麻醉后，你观察到你的病人进入MRI扫描仪。在确保MRI安全标准已达到并且她已充分麻醉且血流动力学稳定后，你移动到监控室。当你在监控室时，你处于哪个区域？", + "A": "区域I", + "B": "区域II", + "C": "区域III", + "D": "区域IV", + "E": "区域V" + } + }, + { + "id": "6d8e3483-faaf-563a-a263-8a4d199392aa", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "25. ASA standards for nonoperating room anesthetizing locations include all of the following EXCEPT which one?", + "A": "Adequate and reliable suction is available.", + "B": "Easy and expeditious access to the patient is required, but limited access to the anesthesia machine and monitoring equipment is acceptable.", + "C": "Defibrillator, emergency drugs, and cardiopulmonary resuscitation equipment are all immediately available.", + "D": "There is adequate illumination of the patient, anesthesia machine, and monitoring equipment with a battery-operated backup light source.", + "E": "Electrical outlets are sufficient for both the anesthesia machines and monitors." + }, + "zh": { + "question": "25. ASA 对非手术室麻醉地点的标准包括以下所有内容，除了哪一项？", + "A": "有足够且可靠的吸引设备可用。", + "B": "需要对患者进行便捷快速的接触，但对麻醉机和监测设备的有限接触是可以接受的。", + "C": "除颤器、急救药物和心肺复苏设备均可立即使用。", + "D": "患者、麻醉机和监测设备有足够的照明，并配有电池供电的备用光源。", + "E": "电源插座足以供麻醉机和监测设备使用。" + } + }, + { + "id": "c60a1a09-a605-5e70-a383-55bb7117bb34", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": ",, Of the following choices, which opioid has consistently been associated with delirium when used for postoperative pain management in the elderly?", + "A": "Fentanyl", + "B": "Morphine", + "C": "Hydromorphone", + "D": "Meperidine" + }, + "zh": { + "question": "在以下选项中，哪种阿片类药物在用于老年人术后疼痛管理时一贯与谵妄有关？", + "A": "芬太尼", + "B": "吗啡", + "C": "氢吗啡酮", + "D": "哌替啶" + } + }, + { + "id": "62f746fa-397f-57f9-9c44-2263ac0b272c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following changes that occur with increasing age can account for the possible increase of morphine's duration of action in the elderly?", + "A": "Increased adipose tissue", + "B": "Increased lean body mass", + "C": "Increased total body water", + "D": "Decreased gastric pH" + }, + "zh": { + "question": "以下哪种随年龄增长而发生的变化可以解释吗啡在老年人中作用时间可能增加的原因？", + "A": "脂肪组织增加", + "B": "瘦体重增加", + "C": "总身体水分增加", + "D": "胃酸度降低" + } + }, + { + "id": "6970a036-01aa-5276-8874-993423007d52", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following opioids would be most appropriate to treat pain in an elderly patient on fluoxetine?", + "A": "Tramadol", + "B": "Meperidine", + "C": "Fentanyl", + "D": "Oxycodone" + }, + "zh": { + "question": "以下哪种阿片类药物最适合用于治疗服用氟西汀的老年患者的疼痛？", + "A": "曲马多", + "B": "哌替啶", + "C": "芬太尼", + "D": "羟考酮" + } + }, + { + "id": "847094f5-bfd3-51bf-9cf9-162a1eb4f01b", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "When comparing an 80-year-old patient with a 20-year-old patient with the same lean body mass, which of the following statements about remifentanil is false?", + "A": "A reduction of the bolus dose will be required in the 80-year-old to have the same therapeutic effect as in the 20-year-old.", + "B": "A reduction of the maintenance infusion rate will be required in the 80-year-old to have the same therapeutic effect as in the 20-year-old.", + "C": "The 80-year-old patient may have a delayed emergence after receiving a remifentanil infusion.", + "D": "The 20-year-old patient may have a delayed emergence after receiving a remifentanil infusion." + }, + "zh": { + "question": "在比较具有相同瘦体重的80岁患者和20岁患者时，关于瑞芬太尼的以下哪项陈述是错误的？", + "A": "80岁的患者需要减少推注剂量才能达到与20岁患者相同的治疗效果。", + "B": "80岁的患者需要减少维持输注速率才能达到与20岁患者相同的治疗效果。", + "C": "80岁的患者在接受瑞芬太尼输注后可能会出现延迟苏醒。", + "D": "20岁的患者在接受瑞芬太尼输注后可能会出现延迟苏醒。" + } + }, + { + "id": "f5aa7b5c-23ae-5b91-8e55-e9a3ac78f940", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "5. An 80-year-old man is scheduled for radical prostatectomy. He denies any significant medical history other than hypertension, for which he takes hydrochlorothiazide. He reports a good exercise tolerance and is able to climb 4 flights of stairs without difficulty. What would be the expected minimum alveolar concentration (MAC) of sevoflurane to prevent movement to surgical stimulation assuming the patient has a response to anesthesia in line with the median population?", + "A": "1.8%", + "B": "1.6%", + "C": "1.4%", + "D": "1.2%" + }, + "zh": { + "question": "5. 一名80岁的男性计划进行根治性前列腺切除术。他除了高血压外否认有任何显著的病史，并服用氢氯噻嗪。他报告有良好的运动耐力，能够轻松爬4层楼梯。假设患者对麻醉的反应与中位数人群一致，预期的七氟醚最低肺泡浓度（MAC）是多少以防止手术刺激引起的运动？", + "A": "1.8%", + "B": "1.6%", + "C": "1.4%", + "D": "1.2%" + } + }, + { + "id": "bc201de4-1b89-576e-94c9-1e25c945d7d1", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 90-year-old man with no significant cardiopulmonary history, other than hypertension, is undergoing an elective right hemicolectomy. After induction of general anesthesia, the patient is noted to be requiring escalating doses of phenylephrine to maintain a mean arterial pressure (MAP) >65 mm Hg. ECG shows normal sinus rhythm, and airway pressures are within normal limits. End tidal carbon dioxide is stable. He is being maintained on desflurane with an expired concentration of 6%. Which of the following is the most appropriate next step?", + "A": "Decrease the desflurane with a goal expired concentration of 5.5%.", + "B": "Decrease the desflurane with a goal expired concentration of 4.6%.", + "C": "Tolerate a MAP of 55 mm Hg.", + "D": "Administer midazolam with the goal of creating a balanced anesthetic." + }, + "zh": { + "question": "一名90岁的男性，除高血压外无显著心肺病史，正在接受择期右半结肠切除术。在诱导全身麻醉后，发现患者需要逐渐增加去氧肾上腺素的剂量以维持平均动脉压（MAP）>65 mm Hg。心电图显示正常窦性心律，气道压力在正常范围内。呼气末二氧化碳稳定。他正在使用呼气浓度为6%的地氟醚维持麻醉。以下哪项是最合适的下一步措施？", + "A": "减少地氟醚，目标呼气浓度为5.5%。", + "B": "减少地氟醚，目标呼气浓度为4.6%。", + "C": "容忍MAP为55 mm Hg。", + "D": "给予咪达唑仑以达到平衡麻醉的目的。" + } + }, + { + "id": "4da2d9d5-dd9a-5bbe-8cff-856439b9e81c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements regarding cardiovascular physiology in the elderly is true?", + "A": "Vascular stiffening leads to a decrease in pulse pressure.", + "B": "Diastolic dysfunction is present in half of those diagnosed with congestive heart failure.", + "C": "Nitric oxide production is increased to balance increases in systemic vascular resistance.", + "D": "Cardiac output is maintained by increased stroke volume and ventricular contractility." + }, + "zh": { + "question": "以下关于老年人心血管生理的说法中哪一项是正确的？", + "A": "血管僵硬导致脉压下降。", + "B": "在被诊断为充血性心力衰竭的人中，一半存在舒张功能障碍。", + "C": "一氧化氮的产生增加以平衡全身血管阻力的增加。", + "D": "通过增加的搏出量和心室收缩力来维持心输出量。" + } + }, + { + "id": "63da3e2b-9aca-52cb-a93f-0a5b725e5c65", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following cardiovascular changes associated with aging is false?", + "A": "Reduced ventricular compliance", + "B": "Decreased blood vessel contractility", + "C": "Desensitization of carotid and aortic baroreceptors", + "D": "Preserved sympathetic and vagal resting tone" + }, + "zh": { + "question": "以下哪项与衰老相关的心血管变化是错误的？", + "A": "心室顺应性降低", + "B": "血管收缩性降低", + "C": "颈动脉和主动脉压力感受器脱敏", + "D": "交感神经和迷走神经的静息张力保持不变" + } + }, + { + "id": "0e187d64-f7c2-5ef4-a845-152393c65cea", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements regarding cardiovascular pathology in elderly patients is false?", + "A": "Out of every 3 patients older than 70 years, 1 patient will develop significant coronary artery disease.", + "B": "Hypertension can develop in the setting of normal systemic vascular resistance.", + "C": "In the developing world, rheumatic heart disease affecting the aortic valve is the most common cause of valvular heart disease.", + "D": "In the absence of disease, resting systolic cardiac function can be preserved even in octogenarians." + }, + "zh": { + "question": "以下关于老年患者心血管病理的陈述中哪一项是错误的？", + "A": "在每3名70岁以上的患者中，1名患者将发展为显著的冠状动脉疾病。", + "B": "在正常全身血管阻力的情况下也可能出现高血压。", + "C": "在发展中国家，影响主动脉瓣的风湿性心脏病是瓣膜性心脏病的最常见原因。", + "D": "在没有疾病的情况下，即使是八十多岁的老人，静息收缩期心功能也可以保持。" + } + }, + { + "id": "93bfae81-8b9f-5ec9-ad01-7bf32e734fa0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements regarding autonomic physiology in the elderly is true?", + "A": "α-Adrenergic sensitivity and response to α-agonists are increased.", + "B": "β-Adrenergic sensitivity and response to β-agonists are increased.", + "C": "Adrenal tissues atrophy, resulting in a decrease in circulating norepinephrine and epinephrine levels.", + "D": "Maintenance of MAP is dependent on increases in vascular resistance." + }, + "zh": { + "question": "以下关于老年人自主神经生理的说法中哪一项是正确的？", + "A": "α-肾上腺素能敏感性和对α-激动剂的反应增加。", + "B": "β-肾上腺素能敏感性和对β-激动剂的反应增加。", + "C": "肾上腺组织萎缩，导致循环中去甲肾上腺素和肾上腺素水平下降。", + "D": "平均动脉压的维持依赖于血管阻力的增加。" + } + }, + { + "id": "8feeb366-b3fa-5054-8d71-58607a1f5c64", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "11. A 84-year-old man is admitted to the hospital after a fall from standing, striking his left chest on a night stand. The patient's medical history includes hypertension, coronary artery disease with multiple drug eluting stent placements in the left and right coronary arteries, non-ST elevation myocardial infarction (5 years ago), and heart failure with a left ventricular (LV) ejection fraction of 35%. He is taking aspirin, clopidogrel, and apixaban (factor Xa [FXa] inhibitor), as well as ibuprofen as needed for intermittent back pain. The patient's laboratory test results reveal the following: Na 134, K 3.2, Cl 100,", + "A": "Andexanet alfa administration is associated with acute kidney injury (AKI).", + "B": "Ibuprofen (NSAID) caused acute interstitial nephritis by inhibition of local prostaglandin production.", + "C": "The patient's urine output was inadequate.", + "D": "The degree of the patient's increase in creatinine is associated with an increased risk of hospital death." + }, + "zh": { + "question": "11. 一名84岁男性在从站立位置跌倒后入院，他的左胸撞到了床头柜。患者的病史包括高血压、冠状动脉疾病（左、右冠状动脉多处药物洗脱支架置入）、非ST段抬高型心肌梗死（5年前）以及左心室射血分数为35%的心力衰竭。他正在服用阿司匹林、氯吡格雷和阿哌沙班（Xa因子抑制剂），以及按需服用布洛芬以缓解间歇性背痛。患者的实验室检查结果显示：钠134，钾3.2，氯100，", + "A": "Andexanet alfa的使用与急性肾损伤（AKI）有关。", + "B": "布洛芬（NSAID）通过抑制局部前列腺素的产生导致急性间质性肾炎。", + "C": "患者的尿量不足。", + "D": "患者肌酐升高的程度与住院死亡风险增加有关。" + } + }, + { + "id": "71e47de5-d333-5d6b-a63e-f7ac839c7cd3", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 82-year-old woman with a medical history of hypertension, hyperlipidemia, and chronic kidney disease (CKD) (baseline Cr 1.4) is brought to the emergency department by ambulance from her retirement home with altered mental status. The patient's vital signs are as follows: T 39.3°C, HR 121, BP 72/45, RR 38, SaO2 88%, and FiO2 1.0 via nonrebreather mask. The patient is admitted to the intensive care unit with subsequent intubation and initiation of norepinephrine (4 µg/min) infusion. The patient's P/F ratio is 102 and serum lactate is 3. Which of the following statements is false?", + "A": "The patient meets criteria for septic shock according to Sepsis-3 consensus.", + "B": "Nondialysis requiring CKD in septic and septic shock patients is associated with increased mortality.", + "C": "Titration of vasopressors to a mean arterial perfusion pressure of 75-85 mm Hg increases mortality.", + "D": "The patient's expected in-hospital mortality is approximately 40%." + }, + "zh": { + "question": "一名82岁的女性，有高血压、高脂血症和慢性肾病（CKD）（基线肌酐1.4）的病史，从养老院被救护车送到急诊科，表现为精神状态改变。患者的生命体征如下：体温39.3°C，心率121，血压72/45，呼吸频率38，血氧饱和度88%，通过非再呼吸面罩吸氧，氧浓度1.0。患者被送入重症监护室，随后进行插管并开始去甲肾上腺素（4 µg/min）输注。患者的P/F比值为102，血清乳酸为3。以下哪项陈述是错误的？", + "A": "根据Sepsis-3共识，患者符合脓毒性休克的标准。", + "B": "在脓毒症和脓毒性休克患者中，不需要透析的慢性肾病与死亡率增加有关。", + "C": "将血管加压药物滴定至平均动脉灌注压75-85 mm Hg会增加死亡率。", + "D": "患者的预期住院死亡率约为40%。" + } + }, + { + "id": "fa76cc36-b7c1-529c-999d-aac94250fcb1", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 85-year-old woman with a history of hypertension, atrial fibrillation, type II diabetes mellitus (DM), hypercholesterolemia, CKD stage IV (glomerular filtration rate 15-29 mL/min; baseline creatinine 2.3), a recent ST-elevation myocardial infarction, and osteoporosis on hormone replacement therapy returns to the hospital with chest pain and dyspnea. Her home medications include aspirin, clopidogrel, apixaban, and lisinopril. She states she was recently started on exenatide (glucagonlike peptide-1 [GLP-1] receptor agonist). The patient shows clinical signs of congestive heart failure. A diagnosis of pericarditis was made. The patient receives diclofenac for pain control and furosemide for a diagnosis of pulmonary edema. Which of the following statements with regard to this patient is true?", + "A": "CKD in women is characterized by low estradiol levels, but estrogen replacement might be associated with progressive renal loss.", + "B": "Exenatide is a preferred oral antiglycemic in patients with severe CKD.", + "C": "Androgens may protect renal function through prevention of parenchymal, fibrotic remodeling.", + "D": "Apixaban is relatively contraindicated in patients with atrial fibrillation and endstage CKD." + }, + "zh": { + "question": "一名85岁女性，有高血压、房颤、II型糖尿病、高胆固醇血症、CKD IV期（肾小球滤过率15-29 mL/min；基线肌酐2.3）、近期ST段抬高型心肌梗死和骨质疏松病史，正在接受激素替代疗法，因胸痛和呼吸困难返回医院。她的家庭用药包括阿司匹林、氯吡格雷、阿哌沙班和赖诺普利。她表示最近开始使用艾塞那肽（胰高血糖素样肽-1 [GLP-1] 受体激动剂）。患者显示充血性心力衰竭的临床症状。诊断为心包炎。患者接受双氯芬酸用于疼痛控制和呋塞米用于诊断肺水肿。关于该患者，下列哪项陈述是正确的？", + "A": "女性CKD的特征是低雌二醇水平，但雌激素替代可能与肾功能的进行性丧失有关。", + "B": "艾塞那肽是重度CKD患者首选的口服降糖药。", + "C": "雄激素可能通过防止实质性纤维化重塑来保护肾功能。", + "D": "阿哌沙班在房颤和终末期CKD患者中相对禁忌。" + } + }, + { + "id": "f16aa290-7b11-510c-9737-1537aee4331a", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "An 83-year-old man with obesity, poorly controlled hypertension, hyperlipidemia, type II DM, and nonalcoholic fatty liver disease (NAFLD) presents to the emergency department with abdominal pain, nausea, and vomiting. Vitals are as follows: T 38.3°C, HR 113, BP 81/51, RR 32, Sa O2 94%, and FiO2 0.4. The patient's WBC count is 17, Hgb 12, Plt 102, Na 145, K 3.4, Cl 104, CO2 15, BUN 34, Cr 1.6, INR 1.6, PTT 41, and albumin 2.3. Which of the following statements is true?", + "A": "Hypoalbuminemia is associated with increased perioperative morbidity but not mortality.", + "B": "Preoperative albumin administration in patients with hypoalbuminemia may increase the incidence of AKI.", + "C": "NAFLD lowers the risk of CKD by decreasing renal artery vascular resistance.", + "D": "The patient is at increased risk of thromboembolic complications due to increased circulating levels of vitamin K–dependent and vitamin K–independent clotting factors." + }, + "zh": { + "question": "一名83岁男性，患有肥胖、控制不良的高血压、高脂血症、II型糖尿病和非酒精性脂肪性肝病（NAFLD），因腹痛、恶心和呕吐来到急诊科。生命体征如下：体温38.3°C，心率113，血压81/51，呼吸频率32，血氧饱和度94%，吸氧浓度0.4。患者的白细胞计数为17，血红蛋白12，血小板102，钠145，钾3.4，氯104，二氧化碳15，尿素氮34，肌酐1.6，国际标准化比值1.6，部分凝血活酶时间41，白蛋白2.3。以下哪项陈述是正确的？", + "A": "低白蛋白血症与围手术期发病率增加有关，但与死亡率无关。", + "B": "在低白蛋白血症患者中，术前给予白蛋白可能增加急性肾损伤的发生率。", + "C": "非酒精性脂肪性肝病通过降低肾动脉血管阻力来降低慢性肾病的风险。", + "D": "由于维生素K依赖和非依赖凝血因子循环水平增加，患者发生血栓栓塞并发症的风险增加。" + } + }, + { + "id": "d5b48359-6b91-539f-9762-e59c701021f0", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "15. An 87-year-old man with a history of perforated diverticulitis is now transferred to the intensive care unit after a >12 hour operation secondary to prolonged sedation and inability to extubate. The patient's intraoperative anesthetic consisted of propofol and sufentanil infusions. The patient was hypotensive for the majority of the case in the absence of large blood loss, requiring varying degrees of vasopressor infusion support. Which aging related changes to liver/renal physiology/anatomy help explain the patient's clinical presentation?", + "A": "Although absolute liver weight decreases in patients older than 50 years, liver blood flow stays largely constant.", + "B": "Drugs with a high hepatic extraction ratio are less affected by the age-related hepatic enzyme changes compared with drugs with a low hepatic extraction ratio.", + "C": "The geriatric population is relatively protected from drug-induced liver injury because of decreased mitochondrial radical oxygen species production.", + "D": "Changes in the medullary vasculature, increased renin-angiotensin-aldosterone system activity, and increased tubular ammonium ion excretion are key features of renal aging." + }, + "zh": { + "question": "15. 一名87岁的男性，有穿孔性憩室炎病史，因长时间镇静和无法拔管，在超过12小时的手术后被转入重症监护室。患者的术中麻醉包括丙泊酚和舒芬太尼输注。在没有大量失血的情况下，患者在大部分手术过程中出现低血压，需要不同程度的血管加压药支持。哪些与衰老相关的肝脏/肾脏生理/解剖变化有助于解释患者的临床表现？", + "A": "虽然绝对肝脏重量在50岁以上的患者中减少，但肝脏血流量基本保持不变。", + "B": "与低肝脏提取率的药物相比，高肝脏提取率的药物受年龄相关的肝酶变化影响较小。", + "C": "老年人群由于线粒体自由基氧物种生成减少而相对不易发生药物性肝损伤。", + "D": "髓质血管结构的变化、肾素-血管紧张素-醛固酮系统活性增加和管状铵离子排泄增加是肾脏老化的关键特征。" + } + }, + { + "id": "85de1549-d4b1-5864-bc98-eb3cbc640315", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 72-year-old man is scheduled for an elective ankle fracture repair. He has a history of anxiety and panic attacks. He prefers not to have a nerve block but is concerned that general anesthesia will considerably increase his risk of developing dementia. You decide to do which of the following?", + "A": "Convince the patient that regional anesthesia is a safer option in this case.", + "B": "Suggest a third option—fracture repair under monitored anesthesia care.", + "C": "Agree that general anesthesia increases risk of dementia and address specific concerns about the nerve block.", + "D": "Explain that there is no convincing evidence that general anesthesia increases the risk of dementia." + }, + "zh": { + "question": "一名72岁的男性计划进行择期踝关节骨折修复手术。他有焦虑和惊恐发作的病史。他不希望进行神经阻滞，但担心全身麻醉会大大增加他患痴呆症的风险。您决定采取以下哪种措施？", + "A": "说服患者在这种情况下区域麻醉是更安全的选择。", + "B": "建议第三种选择——在监测麻醉护理下进行骨折修复。", + "C": "同意全身麻醉增加痴呆风险，并解决关于神经阻滞的具体担忧。", + "D": "解释没有令人信服的证据表明全身麻醉增加痴呆风险。" + } + }, + { + "id": "514d05d8-8e65-532e-80d7-16f0eee9e00c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 78-year-old woman is participating in a study that is assessing pain perception. A cryoprobe on her forearm is gradually cooled to produce a painful stimulus. She has undergone a similar experiment at the age of 27 years. Compared with the results of the experiment obtained in younger age, the findings are likely to elicit which of the following?", + "A": "Increased pain threshold but decreased pain tolerance", + "B": "Unchanged pain threshold and pain tolerance", + "C": "Decreased pain threshold and tolerance", + "D": "Prominent local vasodilatation due to cold-reacting agglutinins" + }, + "zh": { + "question": "一名78岁的女性正在参与一项评估疼痛感知的研究。她前臂上的冷冻探针逐渐冷却以产生疼痛刺激。她在27岁时进行过类似的实验。与年轻时获得的实验结果相比，以下哪项是可能的发现？", + "A": "疼痛阈值增加但疼痛耐受性降低", + "B": "疼痛阈值和疼痛耐受性不变", + "C": "疼痛阈值和耐受性降低", + "D": "由于冷反应凝集素引起的显著局部血管扩张" + } + }, + { + "id": "f1e3429d-17e2-57b1-b689-376e7c7d5db3", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 71-year-old man is scheduled for elective surgical removal of a posterior neck cyst. He is overall healthy but reports occasional dizziness when sitting up in bed after he wakes up in the morning. Of the following choices, which is the most likely the cause of his dizziness in light of his age?", + "A": "Decreased baroreceptor reflex", + "B": "Decreased sympathetic system activity", + "C": "Decreased venous capacitance", + "D": "Decreased brain volume" + }, + "zh": { + "question": "一名71岁的男性计划进行择期手术切除颈后囊肿。他总体健康，但报告早上醒来坐起时偶尔感到头晕。在以下选项中，考虑到他的年龄，哪一个最可能是他头晕的原因？", + "A": "减弱的压力感受器反射", + "B": "交感神经系统活动减少", + "C": "静脉容量减少", + "D": "脑容量减少" + } + }, + { + "id": "6a78305f-1b05-5cc4-aa86-3e7e4f941aa0", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 73-year-old woman is scheduled for hip arthroplasty. She has a history of hypertension, hyperlipidemia, depression, and type 2 DM. She mentions that after a cholecystectomy 3 years ago, as she was recovering in PACU, she saw another elderly patient who was \"acting crazy.\" She asks you if she will \"act crazy\" after her surgery. Of the following choices, which statement is the most appropriate reply in response to her concerns?", + "A": "This is unlikely to happen, as she has an excellent mental status before surgery.", + "B": "It is uncommon for patients who are fit enough to undergo a hip arthroplasty to have postoperative delirium.", + "C": "If she develops postoperative delirium, you expect it to resolve quickly.", + "D": "She may have postoperative delirium, which can affect her recovery from surgery." + }, + "zh": { + "question": "一名73岁的女性计划进行髋关节置换术。她有高血压、高脂血症、抑郁症和2型糖尿病的病史。她提到，3年前胆囊切除术后，在PACU恢复时，她看到另一位老年患者“表现得很疯狂”。她问你，她在手术后是否会“表现得很疯狂”。在以下选项中，哪种说法是对她担忧的最合适的回答？", + "A": "这种情况不太可能发生，因为她在手术前的精神状态非常好。", + "B": "对于身体状况足以进行髋关节置换术的患者来说，术后谵妄是不常见的。", + "C": "如果她出现术后谵妄，你预计它会很快消退。", + "D": "她可能会出现术后谵妄，这可能会影响她的术后恢复。" + } + }, + { + "id": "8d4cef02-867a-59a1-9ffa-f79e750a5c65", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "20. Which of the following lung volumes, or combination of lung volumes, changes most significantly over the lifetime of an adult?", + "A": "Total lung capacity (TLC)", + "B": "Closing capacity (CC)", + "C": "Functional residual capacity (FRC)", + "D": "Tidal volume" + }, + "zh": { + "question": "20. 以下哪种肺容量或肺容量组合在成年人的一生中变化最显著？", + "A": "总肺容量 (TLC)", + "B": "闭合容量 (CC)", + "C": "功能残气量 (FRC)", + "D": "潮气量" + } + }, + { + "id": "ec718f37-2172-5a25-835b-3c3bab563825", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements regarding oxygenation and ventilation in the elderly is false?", + "A": "The resting PaO2 in a 20-year-old is similar to that in an 80-year-old.", + "B": "They have a decreased ventilatory response to hypercapnia.", + "C": "They have a decreased ventilatory response to hypoxia.", + "D": "The muscles of the upper airway atrophy." + }, + "zh": { + "question": "以下关于老年人氧合和通气的说法中哪一项是错误的？", + "A": "20岁时的静息PaO2与80岁时相似。", + "B": "他们对高碳酸血症的通气反应降低。", + "C": "他们对低氧血症的通气反应降低。", + "D": "上呼吸道肌肉萎缩。" + } + }, + { + "id": "c4b1ed80-7943-5a37-a2eb-00a34b14e7b5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following statements regarding oxygenation and ventilation in the elderly (as compared with the average adult) are correct EXCEPT which one?", + "A": "FEV1 (forced expiratory volume in 1 s) is decreased.", + "B": "Diffusing capacity is decreased.", + "C": "The amount of physiologic dead space is increased.", + "D": "Their ventilation/perfusion matching is relatively preserved." + }, + "zh": { + "question": "以下关于老年人（与普通成年人相比）���氧合和通气的陈述都是正确的，除了哪一个？", + "A": "FEV1（一秒钟用力呼气量）减少。", + "B": "弥散能力降低。", + "C": "生理无效腔量增加。", + "D": "他们的通气/灌注匹配相对保持。" + } + }, + { + "id": "f456be80-a9c9-5870-a11d-2692fcbf65f6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "All of the following changes in respiratory mechanics are seen in the geriatric population EXCEPT which one?", + "A": "Decreased compliance of the chest wall", + "B": "Increased compliance of the lung parenchyma", + "C": "Increased curvature of the diaphragm", + "D": "Decreased mass of accessory muscles" + }, + "zh": { + "question": "老年人群中呼吸力学的所有以下变化中，除了哪一项？", + "A": "胸壁顺应性降低", + "B": "肺实质顺应性增加", + "C": "膈肌弯曲度增加", + "D": "辅助肌肉质量减少" + } + }, + { + "id": "062f2b50-8562-5038-9144-18745711dedd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The pattern that most accurately describes the change in CC over time starting from age 30 years and progressing to age 80 years is which of the following?", + "A": "An asymptotic increase, followed by a plateau", + "B": "An exponential increase", + "C": "An approximately linear increase", + "D": "An approximately linear, steep increase until middle age (50 y old), followed by a more gradual decrease" + }, + "zh": { + "question": "从30岁开始到80岁，CC随时间变化的模式最准确地描述为以下哪一项？", + "A": "渐近增加，然后达到平台期", + "B": "指数增加", + "C": "大约线性增加", + "D": "大约线性、陡峭增加到中年（50岁），然后逐渐减少" + } + }, + { + "id": "b5895c05-be57-5ad6-8e60-dab619472991", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The increase in CC seen with aging can BEST be attributed to which of the", + "A": "A relatively more positive intrapleural pressure compressing alveoli", + "B": "A functional extrathoracic large airway obstruction", + "C": "The loss of cartilage from large airways", + "D": "The loss of elastin from surrounding tissues, which once tethered open small airways" + }, + "zh": { + "question": "随着年龄增长，CC的增加最主要可以归因于以下哪一项", + "A": "相对更正的胸膜内压压迫肺泡", + "B": "功能性胸外大气道阻塞", + "C": "大气道软骨的丧失", + "D": "周围组织弹性蛋白的丧失，曾经将小气道牵开" + } + }, + { + "id": "d5163a31-629f-5332-b8c2-35f7fc624448", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "All of the following patients with respiratory failure may be candidates for noninvasive positive pressure ventilation (NIPPV) EXCEPT which one?", + "A": "Decompensated heart failure and SpO2 85% on room air", + "B": "HIV-positive patient with bilateral opacities on chest X-Ray and PaO2 /FiO2 150", + "C": "Urosepsis requiring norepinephrine with tachypnea and SpO2 90% on 6 L nasal cannula", + "D": "Acute chronic obstructive pulmonary disease (COPD) exacerbation and PaCO2 70 mm Hg", + "E": "Immediately following extubation in a patient at high risk for reintubation" + }, + "zh": { + "question": "以下所有呼吸衰竭患者都可能是无创正压通气（NIPPV）的候选者，除了哪一个？", + "A": "失代偿性心力衰竭，室内空气下SpO2 85%", + "B": "HIV阳性患者，胸部X光片显示双侧阴影，PaO2/FiO2 150", + "C": "尿路感染性休克需要去甲肾上腺素，伴有呼吸急促和6升鼻导管下SpO2 90%", + "D": "急性慢性阻塞性肺疾病（COPD）加重，PaCO2 70 mm Hg", + "E": "拔管后立即在高风险再插管的患者" + } + }, + { + "id": "052b846d-6362-59b0-b3fb-f77bbad32f4b", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "You are called to intubate a patient with a COPD exacerbation. Following intubation, you confirm bilateral breath sounds and presence of carbon dioxide by capnogram. You manually ventilate with an Ambu bag while waiting for the ventilator circuit. The automated blood pressure cuff is unable to read a blood pressure, and the pulse oximeter tracing is lost while the blood pressure cuff repeatedly cycles on the ipsilateral arm. ECG shows sinus bradycardia in the 60s. You are unable to palpate a carotid pulse. Your team initiates chest compressions and administers epinephrine. Which of the following is the next maneuver?", + "A": "Increase minute ventilation.", + "B": "Remove endotracheal tube and reintubate.", + "C": "Needle decompression in second intercostal space.", + "D": "Disconnect patient from Ambu bag.", + "E": "Place an arterial line." + }, + "zh": { + "question": "你被叫去为一位COPD急性加重的患者插管。插管后，你通过听诊双侧呼吸音和二氧化碳波形图确认气管插管位置正确。在等待呼吸机回路时，你用Ambu袋手动通气。自动血压袖带无法读取血压，脉搏血氧仪的波形消失，而血压袖带在同侧手臂上反复循环。心电图显示窦性心动过缓，心率在60次左右。你无法触及颈动脉搏动。你的团队开始胸外按压并给予肾上腺素。以下哪项是下一步措施？", + "A": "增加分钟通气量。", + "B": "移除气管插管并重新插管。", + "C": "在第二肋间隙进行针刺减压。", + "D": "将患者与Ambu袋断开连接。", + "E": "放置动脉导管。" + } + }, + { + "id": "e76ec597-c1d7-5f92-b7da-10f157dcaf09", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated with the following settings on volume control ventilation: tidal volume 480 cc, respiratory rate 20 breaths per minute, PEEP (positive end-expiratory pressure) 12 cm H2O, FiO2 50%, plateau pressure 33 cm H2O, and peak inspiratory pressure 35 cm H2O. His ideal body weight is 70 kg. The most recent arterial blood gas test shows PaO2 80 mm Hg, PaCO2 48 mm Hg, and pH 7.33. What change should you make to the ventilator settings?", + "A": "No change.", + "B": "Decrease PEEP.", + "C": "Decrease tidal volume.", + "D": "Increase FiO2 .", + "E": "Switch to pressure support ventilation." + }, + "zh": { + "question": "一名患有急性呼吸窘迫综合征（ARDS）的患者正在使用容量控制通气进行机械通气，设置如下：潮气量480毫升，呼吸频率每分钟20次，PEEP（呼气末正压）12 cm H2O，FiO2 50%，平台压33 cm H2O，峰值吸气压35 cm H2O。他的理想体重是70公斤。最近的动脉血气检查显示PaO2 80 mm Hg，PaCO2 48 mm Hg，pH 7.33。你应该对呼吸机设置做出什么改变？", + "A": "不做改变。", + "B": "降低PEEP。", + "C": "降低潮气量。", + "D": "增加FiO2。", + "E": "切换到压力支持通气。" + } + }, + { + "id": "e4135283-4800-5ade-b4c6-4ea92906c14b", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "4. When preparing to extubate an ICU patient, all of the following criteria should be met EXCEPT which one?", + "A": "Rapid shallow breathing index (RSBI) of less than 100", + "B": "Minimal secretions", + "C": "Presence of cuff leak", + "D": "Successful spontaneous breathing trial (SBT) lasting 30 minutes using continuous positive airway pressure of 5 cm H2O", + "E": "Ability to follow commands" + }, + "zh": { + "question": "4. 在准备拔除ICU患者的气管插管时，以下所有标准都应满足，除了哪一项？", + "A": "快速浅呼吸指数（RSBI）小于100", + "B": "分泌物少", + "C": "存在套囊漏气", + "D": "成功的自发呼吸试验（SBT）持续30分钟，使用5 cm H2O的持续气道正压", + "E": "能够遵循指令" + } + }, + { + "id": "f4598c43-29c6-52d4-98da-20b122a5af11", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "Which of the following hypotensive patients could potentially show improvement in their hemodynamics with the administration of positive pressure ventilation?", + "A": "Large myocardial infarction in left anterior descending territory", + "B": "Acute liver failure (ALF)", + "C": "Acute pulmonary embolism", + "D": "Induction of anesthesia", + "E": "Sepsis" + }, + "zh": { + "question": "以下哪位低血压患者在给予正压通气后可能会改善其血流动力学？", + "A": "左前降支区域的大面积心肌梗死", + "B": "急性肝功能衰竭（ALF）", + "C": "急性肺栓塞", + "D": "麻醉诱导", + "E": "败血症" + } + }, + { + "id": "60fa98ba-7690-51c3-895a-dd3654986d12", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "What is the static thoracic compliance on the following volume control ventilation settings?", + "A": "18 mL/cm H2O", + "B": "22 mL/cm H2O", + "C": "30 mL/cm H2O", + "D": "33 mL/cm H2O", + "E": "50 mL/cm H2O" + }, + "zh": { + "question": "在以下容量控制通气设置中，静态胸腔顺应性是多少？", + "A": "18 mL/cm H2O", + "B": "22 mL/cm H2O", + "C": "30 mL/cm H2O", + "D": "33 mL/cm H2O", + "E": "50 mL/cm H2O" + } + }, + { + "id": "b9e68c38-bb74-5de7-8ef5-84f7a414aca1", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following differentiates pressure support from assist-control pressure control ventilation?", + "A": "Delivered tidal volume increases with increased patient effort.", + "B": "Cycling depends on change in inspiratory flow.", + "C": "Ability of a patient to trigger breaths.", + "D": "Lung injury is unlikely on pressure support ventilation.", + "E": "Delivered tidal volume depends on thoracic compliance." + }, + "zh": { + "question": "以下哪项区别了压力支持通气与辅助控制压力控制通气？", + "A": "随着患者努力增加，送达的潮气量增加。", + "B": "循环取决于吸气流量的变化。", + "C": "患者触发呼吸的能力。", + "D": "在压力支持通气下，肺损伤不太可能发生。", + "E": "送达的潮气量取决于胸腔顺应性。" + } + }, + { + "id": "f397d702-bf73-5c06-92f8-69b5ec816ec9", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following parameters determines the tidal volume delivered in volume control ventilation?", + "A": "Peak inspiratory pressure", + "B": "Lung compliance", + "C": "Airway resistance", + "D": "Inspiratory flow", + "E": "Patient effort" + }, + "zh": { + "question": "在容量控制通气中，以下哪个参数决定了潮气量的输送？", + "A": "吸气峰压", + "B": "肺顺应性", + "C": "气道阻力", + "D": "吸气流量", + "E": "患者努力" + } + }, + { + "id": "26f4fcad-c0a1-5ba9-9e29-51bae7d2c36b", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "All of the following interventions are recommended to reduce the risk of ventilator-associated pneumonia (VAP) EXCEPT which one?", + "A": "Elevation of head of bed at least 30°", + "B": "Early tracheostomy", + "C": "Daily SBTs", + "D": "Noninvasive positive pressure ventilation", + "E": "Minimizing sedation" + }, + "zh": { + "question": "以下所有干预措施均建议用于降低呼吸机相关性肺炎（VAP）的风险，除了哪一项？", + "A": "将床头抬高至少30°", + "B": "早期气管切开", + "C": "每日自发呼吸试验（SBT）", + "D": "无创正压通气", + "E": "最小化镇静" + } + }, + { + "id": "f28a8bcc-e6c7-596e-94ad-6924315888b5", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements regarding catheter-related bloodstream infections (CRBSIs) is true?", + "A": "Central venous catheters (CVCs) should be replaced weekly.", + "B": "CRBSI is diagnosed when blood cultures drawn from the catheter are positive.", + "C": "Arterial lines carry a negligible risk of CRBSI.", + "D": "Skin preparation with chlorhexidine/alcohol is more effective than povidone iodine in preventing CRBSI.", + "E": "The most common pathogens in CRBSI are gram-negative rods." + }, + "zh": { + "question": "以下关于导管相关血流感染（CRBSI）的说法哪一项是正确的？", + "A": "中心静脉导管（CVC）应每周更换一次。", + "B": "当从导管抽取的血培养呈阳性时，诊断为CRBSI。", + "C": "动脉导管的CRBSI风险可以忽略不计。", + "D": "使用氯己定/酒精进行皮肤准备比使用聚维酮碘更能有效预防CRBSI。", + "E": "CRBSI中最常见的病原体是革兰氏阴性杆菌。" + } + }, + { + "id": "0cf3063c-eece-54ff-97e8-efc71d7b0bbf", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is an acceptable indication for replacing a CVC over a guidewire?", + "A": "Replacing a CVC that was emergently placed without maximum barrier precautions", + "B": "Loss of blood return", + "C": "After 14 days of catheter use", + "D": "Fever", + "E": "CVC should never be replaced over a guidewire" + }, + "zh": { + "question": "以下哪项是通过导丝更换中心静脉导管（CVC）的可接受指征？", + "A": "更换在紧急情况下未使用最大屏障预防措施放置的CVC", + "B": "失去回血", + "C": "导管使用14天后", + "D": "发热", + "E": "CVC绝不应通过导丝更换" + } + }, + { + "id": "4b4944b0-7b42-5279-a9bd-9ef4c68b64b9", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "14. Which of the following statements regarding catheter-associated urinary tract infection (CAUTI) is true?", + "A": "External urinary catheters have similar rates of complications compared with indwelling catheters.", + "B": "Asymptomatic catheter-associated bacteriuria should be treated to reduce the risk of developing systemic infection.", + "C": "Intermittent catheterization does not reduce the risk of CAUTI.", + "D": "Indwelling catheters should be replaced at regular intervals to reduce the risk of CAUTI.", + "E": "Screening for bacteriuria is not effective in reducing CAUTI." + }, + "zh": { + "question": "14. 关于导尿管相关尿路感染（CAUTI），以下哪项陈述是正确的？", + "A": "外部导尿管与留置导尿管的并发症发生率相似。", + "B": "无症状的导尿管相关菌尿应进行治疗以降低发生全身感染的风险。", + "C": "间歇性导尿不能降低CAUTI的风险。", + "D": "留置导尿管应定期更换以降低CAUTI的风险。", + "E": "筛查菌尿对减少CAUTI无效。" + } + }, + { + "id": "596a2197-363a-5a6e-84c9-b485251fb840", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Alcohol-based hand rubs are effective in removing all of the following pathogens EXCEPT which one?", + "A": "Methicillin-resistant Staphylococcus aureus (MRSA)", + "B": "Vancomycin-resistant enterococci", + "C": "Clostridium difficile", + "D": "Mycobacterium tuberculosis (MTB)", + "E": "They are effective for all pathogens" + }, + "zh": { + "question": "酒精类手消毒剂对去除以下所有病原体有效，除了哪一个？", + "A": "耐甲氧西林金黄色葡萄球菌 (MRSA)", + "B": "耐万古霉素肠球菌", + "C": "艰难梭菌", + "D": "结核分枝杆菌 (MTB)", + "E": "对所有病原体都有效" + } + }, + { + "id": "ab9d38e7-88b5-5211-a675-c2cee23c89e9", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following statements regarding Clostridium difficile prevention are true EXCEPT which one?", + "A": "Tighter regulations on antibiotic use have decreased the incidence of C. difficile.", + "B": "Only chlorine-containing cleaning products should be used for environmental decontamination.", + "C": "Monotherapy with metronidazole is appropriate for mild cases of C. difficile.", + "D": "Contact precautions can be lifted when diarrhea resolves.", + "E": "Limiting acid suppression therapy can reduce the risk of C. difficile." + }, + "zh": { + "question": "关于艰难梭菌预防的以下所有陈述都正确，除了哪一个？", + "A": "对抗生素使用的更严格规定已减少艰难梭菌的发生率。", + "B": "只有含氯的清洁产品应用于环境去污。", + "C": "甲硝唑单药治疗适用于轻度艰难梭菌病例。", + "D": "当腹泻消失时可以解除接触预防措施。", + "E": "限制酸抑制疗法可以降低艰难梭菌的风险。" + } + }, + { + "id": "2428e814-f3b5-5f76-afaf-7101df27ac1b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following personal protective equipment items (PPEs) is sufficient for a provider to wear before performing endotracheal intubation?", + "A": "Goggles", + "B": "Mask", + "C": "Face shield", + "D": "Gown", + "E": "No PPE required if low suspicion for respiratory infection" + }, + "zh": { + "question": "以下哪种个人防护装备（PPE）足以让医护人员在进行气管插管前穿戴？", + "A": "护目镜", + "B": "口罩", + "C": "面罩", + "D": "防护服", + "E": "如果对呼吸道感染的怀疑较低，则不需要佩戴任何PPE" + } + }, + { + "id": "f7099fbd-773b-5fe0-b832-d0bf0aa74069", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "An HIV-positive patient is admitted to the ICU with respiratory failure requiring intubation. Mycobacterium tuberculosis (MTB) disease is suspected. All of the following statements regarding MTB precautions are true EXCEPT which one?", + "A": "The patient should be placed in a negative-pressure isolation room.", + "B": "Empiric therapy for MTB disease with a 4-drug regimen should be initiated immediately.", + "C": "Contact precautions are not necessary.", + "D": "Airborne precautions can be discontinued if a tuberculin skin test is negative.", + "E": "A bacterial filter should be placed on the ventilator circuit." + }, + "zh": { + "question": "一名HIV阳性患者因呼吸衰竭需要插管而被送入ICU。怀疑是结核分枝杆菌（MTB）感染。以下关于MTB预防措施的陈述中，除了哪一项外，其他都是正确的？", + "A": "患者应被安置在负压隔离病房。", + "B": "应立即开始使用四种药物的经验性治疗方案治疗MTB疾病。", + "C": "不需要接触预防措施。", + "D": "如果结核菌素皮肤试验为阴性，可以停止空气传播预防措施。", + "E": "应在呼吸机回路上安装细菌过滤器。" + } + }, + { + "id": "c892416a-c1ae-589d-977d-7dd0948807df", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "While caring for a patient with acute hepatitis B virus (HBV), an anesthesia resident sustains a needle stick injury. The resident received the HBV vaccine series as an adolescent. Which of the following is true regarding his need for postexposure prophylaxis for HBV?", + "A": "He does not require any HBV prophylaxis or further testing because he has been vaccinated.", + "B": "Anti-HBs titers should be checked.", + "C": "His risk of acquiring HBV is 30%.", + "D": "He should receive 1 dose of hepatitis B immune globulin and be revaccinated.", + "E": "He should undergo baseline testing for anti-HBc now and repeat testing at 6 months." + }, + "zh": { + "question": "在照顾一名急性乙型肝炎病毒（HBV）患者时，一名麻醉科住院医师遭遇针刺伤。该住院医师在青少年时期接种过HBV疫苗系列。关于他对HBV暴露后预防的需求，下列哪项是正确的？", + "A": "他不需要任何HBV预防或进一步检测，因为他已经接种过疫苗。", + "B": "应检查抗HBs滴度。", + "C": "他感染HBV的风险是30%。", + "D": "他应接受1剂乙型肝炎免疫球蛋白并重新接种疫苗。", + "E": "他现在应进行抗HBc基线检测，并在6个月后重复检测。" + } + }, + { + "id": "89d9c8b1-f9ae-5b1d-bbf1-7c7e921f9fec", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "20. A 75-year-old man presents with fever, cough, and infiltrate on chest X-ray. His oxygen saturation is 90% on room air and he is subsequently admitted to the floor for treatment of a presumed pneumonia. He was previously healthy except for hypertension and has not had recent hospital admissions or antibiotic therapy. He has no smoking history. Which of the following empiric antibiotic regimens is appropriate while awaiting the results of sputum culture?", + "A": "Vancomycin and cefepime", + "B": "Piperacillin/tazobactam monotherapy", + "C": "Ceftriaxone and azithromycin", + "D": "Meropenem and levofloxacin", + "E": "Vancomycin, piperacillin/tazobactam, and fluconazole" + }, + "zh": { + "question": "20. 一名75岁男性出现发热、咳嗽和胸部X光片显示浸润。他在室内空气中的氧饱和度为90%，随后因疑似肺炎被收治入院。他之前除了高血压外身体健康，最近没有住院或抗生素治疗史。他没有吸烟史。在等待痰培养结果期间，以下哪种经验性抗生素方案是合适的？", + "A": "万古霉素和头孢吡肟", + "B": "哌拉西林/他唑巴坦单药治疗", + "C": "头孢曲松和阿奇霉素", + "D": "美罗培南和左氧氟沙星", + "E": "万古霉素、哌拉西林/他唑巴坦和氟康唑" + } + }, + { + "id": "54b88f84-61ad-5506-b1ed-c27e598ecc1a", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Additional echocardiography views reveal McConnell sign. Which of the following is the next step in the management of this patient?", + "A": "Cardiac catheterization", + "B": "Systemic fibrinolytic therapy", + "C": "Rapid infusion of 2 L crystalloid", + "D": "Initiation of heparin infusion", + "E": "CT scan" + }, + "zh": { + "question": "额外的超声心动图视图显示麦康奈尔征。以下哪项是该患者管理的下一步？", + "A": "心脏导管插入术", + "B": "全身纤溶治疗", + "C": "快速输注2升晶体液", + "D": "开始肝素输注", + "E": "CT扫描" + } + }, + { + "id": "1e1739f3-18d1-5159-ac64-e121cd256f7e", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is the next step with regard to the appropriate management of this patient's immediate problem?", + "A": "Pericardiocentesis", + "B": "Immediately returning to OR for redo sternotomy", + "C": "Rapid fluid bolus", + "D": "Ordering a transesophageal echocardiography for further evaluation", + "E": "Cardiac catheterization" + }, + "zh": { + "question": "以下哪项是针对该患者当前问题的适当管理的下一步措施？", + "A": "心包穿刺", + "B": "立即返回手术室进行再次胸骨切开术", + "C": "快速输液", + "D": "为进一步评估订购经食道超声心动图", + "E": "心脏导管插入术" + } + }, + { + "id": "ca9e0057-b422-5ee8-a978-df3fef1e7eb9", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "25. A 70-year-old man presents to the hospital with chest pain and dyspnea. ECG shows 2-mm ST elevations in V2-V4. His vital signs are as follows: HR 85, BP 100/55, SpO2 95% on room air. Laboratory test results are remarkable for troponin 3.5 ng/mL and lactate 6 mmol/L. Emergent cardiac catheterization is planned. What other treatment should be initiated at this time?", + "A": "Dopamine", + "B": "1 L crystalloid bolus", + "C": "Dobutamine", + "D": "Norepinephrine", + "E": "No other intervention necessary besides immediate cardiac catheterization" + }, + "zh": { + "question": "25. 一名70岁的男性因胸痛和呼吸困难入院。心电图显示V2-V4导联有2毫米ST段抬高。他的生命体征如下：心率85，血压100/55，室内空气下血氧饱和度95%。实验室检查结果显示肌钙蛋白3.5 ng/mL和乳酸6 mmol/L。计划进行紧急心脏导管插入术。此时应启动什么其他治疗？", + "A": "多巴胺", + "B": "1升晶体液快速输注", + "C": "多巴酚丁胺", + "D": "去甲肾上腺素", + "E": "除了立即进行心脏导管插入术外不需要其他干预" + } + }, + { + "id": "fafbe627-abb0-59e3-ae24-974f902a7839", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Data from a pulmonary artery catheter (PAC) can be used to derive all of the following hemodynamic and oxygen transport parameters EXCEPT which one?", + "A": "Stroke volume", + "B": "Mixed venous oxygen saturation", + "C": "Systemic vascular resistance", + "D": "Oxygen consumption", + "E": "Left ventricle (LV) ejection fraction" + }, + "zh": { + "question": "肺动脉导管（PAC）数据可用于推导以下所有血流动力学和氧气运输参数，除了哪一个？", + "A": "每搏量", + "B": "混合静脉血氧饱和度", + "C": "全身血管阻力", + "D": "氧气消耗", + "E": "左心室（LV）射血分数" + } + }, + { + "id": "89cc982f-9c1d-50eb-ad66-b276d06335e7", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "You are called to evaluate a 60-year-old woman with a history of nephrolithiasis and urinary tract infections who is in the PACU recovering from ureteroscopy and ureteral stone extraction 1 hour ago. Her vital signs are as follows: temperature 37.8°C, HR 110, BP 95/50, and respiratory rate 25 breaths per minute. She appears to be shivering and drowsy but does answer questions appropriately. Which of the following is the next step in your management of this patient?", + "A": "This is likely due to residual effects of anesthetics and pain; continue observation in PACU for now.", + "B": "Discharge to phase II PACU with a prescription for ciprofloxacin.", + "C": "Transfer to ICU.", + "D": "Start vancomycin and cefepime and continue observation in PACU.", + "E": "Suggest her urologist repeat ureteroscopy for possible retained stone." + }, + "zh": { + "question": "您被叫去评估一名60岁女性，她有肾结石和尿路感染的病史，1小时前在PACU从输尿管镜检查和输尿管结石取出术中恢复。她的生命体征如下：体温37.8°C，心率110，血压95/50，呼吸频率25次/分钟。她看起来在发抖和昏昏欲睡，但能适当地回答问题。以下哪项是您对该患者管理的下一步措施？", + "A": "这可能是麻醉药物和疼痛的残余效应；目前继续在PACU观察。", + "B": "出院到第二阶段PACU，并开具环丙沙星处方。", + "C": "转入ICU。", + "D": "开始使用万古霉素和头孢吡肟，并继续在PACU观察。", + "E": "建议她的泌尿科医生重复输尿管镜检查以检查可能的残留结石。" + } + }, + { + "id": "105ea361-e0da-5713-a8d3-38deb8f95878", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "The patient continues to have mean arterial pressures (MAPs) in the low 60s", + "A": "Administer a 500 cc bolus of 5% albumin.", + "B": "Place a central line and initiate norepinephrine.", + "C": "Initiate peripheral phenylephrine.", + "D": "Consider adding antifungal coverage to your antibiotic regimen.", + "E": "MAP is adequate; continue to observe." + }, + "zh": { + "question": "患者的平均动脉压（MAP）持续在60s的低值", + "A": "给予500毫升5%白蛋白快速输注。", + "B": "放置中心静脉导管并开始使用去甲肾上腺素。", + "C": "开始使用外周苯肾上腺素。", + "D": "考虑在抗生素方案中加入抗真菌药物。", + "E": "MAP足够；继续观察。" + } + }, + { + "id": "8d65507f-447a-5c81-a9db-6fb20196b7cb", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "All of the following practices may reduce the risk of ICU-acquired weakness (ICUAW) EXCEPT which one?", + "A": "Treatment of hyperglycemia", + "B": "Minimizing use of steroids", + "C": "Minimizing use of neuromuscular blockers", + "D": "Passive exercises in sedated patients", + "E": "Early diagnosis with electrophysiology studies" + }, + "zh": { + "question": "以下所有做法都可能降低ICU获得性无力（ICUAW）的风险，除了哪一项？", + "A": "治疗高血糖", + "B": "尽量减少使用类固醇", + "C": "尽量减少使用神经肌肉阻滞剂", + "D": "对镇静患者进行被动运动", + "E": "通过电生理研究进行早期诊断" + } + }, + { + "id": "bd48d9a0-80f6-544f-a02e-995fd426d3e8", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "32. Which of the following statements regarding venous thromboembolism (VTE) prevention and treatment is true?", + "A": "Upperextremity deep venous thromboses (DVTs) associated with CVCs do not require systemic anticoagulation.", + "B": "VTE is very unlikely in patients receiving appropriate pharmacologic prophylaxis.", + "C": "Low-molecular-weight heparin (LMWH) is preferred to subcutaneous heparin for patients at high risk of DVT.", + "D": "Prophylactic LMWH is preferred to subcutaneous heparin because it does not carry the risk of heparin-induced thrombocytopenia.", + "E": "An IVC filter should be considered for all trauma patients." + }, + "zh": { + "question": "32. 以下关于静脉血栓栓塞（VTE）的预防和治疗的说法中哪一项是正确的？", + "A": "与中心静脉导管（CVC）相关的上肢深静脉血栓（DVT）不需要全身抗凝治疗。", + "B": "接受适当药物预防的患者发生VTE的可能性很小。", + "C": "对于深静脉血栓高风险患者，低分子量肝素（LMWH）优于皮下注射肝素。", + "D": "预防性使用低分子量肝素优于皮下注射肝素，因为它不具有肝素诱导的血小板减少症的风险。", + "E": "应考虑为所有创伤患者使用下腔静脉（IVC）滤器。" + } + }, + { + "id": "150982cf-ff65-5c03-ac86-433c5f3d2df0", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements regarding nutrition in the ICU is true?", + "A": "Gastric residual volumes should be frequently measured to monitor for feeding intolerance.", + "B": "Initiation of enteral nutrition should be delayed until signs of return of bowel function.", + "C": "Early enteral nutrition decreases mortality.", + "D": "Protein has the lowest respiratory quotient.", + "E": "A postpyloric tube should be placed for enteral feeding." + }, + "zh": { + "question": "以下关于ICU营养的说法哪一项是正确的？", + "A": "应经常测量胃残余量以监测喂养不耐受。", + "B": "应推迟肠内营养的开始，直到肠功能恢复的迹象出现。", + "C": "早期肠内营养可降低死亡率。", + "D": "蛋白质的呼吸商最低。", + "E": "应放置幽门后管进行肠内喂养。" + } + }, + { + "id": "cc0da6b7-cbae-5d61-9b5c-61de34c0674f", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Diagnosis of brain death requires all of the following criteria EXCEPT which one?", + "A": "Absence of spontaneous respirations at PaCO2 of 60 or greater", + "B": "Complete absence of motor function", + "C": "Absent brainstem reflexes", + "D": "Normotension", + "E": "Establishing etiology of coma" + }, + "zh": { + "question": "诊断脑死亡需要满足以下所有标准，除了哪一项？", + "A": "在动脉二氧化碳分压达到60或更高时无自主呼吸", + "B": "完全没有运动功能", + "C": "脑干反射消失", + "D": "血压正常", + "E": "确定昏迷的病因" + } + }, + { + "id": "2c580619-3185-5ba5-9560-3ddaecda3be6", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements regarding the performance of ancillary testing in patients with suspected brain death is true?", + "A": "Isoelectric EEG using frontal leads identifies brain death.", + "B": "Absence of cerebral vessel filling on cerebral angiography is the gold standard ancillary test.", + "C": "At least 1 ancillary test is required in addition to clinical testing for determination of brain death.", + "D": "Noncontrast CT showing extensive edema and herniation can serve as an ancillary test.", + "E": "Evoked potentials are not used as ancillary tests." + }, + "zh": { + "question": "关于在疑似脑死亡患者中进行辅助检测的以下哪项陈述是正确的？", + "A": "使用额叶导联的等电位脑电图识别脑死亡。", + "B": "脑血管造影中脑血管充盈缺失是辅助检测的金标准。", + "C": "除了临床检测外，至少需要一个辅助检测来确定脑死亡。", + "D": "非增强CT显示广泛水肿和脑疝可以作为辅助检测。", + "E": "诱发电位不用于辅助检测。" + } + }, + { + "id": "2133ddfd-0185-5e80-8787-3fcbec708440", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 21-year-old man is admitted to the ICU with a massive subarachnoid hemorrhage and is displaying signs of herniation. He arrives intubated from the emergency department (ED) and is not receiving any sedative agents. His initial physical examination demonstrates GCS 3, absence of brainstem reflexes and no spontaneous respirations with a PaCO2 65. There are 4 strong twitches on train-of-four monitoring on the ulnar nerve. His temperature is 37.5°C. His laboratory test results are unremarkable. He is requiring norepinephrine to maintain SBP >100. He is evaluated by neurosurgery and determined not to be a candidate for surgical intervention. Which of the following is the next appropriate step in management", + "A": "Declare brain death and withdraw ventilator support.", + "B": "Declare brain death and contact organ bank.", + "C": "Increase norepinephrine to goal SBP >120.", + "D": "Perform cerebral angiography.", + "E": "Repeat brain death examination in 6 hours." + }, + "zh": { + "question": "一名21岁男性因大面积蛛网膜下腔出血入ICU，并显示脑疝迹象。他从急诊科（ED）插管到达，没有接受任何镇静剂。他的初步体格检查显示GCS 3，脑干反射缺失，PaCO2 65时无自主呼吸。四联刺激监测尺神经显示4次强烈抽搐。他的体温为37.5°C。实验室检查结果无异常。他需要去甲肾上腺素以维持收缩压>100。神经外科评估后认为不适合手术干预。以下哪项是下一步适当的管理措施？", + "A": "宣布脑死亡并撤除呼吸机支持。", + "B": "宣布脑死亡并联系器官库。", + "C": "增加去甲肾上腺素以达到目标收缩压>120。", + "D": "进行脑血管造影。", + "E": "6小时后重复脑死亡检查。" + } + }, + { + "id": "5511dc98-cf3e-5a0c-ae8e-8810b8eadfa4", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "37. A 30-year-old man with no known medical history is admitted to the ICU after being found on the side of the road following a motor vehicle collision. His GCS is 6 upon arrival and he is promptly intubated. Mannitol was administered just before leaving the ED en route to the ICU. Laboratory test results on", + "A": "Send urine electrolytes and urine osmolarity.", + "B": "Administer hypertonic saline bolus", + "C": "Observe.", + "D": "Administer furosemide.", + "E": "Begin fluid restriction" + }, + "zh": { + "question": "37. 一名30岁无已知病史的男性在发生机动车碰撞后被发现于路边，并被送入ICU。他到达时GCS为6，立即进行了插管。在离开急诊室前往ICU的途中给予了甘露醇。实验室测试结果显示", + "A": "送检尿液电解质和尿液渗透压。", + "B": "给予高渗盐水推注。", + "C": "观察。", + "D": "给予呋塞米。", + "E": "开始限制液体摄入" + } + }, + { + "id": "b8442e7c-2a35-5eaf-b8a3-1aaad3f6456a", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A 70-year-old man is admitted to the ICU following a thoracotomy and lobectomy for lung cancer. Over the next few days, he develops progressively worsening hyponatremia. He is alert and tolerating oral intake. Maintenance IV fluids have been stopped.", + "A": "Syndrome of inappropriate antidiuretic hormone secretion (SIADH)", + "B": "Hypovolemia", + "C": "Pseudohyponatremia", + "D": "Cerebral salt wasting", + "E": "Mineralocorticoid deficiency" + }, + "zh": { + "question": "一名70岁的男性在接受肺癌开胸手术和肺叶切除术后被送入ICU。接下来的几天里，他出现了逐渐加重的低钠血症。他神志清醒，能够耐受口服摄入。维持静脉输液已停止。", + "A": "抗利尿激素分泌不当综合征 (SIADH)", + "B": "低血容量", + "C": "假性低钠血症", + "D": "脑性盐耗损", + "E": "矿物皮质激素缺乏" + } + }, + { + "id": "8848b3e1-1aa0-5dbb-95a2-db4de3531e40", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following is the most appropriate regarding the next step in management of this patient?", + "A": "3% saline", + "B": "500 cc normal saline bolus", + "C": "Fluid restriction", + "D": "Vasopressin receptor antagonist", + "E": "Salt tablets" + }, + "zh": { + "question": "以下哪项是关于该患者管理的下一步最合适的措施？", + "A": "3% 生理盐水", + "B": "500 cc 生理盐水快速输注", + "C": "限制液体摄入", + "D": "加压素受体拮抗剂", + "E": "盐片" + } + }, + { + "id": "b31478fe-0412-5b02-abfe-7ca548013149", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "42. A 55-year-old man with a history of alcohol dependence is admitted to the ICU for management of acute pancreatitis. Enteral feeding is initiated on hospital day 2. Laboratory test results the following day are notable for phosphate 0.8 mg/dL, total calcium 6.5 mg/dL, magnesium 1 mEq/L, potassium 2.8 mEq/L, and albumin 1.5 g/dL. Which of the following is the most appropriate regarding the next step in management of this patient?", + "A": "Increase enteral feeds.", + "B": "Temporarily stop enteral feeding.", + "C": "Switch to total parenteral nutrition.", + "D": "Initiate work-up for hyperparathyroidism.", + "E": "Increase phosphate, magnesium, and potassium content in enteral feeds." + }, + "zh": { + "question": "42. 一名55岁有酒精依赖史的男性因急性胰腺炎入院ICU治疗。住院第2天开始肠内营养。次日的实验室检查结果显示磷酸盐0.8 mg/dL，总钙6.5 mg/dL，镁1 mEq/L，钾2.8 mEq/L，白蛋白1.5 g/dL。以下哪项是对该患者管理的最合适的下一步措施？", + "A": "增加肠内营养。", + "B": "暂时停止肠内营养。", + "C": "改为全肠外营养。", + "D": "开始检查甲状旁腺功能亢进。", + "E": "增加肠内营养中的磷酸盐、镁和钾含量。" + } + }, + { + "id": "94e14a60-45d8-5eff-951c-6b611a00983b", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 6-year-old child is rescued from a pool and is found to be unresponsive and pulseless. His skin is cool and cyanotic. There is one Basic Life Supportcertified rescuer present. All of the following resuscitation maneuvers should be performed EXCEPT:", + "A": "Chest compressions", + "B": "Rescue breaths", + "C": "Heimlich maneuver", + "D": "Vigorous warming", + "E": "Attach Automated external defibrillator (AED) pads" + }, + "zh": { + "question": "一名6岁儿童从游泳池中被救出，发现其无反应且无脉搏。皮肤冰凉且发绀。现场有一名具备基础生命支持认证的救援人员。以下所有复苏操作都应该执行，除了：", + "A": "胸部按压", + "B": "人工呼吸", + "C": "海姆立克急救法", + "D": "剧烈保暖", + "E": "连接自动体外除颤器（AED）电极片" + } + }, + { + "id": "0659025f-0f68-53c1-9d4c-ad8248eb5890", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is true regarding the management of a comatose drowning victim after return of spontaneous circulation (ROSC)?", + "A": "Therapeutic hypothermia is contraindicated.", + "B": "PEEP should be minimized to reduce alveolar injury.", + "C": "Prophylactic antibiotics are indicated if the patient was rescued from a natural body of water.", + "D": "Hypothermic drowning victims may have a better prognosis.", + "E": "Fluid restriction and diuretics are indicated." + }, + "zh": { + "question": "关于自发循环恢复（ROSC）后昏迷溺水患者的管理，下列哪项是正确的？", + "A": "治疗性低温是禁忌的。", + "B": "应尽量减少PEEP以减少肺泡损伤。", + "C": "如果患者是从自然水体中救出的，应使用预防性抗生素。", + "D": "低温溺水患者可能有更好的预后。", + "E": "应限制液体和使用利尿剂。" + } + }, + { + "id": "1dad364b-ea0d-555d-9be6-3158b57217af", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 21-year-old woman with a history of major depression disorder is brought to the ED by her roommate. Her roommate states she found an empty bottle of acetaminophen next to the patient in her bedroom. She is lethargic and vomiting. Which of the following is the first step in management?", + "A": "Measure serum APAP levels.", + "B": "Administer IV N-acetylcysteine (NAC).", + "C": "Administer activated charcoal.", + "D": "Observe clinically for now while trending liver function tests.", + "E": "Transfer to a liver transplant institution." + }, + "zh": { + "question": "一名21岁的女性有重度抑郁症病史，被室友带到急诊室。她的室友说在患者卧室里发现了一个空的对乙酰氨基酚瓶子。她昏昏欲睡并呕吐。以下哪项是管理的第一步？", + "A": "测量血清对乙酰氨基酚水平。", + "B": "静脉注射N-乙酰半胱氨酸（NAC）。", + "C": "给予活性炭。", + "D": "目前临床观察，同时监测肝功能测试。", + "E": "转移到肝移植机构。" + } + }, + { + "id": "42e8522c-5f6e-5148-9136-b5da07da13dc", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are risk factors for APAP hepatoxicity EXCEPT which one?", + "A": "Chronic alcohol use", + "B": "Elderly", + "C": "Malnutrition", + "D": "Pregnancy", + "E": "Concurrent use of certain herbal medications" + }, + "zh": { + "question": "以下哪一项不是对乙酰氨基酚肝毒性的风险因素？", + "A": "长期饮酒", + "B": "老年", + "C": "营养不良", + "D": "怀孕", + "E": "同时使用某些草药" + } + }, + { + "id": "e3f07960-5ec2-5264-8d1d-9cef9c0a288a", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following drug-antidote combinations is incorrect?", + "A": "Metoprolol-glucagon", + "B": "Nortriptyline-sodium bicarbonate", + "C": "Ethanol-fomepizole", + "D": "Diltiazem-insulin", + "E": "Sarin gas-glycopyrrolate" + }, + "zh": { + "question": "以下哪种药物-解毒剂组合是不正确的？", + "A": "美托洛尔-胰高血糖素", + "B": "去甲替林-碳酸氢钠", + "C": "乙醇-甲吡唑", + "D": "地尔硫卓-胰岛素", + "E": "沙林毒气-格隆溴铵" + } + }, + { + "id": "1a931b6f-0428-5cc4-81ad-7cabb0166bfc", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "48. A middle-aged woman is brought to the ED after being rescued from a house fire. She is tachypneic and agitated. She has first- and second-degree burns affecting her right leg (total body surface area 9%). Examination of her airway and nasal passages does not demonstrate any signs of smoke inhalation. Pulse oximetry is 95% on room air. Laboratory test results are notable for pH 7.19, lactate 10 mmol/L, and PCO2 24 mm Hg. Which of the following is/are the most appropriate initial therapy(ies)?", + "A": "Hydroxocobalamin", + "B": "Oxygen at 10 L/min via nonrebreather facemask", + "C": "Intubation", + "D": "Aggressive resuscitation with crystalloid", + "E": "A and B" + }, + "zh": { + "question": "48. 一名中年女性在被从房屋火灾中救出后被送到急诊室。她呼吸急促且烦躁不安。她的右腿有一度和二度烧伤（总身体表面积9%）。对其气道和鼻腔的检查未显示任何烟雾吸入的迹象。室内空气下的脉搏血氧饱和度为95%。实验室检查结果显示pH值为7.19，乳酸为10 mmol/L，PCO2为24 mm Hg。以下哪项是最合适的初始治疗？", + "A": "羟钴胺", + "B": "通过非再呼吸面罩以10 L/min的速度吸氧", + "C": "插管", + "D": "用晶体液进行积极复苏", + "E": "A和B" + } + }, + { + "id": "2e0f0dcf-c7ff-5930-953b-1ac5b93e8153", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements is false of anesthesiologists with chemical dependence?", + "A": "50% are younger than 35 years old.", + "B": "The most frequently abused drugs are nonopiate anesthetics.", + "C": "One-third of these individuals have a family history of addiction.", + "D": "Rates of chemical abuse among residents are higher than among attending anesthesiologists.", + "E": "One-third to one-half of individuals abuse multiple classes of drugs." + }, + "zh": { + "question": "以下哪项关于麻醉医生化学依赖的说法是错误的？", + "A": "50% 的人年龄小于 35 岁。", + "B": "最常滥用的药物是非阿片类麻醉药。", + "C": "三分之一的这些人有家族成瘾史。", + "D": "住院医生的化学物质滥用率高于主治麻醉医生。", + "E": "三分之一到一半的人滥用多种类别的药物。" + } + }, + { + "id": "95222761-b570-5736-8995-d755b3cc7256", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following behaviors is inconsistent with an anesthesiologist with chemical dependence?", + "A": "Withdrawal from friends and family", + "B": "Mood swings, with increased anger and hostility", + "C": "Calling in sick and avoiding call", + "D": "Requesting frequent bathroom breaks", + "E": "Signing out more narcotics than appropriate for given case" + }, + "zh": { + "question": "以下哪种行为与化学依赖的麻醉师不一致？", + "A": "与朋友和家人疏远", + "B": "情绪波动，愤怒和敌意增加", + "C": "请病假和避免值班", + "D": "频繁请求上洗手间", + "E": "签出比实际病例需要更多的麻醉药物" + } + }, + { + "id": "442ae991-180d-5c91-a651-3bba0dad7d0c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "After admission to a treatment center or facility to address chemical", + "A": "Family history of substance abuse", + "B": "Main drug of abuse being a major opiate", + "C": "Having a coexisting psychiatric disorder", + "D": "Returning to practice in anesthesia", + "E": "No previous history of relapse" + }, + "zh": { + "question": "在入院到治疗中心或设施以解决化学物质问题后，哪一项最能预测复发？", + "A": "家族有物质滥用史", + "B": "主要滥用药物为主要阿片类药物", + "C": "存在共存的精神障碍", + "D": "返回麻醉实践", + "E": "无复发史" + } + }, + { + "id": "ce30096b-08c0-5717-bce1-e66ddc3a553d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following legal statutes provides protection for anesthesiologists as they age?", + "A": "Age Discrimination Act", + "B": "Americans with Disabilities Act", + "C": "Equal Pay Act", + "D": "Medical and Family Leave Act", + "E": "Fair Labor Standards Act" + }, + "zh": { + "question": "以下哪项法律法规为麻醉科医生提供年龄保护？", + "A": "《年龄歧视法》", + "B": "《美国残疾人法》", + "C": "《同工同酬法》", + "D": "《医疗和家庭休假法》", + "E": "《公平劳动标准法》" + } + }, + { + "id": "6f891439-a52e-5521-aa43-c2e5f1ef044f", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "5. Which of the following statements is false about the Americans with Disabilities Act of 1990?", + "A": "Reasonable accommodations for employees with disabilities are required.", + "B": "If a condition is episodic, it cannot be considered a disability under this act.", + "C": "Blindness, deafness, and mobility impairments are included.", + "D": "Conditions that often result in illegal activity (eg, kleptomania, pedophilia) are not covered.", + "E": "Mental health conditions (eg, posttraumatic stress disorder, obsessivecompulsive disorder, schizophrenia) may be considered under this act." + }, + "zh": { + "question": "5. 以下关于1990年《美国残疾人法》的说法哪一项是错误的？", + "A": "要求为残疾员工提供合理的便利。", + "B": "如果某种情况是间歇性的，则不能根据该法案被视为残疾。", + "C": "失明、失聪和行动障碍包括在内。", + "D": "通常导致非法活动的情况（例如，盗窃癖、恋童癖）不包括在内。", + "E": "心理健康状况（例如，创伤后应激障碍、强迫症、精神分裂症）可以根据该法案考虑。" + } + }, + { + "id": "fb5388ad-f2f9-56ab-9f89-ac5329128f12", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The American Society of Anesthesiology Statement on Professionalism states that professionalism involves \"the application of ethical principles…\". Which of the following is not delineated in their guidelines for the Ethical Practice of Anesthesiology?", + "A": "Anesthesiologists have ethical responsibilities to their patients.", + "B": "Anesthesiologists have ethical responsibilities to medical colleagues.", + "C": "Anesthesiologists have ethical responsibilities to the health care facilities in which they practice.", + "D": "Anesthesiologists have ethical responsibilities to their families.", + "E": "Anesthesiologists have ethical responsibilities to their community and to society." + }, + "zh": { + "question": "美国麻醉医师学会关于专业精神的声明指出，专业精神涉及“伦理原则的应用……”。以下哪一项未在其麻醉学伦理实践指南中列出？", + "A": "麻醉医师对患者有伦理责任。", + "B": "麻醉医师对医学同事有伦理责任。", + "C": "麻醉医师对其执业的医疗机构有伦理责任。", + "D": "麻醉医师对其家庭有伦理责任。", + "E": "麻醉医师对其社区和社会有伦理责任。" + } + }, + { + "id": "20016fbf-873a-5996-b652-21c5d88471d6", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following test(s) need to be passed before an anesthesia provider can be considered licensed?", + "A": "USMLE Steps 1, 2, and 3", + "B": "ABA BASIC", + "C": "ABA ADVANCED", + "D": "ABA APPLIED", + "E": "B, C, and D" + }, + "zh": { + "question": "以下哪项测试需要通过才能被认为是有执照的麻醉提供者？", + "A": "USMLE 步骤 1、2 和 3", + "B": "ABA 基础", + "C": "ABA 高级", + "D": "ABA 应用", + "E": "B、C 和 D" + } + }, + { + "id": "7266f38d-4104-53ed-9dae-fb99a19102df", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which information is not collected in the National Practitioner Data Bank?", + "A": "Malpractice payments", + "B": "License actions by medical boards", + "C": "Clinical privilege actions taken by hospitals or other health care bodies", + "D": "Participation in substance abuse rehabilitation", + "E": "Actions taken by the Drug Enforcement Agency" + }, + "zh": { + "question": "国家执业者数据银行不收集哪些信息？", + "A": "医疗事故赔偿", + "B": "医疗委员会的执照行动", + "C": "医院或其他医疗机构采取的临床特权行动", + "D": "参与药物滥用康复", + "E": "药物执法局采取的行动" + } + }, + { + "id": "2adc75b4-c4c8-5f9c-8ae1-fdcd0e27d253", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "You are a primary care physician caring for a 72-year-old woman with multiple comorbid illnesses. She asks you about creating a living will. Which of the following subjects would not usually be covered in this document?", + "A": "Wishes regarding CPR", + "B": "Naming a health care proxy", + "C": "Nutritional support (tube feeding)", + "D": "Blood transfusions", + "E": "Respiratory support" + }, + "zh": { + "question": "您是一名初级保健医生，正在照顾一位有多种合并症的72岁女性。她询问您关于制定生前遗嘱的事宜。以下哪一项通常不会在该文件中涉及？", + "A": "关于心肺复苏术的意愿", + "B": "指定医疗代理人", + "C": "营养支持（管饲）", + "D": "输血", + "E": "呼吸支持" + } + }, + { + "id": "2365b153-6f4b-5f98-aaf2-d88f88c61526", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "You are taking care of a 62-year-old man with early-onset dementia who has a subdural hematoma after a fall at home. After looking through his records, you discover he has a court-appointed guardian who is a different individual than his health care proxy. His brother, sister, wife, and children are in the waiting area. Which of the following people possesses the authority to provide consent for nonemergency procedures?", + "A": "Court-appointed guardian", + "B": "Health care proxy/durable power of attorney for health care decisions", + "C": "Spouse", + "D": "Children", + "E": "Siblings" + }, + "zh": { + "question": "您正在照顾一名62岁的男性患者，他因在家中跌倒后出现硬膜下血肿，并患有早发性痴呆。在查看他的记录后，您发现他有一位法院指定的监护人，该监护人与他的医疗代理人不同。他的兄弟、姐妹、妻子和孩子在等候区。以下哪位有权为非紧急手术提供同意？", + "A": "法院指定的监护人", + "B": "医疗代理人/医疗决策的持久授权书", + "C": "配偶", + "D": "子女", + "E": "兄弟姐妹" + } + }, + { + "id": "0dda6097-2d57-51d4-910e-e0ce3eecbb77", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "11. Which of the following statements is false regarding the treatment of a Jehovah's Witness?", + "A": "Some means of blood sequestration or preservation are allowed by some members of the faith.", + "B": "A physician may decline to care for such a patient.", + "C": "Individuals of this faith may differ in which blood products they refuse to receive.", + "D": "Parents of this faith may elect to prevent the use of blood products for their child.", + "E": "Discussions regarding blood product administration should be documented in detail in the chart." + }, + "zh": { + "question": "11. 关于耶和华见证人治疗的以下哪项陈述是错误的？", + "A": "信仰的某些成员允许某些血液分离或保存的方法。", + "B": "医生可以拒绝照顾这样的病人。", + "C": "该信仰的个人可能会在拒绝接受哪些血液制品上有所不同。", + "D": "该信仰的父母可能会选择阻止为其孩子使用血液制品。", + "E": "关于血液制品使用的讨论应在病历中详细记录。" + } + }, + { + "id": "bbe6714a-0e9e-51ac-9b27-7611c64c9bf3", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 75-year-old man with stage IV lung cancer comes in for a rigid bronchoscopy with stenting. He has an existing DNR/DNI order in place. Which of the following is/are automatically allowed when he consents for general anesthesia?", + "A": "Intubation", + "B": "Defibrillation", + "C": "Chest compressions", + "D": "All of the above", + "E": "None of the above" + }, + "zh": { + "question": "一名75岁的男性患有IV期肺癌，前来进行硬性支气管镜检查和支架置入。他已经有DNR/DNI指令。在他同意全身麻醉的情况下，以下哪项是自动允许的？", + "A": "插管", + "B": "电除颤", + "C": "胸外按压", + "D": "以上全部", + "E": "以上都不是" + } + }, + { + "id": "c2e85d12-d08c-5594-beae-31897b99810e", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is an accepted reason by professional societies for an anesthesiologist to participate in executions?", + "A": "Participation is a separate activity from routine clinical practice so should not be considered as part of one's normal clinical work.", + "B": "Being involved is \"beneficent,\" in that one's involvement may facilitate a more humane death.", + "C": "Executions are legal, so participation by clinicians should not be limited.", + "D": "Anesthesiologists are most facile with some of the medications used, so they are obligated to ensure they are used appropriately.", + "E": "None of the above." + }, + "zh": { + "question": "以下哪一项是专业协会接受的麻醉医生参与执行死刑的理由？", + "A": "参与是与常规临床实践分开的活动，因此不应被视为正常临床工作的一部分。", + "B": "参与是“有益的”，因为参与可能会促成更人道的死亡。", + "C": "死刑是合法的，因此不应限制临床医生的参与。", + "D": "麻醉医生对某些使用的药物最为熟练，因此有责任确保其被适当使用。", + "E": "以上都不是。" + } + }, + { + "id": "bb649542-1424-569d-859f-56f46a2cdbec", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "You are an anesthesia resident on an acute pain rotation who stops by the coffee cart in the hospital lobby between consults. Your patient list falls out of your scrub pocket to the floor as you leave. The list is found shortly thereafter by an unrelated health care provider. You go back to look for it when you realize your mistake, but it is gone. Does this constitute a HIPAA (Health Insurance Portability and Accountability Act of 1996) violation, and what is the minimum fine given this situation?", + "A": "$0 because it is not a violation", + "B": "$0 because it was an \"unknowing\" violation", + "C": "$100 because it was an \"unknowing\" violation", + "D": "$10 000 because it constitutes willful neglect", + "E": "$50 000 because the information was \"knowingly\" disclosed" + }, + "zh": { + "question": "您是一名麻醉住院医师，正在急性疼痛轮转期间，在医院大堂的咖啡车旁停留，期间您的患者名单从手术服口袋中掉落在地上。名单很快被一名无关的医疗提供者发现。当您意识到自己的错误时返回寻找，但名单已经不见了。这是否构成HIPAA（1996年健康保险可携性和责任法案）违规行为，并且在这种情况下的最低罚款是多少？", + "A": "$0，因为这不是违规行为", + "B": "$0，因为这是一次“未知”的违规行为", + "C": "$100，因为这是一次“未知”的违规行为", + "D": "$10 000，因为这构成了故意忽视", + "E": "$50 000，因为信息是“故意”披露的" + } + }, + { + "id": "17c58ca7-c255-5664-88d9-64b3ab0807cd", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "You are participating in data collection and analysis for a study to examine the efficacy of a new noninvasive cardiac output monitor. Which of the following is", + "A": "Hospital-encrypted flash drive", + "B": "Unencrypted flash drive in hospital-designated locked drawer", + "C": "Hospital-encrypted laptop", + "D": "Password-protected shareable Google spreadsheet", + "E": "Unencrypted laptop with deidentified data" + }, + "zh": { + "question": "您正在参与一项研究的数据收集和分析，以检查一种新的无创心输出量监测仪的功效。以下哪项是", + "A": "医院加密的闪存驱动器", + "B": "医院指定的锁定抽屉中的未加密闪存驱动器", + "C": "医院加密的笔记本电脑", + "D": "密码保护的可共享Google电子表格", + "E": "包含去识别数据的未加密笔记本电脑" + } + }, + { + "id": "6da11878-34d4-5278-9dd5-021a266f23cd", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 45-year-old woman is diagnosed with metastatic lung cancer. She declines chemotherapy and other interventions and opts instead for hospice care. Allowing the patient to decline all medical conditions upholds which of the following ethical principles?", + "A": "Autonomy", + "B": "Justice", + "C": "Nonmaleficence", + "D": "Beneficence", + "E": "Integrity" + }, + "zh": { + "question": "一名45岁的女性被诊断出患有转移性肺癌。她拒绝化疗和其他干预措施，而是选择临终关怀。允许患者拒绝所有医疗条件支持以下哪一项伦理原则？", + "A": "自主权", + "B": "公正", + "C": "不伤害", + "D": "行善", + "E": "诚��" + } + }, + { + "id": "631120b2-c1d7-5bf1-9a98-c5f2fcc91d9a", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "17. An 86-year-old man with hypertension, chronic obstructive pulmonary disorder, and benign prostatic hyperplasia presents to the emergency department after slipping on a sidewalk during his morning walk. He is found to have a hip fracture and needs surgery. Which of the following diagnoses would rule out his capacity to give informed consent?", + "A": "Schizoaffective disorder", + "B": "Substance use disorder", + "C": "Alzheimer disease", + "D": "Depression", + "E": "None of the above" + }, + "zh": { + "question": "17. 一名86岁的男性患有高血压、慢性阻塞性肺病和良性前列腺增生，在晨跑时滑倒后被送到急诊室。他被发现髋部骨折，需要手术。以下哪种诊断会排除他给予知情同意的能力？", + "A": "分裂情感性障碍", + "B": "物质使用障碍", + "C": "阿尔茨海默病", + "D": "抑郁症", + "E": "以上都不是" + } + }, + { + "id": "dd155e6e-0145-502f-ae53-7fef6f2d7e44", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 42-year-old man presents for liver transplantation. During the procedure, laboratory test results are checked, and ionized calcium is noted to be low. The anesthesia provider begins to administer calcium chloride but after giving 0.5 mL from the syringe realizes that he picked up epinephrine instead. The patient's blood pressure increases but is quickly controlled, and no harm comes to the patient. How is this event qualified?", + "A": "Preventable adverse event", + "B": "Ameliorable adverse event", + "C": "Adverse event due to negligence", + "D": "Near miss", + "E": "Error" + }, + "zh": { + "question": "一名42岁的男性患者前来进行肝移植。在手术过程中，检查了实验室测试结果，发现离子钙水平偏低。麻醉提供者开始给予氯化钙，但在从注射器中注入0.5毫升后意识到他拿错了肾上腺素。患者的血压上升但很快得到控制，患者没有受到伤害。如何界定这一事件？", + "A": "可预防的不良事件", + "B": "可改善的不良事件", + "C": "因疏忽导致的不良事件", + "D": "险些发生的事件", + "E": "错误" + } + }, + { + "id": "5327ee95-4664-51eb-8086-7a7601d07e5d", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "According to closed claims analysis, which of the following is the most common site of peripheral nerve injury after anesthetic care?", + "A": "Brachial plexus", + "B": "Ulnar nerve", + "C": "Lumbosacral nerve root", + "D": "Common peroneal nerve", + "E": "Cervical nerve root" + }, + "zh": { + "question": "根据封闭索赔分析，以下哪一项是麻醉护理后最常见的周围神经损伤部位？", + "A": "臂丛神经", + "B": "尺神经", + "C": "腰骶神经根", + "D": "腓总神经", + "E": "颈神经根" + } + }, + { + "id": "b7d9a94c-eeb8-5973-acd0-2fc5dd00118d", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is a commonly used means of identifying medication errors and resultant adverse events?", + "A": "Chart review", + "B": "Computerized monitoring", + "C": "Claims data", + "D": "Reporting systems", + "E": "All of the above" + }, + "zh": { + "question": "以下哪项是识别用药错误和由此导致的不良事件的常用方法？", + "A": "病历审查", + "B": "计算机监测", + "C": "索赔数据", + "D": "报告系统", + "E": "以上所有" + } + }, + { + "id": "2cc17799-965f-5564-9a80-b940ae5bf908", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following does NOT qualify as a \"sentinel event\" that requires reporting to The Joint Commission?", + "A": "Wrong site surgery", + "B": "Suicide within 7 days of discharge from the hospital", + "C": "Hemolytic transfusion reaction due to administration of incorrect blood group", + "D": "Retained sponge after surgery", + "E": "Infant abduction" + }, + "zh": { + "question": "以下哪项不属于需要向联合委员会报告的“哨兵事件”？", + "A": "错误部位手术", + "B": "出院后7天内自杀", + "C": "因输注错误血型导致的溶血性输血反应", + "D": "手术后遗留纱布", + "E": "婴儿被绑架" + } + }, + { + "id": "8ccc748f-ab9e-5e6d-9ffb-b91c76ff6433", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "You are an anesthesia provider involved in commission of a medical error that results in harm to a patient. Which of the following is your next step?", + "A": "Ameliorate harm and say nothing to patient and family.", + "B": "Immediate full disclosure and apology to patient and family.", + "C": "Consult hospital liability group and risk manager, and/or administrator before moving forward with an apology.", + "D": "Retain a personal lawyer and say nothing to patient and family.", + "E": "Adjust medical record such that personal culpability is minimized." + }, + "zh": { + "question": "您是一名麻醉提供者，涉及导致患者伤害的医疗错误。以下哪项是您的下一步行动？", + "A": "减轻伤害并对患者和家属保持沉默。", + "B": "立即向患者和家属全面披露并道歉。", + "C": "在进行道歉之前，咨询医院责任小组和风险经理，和/或管理员。", + "D": "聘请私人律师，对患者和家属保持沉默。", + "E": "调整医疗记录以尽量减少个人责任。" + } + }, + { + "id": "44f30d51-3042-546b-a402-461058485d6a", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "23. A resident places a radial arterial line before thoracotomy. Which of the following ACGME (Accreditation Council for Graduate Medical Education) competencies does this illustrate?", + "A": "Patient care", + "B": "Medical knowledge", + "C": "Professionalism", + "D": "Interpersonal and communication skills", + "E": "Systems-based practice" + }, + "zh": { + "question": "23. 一名住院医师在开胸手术前放置了桡动脉导管。这说明了以下哪项ACGME（美国医学教育认证委员会）能力？", + "A": "病人护理", + "B": "医学知识", + "C": "专业精神", + "D": "人际关系和沟通技巧", + "E": "基于系统的实践" + } + }, + { + "id": "2bddbac5-2711-505b-9a72-ece562d5d535", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Within the ACGME \"Milestones\" framework of resident assessment, which \"Level\" is seen as the graduation target?", + "A": "Level 1", + "B": "Level 2", + "C": "Level 3", + "D": "Level 4", + "E": "Level 5" + }, + "zh": { + "question": "在ACGME的住院医师评估“里程碑”框架中，哪个“级别”被视为毕业目标？", + "A": "级别1", + "B": "级别2", + "C": "级别3", + "D": "级别4", + "E": "级别5" + } + }, + { + "id": "7d1536e6-cfdb-55a0-8198-5546c905ef48", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An anesthesia provider has achieved certification by the American Board of Anesthesiology (ABA). Which \"Level\" (Milestones framework) has the individual achieved and in which \"core competency?\"", + "A": "Patient care, Level 3", + "B": "Medical knowledge, Level 5", + "C": "Practice-based learning, Level 4", + "D": "Interpersonal and communication skills, Level 5", + "E": "Systems-based practice, Level 3" + }, + "zh": { + "question": "一位麻醉提供者已获得美国麻醉学委员会（ABA）的认证。该个人达到了哪个“水平”（里程碑框架）以及在哪个“核心能力”中？", + "A": "患者护理，水平3", + "B": "医学知识，水平5", + "C": "基于实践的学习，水平4", + "D": "人际和沟通技能，水平5", + "E": "基于系统的实践，水平3" + } + }, + { + "id": "85b079ce-23d3-510e-b7f4-d3790a785144", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following postoperative treatments decreases the risk for deep venous thrombosis?", + "A": "Blood transfusion", + "B": "Epidural anesthesia", + "C": "Etomidate", + "D": "Ketorolac", + "E": "Patient-controlled analgesia" + }, + "zh": { + "question": "以下哪种术后治疗可以降低深静脉血栓的风险？", + "A": "输血", + "B": "硬膜外麻醉", + "C": "依托咪酯", + "D": "酮咯酸", + "E": "病人自控镇痛" + } + }, + { + "id": "59f1e612-be10-5f19-9f00-df3d2f996b1e", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A patient has hoarseness after undergoing surgery involving the aortic arch. The most likely cause is an injury to which of the following nerves?", + "A": "Glossopharyngeal", + "B": "Left recurrent laryngeal", + "C": "Right recurrent laryngeal", + "D": "Left superior laryngeal", + "E": "Right superior laryngeal" + }, + "zh": { + "question": "一名患者在接受涉及主动脉弓的手术后出现声音嘶哑。最可能的原因是以下哪个神经受损？", + "A": "舌咽神经", + "B": "左侧喉返神经", + "C": "右侧喉返神经", + "D": "左侧喉上神经", + "E": "右侧喉上神经" + } + }, + { + "id": "2d81d53e-097d-5fda-ad39-00704d9d5d13", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 36-year-old woman develops acute airway obstruction 24 hours after total thyroidectomy. The most likely cause is", + "A": "bilateral recurrent laryngeal nerve injury", + "B": "unilateral recurrent laryngeal nerve injury", + "C": "hypocalcemia", + "D": "subglottic edema", + "E": "tracheomalacia" + }, + "zh": { + "question": "一名36岁的女性在全甲状腺切除术后24小时出现急性气道阻塞。最可能的原因是", + "A": "双侧喉返神经损伤", + "B": "单侧喉返神经损伤", + "C": "低钙血症", + "D": "声门下水肿", + "E": "气管软化" + } + }, + { + "id": "84bc61bf-0c4a-5902-85f9-511c6bcfb387", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 72-year-old man has massive venous hemorrhage during a radical prostatectomy. Blood pressure decreases from 110/60 to 75/30 mmHg and central venous pressure decreases from 12 to 4 mmHg. PetC02 decreases from 34 to 24 mmHg during constant minute ventilation. The most appropriate next step should be to", + "A": "apply positive end-expiratory pressure to the breathing circuit", + "B": "attempt to aspirate air from the central venous catheter", + "C": "expand intravascular volume", + "D": "place the patient in the Trendelenburg position", + "E": "turn the patient to the left lateral decubitus position" + }, + "zh": { + "question": "一名72岁的男性在进行根治性前列腺切除术时出现大面积静脉出血。血压从110/60降至75/30 mmHg，中心静脉压从12降至4 mmHg。在恒定分钟通气量下，呼气末二氧化碳分压从34降至24 mmHg。最合适的下一步措施是", + "A": "在呼吸回路中应用呼气末正压", + "B": "尝试从中心静脉导管中抽取空气", + "C": "扩充血管内容量", + "D": "将患者置于特伦德伦堡体位", + "E": "将患者转为左侧卧位" + } + }, + { + "id": "1ba46d03-bbef-5855-9b9a-99d37c92e5df", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "A 65-kg, 57-year-old man has an initial activated clotting time (ACT) of 122 seconds prior to elective cardiopulmonary bypass. Five minutes after administration of heparin 200 mg, ACT increases to 154 seconds. After two additional doses of 200 mg each from different lots, ACT increases to 240 seconds. The most appropriate next step is to", + "A": "administer additional heparin 400 mg", + "B": "administer fresh frozen plasma 2 units", + "C": "initiate cardiopulmonary bypass", + "D": "measure the plasma heparin concentration", + "E": "start an infusion of desmopressin" + }, + "zh": { + "question": "一名65公斤、57岁的男性在择期体外循环前的初始活化凝血时间（ACT）为122秒。注射200毫克肝素5分钟后，ACT增加到154秒。在从不同批次中额外注射两次200毫克后，ACT增加到240秒。最合适的下一步是", + "A": "额外注射400毫克肝素", + "B": "注射2单位新鲜冰冻血浆", + "C": "开始体外循环", + "D": "测量血浆肝素浓度", + "E": "开始注射去氨加压素" + } + }, + { + "id": "8f100fe0-35a1-55e9-870f-51fefd5fe223", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "An obese, 75-year-old woman is scheduled for open reduction of a left forearm fracture. Thirty minutes after successful interscalene block using 20 ml of 2% lidocaine, she becomes dyspneic. The dyspnea is most likely related to", + "A": "cervical epidural block", + "B": "cervical sympathetic block with bronchospasm", + "C": "chylothorax", + "D": "elevation of the left hemidiaphragm", + "E": "recurrent laryngeal nerve block" + }, + "zh": { + "question": "一名75岁的肥胖女性计划进行左前臂骨折的开放复位术。在使用20毫升2%利多卡因成功进行颈间神经丛阻滞30分钟后，她出现呼吸困难。呼吸困难最可能与以下哪项有关", + "A": "颈椎硬膜外阻滞", + "B": "颈交感神经阻滞伴支气管痉挛", + "C": "乳糜胸", + "D": "左侧膈肌抬高", + "E": "喉返神经阻滞" + } + }, + { + "id": "2bcfacdb-b04d-5cbf-b755-4378ab4e17f1", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 54-year-old man is scheduled for open reduction of a fracture sustained when he jumped from a burning building. The carboxyhemoglobin concentration is 25%. Which of the following is the most reliable indicator of adequate oxygenation during general anesthesia?", + "A": "PaO2 of 300 mmHg", + "B": "pH of 7.38 with a PaCO2 of 41 mmHg", + "C": "Mixed venous PO2 of 45 mmHg", + "D": "Oxyhemoglobin saturation of 100% measured by co-oximeter", + "E": "SpO2 of 100% measured by pulse oximeter" + }, + "zh": { + "question": "一名54岁的男性计划进行因从燃烧建筑物跳下而导致的骨折开放复位手术。其碳氧血红蛋白浓度为25%。在全身麻醉期间，下列哪项是充分氧合的最可靠指标？", + "A": "PaO2为300 mmHg", + "B": "pH为7.38，PaCO2为41 mmHg", + "C": "混合静脉PO2为45 mmHg", + "D": "通过共氧计测量的氧合血红蛋白饱和度为100%", + "E": "通过脉搏血氧仪测量的SpO2为100%" + } + }, + { + "id": "8ea24c41-d879-5aad-b58e-e731079bf77e", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning diazepam is true?", + "A": "Absorption is more predictable after intramuscular administration than after oral administration", + "B": "It produces a shift to the left of the carbon dioxide ventilatory response curve", + "C": "Rebound drowsiness is caused by a metabolite", + "D": "The degree of CNS depression is independent of serum albumin concentration", + "E": "The extent of amnesia is proportional to the degree of sedation" + }, + "zh": { + "question": "以下关于地西泮的说法哪一项是正确的？", + "A": "肌肉注射后的吸收比口服更可预测", + "B": "它会使二氧化碳通气反应曲线左移", + "C": "反弹嗜睡是由代谢产物引起的", + "D": "中枢神经系统抑制程度与血清白蛋白浓度无关", + "E": "遗忘的程度与镇静的程度成正比" + } + }, + { + "id": "0bf5caf6-4209-5924-9a9e-461905de39fc", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 30-year-old woman has an abrupt change from sinus to nodal rhythm with unchanged heart rate on ECG during induction of halothane anesthesia. Which of the following is the most likely result of this change?", + "A": "Decreased jugular venous pulsation", + "B": "Decreased mean arterial pressure", + "C": "Decreased systemic vascular resistance", + "D": "Increased cardiac output", + "E": "Increased pulse pressure" + }, + "zh": { + "question": "一名30岁的女性在诱导使用氟烷麻醉时，心电图显示从窦性心律突然变为结节性心律，但心率不变。以下哪项最可能是这种变化的结果？", + "A": "颈静脉搏动减少", + "B": "平均动脉压降低", + "C": "全身血管阻力降低", + "D": "心输出量增加", + "E": "脉压增大" + } + }, + { + "id": "640e49b7-394b-5a70-8673-961ad52ca8ba", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Properly performed local anesthetic block of the celiac plexus", + "A": "requires that the needle tip be positioned anterior to the vertebral body of LI", + "B": "preserves efferent parasympathetic outflow", + "C": "produces urinary retention", + "D": "is not associated with hypotension", + "E": "produces truncal cutaneous hypesthesia" + }, + "zh": { + "question": "正确执行的腹腔神经丛局部麻醉阻滞", + "A": "需要将针尖置于第一腰椎椎体的前方", + "B": "保留传出副交感神经流出", + "C": "导致尿潴留", + "D": "不与低血压相关", + "E": "导致躯干皮肤感觉减退" + } + }, + { + "id": "0d823d9e-c1b5-5932-a7f4-d45d978d6c75", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Compared with morphine, a single epidural administration of fentanyl is associated with", + "A": "delayed onset of analgesia", + "B": "increased incidence of pruritus", + "C": "increased incidence of respiratory depression", + "D": "longer duration of action", + "E": "more restricted segmental spread" + }, + "zh": { + "question": "与吗啡相比，单次硬膜外注射芬太尼与以下哪项相关", + "A": "镇痛起效延迟", + "B": "瘙痒发生率增加", + "C": "呼吸抑制发生率增加", + "D": "作用时间更长", + "E": "节段性扩散更受限" + } + }, + { + "id": "eafa6f7c-3df5-5b68-8ec8-2d8ae4af9eee", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Ten days after sustaining burns over 40% of his body surface area, a patient requires greater than expected doses of vecuronium for adequate relaxation of skeletal muscle. The primary cause is increased", + "A": "plasma protein binding of d-tubocurarine", + "B": "metabolism of d-tubocurarine", + "C": "number of acetylcholine receptors", + "D": "renal clearance of d-tubocurarine", + "E": "blood flow to skeletal muscle" + }, + "zh": { + "question": "在身体表面积40%烧伤十天后，患者需要比预期更高剂量的维库溴铵以达到骨骼肌的充分松弛。其主要原因是增加了", + "A": "d-筒箭毒碱的血浆蛋白结合", + "B": "d-筒箭毒碱的代谢", + "C": "乙酰胆碱受体的数量", + "D": "d-筒箭毒碱的肾脏清除", + "E": "骨骼肌的血流量" + } + }, + { + "id": "75a41682-b930-5178-8d9a-bdb3f217d582", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The sudden onset of pulmonary edema can be caused by each of the following EXCEPT", + "A": "rapid re-expansion of the lungs following pneumothorax", + "B": "upper airway obstruction", + "C": "oxygen toxicity", + "D": "rupture of mitral papillary muscle", + "E": "severe preeclampsia" + }, + "zh": { + "question": "以下哪项不会导致急性肺水肿的发生", + "A": "气胸后肺的快速再扩张", + "B": "上呼吸道阻塞", + "C": "氧中毒", + "D": "二尖瓣乳头肌破裂", + "E": "严重子痫前期" + } + }, + { + "id": "f735d09e-dded-5287-8067-41634a127730", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Following extubation after nasotracheal intubation for seven days, a 35-year-old man has fever, facial pain, nasal stuffiness, and purulent nasal secretions. The most likely cause is", + "A": "eustachian tube obstruction", + "B": "frontal sinusitis", + "C": "maxillary sinusitis", + "D": "parotiditis", + "E": "retropharyngeal abscess" + }, + "zh": { + "question": "在进行七天的鼻气管插管拔管后，一名35岁男性出现发热、面部疼痛、鼻塞和脓性鼻分泌物。最可能的原因是", + "A": "咽鼓管阻塞", + "B": "额窦炎", + "C": "上颌窦炎", + "D": "腮腺炎", + "E": "咽后脓肿" + } + }, + { + "id": "7c94c1be-c8b6-5738-8112-d2d2b6b65cfb", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Meperidine has a more rapid onset of action than morphine following intravenous injection because of its", + "A": "lesser ionization", + "B": "greater lipid solubility", + "C": "lesser protein binding", + "D": "smaller volume of distribution", + "E": "slower rate of hepatic clearance" + }, + "zh": { + "question": "哌替啶静脉注射后比吗啡起效更快是因为其", + "A": "较少的电离", + "B": "更大的脂溶性", + "C": "较少的蛋白结合", + "D": "较小的分布容积", + "E": "较慢的肝脏清除率" + } + }, + { + "id": "bcabcf9f-9355-587c-8295-1668833bef66", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The decreased duration of action of an intravenous dose of fentanyl compared with an intravenous dose of morphine is best explained by", + "A": "greater lipid solubility", + "B": "increased hepatic metabolism", + "C": "less protein binding", + "D": "shorter elimination half-life", + "E": "smaller volume of distribution" + }, + "zh": { + "question": "与静脉注射吗啡相比，静脉注射芬太尼作用时间缩短的最佳解释是", + "A": "更大的脂溶性", + "B": "增加的肝脏代谢", + "C": "较少的蛋白结合", + "D": "较短的消除半衰期", + "E": "较小的分布容积" + } + }, + { + "id": "a44563f7-726c-57a3-b370-f357506dc44f", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Spontaneously breathing enflurane at 1 MAC causes increased", + "A": "airway resistance", + "B": "diaphragm function", + "C": "carbon dioxide production", + "D": "intercostal muscle function", + "E": "physiologic dead space" + }, + "zh": { + "question": "自发呼吸1 MAC的恩氟烷会导致增加", + "A": "气道阻力", + "B": "膈肌功能", + "C": "二氧化碳产生", + "D": "肋间肌功能", + "E": "生理无效腔" + } + }, + { + "id": "538832c0-54b5-5a57-a225-1d6683a7dc5b", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "An infant with congenital lobar emphysema is scheduled for thoracotomy. Which of the following should be included in the anesthetic management of this infant?", + "A": "Helium-oxygen inspired gas mixture", + "B": "Nitrous oxide administration", + "C": "Positive pressure ventilation", + "D": "Prophylactic placement of a chest tube", + "E": "Spontaneous ventilation until the chest is opened" + }, + "zh": { + "question": "一名患有先天性肺叶气肿的婴儿计划进行开胸手术。以下哪项应包括在该婴儿的麻醉管理中？", + "A": "氦氧混合气体吸入", + "B": "一氧化二氮的使用", + "C": "正压通气", + "D": "预防性放置胸管", + "E": "在胸腔打开前保持自主呼吸" + } + }, + { + "id": "1fb1d737-afdb-5e3d-bb43-e66a38c002eb", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A 50-year-old patient is undergoing craniotomy for clipping of a cerebral aneurysm with isoflurane, nitrous oxide, and fentanyl anesthesia. At the time of aneurysm exposure, the EEG shows burst suppression. Which of the following is the most likely cause?", + "A": "Cerebral ischemia", + "B": "Cerebral vasospasm", + "C": "Fentanyl effect", + "D": "Isoflurane effect", + "E": "Petit mal seizure activity" + }, + "zh": { + "question": "一名50岁的患者正在接受开颅手术，以异氟醚、氧化亚氮和芬太尼麻醉夹闭脑动脉瘤。在暴露动脉瘤时，脑电图显示爆发抑制。以下哪项最可能是原因？", + "A": "脑缺血", + "B": "脑血管痉挛", + "C": "芬太尼效应", + "D": "异氟醚效应", + "E": "小发作癫痫活动" + } + }, + { + "id": "ac667218-9fd3-59fc-bb44-f3fb36a5d8c0", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 75-year-old man is confused, restless and disoriented two days after an aortic aneurysm repair. Serum sodium concentration is 112 mEq/L, serum osmolality is low, and urine is hypertonic. The most appropriate treatment is", + "A": "restriction of fluid intake", + "B": "administration of isotonic saline solution", + "C": "administration of hypertonic (3%) saline solution", + "D": "administration of spironolactone", + "E": "infusion of mannitol 25 g" + }, + "zh": { + "question": "一名75岁男性在主动脉瘤修复术后两天出现意识混乱、躁动和定向障碍。血清钠浓度为112 mEq/L，血清渗透压低，尿液呈高渗状态。最合适的治疗是", + "A": "限制液体摄入", + "B": "给予等渗盐水溶液", + "C": "给予高渗（3%）盐水溶液", + "D": "给予螺内酯", + "E": "输注25克甘露醇" + } + }, + { + "id": "572a5b4d-ef38-548f-8817-bd57f0c4bb2c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following complications is the primary cause of neurologic deficit following carotid endarterectomy?", + "A": "Global hypoperfusion", + "B": "Hypertension", + "C": "Hypotension", + "D": "Improper shunt insertion", + "E": "Thromboembolism" + }, + "zh": { + "question": "以下哪种并发症是颈动脉内膜切除术后神经功能缺损的主要原因？", + "A": "全身低灌注", + "B": "高血压", + "C": "低血压", + "D": "分流插入不当", + "E": "血栓栓塞" + } + }, + { + "id": "b107cc36-79c0-5d93-9779-81b73bc23d0a", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 30-year-old primiparous woman delivered a healthy infant by cesarean section during uneventful spinal anesthesia with tetracaine 10 mg in 2 ml of 5% dextrose solution. Twelve hours after delivery she has bilateral loss of pain and temperature sensibility, but not touch, below T8 and paralysis of both legs. The most likely cause of this complication is", + "A": "chemical arachnoiditis", + "B": "injection of tetracaine into the spinal cord", + "C": "demyelination of the posterior tracts", + "D": "thrombosis of the anterior spinal artery", + "E": "cord transection from spondylolisthesis" + }, + "zh": { + "question": "一名30岁的初产妇在使用10毫克的丁卡因和2毫升5%葡萄糖溶液进行顺利的脊髓麻醉下，通过剖腹产分娩了一名健康婴儿。分娩12小时后，她出现了双侧痛觉和温度觉丧失，但触觉未受影响，T8以下区域及双腿瘫痪。此并发症最可能的原因是", + "A": "化学性蛛网膜炎", + "B": "丁卡因注射到脊髓中", + "C": "后束脱髓鞘", + "D": "前脊髓动脉血栓形成", + "E": "脊髓因椎体滑脱而横断" + } + }, + { + "id": "130d74c0-cc79-5799-9ff8-c08d849f575d", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "Following cardiopulmonary bypass, right ventricular distention is noted after infusion of protamine 40 mg. Pulmonary artery pressure has increased from 25/18 to 50/30 mmHg and systemic arterial pressure has decreased from 110/65 to 0 mmHg. Which of the following is the most appropriate treatment?", + "A": "Administration of amrinone", + "B": "Administration of nitroglycerin", + "C": "Administration of phenylephrine", + "D": "Initiation of intra-aortic balloon pump assist", + "E": "Reheparinization and resumption of cardiopulmonary bypass" + }, + "zh": { + "question": "在体外循环后，注射40毫克鱼精蛋白后观察到右心室扩张。肺动脉压从25/18 mmHg升高到50/30 mmHg，系统动脉压从110/65 mmHg下降到0 mmHg。以下哪种治疗最为合适？", + "A": "给予氨力农", + "B": "给予硝酸甘油", + "C": "给予去氧肾上腺素", + "D": "启动主动脉内球囊反搏辅助", + "E": "重新给予肝素并恢复体外循环" + } + }, + { + "id": "f370d653-61f7-5fbb-9b08-f52464f426a3", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Phase II neuromuscular block is characterized by", + "A": "depressed twitch height, sustained tetanus, post-tetanic potentiation", + "B": "depressed twitch height, tetanic fade, post-tetanic potentiation", + "C": "depressed twitch height, tetanic fade, no post-tetanic potentiation", + "D": "normal twitch height, tetanic fade, post-tetanic potentiation", + "E": "normal twitch height, tetanic fade, no post-tetanic potentiation" + }, + "zh": { + "question": "II期神经肌肉阻滞的特征是", + "A": "抽搐高度降低，强直收缩持续，强直后增强", + "B": "抽搐高度降低，强直收缩衰退，强直后增强", + "C": "抽搐高度降低，强直收缩衰退，无强直后增强", + "D": "抽搐高度正常，强直收缩衰退，强直后增强", + "E": "抽搐高度正常，强直收缩衰退，无强直后增强" + } + }, + { + "id": "ce17dd92-be06-5cbf-bcd6-753a05fb96d6", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "A patient is undergoing exploration of a stab wound to the left side of the neck. On awake laryngoscopy, the left vocal cord is in midposition and the right vocal cord is abducted during inspiration. The most likely cause of these findings is trauma to which of the following structures on the left?", + "A": "C7-8 nerve root", + "B": "Stellate ganglion", + "C": "Glossopharyngeal nerve", + "D": "Superior laryngeal nerve", + "E": "Vagus nerve" + }, + "zh": { + "question": "一名患者正在接受左侧颈部刺伤的探查。在清醒喉镜检查中，左侧声带处于中位，右侧声带在吸气时外展。最可能导致这些发现的原因是左侧哪个结构的损伤？", + "A": "C7-8 神经根", + "B": "星状神经节", + "C": "舌咽神经", + "D": "上喉神经", + "E": "迷走神经" + } + }, + { + "id": "a3820a6e-cdce-5c94-9bfc-a0c850fad333", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 15-kg, 3-year-old child is anesthetized for an inguinal hernia repair with halothane and nitrous oxide. The trachea is intubated after administration of succinylcholine 30 mg. At the conclusion of the 45-minute procedure, the child is not breathing; a peripheral nerve twitch monitor indicates no response to a train-of-four stimulus. Further investigation is most likely to show", + "A": "abnormal response to nondepolarizing muscle relaxants", + "B": "a low dibucaine number", + "C": "a low plasma cholinesterase concentration", + "D": "an underlying myopathy", + "E": "a positive halothane-caffeine contracture test" + }, + "zh": { + "question": "一名15公斤、3岁的儿童在使用氟烷和氧化亚氮进行腹股沟疝修补手术时被麻醉。给予30毫克琥珀胆碱后进行气管插管。在45分钟的手术结束时，孩子没有呼吸；外周神经刺激监测器显示对四联刺激无反应。进一步调查最有可能显示", + "A": "对非去极化肌松药的异常反应", + "B": "低地布卡因数", + "C": "低血浆胆碱酯酶浓度", + "D": "潜在的肌病", + "E": "阳性的氟烷-咖啡因收缩试验" + } + }, + { + "id": "d9fbf38d-e38d-51ed-8b54-1be1fd1bacdb", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The principal rationale for the use of warmed humidified inspired anesthetic gases in children is to", + "A": "decrease postoperative respiratory complications", + "B": "decrease postoperative shivering", + "C": "preserve ciliary function", + "D": "prevent dehydration", + "E": "prevent evaporative heat loss" + }, + "zh": { + "question": "在儿童中使用加温加湿的吸入麻醉气体的主要理由是", + "A": "减少术后呼吸并发症", + "B": "减少术后寒战", + "C": "保护纤毛功能", + "D": "防止脱水", + "E": "防止蒸发性热量损失" + } + }, + { + "id": "c3418585-d841-5d22-b22b-8724080fe766", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 33-year-old woman is scheduled for emergency appendectomy under general anesthesia. She has hypertrophic cardiomyopathy and has had two episodes of syncope in the past year. Which of the following statements concerning anesthetic management is true?", + "A": "Spinal anesthesia is preferred to general anesthesia", + "B": "Deep levels of isoflurane anesthesia are appropriate", + "C": "Fluid administration should be restricted", + "D": "Phenylephrine is preferred to ephedrine to treat hypotension", + "E": "Positive end-expiratory pressure will decrease left ventricular outflow obstruction" + }, + "zh": { + "question": "一名33岁的女性计划在全身麻醉下进行紧急阑尾切除术。她患有肥厚型心肌病，过去一年中有过两次晕厥发作。以下关于麻醉管理的说法哪一项是正确的？", + "A": "硬膜外麻醉优于全身麻醉", + "B": "深度异氟醚麻醉是合适的", + "C": "应限制液体输注", + "D": "去氧肾上腺素优于麻黄碱用于治疗低血压", + "E": "呼气末正压会减少左心室流出道梗阻" + } + }, + { + "id": "e162b65a-e625-576f-94e0-52c68f08c1f4", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 45-year-old patient with chronic alcoholism develops jaundice four days after a cholecystectomy under halothane/morphine general anesthesia. Bilirubin and alkaline phosphatase are elevated, but ALT is only slightly above normal. All values were within normal limits preoperatively. The most likely cause of jaundice is", + "A": "opioid-induced spasm of the sphincter of Oddi", + "B": "hepatic dysfunction secondary to halothane exposure", + "C": "worsening of underlying chronic hepatitis", + "D": "extrahepatic biliary obstruction", + "E": "acute viral hepatitis" + }, + "zh": { + "question": "一名45岁的慢性酗酒患者在接受氟烷/��啡全身麻醉下的胆囊切除术四天后出现黄疸。胆红素和碱性磷酸酶升高，但ALT仅略高于正常水平。术前所有数值均在正常范围内。黄疸最可能的原因是", + "A": "阿片类药物引起的Oddi括约肌痉挛", + "B": "氟烷暴露引起的肝功能障碍", + "C": "潜在慢性肝炎的恶化", + "D": "肝外胆道梗阻", + "E": "急性病毒性肝炎" + } + }, + { + "id": "f0d2a3ac-0c02-5239-a339-7a95b586b684", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "In a patient taking a beta-adrenergic blocker, the drug most likely to produce atrioventricular junctional block is", + "A": "diltiazem", + "B": "fentanyl", + "C": "halothane", + "D": "nifedipine", + "E": "verapamil" + }, + "zh": { + "question": "在服用β-肾上腺素能阻滞剂的患者中，最有可能引起房室结阻滞的药物是", + "A": "地尔硫卓", + "B": "芬太尼", + "C": "氟烷", + "D": "硝苯地平", + "E": "维拉帕米" + } + }, + { + "id": "f2f8ab7a-5375-5c71-ad49-901e2473925f", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements about thiopental is true?", + "A": "Rapid uptake into maternal tissues limits its transfer to the fetus", + "B": "Its short duration of action is due to its extensive binding to plasma proteins", + "C": "Accumulation in fat leads to acute tolerance", + "D": "Alkalinity of solution causes respiratory depression", + "E": "Uptake into brain is slowed by respiratory acidosis" + }, + "zh": { + "question": "以下关于硫喷妥钠的说法哪一项是正确的？", + "A": "快速进入母体组织限制了其向胎儿的转移", + "B": "其作用时间短是由于其广泛结合于血浆蛋白", + "C": "在脂肪中的积累导致急性耐受", + "D": "溶液的碱性导致呼吸抑制", + "E": "呼吸性酸中毒减缓了其进入大脑" + } + }, + { + "id": "331434d9-d5f6-56ce-9fec-69e4afa6f0f0", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The most effective treatment of severe carbon monoxide poisoning in a 2-year-old child is", + "A": "intravenous administration of methylene blue", + "B": "intravenous administration of thiocyanate", + "C": "intravenous administration of thiosulfate", + "D": "exchange transfusion", + "E": "hyperbaric oxygenation" + }, + "zh": { + "question": "对2岁儿童严重一氧化碳中毒最有效的治疗是", + "A": "静脉注射亚甲蓝", + "B": "静脉注射硫氰酸盐", + "C": "静脉注射硫代硫酸盐", + "D": "换血疗法", + "E": "高压氧治疗" + } + }, + { + "id": "3429d3d5-c615-588c-856f-f448cef5be14", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements concerning myasthenia gravis is true?", + "A": "Neostigmine is inappropriate for antagonism of neuromuscular blockade", + "B": "The number of acetylcholine receptors is decreased", + "C": "Plasma cholinesterase concentration is decreased", + "D": "The risk for malignant hyperthermia is increased", + "E": "Succinylcholine is contraindicated" + }, + "zh": { + "question": "以下关于重症肌无力的说法哪一项是正确的？", + "A": "新斯的明不适用于拮抗神经肌肉阻滞", + "B": "乙酰胆碱受体的数量减少", + "C": "血浆胆碱酯酶浓度降低", + "D": "恶性高热的风险增加", + "E": "琥珀胆碱禁忌使用" + } + }, + { + "id": "f5af5a4f-9ab6-5276-ad83-50fd6bd44045", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An infant is delivered by forceps following labor in which variable decelerations were noted. Amniotic fluid was clear. Initial evaluation shows a cyanotic, limp infant with a heart rate of 80 bpm, poor respiratory efforts, and grimacing in response to suctioning. The most appropriate method of resuscitation for this newborn is", + "A": "vigorous tactile stimulation", + "B": "bag and mask ventilation with oxygen", + "C": "immediate endotracheal intubation", + "D": "administration of sodium bicarbonate 1 mEq/kg", + "E": "volume expansion with normal saline solution 10 mL/kg" + }, + "zh": { + "question": "一名婴儿在分娩过程中使用产钳接生，期间观察到变异减速。羊水清澈。初步评估显示婴儿发绀、无力，心率为80次/分钟，呼吸努力差，对吸引反应为皱眉。对该新生儿最合适的复苏方法是", + "A": "强烈的触觉刺激", + "B": "使用氧气的面罩通气", + "C": "立即气管插管", + "D": "给予1 mEq/kg的碳酸氢钠", + "E": "用10 mL/kg的生理盐水进行容量扩充" + } + }, + { + "id": "da9e0a58-44f0-5173-a53d-a43367b92b4b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "In a patient who is to undergo clipping of a cerebral aneurysm, an advantage of isoflurane over nitroprusside for induction of hypotension is", + "A": "better maintenance of cardiac output", + "B": "better maintenance of cerebral blood flow", + "C": "greater decrease in cerebral oxygen consumption", + "D": "greater decrease in afterload", + "E": "more rapid titration of systemic blood pressure" + }, + "zh": { + "question": "在一名即将接受脑动脉瘤夹闭手术的患者中，异氟醚相比于硝普钠用于诱导低血压的一个优势是", + "A": "更好地维持心输出量", + "B": "更好地维持脑血流", + "C": "更大程度地降低脑氧消耗", + "D": "更大程度地降低后负荷", + "E": "更快速地滴定全身血压" + } + }, + { + "id": "8d5c407a-6a84-5168-bee7-8a91a72b6760", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "If both recurrent laryngeal nerves were severed during a difficult thyroidectomy for cancer, the most likely finding would be", + "A": "paralysis of the cricothyroid muscles", + "B": "cadaveric positioning of the true vocal cords", + "C": "anesthesia of both sides of the epiglottis", + "D": "bilateral pure adductor vocal cord paralysis", + "E": "stridor" + }, + "zh": { + "question": "如果在癌症的困难甲状腺切除术中切断了两侧的喉返神经，最可能的发现是", + "A": "环甲肌麻痹", + "B": "真声带呈尸体样位置", + "C": "会厌两侧麻醉", + "D": "双侧纯内收型声带麻痹", + "E": "喘鸣" + } + }, + { + "id": "d35954db-3260-5f39-ab04-746d4a17f8d4", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following findings is characteristic of whole blood preserved in CPD and stored at 4°C for one week?", + "A": "Increased potassium concentration", + "B": "Normal concentrations of factors V and VIII", + "C": "PaCO2 of 40 mmHg", + "D": "pH of 7.3", + "E": "50% Viable platelets" + }, + "zh": { + "question": "以下哪项是用CPD保存并在4°C储存一周的全血的特征性发现？", + "A": "钾浓度增加", + "B": "V因子和VIII因子浓度正常", + "C": "PaCO2为40 mmHg", + "D": "pH值为7.3", + "E": "50%活性血小板" + } + }, + { + "id": "785242be-7a22-5e55-8504-a6d39ccc5e44", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 70-year-old man who has just undergone an abdominal aortic aneurysm repair under halothane anesthesia develops hypertension, dyspnea, and cyanosis shortly after awakening in the recovery room. Administration of furosemide 20 mg intravenously improves the cyanosis within 10 minutes. This immediate effect of furosemide is best explained by", + "A": "inotropic effect from electrolyte shifts", + "B": "decreased preload through diuresis", + "C": "increased peripheral venous capacitance", + "D": "decreased pulmonary vascular resistance", + "E": "increased coronary blood flow" + }, + "zh": { + "question": "一名70岁的男性在接受卤烷麻醉下的腹主动脉瘤修复术后，刚醒来在恢复室时出现高血压、呼吸困难和发绀。静脉注射20毫克呋塞米后，发绀在10分钟内得到改善。呋塞米的这种立即效果最好解释为", + "A": "电解质转移引起的正性肌力作用", + "B": "通过利尿减少前负荷", + "C": "增加外周静脉容量", + "D": "降低肺血管阻力", + "E": "增加冠状动脉血流量" + } + }, + { + "id": "318aabb4-0ee3-5409-8764-990ea3086727", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Halothane anesthesia is usually associated with an increase in", + "A": "cardiac contractility", + "B": "venous capacitance", + "C": "arterial pressure", + "D": "venous return", + "E": "heart rate" + }, + "zh": { + "question": "氟烷麻醉通常与以下哪项增加有关？", + "A": "心肌收缩力", + "B": "静脉容量", + "C": "动脉压", + "D": "静脉回流", + "E": "心率" + } + }, + { + "id": "ecb30a73-6fc3-560b-82c6-2729ed0bbdc5", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During active labor, 10 ml of bupivacaine 0.5% with epinephrine 1:200,000 is administered epidurally. Fifteen minutes later, maternal blood pressure is 70/50 mmHg and heart rate is 70 bpm; fetal heart rate is 90 bpm for 45 seconds, with loss of beat-to-beat variability. The most likely explanation for the fetal vital signs is", + "A": "fetal bupivacaine cardiotoxicity", + "B": "maternal bupivacaine cardiotoxicity", + "C": "maternal hypotension", + "D": "uterine artery vasoconstriction", + "E": "umbilical cord compression" + }, + "zh": { + "question": "在活跃期分娩期间，硬膜外注射10毫升0.5%布比卡因与1:200,000肾上腺素。十五分钟后，母体血压为70/50 mmHg，心率为70 bpm；胎儿心率为90 bpm持续45秒，伴随搏动间变异消失。胎儿生命体征的最可能解释是", + "A": "胎儿布比卡因心脏毒性", + "B": "母体布比卡因心脏毒性", + "C": "母体低血压", + "D": "子宫动脉血管收缩", + "E": "脐带压迫" + } + }, + { + "id": "d2b0f2d1-174a-5921-80d3-f7db7549f74b", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 65-year-old man undergoes prostatectomy in the lithotomy position under spinal anesthesia using bupivacaine 12 mg. Ten hours later, he reports that his left foot is numb. Examination shows decreased pinprick sensation over the lateral dorsal aspect of the left foot; dorsiflexion is limited. Which of the following is the most likely cause?", + "A": "Cauda equina syndrome", + "B": "Compression of the common peroneal nerve", + "C": "Compression of the posterior tibial nerve", + "D": "L5 nerve root damage", + "E": "Stretching of the sciatic nerve" + }, + "zh": { + "question": "一名65岁男性在脊髓麻醉下使用12毫克布比卡因进行截石位前列腺切除术。十小时后，他报告左脚麻木。检查显示左脚外侧背部针刺感觉减退；背屈受限。以下哪项是最可能的原因？", + "A": "马尾综合征", + "B": "腓总神经受压", + "C": "胫后神经受压", + "D": "L5神经根损伤", + "E": "坐骨神经牵拉" + } + }, + { + "id": "6a988cb5-fd43-514e-81a8-ec2d835b9cff", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following phenomena is primarily responsible for the decrease in core body temperature that commonly occurs during the first hour of general anesthesia?", + "A": "Convective heat loss from cutaneous vasodilation", + "B": "Decreased heat production", + "C": "Evaporative heat loss during skin preparation", + "D": "Heat loss from the respiratory tract", + "E": "Redistribution of core body heat to the periphery" + }, + "zh": { + "question": "以下哪种现象主要导致全身麻醉的第一个小时内核心体温的下降？", + "A": "皮肤血管扩张引起的对流散热", + "B": "产热减少", + "C": "皮肤准备过程中的蒸发散热", + "D": "呼吸道的热量损失", + "E": "核心体热向外周的重新分布" + } + }, + { + "id": "975c1ff5-d339-52b3-ab9c-22f03eb4cb4f", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is an effect of hypothermia in neonates?", + "A": "Decreased duration of neuromuscular blockade", + "B": "Increased narcotic requirements", + "C": "Increased pulmonary vascular resistance", + "D": "Metabolic alkalosis", + "E": "Shivering" + }, + "zh": { + "question": "以下哪项是新生儿低体温的影响？", + "A": "神经肌肉阻滞持续时间缩短", + "B": "麻醉药物需求增加", + "C": "肺血管阻力增加", + "D": "代谢性碱中毒", + "E": "发抖" + } + }, + { + "id": "10af43af-b72f-5fb3-8211-ec440ae10a7a", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "An unconscious adult patient is being ventilated through an esophageal obturator airway (EOA) in the emergency department. In the absence of cervical spine injury, which of the following is appropriate?", + "A": "Use of the EOA for airway management until the patient regains consciousness", + "B": "Removal of the EOA before insertion of an endotracheal tube", + "C": "Placement of an endotracheal tube before removal of the EOA", + "D": "Removal of the EOA under fiberoptic endoscopic visualization", + "E": "Cricothyroidotomy" + }, + "zh": { + "question": "在急诊科，一名无意识的成年患者正在通过食管阻塞气道（EOA）进行通气。在没有颈椎损伤的情况下，下列哪项是合适的？", + "A": "使用EOA进行气道管理，直到患者恢复意识", + "B": "在插入气管插管之前移除EOA", + "C": "在移除EOA之前放置气管插管", + "D": "在纤维内窥镜可视化下移除EOA", + "E": "环甲膜切开术" + } + }, + { + "id": "f1644bc0-61c8-5837-a95b-81c7fd5b2735", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning flumazenil is true?", + "A": "Hepatic clearance is low", + "B": "It binds irreversibly with the benzodiazepine receptor", + "C": "It causes hypertension and tachycardia", + "D": "It has a shorter duration of action than midazolam", + "E": "It reverses opioid-induced respiratory depression" + }, + "zh": { + "question": "以下关于氟马西尼的说法哪一项是正确的？", + "A": "肝脏清除率低", + "B": "它与苯二氮卓受体不可逆结合", + "C": "它引起高血压和心动过速", + "D": "它的作用持续时间比咪达唑仑短", + "E": "它逆转阿片类药物引起的呼吸抑制" + } + }, + { + "id": "d87545c2-d11a-552a-98cf-e4f846c03683", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 65-year-old man with essential hypertension well controlled around 140/90 mmHg with hydrochlorothiazide is scheduled for right colectomy for carcinoma. Preoperative EKG and all laboratory values are normal except for a hematocrit of 29% and serum potassium level of 3.2 mEq/L. Central venous pressure (CVP) measured from an internal jugular catheter inserted before induction of anesthesia is 7 mmHg. Ten minutes after induction with thiopental 200 mg followed by enflurane 3% in nitrous oxide and oxygen (50% each), blood pressure decreases suddenly from 110/70 to 80/50 mmHg with heart rate unchanged at 78 bpm. CVP is now 20 mmHg and the EKG demonstrates a midjunctional rhythm. After discontinuing the enflurane, the most appropriate action would be to", + "A": "administer furosemide 20 mg intravenously", + "B": "verify proper placement of the CVP catheter", + "C": "administer atropine 0.4 mg intravenously", + "D": "administer packed erythrocytes 1 unit", + "E": "administer potassium 20 mEq in 250 ml of intravenous fluid over 15 minutes" + }, + "zh": { + "question": "一名65岁患有原发性高血压的男性，使用氢氯噻嗪将血压控制在140/90 mmHg左右，计划进行右半结肠切除术以治疗癌症。术前心电图和所有实验室值均正常，除外血细胞比容为29%和血清钾水平为3.2 mEq/L。麻醉诱导前通过内颈静脉导管测得的中心静脉压（CVP）为7 mmHg。用200 mg硫喷妥钠诱导后，接着使用3%安氟醚与氧化亚氮和氧（各50%）进行麻醉，10分钟后，血压从110/70 mmHg突然降至80/50 mmHg，心率保持在78次/分钟不变。此时CVP为20 mmHg，心电图显示中间交界性心律。在停止使用安氟醚后，最适当的措施是", + "A": "静脉注射20 mg呋塞米", + "B": "确认CVP导管的正确放置", + "C": "静脉注射0.4 mg阿托品", + "D": "输注1单位浓缩红细胞", + "E": "在15分钟内将20 mEq钾溶于250 ml静脉输液中" + } + }, + { + "id": "2928083e-e2b2-57db-8d57-a4053b73bd57", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "When performed with identical doses, which of the following types of regional block is associated with the highest plasma concentration of the drug?", + "A": "Brachial plexus", + "B": "Caudal", + "C": "Intercostal", + "D": "Subcutaneous infiltration", + "E": "Thoracic epidural" + }, + "zh": { + "question": "在相同剂量下，以下哪种区域阻滞类型与药物的最高血浆浓度相关？", + "A": "臂丛神经阻滞", + "B": "尾部阻滞", + "C": "肋间阻滞", + "D": "皮下浸润", + "E": "胸椎硬膜外阻滞" + } + }, + { + "id": "a4e18e1e-1200-5b41-bff3-d75458f92f08", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Infants with untreated pyloric stenosis are at increased risk for each of the following EXCEPT", + "A": "congenital heart disease", + "B": "dehydration", + "C": "hypokalemia", + "D": "increased gastric acidity", + "E": "metabolic alkalosis" + }, + "zh": { + "question": "未治疗的幽门狭窄婴儿增加以下哪种风险，除了", + "A": "先天性心脏病", + "B": "脱水", + "C": "低钾血症", + "D": "胃酸增加", + "E": "代谢性碱中毒" + } + }, + { + "id": "385505f0-83fa-5edd-a05e-c6983644df1a", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning the metabolism of atracurium is true?", + "A": "It is related to cardiac output", + "B": "It is decreased by hyperthermia", + "C": "It is unaffected by increasing age", + "D": "It is decreased by low plasma cholinesterase activity", + "E": "It is decreased in renal failure" + }, + "zh": { + "question": "以下关于阿曲库铵代谢的说法中哪一项是正确的？", + "A": "与心输出量有关", + "B": "高热会降低其代谢", + "C": "不受年龄增加的影响", + "D": "低血浆胆碱酯酶活性会降低其代谢", + "E": "肾功能衰竭会降低其代谢" + } + }, + { + "id": "1bdf6e32-c16d-54da-b0b8-6331914429af", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "In a 35-year-old patient, which of the following is associated with an increased duration of clinical narcosis following infusion of a total dose of 10 mg/kg thiopental over three hours?", + "A": "Alcoholism in remission", + "B": "Asthma", + "C": "Fever", + "D": "Obesity", + "E": "Use of appetite suppressants" + }, + "zh": { + "question": "在一名35岁的患者中，以下哪项与在三小时内输注总剂量为10 mg/kg的硫喷妥后临床麻醉时间延长有关？", + "A": "戒酒后康复期", + "B": "哮喘", + "C": "发热", + "D": "肥胖", + "E": "使用食欲抑制剂" + } + }, + { + "id": "deaf3bba-49fd-55ef-8ff1-c8a75dc1c660", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following is the most appropriate action after an anesthetic vaporizer is tipped?", + "A": "Return to the manufacturer for recalibration", + "B": "Flush the vaporizer with oxygen at 5 L/min for 24 hours", + "C": "Store the vaporizer for 24 hours at room temperature", + "D": "Set the vaporizer at low concentration and flush with oxygen at 10 L/min for 30 minutes", + "E": "Verify the vaporizer output with mass spectrography" + }, + "zh": { + "question": "以下哪项是麻醉蒸发器倾斜后最合适的处理措施？", + "A": "送回制造商重新校准", + "B": "用5 L/min的氧气冲洗蒸发器24小时", + "C": "将蒸发器在室温下存放24小时", + "D": "将蒸发器设置在低浓度并用10 L/min的氧气冲洗30分钟", + "E": "用质谱法验证蒸发器输出" + } + }, + { + "id": "50a30478-1880-5f4f-a8a5-0aa31f2c69c4", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 64-year-old, 87-kg woman in good general health is undergoing a right knee arthroplasty while in the supine position with general anesthesia consisting of enflurane 2% and nitrous oxide 50% in oxygen. She is breathing spontaneously through a 7-mm endotracheal tube. During the first 30 minutes of the procedure, the arterial oxygen saturation measured by pulse oximetry decreases from 98% to 92%. The most likely cause of the desaturation is", + "A": "decreased functional residual capacity", + "B": "diffusion hypoxia", + "C": "hypercarbia", + "D": "increased airway resistance produced by the endotracheal tube", + "E": "inhibition of hypoxic pulmonary vasoconstriction" + }, + "zh": { + "question": "一名64岁、87公斤的女性，身体状况良好，在仰卧位下接受右膝关节置换术，使用全身麻醉，包括2%的恩氟烷和50%的氧化亚氮。她通过7毫米的气管导管自发呼吸。在手术的前30分钟内，脉搏血氧仪测得的动脉氧饱和度从98%下降到92%。最可能导致氧饱和度下降的原因是", + "A": "功能残气量减少", + "B": "弥散性缺氧", + "C": "高碳酸血症", + "D": "气管导管引起的气道阻力增加", + "E": "缺氧性肺血管收缩的抑制" + } + }, + { + "id": "721200d3-1cae-5908-8ccd-970c9be57629", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 55-year-old man who is scheduled to undergo carotid endarterectomy (CEA) has a persistent myocardial filling defect at three hours on a dipyridamole-thallium scan. Which of the following statements is correct?", + "A": "Coronary autoregulation is effective in this segment", + "B": "Coronary revascularization should precede CEA", + "C": "Isoflurane is contraindicated", + "D": "Myocardial infarction is impending", + "E": "There is a segment of nonviable myocardium" + }, + "zh": { + "question": "一名55岁的男性计划接受颈动脉内膜切除术（CEA），在二磷酸吡啶-铊扫描中，三小时后仍有持续的心肌充盈缺损。以下哪项陈述是正确的？", + "A": "冠状动脉自我调节在此段有效", + "B": "冠状动脉血运重建应先于CEA进行", + "C": "异氟醚禁用", + "D": "心肌梗死即将发生", + "E": "存在一段不可存活的心肌" + } + }, + { + "id": "72a5253a-8f8c-5d24-ba9c-022c931317d2", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A multigravid woman is receiving oxytocin by infusion for augmentation of labor. Fetal heart rate is 190 bpm with beat-to-beat variability of 6 to 8 bpm. The most appropriate immediate action would be to", + "A": "continue observation", + "B": "sample fetal scalp blood", + "C": "discontinue oxytocics", + "D": "administer a beta-adrenergic blocker to the mother", + "E": "deliver the fetus" + }, + "zh": { + "question": "一位经产妇正在接受催产素输注以促进分娩。胎儿心率为190次/分钟，心率变异为6到8次/分钟。最合适的立即行动是", + "A": "继续观察", + "B": "采集胎儿头皮血", + "C": "停止使用催产素", + "D": "给母亲使用β-肾上腺素能阻滞剂", + "E": "分娩胎儿" + } + }, + { + "id": "041275a1-0afe-53d1-b571-d7ac55b7a857", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A patient undergoes thoracotomy in the lateral decubitus position. Which of the following maneuvers is most likely to increase PaO2 during one-lung ventilation?", + "A": "Applying continuous positive airway pressure to the nondependent lung", + "B": "Applying positive end-expiratory pressure to the dependent lung", + "C": "Increasing inspiratory flow rate", + "D": "Increasing the tidal volume", + "E": "Increasing the ventilatory rate" + }, + "zh": { + "question": "一名患者在侧卧位下接受开胸手术。在单肺通气期间，下列哪种操作最有可能增加PaO2？", + "A": "对非依赖肺施加持续气道正压", + "B": "对依赖肺施加呼气末正压", + "C": "增加吸气流速", + "D": "增加潮气量", + "E": "增加通气率" + } + }, + { + "id": "8b43d293-b3ca-5cc9-8da8-5e8745a7728a", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A patient sustains cardiac arrest while being mechanically ventilated. Which of the following is the most likely effect on PetCO2?", + "A": "Gradual increase with the duration of asystole", + "B": "Maintenance of the prearrest value", + "C": "Abrupt decrease below the prearrest value", + "D": "Decrease when thoracic compression is started", + "E": "Gradual decrease independent of the ventilator cycle" + }, + "zh": { + "question": "一名患者在机械通气时发生心脏骤停。以下哪项是对呼气末二氧化碳分压（PetCO2）的最可能影响？", + "A": "随着心脏停搏时间的延长逐渐增加", + "B": "维持在心脏骤停前的数值", + "C": "突然下降到心脏骤停前的数值以下", + "D": "在开始胸部按压时下降", + "E": "独立于呼吸机周期逐渐下降" + } + }, + { + "id": "24f2e4bf-26e1-546b-b235-b8c8eb159ffa", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A patient undergoes differential spinal block for evaluation of persistent foot pain. If the pain returns coincident with a decrease in skin temperature, which of the following is the most appropriate conclusion?", + "A": "A somatic origin is ruled out", + "B": "The patient has causalgia", + "C": "The patient has peripheral vascular disease", + "D": "The pain is caused by central neuropathy", + "E": "Lumbar sympathetic blocks are indicated" + }, + "zh": { + "question": "一名患者接受差异性脊髓阻滞以评估持续的足部疼痛。如果疼痛与皮肤温度下降同时出现，以下哪项是最合适的结论？", + "A": "排除躯体起源", + "B": "患者有灼性神经痛", + "C": "患者有外周血管疾病", + "D": "疼痛由中枢神经病变引起", + "E": "建议进行腰交感神经阻滞" + } + }, + { + "id": "f6ed4acc-f4e4-5361-b591-b7e178f0494d", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 54-year-old woman who is scheduled to undergo emergency exploratory laparotomy takes warfarin sodium for anticoagulation. Prothrombin time is 19 sec (control 12 sec). Which of the following agents is most appropriate to reverse the effects of warfarin?", + "A": "Cryoprecipitate", + "B": "Desmopressin (DDAVP)", + "C": "Factor IX concentrate", + "D": "Fresh frozen plasma", + "E": "Pooled factor VIII" + }, + "zh": { + "question": "一名54岁的女性计划进行紧急探查性剖腹手术，她服用华法林钠进行抗凝。凝血酶原时间为19秒（对照为12秒）。以下哪种药物最适合逆转华法林的作用？", + "A": "冷沉淀", + "B": "去氨加压素 (DDAVP)", + "C": "凝血因子IX浓缩物", + "D": "新鲜冰冻血浆", + "E": "混合凝血因子VIII" + } + }, + { + "id": "297409c7-4340-5553-a2ae-8ab46f1e8250", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following decreases dead space in an anesthetic circle system?", + "A": "Larger surface area of the expiratory unidirectional valve", + "B": "Placing a septum in the Y-piece", + "C": "Shorter expiratory limb tubing", + "D": "Smaller carbon dioxide absorber", + "E": "Smaller reservoir bag" + }, + "zh": { + "question": "以下哪项可以减少麻醉回路系统中的无效腔？", + "A": "更大的呼气单向阀表面积", + "B": "在Y型接头中放置隔板", + "C": "更短的呼气管路", + "D": "更小的二氧化碳吸收器", + "E": "更小的储气囊" + } + }, + { + "id": "ec9d214c-1f84-5d29-802e-40b686f5cef6", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A 58-year-old man with a history of angina is undergoing resection of an abdominal aortic aneurysm under morphine, nitrous oxide, d-tubocurarine anesthesia. Just before removal of the aortic cross-clamp, heart rate is 74 bpm, blood pressure is 115/70 mmHg, and pulmonary artery occlusion pressure is 7 mmHg. Immediately after removal of the cross-clamp, heart rate increases to 120 bpm, blood pressure decreases to 80/55 mmHg, and pulmonary artery occlusion pressure decreases to 3 mmHg. The V5 lead on the EKG demonstrates sudden ST-segment depression and T-wave inversion. Initial therapy should be", + "A": "reapplication of the aortic cross-clamp", + "B": "intravenous administration of sodium bicarbonate", + "C": "initiation of a phenylephrine infusion", + "D": "rapid expansion of blood volume by transfusion", + "E": "initiation of a nitroglycerin infusion" + }, + "zh": { + "question": "一名58岁有心绞痛病史的男性在吗啡、氧化亚氮、d-筒箭毒碱麻醉下进行腹主动脉瘤切除术。在去除主动脉夹之前，心率为74次/分钟，血压为115/70 mmHg，肺动脉楔压为7 mmHg。去除夹子后，心率立即增加到120次/分钟，血压下降到80/55 mmHg，肺动脉楔压下降到3 mmHg。心电图V5导联显示突然的ST段压低和T波倒置。初始治疗应为", + "A": "重新应用主动脉夹", + "B": "静脉注射碳酸氢钠", + "C": "开始去氧肾上腺素输注", + "D": "通过输血快速扩充血容量", + "E": "开始硝酸甘油输注" + } + }, + { + "id": "ef9df767-8a91-5921-902b-7a09f495dc4d", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Ten minutes after induction of anesthesia with thiopental and isoflurane but before incision, a patient's nasopharyngeal temperature has decreased to 35.4°C. Which of the following contributed most to this decrease in temperature?", + "A": "Anesthesia-induced block of nonshivering thermogenesis", + "B": "Failure to use a warming blanket", + "C": "Infusion of room-temperature crystalloid", + "D": "Inhalation of room-temperature gases", + "E": "Mixing of peripheral and central blood" + }, + "zh": { + "question": "在用硫喷妥钠和异氟醚诱导麻醉十分钟后但在切口前，患者的鼻咽温度已降至35.4°C。以下哪项最可能导致这种温度下降？", + "A": "麻醉引起的非寒战性产热阻滞", + "B": "未使用加热毯", + "C": "输注室温晶体液", + "D": "吸入室温气体", + "E": "外周血与中心血混合" + } + }, + { + "id": "f976cceb-6a6f-5e89-8cd3-8c309eb760ec", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During a cardiac arrest with effective chest compression and positive-pressure ventilation, 50 mEq of sodium bicarbonate is administered. Which of the following is the most likely result?", + "A": "Decreased mixed venous pH", + "B": "Decreased SpO2", + "C": "Increased PetCO2", + "D": "Increased plasma lactate concentration", + "E": "Increased serum potassium concentration" + }, + "zh": { + "question": "在有效的胸外按压和正压通气下进行心脏骤停时，给予50 mEq的碳酸氢钠。以下哪项是最可能的结果？", + "A": "混合静脉pH值降低", + "B": "SpO2降低", + "C": "呼气末二氧化碳分压（PetCO2）增加", + "D": "血浆乳酸浓度增加", + "E": "血清钾浓度增加" + } + }, + { + "id": "35ab40ef-bdd2-5d5d-ba8e-3ca5f3f9102d", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following values is associated with acute tubular necrosis EXCEPT", + "A": "urine osmolality of 200 mOsm/L", + "B": "urine sodium concentration of 15 mEq/L", + "C": "urine specific gravity of 1.009", + "D": "urine/serum osmolality ratio of 1.2", + "E": "fractional excretion of sodium of 4%" + }, + "zh": { + "question": "以下每个数值都与急性肾小管坏死相关，除了", + "A": "尿渗透压为200 mOsm/L", + "B": "尿钠浓度为15 mEq/L", + "C": "尿比重为1.009", + "D": "尿/血清渗透压比为1.2", + "E": "钠的分数排泄率为4%" + } + }, + { + "id": "59a4db4f-63f8-5f4d-ae3b-f2d6a4fbd45d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning awareness (recall) during opioid anesthesia is true?", + "A": "It is usually not associated with pain", + "B": "It correlates well with intact auditory evoked responses", + "C": "It is prevented if the dose of opioid blocks the hemodynamic response to stimuli", + "D": "It is prevented if the dose of opioid is adequate to prevent movement without muscle relaxants", + "E": "It is predicted by a specific EEG pattern" + }, + "zh": { + "question": "以下关于阿片类药物麻醉期间意识（回忆）的说法哪一项是正确的？", + "A": "通常与疼痛无关", + "B": "与完整的听觉诱发反应密切相关", + "C": "如果阿片类药物的剂量足以阻止对刺激的血流动力学反应，则可预防", + "D": "如果阿片类药物的剂量足以在没有肌肉松弛剂的情况下防止运动，则可预防", + "E": "由特定的脑电图模式预测" + } + }, + { + "id": "da2ef699-7c7c-59a6-8889-c0c2ea81aa97", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "Peak airway pressure increases from 25 to 50 cmH2O when beginning right endobronchial ventilation with a right double-lumen tube. The most likely explanation for this increase is", + "A": "failure to decrease tidal volume", + "B": "inadvertent intubation of the left mainstem bronchus", + "C": "intrinsic resistance of small endobronchial lumina", + "D": "obstruction of the orifice of the right upper lobe", + "E": "overinflation of the bronchial tube cuff" + }, + "zh": { + "question": "当使用右侧双腔管开始右侧支气管通气时，峰值气道压力从25 cmH2O增加到50 cmH2O。对此增加最可能的解释是", + "A": "未能减少潮气量", + "B": "误插入左主支气管", + "C": "小支气管腔的内在阻力", + "D": "右上叶开口阻塞", + "E": "支气管管套过度充气" + } + }, + { + "id": "0821c37d-d6a0-5391-aebf-3e07913e9e89", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements about the standard error of the mean (SE) is true?", + "A": "Sample mean SE has approximately a 95% chance of containing the population mean", + "B": "The SE describes the precision of the population mean", + "C": "The SE describes the range of the sample values", + "D": "The SE is greater than the standard deviation", + "E": "The SE is obtained by multiplying the sample standard deviation by the square root of the sample size" + }, + "zh": { + "question": "以下关于均值标准误（SE）的说法中哪一项是正确的？", + "A": "样本均值SE大约有95%的概率包含总体均值", + "B": "SE描述了总体均值的精确度", + "C": "SE描述了样本值的范围", + "D": "SE大于标准差", + "E": "SE是通过将样本标准差乘以样本量的平方根获得的" + } + }, + { + "id": "012e2f6f-dcd6-568d-8c63-b2e6c485fba3", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning diabetes mellitus in pregnancy is true?", + "A": "Beta-mimetic tocolytics cause maternal hypoglycemia", + "B": "Epidural anesthesia produces hyperglycemia", + "C": "Fetal insulin secretion is suppressed", + "D": "Maternal insulin does not cross the placenta", + "E": "Maternal insulin resistance develops abruptly after delivery" + }, + "zh": { + "question": "以下关于妊娠期糖尿病的陈述中哪一项是正确的？", + "A": "β-拟交感神经药物引产剂导致母体低血糖", + "B": "硬膜外麻醉引起高血糖", + "C": "胎儿胰岛素分泌受到抑制", + "D": "母体胰岛素不通过胎盘", + "E": "母体胰岛素抵抗在分娩后突然出现" + } + }, + { + "id": "112ed515-dca6-5faa-9ad1-3580d410648e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Pulmonary artery occlusion pressure", + "A": "does not reliably reflect left ventricular end-diastolic volume when left ventricular compliance is reduced", + "B": "inaccurately reflects left atrial pressure when left atrial pressure exceeds 15 mmHg", + "C": "is measured at end-inspiration in mechanically ventilated patients", + "D": "overestimates left atrial pressure in patients with poor lung compliance", + "E": "reflects left atrial pressure only if the catheter tip is located in zone II of the lung" + }, + "zh": { + "question": "肺动脉阻塞压", + "A": "当左心室顺应性降低时，不能可靠地反映左心室舒张末期容积", + "B": "当左心房压力超过15 mmHg时，不能准确反映左心房压力", + "C": "在机械通气患者中于吸气末期测量", + "D": "在肺顺应性差的患者中高估左心房压力", + "E": "只有当导管尖端位于肺的II区时，才能反映左心房压力" + } + }, + { + "id": "399d848f-2d9c-5d7f-b0b6-db2fccd777ed", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The human immunodeficiency virus (HIV)", + "A": "is inactivated by irradiation", + "B": "is transmitted by cryoprecipitate", + "C": "is transmitted by 5% albumin", + "D": "passes through intact dermis", + "E": "provokes an immediate antibody response" + }, + "zh": { + "question": "人类免疫缺陷病毒（HIV）", + "A": "可通过辐射灭活", + "B": "通过冷沉淀传染", + "C": "通过5%白蛋白传染", + "D": "穿过完整的真皮", + "E": "引发立即的抗体反应" + } + }, + { + "id": "2e0376b5-532d-5ffc-9bfe-ac99b123307d", + "choice_num": 4, + "answer": "E", + "level": 2, + "en": { + "question": "A healthy patient is receiving general endotracheal anesthesia with nitrous oxide 4 L/min, oxygen 2 L/min, and isoflurane 1% with spontaneous ventilation. The inspiratory breathing hose becomes disconnected from the inspiratory valve. The earliest alarm will be produced by", + "A": "a pulse oximeter with finger probe set to alarm at 60% saturation", + "B": "a mass spectrometer set to alarm when no breath is detected for 30 seconds", + "C": "an oxygen analyzer mounted on the inspiratory valve outlet and set to alarm at 25% oxygen concentration", + "D": "a capnograph sensor at the Y-piece that alarms when end-tidal carbon dioxide tension is greater than 60 mmHg" + }, + "zh": { + "question": "一名健康患者正在接受全身气管插管麻醉，使用4 L/min的氧化亚氮、2 L/min的氧气和1%的异氟醚进行自主通气。吸气管从吸气阀上脱落。最早发出警报的是", + "A": "设定在60%饱和度报警的指尖探头脉搏血氧仪", + "B": "设定在30秒内未检测到呼吸时报警的质谱仪", + "C": "安装在吸气阀出口并设定在氧气浓度为25%时报警的氧气分析仪", + "D": "安装在Y型接头处的二氧化碳图传感器，当呼气末二氧化碳张力大于60 mmHg时报警" + } + }, + { + "id": "da07f4ee-5222-503e-9abe-a10348613502", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 75-year-old man with a left bundle branch block is undergoing placement of a pulmonary artery catheter through the right internal jugular vein. He becomes pale and his heart rate decreases to 40 bpm when the catheter tip enters the right ventricle. The most likely cause is", + "A": "a catheter loop in the right atrium", + "B": "acute myocardial infarction", + "C": "acute pneumothorax", + "D": "carotid sinus reflex", + "E": "complete heart block" + }, + "zh": { + "question": "一名75岁的男性患者，伴有左束支传导阻滞，正在通过右颈内静脉放置肺动脉导管。当导管尖端进入右心室时，他变得面色苍白，心率降至40次/分钟。最可能的原因是", + "A": "导管在右心房形成环路", + "B": "急性心肌梗死", + "C": "急性气胸", + "D": "颈动脉窦反射", + "E": "完全性心脏传导阻滞" + } + }, + { + "id": "84e8c6d4-744f-58f3-b7f1-399e21370c14", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the best initial treatment of anaphylaxis that occurs during general anesthesia?", + "A": "Diphenhydramine", + "B": "Dopamine", + "C": "Epinephrine", + "D": "Hydrocortisone", + "E": "Ranitidine" + }, + "zh": { + "question": "以下哪项是全身麻醉期间发生的过敏反应的最佳初始治疗方法？", + "A": "苯海拉明", + "B": "多巴胺", + "C": "肾上腺素", + "D": "氢化可的松", + "E": "雷尼替丁" + } + }, + { + "id": "34a5c3c3-dfb0-5f00-8261-af9d3dae929a", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "Three hours after undergoing coronary artery bypass grafting, an elderly man develops severe hypotension after intravenous administration of morphine 4 mg. Pulmonary artery occlusion pressure is 27 mmHg and central venous pressure is 30 mmHg. Transesophageal echocardiography shows decreased end-diastolic ventricular volumes. Which of the following is the most likely diagnosis?", + "A": "Anaphylactoid reaction", + "B": "Cardiac tamponade", + "C": "Coronary graft occlusion", + "D": "Excessive fluid administration", + "E": "Pulmonary thromboembolus" + }, + "zh": { + "question": "一名老年男性在接受冠状动脉旁路移植术后三小时，静脉注射4毫克吗啡后出现严重低血压。肺动脉楔压为27 mmHg，中心静脉压为30 mmHg。经食道超声心动图显示心室舒张末期容积减少。以下哪项是最可能的诊断？", + "A": "类过敏反应", + "B": "心脏压塞", + "C": "冠状动脉移植闭塞", + "D": "过量液体输注", + "E": "肺血栓栓塞" + } + }, + { + "id": "fed72e3d-86e2-51c0-9207-42b46e848c88", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The most common transfusion-related infection is", + "A": "bacterial sepsis", + "B": "cytomegalovirus infection", + "C": "hepatitis B", + "D": "hepatitis C (non-A, non-B)", + "E": "human immunodeficiency virus infection" + }, + "zh": { + "question": "最常见的输血相关感染是", + "A": "细菌性败血症", + "B": "巨细胞病毒感染", + "C": "乙型肝炎", + "D": "丙型肝炎（非甲非乙）", + "E": "人类免疫缺陷病毒感染" + } + }, + { + "id": "04b34464-96d7-5ada-84ce-4214604dd11e", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 3.3-kg neonate is brought to the operating room for repair of a left diaphragmatic hernia. A 3-mm endotracheal tube is placed to a depth of 9 cm. Initial arterial blood gas values from a right radial catheter while spontaneously breathing oxygen 50% are PaO2 82 mmHg, PaCO2 41 mmHg, pH 7.33, and base excess -5. After reduction of the hernia (during closure of the abdomen), vigorous attempts to expand the atelectatic lung are unsuccessful. The infant rapidly becomes very dusky, heart rate is 60 bpm, breath sounds are distant and squeaky bilaterally, and pulmonary compliance is decreased. Which of the following should be done first?", + "A": "Obtain a radiograph of the chest", + "B": "Place a chest tube on the left side", + "C": "Place a chest tube on the right side", + "D": "Withdraw the endotracheal tube 1 cm and suction", + "E": "Reopen the abdomen" + }, + "zh": { + "question": "一名3.3公斤的新生儿被送到手术室进行左侧膈疝修补。插入一根3毫米的气管导管，深度为9厘米。在自发呼吸50%氧气时，从右侧桡动脉导管获得的初始动脉血气值为PaO2 82 mmHg，PaCO2 41 mmHg，pH 7.33，碱剩余-5。在疝气还纳后（腹部闭合期间），努力扩张肺不成功。婴儿迅速变得非常暗淡，心率为60次/分钟，双侧呼吸音遥远且尖锐，肺顺应性降低。以下哪项应首先进行？", + "A": "拍摄胸部X光片", + "B": "在左侧放置胸管", + "C": "在右侧放置胸管", + "D": "将气管导管退出1厘米并吸引", + "E": "重新打开腹部" + } + }, + { + "id": "c67b283e-c5ee-5cea-bbb3-cd40d413bd31", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the most appropriate pharmacologic therapy for trigeminal neuralgia?", + "A": "Buprenorphine", + "B": "Carbamazepine", + "C": "Chlorpromazine", + "D": "Pentazocine", + "E": "Phenelzine" + }, + "zh": { + "question": "以下哪种药物治疗三叉神经痛最为合适？", + "A": "布托啡诺", + "B": "卡马西平", + "C": "氯丙嗪", + "D": "喷他佐辛", + "E": "苯乙肼" + } + }, + { + "id": "e8a530e7-84c4-5f1d-a74d-58dd5350e7b5", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Twenty minutes after thiopental induction for femoral herniorrhaphy, a 34-year-old woman is breathing spontaneously and receiving nitrous oxide-oxygen (2 liters each) and enflurane 3% by face mask. Pulse is 90 bpm, blood pressure is 80/60 mmHg, end-tidal enflurane concentration is 2%, and end-tidal carbon dioxide tension is 48 mmHg. Which of the following is most likely to occur on skin incision?", + "A": "Pupillary dilation", + "B": "Laryngeal stridor", + "C": "Gross muscular movement", + "D": "Increased blood pressure", + "E": "No response" + }, + "zh": { + "question": "在硫喷妥钠诱导进行股疝修补术二十分钟后，一名34岁的女性正在自发呼吸，并通过面罩吸入氧化亚氮-氧气（各2升）和3%的恩氟烷。脉搏为90次/分钟，血压为80/60 mmHg，呼气末恩氟烷浓度为2%，呼气末二氧化碳张力为48 mmHg。下列哪项最有可能在皮肤切开时发生？", + "A": "瞳孔扩张", + "B": "喉鸣", + "C": "明显的肌肉运动", + "D": "血压升高", + "E": "无反应" + } + }, + { + "id": "edc2d74f-31e5-5161-960a-5b6f1c177958", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following complications of caudal anesthesia with 0.25% bupivacaine is more likely in children than in adults?", + "A": "Intravascular injection", + "B": "Neurotoxicity", + "C": "Profound motor block", + "D": "Systemic toxicity", + "E": "Total spinal block" + }, + "zh": { + "question": "以下哪种 0.25% 布比卡因尾部麻醉的并发症在儿童中比在成人中更常见？", + "A": "血管内注射", + "B": "神经毒性", + "C": "深度运动阻滞", + "D": "全身毒性", + "E": "全脊髓阻滞" + } + }, + { + "id": "f6552280-80fd-5cda-8243-02ee0472a7be", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following anesthetic techniques is most appropriate for a woman in the second stage of labor?", + "A": "Epidural opioids", + "B": "Local infiltration of the perineum", + "C": "Lumbar sympathetic block", + "D": "Paracervical nerve block", + "E": "Pudendal nerve block" + }, + "zh": { + "question": "以下哪种麻醉技术最适合处于第二产程的女性？", + "A": "硬膜外阿片类药物", + "B": "会阴局部浸润", + "C": "腰交感神经阻滞", + "D": "宫颈旁神经阻滞", + "E": "阴部神经阻滞" + } + }, + { + "id": "6d65a370-a05f-5cfb-be25-fdb3634330e6", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Leakage current and microshock hazards are eliminated by", + "A": "an isolation transformer", + "B": "conductive flooring", + "C": "a three-wire grounding system", + "D": "a line-isolation monitor", + "E": "none of the above" + }, + "zh": { + "question": "漏电流和微电击危险可以通过以下方式消除", + "A": "隔离变压器", + "B": "导电地板", + "C": "三线接地系统", + "D": "线路隔离监测器", + "E": "以上都不是" + } + }, + { + "id": "932b7dee-1760-55ed-a3e7-15083d847c79", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A patient has a heart rate of 110 bpm one year after heart transplantation. His tachycardia is most likely the result of", + "A": "altered baroreceptor sensitivity", + "B": "cardiac denervation", + "C": "compensation for a fixed stroke volume", + "D": "cyclosporine", + "E": "prednisone" + }, + "zh": { + "question": "一名患者在心脏移植一年后心率为110次/分钟。他的心动过速最可能是由于", + "A": "改变的压力感受器敏感性", + "B": "心脏去神经支配", + "C": "对固定的每搏输出量的补偿", + "D": "环孢素", + "E": "泼尼松" + } + }, + { + "id": "77926a83-db22-5f82-a7f6-59723f1bd7d0", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following factors may lead to erroneous readings using pulse oximetry EXCEPT", + "A": "electrocautery", + "B": "high cardiac output states", + "C": "infrared lights near the sensor", + "D": "intravenous dyes", + "E": "severe hemodilution" + }, + "zh": { + "question": "以下每个因素都可能导致脉搏血氧仪读数错误，除了", + "A": "电灼术", + "B": "高心输出状态", + "C": "传感器附近的红外光", + "D": "静脉注射染料", + "E": "严重血液稀释" + } + }, + { + "id": "5808b73a-6807-5aee-a9c0-1fb2a2a09ad9", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the most appropriate initial management of a patient with hypotension secondary to sepsis?", + "A": "Calcium chloride", + "B": "Corticosteroids", + "C": "Crystalloid infusion", + "D": "Dopamine", + "E": "Fresh frozen plasma" + }, + "zh": { + "question": "以下哪项是对继发于脓毒症的低血压患者最合适的初始处理？", + "A": "氯化钙", + "B": "皮质类固醇", + "C": "晶体液输注", + "D": "多巴胺", + "E": "新鲜冰冻血浆" + } + }, + { + "id": "e6939849-700c-5de7-b027-d24a34d18129", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "You are asked to evaluate a 2000-g male infant three hours after vaginal delivery because of a respiratory rate of 50/min, pulse rate of 115 bpm, and the following arterial blood gas values while breathing room air: PaO2 64 mmHg, PaCO2 43 mmHg, and pH 7.33. His mother received meperidine 75 mg two hours before delivery. Appropriate management includes", + "A": "administration of naloxone 50 mcg intramuscularly", + "B": "increasing the FiO2 to 0.4", + "C": "intubation and mechanical ventilation at an FiO2 of 0.5", + "D": "administration of oxygen 50% with 5 cm H2O continuous positive airway pressure", + "E": "observation, with no action at present" + }, + "zh": { + "question": "在阴道分娩后三小时，你被要求评估一名2000克的男性婴儿，因为他的呼吸频率为50次/分钟，脉搏率为115次/分钟，并且在呼吸室内空气时的动脉血气值如下：PaO2 64 mmHg，PaCO2 43 mmHg，pH 7.33。他的母亲在分娩前两小时接受了75毫克的哌替啶。适当的管理包括", + "A": "肌肉注射50微克纳洛酮", + "B": "将FiO2增加到0.4", + "C": "在FiO2为0.5的情况下进行插管���机械通气", + "D": "给予50%氧气并施加5 cm H2O的持续正压通气", + "E": "观察，目前不采取行动" + } + }, + { + "id": "865b1681-1f79-585f-85d1-2e1908e6232b", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "In an infant, spinal anesthesia to a sensory level of T8 is achieved with tetracaine administered at the L2-3 interspace. Compared with spinal anesthesia to the same sensory level in an adult, this anesthetic is associated with a", + "A": "greater decrease in blood pressure", + "B": "higher risk for neurotoxicity", + "C": "higher risk for systemic toxicity", + "D": "lower risk for spinal cord injury", + "E": "shorter duration of action" + }, + "zh": { + "question": "在婴儿中，通过在 L2-3 间隙注射丁卡因实现的脊髓麻醉达到 T8 感觉水平。与成人达到相同感觉水平的脊髓麻醉相比，这种麻醉与以下哪种情况相关", + "A": "血压下降更明显", + "B": "神经毒性的风险更高", + "C": "全身毒性的风险更高", + "D": "脊髓损伤的风险更低", + "E": "作用时间更短" + } + }, + { + "id": "042112cb-5eb2-5f66-9840-b8749116142f", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "In the operating room", + "A": "conductive floors are necessary for electrical safety", + "B": "the ECG monitor may be used as a grounding source", + "C": "an improperly grounded electrocautery causes ventricular fibrillation", + "D": "an isolation transformer offers no protection against microelectrocution", + "E": "a line isolation monitor will interrupt power automatically if excessive leakage to ground is detected" + }, + "zh": { + "question": "在手术室中", + "A": "导电地板对于电气安全是必要的", + "B": "心电图监护仪可以用作接地源", + "C": "接地不当的电烧器会导致心室颤动", + "D": "隔离变压器对微电击没有保护作用", + "E": "如果检测到过多的漏电到地，线路隔离监视器将自动中断电源" + } + }, + { + "id": "63e56994-085b-5f59-a2f1-dbf3483b7e10", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 45-year-old man with chronic liver failure is scheduled for liver transplantation. Which of the following preoperative findings is most likely?", + "A": "Hypoxemia", + "B": "Increased platelet count", + "C": "Increased systemic vascular resistance", + "D": "Increased serum factor VIII concentration", + "E": "Metabolic alkalosis" + }, + "zh": { + "question": "一名45岁患有慢性肝功能衰竭的男性计划进行肝移植。以下哪项术前发现最有可能？", + "A": "低氧血症", + "B": "血小板计数增加", + "C": "全身血管阻力增加", + "D": "血清VIII因子浓度增加", + "E": "代谢性碱中毒" + } + }, + { + "id": "6320372e-04dc-5c12-97cf-55c19d51bfe0", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A 15-year-old previously healthy boy is scheduled for a celiotomy to relieve an acute intestinal obstruction. A rapid sequence induction is used. Anesthesia is maintained with a balanced technique including nitrous oxide and oxygen (5L:2L), meperidine, and pancuronium. Because of abdominal distention and the high pressure required for inflation of the lungs, a nasogastric tube is inserted. The abdomen remains distended, but compliance improves dramatically. At this time the patient is cyanotic, PaO2 is 48 mmHg, PaCO2 is 52 mmHg, and pH is 7.29. Nitrous oxide is discontinued. The most important therapeutic measure is to", + "A": "remove the nasogastric tube", + "B": "insert a chest tube on the right side", + "C": "withdraw the endotracheal tube 1 cm", + "D": "deflate the cuff on the endotracheal tube", + "E": "replace the endotracheal tube with one of larger internal diameter" + }, + "zh": { + "question": "一名15岁之前健康的男孩计划进行剖腹手术以缓解急性肠梗阻。使用快速序贯诱导。麻醉维持采用平衡技术，包括氧化亚氮和氧气（5L:2L）、哌替啶和潘库溴铵。由于腹胀和肺部充气所需的高压，插入了鼻胃管。腹部仍然膨胀，但顺应性显著改善。此时患者出现紫绀，PaO2为48 mmHg，PaCO2为52 mmHg，pH为7.29。停止使用氧化亚氮。最重要的治疗措施是", + "A": "移除鼻胃管", + "B": "在右侧插入胸管", + "C": "将气管插管向外撤1厘米", + "D": "放气气管插管的套囊", + "E": "用内径更大的气管插管替换现有的气管插管" + } + }, + { + "id": "9dacfc5e-5c7a-59d9-8f00-a4ec5fe6e2c6", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 35-year-old man has acute onset of low back pain, lower extremity weakness, and bladder dysfunction. He had a lumbar laminectomy two years ago. A myelogram shows disk herniation at L4-5. The most appropriate management is", + "A": "bed rest", + "B": "administration of a nonsteroidal anti-inflammatory agent", + "C": "epidural administration of a corticosteroid", + "D": "epidural administration of a local anesthetic", + "E": "surgical decompression" + }, + "zh": { + "question": "一名35岁男性急性出现下背痛、下肢无力和膀胱功能障碍。他两年前做过腰椎板切除术。脊髓造影显示L4-5椎间盘突出。最合适的处理是", + "A": "卧床休息", + "B": "使用非甾体抗炎药", + "C": "硬膜外注射皮质类固醇", + "D": "硬膜外注射局部麻醉剂", + "E": "手术减压" + } + }, + { + "id": "3c7164ed-ee13-5ae9-9091-3c12ff2cbfd8", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Each of the following statements about pheochromocytoma is true EXCEPT:", + "A": "Preoperative administration of alpha-adrenergic inhibitors will usually reverse EKG changes due to catecholamine myocarditis", + "B": "Preoperative administration of alpha-adrenergic inhibitors decreases operative mortality", + "C": "Beta-adrenergic inhibitors should be administered preoperatively only in conjunction with alpha-adrenergic inhibitors", + "D": "Vasopressor therapy may be necessary postoperatively for treatment of hypotension", + "E": "Nasal congestion is a sign of inadequate alpha-adrenergic block" + }, + "zh": { + "question": "以下关于嗜铬细胞瘤的陈述中，除了哪一项外，其他都正确：", + "A": "术前使用α-肾上腺素能抑制剂通常会逆转因儿茶酚胺性心肌炎引起的心电图变化", + "B": "术前使用α-肾上腺素能抑制剂可降低手术死亡率", + "C": "β-肾上腺素能抑制剂应仅在与α-肾上腺素能抑制剂联合使用时术前给予", + "D": "术后可能需要使用升压药治疗低血压", + "E": "鼻塞是α-肾上腺素能阻滞不足的表现" + } + }, + { + "id": "42795862-a9da-5433-9248-a5284a1fda3c", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 120-kg 56-year-old man undergoing gastrectomy during anesthesia with fentanyl and isoflurane has a PetCO2 of 35 mmHg and a PaCO2 of 50 mmHg. His FEV,/FVC ratio is 80% of predicted. Heart rate is 120 bpm and arterial blood pressure is 80/40 mmHg. Which of the following is the most likely cause of the difference in PaCO2 and PetCO2?", + "A": "Aspiration pneumonitis", + "B": "Chronic obstructive pulmonary disease", + "C": "Decreased cardiac output", + "D": "Decreased VD/VT ratio", + "E": "Increased QS/QT ratio" + }, + "zh": { + "question": "一名120公斤的56岁男性在使用芬太尼和异氟醚进行麻醉的胃切除术中，PetCO2为35 mmHg，PaCO2为50 mmHg。他的FEV1/FVC比率为预测值的80%。心率为120次/分钟，动脉血压为80/40 mmHg。以下哪项最可能是PaCO2和PetCO2差异的原因？", + "A": "吸入性肺炎", + "B": "慢性阻塞性肺病", + "C": "心输出量减少", + "D": "死腔/潮气量比减少", + "E": "分流/心输出量比增加" + } + }, + { + "id": "429e4263-18d5-5c14-9932-6c63d2c0ada8", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 70-kg, 46-year-old man is undergoing clipping of a cerebral aneurysm with nitrous oxide, opioid, relaxant anesthesia. He is otherwise healthy. As the surgeons are about to enter the dura, the brain is noted to be tense and bulging. Heart rate is 100 bpm and mean arterial pressure is 90 mmHg. PaO2 is 120 mmHg, PaCO2 is 23 mmHg, and pH is 7.50. Which of the following should be done immediately?", + "A": "Hyperventilation to a PaCO2 of 15 to 20 mmHg", + "B": "Administration of furosemide 20 mg intravenously", + "C": "Administration of mannitol 0.5 g/kg", + "D": "Administration of thiopental 250 mg in increments", + "E": "Addition of halothane 1% to deepen anesthesia" + }, + "zh": { + "question": "一名70公斤、46岁的男性正���接受使用氧化亚氮、阿片类药物和肌肉松弛剂麻醉的脑动脉瘤夹闭手术。他身体健康。当外科医生即将进入硬脑膜时，发现大脑紧张且隆起。心率为100次/分钟，平均动脉压为90 mmHg。PaO2为120 mmHg，PaCO2为23 mmHg，pH值为7.50。以下哪项应立即进行？", + "A": "过度通气至PaCO2为15至20 mmHg", + "B": "静脉注射呋塞米20 mg", + "C": "给予甘露醇0.5 g/kg", + "D": "分次给予硫喷妥钠250 mg", + "E": "加入1%氟烷以加深麻醉" + } + }, + { + "id": "ba168b95-0ccc-5574-8e71-5108700d0f51", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 28-year-old woman receives a lumbar epidural anesthetic for uncomplicated labor and delivery. During removal of the catheter, 1 cm breaks off and remains in her back. After informing the patient, the most appropriate management is", + "A": "no intervention unless symptoms occur", + "B": "prophylactic antibiotics", + "C": "epidural corticosteroids", + "D": "dye contrast study of the epidural space", + "E": "neurosurgical exploration" + }, + "zh": { + "question": "一名28岁的女性接受了腰椎硬膜外麻醉以进行无并发症的分娩。在拔除导管时，1厘米的导管断裂并留在她的背部。在告知患者后，最合适的处理方式是", + "A": "除非出现症状，否则不进行干预", + "B": "预防性使用抗生素", + "C": "硬膜外注射皮质类固醇", + "D": "硬膜外腔的造影研究", + "E": "神经外科探查" + } + }, + { + "id": "f5d9b821-ef7a-5716-a8bf-47d9f85aaf24", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 60-kg, 70-year-old man requires open reduction and internal fixation of an intertrochanteric fracture sustained 24 hours ago. Serum creatinine concentration is 1 mg/dl and blood urea nitrogen concentration is 40 mg/dl. The most likely cause of these findings is", + "A": "acute tubular necrosis", + "B": "chronic renal insufficiency", + "C": "dehydration", + "D": "obstruction of the bladder outlet", + "E": "recent gastrointestinal hemorrhage" + }, + "zh": { + "question": "一名60公斤、70岁的男性需要进行24小时前发生的股骨粗隆间骨折的切开复位内固定手术。血清肌酐浓度为1 mg/dl，血尿素氮浓度为40 mg/dl。最可能的原因是", + "A": "急性肾小管坏死", + "B": "慢性肾功能不全", + "C": "脱水", + "D": "膀胱出口梗阻", + "E": "近期胃肠道出血" + } + }, + { + "id": "f90c6739-2023-569e-9861-17ddc5f22976", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following nerves is most likely to be injured by a fracture of the shaft of the humerus?", + "A": "Axillary", + "B": "Median", + "C": "Musculocutaneous", + "D": "Radial", + "E": "Ulnar" + }, + "zh": { + "question": "肱骨干骨折最可能损伤以下哪一条神经？", + "A": "腋神经", + "B": "正中神经", + "C": "肌皮神经", + "D": "桡神经", + "E": "尺神经" + } + }, + { + "id": "21aab6ee-98f3-5e00-a4f3-666896a0d2ff", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "In a 5-kg boy with Treacher Collins syndrome who is to undergo cleft palate repair, endotracheal intubation is best accomplished with", + "A": "awake nasal intubation after topical anesthesia", + "B": "halothane anesthesia with spontaneous ventilation", + "C": "light isoflurane anesthesia and a muscle relaxant", + "D": "thiopental and succinylcholine sequence intravenously", + "E": "nasal intubation after administration of ketamine intramuscularly" + }, + "zh": { + "question": "在一名5公斤的Treacher Collins综合征男孩进行腭裂修复手术时，气管插管最好通过以下哪种方式完成", + "A": "局部麻醉后清醒鼻插管", + "B": "使用氟烷麻醉并自发通气", + "C": "轻度异氟醚麻醉和肌肉松弛剂", + "D": "静脉注射硫喷妥钠和琥珀胆碱序列", + "E": "肌肉注射氯胺酮后进行鼻插管" + } + }, + { + "id": "d8a92ebf-09d1-52b2-a97c-1b4e5cd1cfa7", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 70-kg 61-year-old patient undergoes a four-hour resection of an abdominal aortic aneurysm during anesthesia with fentanyl and enflurane. Infrarenal clamping is required during the procedure. Twelve hours after the procedure, urine output is 15 ml/hr with a fractional sodium excretion of 6%. Which of the following is the most likely cause?", + "A": "Enflurane nephrotoxicity", + "B": "Hypovolemia", + "C": "Intraoperative renal ischemia", + "D": "Positive pressure ventilation", + "E": "Unilateral ureteral obstruction" + }, + "zh": { + "question": "一名70公斤的61岁患者在使用芬太尼和恩氟烷麻醉下进行为期四小时的腹主动脉瘤切除术。手术过程中需要进行肾下夹闭。手术后十二小时，尿量为15毫升/小时，钠排泄分数为6%。以下哪项是最可能的原因？", + "A": "恩氟烷肾毒性", + "B": "低血容量", + "C": "术中肾缺血", + "D": "正压通气", + "E": "单侧输尿管梗阻" + } + }, + { + "id": "2006d9db-5118-5092-a2fb-a7888e4640d4", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements about patient-controlled analgesia using opioids is true?", + "A": "It is not associated with respiratory depression", + "B": "It obviates loading doses", + "C": "It requires a background opioid infusion to be effective", + "D": "It requires intravenous administration to be effective", + "E": "It requires less drug than intramuscular dosing for similar analgesia" + }, + "zh": { + "question": "以下关于使用阿片类药物的患者自控镇痛的说法中哪一项是正确的？", + "A": "它与呼吸抑制无关", + "B": "它不需要负荷剂量", + "C": "它需要背景阿片类药物输注才能有效", + "D": "它需要静脉给药才能有效", + "E": "与肌肉注射相比，它需要更少的药物来达到类似的镇痛效果" + } + }, + { + "id": "2d18ea3a-4a9e-514b-845d-202d5e3fe9a6", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following pre-existing conditions predisposes to new-onset third-degree heart block during pulmonary artery catheterization?", + "A": "First-degree heart block", + "B": "Left bundle branch block", + "C": "Sick sinus syndrome", + "D": "Sinus bradycardia", + "E": "Wenckebach second-degree heart block" + }, + "zh": { + "question": "以下哪种既存病症会导致在进行肺动脉导管插入术时发生新发的三度房室传导阻滞？", + "A": "一度房室传导阻滞", + "B": "左束支传导阻滞", + "C": "病态窦房结综合征", + "D": "窦性心动过缓", + "E": "文氏二度房室传导阻滞" + } + }, + { + "id": "87a1710e-d29e-5693-863e-9493636339aa", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 62-year-old man is scheduled for coronary artery bypass grafting. During induction of anesthesia with fentanyl, high peak inspiratory pressures occur with manual ventilation, and peripheral oxygen saturation decreases from 100% to 94%. The most appropriate management is administration of", + "A": "albuterol", + "B": "isoflurane", + "C": "midazolam", + "D": "nitroglycerin", + "E": "succinylcholine" + }, + "zh": { + "question": "一名62岁的男性计划进行冠状动脉旁路移植术。在使用芬太尼诱导麻醉期间，手动通气时出现高峰吸气压，外周氧饱和度从100%下降到94%。最合适的处理是给予", + "A": "沙丁胺醇", + "B": "异氟醚", + "C": "咪达唑仑", + "D": "硝酸甘油", + "E": "琥珀胆碱" + } + }, + { + "id": "b2928ec5-8b70-5cc9-adb5-c0a7cb98be1e", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "With respect to mechanical ventilation, which of the following statements concerning the portion of tidal volume known as compression volume is true?", + "A": "It is calculated by dividing the volume of gas delivered to the patient by the peak pressure", + "B": "It does not contribute to the volume of gas entering the patient", + "C": "It is not included in the volume measured by a spirometer on the inspiratory limb", + "D": "It decreases with the addition of a humidifier to the breathing circuit", + "E": "It decreases with the addition of one-way valves at the Y connector of the breathing circuit" + }, + "zh": { + "question": "关于机械通气，以下关于潮气量中称为压���量的部分的说法哪一项是正确的？", + "A": "它是通过将输送给患者的气体体积除以峰压来计算的", + "B": "它不贡献于进入患者的气体体积", + "C": "它不包括在吸气支路上用肺活量计测量的体积中", + "D": "在呼吸回路中加入加湿器后，它会减少", + "E": "在呼吸回路的Y连接器处加入单向阀后，它会减少" + } + }, + { + "id": "2de1f3ad-b0b5-5934-85a4-a8aa6bcf885b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 50-year-old patient undergoes subtotal thyroidectomy for Graves' disease. In the immediate postoperative period, he has marked hoarseness but no stridor. The most likely cause of the hoarseness is trauma to the", + "A": "external branch of the superior laryngeal nerve", + "B": "internal branch of the superior laryngeal nerve", + "C": "recurrent laryngeal nerve", + "D": "glossopharyngeal nerve", + "E": "vocal cords" + }, + "zh": { + "question": "一名50岁的患者因Graves病接受了次全甲状腺切除术。在术后立即期，他出现明显的声音嘶哑，但没有喘鸣。声音嘶哑最可能的原因是损伤了", + "A": "喉上神经外支", + "B": "喉上神经内支", + "C": "喉返神经", + "D": "舌咽神经", + "E": "声带" + } + }, + { + "id": "4dc63d94-cf8c-5279-91a1-4a0f0de360d2", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the most reliable indicator of adequate reversal of neuromuscular block?", + "A": "Inspiratory force equal to -30 cmH20", + "B": "Sustained head lift for 5 seconds", + "C": "Train-of-four ratio of 0.7", + "D": "Twitch height at 100% of control", + "E": "Vital capacity of 15 ml/kg" + }, + "zh": { + "question": "以下哪项是充分逆转神经肌肉阻滞的最可靠指标？", + "A": "吸气力等于-30 cmH20", + "B": "持续抬头5秒", + "C": "四联刺激比率为0.7", + "D": "抽搐高度达到控制值的100%", + "E": "肺活量为15 ml/kg" + } + }, + { + "id": "8badf02c-18dc-5765-8cf8-f11a65c6cda2", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following conditions is a contraindication to the use of succinylcholine?", + "A": "Burns of 50% body surface area occurring 12 hours ago", + "B": "Cirrhosis", + "C": "Myotonic dystrophy", + "D": "Seizure disorder", + "E": "Spinal cord transection within the past six hours" + }, + "zh": { + "question": "下列哪种情况是琥珀胆碱使用的禁忌症？", + "A": "12小时前发生的50%体表面积烧伤", + "B": "肝硬化", + "C": "肌强直性营养不良", + "D": "癫痫病", + "E": "过去六小时内的脊髓横断" + } + }, + { + "id": "bb0eb1b5-dd94-5583-aac8-b69ab06a405a", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Desflurane is delivered using a vaporizer that contains internal heaters because", + "A": "heat decreases the drug's viscosity", + "B": "heat reduces thermal loss in the patient", + "C": "heat increases the drug's oil-gas partition coefficient", + "D": "heat prevents fluctuations of vapor pressure", + "E": "it does not vaporize adequately at room temperature" + }, + "zh": { + "question": "地氟烷使用含有内部加热器的蒸发器进行输送，因为", + "A": "加热降低了药物的粘度", + "B": "加热减少了患者的热量损失", + "C": "加热增加了药物的油气分配系数", + "D": "加热防止蒸气压波动", + "E": "在室温下不能充分蒸发" + } + }, + { + "id": "d7057b18-5e01-58c9-b205-a64904143db7", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The speed of induction of anesthesia with an inhalational agent is increased by", + "A": "decreased cardiac output", + "B": "decreased minute ventilation", + "C": "increased functional residual capacity", + "D": "right-to-left intracardiac shunt", + "E": "use of a more soluble agent" + }, + "zh": { + "question": "通过以下哪种方式可以加快吸入性麻醉剂的麻醉诱导速度？", + "A": "心输出量减少", + "B": "每分钟通气量减少", + "C": "功能残气���增加", + "D": "右向左心内分流", + "E": "使用溶解度更高的药物" + } + }, + { + "id": "efae3631-0a69-5da8-aa39-e0958767b727", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "During extracorporeal shock wave lithotripsy, the shock wave should be synchronized with", + "A": "the P wave of the ECG", + "B": "the R wave of the ECG", + "C": "the T wave of the ECG", + "D": "peak inspiration", + "E": "end-expiration" + }, + "zh": { + "question": "在体外冲击波碎石术中，冲击波应与以下哪个同步", + "A": "心电图的P波", + "B": "心电图的R波", + "C": "心电图的T波", + "D": "吸气峰值", + "E": "呼气末期" + } + }, + { + "id": "7b61bcf4-2eba-52ca-a5ad-23e9923dac1b", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A patient with chronic paraplegia (T4 level) is undergoing cystoscopy and removal of bladder calculi without anesthesia. After 10 minutes, blood pressure is 240/100 mmHg and pulse is 50 bpm. The most appropriate management is administration of", + "A": "spinal anesthesia", + "B": "inhalational anesthesia", + "C": "thiopental intravenously", + "D": "methyldopa intravenously", + "E": "nitroprusside intravenously" + }, + "zh": { + "question": "一名患有慢性截瘫（T4水平）的患者在没有麻醉的情况下进行膀胱镜检查和膀胱结石去除术。10分钟后，血压为240/100 mmHg，脉搏为50 bpm。最合适的处理是给予", + "A": "脊髓麻醉", + "B": "吸入麻醉", + "C": "静脉注射硫喷妥钠", + "D": "静脉注射甲基多巴", + "E": "静脉注射硝普钠" + } + }, + { + "id": "ace215a0-dc53-5761-b3f1-6bfda747d174", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following malfunctions causes the line isolation monitor to alarm?", + "A": "Discharge of static electricity", + "B": "Flow of current to ground in the isolated circuit", + "C": "Interruption of current to electrical outlets caused by a circuit breaker", + "D": "Surge of current in the main power supply", + "E": "Total electrical current exceeding circuit capacity" + }, + "zh": { + "question": "以下哪种故障会导致线路隔离监测器报警？", + "A": "静电放电", + "B": "隔离电路中电流流向接地", + "C": "断路器导致电源插座电流中断", + "D": "主电源电流激增", + "E": "总电流超过电路容量" + } + }, + { + "id": "84ab30a8-6a7d-5e65-96ef-23bb50b1e280", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A patient with a fasting blood glucose concentration of 100 mg/dL undergoes a four-hour operation under general anesthesia without intraoperative administration of glucose. On emergence the most likely finding will be", + "A": "marked hypoglycemia", + "B": "mild hypoglycemia", + "C": "normoglycemia", + "D": "mild hyperglycemia", + "E": "marked hyperglycemia" + }, + "zh": { + "question": "一名空腹血糖浓度为100 mg/dL的患者在全身麻醉下进行四小时手术，术中未给予葡萄糖。苏醒时最可能的发现是", + "A": "明显低血糖", + "B": "轻度低血糖", + "C": "正常血糖", + "D": "轻度高血糖", + "E": "明显高血糖" + } + }, + { + "id": "9ff9b0d3-fb8e-566f-88d4-c4a874588b9a", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following limits the use of nalbuphine for relief of postoperative pain?", + "A": "High incidence of nausea and vomiting", + "B": "High incidence of delayed respiratory depression", + "C": "Potential for inducing seizures with repeated doses", + "D": "Relatively low maximal analgesic effect", + "E": "Short duration of action" + }, + "zh": { + "question": "以下哪项限制了纳布啡用于缓解术后疼痛？", + "A": "恶心和呕吐的发生率高", + "B": "延迟性呼吸抑制的发生率高", + "C": "重复剂量可能诱发癫痫", + "D": "最大镇痛效果相对较低", + "E": "作用时间短" + } + }, + { + "id": "ef82526a-93f2-57d6-80df-ff20f269c458", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 35-kg child requires mechanical ventilation with 100% oxygen at a tidal volume of 350 mL and a rate of 20/min during a severe asthma attack. The most likely cause of severe hypotension after initiating mechanical ventilation is", + "A": "hypoxic circulatory depression", + "B": "inadequate expiratory time", + "C": "increased pulmonary vascular resistance", + "D": "respiratory alkalosis", + "E": "tension pneumothorax" + }, + "zh": { + "question": "一名35公斤的儿童在严重哮喘发作期间需要使用100%氧气进行机械通气，潮气量为350毫升，频率为20次/分钟。启动机械通气后严重低血压的最可能原因是", + "A": "缺氧性循环抑制", + "B": "呼气时间不足", + "C": "肺血管阻力增加", + "D": "呼吸性碱中毒", + "E": "张力性气胸" + } + }, + { + "id": "8574c8d9-8dbb-5fbf-957c-a2b144b5a75b", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 4-year-old child has just undergone a one-hour tonsillectomy with a volatile anesthetic, nitrous oxide, and oxygen. Which of the following will result in the most rapid emergence?", + "A": "Decreased PaCO2", + "B": "Increased cardiac output", + "C": "Increased fresh gas flow", + "D": "Increased solubility of the volatile agent", + "E": "Presence of a ventricular septal defect" + }, + "zh": { + "question": "一名4岁儿童刚刚接受了一小时的扁桃体切除术，使用了挥发性麻醉剂、一氧化二氮和氧气。以下哪项将导致最快的苏醒？", + "A": "降低PaCO2", + "B": "增加心输出量", + "C": "增加新鲜气体流量", + "D": "增加挥发性药物的溶解度", + "E": "存在室间隔缺损" + } + }, + { + "id": "75a19dda-4c86-5a45-a428-12cbbc675a59", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The most important anesthetic consideration in Pierre Robin syndrome is", + "A": "anterior tilt of the larynx", + "B": "hyperplasia of the internal surface of the maxilla", + "C": "mandibular hypoplasia", + "D": "hypertrophy of the epiglottis", + "E": "tracheomalacia" + }, + "zh": { + "question": "Pierre Robin 综合征中最重要的麻醉考虑因素是", + "A": "喉部的前倾", + "B": "上颌骨内表面的增生", + "C": "下颌发育不全", + "D": "会厌肥大", + "E": "气管软化" + } + }, + { + "id": "89b6c326-613e-5d61-a25c-850f383a4e86", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Three hours prior to induction of anesthesia for elective laparotomy, a 40-kg 8-year-old boy is anxious and clings to his parents. Which of the following preanesthetic medications is most appropriate?", + "A": "Oral ketamine", + "B": "Oral midazolam", + "C": "Rectal methohexital", + "D": "Intramuscular droperidol", + "E": "Intramuscular promethazine" + }, + "zh": { + "question": "在择期剖腹手术麻醉诱导前的三小时，一名40公斤的8岁男孩感到焦虑并紧紧依偎在父母身边。以下哪种术前用药最为合适？", + "A": "口服氯胺酮", + "B": "口服咪达唑仑", + "C": "直肠美索己妥", + "D": "肌肉注射氟哌利多", + "E": "肌肉注射异丙嗪" + } + }, + { + "id": "c3f29e50-e18f-513f-b8b2-4713ce77846a", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "Cardiac output measured by thermodilution with a pulmonary artery catheter most accurately reflects systemic blood flow in a patient with", + "A": "aortic regurgitation", + "B": "atrial septal defect", + "C": "patent ductus arteriosus", + "D": "tricuspid insufficiency", + "E": "ventricular septal defect" + }, + "zh": { + "question": "通过使用肺动脉导管的热稀释法测量的心输出量最准确地反映了以下哪种患者的全身血流？", + "A": "主动脉瓣关闭不全", + "B": "房间隔缺损", + "C": "动脉导管未闭", + "D": "三尖瓣关闭不全", + "E": "室间隔缺损" + } + }, + { + "id": "bac89d2d-e709-57ef-b4b3-960e56cf4166", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is most likely to increase hepatic blood flow during general anesthesia?", + "A": "Addition of positive end-expiratory pressure", + "B": "Discontinuation of isoflurane and administration of enflurane", + "C": "Increased PaCO2", + "D": "Moderate controlled hypotension", + "E": "Subarachnoid administration of morphine" + }, + "zh": { + "question": "在全身麻醉期间，以下哪项最有可能增加肝血流量？", + "A": "增加呼气末正压", + "B": "停止使用异氟醚并使用恩氟醚", + "C": "增加动脉二氧化碳分压（PaCO2）", + "D": "中度控制性低血压", + "E": "蛛网膜下腔注射吗啡" + } + }, + { + "id": "f9d0c408-7ba2-538c-ac04-35b00d209ef7", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "During laser excision of vocal cord polyps in a 5-year-old boy, dark smoke suddenly appears in the surgical field. The trachea is intubated and anesthesia is being maintained with halothane, nitrous oxide, and oxygen. The most appropriate initial step is to", + "A": "change from oxygen and nitrous oxide to air", + "B": "fill the oropharynx with water", + "C": "instill water into the endotracheal tube", + "D": "remove the endotracheal tube", + "E": "ventilate with carbon dioxide" + }, + "zh": { + "question": "在一名5岁男孩的声带息肉激光切除术中，手术区域突然出现黑烟。气管已插管，麻醉维持使用的是氟烷、氧化亚氮和氧气。最合适的初步措施是", + "A": "将氧气和氧化亚氮换成空气", + "B": "用水填满口咽部", + "C": "向气管导管内注入水", + "D": "移除气管导管", + "E": "用二氧化碳通气" + } + }, + { + "id": "857d5b13-ac39-5087-8d3a-d09836d9886f", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "Addition of 20 cmH2O positive end-expiratory pressure to a patient receiving controlled mechanical ventilation decreases cardiac output and left ventricular function by", + "A": "increasing right ventricular preload", + "B": "increasing right ventricular afterload", + "C": "increasing left ventricular preload", + "D": "increasing left ventricular afterload", + "E": "producing myocardial ischemia" + }, + "zh": { + "question": "在接受控制性机械通气的患者中，增加20 cmH2O的呼气末正压会通过以下哪种方式降低心输出量和左心室功能", + "A": "增加右心室前负荷", + "B": "增加右心室后负荷", + "C": "增加左心室前负荷", + "D": "增加左心室后负荷", + "E": "导致心肌缺血" + } + }, + { + "id": "aa85f504-0606-557b-a67c-2e8242c2173e", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following is an adverse effect of ritodrine used for suppression of labor EXCEPT", + "A": "dysrhythmias", + "B": "hyperglycemia", + "C": "hyperkalemia", + "D": "hypotension", + "E": "pulmonary edema" + }, + "zh": { + "question": "以下哪一项不是利托君用于抑制分娩的副作用", + "A": "心律失常", + "B": "高血糖", + "C": "高钾血症", + "D": "低血压", + "E": "肺水肿" + } + }, + { + "id": "3526b195-3c30-53a5-b805-620d10861ac6", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 16-year-old girl is receiving isoflurane, nitrous oxide, oxygen, and pancuronium for insertion of a Harrington rod. In order to perform a \"wake-up test\" the muscle relaxant was antagonized with neostigmine 2.5 mg and atropine 1 mg. The patient abruptly moved all extremities and was given thiopental 100 mg and succinylcholine 100 mg rapidly. Forty-five minutes later no twitch could be elicited with a nerve stimulator. The most likely explanation is", + "A": "a dibucaine number of 20", + "B": "incomplete antagonism of pancuronium", + "C": "prolongation of the action of succinylcholine by neostigmine", + "D": "spinal cord damage caused by the abrupt arousal", + "E": "synergism between succinylcholine and pancuronium" + }, + "zh": { + "question": "一名16岁女孩正在接受异氟醚、氧化亚氮、氧气和潘库溴铵用于哈林顿棒的植入。为了进行“唤醒测试”，用2.5毫克新斯的明和1毫克阿托品拮抗肌肉松弛剂。患者突然移动了四肢，迅速给予100毫克硫喷妥钠和100毫克琥珀胆碱。四十五分钟后，用神经刺激器无法引出抽搐。最可能的解释是", + "A": "二丁卡因数为20", + "B": "潘库溴铵的拮抗不完全", + "C": "新斯的明延长了琥珀胆碱的作用", + "D": "由突然唤醒引起的脊髓损伤", + "E": "琥珀胆碱和潘库溴铵之间的协同作用" + } + }, + { + "id": "d3039d9e-a0a7-5cea-bb0b-abea87b0427b", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following factors is the LEAST important determinant of postdural puncture headache?", + "A": "Age of the patient", + "B": "Gauge of the spinal needle", + "C": "Gender of the patient", + "D": "Pregnancy", + "E": "Time until ambulation" + }, + "zh": { + "question": "以下哪项因素是决定硬膜穿刺后头痛最不重要的因素？", + "A": "患者的年龄", + "B": "脊椎针的规格", + "C": "患者的性别", + "D": "怀孕", + "E": "活动时间" + } + }, + { + "id": "aa4960fa-695c-5f07-a8a0-27460db22fc6", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The alveolar concentrations of anesthetics increase more rapidly in children than in adults because of a greater", + "A": "blood volume (per kg body mass)", + "B": "cardiac index", + "C": "MAC", + "D": "ratio of alveolar ventilation to functional residual capacity", + "E": "tidal volume (per kg body mass)" + }, + "zh": { + "question": "麻醉剂的肺泡浓度在儿童中比在成人中增加得更快，因为儿童具有更大的", + "A": "血容量（每公斤体重）", + "B": "心脏指数", + "C": "最低肺泡浓度（MAC）", + "D": "肺泡通气量与功能残气量的比率", + "E": "潮气量（每公斤体重）" + } + }, + { + "id": "8f091c83-f804-537a-95a0-d8032c18023f", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements regarding fetal heart rate patterns is true?", + "A": "Early decelerations suggest umbilical cord compression", + "B": "Fetal heart rates between 160 and 180 bpm are normal", + "C": "Fetal heart rate unaffected by uterine contraction suggests fetal well-being", + "D": "Late decelerations indicate inadequate uteroplacental perfusion", + "E": "Variable decelerations indicate need for urgent delivery" + }, + "zh": { + "question": "以下关于胎心率模式的说法哪一项是正确的？", + "A": "早期减速提示脐带受压", + "B": "胎心率在160到180次/分钟之间是正常的", + "C": "胎心率不受子宫收缩影响提示胎儿健康", + "D": "晚期减速表示子宫胎盘灌注不足", + "E": "变异减速提示需要紧急分娩" + } + }, + { + "id": "c0e0dc29-408b-54a0-bd77-7614a027c36f", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A patient being mechanically ventilated in the ICU requires wound debridement twice daily. Each of the following agents would be appropriate for induction of brief general anesthesia EXCEPT", + "A": "nitrous oxide", + "B": "etomidate", + "C": "ketamine", + "D": "methohexital", + "E": "midazolam" + }, + "zh": { + "question": "在ICU接受机械通气的患者需要每天两次进行伤口清创。以下每种药物都适合用于短暂全身麻醉的诱导，除了", + "A": "一氧化二氮", + "B": "依托咪酯", + "C": "氯胺酮", + "D": "甲氧己妥", + "E": "咪达唑仑" + } + }, + { + "id": "ffcc034a-a192-5ec9-ba44-920ce1fafb82", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Dantrolene", + "A": "antagonizes the effect of nondepolarizing muscle relaxants", + "B": "produces clinically detectable muscle weakness when administered intravenously prior to anesthesia", + "C": "is indicated for neuroleptic malignant syndrome", + "D": "may cause hepatic failure when used prophylactically before anesthesia", + "E": "has increased effectiveness when combined with calcium entry blockers" + }, + "zh": { + "question": "丹曲林", + "A": "拮抗非去极化肌肉松弛剂的作用", + "B": "在麻醉前静脉注射时会产生临床可检测的肌肉无力", + "C": "适用于神经阻滞性恶性综合征", + "D": "在麻醉前预防性使用时可能导致肝功能衰竭", + "E": "与钙通道阻滞剂联合使用时效果增强" + } + }, + { + "id": "9c3a9fe7-7b4b-5132-a134-6d1f56c6b06b", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A patient receiving mechanical ventilation with oxygen 60% postoperatively has a PaO2 of 160 mmHg and a PaCO2 of 38 mmHg. One hour later, with mechanical ventilation unchanged, the PaO2 is 150 mmHg and PaCO2 is 48 mmHg. The most likely cause of these changes is", + "A": "metabolic acidosis", + "B": "pulmonary embolism", + "C": "increased body temperature", + "D": "interstitial pulmonary edema", + "E": "aspiration pneumonia" + }, + "zh": { + "question": "一名术后接受60%氧气机械通气的患者，PaO2为160 mmHg，PaCO2为38 mmHg。一小时后，机械通气未变，PaO2为150 mmHg，PaCO2为48 mmHg。这些变化最可能的原因是", + "A": "代谢性酸中毒", + "B": "肺栓塞", + "C": "体温升高", + "D": "间质性肺水肿", + "E": "吸入性肺炎" + } + }, + { + "id": "a370f52b-f600-518e-aba1-961aa891890a", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 76-year-old patient is restless and hallucinating in the preoperative holding area. He received morphine 5 mg and scopolamine 0.4 mg intramuscularly as premedication and is now breathing oxygen 2 L/min through nasal prongs. SpO2 is 98%. Which of the following is the most appropriate next step?", + "A": "Administration of naloxone", + "B": "Administration of physostigmine", + "C": "Induction of general anesthesia", + "D": "Determination of serum electrolyte concentrations", + "E": "CT scan of the head" + }, + "zh": { + "question": "一名76岁的患者在术前等候区感到不安并出现幻觉。他作为术前用药接受了5毫克吗啡和0.4毫克东莨菪碱的肌肉注射，现在通过鼻导管吸入2升/分钟的氧气。SpO2为98%。以下哪项是最合适的下一步措施？", + "A": "给予纳洛酮", + "B": "给予毒扁豆碱", + "C": "诱导全身麻醉", + "D": "测定血清电解质浓度", + "E": "进行头部CT扫描" + } + }, + { + "id": "82fe3512-e2fa-580a-9369-61e42310c3dc", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements concerning autonomic hyperreflexia after spinal cord transection is true?", + "A": "It occurs within 24 hours after the injury", + "B": "It occurs with lesions below T10", + "C": "It is caused by a reflex increase in parasympathetic outflow", + "D": "It is characterized by paroxysmal hypotension and tachycardia", + "E": "It is prevented by blocking afferent visceral pathways" + }, + "zh": { + "question": "以下关于脊髓横断后自主神经反射亢进的说法哪一项是正确的？", + "A": "它发生在受伤后24小时内", + "B": "它发生在T10以下的损伤", + "C": "它是由副交感神经输出反射性增加引起的", + "D": "它的特征是阵发性低血压和心动过速", + "E": "通过阻断传入内脏通路可以预防它" + } + }, + { + "id": "e9a8d227-0dcd-5489-9fd2-9fdf6eb2732d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is true of both the neonatal and adult airways?", + "A": "Epiglottic innervation is primarily vagal", + "B": "Sniffing position requires placement of a pillow under the occiput", + "C": "The cricoid ring is the narrowest part of the airway", + "D": "The epiglottis has a relatively similar size and shape", + "E": "The glottis is located at C3-4" + }, + "zh": { + "question": "以下哪项是新生儿和成人气道的共同特点？", + "A": "会厌的神经支配主要是迷走神经", + "B": "嗅探位置需要在枕骨下放置枕头", + "C": "环状软骨是气道最狭窄的部分", + "D": "会厌的大小和形状相对相似", + "E": "声门位于C3-4" + } + }, + { + "id": "f7a35476-ffcf-5be0-9178-4dc10193c2fd", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following combinations of anesthetic and incorrect vaporizer results in the smallest error in delivered concentration?", + "A": "Sevoflurane in a halothane vaporizer", + "B": "Sevoflurane in an isoflurane vaporizer", + "C": "Halothane in a desflurane vaporizer", + "D": "Isoflurane in a halothane vaporizer", + "E": "Sevoflurane in a desflurane vaporizer" + }, + "zh": { + "question": "以下哪种麻醉剂与错误蒸发器的组合导致输送浓度的误差最小？", + "A": "在氟烷蒸发器中使用七氟醚", + "B": "在异氟醚蒸发器中使用七氟醚", + "C": "在地氟醚蒸发器中使用氟烷", + "D": "在氟烷蒸发器中使用异氟醚", + "E": "在地氟醚蒸发器中使用七氟醚" + } + }, + { + "id": "465a4fba-bc94-5e3c-b5df-9ccadd268d00", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 35-year-old woman with a grade III subarachnoid hemorrhage is undergoing clipping of a middle cerebral artery aneurysm 48 hours after initial hemorrhage. Which of the following drugs used to induce hypotension is LEAST likely to affect intracranial pressure?", + "A": "Esmolol", + "B": "Hydralazine", + "C": "Isoflurane", + "D": "Nitroglycerin", + "E": "Sodium nitroprusside" + }, + "zh": { + "question": "一名35岁的女性，患有III级蛛网膜下腔出血，在初次出血48小时后进行大脑中动脉动脉瘤夹闭术。以下哪种用于诱导低血压的药物最不可能影响颅内压？", + "A": "艾司洛尔", + "B": "肼屈嗪", + "C": "异氟醚", + "D": "硝酸甘油", + "E": "硝普钠" + } + }, + { + "id": "bd59883c-796a-573d-bf2f-94289b840db2", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Increasing preload, systemic vascular resistance and heart rate will best maintain hemodynamic stability in patients with", + "A": "aortic stenosis", + "B": "asymmetric septal hypertrophy (IHSS)", + "C": "cardiac tamponade", + "D": "mitral regurgitation", + "E": "mitral stenosis" + }, + "zh": { + "question": "增加前负荷、全身血管阻力和心率将最好地维持以下患者的血流动力学稳定性", + "A": "主动脉瓣狭窄", + "B": "不对称性室间隔肥厚（IHSS）", + "C": "心脏压塞", + "D": "二尖瓣返流", + "E": "二尖瓣狭窄" + } + }, + { + "id": "3c1fcb80-3942-50c9-8b59-9de387b62d1c", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is an effect of magnesium sulfate at the neuromuscular junction?", + "A": "Augmentation of acetylcholine reuptake", + "B": "Decrease in acetylcholine binding", + "C": "Decrease in acetylcholine metabolism", + "D": "Decrease in the prejunctional release of acetylcholine", + "E": "Potentiation of the effects of ionized calcium" + }, + "zh": { + "question": "以下哪项是硫酸镁在神经肌肉接头处的作用？", + "A": "增强乙酰胆碱的再摄取", + "B": "减少乙酰胆碱的结合", + "C": "减少乙酰胆碱的代谢", + "D": "减少突触前乙酰胆碱的释放", + "E": "增强离子化钙的作用" + } + }, + { + "id": "b8fb8d73-3dde-5852-8f26-02c8f545472e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A patient with end-stage renal disease has prolonged ventilatory depression after administration of morphine. The most likely cause is increased", + "A": "serum concentration of morphine-6-glucuronide", + "B": "elimination half-life of morphine", + "C": "opioid receptors", + "D": "receptor affinity", + "E": "volume of distribution" + }, + "zh": { + "question": "一名终末期肾病患者在使用吗啡后出现了延长的呼吸抑制。最可能的原因是增加了", + "A": "吗啡-6-葡萄糖醛酸苷的血清浓度", + "B": "吗啡的消除半衰期", + "C": "阿片受体", + "D": "受体亲和力", + "E": "分布容积" + } + }, + { + "id": "ab554063-c52a-5d75-8234-232f24676739", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Fentanyl-induced bradycardia is", + "A": "independent of the speed of injection", + "B": "independent of dose", + "C": "caused by direct inhibition of adrenal catecholamine release", + "D": "caused by vagal stimulation", + "E": "caused by direct SA node depression" + }, + "zh": { + "question": "芬太尼引起的心动过缓是", + "A": "与注射速度无关", + "B": "与剂量无关", + "C": "由直接抑制肾上腺儿茶酚胺释放引起", + "D": "由迷走神经刺激引起", + "E": "由直接抑制窦房结引起" + } + }, + { + "id": "cf97a69f-ca40-5b2e-b2f6-f03c117b6c9c", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "During induction of anesthesia, a patient is breathing isoflurane from a semiclosed circle absorber system. The temperature-compensated vaporizer is set to deliver isoflurane 1.5%. Which of the following will result in the lowest inspired concentration of isoflurane?", + "A": "Doubling the length of circle system hoses", + "B": "Decreasing the barometric pressure", + "C": "Changing from rubber to plastic breathing hoses", + "D": "Decreasing fresh gas flow", + "E": "Exhaustion of the soda lime" + }, + "zh": { + "question": "在麻醉诱导期间，患者通过半闭合循环吸收系统吸入异氟醚。温度补偿蒸发器设置为提供1.5%的异氟醚。以下哪项会导致吸入的异氟醚浓度最低？", + "A": "将循环系统软管长度加倍", + "B": "降低大气压力", + "C": "将呼吸软管从橡胶换成塑料", + "D": "减少新鲜气体流量", + "E": "苏打石灰耗尽" + } + }, + { + "id": "3ae0b40f-197a-571d-ac26-ca4353a99122", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following findings is most likely in patients with acute transection of the spinal cord at the level of C6?", + "A": "Autonomic hyperreflexia", + "B": "Hyperkalemia with administration of succinylcholine", + "C": "Hypotension", + "D": "Increased pulmonary blood flow", + "E": "Tachycardia" + }, + "zh": { + "question": "以下哪项发现最有可能出现在C6水平急性脊髓横断的患者中？", + "A": "自主神经反射亢进", + "B": "使用琥珀胆碱后出现高钾血症", + "C": "低血压", + "D": "肺血流量增加", + "E": "心动过速" + } + }, + { + "id": "b8a00cc5-c6a1-5839-bf82-a9e3b21e6908", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following decreases the clearance of atracurium?", + "A": "Administration of cimetidine", + "B": "Cholinesterase deficiency", + "C": "Hepatic insufficiency", + "D": "Hypothermia", + "E": "Renal insufficiency" + }, + "zh": { + "question": "以下哪项会降低阿曲库铵的清除率？", + "A": "使用西咪替丁", + "B": "胆碱酯酶缺乏", + "C": "肝功能不全", + "D": "低体温", + "E": "肾功能不全" + } + }, + { + "id": "d6b8ffa5-1ac1-582a-bd84-5a900e81d745", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 100-kg, 42-year-old woman received enflurane and oxygen for clipping of an intracranial aneurysm lasting eight hours. In the first two postoperative hours, urine output is 2 liters. Serum sodium concentration is 152 mEq/L. Urine osmolality and central venous pressure are low. Which of the following is best used to establish the diagnosis?", + "A": "Pulmonary artery occlusion pressure", + "B": "Serum fluoride concentration", + "C": "Serum osmolality", + "D": "Response to antidiuretic hormone", + "E": "Response to fluid restriction" + }, + "zh": { + "question": "一名100公斤、42岁的女性接受了恩氟烷和氧气用于持续八小时的颅内动脉瘤夹闭术。在术后最初的两个小时内，尿量为2升。血清钠浓度为152 mEq/L。尿液渗透压和中心静脉压较低。以下哪项最适合用于确立诊断？", + "A": "肺动脉楔压", + "B": "血清氟浓度", + "C": "血清渗透压", + "D": "对抗利尿激素的反应", + "E": "对限水的反应" + } + }, + { + "id": "9051beed-7216-5475-bdef-f8f7dd984f0b", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The primary purpose of denitrogenation prior to anesthetic induction is to", + "A": "blunt hypoxic pulmonary vasoconstriction", + "B": "improve ventilation and perfusion matching", + "C": "increase contribution of second gas effect to rate of induction", + "D": "increase oxygen reserve in the functional residual capacity", + "E": "maximize arterial oxygen content" + }, + "zh": { + "question": "麻醉诱导前去氮的主要目的是", + "A": "减弱缺���性肺血管收缩", + "B": "改善通气和灌注的匹配", + "C": "增加第二气体效应对诱导速度的贡献", + "D": "增加功能残气量中的氧储备", + "E": "最大化动脉氧含量" + } + }, + { + "id": "2609a83c-0803-5955-81a3-6ff1eb8732c3", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following findings would be considered normal in the EEG of an adult?", + "A": "Decreased frequency during induction with halogenated anesthetics", + "B": "Decreased frequency in frontal areas with administration of nitrous oxide 50%", + "C": "Dominance of beta rhythm at 20 to 30 Hz during the awake relaxed state", + "D": "Electrical silence with administration of isoflurane 2.5 MAC", + "E": "The presence of burst-suppression during natural sleep" + }, + "zh": { + "question": "以下哪项在成人的脑电图中被认为是正常的？", + "A": "使用卤代麻醉剂诱导时频率降低", + "B": "使用50%一氧化二氮时额区频率降低", + "C": "在清醒放松状态下20到30 Hz的β节律占主导", + "D": "使用2.5 MAC的异氟醚时出现电静默", + "E": "自然睡眠期间出现爆发抑制" + } + }, + { + "id": "6b61bbed-9f0e-5249-9ec6-fbe15dc88775", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning a patient who has been receiving nitroprusside for several days is true?", + "A": "Biotransformation of cyanide requires a sulfur donor", + "B": "Formation of methemoglobin increases cyanide toxicity", + "C": "Increased serum thiocyanate concentrations are innocuous", + "D": "Mixed venous P02 decreases as cyanide toxicity develops", + "E": "Serum thiocyanate concentrations reflect the degree of cyanide toxicity" + }, + "zh": { + "question": "关于接受硝普钠治疗数天的患者，下列哪项陈述是正确的？", + "A": "氰化物的生物转化需要硫供体", + "B": "高铁血红蛋白的形成会增加氰化物的毒性", + "C": "血清硫氰酸盐浓度升高是无害的", + "D": "随着氰化物毒性的发展，混合静脉血氧分压下降", + "E": "血清硫氰酸盐浓度反映氰化物毒性的程度" + } + }, + { + "id": "3c521ba9-7f31-5719-9b0f-d0ad0f95cecc", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following statements about the blood supply of the spinal cord is true EXCEPT:", + "A": "The anterior spinal artery is made up of branches from the vertebral, intercostal, and iliac arteries", + "B": "The segmental blood supply of the cord depends upon the location of the arteria radicularis magna (Adamkiewicz)", + "C": "The posterior spinal arteries supply most of the spinal cord", + "D": "Obstruction of the inferior vena cava increases blood flow through the epidural venous plexus", + "E": "The spinal cord is supplied by one anterior spinal artery and two posterior spinal arteries" + }, + "zh": { + "question": "关于脊髓的血液供应，下列说法中正确的是，除了：", + "A": "前脊髓动脉由椎动脉、肋间动脉和髂动脉的分支组成", + "B": "脊髓的节段性血供取决于大根动脉（Adamkiewicz动脉）的位置", + "C": "后脊髓动脉供应大部分脊髓", + "D": "下腔静脉阻塞会增加硬膜外静脉丛的血流量", + "E": "脊髓由一条前脊髓动脉和两条后脊髓动脉供血" + } + }, + { + "id": "111260c4-04f0-57b1-9274-176e5f0deb31", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning pressure support ventilation is true?", + "A": "It augments gas inflow in response to spontaneous inspiration", + "B": "It increases inspiratory airway pressure during controlled mandatory ventilation", + "C": "It requires the use of positive end-expiratory pressure", + "D": "It functions independently of airway resistance/lung compliance", + "E": "It correlates linearly with spontaneously achieved tidal volume" + }, + "zh": { + "question": "以下关于压力支持通气的说法哪一项是正确的？", + "A": "它在自发吸气时增加气体流入", + "B": "它在控制性强制通气期间增加吸气气道压力", + "C": "它需要使用呼气末正压", + "D": "它独立于气道阻力/肺顺应性而运行", + "E": "它与自发达到的潮气量呈线性相关" + } + }, + { + "id": "4978f630-5944-5193-aeb9-c7dfeb25943d", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 35-year-old patient with asymmetric septal hypertrophy (IHSS) is undergoing bladder suspension with sevoflurane 1%, nitrous oxide 50%, and oxygen 50%. Immediately after skin incision, blood pressure decreases to 90/60 mmHg and junctional tachycardia of 150 bpm is noted on the ECG. Which of the following is the most appropriate management?", + "A": "Decreasing sevoflurane concentration", + "B": "Infusion of nitroglycerin", + "C": "Intravenous administration of a fluid bolus", + "D": "Intravenous administration of esmolol", + "E": "Intravenous administration of phenylephrine" + }, + "zh": { + "question": "一名35岁的患者患有不对称性室间隔肥厚（IHSS），正在接受1%七氟醚、50%氧化亚氮和50%氧气的膀胱悬吊术。皮肤切开后立即，血压降至90/60 mmHg，心电图显示交界性心动过速150次/分钟。以下哪项是最合适的处理方法？", + "A": "减少七氟醚浓度", + "B": "输注硝酸甘油", + "C": "静脉注射液体推注", + "D": "静脉注射艾司洛尔", + "E": "静脉注射去氧肾上腺素" + } + }, + { + "id": "d49657dc-540e-5414-be95-68b25cad1f10", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Alveolar dead space is decreased by", + "A": "halothane anesthesia", + "B": "positive end-expiratory pressure", + "C": "deliberate hypotension", + "D": "atropine premedication", + "E": "decreased tidal volume" + }, + "zh": { + "question": "肺泡无效腔减少的原因是", + "A": "氟烷麻醉", + "B": "呼气末正压", + "C": "故意低血压", + "D": "阿托品术前用药", + "E": "潮气量减少" + } + }, + { + "id": "06cf6b22-49b1-51f6-94e6-247cdb06d731", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "For 30 minutes, a patient has been receiving oxygen 2 L, nitrous oxide 2 L, and halothane from an agent-specific vaporizer set at 1%. A mass spectrometer sampling gas from the patient's airway shows an end-tidal halothane concentration of 0.7%. The most likely explanation for this difference is", + "A": "hyperventilation", + "B": "low cardiac output", + "C": "the second-gas effect", + "D": "tissue solubility of halothane", + "E": "vaporizer temperature less than 19°C" + }, + "zh": { + "question": "患者已经接受氧气2升、氧化亚氮2升和来自特定挥发器的1%氟烷30分钟。质量光谱仪从患者气道采样的气体显示呼气末氟烷浓度为0.7%。这种差异最可能的解释是", + "A": "过度通气", + "B": "心输出量低", + "C": "第二气体效应", + "D": "氟烷的组织溶解性", + "E": "挥发器温度低于19°C" + } + }, + { + "id": "e5639b90-f99f-5804-9e88-ac515194d4b2", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A meconium-stained, full-term infant has an initial Apgar score of 2. The oropharynx is suctioned and the infant is placed on a heated table. Which of the following is the most appropriate next step in management of the airway?", + "A": "If the oropharynx is clear, observation for respiratory effort", + "B": "Placement of an oxygen mask and application of positive pressure to clear the airway", + "C": "Nasotracheal suctioning", + "D": "Tracheal suctioning using the endotracheal tube", + "E": "Intubation and ventilation with 100% oxygen" + }, + "zh": { + "question": "一个胎粪染色的足月婴儿初始阿普加评分为2。口咽部已被吸引，婴儿被放置在加热台上。以下哪项是管理气道的最适当的下一步措施？", + "A": "如果口咽部清理干净，观察呼吸努力", + "B": "放置氧气面罩并施加正压以清理气道", + "C": "鼻气管吸引", + "D": "使用气管插管进行气管吸引", + "E": "插管并使用100%氧气进行通气" + } + }, + { + "id": "5bba44f9-debb-5005-a69c-e5890875d272", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following statements concerning norepinephrine is true EXCEPT:", + "A": "Extraneuronal uptake is important in the termination of its activity", + "B": "It is formed from dopamine", + "C": "Its release is facilitated by ephedrine", + "D": "Its uptake is affected by cocaine", + "E": "It has minimal beta2-adrenergic activity" + }, + "zh": { + "question": "以下关于去甲肾上腺素的陈述中，除了哪一项外，其他都是正确的：", + "A": "细胞外摄取在其活性终止中很重要", + "B": "它由多巴胺形成", + "C": "麻黄碱促进其释放", + "D": "可卡因影响其摄取", + "E": "它的β2-肾上腺素能活性很小" + } + }, + { + "id": "86860281-b1c5-547b-8e56-5ed9dd78e1d7", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "Following a right lower lobectomy, a patient develops a bronchopleural fistula and becomes hypoxic. He is orally intubated and mechanically ventilated with pure oxygen. PaO2 is 65 mmHg, PaCO2 is 70 mmHg, and pH is 7.25. Which of the following will produce the most favorable change in the blood gases?", + "A": "Increasing ventilatory frequency", + "B": "Increasing suction on the chest tube", + "C": "Applying 10 cmH2O positive end-expiratory pressure", + "D": "Using a double-lumen tube for differential ventilation", + "E": "Starting negative-pressure ventilation" + }, + "zh": { + "question": "在右下肺叶切除术后，患者出现支气管胸膜瘘并变得缺氧。他经口插管并用纯氧进行机械通气。PaO2为65 mmHg，PaCO2为70 mmHg，pH为7.25。以下哪项措施将对血气产生最有利的变化？", + "A": "增加通气频率", + "B": "增加胸管的吸引力", + "C": "应用10 cmH2O的呼气末正压", + "D": "使用双腔管进行差异通气", + "E": "开始负压通气" + } + }, + { + "id": "64d0b06a-161c-5a83-8dce-d8ad7588d652", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "After the first 70 minutes of a transurethral resection of the prostate, a 70-year-old man becomes confused and has tachycardia, hypertension, and shortness of breath. Serum sodium concentration is 116 mEq/L. After informing the surgeon that the procedure should be terminated as soon as possible, the most appropriate next step would be to", + "A": "administer furosemide", + "B": "administer labetalol", + "C": "administer 3% sodium chloride", + "D": "change the irrigating solution to normal saline", + "E": "induce general endotracheal anesthesia" + }, + "zh": { + "question": "在前列腺经尿道切除术进行到第70分钟时，一名70岁的男性出现意识混乱、心动过速、高血压和呼吸急促。血清钠浓度为116 mEq/L。在告知外科医生应尽快终止手术后，最合适的下一步措施是", + "A": "给予呋塞米", + "B": "给予拉贝洛尔", + "C": "给予3%氯化钠", + "D": "将冲洗液更换为生理盐水", + "E": "诱导全身气管插管麻醉" + } + }, + { + "id": "88bc1e1f-3a22-5a3e-a2d2-115adecb4ead", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "In the absence of coronary artery disease, isoflurane-induced vasodilation and tachycardia are beneficial hemodynamic goals for which of the following cardiac diseases?", + "A": "Aortic regurgitation", + "B": "Aortic stenosis", + "C": "Asymmetric septal hypertrophy (IHSS)", + "D": "Mitral stenosis", + "E": "Pulmonary regurgitation" + }, + "zh": { + "question": "在没有冠状动脉疾病的情况下，异氟醚引起的血管扩张和心动过速对以下哪种心脏病是有益的血流动力学目标？", + "A": "主动脉瓣关闭不全", + "B": "主动脉瓣狭窄", + "C": "不对称性室间隔肥厚（IHSS）", + "D": "二尖瓣狭窄", + "E": "肺动脉瓣关闭不全" + } + }, + { + "id": "64d7ad48-3792-508f-8828-0b388d076d0c", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "During enflurane anesthesia for colectomy in a 75-year-old man with sepsis, urine output decreases to 10 ml/hr. Heart rate is 120 bpm, blood pressure is 100/50 mmHg, central venous pressure is 10 mmHg, and pulmonary artery occlusion pressure is 15 mmHg. The most appropriate management at this time is to", + "A": "measure cardiac output", + "B": "increase fluid administration", + "C": "infuse dopamine", + "D": "administer propranolol", + "E": "switch from enflurane to isoflurane" + }, + "zh": { + "question": "在一名75岁患有败血症的男性进行结肠切除术的恩氟烷��醉期间，尿量减少到10 ml/hr。心率为120次/分钟，血压为100/50 mmHg，中心静脉压为10 mmHg，肺动脉楔压为15 mmHg。此时最合适的处理是", + "A": "测量心输出量", + "B": "增加液体输注", + "C": "输注多巴胺", + "D": "给予普萘洛尔", + "E": "从恩氟烷换成异氟烷" + } + }, + { + "id": "04844053-d5aa-5a0e-b499-21b1d8a078e0", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning postspinal headache is true?", + "A": "Cerebrospinal fluid leukocytosis occurs", + "B": "Intravenous caffeine therapy is more effective than epidural blood patch", + "C": "The incidence decreases with age", + "D": "The incidence is higher in males than in females of all ages", + "E": "The incidence is the same after single or multiple dural punctures" + }, + "zh": { + "question": "以下关于脊髓后头痛的说法哪一项是正确的？", + "A": "出现脑脊液白细胞增多", + "B": "静脉咖啡因治疗比硬膜外血补片更有效", + "C": "发病率随年龄增长而降低", + "D": "在所有年龄段中，男性的发病率高于女性", + "E": "单次或多次硬膜穿刺后的发病率相同" + } + }, + { + "id": "628bb52c-2607-5d2c-a909-49a8dc75073d", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "At term which of the following would produce the greatest increase in uterine blood flow?", + "A": "Increasing PaO2 to greater than 100 mmHg", + "B": "Administering ritodrine intravenously", + "C": "Administering halothane to 1 MAC", + "D": "Administering magnesium sulfate intravenously", + "E": "Increasing PaCO2 from 35 to 40 mmHg" + }, + "zh": { + "question": "在足月时，下列哪项会导致子宫血流量最大增加？", + "A": "将PaO2增加到大于100 mmHg", + "B": "静脉注射利托君", + "C": "给予1 MAC的氟烷", + "D": "静脉注射硫酸镁", + "E": "将PaCO2从35增加到40 mmHg" + } + }, + { + "id": "5d2758b3-f195-5730-a410-34f342298fe9", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "After receiving an axillary block for carpal tunnel release, a patient has pain on incision. Which of the following nerves should be blocked at the level of the elbow to relieve the pain?", + "A": "Intercostobrachial", + "B": "Median", + "C": "Musculocutaneous", + "D": "Radial", + "E": "Ulnar" + }, + "zh": { + "question": "在接受腋神经阻滞进行腕管松解术后，患者在切口处感到疼痛。为了缓解疼痛，应该在肘部水平阻滞以下哪一条神经？", + "A": "肋间臂神经", + "B": "正中神经", + "C": "肌皮神经", + "D": "桡神经", + "E": "尺神经" + } + }, + { + "id": "c48d6997-5db1-5e03-af7c-61a05d90dbc4", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 60-year-old man undergoes transurethral resection of a bladder tumor in the lithotomy position with spinal anesthesia. During the procedure the surgeon reports that the patient's right leg is \"jumping.\" This movement is most likely caused by stimulation of which of the following nerves?", + "A": "Femoral", + "B": "Lateral femoral cutaneous", + "C": "Obturator", + "D": "Pudendal", + "E": "Sciatic" + }, + "zh": { + "question": "一名60岁的男性在截石位接受脊髓麻醉下的经尿道膀胱肿瘤切除术。手术过程中，外科医生报告患者的右腿在“跳动”。这种运动最可能是由刺激以下哪一条神经引起的？", + "A": "股神经", + "B": "股外侧皮神经", + "C": "闭孔神经", + "D": "阴部神经", + "E": "坐骨神经" + } + }, + { + "id": "97a3dc73-a7e6-5d66-9ee5-76c35f853312", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A successful ankle block for transmetatarsal amputation of the first and second toes should include each of the following nerves EXCEPT the", + "A": "saphenous", + "B": "deep peroneal", + "C": "superficial peroneal", + "D": "sural", + "E": "tibial" + }, + "zh": { + "question": "对于第一和第二脚趾的跖骨截肢，成功的踝部阻滞应包括以下神经，除了", + "A": "隐神经", + "B": "腓深神经", + "C": "腓浅神经", + "D": "腓肠神经", + "E": "胫神经" + } + }, + { + "id": "70a2114d-6138-507b-a0d0-34e079ea5554", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following is an effect of rapid infusion of mannitol EXCEPT", + "A": "depletion of electrolytes", + "B": "impaired platelet adhesiveness", + "C": "increased intracranial pressure", + "D": "increased intravascular fluid volume", + "E": "increased renal blood flow" + }, + "zh": { + "question": "以下各项中，快速输注甘露醇的作用不包括", + "A": "电解质耗竭", + "B": "血小板粘附性受损", + "C": "颅内压升高", + "D": "血管内液体容量增加", + "E": "肾血流量增加" + } + }, + { + "id": "7133a576-283d-5f6e-8601-5d59c37120cf", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is an effect of metoclopramide?", + "A": "Decreased lower esophageal sphincter tone", + "B": "Decreased MAC for enflurane", + "C": "Extrapyramidal signs", + "D": "Increased gastric pH", + "E": "Relief of intestinal obstruction" + }, + "zh": { + "question": "下列哪项是甲氧氯普胺的作用？", + "A": "降低下食管括约肌张力", + "B": "降低恩氟烷的最低肺泡浓度（MAC）", + "C": "锥体外系症状", + "D": "增加胃液pH值", + "E": "缓解肠梗阻" + } + }, + { + "id": "3d032d06-b85e-5083-ad0f-3ad2b0b49200", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The rate of induction with inhalational agents is more rapid in neonates than adults because of a relatively increased", + "A": "cardiac output", + "B": "cerebral blood flow", + "C": "functional residual capacity", + "D": "metabolic rate", + "E": "minute ventilation" + }, + "zh": { + "question": "与成人相比，新生儿使用吸入性麻醉剂的诱导速度更快，因为相对增加了", + "A": "心输出量", + "B": "脑血流量", + "C": "功能残气量", + "D": "代谢率", + "E": "每分钟通气量" + } + }, + { + "id": "2cb4dd86-aba0-5c59-9c43-0124565017d5", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following decreases the risk for burns during electrocauterization?", + "A": "Conductive flooring", + "B": "Grounding of the patient to the operating table", + "C": "Increased resistance at the return electrode", + "D": "Isolation of the current output of the electrosurgical unit", + "E": "Placement of the return electrode at a distance from the surgical site" + }, + "zh": { + "question": "以下哪项可以降低电灼术中烧伤的风险？", + "A": "导电地板", + "B": "将患者接地到手术台", + "C": "增加返回电极的电阻", + "D": "隔离电外科设备的电流输出", + "E": "将返回电极放置在远离手术部位的地方" + } + }, + { + "id": "dfd4c827-a2a3-5d60-8e22-74db52e6570d", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is a complication of glycine used for irrigation during transurethral resection of the prostate?", + "A": "Epileptiform activity on EEG", + "B": "Peripheral neuropathy", + "C": "Tachycardia", + "D": "Transient blindness", + "E": "Transient deafness" + }, + "zh": { + "question": "以下哪项是经尿道前列腺切除术中使用甘氨酸冲洗的并发症？", + "A": "脑电图上的癫痫样活动", + "B": "周围神经病变", + "C": "心动过速", + "D": "暂时性失明", + "E": "暂时性失聪" + } + }, + { + "id": "56d6c62a-2c7c-53f0-b816-23a81bf91d21", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "When antagonizing neuromuscular block produced by pancuronium, the combination of simultaneously administered anticholinergic and anticholinesterase drugs that is most likely to produce bradycardia is", + "A": "glycopyrrolate and pyridostigmine", + "B": "atropine and edrophonium", + "C": "glycopyrrolate and edrophonium", + "D": "atropine and neostigmine", + "E": "glycopyrrolate and neostigmine" + }, + "zh": { + "question": "在拮抗由潘库溴铵引起的神经肌肉阻滞时，同时给予的抗胆碱药和抗胆碱酯酶药物中最有可能引起心动过缓的组合是", + "A": "东莨菪碱和吡啶斯的明", + "B": "阿托品和依酚氯铵", + "C": "东莨菪碱和依酚氯铵", + "D": "阿托品和新斯的明", + "E": "东莨菪碱和新斯的明" + } + }, + { + "id": "b7d67706-4c75-5a83-b0bf-2e5f544cb41e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is a characteristic of phase II neuromuscular block?", + "A": "It is diagnosed by the intravenous administration of calcium", + "B": "It is potentiated by edrophonium", + "C": "It produces nondepolarizing train-of-four characteristics", + "D": "It requires evaluation for pseudocholinesterase deficiency", + "E": "It requires less succinylcholine than a phase I block" + }, + "zh": { + "question": "以下哪项是II期神经肌肉阻滞的特征？", + "A": "通过静脉注射钙进行诊断", + "B": "被依酚氯铵增强", + "C": "产生非去极化的四联刺激特征", + "D": "需要评估假性胆碱酯酶缺乏", + "E": "需要的琥珀胆碱比I期阻滞少" + } + }, + { + "id": "80b10f0d-34b4-56b1-a57a-2863c14f4c9b", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Compared with a normal child, which of the following is expected during inhalation induction in a child with a 2:1 left-to-right intracardiac shunt?", + "A": "Decreased rate of rise of alveolar anesthetic tension", + "B": "Decreased anesthetic concentration in pulmonary artery blood", + "C": "Decreased cerebral blood flow", + "D": "Increased anesthetic concentration in vena cava blood", + "E": "No difference in time for anesthetic induction" + }, + "zh": { + "question": "与正常儿童相比，具有2:1左向右心内分流的儿童在吸入诱导期间预期会出现以下哪种情况？", + "A": "肺泡麻醉张力上升速率降低", + "B": "肺动脉血中的麻醉浓度降低", + "C": "脑血流量减少", + "D": "腔静脉血中的麻醉浓度增加", + "E": "麻醉诱导时间无差异" + } + }, + { + "id": "4a6f9984-9e90-54fa-a814-fff40908ef60", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 6-year-old boy undergoes craniotomy in the supine position for brain tumor during anesthesia with 1.5% isoflurane in oxygen. PetCO2 is 38 mmHg, heart rate is 78 bpm, and blood pressure is 130/80 mmHg. After opening the dura, the surgeon notes that the brain is bulging. Which of the following management options is LEAST likely to significantly decrease brain size?", + "A": "Decreased isoflurane concentration", + "B": "Furosemide", + "C": "Hyperventilation to a PaCO: of 25 mmHg", + "D": "Mannitol", + "E": "Nitroprusside" + }, + "zh": { + "question": "一名6岁男孩在全麻下接受1.5%异氟醚和氧气的颅骨切开术，体位为仰卧位，治疗脑肿瘤。PetCO2为38 mmHg，心率为78次/分钟，血压为130/80 mmHg。打开硬脑膜后，外科医生注意到大脑膨出。以下哪种处理方式最不可能显著减小大脑体积？", + "A": "降低异氟醚浓度", + "B": "呋塞米", + "C": "过度通气至PaCO2为25 mmHg", + "D": "甘露醇", + "E": "硝普钠" + } + }, + { + "id": "8e39e22e-1527-5a3c-976d-982371e447b5", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Assignment of a patient to an ASA physical status category is used to", + "A": "facilitate comparisons among different patient groups and institutions", + "B": "guide the choice of anesthetic technique", + "C": "permit accurate determination of charges for professional services", + "D": "predict anesthetic risk", + "E": "predict perioperative mortality" + }, + "zh": { + "question": "将患者分配到ASA身体状态类别用于", + "A": "便于不同患者群体和机构之间的比较", + "B": "指导麻醉技术的选择", + "C": "允许准确确定专业服务的费用", + "D": "预测麻醉风险", + "E": "预测围手术期死亡率" + } + }, + { + "id": "003e6847-48cb-5269-a7dd-96f321b3c48c", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 70-year-old man with stable angina is scheduled for cataract removal with a retrobulbar block. After injection of 5 ml of 0.75% bupivacaine, heart rate decreases from 90 to 55 bpm, and frequent premature ventricular contractions are noted on the EKG. These changes are most likely caused by", + "A": "intravascular injection of bupivacaine", + "B": "subarachnoid injection of bupivacaine", + "C": "myocardial ischemia", + "D": "oculocardiac reflex", + "E": "retrobulbar hemorrhage" + }, + "zh": { + "question": "一名70岁的男性患有稳定型心绞痛，计划进行白内障摘除术并采用球后阻滞。在注射5毫升0.75%的布比卡因后，心率从90次/分钟下降到55次/分钟，心电图上出现频繁的室性早搏。这些变化最可能是由以下原因引起的", + "A": "布比卡因的血管内注射", + "B": "布比卡因的蛛网膜下腔注射", + "C": "心肌缺血", + "D": "眼心反射", + "E": "球后出血" + } + }, + { + "id": "2db8ca88-1a7e-5cbe-b9dd-02822219b9d7", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A patient develops jaundice one week after undergoing laparoscopic cholecystectomy during halothane anesthesia. Laboratory studies show an increased serum alkaline phosphatase concentration, a mildly increased serum aspartate aminotransferase concentration, and a markedly increased conjugated bilirubin fraction. Which of the following is the most likely diagnosis?", + "A": "Biliary obstruction", + "B": "Gilbert's disease", + "C": "Halothane-associated hepatitis", + "D": "Hematoma resorption", + "E": "Infectious hepatitis" + }, + "zh": { + "question": "一名患者在接受卤烷麻醉下的腹腔镜胆囊切除术后一周出现黄疸。实验室检查显示血清碱性磷酸酶浓度升高，血清天冬氨酸氨基转移酶浓度轻度升高，结合胆红素分数显著升高。以下哪项是最可能的诊断？", + "A": "胆道梗阻", + "B": "Gilbert综合征", + "C": "卤烷相关性肝炎", + "D": "血肿吸收", + "E": "感染性肝炎" + } + }, + { + "id": "1a91c5d2-2133-5872-b0e8-17ac42a839c2", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "An asymptomatic 38-year-old woman is scheduled for elective cesarean delivery. The preoperative EKG shows left axis deviation that was not present one year ago. The most appropriate next step is to", + "A": "postpone the procedure and consult a cardiologist", + "B": "postpone the procedure and obtain an echocardiogram", + "C": "proceed with the procedure after administration of digitalis", + "D": "proceed with the procedure but avoid inhalational agents", + "E": "proceed without intervention since this is a normal finding" + }, + "zh": { + "question": "一名38岁无症状的女性计划进行择期剖宫产。术前心电图显示左轴偏移，而一年前并未出现这种情况。最合适的下一步是", + "A": "推迟手术并咨询心脏病专家", + "B": "推迟手术并进行超声心动图检查", + "C": "在给予洋地黄后进行手术", + "D": "进行手术但避免使用吸入性麻醉剂", + "E": "不进行干预，因为这是正常现象" + } + }, + { + "id": "80a70d21-c99b-55b6-8c72-436b81bd2f8f", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with epidural administration of hydrophilic opioids, epidural administration of lipophilic opioids is associated with", + "A": "earlier onset of pruritus", + "B": "greater motor block when combined with local anesthetics", + "C": "higher incidence of delayed respiratory depression", + "D": "lesser sensitivity to reversal of analgesia by naloxone", + "E": "slower onset of analgesia" + }, + "zh": { + "question": "与亲水性阿片类药物的硬膜外给药相比，脂溶性阿片类药物的硬膜外给药与以下哪项相关", + "A": "瘙痒的发作更早", + "B": "与局部麻醉剂联合使用时运动阻滞更强", + "C": "延迟性呼吸抑制的发生率更高", + "D": "对纳洛酮逆转镇痛的敏感性较低", + "E": "镇痛起效较慢" + } + }, + { + "id": "9336c9bf-a997-5d45-84a9-268e8be20c6a", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A tourniquet with dual bladders is being used for intravenous regional anesthesia of the upper extremity. At what point in the procedure should the distal tourniquet be inflated?", + "A": "During injection of the local anesthetic", + "B": "After the patient complains of tourniquet pain", + "C": "Coincident with inflation of the proximal tourniquet", + "D": "After the proximal tourniquet is deflated", + "E": "Prior to exsanguination of the limb" + }, + "zh": { + "question": "在进行上肢静脉区域麻醉时使用双气囊止血带。在手术的哪个阶段应该充气远端止血带？", + "A": "在注射局部麻醉药时", + "B": "在患者抱怨止血带疼痛后", + "C": "与近端止血带充气同时", + "D": "在近端止血带放气后", + "E": "在肢体放血之前" + } + }, + { + "id": "0713116e-a86c-57ce-bb66-46713d59bb5a", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 60-kg, 38-year-old woman undergoes laparoscopic tubal ligation. Paralysis is maintained for one hour with infusion of succinylcholine at a rate of 10 mg/min. At the end of the procedure, respirations are shallow and tetanic fade is noted on neuromuscular stimulation. In addition to continued mechanical ventilation, which of the following is the most appropriate next step in management?", + "A": "Observe until the patient recovers spontaneously", + "B": "Monitor until PetC02 reaches 50 mmHg", + "C": "Determine dibucaine number", + "D": "Administer fresh frozen plasma", + "E": "Administer glycopyrrolate and neostigmine" + }, + "zh": { + "question": "一名60公斤、38岁的女性接受腹腔镜输卵管结扎术。通过以10 mg/min的速度输注琥珀胆碱维持麻痹一小时。在手术结束时，呼吸浅，神经肌肉刺激时出现强直性衰退。除了继续机械通气外，以下哪项是最合适的下一步管理措施？", + "A": "观察直到患者自行恢复", + "B": "监测直到呼气末二氧化碳分压达到50 mmHg", + "C": "测定地布卡因数值", + "D": "给予新鲜冰冻血浆", + "E": "给予羟丁酸和新斯的明" + } + }, + { + "id": "58ca7b58-4e79-5c3c-b304-403bd90b30c9", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "When the inspired gas is changed from air to 20% oxygen and 80% nitrous oxide, PaO2 increases because", + "A": "increased pulmonary artery pressure perfuses alveoli that previously enhanced dead space", + "B": "nitrous oxide stimulates the respiratory center", + "C": "rapid absorption of nitrous oxide increases alveolar oxygen concentration", + "D": "replacement of nitrogen by nitrous oxide expands atelectatic alveoli", + "E": "respiratory depression from nitrous oxide shifts the oxyhemoglobin dissociation curve" + }, + "zh": { + "question": "当吸入气体从空气变为20%氧气和80%氧化亚氮时，PaO2增加是因为", + "A": "肺动脉压增加灌注了先前增加无效腔的肺泡", + "B": "氧化亚氮刺激呼吸中枢", + "C": "氧化亚氮的快速吸收增加了肺泡氧浓度", + "D": "氧化亚氮取代氮气扩张了不张的肺泡", + "E": "氧化亚氮引起的呼吸抑制使氧合血红蛋白解离曲线发生变化" + } + }, + { + "id": "cede7788-f46e-53b7-879c-e07e98e0f118", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 62-year-old man is undergoing elective coronary artery bypass grafting and aortic valve replacement for three-vessel coronary artery disease and aortic stenosis. Shortly after intubation, heart rate increases from 75 to 100 bpm and blood pressure decreases from 130/70 to 70/40 mmHg with acute, severe ST-segment depression in lead V5. Which of the following is the most appropriate management?", + "A": "Crystalloid", + "B": "Ephedrine", + "C": "Esmolol", + "D": "Nitroglycerin", + "E": "Phenylephrine" + }, + "zh": { + "question": "一名62岁的男性正在接受选择性冠状动脉旁路移植术和主动脉瓣置换术，以治疗三支冠状动脉疾病和主动脉瓣狭窄。插管后不久，心率从75次/分钟增加到100次/分钟，血压从130/70 mmHg下降到70/40 mmHg，并在导联V5出现急性、严重的ST段压低。以下哪项是最合适的处理措施？", + "A": "晶体液", + "B": "麻黄碱", + "C": "艾司洛尔", + "D": "硝酸甘油", + "E": "去氧肾上腺素" + } + }, + { + "id": "ee262378-6ac0-50dd-a6f7-eaa2dbabf1b6", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following will occur if the top of the oxygen flowmeter is cracked and leaking during anesthesia with nitrous oxide and oxygen?", + "A": "The back-pressure check valve will protect against a hypoxic gas mixture", + "B": "The fail-safe mechanism will protect against a hypoxic gas mixture", + "C": "The inspired oxygen concentration will be less than that set by the flowmeters", + "D": "The leak will be detected if the circle is pressurized prior to use", + "E": "The rotameter will accurately reflect the fresh gas flow to the patient" + }, + "zh": { + "question": "在使用氧化亚氮和氧气进行麻醉时，如果氧气流量计的顶部破裂并泄漏，会发生以下哪种情况？", + "A": "背压止回阀将防止低氧气体混合物", + "B": "失效保护机制将防止低氧气体混合物", + "C": "吸入的氧气浓度将低于流量计设定的浓度", + "D": "如果在使用前对环路加压，将检测到泄漏", + "E": "转子流量计将准确反映输送给患者的新鲜气体流量" + } + }, + { + "id": "a31e0b7e-fcf7-5067-8b03-0e6d6dab4884", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "If administered prior to induction of anesthesia, which of the following drugs is most likely to cause tachycardia?", + "A": "Fentanyl", + "B": "Meperidine", + "C": "Midazolam", + "D": "Morphine", + "E": "Sufentanil" + }, + "zh": { + "question": "如果在麻醉诱导前给予，以下哪种药物最有可能引起心动过速？", + "A": "芬太尼", + "B": "哌替啶", + "C": "咪达唑仑", + "D": "吗啡", + "E": "舒芬太尼" + } + }, + { + "id": "35a0685e-c339-5ed4-b0e5-c001d7099377", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "An EKG shows ventricular tachycardia in a patient with a heart rate of 160 bpm and a blood pressure of 90/60 mmHg. The best initial therapeutic maneuver prior to cardioversion is", + "A": "carotid sinus massage", + "B": "intravenous administration of bretylium", + "C": "intravenous administration of amiodarone", + "D": "intravenous administration of propranolol", + "E": "precordial \"thump\"" + }, + "zh": { + "question": "一名患者心电图显示室性心动过速，心率为160次/分钟，血压为90/60 mmHg。在心脏复律之前，最佳的初始治疗措施是", + "A": "颈动脉窦按摩", + "B": "静脉注射溴苄铵", + "C": "静脉注射胺碘酮", + "D": "静脉注射普萘洛尔", + "E": "胸前“重击”" + } + }, + { + "id": "14e7cb8f-93aa-5a1a-a01b-aca003eeb270", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements regarding innervation of the upper extremity is true?", + "A": "Blockade of the radial nerve decreases the patient's ability to spread the fingers apart", + "B": "The brachial plexus receives preganglionic sympathetic fibers arising from C5 through T2", + "C": "Interscalene injection of the brachial plexus at C6 is likely to spare the axillary nerve.", + "D": "The musculocutaneous nerves receive contributions from C5 and C6", + "E": "The vertebral artery lies posterior to the nerve roots of the brachial plexus" + }, + "zh": { + "question": "以下关于上肢神经支配的说法哪一项是正确的？", + "A": "阻滞桡神经会降低患者分开手指的能力", + "B": "臂丛接收来自C5到T2的交感神经节前纤维", + "C": "在C6处进行臂丛的斜角肌间注射可能会保留腋神经。", + "D": "肌皮神经接收来自C5和C6的贡献", + "E": "椎动脉位于臂丛神经根的后方" + } + }, + { + "id": "91555d17-a25a-5f5e-ac01-47d61a8f01db", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 60-kg, 17-year-old girl with severe idiopathic scoliosis is scheduled for Harrington rod fixation. Which of the following respiratory parameters is compatible with this disorder?", + "A": "Alveolar-to-arterial oxygen tension difference (A-aDO2) less than 100 mmHg while breathing pure oxygen", + "B": "FEV1/FVC ratio less than 50%", + "C": "Forced vital capacity less than 2000 ml", + "D": "Intrapulmonary shunt less than 10%", + "E": "Normal pulmonary vascular resistance" + }, + "zh": { + "question": "一名60公斤、17岁的女孩患有严重���特发性脊柱侧凸，计划进行Harrington棒固定术。以下哪项呼吸参数与该疾病相符？", + "A": "吸入纯氧时肺泡-动脉氧分压差（A-aDO2）小于100 mmHg", + "B": "FEV1/FVC比率小于50%", + "C": "用力肺活量小于2000 ml", + "D": "肺内分流小于10%", + "E": "正常的肺血管阻力" + } + }, + { + "id": "c9abdde9-727a-5db8-89e9-ba3f61a413ca", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The duration of action of an induction dose of thiopental is determined primarily by its", + "A": "rate of elimination", + "B": "rate of metabolism", + "C": "redistribution from brain to fat", + "D": "redistribution from brain to muscle", + "E": "hepatic extraction" + }, + "zh": { + "question": "硫喷妥钠诱导剂量的作用持续时间主要由其决定", + "A": "消除速率", + "B": "代谢速率", + "C": "从大脑到脂肪的重新分布", + "D": "从大脑到肌肉的重新分布", + "E": "肝脏提取" + } + }, + { + "id": "4bfd778b-3cdd-5f89-90ee-8b46d1234783", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Cerebral blood flow is decreased by", + "A": "chronic respiratory acidosis", + "B": "hypoxia", + "C": "hypoglycemia", + "D": "polycythemia", + "E": "the postictal state" + }, + "zh": { + "question": "哪些因素会导致脑血流减少？", + "A": "慢性呼吸性酸中毒", + "B": "缺氧", + "C": "低血糖", + "D": "红细胞增多症", + "E": "发作后状态" + } + }, + { + "id": "31973a0b-cb68-55d3-a677-b2ff84b330bc", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Percutanous cordotomy is being considered for a patient with severe pain that has persisted for three months after amputation of the arm for osteogenic sarcoma. Which of the following statements is true?", + "A": "An effective cordotomy will produce motor block", + "B": "A series of stellate ganglion blocks will provide permanent relief", + "C": "Cordotomy must be performed with the patient awake", + "D": "Cordotomy will effectively relieve phantom limb pain", + "E": "Spinal opioids are an alternative treatment of this pain" + }, + "zh": { + "question": "对于一名因骨肉瘤截肢后持续三个月的严重疼痛患者，正在考虑进行经皮脊髓切断术。以下哪项陈述是正确的？", + "A": "有效的脊髓切断术会产生运动阻滞", + "B": "一系列星状神经节阻滞将提供永久缓解", + "C": "脊髓切断术必须在患者清醒时进行", + "D": "脊髓切断术将有效缓解幻肢痛", + "E": "脊髓内阿片类药物是这种疼痛的替代治疗方法" + } + }, + { + "id": "f3c65334-9059-52d1-8542-5c742e2a4e6a", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A patient with lumbar disk disease requires lumbar epidural injection of a corticosteroid for control of low back pain. Which of the following statements concerning this treatment is true?", + "A": "Maximum effect occurs one hour after injection", + "B": "Maximum effect occurs when drug concentration peaks in cerebrospinal fluid", + "C": "Maximum effect occurs during the acute phase of the disease", + "D": "The beneficial effect results primarily from sympathetic neurolysis", + "E": "It is contraindicated if the patient has had prior surgical procedures on the lumbar disks" + }, + "zh": { + "question": "一名患有腰椎间盘疾病的患者需要进行腰椎硬膜外注射皮质类固醇以控制腰痛。关于这种治疗，下列哪项陈述是正确的？", + "A": "最大效果在注射后一小时出现", + "B": "最大效果在药物浓度在脑脊液中达到峰值时出现", + "C": "最大效果在疾病的急性期出现", + "D": "有益效果主要来自交感神经溶解", + "E": "如果患者曾经在腰椎间盘上进行过手术，则禁忌使用" + } + }, + { + "id": "7b6ab6f2-01f5-5efb-9103-d5a2a6ef102a", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "Mismatching of ventilation to perfusion in the lung is greatest in which of the following situations?", + "A": "Awake patient, spontaneous ventilation, lateral decubitus position", + "B": "Anesthetized patient, controlled ventilation, supine position", + "C": "Anesthetized patient, controlled ventilation, lateral decubitus position", + "D": "Anesthetized patient, controlled ventilation, sitting position", + "E": "Anesthetized patient, spontaneous ventilation, prone position" + }, + "zh": { + "question": "在以下哪种情况下，肺通气与灌注的不匹配最为严重？", + "A": "清醒患者，自主通气，侧卧位", + "B": "麻醉患者，控制通气，仰卧位", + "C": "麻醉患者，控制通气，侧卧位", + "D": "麻醉患者，控制通气，坐位", + "E": "麻醉患者，自主通气，俯卧位" + } + }, + { + "id": "5e475aee-a4aa-5ba0-b3b7-3b43529fd232", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "In patients with blunt head trauma, cerebral perfusion pressure is determined by the gradient between", + "A": "diastolic pressure and central venous pressure", + "B": "intracranial pressure and central venous pressure", + "C": "mean arterial pressure and central venous pressure", + "D": "mean arterial pressure and intracranial pressure", + "E": "systolic pressure and intracranial pressure" + }, + "zh": { + "question": "在钝性头部创伤患者中，脑灌注压由以下之间的梯度决定", + "A": "舒张压和中心静脉压", + "B": "颅内压和中心静脉压", + "C": "平均动脉压和中心静脉压", + "D": "平均动脉压和颅内压", + "E": "收缩压和颅内压" + } + }, + { + "id": "34676cee-a13b-59aa-a129-631027b0491b", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "During therapy for eclampsia, toxic blood levels of magnesium sulfate can be distinguished from therapeutic levels by the presence of", + "A": "diminished knee jerk reflex", + "B": "a widened QRS complex on EKG", + "C": "fetal tachycardia", + "D": "maternal drowsiness", + "E": "uterine rigidity" + }, + "zh": { + "question": "在治疗子痫期间，硫酸镁的毒性血液水平可以通过以下症状与治疗水平区分开来", + "A": "膝反射减弱", + "B": "心电图上QRS波群增宽", + "C": "胎儿心动过速", + "D": "母体嗜睡", + "E": "子宫僵硬" + } + }, + { + "id": "7e6cda50-b66e-5b53-8678-f78465bc2eff", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "During transurethral resection of the prostate, intravascular absorption of glycine irrigant most commonly produces", + "A": "alkalosis", + "B": "hemolysis", + "C": "hypertension", + "D": "tachycardia", + "E": "wheezing" + }, + "zh": { + "question": "在经尿道前列腺切除术中，甘氨酸灌洗液的血管内吸收最常引起", + "A": "碱中毒", + "B": "溶血", + "C": "高血压", + "D": "心动过速", + "E": "喘息" + } + }, + { + "id": "317d72c7-436a-5e55-ab69-ea10d8982041", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 27-year-old man with a one-month history of quadriplegia at a C6 level is given general anesthesia for cystoscopy. During the cystoscopy, blood pressure suddenly increases to 220/120 mmHg. Further evaluation is most likely to show", + "A": "atrial fibrillation (ventricular rate 100 bpm)", + "B": "paroxysmal atrial tachycardia (150 bpm)", + "C": "sinus bradycardia", + "D": "piloerection above the level of C6", + "E": "sweating above the level of C6" + }, + "zh": { + "question": "一名27岁的男性有一个月的C6水平四肢瘫痪病史，接受全身麻醉进行膀胱镜检查。在膀胱镜检查过程中，血压突然升高至220/120 mmHg。进一步评估最可能显示", + "A": "心房颤动（心室率100次/分钟）", + "B": "阵发性心房心动过速（150次/分钟）", + "C": "窦性心动过缓", + "D": "C6水平以上的立毛反应", + "E": "C6水平以上的出汗" + } + }, + { + "id": "add6e482-8f5b-5cfd-96ad-d882b41166e3", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An isoflurane-specific vaporizer that is 25% full is mistakenly refilled with halothane, and the dial is set at 1.5%. Which of the following statements concerning this situation is true?", + "A": "The gas mixture will contain equal partial pressures of halothane and isoflurane", + "B": "The gas mixture will produce a greater depth of anesthesia than 1.5% isoflurane alone", + "C": "The gas mixture will produce a greater depth of anesthesia than 1.5% halothane alone", + "D": "The liquid mixture will have a higher vapor pressure than 1.5% halothane alone", + "E": "The liquid mixture will have a higher vapor pressure if it is placed in a halothane-specific vaporizer" + }, + "zh": { + "question": "一个装有25%异氟醚的专用蒸发器被错误地加注了氟烷，旋钮设置为1.5%。关于这种情况，下列哪项陈述是正确的？", + "A": "气体混合物将包含等量的氟烷和异氟醚的分压", + "B": "气体混合物将产生比单独1.5%异氟醚更深的麻醉深度", + "C": "气体混合物将产生比单独1.5%氟烷更深的麻醉深度", + "D": "液体混合物的蒸气压将高于单独1.5%氟烷", + "E": "如果将液体混合物放入氟烷专用蒸发器中，其蒸气压将更高" + } + }, + { + "id": "5fd64dfd-c0c0-50d5-a370-53faeb84aaba", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Recommendations for maximal allowable trace anesthesia gases are based on", + "A": "achievable levels with modern scavenging systems", + "B": "data from animal studies", + "C": "data on methionine synthetase levels in anesthesiologists", + "D": "evidence for an association with malignancy in anesthesiologists", + "E": "evidence for an association with spontaneous abortion In operating room personnel" + }, + "zh": { + "question": "最大允许的麻醉气体痕量的建议基于", + "A": "现代废气收集系统可达到的水平", + "B": "动物研究的数据", + "C": "麻醉师体内蛋氨酸合成酶水平的数据", + "D": "麻醉师与恶性肿瘤相关的证据", + "E": "手术室人员与自然流产相关的证据" + } + }, + { + "id": "3357a350-6315-5195-b0cc-6e6f31a16846", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "If minute ventilation is held constant, which of the following is LEAST likely to alter PaCO2?", + "A": "General anesthesia", + "B": "Hypothermia", + "C": "Increased dead space", + "D": "Increased pulmonary shunt", + "E": "Induced hypotension" + }, + "zh": { + "question": "如果分钟通气量保持不变，以下哪项最不可能改变PaCO2？", + "A": "全身麻醉", + "B": "低体温", + "C": "增加无效腔", + "D": "增加肺分流", + "E": "诱导性低血压" + } + }, + { + "id": "0a4219f7-903a-52b3-acdc-e75a83a0cf62", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A healthy 57-year-old man with a ureteral calculus is scheduled for immersion extracorporeal shock wave lithotripsy. Which of the following statements is true?", + "A": "Delivery of the shock wave is timed by the R wave of the ECG", + "B": "Continuous epidural anesthesia is contraindicated because of the risk for infection", + "C": "If a regional technique is used, a T10 sensory level is required for adequate anesthesia", + "D": "If general anesthesia is used, high tidal volumes and low respiratory rate are preferred", + "E": "Removal of the patient from the bath is accompanied by an increase in blood pressure" + }, + "zh": { + "question": "一名健康的57岁男性患有输尿管结石，计划进行浸入式体外冲击波碎石术。以下哪项陈述是正确的？", + "A": "冲击波的传递是由心电图的R波定时的", + "B": "连续硬膜外麻醉因感染风险而禁忌", + "C": "如果使用区域麻醉技术，则需要T10感觉水平以获得足够的麻醉", + "D": "如果使用全身麻醉，优选高潮气量和低呼吸频率", + "E": "将患者从浴缸中移出时伴随血压升高" + } + }, + { + "id": "54560f71-970c-5cb4-b236-e22b03177293", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is the greatest disadvantage of pressure-cycled ventilation?", + "A": "Increased I:E ratio", + "B": "Increased mechanical dead space", + "C": "Increased risk for barotrauma", + "D": "Variable respiratory rates", + "E": "Variable tidal volumes" + }, + "zh": { + "question": "以下哪项是压力循环通气的最大缺点？", + "A": "增加的吸呼比", + "B": "增加的机械死腔", + "C": "���加气压伤的风险", + "D": "可变的呼吸频率", + "E": "可变的潮气量" + } + }, + { + "id": "1028bc8b-7b88-5265-ae9d-9a3b935eae56", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "During ligation of a patent ductus arteriosus, a newborn infant receives a total gas flow of 5 L/min through a nonheated Jackson-Rees system. Operating room temperature is maintained at 30°C. The primary cause of a rapid decrease in rectal temperature from 36.8°C to 35°C is", + "A": "absence of the central temperature control mechanism", + "B": "conductive heat loss", + "C": "convective heat loss", + "D": "evaporative heat loss", + "E": "radiant heat loss" + }, + "zh": { + "question": "在动脉导管未闭结扎术中，新生儿通过未加热的Jackson-Rees系统接收总气流量为5 L/min。手术室温度保持在30°C。直肠温度从36.8°C迅速下降到35°C的主要原因是", + "A": "缺乏中央温度控制机制", + "B": "传导性热量损失", + "C": "对流性热量损失", + "D": "蒸发性热量损失", + "E": "辐射性热量损失" + } + }, + { + "id": "bd14b314-02bb-5c7e-8474-f28a9c2699bd", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following is a complication of celiac plexus block with 0.5% lidocaine 40 ml EXCEPT", + "A": "hematuria", + "B": "ileus", + "C": "postural hypotension", + "D": "retroperitoneal hematoma", + "E": "weakness of hip flexors" + }, + "zh": { + "question": "以下每项都是使用0.5%利多卡因40毫升进行腹腔神经丛阻滞的并发症，除了", + "A": "血尿", + "B": "肠梗阻", + "C": "体位性低血压", + "D": "腹膜后血肿", + "E": "髋屈肌无力" + } + }, + { + "id": "e32d2fb0-9372-562e-9bda-f620efff2c12", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following complications is more likely to occur during cannulation of the left internal jugular vein than during cannulation of the right internal jugular vein?", + "A": "Injury to the thoracic duct", + "B": "Injury to the recurrent laryngeal nerve", + "C": "Injury to the phrenic nerve", + "D": "Perforation of the esophagus", + "E": "Pneumothorax" + }, + "zh": { + "question": "在插入左侧颈内静脉时，比插入右侧颈内静脉更可能发生以下哪种并发症？", + "A": "胸导管损伤", + "B": "喉返神经损伤", + "C": "膈神经损伤", + "D": "食管穿孔", + "E": "气胸" + } + }, + { + "id": "cc352083-506b-5ab3-b255-5b613aa92c9e", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 48-year-old woman underwent a posterior fossa craniotomy in the sitting position. Monitoring included precordial Doppler, arterial blood pressure, central venous pressure (CVP), and urine output. Furosemide was used intraopera-tively for cerebral decompression, and the operation was uneventful. In the recovery room, she was awake with stable vital signs when the CVP suddenly increased from 6 to 25 mmHg without any change in blood pressure. Shortly thereafter, premature ventricular contractions are noted. After administering lidocaine 1 mg/kg intravenously, the most appropriate action is to", + "A": "position the patient head down, right side up and aspirate the CVP catheter", + "B": "withdraw the CVP catheter 5 cm", + "C": "infuse potassium chloride rapidly", + "D": "administer furosemide", + "E": "ask the neurosurgeon to reevaluate the patient immediately" + }, + "zh": { + "question": "一名48岁的女性在坐位下接受了后颅窝开颅手术。监测包括心前区多普勒、动脉血压、中心静脉压（CVP）和尿量。术中使用呋塞米进行脑减压，手术顺利。在恢复室中，她清醒且生命体征稳定，但CVP突然从6 mmHg升至25 mmHg，而血压没有变化。不久之后，出现了室性早搏。在静脉注射利多卡因1 mg/kg后，最合适的措施是", + "A": "将患者头部放低，右侧抬高，并抽吸CVP导管", + "B": "将CVP导管撤出5厘米", + "C": "快速输注氯化钾", + "D": "给予呋塞米", + "E": "要求神经外科医生立即重新评估患者" + } + }, + { + "id": "47d101a2-c951-5dc4-a6f9-f01a7972d69d", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A woman with chronic obstructive pulmonary disease is extubated and minimally responsive after isoflurane anesthesia. She is receiving oxygen 6 L/min through a face mask. Respirations are 10/min, PaO2 is 68 mmHg, PaCO2 is 54 mmHg, and pH is 7.28. The most likely cause of the respiratory acidemia is", + "A": "blunted sensitivity to low pH in the medullary respiratory center", + "B": "chronic carbon dioxide retention", + "C": "decreased lung volume from supine positioning", + "D": "depression of carotid body chemoreceptors by halothane", + "E": "suppression of hypoxic ventilatory drive by supplemental oxygen" + }, + "zh": { + "question": "一名患有慢性阻塞性肺病的女性在异氟醚麻醉后拔管，反应微弱。她通过面罩以6 L/min的速度吸氧。呼吸频率为10次/分钟，PaO2为68 mmHg，PaCO2为54 mmHg，pH值为7.28。呼吸性酸中毒最可能的原因是", + "A": "延髓呼吸中枢对低pH的敏感性减弱", + "B": "慢性二氧化碳潴留", + "C": "仰卧位导致的肺容量减少", + "D": "颈动脉体化学感受器被氟烷抑制", + "E": "补充氧气抑制了低氧通气驱动" + } + }, + { + "id": "e61705fa-1f3d-5015-8a6a-706a2d64d919", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following procedures is most specific for diagnosing reflex sympathetic dystrophy in a patient with pain of the lower extremity?", + "A": "Caudal epidural local anesthetic block", + "B": "Differential spinal anesthesia", + "C": "Intravenous regional administration of bretylium", + "D": "Lumbar epidural administration of a corticosteroid", + "E": "Paramedian L1-L5 facet injections of lidocaine" + }, + "zh": { + "question": "以下哪种操作最能特异性地诊断下肢疼痛患者的反射性交感神经营养不良？", + "A": "尾部硬膜外局部麻醉阻滞", + "B": "差异性脊髓麻醉", + "C": "静脉区域给予溴苄铵", + "D": "腰部硬膜外给予皮质类固醇", + "E": "L1-L5旁正中面注射利多卡因" + } + }, + { + "id": "3395c697-79aa-5231-86d4-cf9f27aa4e3d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Bronchospasm occurring during anesthesia in a patient with an ileal carcinoid is best treated by administration of", + "A": "aminophylline", + "B": "dexamethasone", + "C": "halothane", + "D": "ketamine", + "E": "somatostatin" + }, + "zh": { + "question": "在麻醉期间发生支气管痉挛的回肠类癌患者最好通过以下哪种药物治疗", + "A": "氨茶碱", + "B": "地塞米松", + "C": "氟烷", + "D": "氯胺酮", + "E": "生长抑素" + } + }, + { + "id": "44e3d737-c538-561e-aeb2-0f199d1a1a0f", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 50-year-old woman develops stridor 10 hours after undergoing thyroidectomy. The most appropriate management is administration of which of the following drugs?", + "A": "Albuterol", + "B": "Calcium chloride", + "C": "Ipratropium bromide", + "D": "Racemic epinephrine", + "E": "Triiodothyronine" + }, + "zh": { + "question": "一名50岁的女性在甲状腺切除术后10小时出现喘鸣。最合适的处理是给予以下哪种药物？", + "A": "沙丁胺醇", + "B": "氯化钙", + "C": "异丙托溴铵", + "D": "消旋肾上腺素", + "E": "三碘甲状腺原氨酸" + } + }, + { + "id": "b3c9e190-7b42-5e21-aa5a-75aebc848c30", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Following axillary block for insertion of an arteriovenous fistula in the forearm, a patient has pain on surgical incision. Which of the following nerves should be blocked to relieve this pain?", + "A": "Axillary", + "B": "Median", + "C": "Musculocutaneous", + "D": "Radial", + "E": "Ulnar" + }, + "zh": { + "question": "在前臂动静脉瘘插入术的腋窝阻滞后，患者在手术切口处感到疼痛。应阻滞以下哪一条神经以缓解这种疼痛？", + "A": "腋神经", + "B": "正中神经", + "C": "肌皮神经", + "D": "桡神经", + "E": "尺神经" + } + }, + { + "id": "7f2fa182-d543-5d53-beb0-9c1a2984c1ec", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "At the time of cesarean delivery, thick dark meconium is noted and the newborn is flaccid, apneic, bradycardic, and cyanotic. The most appropriate initial action is", + "A": "atropine administration", + "B": "sodium bicarbonate administration", + "C": "naloxone administration", + "D": "controlled ventilation", + "E": "tracheal suctioning" + }, + "zh": { + "question": "在剖宫产时，发现有浓厚的深色胎粪，新生儿表现为松弛、呼吸暂停、心动过缓和发绀。最合适的初步措施是", + "A": "阿托品给药", + "B": "碳酸氢钠给药", + "C": "纳洛酮给药", + "D": "控制通气", + "E": "气管吸引" + } + }, + { + "id": "fb551ec2-8a99-554b-87d1-bec2c2585476", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A pulmonary artery catheter is placed in an awake patient breathing room air. Typical right ventricular and pulmonary artery pressure tracings are obtained. With the catheter balloon inflated, blood drawn from the distal port has a PaO2 of 100 mmHg, while a simultaneous radial artery sample has a PaO2 of 90 mmHg. These data indicate that the", + "A": "shunt fraction is greater than 10%", + "B": "catheter is in the wedged position", + "C": "catheter has entered a pulmonary vein", + "D": "cardiac output is abnormally high", + "E": "oxygen electrode is malfunctioning" + }, + "zh": { + "question": "在清醒的患者中放置肺动脉导管，患者呼吸室内空气。获得典型的右心室和肺动脉压力波形。在导管球囊充气的情况下，从远端口抽取的血液PaO2为100 mmHg，而同时从桡动脉抽取的样本PaO2为90 mmHg。这些数据表明", + "A": "分流分数大于10%", + "B": "导管处于楔入位置", + "C": "导管进入了肺静脉", + "D": "心输出量异常高", + "E": "氧电极故障" + } + }, + { + "id": "9f251a10-5dd5-5cae-a1d0-6f6d72011944", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 62-year-old man is in the intensive care unit after successful craniotomy for excision of a meningioma. Blood volume is normal; laboratory studies show serum sodium concentration of 120 mEq/L, serum osmolality of 260 mOsm/L, urine sodium concentration of 50 mEq/L, and urine osmolality of 820 mOsm/L. Which of the following is the most likely explanation?", + "A": "Fluid overload with 5% dextrose in water", + "B": "Inappropriate secretion of antidiuretic hormone", + "C": "Increased free water clearance", + "D": "Nephrogenic diabetes insipidus", + "E": "Neurogenic diabetes insipidus" + }, + "zh": { + "question": "一名62岁的男性在成功进行脑膜瘤切除术后的重症监护病房中。血容量正常；实验室检查显示血清钠浓度为120 mEq/L，血清渗透压为260 mOsm/L，尿钠浓度为50 mEq/L，尿渗透压为820 mOsm/L。以下哪项是最可能的解释？", + "A": "用5%葡萄糖水液体过载", + "B": "抗利尿激素分泌不当", + "C": "游离水清除增加", + "D": "肾性尿崩症", + "E": "神经性尿崩症" + } + }, + { + "id": "4949d9b6-7aff-5ce2-a3e0-546d91ee2f6e", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "In a patient with adult respiratory distress syndrome who is being mechanically ventilated, which of the following findings indicates the most severe disease?", + "A": "Decreased functional residual capacity", + "B": "Decreased lung compliance", + "C": "Hypercarbia", + "D": "Hypoxemia", + "E": "Increased dead space" + }, + "zh": { + "question": "在一名患有成人呼吸窘迫综合征并接受机械通气的患者中，以下哪项发现表明病情最严重？", + "A": "功能残气量减少", + "B": "肺顺应性降低", + "C": "高碳酸血症", + "D": "低氧血症", + "E": "死腔增加" + } + }, + { + "id": "a257160a-50f7-5eed-b783-67350cf51837", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "One hour after induction of anesthesia for a posterior fossa craniotomy using opioid, relaxant, and nitrous oxide, the brain begins to protrude through the dura. The most effective measure to decrease intracranial pressure is to", + "A": "administer additional opioid", + "B": "decrease PaCO2 from 25 to 15 mmHg", + "C": "drain cerebrospinal fluid", + "D": "discontinue nitrous oxide", + "E": "induce hypotension" + }, + "zh": { + "question": "在使用阿片类药物、肌松药和氧化亚氮进行后颅窝开颅术麻醉诱导一小时后，大脑开始通过硬脑膜突出。降低颅内压的最有效措施是", + "A": "给予额外的阿片类药物", + "B": "将PaCO2从25 mmHg降低到15 mmHg", + "C": "引流脑脊液", + "D": "停止使用氧化亚氮", + "E": "诱导低血压" + } + }, + { + "id": "8d1e6617-bda0-5fc5-924c-3798a6bcbc1c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A parturient receives ketamine 2 mg/kg and succinylcholine 1.5 mg/kg for induction prior to elective cesarean delivery. Which of the following is most likely to be present in the newborn infant?", + "A": "Normal muscle tone", + "B": "Bradycardia", + "C": "Opisthotonos", + "D": "Respiratory depression", + "E": "Seizures" + }, + "zh": { + "question": "一名产妇在择期剖宫产前接受了氯胺酮 2 mg/kg 和 琥珀胆碱 1.5 mg/kg 的诱导。以下哪项最有可能出现在新生儿中？", + "A": "正常肌张力", + "B": "心动过缓", + "C": "角弓反张", + "D": "呼吸抑制", + "E": "癫痫发作" + } + }, + { + "id": "072ea7f2-cd26-5232-9512-6eca0aba46ec", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "In a 5-kg child, the end-tidal carbon dioxide tension is 35 mmHg during spontaneous ventilation through a Mapleson D system. Which single change is most likely to increase this value?", + "A": "Decreasing the fresh gas flow", + "B": "Increasing respiratory minute volume", + "C": "Opening the pressure release valve", + "D": "Removing the reservoir bag", + "E": "Substituting larger bore tubing" + }, + "zh": { + "question": "在一个5公斤的儿童中，通过Mapleson D系统进行自主通气时，呼气末二氧化碳张力为35 mmHg。哪一项单独的改变最有可能增加这个值？", + "A": "减少新鲜气体流量", + "B": "增加呼吸分钟通气量", + "C": "打开压力释放阀", + "D": "移除储气袋", + "E": "更换为更大口径的管道" + } + }, + { + "id": "8e1188b1-428e-55f8-a4d2-435727c2c384", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A patient has seizure activity 30 seconds after injection of 0.25% bupivacaine 2 ml with epinephrine 1:200,000 for stellate ganglion block. The most likely cause is", + "A": "reaction to epinephrine in the anesthetic solution", + "B": "anaphylactoid reaction to bupivacaine", + "C": "subarachnoid injection of bupivacaine", + "D": "peridural venous injection of bupivacaine", + "E": "vertebral artery injection of bupivacaine" + }, + "zh": { + "question": "患者在注射0.25%布比卡因2毫升与1:200,000肾上腺素用于星状神经节阻滞后30秒出现癫痫活动。最可能的原因是", + "A": "对麻醉溶液中肾上腺素的反应", + "B": "对布比卡因的类过敏反应", + "C": "布比卡因的蛛网膜下腔注射", + "D": "布比卡因的硬膜外静脉注射", + "E": "布比卡因的椎动脉注射" + } + }, + { + "id": "ae577548-3594-5ad0-87f0-a7de125cd2fd", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A sensory level of T2 is achieved after administration of spinal anesthesia. Which of the following lung volumes is LEAST likely to be affected?", + "A": "Expiratory reserve volume", + "B": "Inspiratory reserve volume", + "C": "Inspiratory capacity", + "D": "Tidal volume", + "E": "Vital capacity" + }, + "zh": { + "question": "在施行脊髓麻醉后达到T2感觉平面。以下哪种肺容量最不可能受到影响？", + "A": "呼气储备容量", + "B": "吸气储备容量", + "C": "吸气容量", + "D": "潮气量", + "E": "肺活量" + } + }, + { + "id": "d5a195d1-09e7-5a0b-a71c-719f56c1a8fb", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 55-year-old woman who is scheduled to undergo carotid endarterectomy has a history of essential hypertension and chronic obstructive pulmonary disease. Over a 30-minute period beginning one hour after induction of general anesthesia, Sp02 decreases from 99% to 95%. During that time, she has received fentanyl 100 mcg, isoflurane 1%, nitrous oxide 49.5%, oxygen 49.5%, and a nitroglycerin infusion to maintain blood pressure at approximately 160/95 mmHg. Which of the following is the most likely cause for the decline in oxygen saturation?", + "A": "Decreased cardiac output", + "B": "Increased dead space ventilation", + "C": "Inhibition of hypoxic pulmonary vasoconstriction", + "D": "Mainstem intubation", + "E": "Second gas effect" + }, + "zh": { + "question": "一名55岁的女性计划接受颈动脉内膜切除术，她有原发性高血压和慢性阻塞性肺病的病史。在全身麻醉诱导后一小时开始的30分钟内，SpO2从99%下降到95%。在此期间，她接受了100微克芬太尼、1%异氟醚、49.5%氧化亚氮、49.5%氧气，并通过硝酸甘油输注将血压维持在约160/95 mmHg。以下哪项是氧饱和度下降的最可能原因？", + "A": "心输出量减少", + "B": "无效腔通气增加", + "C": "抑制低氧性肺血管收缩", + "D": "主支气管插管", + "E": "第二气体效应" + } + }, + { + "id": "e1267a71-b6c9-5812-b063-e48733d0e4dd", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Each of the following is a physiologic effect of intra-aortic balloon pump therapy EXCEPT", + "A": "decreased peak systolic pressure", + "B": "increased cardiac output", + "C": "increased coronary perfusion", + "D": "increased diastolic pressure", + "E": "increased total peripheral resistance" + }, + "zh": { + "question": "以下哪项不是主动脉内球囊反搏治疗的生理效应", + "A": "降低峰值收缩压", + "B": "增加心输出量", + "C": "增加冠状动脉灌注", + "D": "增加舒张压", + "E": "增加总外周阻力" + } + }, + { + "id": "5ea22fdf-deb4-5cf2-b20b-5c9ce0868f36", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Patients with acute alcohol intoxication are at increased risk for each of the following complications of general anesthesia EXCEPT", + "A": "aspiration of gastric contents", + "B": "hyperglycemia", + "C": "hypothermia", + "D": "ketoacidosis", + "E": "respiratory depression" + }, + "zh": { + "question": "急性酒精中毒的患者在全身麻醉时增加了以下并发症的风险，除了", + "A": "胃内容物吸入", + "B": "高血糖", + "C": "体温过低", + "D": "酮症酸中毒", + "E": "呼吸抑制" + } + }, + { + "id": "768e86a3-3ed9-5145-b7a2-9d8bf0ee72b1", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 35-year-old woman with systemic lupus erythematosus is admitted to the critical care unit following sudden onset of severe chest pain. Examination shows tachycardia, hypotension, pulmonary edema, and a blowing systolic murmur in the left parasternal region. The most appropriate management is", + "A": "aerosol administration of terbutaline", + "B": "intravenous infusion of phenylephrine and nitroglycerin", + "C": "intravenous infusion of esmolol", + "D": "intravenous infusion of epinephrine and nitroprusside", + "E": "volume loading with lactated Ringer's solution" + }, + "zh": { + "question": "一名35岁的系统性红斑狼疮女性患者因突发严重胸痛被送入重症监护室。检查显示心动过速、低血压、肺水肿以及左胸骨旁区有吹风样收缩期杂音。最合适的处理是", + "A": "雾化吸入特布他林", + "B": "静脉输注去氧肾上腺素和硝酸甘油", + "C": "静脉输注艾司洛尔", + "D": "静脉输注肾上腺素和硝普钠", + "E": "用乳酸林格氏液进行容量负荷" + } + }, + { + "id": "f03666b9-844d-564f-99ea-70ea6aa4b90e", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 20-kg, 5-year-old boy under treatment for five days for a cerebral contusion not requiring an operation is still unconscious. After three days of mechanical ventilation, humidified oxygen 40% via T-tube is started. Arterial blood gas analysis shows PaO2 120 mmHg, PaCO2 44 mmHg, pH 7.48, and base excess +6. A nasogastric tube is in place and draining to gravity. Daily fluid therapy has been 5% dextrose in 0.5 normal saline solution 500 ml and 5% dextrose in lactated Ringer's solution 500 ml. Serum electrolyte concentrations are sodium 140, potassium 3.2, and chloride 91 mEq/L. Serum osmolality is 300 mOsm/L. Urine output averages 15 ml/hour. Dexamethasone 8 mg/day has been the only drug therapy. This patient most likely requires", + "A": "additional intravenous fluids", + "B": "furosemide diuresis", + "C": "administration of ammonium chloride", + "D": "reinstitution of mechanical ventilation", + "E": "administration of potassium chloride" + }, + "zh": { + "question": "一名20公斤、5岁男孩因脑挫伤接受治疗五天，无需手术，仍处于昏迷状态。经过三天的机械通气后，开始通过T管给予40%湿化氧气。动脉血气分析显示PaO2 120 mmHg，PaCO2 44 mmHg，pH 7.48，碱剩余+6。鼻胃管已放置并引流至重力。每日液体治疗为500毫升5%葡萄糖0.5倍生理盐水和500毫升5%葡萄糖乳酸林格氏液。血清电解质浓度为钠140，钾3.2，氯91 mEq/L。血清渗透压为300 mOsm/L。尿量平均为15毫升/小时。地塞米松8毫克/天是唯一的药物治疗。该患者最可能需要", + "A": "额外的静脉输液", + "B": "呋塞米利尿", + "C": "氯化铵的给药", + "D": "重新进行机械通气", + "E": "氯化钾的给药" + } + }, + { + "id": "28206443-476e-5fcf-8a31-859765743728", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Pulmonary artery diastolic pressure is an unreliable indicator of left ventricular end-diastolic pressure in patients with", + "A": "acute cardiogenic pulmonary edema", + "B": "aortic stenosis", + "C": "acute mitral regurgitation", + "D": "myocardial ischemia", + "E": "severe emphysema" + }, + "zh": { + "question": "在以下患者中，肺动脉舒张压是左心室舒张末期压力的不可靠指标", + "A": "急性心源性肺水肿", + "B": "主动脉瓣狭窄", + "C": "急性二尖瓣返流", + "D": "心肌缺血", + "E": "严重肺气肿" + } + }, + { + "id": "ced30b94-fe0a-5560-b634-10f19db72dd1", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Neostigmine administered intravenously without atropine can produce each of the following EXCEPT", + "A": "arousal", + "B": "bradycardia", + "C": "bronchoconstriction", + "D": "increased gastric motility", + "E": "increased urinary bladder tone" + }, + "zh": { + "question": "静脉注射新斯的明而不使用阿托品可以产生以下各项，除了", + "A": "觉醒", + "B": "心动过缓", + "C": "支气管收缩", + "D": "胃肠蠕动增加", + "E": "膀胱张力增加" + } + }, + { + "id": "5e0e3957-3eb1-526e-9fa3-bc166aaa5be6", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is the most effective treatment of shivering following general anesthesia?", + "A": "Administration of droperidol", + "B": "Administration of morphine", + "C": "Administration of midazolam", + "D": "Administration of warm intravenous fluids", + "E": "Skin-surface warming" + }, + "zh": { + "question": "以下哪项是全身麻醉后寒战最有效的治疗方法？", + "A": "给予氟哌利多", + "B": "给予吗啡", + "C": "给予咪达唑仑", + "D": "给予温热的静脉输液", + "E": "皮肤表面加温" + } + }, + { + "id": "91b77a67-7937-5a3a-9134-7d2ba8c0b821", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The accuracy of oxyhemoglobin saturation determined by digital pulse oximetry is affected significantly by each of the following EXCEPT", + "A": "movement of the patient", + "B": "isovolemic hemodilution to a hematocrit of 23%", + "C": "position of the operating room light", + "D": "intravenous administration of methylene blue", + "E": "infusion of phenylephrine" + }, + "zh": { + "question": "以下各项中，哪一项不会显著影响数字脉搏血氧仪测定的氧合血红蛋白饱和度的准确性？", + "A": "患者的移动", + "B": "等容血液稀释至23%的血细胞比容", + "C": "手术室灯光的位置", + "D": "静脉注射亚甲蓝", + "E": "去氧肾上腺素的输注" + } + }, + { + "id": "c8dd4acc-3f6d-5718-acb5-59fcac724675", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The syndrome of inappropriate ADH secretion is characterized by", + "A": "ADH secretion unrelated to serum osmolality", + "B": "decreased ADH secretion in response to hypovolemia", + "C": "highly dilute urine", + "D": "hypernatremia", + "E": "negative water balance" + }, + "zh": { + "question": "不适当的抗利尿激素分泌综合征的特征是", + "A": "抗利尿激素分泌与血清渗透压无关", + "B": "在低血容量反应中抗利尿激素分泌减少", + "C": "尿液高度稀释", + "D": "高钠血症", + "E": "负水平衡" + } + }, + { + "id": "33fca6ea-af93-5f22-9d1b-3dcbc7bec55a", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A patient is placed in the prone jackknife position for lumbar subarachnoid injection of tetracaine 10 mg in 10 ml of preservative-free sterile water. Which of the following results is most likely?", + "A": "Respiratory insufficiency", + "B": "Sensory and motor block at T4-S1", + "C": "Sensory and motor block at L1-S5", + "D": "Sensory loss without motor block at L1-S5", + "E": "Sensory and motor block at S3-S5" + }, + "zh": { + "question": "一名患者被置于俯卧折刀位，以进行腰椎蛛网膜下腔注射10毫克的无防腐剂无菌水四卡因。以下哪种结果最有可能？", + "A": "呼吸功能不全", + "B": "T4-S1的感觉和运动阻滞", + "C": "L1-S5的感觉和运动阻滞", + "D": "L1-S5的感觉丧失而无运动阻滞", + "E": "S3-S5的感觉和运动阻滞" + } + }, + { + "id": "cfd6800e-224f-5d1e-85b5-ef048771a4b6", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Each of the following conditions is a complication of mediastinoscopy EXCEPT", + "A": "air embolism", + "B": "hemorrhage", + "C": "injury to the left recurrent laryngeal nerve", + "D": "occlusion of the left carotid artery", + "E": "tension pneumothorax" + }, + "zh": { + "question": "以下每种情况都是纵隔镜检查的并发症，除了", + "A": "空气栓塞", + "B": "出血", + "C": "左侧喉返神经损伤", + "D": "左颈动脉闭塞", + "E": "张力性气胸" + } + }, + { + "id": "caaad5e8-3d19-5895-a24b-af5c2957e9cf", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following factors is the major cause of hypotension following release of the infrarenal aortic cross-clamp during aortic reconstruction?", + "A": "Abnormal myocardial function", + "B": "Decreased systemic vascular resistance", + "C": "Down-regulation of adrenergic receptors", + "D": "Increased PaCO2", + "E": "Suppression of the renin-angiotensin system" + }, + "zh": { + "question": "以下哪项因素是主动脉重建过程中释放肾下主动脉夹后低血压的主要原因？", + "A": "异常的心肌功能", + "B": "全身血管阻力下降", + "C": "肾上腺素能受体下调", + "D": "PaCO2 增加", + "E": "肾素-血管紧张素系统抑制" + } + }, + { + "id": "2a5f3f32-aca4-5fd8-b245-824019d5c0fd", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Following hypothermic cardiopulmonary bypass, adequacy of total body rewarming is best indicated by normothermia recorded from the", + "A": "upper esophagus", + "B": "lower esophagus", + "C": "pulmonary artery", + "D": "rectum", + "E": "great toe" + }, + "zh": { + "question": "在低温体外循环后，全身复温的充分性最好通过以下哪个部位的正常体温来指示？", + "A": "上食管", + "B": "下食管", + "C": "肺动脉", + "D": "直肠", + "E": "大脚趾" + } + }, + { + "id": "b47b7209-6c23-5b17-bd9e-b73137749d7d", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Six months after repair of a lacerated peroneal nerve, a patient has electric-shock-like pain when pressure is applied to the middle of the gastrocnemius muscle. The most appropriate initial management is", + "A": "administration of carbamazepine", + "B": "epidural injection of morphine", + "C": "local infiltration with bupivacaine", + "D": "lumbar sympathetic blockade", + "E": "peroneal nerve blockade" + }, + "zh": { + "question": "在修复腓神经裂伤六个月后，患者在对腓肠肌中部施加压力时出现电击样疼痛。最合适的初始处理是", + "A": "给予卡马西平", + "B": "硬膜外注射吗啡", + "C": "局部浸润布比卡因", + "D": "腰交感神经阻滞", + "E": "腓神经阻滞" + } + }, + { + "id": "4e2784b7-5dfb-5d91-a150-f439e006ce3c", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Compared with blood anticoagulated with CPD, blood stored in CPDA-1 has", + "A": "better preservation of 2,3-DPG concentration", + "B": "better preservation of ATP concentration in erythrocytes", + "C": "shorter erythrocyte survival", + "D": "shorter shelf life", + "E": "decreased platelet aggregation" + }, + "zh": { + "question": "与用CPD抗凝的血液相比，储存在CPDA-1中的血液具有", + "A": "更好的2,3-DPG浓度保存", + "B": "更好的红细胞ATP浓度保存", + "C": "更短的红细胞存活时间", + "D": "更短的保质期", + "E": "减少的血小板聚集" + } + }, + { + "id": "fb27306f-f8e9-5bfa-8748-c61780a95704", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Following antagonism of a nondepolarizing muscle relaxant with neostigmine, twitch height is normal. To achieve this effect, the percentage of the acetylcholine receptor pool that must be free of muscle relaxant is", + "A": "10", + "B": "25", + "C": "33", + "D": "50", + "E": "75" + }, + "zh": { + "question": "在用新斯的明拮抗非去极化肌松药后，抽搐高度正常。要达到这种效果，必须有多少百分比的乙酰胆碱受体池不被肌松药占据", + "A": "10", + "B": "25", + "C": "33", + "D": "50", + "E": "75" + } + }, + { + "id": "64759a0b-a659-503f-a903-f1e28b0b839a", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Compared with adults, neonatal respiratory function is characterized by", + "A": "a lower ratio of dead space to tidal volume", + "B": "a more compliant chest wall", + "C": "a more positive intrapleural pressure at end-expiration", + "D": "less susceptibility to atelectasis", + "E": "the same oxygen requirement per kilogram of body weight" + }, + "zh": { + "question": "与成人相比，新生儿的呼吸功能特点是", + "A": "死腔与潮气量的比率较低", + "B": "胸壁更具顺应性", + "C": "呼气末胸膜内压更为正值", + "D": "对肺不张的敏感性较低", + "E": "每公斤体重的氧需求相同" + } + }, + { + "id": "927ed4cd-c53a-5134-aa0e-31d6c3c14ab2", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During laser excision of a vocal cord polyp, the tracheal tube ignites. Which of the following is the most appropriate next step?", + "A": "Continue ventilation with air", + "B": "Ensure patency of the endotracheal tube", + "C": "Extubate the trachea", + "D": "Flood the surgical field with saline solution", + "E": "Increase the concentration of nitrous oxide" + }, + "zh": { + "question": "在激光切除声带息肉期间，气管导管着火。以下哪项是最合适的下一步措施？", + "A": "继续用空气通气", + "B": "确保气管导管通畅", + "C": "拔除气管导管", + "D": "用生理盐水淹没手术区域", + "E": "增加一氧化二氮的浓度" + } + }, + { + "id": "c2060981-29aa-5083-bb0a-7d8457f1c83b", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "One day after a vaginal hysterectomy under epidural anesthesia, a patient has numbness and inability to dorsiflex the right foot. Her legs were placed in leg holders during the operation. The most likely cause is", + "A": "epidural hematoma", + "B": "common peroneal nerve injury", + "C": "sacral nerve root injury", + "D": "sacral plexus injury", + "E": "sciatic nerve injury" + }, + "zh": { + "question": "在硬膜外麻醉下进行阴道子宫切除术后一天，患者出现右脚麻木和无法背屈。手术期间，她的双腿被放置在腿托中。最可能的原因是", + "A": "硬膜外血肿", + "B": "腓总神经损伤", + "C": "骶神经根损伤", + "D": "骶丛损伤", + "E": "坐骨神经损伤" + } + }, + { + "id": "faead0a2-3aed-55a7-b47f-4b066e0876d9", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 45-year-old woman who sustained a subarachnoid hemorrhage 18 hours ago develops a severe headache and becomes unresponsive. Which of the following is the most likely cause of this patient's change in mental status?", + "A": "Cerebral edema", + "B": "Cerebral embolism", + "C": "Cerebral vasospasm", + "D": "Hypertensive encephalopathy", + "E": "Second subarachnoid hemorrhage" + }, + "zh": { + "question": "一名45岁的女性在18小时前发生了蛛网膜下腔出血，现出现严重头痛并失去反应。以下哪项最可能是该患者精神状态改变的原因？", + "A": "脑水肿", + "B": "脑栓塞", + "C": "脑血管痉挛", + "D": "高血压脑病", + "E": "再次蛛网膜下腔出血" + } + }, + { + "id": "745a50c8-eae0-5a2f-88c3-8de737255d1a", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A healthy, spontaneously breathing, supine, anesthetized patient has a PaCO2 to PetCO2 difference of 3 mmHg. Following institution of mechanical ventilation the value increases to 12 mmHg. The most likely cause of this change is", + "A": "cephalad displacement of the diaphragm", + "B": "decreased production of carbon dioxide", + "C": "increased cardiac output", + "D": "increased shunting of blood through dependent lung zones", + "E": "increased ventilation of nondependent lung zones" + }, + "zh": { + "question": "一位健康的、自然呼吸、仰卧、麻醉的患者，其PaCO2与PetCO2的差值为3 mmHg。在实施机械通气后，该值增加到12 mmHg。此变化最可能的原因是", + "A": "膈肌向头侧移位", + "B": "二氧化碳生成减少", + "C": "心输出量增加", + "D": "血液通过依赖性肺区的分流增加", + "E": "非依赖性肺区的通气增加" + } + }, + { + "id": "69323dea-dc2a-57c5-828b-64f077d0dde8", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 67-year-old man undergoes a perineal procedure under epidural anesthesia in the lithotomy position with extreme flexion of the thigh at the hip. No sedatives are used, and the surgery is uneventful. Forty-eight hours later, the patient cannot flex his left knee. Which of the following is the most likely cause?", + "A": "Epidural hematoma", + "B": "L5 nerve root injury", + "C": "Obturator nerve injury", + "D": "Peroneal nerve injury", + "E": "Sciatic nerve injury" + }, + "zh": { + "question": "一名67岁的男性在硬膜外麻醉下以截石位进行会阴手术，髋关节处大腿极度屈曲。未使用镇静剂，手术顺利。四十八小时后，患者无法屈曲左膝。以下哪项是最可能的原因？", + "A": "硬膜外血肿", + "B": "L5神经根损伤", + "C": "闭孔神经损伤", + "D": "腓神经损伤", + "E": "坐骨神经损伤" + } + }, + { + "id": "b56b5766-1994-52ff-8033-c9fe4dd75788", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Nine months after sustaining an injury to the left forearm, a 30-year-old woman has diffuse, burning pain on the anterior aspect of the forearm and posterior aspect of the hand and discoloration of the skin in the affected areas. The patient should be informed that", + "A": "if left untreated, muscle atrophy may develop in the involved limb", + "B": "if left untreated, the pain will remain well localized", + "C": "physical therapy is not indicated", + "D": "the symptoms are directly related to the severity of the initial injury", + "E": "the symptoms are most likely secondary to underlying peripheral vascular disease" + }, + "zh": { + "question": "在左前臂受伤九个月后，一名30岁的女性在前臂前侧和手后侧出现弥漫性烧灼痛，并且受影响区域的皮肤变色。应告知患者", + "A": "如果不治疗，受累肢体可能会出现肌肉萎缩", + "B": "如果不治疗，疼痛将保持局部化", + "C": "不建议进行物理治疗", + "D": "症状与初始损伤的严重程度直接相关", + "E": "症状最有可能是由潜在的周围血管疾病引起的" + } + }, + { + "id": "220c844f-a483-528e-ba69-38608793eac0", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Hyperkalemia in response to the administration of an intubating dose of succinylcholine is associated with each of the following disorders EXCEPT", + "A": "poliomyelitis", + "B": "multiple sclerosis", + "C": "hemiplegia", + "D": "acute cervical cord transection", + "E": "familial periodic paralysis" + }, + "zh": { + "question": "以下疾病中，除哪一项外，其他均与给予插管剂量的琥珀胆碱后出现高钾血症有关", + "A": "脊髓灰质炎", + "B": "多发性硬化症", + "C": "偏瘫", + "D": "急性颈髓横断", + "E": "家族性周期性麻痹" + } + }, + { + "id": "a59e9867-2ee2-57c7-9af7-af432d72d57e", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is the most likely beneficial effect of hyperbaric oxygen therapy in a 24-year-old scuba diver with decompression sickness?", + "A": "Decreased production of carbon dioxide", + "B": "Decreased size of gas bubbles", + "C": "Increased functional residual capacity", + "D": "Reversal of membrane pressure effects", + "E": "Shift of the oxyhemoglobin dissociation curve to the left" + }, + "zh": { + "question": "以下哪项是高压氧治疗对一名24岁患有减压病的潜水员最可能的有益效果？", + "A": "减少二氧化碳的产生", + "B": "减小气泡的大小", + "C": "增加功能残气量", + "D": "逆转膜压力效应", + "E": "氧合血红蛋白解离曲线左移" + } + }, + { + "id": "a53b90ce-41f7-5b7a-8369-83408a97fbfa", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is suggestive of epiglottitis rather than croup?", + "A": "A 2-year-old child with a harsh, barking cough", + "B": "A 4-year-old child who insists on sitting up and leaning forward", + "C": "Leukocyte count of 10,000/mm3 with marked lymphocytosis", + "D": "Rectal temperature of 38.5°C", + "E": "Subglottic narrowing (steeple sign) on lateral neck radiograph" + }, + "zh": { + "question": "以下哪项提示会厌炎而非哮吼？", + "A": "2岁儿童伴有刺耳的犬吠样咳嗽", + "B": "4岁儿童坚持坐起并向前倾", + "C": "白细胞计数为10,000/mm3，伴明显淋巴细胞增多", + "D": "直肠温度为38.5°C", + "E": "侧颈部X光片显示声门下狭窄（尖塔征）" + } + }, + { + "id": "3a8de211-96bf-5d45-b688-cb6ad7257a1d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "In calculating the fluid requirements for a newborn undergoing repair of an omphalocele, the third-space loss should be replaced by", + "A": "0.9% saline solution", + "B": "2.5% dextrose in 0.45% saline solution", + "C": "5% dextrose in lactated Ringer's solution", + "D": "5% dextrose in water", + "E": "5% dextrose in 0.25% saline solution" + }, + "zh": { + "question": "在计算新生儿进行脐膨出修复手术的液体需求时，第三间隙损失应通过以下方式补充", + "A": "0.9% 生理盐水", + "B": "2.5% 葡萄糖在 0.45% 生理盐水中", + "C": "5% 葡萄糖在乳酸林格氏液中", + "D": "5% 葡萄糖在水中", + "E": "5% 葡萄糖在 0.25% 生理盐水中" + } + }, + { + "id": "17ea4be7-6efa-570a-b919-62319991ffae", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The most important factor regulating blood flow to ischemic cerebral tissue is", + "A": "systolic blood pressure", + "B": "PaO2", + "C": "cerebral perfusion pressure", + "D": "PaCO2", + "E": "cerebral oxygen consumption" + }, + "zh": { + "question": "调节缺血性脑组织血流的最重要因素是", + "A": "收缩压", + "B": "动脉氧分压（PaO2）", + "C": "脑灌注压", + "D": "动脉二氧化碳分压（PaCO2）", + "E": "脑氧消耗量" + } + }, + { + "id": "d627937e-10ec-59dd-bd12-bb697e68f14c", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Measurement of which of the following provides the most reliable information about the severity of bronchospasm?", + "A": "Diffusing capacity", + "B": "Expiratory reserve volume", + "C": "Forced expiratory volume in 1 second", + "D": "Residual volume", + "E": "Total lung capacity" + }, + "zh": { + "question": "测量以下哪项可以提供关于支气管痉挛严重程度的最可靠信息？", + "A": "弥散能力", + "B": "呼气储备量", + "C": "1秒钟用力呼气量", + "D": "残气量", + "E": "肺总量" + } + }, + { + "id": "165389a1-0680-5f64-9eff-b8af0780e3b9", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "When inspired anesthetic gases are humidified", + "A": "most particles 1 to 2 microns in size are deposited in the trachea", + "B": "respiratory epithelial cilia become less active", + "C": "alveolar water vapor pressure is unchanged", + "D": "respiratory heat loss is abolished", + "E": "sterilization of breathing apparatus is mandatory" + }, + "zh": { + "question": "当吸入的麻醉气体被加湿时", + "A": "大多数1到2微米大小的颗粒沉积在气管中", + "B": "呼吸上皮纤毛的活性降低", + "C": "肺泡水蒸气压不变", + "D": "呼吸热量损失被消除", + "E": "呼吸设备的消毒是强制性的" + } + }, + { + "id": "0911baee-ddfe-5fef-81a4-5953a70c8278", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "If a patient with chronic obstructive pulmonary disease is uncooperative during pulmonary function testing, the most accurate assessment of his disease will be derived from the", + "A": "forced expiratory volume in 1 second", + "B": "forced midexpiratory flow", + "C": "forced vital capacity", + "D": "maximal voluntary ventilation", + "E": "peak flow rate" + }, + "zh": { + "question": "如果一名患有慢性阻塞性肺疾病的患者在肺功能测试中不合作，最准确的疾病评估将来自于", + "A": "1秒钟用力呼气量", + "B": "用力中段呼气流量", + "C": "用力肺活量", + "D": "最大自主通气量", + "E": "峰值流量" + } + }, + { + "id": "96a0f928-9694-5080-a02f-2439ed97dd44", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Postoperatively a 70-kg patient has a serum sodium value of 130 mEq/L. To increase this value to 140 mEq/L would require the administration of how much sodium in mEq?", + "A": "140", + "B": "250", + "C": "420", + "D": "600", + "E": "740" + }, + "zh": { + "question": "术后，一名70公斤的患者血清钠值为130 mEq/L。要将此值增加到140 mEq/L，需要给予多少毫当量的钠？", + "A": "140", + "B": "250", + "C": "420", + "D": "600", + "E": "740" + } + }, + { + "id": "4a64a931-74a5-5d27-b29f-f8899cbdd03a", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "During attempted awake intubation, the patient gags when the laryngoscope presses on the base of the tongue. Which of the following cranial nerves is responsible for the afferent limb of this reflex?", + "A": "Trigeminal", + "B": "Facial", + "C": "Glossopharyngeal", + "D": "Vagus", + "E": "Hypoglossal" + }, + "zh": { + "question": "在尝试清醒插管时，当喉镜压在舌根部时，患者出现呕吐反射。以下哪一对颅神经负责该反射的传入部分？", + "A": "三叉神经", + "B": "面神经", + "C": "舌咽神经", + "D": "迷走神经", + "E": "舌下神经" + } + }, + { + "id": "0f8233ae-c1c6-533d-b2be-6be6a160cf4f", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is most likely in a 30-year-old patient with untreated hypothyroidism?", + "A": "Cardiac arrhythmias with ketamine administration", + "B": "Decreased ventilatory response to hypoxia", + "C": "Hypoglycemia", + "D": "Increased MAC of inhalational anesthetics", + "E": "Peripheral vasodilatation" + }, + "zh": { + "question": "在一名30岁未治疗的甲状腺功能减退症患者中，以下哪项最有可能出现？", + "A": "使用氯胺酮时出现心律失常", + "B": "对低氧的通气反应降低", + "C": "低血糖", + "D": "吸入麻醉药的MAC增加", + "E": "外周血管扩张" + } + }, + { + "id": "66750711-0bf8-5763-9cd1-d92f7229ab8c", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The most medial of the following components in the antecubital fossa is the", + "A": "brachial artery", + "B": "brachioradialis muscle", + "C": "cephalic vein", + "D": "median nerve", + "E": "radial nerve" + }, + "zh": { + "question": "在肘窝中以下成分中最靠内侧的是", + "A": "肱动脉", + "B": "肱桡肌", + "C": "头静脉", + "D": "正中神经", + "E": "桡神经" + } + }, + { + "id": "661ad5f8-5997-5367-a378-99a12e5e2882", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "For any given FiO2 and PaCO2, the PaO2 is lower in a healthy paralyzed patient anesthetized with isoflurane than in the same patient unanesthetized and breathing spontaneously. The primary cause of this difference is", + "A": "controlled ventilation", + "B": "increased airway resistance", + "C": "inhibition of hypoxic pulmonary vasoconstriction", + "D": "intraoperative hypothermia", + "E": "preferential ventilation of nondependent lung" + }, + "zh": { + "question": "对于任何给定的FiO2和PaCO2，使用异氟醚麻醉的健康瘫痪患者的PaO2低于同一患者未麻醉且自主呼吸时。造成这种差异的主要原因是", + "A": "控制通气", + "B": "气道阻力增加", + "C": "抑制低氧性肺血管收缩", + "D": "术中低体温", + "E": "非依赖性肺的优先通气" + } + }, + { + "id": "53e144d6-b8f9-5760-bf4d-2ea90fd3e755", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A 33-year-old primigravid woman with myasthenia gravis, well-controlled with pyridostigmine, is in labor with the cervix dilated 7 cm. She has a headache and feels very nervous. Blood pressure is 160/115 mmHg, she has 3+ pitting edema, and urinalysis shows 4+ protein. Appropriate management of her labor should include", + "A": "lumbar epidural block with bupivacaine 8 ml of 0.5% solution", + "B": "chlorpromazine 2.5 mg administered intravenously", + "C": "avoidance of narcotics", + "D": "lumbar epidural block with 2-chloroprocaine 8 ml of 3% solution", + "E": "chlorpromazine 10 mg administered intramuscularly" + }, + "zh": { + "question": "一名33岁的初产妇患有重症肌无力，通过吡啶斯的明控制良好，目前宫颈扩张7厘米，正在分娩中。她感到头痛和非常紧张。血压为160/115 mmHg，有3+凹陷性水肿，尿液分析显示4+蛋白。对她分娩的适当管理应包括", + "A": "腰椎硬膜外阻滞，使用8 ml 0.5%布比卡因溶液", + "B": "静脉注射2.5 mg氯丙嗪", + "C": "避免使用麻醉药", + "D": "腰椎硬膜外阻滞，使用8 ml 3% 2-氯普鲁卡因溶液", + "E": "肌肉注射10 mg氯丙嗪" + } + }, + { + "id": "d2b9927b-6390-5a21-b5ac-14175edf335f", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "A woman has weakness of the right quadriceps and a decreased knee jerk reflex on the right one day after forceps delivery under epidural anesthesia. The most likely cause is", + "A": "epidural hematoma", + "B": "intrapelvic nerve trauma", + "C": "lithotomy positioning", + "D": "reaction to the preservative in the anesthetic solution", + "E": "trauma from the epidural needle" + }, + "zh": { + "question": "一名女性在硬膜外麻醉下使用产钳分娩后一天，出现右侧股四头肌无力和右侧膝反射减弱。最可能的原因是", + "A": "硬膜外血肿", + "B": "盆腔内神经损伤", + "C": "截石位姿势", + "D": "对麻醉溶液中防腐剂的反应", + "E": "硬膜外针的创伤" + } + }, + { + "id": "97681bf7-d984-5c07-9c6f-0f9958a51833", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Long-term use of cimetidine is associated with", + "A": "delayed emergence after thiopental induction", + "B": "increased hypotension after morphine", + "C": "increased risk for isoflurane-induced nephrotoxicity", + "D": "prolonged action of succinylcholine", + "E": "prolonged sedation with diazepam" + }, + "zh": { + "question": "长期使用西咪替丁与以下哪项有关", + "A": "硫喷妥钠诱导后苏醒延迟", + "B": "吗啡后低血压增加", + "C": "异氟醚诱导的肾毒性风险增加", + "D": "琥珀胆碱作用时间延长", + "E": "地西泮镇静时间延长" + } + }, + { + "id": "97c73293-f41c-54fa-839a-f3d6a79671e9", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "The following changes occur during posterior cervical fusion in the prone position under halothane and nitrous oxide anesthesia with mechanical ventilation: HR 78 --> 84 with frequent PVCs; BP 110/70 --> 90/50; EtCO2 4.5% --> 2.0%; EtN2 0.12% --> 4% The most appropriate next step is to", + "A": "administer lidocaine intravenously", + "B": "decrease ventilatory rate", + "C": "discontinue halothane", + "D": "lower the patient's head", + "E": "inspect the ventilator bellows" + }, + "zh": { + "question": "在使用氟烷和氧化亚氮麻醉并进行机械通气的俯卧位后颈椎融合术中，发生以下变化：心率 78 --> 84，伴有频繁的室性早搏；血压 110/70 --> 90/50；呼气末二氧化碳分压 4.5% --> 2.0%；呼气末氮气分压 0.12% --> 4%。最合适的下一步措施是", + "A": "静脉注射利多卡因", + "B": "降低通气频率", + "C": "停止使用氟烷", + "D": "降低患者头部", + "E": "检查呼吸机风箱" + } + }, + { + "id": "58afbbcb-7eae-5f82-b854-ccdaaaf695bb", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "A 30-year-old woman underwent emergency cesarean delivery under general anesthesia at 36 weeks' gestation because of preeclampsia. Two hours after the operation, she is still intubated and apneic and cannot be aroused. Deep tendon reflexes are 1+. With mechanical ventilation at an FiO2 of 0.4, PaO2 is 130 mmHg, PaCO2 is 32 mmHg, pH is 7.45, and base excess is -0.6. The most likely cause is", + "A": "hypovolemic shock", + "B": "intracerebral hemorrhage", + "C": "nitroprusside toxicity", + "D": "overdose of magnesium sulfate", + "E": "pituitary necrosis" + }, + "zh": { + "question": "一名30岁的女性因子痫前期在妊娠36周时接受了全身麻醉下的紧急剖宫产。手术后两小时，她仍然插管且无呼吸，无法唤醒。深腱反射为1+。在FiO2为0.4的机械通气下，PaO2为130 mmHg，PaCO2为32 mmHg，pH为7.45，碱剩余为-0.6。最可能的原因是", + "A": "低血容量性休克", + "B": "颅内出血", + "C": "硝普钠中毒", + "D": "硫酸镁过量", + "E": "垂体坏死" + } + }, + { + "id": "ba181bb1-312b-5f31-bbe9-499d252d4f3d", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Which of the following is the most likely cause of the rapid onset of local anesthesia when sodium bicarbonate is added to lidocaine?", + "A": "Decreased extracellular calcium ion concentration", + "B": "Increased extracellular pH", + "C": "Increased intracellular pH", + "D": "Increased ionized lidocaine diffusion", + "E": "Increased nonionized lidocaine concentration" + }, + "zh": { + "question": "以下哪项是加入碳酸氢钠到利多卡因中导致局部麻醉快速起效的最可能原因？", + "A": "细胞外钙离子浓度降低", + "B": "细胞外pH值升高", + "C": "细胞内pH值升高", + "D": "离子化利多卡因扩散增加", + "E": "非离子化利多卡因浓度增加" + } + }, + { + "id": "5ab12a79-41ca-5498-92d6-f6a53cb90acd", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 40-year-old man who is scheduled to undergo repair of a tendon laceration of the left hand has complete anesthesia in the median, radial, and ulnar nerve distributions after supraclavicular block. Two hours of tourniquet inflation are required for completion of the procedure. The most appropriate next step is an additional block of which of the following?", + "A": "Axillary nerve", + "B": "Intercostobrachial nerve", + "C": "Lateral antebrachial cutaneous nerve", + "D": "Musculocutaneous nerve", + "E": "Stellate ganglion" + }, + "zh": { + "question": "一名40岁的男性计划进行左手肌腱裂伤修复术，在锁骨上阻滞后，他在正中神经、桡神经和尺神经分布区完全麻醉。手术需要两个小时的止血带充气时间。最合适的下一步是对以下哪一项进行额外阻滞？", + "A": "腋神经", + "B": "肋间臂神经", + "C": "外侧前臂皮神经", + "D": "肌皮神经", + "E": "星状神经节" + } + }, + { + "id": "02432d2a-35f0-5917-ac8e-d0ffdf6ac038", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Uterine blood flow is", + "A": "autoregulated in normal unanesthetized parturients", + "B": "decreased by the addition of epinephrine 1:200,000 to lidocaine administered epidurally", + "C": "decreased by intravenous infusion of ritodrine in unanesthetized parturients", + "D": "increased by administration of magnesium sulfate to patients with preeclampsia", + "E": "unchanged after paracervical injection of lidocaine without epinephrine" + }, + "zh": { + "question": "子宫血流是", + "A": "在正常未麻醉的产妇中是自我调节的", + "B": "通过在硬膜外注射的利多卡因中加入1:200,000的肾上腺素而减少", + "C": "通过在未麻醉的产妇中静脉输注利托君而减少", + "D": "通过对患有子痫前期的患者给予硫酸镁而增加", + "E": "在宫颈旁注射不含肾上腺素的利多卡因后不变" + } + }, + { + "id": "6368c3e1-651d-52cb-b69d-eb7b3ecd0875", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 38-year-old woman with hyperthyroidism is undergoing open reduction and internal fixation of a fractured humerus with isoflurane anesthesia. Intraoperatively her heart rate increases to 120 bpm with occasional premature ventricular contractions. The most appropriate therapy at this time is to", + "A": "discontinue isoflurane", + "B": "administer edrophonium", + "C": "administer esmolol", + "D": "administer lidocaine", + "E": "administer propylthiouracil" + }, + "zh": { + "question": "一名38岁的甲亢女性正在接受异氟醚麻醉下的肱骨骨折切开复位内固定术。术中她的心率增加到120次/分钟，并出现偶发性室性早搏。此时最合适的治疗是", + "A": "停止使用异氟醚", + "B": "给予依酚氯铵", + "C": "给予艾司洛尔", + "D": "给予利多卡因", + "E": "给予丙硫氧嘧啶" + } + }, + { + "id": "c0f38cb5-d810-5027-8759-aa80b3482cb1", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning caudal anesthesia in children is true?", + "A": "The dural sac extends further caudad than in adults", + "B": "Delay of postoperative micturition occurs in most patients", + "C": "The sensory level of analgesia is poorly correlated with the dose of local anesthetic", + "D": "It is technically difficult because of poorly defined sacral anatomy", + "E": "It is contraindicated in infants younger than 1 year of age" + }, + "zh": { + "question": "以下关于儿童尾部麻醉的说法中哪一项是正确的？", + "A": "硬膜囊向尾侧延伸比成人更远", + "B": "大多数患者术后排尿延迟", + "C": "镇痛的感觉水平与局部麻醉剂的剂量相关性差", + "D": "由于骶骨解剖结构不明确，技术上很困难", + "E": "1岁以下婴儿禁用" + } + }, + { + "id": "5f949385-eac3-5d04-99ca-5d7d48c1022b", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with adults, caudal anesthesia in children is associated with", + "A": "higher risk for subarachnoid puncture", + "B": "more severe hypotension", + "C": "more rapid onset of sensory block", + "D": "smaller volume of anesthetic per kilogram of body weight", + "E": "toxic effects at lower serum levels of bupivacaine" + }, + "zh": { + "question": "与成人相比，儿童的尾部麻醉与以下哪项相关", + "A": "蛛网膜下腔穿刺的风险更高", + "B": "更严重的低血压", + "C": "感觉阻滞起效更快", + "D": "每公斤体重的麻醉剂量更小", + "E": "布比卡因在较低血清水平时的毒性作用" + } + }, + { + "id": "876764c2-032d-54a7-b407-6089208299a4", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A parturient received 1000 ml of dextrose 5% in lactated Ringer's solution 20 minutes prior to delivery. Ten minutes later her blood glucose concentration is 580 mg/dl. In this situation", + "A": "the risk for fetal intraventricular hemorrhage is increased", + "B": "the risk for neonatal hypoglycemia is increased", + "C": "placental glucose transport is insulin dependent", + "D": "the neonate should be given dextrose 50% in water if depressed at delivery", + "E": "the mother should be given insulin prior to delivery" + }, + "zh": { + "question": "一名产妇在分娩前20分钟接受了1000毫升5%葡萄糖乳酸林格氏液��十分钟后，她的血糖浓度为580 mg/dl。在这种情况下", + "A": "胎儿脑室内出血的风险增加", + "B": "新生儿低血糖的风险增加", + "C": "胎盘葡萄糖运输依赖于胰岛素", + "D": "如果新生儿在分娩时抑郁，应给予50%葡萄糖水", + "E": "母亲应在分娩前给予胰岛素" + } + }, + { + "id": "28e28fb2-3678-5b79-987f-d0a5d8b3f1d2", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A patient receives 1.5% bupivacaine 40 ml and epinephrine 1:200,000 for axillary brachial plexus block for reduction of a forearm fracture. The tourniquet is inflated to 300 mmHg; 45 minutes later, the patient has pain that radiates to the posteromedial elbow. Which of the following nerves is NOT adequately blocked?", + "A": "Intercostobrachial", + "B": "Median", + "C": "Musculocutaneous", + "D": "Ulnar", + "E": "Radial" + }, + "zh": { + "question": "一名患者接受1.5%布比卡因40毫升和1:200,000肾上腺素用于腋窝臂丛阻滞，以减少前臂骨折。止血带充气至300 mmHg；45分钟后，患者感到疼痛辐射到肘部后内侧。以下哪一条神经没有被充分阻滞？", + "A": "肋间臂神经", + "B": "正中神经", + "C": "肌皮神经", + "D": "尺神经", + "E": "桡神经" + } + }, + { + "id": "ae31a914-bf4f-5826-815f-06719c981b67", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Compared with the response of a normal patient, administration of a bolus dose of pancuronium (0.15 mg/kg) to a patient with cirrhosis and ascites would be associated with", + "A": "longer duration", + "B": "more rapid onset", + "C": "more intense block", + "D": "more difficult reversibility", + "E": "similar pharmacokinetics" + }, + "zh": { + "question": "与正常患者的反应相比，给予肝硬化和腹水患者一剂量的潘库溴铵（0.15 mg/kg）将与以下哪种情况相关", + "A": "持续时间更长", + "B": "起效更快", + "C": "阻滞更强", + "D": "更难逆转", + "E": "药代动力学相似" + } + }, + { + "id": "d1e0589b-ffac-59fe-a333-6805929770ef", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 55-year-old man is undergoing craniotomy in the sitting position. Mean arterial pressure is 75 mmHg; arterial blood gas values are PaCO2 41 mmHg and pH 7.37. End-tidal CO2 is 7 mmHg. Which of the following is the most likely cause of the increased PaCO2 to PetCO2 gradient?", + "A": "Decreased cardiac output", + "B": "Endobronchial intubation", + "C": "Hyperinflation of the lungs", + "D": "Partial disconnect of the capnograph sample tubing", + "E": "Venous air embolism" + }, + "zh": { + "question": "一名55岁的男性正在坐位进行开颅手术。平均动脉压为75 mmHg；动脉血气值为PaCO2 41 mmHg和pH 7.37。呼气末二氧化碳为7 mmHg。以下哪项是导致PaCO2与PetCO2梯度增加的最可能原因？", + "A": "心输出量减少", + "B": "支气管内插管", + "C": "肺过度充气", + "D": "二氧化碳监测取样管部分断开", + "E": "静脉空气栓塞" + } + }, + { + "id": "4489bca4-f06d-53a4-adaa-f3e6de36d538", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following increases during infusion of epinephrine?", + "A": "Glycogen synthesis", + "B": "Intracellular glucose concentration", + "C": "Intracellular potassium concentration", + "D": "Lipogenesis", + "E": "Protein synthesis" + }, + "zh": { + "question": "在注射肾上腺素期间，下列哪项增加？", + "A": "糖原合成", + "B": "细胞内葡萄糖浓度", + "C": "细胞内钾浓度", + "D": "脂肪生成", + "E": "蛋白质合成" + } + }, + { + "id": "0ddf40e6-6629-5272-9582-e451f06c7991", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Alveolar stability at varying lung volumes is maintained by", + "A": "constant surface tension", + "B": "increased surface tension at low lung volume", + "C": "decreased surface tension at high lung volume", + "D": "decreased surface tension at low lung volume", + "E": "none of the above" + }, + "zh": { + "question": "在不同肺容量下维持肺泡稳定性的是", + "A": "恒定的表面张力", + "B": "在低肺容量时增加的表面张力", + "C": "在高肺容量时减少的表面张力", + "D": "在低肺容量时减少的表面张力", + "E": "以上都不是" + } + }, + { + "id": "5e18eb86-80b9-5c94-98f7-d5322b293fa8", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "An unvaccinated health care worker is stuck by a needle contaminated with blood from an HBsAg-positive patient. Which of the following statements concerning this situation is true?", + "A": "The risk for development of HIV infection is greater than the risk for development of hepatitis", + "B": "Hepatitis immune globulin is indicated if the health care worker is HBcAg positive", + "C": "Hepatitis B vaccine should be administered", + "D": "Hepatitis immune globulin will protect equally against hepatitis B and hepatitis C (non-A, non-B)", + "E": "Hepatitis B vaccine carries a risk for transmission of HIV" + }, + "zh": { + "question": "一名未接种疫苗的医护人员被一根被HBsAg阳性患者的血液污染的针刺伤。关于这种情况，下列哪项陈述是正确的？", + "A": "感染HIV的风险大于感染肝炎的风险", + "B": "如果医护人员HBcAg阳性，则应使用肝炎免疫球蛋白", + "C": "应接种乙型肝炎疫苗", + "D": "肝炎免疫球蛋白对乙型肝炎和丙型肝炎（非A非B型）具有同等的保护作用", + "E": "乙型肝炎疫苗有传播HIV的风险" + } + }, + { + "id": "bd4b470d-73ef-5887-9f53-88a024d8a6bb", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which Mapleson breathing circuit permits the LEAST amount of fresh gas inflow to prevent rebreathing during spontaneous ventilation?", + "A": "A", + "B": "B", + "C": "C", + "D": "D", + "E": "E" + }, + "zh": { + "question": "哪种Mapleson呼吸回路在自发通气时需要最少的新鲜气体流入量以防止再呼吸？", + "A": "A", + "B": "B", + "C": "C", + "D": "D", + "E": "E" + } + }, + { + "id": "44d9a726-92af-5c8f-b4b6-3a0a21f781a1", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Compared with thiopental, methohexital is characterized by", + "A": "better absorption after rectal administration", + "B": "greater protein binding", + "C": "greater hepatic clearance", + "D": "larger volume of distribution", + "E": "more complete biotransformation" + }, + "zh": { + "question": "与硫喷妥钠相比，甲氧己妥的特点是", + "A": "直肠给药后吸收更好", + "B": "更高的蛋白结合率", + "C": "更大的肝脏清除率", + "D": "更大的分布容积", + "E": "更完全的生物转化" + } + }, + { + "id": "9437afda-3cb1-57e7-931e-fb90620a5f53", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 50-year-old man with severe coronary artery disease undergoes coronary artery bypass grafting. Five minutes after successful termination of cardiopulmonary bypass, ST-segment elevation is noted in lead II of the ECG, and the following findings are noted: BP 70/40, Pulse 80, CVP 16 cmH2O, PAp 25/10. Appropriate management is to", + "A": "administer propranolol", + "B": "administer nitroglycerin", + "C": "administer dopamine", + "D": "administer crystalloid fluid", + "E": "return the patient to cardiopulmonary bypass" + }, + "zh": { + "question": "一名50岁的男性患有严重的冠状动脉疾病，接受冠状动脉旁路移植术。成功终止体外循环五分钟后，心电图II导联出现ST段抬高，并观察到以下情况：血压70/40，脉搏80，中心静脉压16 cmH2O，肺动脉压25/10。适当的处理是", + "A": "给予普萘洛尔", + "B": "给予硝酸甘油", + "C": "给予多巴胺", + "D": "给予晶体液", + "E": "将患者返回体外循环" + } + }, + { + "id": "68aecd4f-4167-5464-86f9-e702a511f523", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 55-year-old man has quadriplegia after undergoing suboccipital craniotomy in the sitting position for treatment of acoustic neuroma. Which of the following is the most likely cause?", + "A": "Air embolism with the presence of a probe-patent foramen ovale", + "B": "Compression of the cervical cord related to neck flexion", + "C": "Jugular venous obstruction", + "D": "Postoperative tension pneumocephalus", + "E": "Sustained elevation of cerebral perfusion pressure" + }, + "zh": { + "question": "一名55岁的男性在坐位下接受枕下开颅术治疗听神经瘤后出现四肢瘫痪。以下哪项是最可能的原因？", + "A": "存在探针开放卵圆孔的空气栓塞", + "B": "与颈部屈曲相关的颈髓压迫", + "C": "颈静脉阻塞", + "D": "术后张力性气颅", + "E": "脑灌注压持续升高" + } + }, + { + "id": "9956dc05-70dc-5872-b72f-f5ef99e63b9c", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "In an unpremedicated, spontaneously breathing patient, an alveolar halothane concentration of 0.74% in oxygen is consistently associated with", + "A": "absence of overt response to skin incision", + "B": "constricted pupils", + "C": "flaccidity of abdominal muscles", + "D": "normal glomerular filtration rate", + "E": "normal myocardial contractility" + }, + "zh": { + "question": "在未预先用药且自主呼吸的患者中，氧气中0.74%的肺泡氟烷浓度通常与以下哪项相关", + "A": "对皮肤切口无明显反应", + "B": "瞳孔缩小", + "C": "腹肌松弛", + "D": "正常的肾小球滤过率", + "E": "正常的心肌收缩力" + } + }, + { + "id": "5eaf1b12-d3db-514b-9163-5cfc0bcf778f", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following detects the smallest volume of venous air embolization?", + "A": "Changing the precordial Doppler ultrasound signal", + "B": "Decreasing PetC02", + "C": "Decreasing Sp02", + "D": "Increasing central venous pressure", + "E": "Increasing pulmonary artery pressure" + }, + "zh": { + "question": "以下哪项可以检测到最小体积的静脉空气栓塞？", + "A": "心前区多普勒超声信号的变化", + "B": "PetCO2的下降", + "C": "SpO2的下降", + "D": "中心静脉压的升高", + "E": "肺动脉压的升高" + } + }, + { + "id": "e3c2bda1-cc45-5d60-b9ef-110348f618a2", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "In a healthy patient receiving an epidural analgesic infusion postoperatively, clear fluid is noted to drip back freely from the epidural catheter. Which of the following findings correctly identifies the associated fluid?", + "A": "Precipitation when mixed with an equal volume of pancuronium = local anesthetic", + "B": "pH 7.1 = saline solution", + "C": "Glucose 120 mg/dl = CSF", + "D": "Sodium 130 mEq/L = CSF", + "E": "PCO2 51 mmHg = CSF" + }, + "zh": { + "question": "在一位健康患者术后接受硬膜外镇痛输注时，注意到硬膜外导管中有清液自由滴出。以下哪项发现正确识别了相关液体？", + "A": "与等量的潘库溴铵混合时沉淀 = 局部麻醉剂", + "B": "pH 7.1 = 生理盐水", + "C": "葡萄糖 120 mg/dl = 脑脊液", + "D": "钠 130 mEq/L = 脑脊液", + "E": "PCO2 51 mmHg = 脑脊液" + } + }, + { + "id": "88c86958-2c0c-57b4-bf14-025afe4dfe40", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Compared with a patient who is breathing spontaneously, a patient in the supine position receiving controlled positive-pressure ventilation will most likely have which of the following findings?", + "A": "Decreased pulmonary vascular resistance", + "B": "Decreased ratio of dead space to tidal volume", + "C": "Increased ventilation of nondependent alveoli", + "D": "Increased perfusion of nondependent alveoli", + "E": "Improved matching of ventilation to perfusion" + }, + "zh": { + "question": "与自主呼吸的患者相比，仰卧位接受控制性正压通气的患者最有可能出现以下哪种情况？", + "A": "肺血管阻力降低", + "B": "死腔与潮气量的比率降低", + "C": "非依赖性肺泡的通气增加", + "D": "非依赖性肺泡的灌注增加", + "E": "通气与灌注的匹配改善" + } + }, + { + "id": "8b8b0b9f-0eb1-5111-bf34-d8e46895ac22", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A subarachnoid block to a sensory level of the second thoracic dermatome is associated with each of the following EXCEPT", + "A": "total sympathetic block", + "B": "decreased gastrointestinal smooth muscle tone", + "C": "bradycardia", + "D": "relaxation of gastrointestinal sphincters", + "E": "decreased renal blood flow" + }, + "zh": { + "question": "蛛网膜下腔阻滞至第二胸段皮节的感觉水平与以下各项有关，除了", + "A": "完全交感神经阻滞", + "B": "胃肠道平滑肌张力降低", + "C": "心动过缓", + "D": "胃肠道括约肌松弛", + "E": "肾血流量减少" + } + }, + { + "id": "988010e7-7582-5768-ad0b-4864d5043e45", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following drugs increases the duration of succinylcholine action EXCEPT", + "A": "echothiophate", + "B": "gentamicin", + "C": "magnesium sulfate", + "D": "pyridostigmine", + "E": "trimethaphan" + }, + "zh": { + "question": "下列每种药物都会延长琥珀胆碱的作用时间，除了", + "A": "磷酸二乙酯", + "B": "庆大霉素", + "C": "硫酸镁", + "D": "吡啶斯的明", + "E": "三甲胺" + } + }, + { + "id": "39804efa-c37d-5845-9d6d-c63e7e05c610", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A previously healthy 28-year-old man is admitted to the emergency department with a probable opioid overdose. Arterial blood gas values are: PaO2 49 mmHg, PaCO2 76 mmHg, and pH 7.12 while breathing room air. Which of the following statements is true?", + "A": "Aspiration of gastric contents must have occurred", + "B": "Hypoventilation alone can explain the acidosis and hypoxemia", + "C": "The hypoxemia is probably due to noncardiogenic pulmonary edema", + "D": "Naloxone should be administered only if the patient is normothermic", + "E": "Pure oxygen is contraindicated" + }, + "zh": { + "question": "一名先前健康的28岁男性因可能的阿片类药物过量被送入急诊科。动脉血气值为：PaO2 49 mmHg，PaCO2 76 mmHg，pH 7.12，呼吸室内空气。以下哪项陈述是正确的？", + "A": "一定发生了胃内容物吸入", + "B": "单纯的通气不足可以解释酸中毒和低氧血症", + "C": "低氧血症可能是由于非心源性肺水肿引起的", + "D": "只有在患者体温正常时才应给予纳洛酮", + "E": "纯氧是禁忌的" + } + }, + { + "id": "3a0efbe8-233f-570e-829f-209abddd65f9", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 30-year-old man receives spinal anesthesia to the level of T4. Ten minutes later, heart rate and blood pressure abruptly decrease to 30 bpm and 60/25 mmHg, respectively. The most appropriate management is administration of which of the following drugs?", + "A": "Atropine", + "B": "Epinephrine", + "C": "Isoproterenol", + "D": "Metaraminol", + "E": "Phenylephrine" + }, + "zh": { + "question": "一名30岁的男性接受了T4水平的脊髓麻醉。十分钟后，心率和血压突然降至30次/分钟和60/25 mmHg。最合适的处理是给予以下哪种药物？", + "A": "阿托品", + "B": "肾上腺素", + "C": "异丙肾上腺素", + "D": "美他明诺", + "E": "苯肾上腺素" + } + }, + { + "id": "b3800c10-c47f-5984-b094-1a97ec60139d", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A full-term neonate has physical findings suggestive of congenital diaphragmatic hernia. Initial Apgar score is 2. Which of the following is the most appropriate initial management?", + "A": "Placement of an orogastric tube", + "B": "Insertion of a chest tube", + "C": "Controlled ventilation by face mask", + "D": "Controlled ventilation through an endotracheal tube", + "E": "Spontaneous ventilation through an endotracheal tube" + }, + "zh": { + "question": "一名足月新生儿的体格检查提示先天性膈疝。初始阿普加评分为2。以下哪项是最合适的初始处理？", + "A": "放置口胃管", + "B": "插入胸管", + "C": "面罩控制通气", + "D": "通过气管插管进行控制通气", + "E": "通过气管插管进行自主通气" + } + }, + { + "id": "b5f507c9-db9e-53a8-9eb0-9d9d298b5c58", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The muscular action most likely to remain intact following an axillary brachial plexus block is", + "A": "flexion at the elbow", + "B": "extension at the wrist", + "C": "flexion of digits 3, 4, and 5", + "D": "extension of digits 1, 2, and 3", + "E": "extension at the elbow" + }, + "zh": { + "question": "在腋窝臂丛神经阻滞后最有可能保持完整的肌肉动作是", + "A": "肘部屈曲", + "B": "手腕伸展", + "C": "第3、4和5指的屈曲", + "D": "第1、2和3指的伸展", + "E": "肘部伸展" + } + }, + { + "id": "aeb6d102-884a-5937-a958-938aec413718", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A previously healthy, 60-kg, 17-year-old boy is undergoing emergency surgery for a gunshot wound involving the iliac vein. Ventilation is controlled with a tidal volume of 700 ml/breath, rate of 10/min, and peak inspiratory pressure of 30 cmH2O. Body temperature is normal. The most likely cause of an end-tidal carbon dioxide partial pressure of 16 mmHg is", + "A": "endobronchial intubation", + "B": "excessive expiratory time", + "C": "excessive tidal volume", + "D": "low cardiac output", + "E": "pulmonary aspiration" + }, + "zh": { + "question": "一名先前健康的60公斤、17岁男孩因涉及髂静脉的枪伤正在接受紧急手术。通气控制为潮气量700毫升/次，频率10次/分钟，峰值吸气压为30 cmH2O。体温正常。呼气末二氧化碳分压为16 mmHg的最可能原因是", + "A": "支气管内插管", + "B": "呼气时间过长", + "C": "潮气量过大", + "D": "心输出量低", + "E": "肺部误吸" + } + }, + { + "id": "f6060227-67c2-5204-92ef-2368065e0304", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Compared with normal adults, which of the following characteristics of neonates best explains the more rapid inhalation induction in neonates?", + "A": "Greater cardiac index", + "B": "Greater metabolic rate", + "C": "Greater perfusion of vessel-rich tissues", + "D": "Greater ratio of alveolar ventilation to functional residual capacity", + "E": "Less lean body mass" + }, + "zh": { + "question": "与正常成人相比，下列哪一项新生儿的特征最能解释新生儿更快的吸入诱导？", + "A": "更高的心脏指数", + "B": "更高的代谢率", + "C": "血管丰富组织的灌注更高", + "D": "肺泡通气与功能残气量的比率更高", + "E": "更少的瘦体重" + } + }, + { + "id": "ecbd4aea-612d-533f-9da5-629e3a770594", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "With an interscalene brachial plexus block", + "A": "more local anesthetic drug is required than for axillary block", + "B": "the biceps and brachialis muscles are blocked last", + "C": "the intercostobrachial nerve is usually blocked", + "D": "the lateral antebrachial cutaneous nerve is usually spared", + "E": "the ulnar nerve is most likely to be spared" + }, + "zh": { + "question": "在进行斜角肌间隙臂丛神经阻滞时", + "A": "所需的局麻药物比腋窝阻滞多", + "B": "肱二头肌和肱肌是最后被阻滞的", + "C": "肋间臂神经通常被阻滞", + "D": "外侧前臂皮神经通常被保留", + "E": "尺神经最有可能被保留" + } + }, + { + "id": "066b3a6b-9ccd-5ad3-bcf6-2fb2ea4402fe", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with healthy nonhypertensive patients, in patients with untreated hypertension undergoing anesthesia and operation,", + "A": "cerebral ischemia may occur at higher blood pressures", + "B": "intravenous fluid should be restricted before induction", + "C": "left ventricular hypertrophy enhances compensation for intraoperative fluid loss", + "D": "responses to sympathetic stimulation are decreased", + "E": "the incidence of intraoperative hypotension is lower" + }, + "zh": { + "question": "与健康的非高血压患者相比，在未经治疗的高血压患者接受麻醉和手术时，", + "A": "脑缺血可能发生在较高的血压下", + "B": "在诱导前应限制静脉输液", + "C": "左心室肥厚增强了对术中液体丢失的补偿", + "D": "对交感神经刺激的反应减弱", + "E": "术中低血压的发生率较低" + } + }, + { + "id": "e6b597e1-ce43-541e-8d58-5d9a8447347d", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "At a body temperature of 30°C, resistance to blood flow increases because of", + "A": "increased hematocrit", + "B": "increased plasma fibrinogen concentration", + "C": "increased viscosity of blood", + "D": "rouleaux formation of red blood cells", + "E": "sequestration of platelets in portal circulation" + }, + "zh": { + "question": "在体温为30°C时，血流阻力增加是因为", + "A": "血细胞比容增加", + "B": "血浆纤维蛋白原浓度增加", + "C": "血液粘度增加", + "D": "红细胞形成缗钱状", + "E": "血小板在门静脉循环中被隔离" + } + }, + { + "id": "3b2201eb-2e5c-59a4-ba03-967a5e36c1b0", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following spirometric tests is most likely to be accurate in a patient with severe pain?", + "A": "Forced expiratory volume in one second", + "B": "Peak expiratory flow rate", + "C": "Maximum midexpiratory flow", + "D": "Maximum breathing capacity", + "E": "Negative inspiratory pressure" + }, + "zh": { + "question": "以下哪项肺活量测定测试在严重疼痛的患者中最有可能准确？", + "A": "第一秒用力呼气量", + "B": "峰值呼气流量", + "C": "最大中段呼气流量", + "D": "最大呼吸容量", + "E": "负吸气压" + } + }, + { + "id": "be134997-1ac1-54df-b393-84fc2816fd65", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following is an effect of intravascular radiographic contrast media EXCEPT", + "A": "altered protein binding of anesthetic drugs", + "B": "bronchospasm", + "C": "increased systemic vascular resistance", + "D": "pulmonary edema", + "E": "seizures" + }, + "zh": { + "question": "以下每项都是血管内放射性造影剂的作用，除了", + "A": "麻醉药物的蛋白结合改变", + "B": "支气管痉挛", + "C": "全身血管阻力增加", + "D": "肺水肿", + "E": "癫痫发作" + } + }, + { + "id": "2bafaffb-a671-59fd-bf1f-1e5a2a073a65", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 4-month-old child undergoing a craniectomy for craniosynostosis is anesthetized with nitrous oxide and halothane. Suddenly the systolic blood pressure decreases from 75 to 30 mmHg, and the PetCO2 decreases from 35 to 6 mmHg. Which of the following maneuvers is LEAST likely to have a beneficial effect?", + "A": "Administration of a fluid bolus", + "B": "Administration of a vasopressor", + "C": "Application of positive end-expiratory pressure", + "D": "Discontinuation of nitrous oxide", + "E": "Flooding the surgical wound with saline solution" + }, + "zh": { + "question": "一名4个月大的儿童因颅缝早闭症接受颅骨切除术，使用氧化亚氮和氟烷进行麻醉。突然，收缩压从75 mmHg降至30 mmHg，呼气末二氧化碳分压从35降至6 mmHg。以下哪种操作最不可能产生有益效果？", + "A": "给予液体推注", + "B": "给予升压药", + "C": "应用呼气末正压", + "D": "停止使用氧化亚氮", + "E": "用生理盐水冲洗手术伤口" + } + }, + { + "id": "7df9bd30-4840-5392-9439-ad6f547fd5fe", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 70-kg patient experiences pain on incision of a thigh abscess. The area around the abscess had been infiltrated with 30 ml of 1% lidocaine in 1:200,000 epinephrine. The local anesthetic was most likely ineffective because of", + "A": "acidosis at the site of the injection", + "B": "epinephrine-induced limitation of drug diffusion", + "C": "insufficient dose", + "D": "low ionization of lidocaine", + "E": "protein binding of lidocaine" + }, + "zh": { + "question": "一名70公斤的患者在切开大腿脓肿时感到疼痛。脓肿周围区域已用30毫升1%利多卡因和1:200,000肾上腺素浸润。局部麻醉剂最可能无效的原因是", + "A": "注射部位的酸中毒", + "B": "肾上腺素引起的药物扩散限制", + "C": "剂量不足", + "D": "利多卡因的低���离", + "E": "利多卡因的蛋白结合" + } + }, + { + "id": "614b6b9f-a6ba-58d7-9bef-457510ea0c3d", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is associated with the application of a transdermal fentanyl patch?", + "A": "Achievement of a peak plasma level within one hour", + "B": "Continued uptake after patch removal", + "C": "Dose-independent plasma clearance", + "D": "Tachyphylaxis when used for cancer pain", + "E": "Naloxone-resistant toxicity" + }, + "zh": { + "question": "以下哪项与透皮芬太尼贴片的应用有关？", + "A": "在一小时内达到峰值血浆水平", + "B": "去除贴片后继续吸收", + "C": "剂量无关的血浆清除", + "D": "用于癌痛时出现快速耐受", + "E": "耐纳洛酮的毒性" + } + }, + { + "id": "93385df8-b92c-58db-81c9-bc158f46da6f", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A waste-gas scavenger has an active disposal system. Which of the following safety features is necessary to prevent removal of excess gas from the breathing circuit?", + "A": "Positive-pressure relief mechanism", + "B": "Negative-pressure relief mechanism", + "C": "Low-volume scavenging reservoir", + "D": "High-volume scavenging reservoir", + "E": "Maximum vacuum flow rate of 5 L/min" + }, + "zh": { + "question": "废气清除器具有主动排放系统。以下哪项安全功能是防止从呼吸回路中去除过量气体所必需的？", + "A": "正压释放机制", + "B": "负压释放机制", + "C": "低容量清除储罐", + "D": "高容量清除储罐", + "E": "最大真空流量为5 L/min" + } + }, + { + "id": "26669121-c424-5f14-a258-45e21ac44e6d", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "The metabolism of which of the following hypotensive agents is most likely to be affected in patients with severe renal disease?", + "A": "Esmolol", + "B": "Hydralazine", + "C": "Nitroglycerin", + "D": "Nitroprusside", + "E": "Trimethaphan" + }, + "zh": { + "question": "以下哪种降压药的代谢最有可能在严重肾病患者中受到影响？", + "A": "艾司洛尔", + "B": "肼屈嗪", + "C": "硝酸甘油", + "D": "硝普钠", + "E": "曲美他嗪" + } + }, + { + "id": "a857537d-608e-5699-9b35-e60d5757965d", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 68-year-old man who is scheduled for outpatient cystoscopy has non-insulin-dependent diabetes mellitus controlled with glipizide (Glucatrol) 5 mg twice daily. He has had nothing to eat since awakening this morning and has not taken glipizide today. His blood glucose level is 185 mg/dl. Before proceeding, the most appropriate management is to administer", + "A": "glipizide 5 mg orally", + "B": "NPH insulin 10 units subcutaneously", + "C": "regular insulin 10 units intravenously", + "D": "dextrose and regular insulin by infusion", + "E": "no additional diabetic medication" + }, + "zh": { + "question": "一名68岁的男性计划进行门诊膀胱镜检查，他患有非胰岛素依赖型糖尿病，通过每日两次服用5毫克格列吡嗪（Glucatrol）控制。他今天早上醒来后没有进食，也没有服用格列吡嗪。他的血糖水平为185 mg/dl。在继续进行手术之前，最合适的管理措施是给予", + "A": "口服5毫克格列吡嗪", + "B": "皮下注射10单位NPH胰岛素", + "C": "静脉注射10单位常规胰岛素", + "D": "输注葡萄糖和常规胰岛素", + "E": "不额外使用糖尿病药物" + } + }, + { + "id": "90e14375-13d6-5bed-a8ff-4dd8adcd381d", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 1100-g, 10-day-old infant is to undergo ligation of a patent ductus arteriosus after unsuccessful medical treatment. Within three minutes of intravenous administration of atropine 20 mcg, fentanyl 20 mcg, and pancuronium 0.1 mg, systemic blood pressure decreases from 80 to 30 mmHg, heart rate from 180 to 140 bpm, and arterial oxygen saturation from 90% to 80%. The most appropriate management is to", + "A": "increase FiO2", + "B": "administer additional atropine", + "C": "infuse crystalloid", + "D": "infuse prostaglandin E1", + "E": "administer phenylephrine" + }, + "zh": { + "question": "一名1100克、10天大的婴儿在药物治疗无效后需进行动脉导管未闭结扎术。在静脉注射阿托品20微克、芬太尼20微克和潘库溴铵0.1毫克后三分钟，系统血压从80降至30毫米汞柱，心率从180降至140次/分钟，动脉氧饱和度从90%降至80%。最合适的处理是", + "A": "增加吸入氧浓度", + "B": "追加阿托品", + "C": "输注晶体液", + "D": "输注前列腺素E1", + "E": "给予去氧肾上腺素" + } + }, + { + "id": "c578a956-74bf-52f0-8371-5791e0c5dbf1", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Left ventricular end-diastolic volume is most likely to be underestimated by pulmonary artery occlusion pressure in patients with", + "A": "acute myocardial ischemia", + "B": "aortic insufficiency", + "C": "mitral stenosis", + "D": "primary pulmonary hypertension", + "E": "tricuspid stenosis" + }, + "zh": { + "question": "在以下哪种患者中，肺动脉阻塞压最有可能低估左心室舒张末期容积？", + "A": "急性心肌缺血", + "B": "主动脉关闭不全", + "C": "二尖瓣狭窄", + "D": "原发性肺动脉高压", + "E": "三尖瓣狭窄" + } + }, + { + "id": "863a041c-6272-51ee-805d-e3f851cc4cda", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 72-year-old woman is somnolent one day after left carotid endarterectomy. She has smoked 2 packs of cigarettes daily for 50 years. Six weeks ago, she underwent right carotid endarterectomy. At this time, arterial blood gases while breathing room air are PO2, 45 mmHg, PCO2, 60 mmHg, and pH 7.30. Which of the following is the most likely cause of the increased PCO2?", + "A": "Bilateral vocal cord paralysis", + "B": "Cerebral infarction", + "C": "Congestive heart failure", + "D": "Denervation of the carotid bodies", + "E": "Phrenic nerve injury" + }, + "zh": { + "question": "一名72岁的女性在左侧颈动脉内膜切除术后一天嗜睡。她每天吸烟2包，已有50年。六周前，她接受了右侧颈动脉内膜切除术。此时，在呼吸室内空气时的动脉血气为PO2 45 mmHg，PCO2 60 mmHg，pH 7.30。以下哪一项是PCO2增加的最可能原因？", + "A": "双侧声带麻痹", + "B": "脑梗塞", + "C": "充血性心力衰竭", + "D": "颈动脉体去神经", + "E": "膈神经损伤" + } + }, + { + "id": "306fd87e-e12a-501d-9b62-807df55e6354", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A patient is scheduled for right pneumonectomy. A left-sided double-lumen endobronchial tube is inserted. After the endobronchial side is clamped and both cuffs are inflated, breath sounds are heard only on the left. Which of the following is the most likely cause?", + "A": "Herniation of the endobronchial cuff over the carina", + "B": "Occlusion of the right upper lobe bronchus", + "C": "Placement of the endobronchial lumen in the left mainstem bronchus", + "D": "Placement of the endobronchial lumen in the right mainstem bronchus", + "E": "Placement of the endobronchial lumen in the trachea" + }, + "zh": { + "question": "一名患者计划进行右侧肺切除术。插入了左侧双腔支气管导管。在夹住支气管侧并充气两个袖带后，只能在左侧听到呼吸音。以下哪项是最可能的原因？", + "A": "支气管袖带疝入隆突", + "B": "右上叶支气管闭塞", + "C": "支气管腔置于左主支气管", + "D": "支气管腔置于右主支气管", + "E": "支气管腔置于气管内" + } + }, + { + "id": "4f07ab91-5daa-5fdf-a401-6c4642ebe2c2", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following interventions is most effective in preventing neurologic injury resulting from global cerebral ischemia?", + "A": "Induction of barbiturate coma prior to ischemia", + "B": "Maintenance of serum glucose concentration greater than 200 mg/dl prior to ischemia", + "C": "Induction of hypothermia to a core temperature of 15 degrees C prior to ischemia", + "D": "Maintenance of PaCO2 less than 25 mmHg following ischemia", + "E": "Prevention of systemic hypertension following ischemia" + }, + "zh": { + "question": "以下哪种干预措施在预防由全脑缺血引起的神经损伤方面最有效？", + "A": "在缺血前诱导巴比妥昏迷", + "B": "在缺血前维持血清葡萄糖浓度大于200 mg/dl", + "C": "在缺血前将核心体温诱导至15摄氏度的低温", + "D": "在缺血后维持PaCO2低于25 mmHg", + "E": "在缺血后预防全身性高血压" + } + }, + { + "id": "be9347f8-202e-51d3-a2bb-6293d40b35ab", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning the effects of glycopyrrolate is true?", + "A": "It decreases gastric pH", + "B": "It causes bronchoconstriction", + "C": "It decreases lower esophageal sphincter tone", + "D": "It does not prevent succinylcholine-induced bradycardia", + "E": "It causes a central anticholinergic syndrome" + }, + "zh": { + "question": "以下关于格隆溴铵作用的陈述中哪一项是正确的？", + "A": "它降低胃液pH值", + "B": "它引起支气管收缩", + "C": "它降低下食道括约肌张力", + "D": "它不能预防琥珀胆碱引起的心动过缓", + "E": "它引起中枢抗胆碱能综合征" + } + }, + { + "id": "affe9bb4-5a0f-544b-9ae0-8207eb586ecd", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 70-kg, 77-year-old man Is undergoing left nephrectomy with nitrous oxide, oxygen, fentanyl, and midazolam anesthesia. He has a 90 pack-year history of cigarette smoking and has chronic obstructive pulmonary disease. One hour after incision, expiratory wheezing occurs and peak Inspiratory pressure increases from 35 to 65 cmH20; end-tidal PCO2 is unchanged, but SpO2 decreases from 97% to 88%. The most likely cause is", + "A": "endobronchial intubation", + "B": "overinflation of the endotracheal tube cuff", + "C": "pneumothorax", + "D": "pulmonary edema", + "E": "pulmonary embolism" + }, + "zh": { + "question": "一名70公斤、77岁的男性正在接受左肾切除术，使用氧化亚氮、氧气、芬太尼和咪达唑仑麻醉。他有90包年吸烟史，并患有慢性阻塞性肺疾病。切口后一小时，出现呼气性喘鸣，峰值吸气压从35增加到65 cmH2O；呼气末PCO2不变，但SpO2从97%下降到88%。最可能的原因是", + "A": "支气管内插管", + "B": "气管导管套囊过度充气", + "C": "气胸", + "D": "肺水肿", + "E": "肺栓塞" + } + }, + { + "id": "e524a28a-3be3-5bbe-88d0-1d9154a08f53", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Myofascial pain is an example of", + "A": "a central pain state", + "B": "neuropathic pain", + "C": "psychogenic pain", + "D": "somatic pain", + "E": "visceral pain" + }, + "zh": { + "question": "肌筋膜疼痛是以下哪种疼痛的例子", + "A": "中枢性疼痛状态", + "B": "神经病理性疼痛", + "C": "心因性疼痛", + "D": "躯体性疼痛", + "E": "内脏性疼痛" + } + }, + { + "id": "09dd628d-4798-5fb5-9130-018ce9725e32", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 5-year-old boy is to undergo microlaryngeal carbon dioxide laser vaporization of laryngotracheal papillomas under halothane administered through a small polyvinylchloride (PVC) endotracheal tube. The diluent gas mixture LEAST likely to support laser combustion of the PVC tube is", + "A": "oxygen 40%, nitrous oxide 60%", + "B": "oxygen 25%, nitrous oxide 75%", + "C": "oxygen 30%, nitrogen 70%", + "D": "oxygen 30%, helium 70%", + "E": "oxygen 30%, air 70%" + }, + "zh": { + "question": "一名5岁男孩将在全麻下接受二氧化碳激光汽化喉气管乳头状瘤的手术，麻醉药物为通过小型聚氯乙烯（PVC）气管导管给入的氟烷。最不可能支持PVC导管激光燃烧的稀释气体混合物是", + "A": "氧气40%，氧化亚氮60%", + "B": "氧气25%，氧化亚氮75%", + "C": "氧气30%，氮气70%", + "D": "氧气30%，氦气70%", + "E": "氧气30%，空气70%" + } + }, + { + "id": "784eb082-eeaa-53f8-8b96-af87b2458846", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 70-year-old man undergoes cross clamping of the aorta for repair of an abdominal aneurysm. Which of the following methods is most appropriate for decreasing hypotension associated with removal of the cross clamp?", + "A": "Administration of a phenylephrine bolus when the cross clamp is removed", + "B": "Correction of any base deficit with sodium bicarbonate during clamping", + "C": "Decrease of anesthetic to allow blood pressure to increase to 20% above preclamp levels", + "D": "Volume loading to increase pulmonary artery occlusion pressure prior to removal", + "E": "Infusion of dopamine 10 minutes prior to removal" + }, + "zh": { + "question": "一名70岁的男性接受主动脉交叉夹闭以修复腹部动脉瘤。以下哪种方法最适合减少与移除交叉夹闭相关的低血压？", + "A": "在移除交叉夹闭时给予去氧肾上腺素推注", + "B": "在夹闭期间用碳酸氢钠纠正任何碱基缺失", + "C": "减少麻醉以使血压增加到夹闭前水平的20%以上", + "D": "在移除前进行容量负荷以增加肺动脉阻塞压", + "E": "在移除前10分钟输注多巴胺" + } + }, + { + "id": "856677c6-eb03-5f1a-845d-87925e574aab", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During surgery of the forearm under axillary block, a patient has pain in the lateral aspect of the forearm and responds by flexing the elbow. The most likely cause is inadequate block of which of the following nerves?", + "A": "Axillary", + "B": "Intercostobrachial", + "C": "Musculocutaneous", + "D": "Radial", + "E": "Ulnar" + }, + "zh": { + "question": "在腋窝阻滞下进行前臂手术时，患者在前臂外侧感到疼痛，并通过屈肘作出反应。最可能的原因是以下哪个神经阻滞不充分？", + "A": "腋神经", + "B": "肋间臂神经", + "C": "肌皮神经", + "D": "桡神经", + "E": "尺神经" + } + }, + { + "id": "83187d89-4726-5b20-ab4c-5fcf2f5e7009", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the most likely effect of infrarenal cross clamping of the aorta without pharmacologic manipulation?", + "A": "Decreased cardiac output", + "B": "Decreased pulmonary artery occlusion pressure", + "C": "Increased left ventricular stroke volume", + "D": "Increased renal blood flow", + "E": "Improved myocardial oxygen supply-demand ratio" + }, + "zh": { + "question": "以下哪项是无药物干预下，肾下主动脉交叉夹闭最可能的影响？", + "A": "心输出量减少", + "B": "肺动脉楔压减少", + "C": "左心室搏出量增加", + "D": "肾血流量增加", + "E": "心肌氧供需比改善" + } + }, + { + "id": "eb06bdee-2744-5fb5-86c7-be9d816d2a81", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A previously healthy 28-year-old woman scheduled for laparoscopic tubal ligation becomes, agitated and refuses to undergo the procedure after being brought to the operating room. This behavior most likely resulted from preoperative administration of", + "A": "droperidol", + "B": "cimetidine", + "C": "atropine", + "D": "meperidine", + "E": "midazolam" + }, + "zh": { + "question": "一名之前健康状况良好的28岁女性计划进行腹腔镜输卵管结扎术，但在被带入手术室后变得激动并拒绝接受手术。这种行为最有可能是由于术前给予了哪种药物", + "A": "氟哌利多", + "B": "西咪替丁", + "C": "阿托品", + "D": "哌替啶", + "E": "咪达唑仑" + } + }, + { + "id": "2b4c2697-0458-58aa-8d31-9a0394f80031", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 75-kg, 45-year-old patient with quadriplegia at the level of C6 is scheduled for elective cholecystectomy. Pulmonary function tests show an FVC of 2.4 L and an FEV, of 1.2 L. Which of the following is the most appropriate conclusion based on these findings?", + "A": "Intercostal muscle function is normal", + "B": "SpO, will be 80% or less while breathing room air", + "C": "Total lung capacity is normal", + "D": "The patient has chronic obstructive pulmonary disease", + "E": "These findings are expected in this patient" + }, + "zh": { + "question": "一名75公斤、45岁的患者患有C6水平的四肢瘫痪，计划进行择期胆囊切除术。肺功能测试显示FVC为2.4升，FEV1为1.2升。根据这些发现，以下哪项是最合适的结论？", + "A": "肋间肌功能正常", + "B": "在呼吸室内空气时，SpO2将为80%或更低", + "C": "总肺容量正常", + "D": "患者患有慢性阻塞性肺疾病", + "E": "这些发现是该患者预期的结果" + } + }, + { + "id": "35518728-a7ef-5a98-9650-597dc86700d8", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The plasma concentration of equal doses of a local anesthetic is highest when the site of administration is", + "A": "axillary brachial plexus", + "B": "caudal", + "C": "intercostal", + "D": "lumbar epidural", + "E": "subcutaneous" + }, + "zh": { + "question": "相同剂量的局部麻醉药在以下哪个给药部位的血浆浓度最高？", + "A": "腋神经丛", + "B": "尾部", + "C": "肋间", + "D": "腰椎硬膜外", + "E": "皮下" + } + }, + { + "id": "bace3a70-14a5-5bfd-b914-802a8c8d4ba9", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A radial artery catheter is to be used for blood pressure measurement during a sitting craniotomy. When zeroing the transducer, which of the following describes the best levels for placement of the transducer and opening of the system to air? (Transducer,\tOpening to Air)", + "A": "Head\tWrist", + "B": "Head\tHead", + "C": "Head\tHeart", + "D": "Heart\tHeart", + "E": "Heart\tWrist" + }, + "zh": { + "question": "在坐位开颅手术中使用桡动脉导管进行血压测量。调零传感器时，以下哪一项描述了传感器放置和系统开口对空气的最佳水平？（传感器，开口对空气）", + "A": "头部 手腕", + "B": "头部 头部", + "C": "头部 心脏", + "D": "心脏 心脏", + "E": "心脏 手腕" + } + }, + { + "id": "c9833352-1d14-5523-9e1d-e78bf3ca4ca3", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "After receiving excessive intraoperative blood replacement, a patient anesthetized with fentanyl, diazepam, and nitrous oxide develops acute pulmonary edema. The drug most likely to help him acutely is", + "A": "isoflurane", + "B": "nitroprusside", + "C": "digoxin", + "D": "nitroglycerin", + "E": "furosemide" + }, + "zh": { + "question": "在接受过量的术中输血后，一名使用芬太尼、地西泮和氧化亚氮麻醉的患者出现急性肺水肿。最有可能立即帮助他的药物是", + "A": "异氟醚", + "B": "硝普钠", + "C": "地高辛", + "D": "硝酸甘油", + "E": "呋塞米" + } + }, + { + "id": "122d8809-5832-5dc8-a918-68b38030333b", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A man with alcoholic cirrhosis and a hemoglobin concentration of 10 g/dl has an intraoperative PaO2 of 75 mmHg at an FiO2 of 0.5. Which of the following is the most likely cause of the low PaO2?", + "A": "Anemia", + "B": "Decreased cardiac output", + "C": "Increased dead space", + "D": "Intrahepatic arteriovenous shunts", + "E": "Intrapulmonary arteriovenous shunts" + }, + "zh": { + "question": "一名患有酒精性肝硬化且血红蛋白浓度为10 g/dl的男性在FiO2为0.5时，术中PaO2为75 mmHg。以下哪项最可能是PaO2低的原因？", + "A": "贫血", + "B": "心输出量减少", + "C": "死腔增加", + "D": "肝内动静脉分流", + "E": "肺内动静脉分流" + } + }, + { + "id": "36a2e91b-349f-5d4a-8eee-4706e846fb52", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "Two days after myocardial infarction involving the left anterior descending coronary artery, a patient's blood pressure decreases acutely from 125/80 to 70/40 mmHg, heart rate increases from 75 to 90 bpm, pulmonary artery pressure increases to 50/30 mmHg, and urine output decreases from 60 to 10 ml/hr. Thermodilution cardiac output has increased from 4 to 7 L/min. The most appropriate action is to", + "A": "compare mixed venous oxygen saturation in the right atrium and pulmonary artery", + "B": "draw blood for culture and start antibiotic therapy", + "C": "start dopamine infusion in low dose", + "D": "administer a fluid challenge", + "E": "monitor peripheral capillary oxygenation by transcutaneous oximetry" + }, + "zh": { + "question": "在左前降支冠状动脉心肌梗死两天后，患者的血压从125/80急剧下降到70/40 mmHg，心率从75增加到90次/分钟，肺动脉压增加到50/30 mmHg，尿量从60减少到10 ml/小时。热稀释心输出量从4升/分钟增加到7升/分钟。最合适的措施是", + "A": "比较右心房和肺动脉的混合静脉氧饱和度", + "B": "抽血培养并开始抗生素治疗", + "C": "开始低剂量多巴胺输注", + "D": "进行液体挑战", + "E": "通过经皮血氧测量监测外周毛细血管氧合" + } + }, + { + "id": "1f09cef3-d7cf-5cd7-8185-5d336874ae18", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Recognized side effects of magnesium sulfate used for the treatment of preeclampsia that would be of anesthetic concern include each of the following EXCEPT", + "A": "maternal pulmonary edema", + "B": "neonatal hypotonia", + "C": "increased maternal sensitivity to succinylcholine", + "D": "increased maternal sensitivity to vecuronium", + "E": "maternal hypokalemia" + }, + "zh": { + "question": "用于治疗子痫前期的硫酸镁的公认副作用中，除了以下哪一项外，其他都可能引起麻醉方面的关注", + "A": "孕妇肺水肿", + "B": "新生儿肌张力低下", + "C": "孕妇对琥珀胆碱的敏感性增加", + "D": "孕妇对维库溴铵的敏感性增加", + "E": "孕妇低钾血症" + } + }, + { + "id": "9160aa8d-9fd3-5d75-8b6e-755eb62eef60", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "A complication of terbutaline therapy to terminate premature labor is", + "A": "bronchoconstriction", + "B": "hypoglycemia", + "C": "fetal bradycardia", + "D": "closure of the fetal ductus arteriosus", + "E": "pulmonary edema" + }, + "zh": { + "question": "使用特布他林治疗以终止早产的并发症是", + "A": "支气管收缩", + "B": "低血糖", + "C": "胎儿心动过缓", + "D": "胎儿动脉导管闭合", + "E": "肺水肿" + } + }, + { + "id": "a64a3e12-3ecf-534f-acf2-680398bcc0ec", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 78-year-old man who is scheduled for an inguinal hernia repair has a preoperative ECG showing left bundle branch block. He has had no symptoms of cardiovascular disease. This ECG finding most likely indicates", + "A": "cardiac disease", + "B": "the need for spinal anesthesia", + "C": "an electrolyte disturbance", + "D": "the need for insertion of a temporary pacemaker", + "E": "a normal finding in a patient of this age" + }, + "zh": { + "question": "一名78岁的男性计划进行腹股沟疝修补术，术前心电图显示左束支传导阻滞。他没有心血管疾病的症状。该心电图结果最可能表明", + "A": "心脏疾病", + "B": "需要进行脊椎麻醉", + "C": "电解质紊乱", + "D": "需要植入临时起搏器", + "E": "在该年龄患者中属于正常现象" + } + }, + { + "id": "80ccb14c-9f2f-5eec-826c-c5a7fda4f68a", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is a sign of cyanide toxicity during nitroprusside therapy?", + "A": "Decreased SpO2", + "B": "Increased PaCO2", + "C": "Increased arteriovenous oxygen tension difference", + "D": "Increased mixed venous pH", + "E": "Increased mixed venous PO2" + }, + "zh": { + "question": "以下哪项是硝普钠治疗期间氰化物中毒的表现？", + "A": "SpO2下降", + "B": "PaCO2升高", + "C": "动静脉氧分压差增大", + "D": "混合静脉pH升高", + "E": "混合静脉PO2升高" + } + }, + { + "id": "c1d76d17-5522-5658-a051-bb4f514d0abb", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following is the most likely cause of a decrease in end-tidal carbon dioxide tension during general anesthesia with a constant minute ventilation?", + "A": "Administration of sodium bicarbonate", + "B": "Intravenous administration of hypertonic glucose solution", + "C": "Decrease in cardiac output", + "D": "Decrease in fresh gas flow in a Bain circuit", + "E": "Malfunction of the inspiratory valve in a circle system" + }, + "zh": { + "question": "在全身麻醉期间，分钟通气量恒定的情况下，以下哪项最可能导致呼气末二氧化碳张力下降？", + "A": "���予碳酸氢钠", + "B": "静脉注射高渗葡萄糖溶液", + "C": "心输出量减少", + "D": "Bain回路中新鲜气流减少", + "E": "环路系统中吸气阀故障" + } + }, + { + "id": "8bcd7d88-fb4b-503d-9b51-c7e303819c6f", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "The most likely cause of bilateral fixed and dilated pupils after clipping of a basilar artery aneurysm is", + "A": "preoperative administration of atropine", + "B": "intraoperative infusion of trimethaphan", + "C": "naloxone antagonism of opioid", + "D": "persistent hypothermia", + "E": "brain stem ischemia" + }, + "zh": { + "question": "在夹闭基底动脉动脉瘤后，双侧固定和散大的瞳孔最可能的原因是", + "A": "术前使用阿托品", + "B": "术中输注曲美他嗪", + "C": "纳洛酮拮抗阿片类药物", + "D": "持续低体温", + "E": "脑干缺血" + } + }, + { + "id": "b732f380-2781-5741-8810-859edbe6f373", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 27-year-old man with type I von Willebrand's disease requires internal fixation of an open fracture of the femur. Prothrombin time, partial thromboplastin time, and platelet count are normal. During surgery, there is significant oozing from the wound and the surgeon notes poor clot quality. The most appropriate therapy at this time is administration of", + "A": "cryoprecipitate", + "B": "desmopressin", + "C": "fresh frozen plasma", + "D": "lyophilized factor VII concentrate", + "E": "platelets" + }, + "zh": { + "question": "一名27岁的男性患有I型血友病，需要进行股骨开放性骨折的内固定手术。凝血酶原时间、部分凝血活酶时间和血小板计数均正常。手术过程中，伤口有明显渗血，外科医生注意到凝血质量差。此时最合适的治疗是给予", + "A": "冷沉淀", + "B": "去氨加压素", + "C": "新鲜冰冻血浆", + "D": "冻干VII因子浓缩物", + "E": "血小板" + } + }, + { + "id": "28c4f771-a8df-5972-9b56-3b5b66c49921", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 40-year-old man is undergoing open reduction and internal fixation of a fractured femur. During anesthesia with fentanyl, sevoflurane, and oxygen, heart rate decreases to 20 bpm and 6 premature ventricular contractions per minute are noted. No pulse is detected. The most appropriate next step is to", + "A": "administer atropine", + "B": "administer epinephrine", + "C": "administer lidocaine", + "D": "apply a transthoracic pacemaker", + "E": "start cardiopulmonary resuscitation" + }, + "zh": { + "question": "一名40岁的男性正在接受股骨骨折的切开复位和内固定手术。在使用芬太尼、七氟醚和氧气进行麻醉期间，心率下降到20次/分钟，并观察到每分钟6次室性早搏。未检测到脉搏。最合适的下一步措施是", + "A": "给予阿托品", + "B": "给予肾上腺素", + "C": "给予利多卡因", + "D": "使用经胸起搏器", + "E": "开始心肺复苏" + } + }, + { + "id": "226d428b-8d01-5e4a-bb21-3a97b369227a", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Compared with adult hemoglobin, which of the following is a characteristic of fetal hemoglobin?", + "A": "It has a greater oxygen-carrying capacity", + "B": "It has a lower P50", + "C": "It is more likely to cause an artifactual increase in Sp02", + "D": "It is more likely to sickle", + "E": "It unloads oxygen more readily at the tissues" + }, + "zh": { + "question": "与成人血红蛋白相比，下列哪一项是胎儿血红蛋白的特征？", + "A": "它具有更大的携氧能力", + "B": "它的P50较低", + "C": "它更可能导致SpO2的假性升高", + "D": "它更容易发生镰状化", + "E": "它在组织中更容易释放氧气" + } + }, + { + "id": "4d3b81af-d9c1-5c93-8bad-6416c624926c", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Transcutaneous electrical nerve stimulation is LEAST likely to be effective in which of the following pain syndromes?", + "A": "Acute postoperative pain", + "B": "Chronic pancreatitis", + "C": "Myofascial syndrome", + "D": "Phantom limb pain", + "E": "Reflex sympathetic dystrophy" + }, + "zh": { + "question": "经皮神经电刺激最不可能对以下哪种疼痛综合征有效？", + "A": "急性术后疼痛", + "B": "慢性胰腺炎", + "C": "肌筋膜综合征", + "D": "幻肢痛", + "E": "反射性交感神经营养不良" + } + }, + { + "id": "e94c1776-f186-5501-af51-826e1b776b4c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements concerning monitoring of neuromuscular function during general anesthesia is true?", + "A": "Facial nerve electrodes underestimate recovery from block, compared with ulnar nerve electrodes", + "B": "More current is required to depolarize a nerve beneath the negative electrode than beneath the positive electrode", + "C": "Needle electrodes should be electrically grounded", + "D": "Supramaximal voltage is 10% higher than the voltage required to elicit pain in the awake patient", + "E": "The amount of neuromuscular block is underestimated if electrodes are placed on a paretic limb" + }, + "zh": { + "question": "以下关于全身麻醉期间神经肌肉功能监测的说法中哪一项是正确的？", + "A": "与尺神经电极相比，面神经电极低估了阻滞的恢复情况", + "B": "负电极下的神经去极化所需的电流比正电极下的多", + "C": "针电极应接地", + "D": "超最大电压比在清醒患者中引起疼痛所需的电压高10%", + "E": "如果电极放置在瘫痪的肢体上，神经肌肉阻滞的程度会被低估" + } + }, + { + "id": "c965b996-1be6-5606-85ab-16bf1c952aec", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "During one-lung ventilation, each of the following affects hypoxic pulmonary vasoconstriction in the nonventilated lung EXCEPT", + "A": "application of continuous positive airway pressure to the nonventilated lung", + "B": "high alveolar pO2 in the ventilated lung", + "C": "infusion of isoproterenol", + "D": "low mixed venous pO2", + "E": "pulmonary hypertension" + }, + "zh": { + "question": "在单肺通气期间，以下每一项都会影响未通气肺的缺氧性肺血管收缩，除了", + "A": "对未通气肺应用持续气道正压", + "B": "通气肺的肺泡氧分压高", + "C": "异丙肾上腺素的输注", + "D": "混合静脉氧分压低", + "E": "肺动脉高压" + } + }, + { + "id": "9799f25d-5aed-50cd-9920-b315b3c6a4e6", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "Two hours after coronary artery bypass grafting, a 60-year-old man has a heart rate of 140 bpm and blood pressure of 80/60 mmHg. Cardiac index is 1.5 L/min/m2. Central venous pressure is 23 mmHg with large a-waves in the right atrial pressure tracing. A pulsus paradoxus of 6 mmHg is noted. Which of the following is the most likely diagnosis?", + "A": "Atrial flutter", + "B": "Cardiac tamponade", + "C": "Hypovolemia", + "D": "Junctional tachycardia", + "E": "Tension pneumothorax" + }, + "zh": { + "question": "冠状动脉旁路移植术后两小时，一名60岁男性的心率为140次/分钟，血压为80/60 mmHg。心脏指数为1.5 L/min/m2。中心静脉压为23 mmHg，右心房压力描记中可见大的a波。注意到6 mmHg的奇脉。以下哪项是最可能的诊断？", + "A": "心房扑动", + "B": "心脏压塞", + "C": "低血容量", + "D": "交界性心动过速", + "E": "张力性气胸" + } + }, + { + "id": "84d73816-e1f9-593b-a37d-5e49d9332b00", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "The lungs of a 7-kg infant are being ventilated with a volume-cycled ventilator at a rate of 20/min. The anesthetic circuit has a compressible volume of 5 ml/cm H2O, and the peak inspiratory pressure is 20 cmH2O. To achieve adequate ventilation, the ventilator tidal volume should be set at", + "A": "50 ml", + "B": "125 ml", + "C": "175 ml", + "D": "225 ml", + "E": "300 ml" + }, + "zh": { + "question": "一名体重7公斤的婴儿的肺部正在以每分钟20次的频率使用容量循环呼吸机进行通气。麻醉回路的可压缩体积为5 ml/cm H2O，峰值吸气压为20 cmH2O。为了实现足够的通气，呼吸机的潮气量应设置为", + "A": "50 ml", + "B": "125 ml", + "C": "175 ml", + "D": "225 ml", + "E": "300 ml" + } + }, + { + "id": "9338c146-8bb1-565c-acd7-40662aebcb1a", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "After termination of cardiopulmonary bypass, a patient who is chronically digitalized receives digoxin 0.5 mg in error. An ECG shows sinus bradycardia with intermittent sinus arrest; blood pressure is 90/60 mmHg. Which of the following drugs is contraiindicated in this patient?", + "A": "Atropine", + "B": "Calcium chloride", + "C": "Ephedrine", + "D": "Magnesium sulfate", + "E": "Phenylephrine" + }, + "zh": { + "question": "在终止体外循环后，一名长期服用洋地黄的患者误服了0.5毫克地高辛。心电图显示窦性心动过缓伴间歇性窦性停搏；血压为90/60 mmHg。以下哪种药物在该患者中禁用？", + "A": "阿托品", + "B": "氯化钙", + "C": "麻黄碱", + "D": "硫酸镁", + "E": "去氧肾上腺素" + } + }, + { + "id": "4ebe5bec-4e87-5afd-8525-dbc4789e961e", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "After weaning from cardiopulmonary bypass following mitral valve replacement, a patient's cardiac output is reported to be 3.7 L/min measured by thermodilution technique using 5% dextrose in water 10 ml at room temperature as injec-tate. This value could be falsely high if", + "A": "normal saline solution were mistakenly used", + "B": "the patient's hematocrit were still 25%", + "C": "only 9.0 ml of injectate were used", + "D": "atrial fibrillation were present", + "E": "the room were excessively cold" + }, + "zh": { + "question": "在二尖瓣置换术后脱离体外循环后，使用室温下的5%葡萄糖水10 ml作为注射液，通过热稀释技术测得患者的心输出量为3.7 L/min。如果以下情况发生，该值可能会被错误地高估", + "A": "错误地使用了生理盐水", + "B": "患者的血细胞比容仍为25%", + "C": "仅使用了9.0 ml的注射液", + "D": "存在心房颤动", + "E": "房间过于寒冷" + } + }, + { + "id": "299118c7-b87b-564f-af9f-79cb223da300", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "After removing the electrocautery pad from the thigh, a burn is noted at that site. Which of the following most likely contributed to this injury?", + "A": "A line-isolation monitor fault", + "B": "Current leak from the EKG module", + "C": "Defective grounding of the electrocautery unit", + "D": "Dried gel on the electrocautery pad", + "E": "Excessive current setting for cutting mode" + }, + "zh": { + "question": "从大腿上移除电烧灼垫后，发现该处有烧伤。以下哪项最有可能导致这种损伤？", + "A": "线路隔离监测器故障", + "B": "心电图模块的电流泄漏", + "C": "电烧灼装置接地不良", + "D": "电烧灼垫上的凝胶干燥", + "E": "切割模式的电流设置过高" + } + }, + { + "id": "5babc330-75c9-5045-bfd2-7fe485ede39d", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "During general anesthesia, a patient has the acute onset of atrial fibrillation with rapid ventricular response and hypotension to 50 mmHg systolic. The most appropriate treatment is", + "A": "cardioversion", + "B": "digoxin", + "C": "esmolol", + "D": "ouabain", + "E": "verapamil" + }, + "zh": { + "question": "在全身麻醉期间，患者急性出现心房颤动伴快速心室反应和低血压至50 mmHg收缩压。最合适的治疗是", + "A": "电复律", + "B": "地高辛", + "C": "艾司洛尔", + "D": "毒毛花苷K", + "E": "维拉帕米" + } + }, + { + "id": "2ead731d-e1c3-524a-83fa-405ae3e3a637", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is most likely to decrease uterine tone?", + "A": "Administration of isoflurane 1%", + "B": "Administration of nitrous oxide 50%", + "C": "Intravascular injection of 5 ml of 0.5% bupivacaine", + "D": "Intravenous administration of ketamine 2 mg/kg", + "E": "Paracervical block with 20 ml of 1% lidocaine" + }, + "zh": { + "question": "以下哪项最有可能降低子宫张力？", + "A": "给予1%异氟醚", + "B": "给予50%氧化亚氮", + "C": "血管内注射5毫升0.5%布比卡因", + "D": "静脉注射2 mg/kg氯胺酮", + "E": "宫颈旁阻滞注射20毫升1%利多卡因" + } + }, + { + "id": "58b9ecca-1414-5fad-874c-24468d17f4ab", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "During laser microsurgery of the larynx using an endotracheal tube, a fire occurs in the airway. Which of the following is the most appropriate initial management?", + "A": "Increase FiO2 to 1.0", + "B": "Instill saline into the endotracheal tube", + "C": "Perform cricothyroidotomy", + "D": "Remove the endotracheal tube", + "E": "Ventilate with air" + }, + "zh": { + "question": "在使用气管插管进行喉部激光显微手术时，气道内发生火灾。以下哪项是最合适的初步处理？", + "A": "将吸入氧浓度增加到1.0", + "B": "向气管插管内注入生理盐水", + "C": "进行环甲膜切开术", + "D": "移除气管插管", + "E": "用空气通气" + } + }, + { + "id": "dd0771dd-aca2-50db-b7d4-9f72da99f1b7", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following conditions causes resistance to nondepolarizing neuromuscular blockade EXCEPT", + "A": "chronic severe infections", + "B": "major burns", + "C": "myotonia congenita", + "D": "prolonged immobilization", + "E": "upper motor neuron injury" + }, + "zh": { + "question": "以下每种情况都会导致对非去极化神经肌肉阻滞的抵抗，除了", + "A": "慢性严重感染", + "B": "大面积烧伤", + "C": "先天性肌强直", + "D": "长期固定不动", + "E": "上运动神经元损伤" + } + }, + { + "id": "306f498c-c187-5733-a89a-3b94a30438a4", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The highest serum fluoride levels are seen following the administration of which of the following volatile anesthetics?", + "A": "Desflurane", + "B": "Enflurane", + "C": "Halothane", + "D": "Isoflurane", + "E": "Sevoflurane" + }, + "zh": { + "question": "以下哪种挥发性麻醉药的使用后会出现最高的血清氟化物水平？", + "A": "地氟烷", + "B": "恩氟烷", + "C": "氟烷", + "D": "异氟烷", + "E": "七氟烷" + } + }, + { + "id": "11ff2f22-517f-562f-8ccb-c42a3ac18700", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 2600-g neonate is to undergo surgical repair of a small gastroschisis. The infant is preoxygenated with 100% oxygen. Arterial hemoglobin desaturation is noted during laryngoscopy after a rapid-sequence induction. Which of the following is the most likely cause?", + "A": "High fetal hemoglobin concentration", + "B": "High ratio of oxygen consumption to functional residual capacity", + "C": "Low functional residual capacity in milliliters per kilogram", + "D": "Poor thoracic compliance", + "E": "Patent ductus arteriosus" + }, + "zh": { + "question": "一名2600克的新生儿将接受小型腹裂的手术修复。婴儿用100%氧气进行预氧合。在快速序贯诱导后的喉镜检查中注意到动脉血红蛋白脱饱和。以下哪项是最可能的原因？", + "A": "高胎儿血红蛋白浓度", + "B": "氧耗与功能残气量的比率高", + "C": "每公斤体重的功能残气量低", + "D": "胸腔顺应性差", + "E": "动脉导管未闭" + } + }, + { + "id": "b6a4e8cf-75b0-5cd3-866b-bf72ee21f53f", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "While delivering nitrous oxide 1.5 L/min, oxygen 1.5 L/min, and halothane 1%, a leak in the oxygen flowmeter will most likely be detected by the", + "A": "low airway pressure alarm", + "B": "\"fail-safe\" system", + "C": "oxygen analyzer on the expiratory limb", + "D": "oxygen flowmeter reading", + "E": "mass spectrometric analysis of gases" + }, + "zh": { + "question": "在输送一氧化二氮1.5 L/min、氧气1.5 L/min和1%氟烷时，氧气流量计的泄漏最有可能通过以下哪项检测到", + "A": "低气道压力报警", + "B": "“失效保护”系统", + "C": "呼气端的氧气分析仪", + "D": "氧气流量计读数", + "E": "气体的质谱分析" + } + }, + { + "id": "9ccf16e6-14ec-58a1-ae44-b6bc8d0f5edb", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A patient who has severe pain from unresectable cancer of the base of the tongue is referred for a neurolytic block. A block of which of the following will be effective?", + "A": "Gasserian ganglion", + "B": "Glossopharyngeal nerve", + "C": "Hypoglossal nerve", + "D": "Mandibular nerve", + "E": "Vagus nerve" + }, + "zh": { + "question": "一名患有无法切除的舌根癌症并伴有剧烈疼痛的患者被推荐进行神经溶解阻滞。阻滞以下哪一项将有效？", + "A": "半月神经节", + "B": "舌咽神经", + "C": "舌下神经", + "D": "下颌神经", + "E": "迷走神经" + } + }, + { + "id": "cfb63860-dbda-5d91-b204-035798bca476", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "During an inguinal hernia repair, a newborn infant will have a larger fluid requirement (in milliliters per kilogram) than an adult because of relatively greater", + "A": "insensible water loss", + "B": "lean body mass", + "C": "metabolic rate", + "D": "sodium loss", + "E": "third space losses" + }, + "zh": { + "question": "在腹股沟疝修补术中，新生儿的液体需求量（以毫升每公斤计）比成人大，因为相对较大的", + "A": "无形水分丢失", + "B": "瘦体重", + "C": "代谢率", + "D": "钠丢失", + "E": "第三间隙损失" + } + }, + { + "id": "ead7d0df-5317-5c1f-8f6c-0c916a390f62", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "An 88-kg man is anesthetized with 66% nitrous oxide, 33% oxygen, and 1% isoflurane using a circle system. Following tracheal intubation, the nitrous oxide flow is set at 1 L/min and the oxygen flow is set at 0.5 L/min. After two hours the oxygen monitor indicates a circuit oxygen concentration of only 25% despite the flows noted above. The most likely explanation for this discrepancy is", + "A": "decrease of oxygen pipeline pressure to 20 psi", + "B": "increase in the concentration of nitrous oxide in the circuit", + "C": "inaccuracy of flowmeters at low flow rates", + "D": "malfunction of the oxygen monitor", + "E": "progressive hypothermia" + }, + "zh": { + "question": "一名88公斤的男性患者使用环路系统接受66%氧化亚氮、33%氧气和1%异氟醚的麻醉。气管插管后，氧化亚氮流量设定为1 L/min，氧气流量设定为0.5 L/min。两小时后，尽管流量如上所述，氧气监测仪显示回路中的氧气浓度仅为25%。这种差异最可能的解释是", + "A": "氧气管道压力降至20 psi", + "B": "回路中氧化亚氮浓度增加", + "C": "低流量时流量计不准确", + "D": "氧气监测仪故障", + "E": "进行性低体温" + } + }, + { + "id": "56f994b0-ab40-5453-ab51-06470eaaeb36", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 30-year-old man has had burning pain, allodynia, and edema of the hand for six weeks after sustaining a forearm fracture. Appropriate treatment includes each of the following EXCEPT", + "A": "physical therapy, employing stress loading", + "B": "oral prazosin", + "C": "intravenous regional sympathetic block with guanethidine", + "D": "stellate ganglion block with 6% phenol", + "E": "transcutaneous electrical nerve stimulation" + }, + "zh": { + "question": "一名30岁的男性在前臂骨折后六周出现烧灼痛、异常痛觉和手部水肿。适当的治疗包括以下各项，除了", + "A": "物理治疗，采用负重训练", + "B": "口服哌唑嗪", + "C": "使用胍乙啶的静脉区域交感神经阻滞", + "D": "使用6%苯酚的星状神经节阻滞", + "E": "经皮神经电刺激" + } + }, + { + "id": "06e2c149-2ec5-5f4b-a781-3ce2bb54367e", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A 70-year-old man who underwent bilateral carotid endarterectomies two years ago is to undergo anesthesia and surgery. The denervation of the carotid bodies is likely to result in", + "A": "chronic respiratory alkalosis", + "B": "decreased ventilatory response to hypoxemia", + "C": "increased ventilatory response to hypercarbia", + "D": "labile hypertension", + "E": "resting bradycardia" + }, + "zh": { + "question": "一名两年前接受过双侧颈动脉内膜切除术的70岁男性即将接受麻醉和手术。颈动脉体去神经化可能导致", + "A": "慢性呼吸性碱中毒", + "B": "对低氧血症的通气反应减弱", + "C": "对高碳酸血症的通气反应增强", + "D": "不稳定的高血压", + "E": "静息性心动过缓" + } + }, + { + "id": "ea47549d-603a-5969-97b8-b1ab37603c2c", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following drugs best facilitates management of cerebral vasospasm after subarachnoid hemorrhage?", + "A": "Nifedipine", + "B": "Nimodipine", + "C": "Nitroglycerin", + "D": "Nitroprusside", + "E": "Thiopental" + }, + "zh": { + "question": "以下哪种药物最有助于管理蛛网膜下腔出血后的脑血管痉挛？", + "A": "硝苯地平", + "B": "尼莫地平", + "C": "硝酸甘油", + "D": "硝普钠", + "E": "硫喷妥钠" + } + }, + { + "id": "4259c820-0f35-56b4-9fc6-dd8599030846", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 45-year-old man is scheduled for exploratory laparotomy. Six months ago, he received doxorubicin (Adriamycin) therapy for testicular cancer. This patient is at increased risk for", + "A": "abnormal liver function", + "B": "bone marrow depression", + "C": "heart failure", + "D": "chronic renal failure", + "E": "pulmonary fibrosis" + }, + "zh": { + "question": "一名45岁的男性计划进行探查性剖腹手术。六个月前，他因睾丸癌接受了多柔比星（阿霉素）治疗。该患者的风险增加是", + "A": "肝功能异常", + "B": "骨髓抑制", + "C": "心力衰竭", + "D": "慢性肾衰竭", + "E": "肺纤维化" + } + }, + { + "id": "26e67943-a475-544d-a990-0cd492674bef", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "As part of a preoperative evaluation, a patient had a thallium scan showing a 'cold spot' over the left ventricle that occurs with moderate exercise and disappears at rest. This most likely indicates", + "A": "moderate-sized aneurysm of the left ventricle", + "B": "acute myocardial ischemia", + "C": "recent myocardial infarction", + "D": "old myocardial infarction", + "E": "Prinzmetal's variant angina" + }, + "zh": { + "question": "在术前评估中，患者进行的铊扫描显示左心室在中等运动时出现“冷点”，而在休息时消失。这最可能表明", + "A": "左心室中等大小的动脉瘤", + "B": "急性心肌缺血", + "C": "近期心肌梗死", + "D": "陈旧性心肌梗死", + "E": "Prinzmetal变异型心绞痛" + } + }, + { + "id": "49a52c51-922c-5dc3-ab23-e5c7ef2d8636", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Normal pregnancy is associated with a decrease in each of the following EXCEPT", + "A": "expiratory reserve volume", + "B": "FEV1/FVC ratio", + "C": "functional residual capacity", + "D": "thoracic compliance", + "E": "vital capacity" + }, + "zh": { + "question": "正常妊娠与以下各项的减少有关，除了", + "A": "呼气储备量", + "B": "FEV1/FVC 比率", + "C": "功能残气量", + "D": "胸廓顺应性", + "E": "肺活量" + } + }, + { + "id": "208d138b-ea73-5793-bffe-e9bf066fd298", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 70-year-old man with mild hypertension and aortoiliac occlusive disease is undergoing aortofemoral bypass grafting. Which of the following interventions is most effective in maintaining renal perfusion during infrarenal aortic clamping?", + "A": "Infusion of dopamine at 2 mcg/kg/min", + "B": "Infusion of sodium nitroprusside", + "C": "Intravenous administration of furosemide", + "D": "Intravenous administration of mannitol", + "E": "Volume loading with crystalloid" + }, + "zh": { + "question": "一名70岁患有轻度高血压和髂动脉闭塞性疾病的男性正在接受髂股动脉旁路移植术。在肾下主动脉夹闭期间，以下哪种干预措施最有效地维持肾灌注？", + "A": "以2微克/千克/分钟的速度输注多巴胺", + "B": "输注硝普钠", + "C": "静脉注射呋塞米", + "D": "静脉注射甘露醇", + "E": "晶体液容量负荷" + } + }, + { + "id": "fe351ae6-3d45-56ce-8348-7194207f8907", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 70-kg, 20-year-old athlete receives nitrous oxide and oxygen, thiopental, and fentanyl 1.25 mg (25 ml) during a knee reconstruction procedure lasting three hours. Postoperatively, he does not awaken or resume spontaneous breathing for three hours. The most likely explanation for the prolonged effect of fentanyl is", + "A": "dose-dependent elimination half-life", + "B": "genetically slow biotransformation", + "C": "large volume of distribution", + "D": "presence of an active metabolite in high concentration", + "E": "time required for hepatic elimination" + }, + "zh": { + "question": "一名70公斤、20岁的运动员在进行持续三小时的膝关节重建手术中接受了氧化亚氮和氧气、硫喷妥钠以及1.25毫克（25毫升）芬太尼的麻醉。术后，他在三小时内没有苏醒或恢复自主呼吸。芬太尼作用时间延长的最可能解释是", + "A": "剂量依赖的消除半衰期", + "B": "遗传性缓慢生物转化", + "C": "大的分布容积", + "D": "高浓度的活性代谢物存在", + "E": "肝脏消除所需的时间" + } + }, + { + "id": "90d84fbb-0a41-5664-8c4b-0892bfbd03ab", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Optimal ventilation of a newborn with congenital diaphragmatic hernia should consist of", + "A": "PaCO2 30 mmHg, low tidal volumes", + "B": "PaCO2 30 mmHg, high tidal volumes", + "C": "PaCO2 40 mmHg, low tidal volumes", + "D": "PaCO2 40 mmHg, high tidal volumes", + "E": "PaCO2 45 mmHg, low tidal volumes" + }, + "zh": { + "question": "对患有先天性膈疝的新生儿进行最佳通气应包括", + "A": "PaCO2 30 mmHg，低潮气量", + "B": "PaCO2 30 mmHg，高潮气量", + "C": "PaCO2 40 mmHg，低潮气量", + "D": "PaCO2 40 mmHg，高潮气量", + "E": "PaCO2 45 mmHg，低潮气量" + } + }, + { + "id": "f5900b86-e669-5cd0-8024-11f07fcd1aa2", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "At equipotent doses, which of the following opioids is most likely to migrate cephalad in cerebrospinal fluid after epidural administration?", + "A": "Fentanyl", + "B": "Hydromorphone", + "C": "Meperidine", + "D": "Morphine", + "E": "Sufentanil" + }, + "zh": { + "question": "在等效剂量下，下列哪种阿片类药物在硬膜外给药后最有可能在脑脊液中向头侧迁移？", + "A": "芬太尼", + "B": "氢吗啡酮", + "C": "哌替啶", + "D": "吗啡", + "E": "舒芬太尼" + } + }, + { + "id": "ce677fa1-df7d-5a25-9e5d-92abae9beb83", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is a cardiorespiratory effect of epidural block to a T4 sensory level?", + "A": "Decreased expiratory reserve volume", + "B": "Decreased tidal volume", + "C": "Increased circulating catecholamine concentrations", + "D": "Increased heart rate", + "E": "Unchanged vital capacity" + }, + "zh": { + "question": "以下哪项是硬膜外阻滞至T4感觉平面的心肺效应？", + "A": "呼气储备量减少", + "B": "潮气量减少", + "C": "循环儿茶酚胺浓度增加", + "D": "心率增加", + "E": "肺活量不变" + } + }, + { + "id": "a48ef704-9fdf-5a0e-ba66-9af7db53f3f4", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The effect of neomycin at the neuromuscular junction is", + "A": "decreased by depolarizing relaxants", + "B": "partially reversed by calcium", + "C": "potentiated by anticholinesterases", + "D": "prevented by pretreatment with magnesium", + "E": "primarily prejunctional" + }, + "zh": { + "question": "新霉素在神经肌肉接头的作用是", + "A": "被去极化肌松药减少", + "B": "部分被钙逆转", + "C": "被抗胆碱酯酶药增强", + "D": "通过预处理镁来预防", + "E": "主要是接头前的" + } + }, + { + "id": "4bffa74d-0e81-571a-9f5e-d2386ed24d50", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 70-kg 24-year-old man with bilateral pneumonia whose lungs are being mechanically ventilated has the following measured parameters: tidal volume 750 ml; FiO2 0.7; rate 12/min; positive end-expiratory pressure 10 cmH2O; PaO2 75 mmHg; PaCO2 55 mmHg; pH 7.30. Which of the following alterations should be made in the ventilatory settings?", + "A": "Decreasing positive end-expiratory pressure", + "B": "Decreasing respiratory rate", + "C": "Increasing fresh gas flow rate", + "D": "Increasing FiO2", + "E": "Increasing tidal volume" + }, + "zh": { + "question": "一名70公斤的24岁男性，患有双侧肺炎，正在接受机械通气，测得以下参数：潮气量750毫升；吸入氧浓度0.7；呼吸频率12次/分钟；呼气末正压10 cmH2O；动脉氧分压75 mmHg；动脉二氧化碳分压55 mmHg；pH值7.30。应对通气设置进行以下哪项调整？", + "A": "减少呼气末正压", + "B": "减少呼吸频率", + "C": "增加新鲜气体流量", + "D": "增加吸入氧浓度", + "E": "增加潮气量" + } + }, + { + "id": "7685d363-cd18-52b7-9079-3aaff51dd0c3", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 36-year-old woman who undergoes peritoneal dialysis for chronic renal failure requires emergency surgical exploration for bowel obstruction. Serum creatinine concentration is 9.8 mg/dl and BUN concentration is 124 mg/dl. The most likely abnormality of coagulation is", + "A": "decreased euglobulin lysis time", + "B": "decreased platelet count", + "C": "prolonged activated partial thromboplastin time", + "D": "prolonged bleeding time", + "E": "prolonged prothrombin time" + }, + "zh": { + "question": "一名36岁的女性因慢性肾衰竭进行腹膜透析，需要紧急手术探查肠梗阻。血清肌酐浓度为9.8 mg/dl，BUN浓度为124 mg/dl。最可能的凝血异常是", + "A": "降低的优球蛋白溶解时间", + "B": "降低的血小板计数", + "C": "延长的活化部分凝血活酶时间", + "D": "延长的出血时间", + "E": "延长的凝血酶原时间" + } + }, + { + "id": "36806a70-ec74-5190-98d6-9aa69ebab2d7", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "If the low-pressure alarm of an anesthesia circuit is broken, which of the following monitors will provide the earliest indication of a disconnected ventilator hose?", + "A": "Fail-safe system", + "B": "Infrared capnograph", + "C": "Nitrogen analyzer", + "D": "Oxygen analyzer", + "E": "Pulse oximeter" + }, + "zh": { + "question": "如果麻醉回路的低压报警器损坏，以下哪种监测仪器能最早指示呼吸机软管断开？", + "A": "失效保护系统", + "B": "红外线二氧化碳图", + "C": "氮气分析仪", + "D": "氧气分析仪", + "E": "脉搏血氧仪" + } + }, + { + "id": "8e205603-fcbb-5f16-bfc6-e61040730299", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "During right upper lobectomy and one-lung ventilation with a double-lumen endotracheal tube, the PaO2 decreases to 40 mmHg. The PaCO2 is 39 mmHg. Which of the following is most appropriate?", + "A": "Confirm position of the tube with bronchoscopy", + "B": "Apply 5 cmH20 continuous positive airway pressure to the nondependent lung", + "C": "Apply 5 cmH20 positive end-expiratory pressure to the dependent lung", + "D": "Resume two-lung ventilation", + "E": "Clamp the pulmonary artery of the nondependent lung" + }, + "zh": { + "question": "在进行右上肺叶切除术和使用双腔气管导管进行单肺通气时，PaO2降至40 mmHg。PaCO2为39 mmHg。以下哪项最合适？", + "A": "用支气管镜确认导管位置", + "B": "对非依赖肺施加5 cmH2O的持续气道正压", + "C": "对依赖肺施加5 cmH2O的呼气末正压", + "D": "恢复双肺通气", + "E": "夹闭非依赖肺的肺动脉" + } + }, + { + "id": "3a4034dc-5ff2-50f3-a508-259ce6ddd166", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning the management of diabetes mellitus during pregnancy is true?", + "A": "Insulin requirements remain essentially unchanged during pregnancy", + "B": "Maternal blood glucose concentration of 200 mg/dL is optimal", + "C": "Maternal hyperglycemia may cause neonatal acidosis", + "D": "Neonatal hyperglycemia is common", + "E": "Infants delivered under general anesthesia have lower Apgar scores than those delivered under spinal anesthesia" + }, + "zh": { + "question": "以下关于妊娠期糖尿病管理的说法哪一项是正确的？", + "A": "妊娠期胰岛素需求基本不变", + "B": "母体血糖浓度200 mg/dL是最佳的", + "C": "母体高血糖可能导致新生儿酸中毒", + "D": "新生儿高血糖很常见", + "E": "在全身麻醉下分娩的婴儿Apgar评分低于在脊椎麻醉下分娩的婴儿" + } + }, + { + "id": "10a8b7f1-8f23-5e5b-b89a-de287fcaebcc", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Normal pseudocholinesterase", + "A": "is highly concentrated at the motor end-plate", + "B": "hydrolyzes succinylcholine by Hofmann elimination", + "C": "is produced primarily at nerve terminals", + "D": "is antagonized by acetylcholinesterase inhibitors", + "E": "resists dibucaine inhibition more than its atypical variant" + }, + "zh": { + "question": "正常的假胆碱酯酶", + "A": "在运动终板高度集中", + "B": "通过霍夫曼消除水解琥珀酰胆碱", + "C": "主要在神经末梢产生", + "D": "被乙酰胆碱酯酶抑制剂拮抗", + "E": "比其非典型变体更能抵抗地布卡因抑制" + } + }, + { + "id": "c6cd4b3d-edcc-5ecd-8738-0b0406621c6a", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Which of the following effects of catecholamine results in the greatest increase in preload?", + "A": "Augmented contractility", + "B": "Decreased afterload", + "C": "Decreased venous capacitance", + "D": "Improved chronotropism", + "E": "Increased cardiac output" + }, + "zh": { + "question": "以下哪种儿茶酚胺的作用会导致前负荷最大程度的增加？", + "A": "增强的收缩力", + "B": "降低的后负荷", + "C": "降低的静脉容量", + "D": "改善的心率", + "E": "增加的心输出量" + } + }, + { + "id": "2902bf20-7d64-585e-8900-912e316454f7", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A 2.2-kg, 6-hour-old neonate is to undergo gastrostomy followed by repair of a tracheoesophageal fistula. During induction with halothane, air, and oxygen, the abdomen becomes distended. Appropriate management is to", + "A": "intubate and assist spontaneous ventilation", + "B": "intubate and control ventilation", + "C": "insert an orogastric tube", + "D": "allow the patient to breathe spontaneously by mask until gastrostomy", + "E": "control ventilation by mask until gastrostomy" + }, + "zh": { + "question": "一名2.2公斤、6小时大的新生儿将接受胃造口术，随后修复气管食管瘘。在使用氟烷、空气和氧气进行诱导期间，腹部变得膨胀。适当的处理是", + "A": "插管并协助自主通气", + "B": "插管并控制通气", + "C": "插入口胃管", + "D": "允许患者通过面罩自主呼吸直到胃造口术", + "E": "通过面罩控制通气直到胃造口术" + } + }, + { + "id": "0f3f0c2e-3d64-5f38-bb3a-fbd60224d2c8", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "Four days after mitral valve replacement, a 49-year-old, 70-kg woman who has had oliguric renal failure since the operation requires insertion of a Schribner shunt for hemodialysis. Her BUN concentration is 104 mg/dl, serum creatinine is 9.3 mg/dl, serum sodium is 130 mEq/L, and serum potassium is 6.7 mEq/L. During the operation under local anesthesia, diazepam 7.5 mg and morphine 10 mg are administered intravenously to control agitation. Five minutes later while she is sleeping quietly, unifocal premature ventricular contractions appear at a rate of 10 per minute on the ECG monitor. The most appropriate therapy is to", + "A": "administer calcium gluconate 250 mg intravenously", + "B": "augment ventilation with bag and mask", + "C": "administer lidocaine 100 mg intravenously", + "D": "administer NaHC03 50 mEq intravenously", + "E": "observe only" + }, + "zh": { + "question": "二尖瓣置换术后四天，一名49岁、70公斤的女性患者自手术以来出现少尿性肾衰竭，需要插入Schribner分流管进行血液透析。她的BUN浓度为104 mg/dl，血清肌酐为9.3 mg/dl，血清钠为130 mEq/L，血清钾为6.7 mEq/L。在局部麻醉下进行手术时，静脉注射了7.5 mg地西泮和10 mg吗啡以控制躁动。五分钟后，当她安静地入睡时，心电监护仪上出现了每分钟10次的单源性室性早搏。最合适的治疗是", + "A": "静脉注射250 mg葡萄糖酸钙", + "B": "用呼吸袋和面罩加强通气", + "C": "静脉注射100 mg利多卡因", + "D": "静脉注射50 mEq碳酸氢钠", + "E": "仅观察" + } + }, + { + "id": "237aa3b6-6a6f-5f04-a2e0-d81122596e06", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 2.3-kg 1-day-old term infant requires repair of a gastroschisis. Which of the following combinations is most appropriate for intraoperative fluid management?", + "A": "Dextrose 5% in water for maintenance and lactated Ringer's solution for replacement of third space losses", + "B": "Dextrose 10% in water for maintenance and lactated Ringer's solution for replacement of third space losses", + "C": "Lactated Ringer's solution for maintenance and replacement of third space losses", + "D": "Lactated Ringer's solution for maintenance and albumin 5% for replacement of third space losses", + "E": "Normal saline solution for maintenance and lactated Ringer's solution for replacement of third space losses" + }, + "zh": { + "question": "一名2.3公斤的足月1天大的婴儿需要进行腹裂修复。以下哪种组合最适合术中液体管理？", + "A": "5%葡萄糖水用于维持，乳酸林格氏液用于第三间隙损失的补充", + "B": "10%葡萄糖水用于维持，乳酸林格氏液用于第三间隙损失的补充", + "C": "乳酸林格氏液用于维持和第三间隙损失的补充", + "D": "乳酸林格氏液用于维持，5%白蛋白用于第三间隙损失的补充", + "E": "生理盐水用于维持，乳酸林格氏液用于第三间隙损失的补充" + } + }, + { + "id": "9ee47c6d-7e02-5a61-910f-65f6a1ddd137", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Metoclopramide acts to", + "A": "block dopamine receptors", + "B": "decrease gastric acid production", + "C": "decrease lower esophageal sphincter tone", + "D": "delay gastric emptying", + "E": "facilitate central cholinergic stimulation" + }, + "zh": { + "question": "甲氧氯普胺的作用是", + "A": "阻断多巴胺受体", + "B": "减少胃酸分泌", + "C": "降低食管下括约肌张力", + "D": "延缓胃排空", + "E": "促进中枢胆碱能刺激" + } + }, + { + "id": "39fdb736-6ad2-509d-ba46-28fdbd08ce20", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "When using a Venturi face mask with a reservoir bag", + "A": "a known constant FiO2 is delivered", + "B": "the reservoir bag ensures predictable FiO2 while conserving fresh gas flow", + "C": "low fresh gas flows will not decrease FiO2", + "D": "the system prevents hypocarbia during tachypnea", + "E": "the system increases anatomic dead space" + }, + "zh": { + "question": "使用带储气袋的文丘里面罩时", + "A": "提供已知恒定的FiO2", + "B": "储气袋在节省新鲜气体流量的同时确保可预测的FiO2", + "C": "低新鲜气体流量不会降低FiO2", + "D": "系统在呼吸急促时防止低碳酸血症", + "E": "系统增加解剖死腔" + } + }, + { + "id": "33ae59a7-8ab1-57a5-8769-4f6f4a74ae21", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Pseudocholinesterase", + "A": "is increased in patients with myasthenia gravis", + "B": "is inhibited by glycopyrrolate", + "C": "is inhibited by pilocarpine", + "D": "is synthesized by the liver", + "E": "reverses atracurium blockade" + }, + "zh": { + "question": "假性胆碱酯酶", + "A": "在重症肌无力患者中增加", + "B": "被东莨菪碱抑制", + "C": "被匹鲁卡品抑制", + "D": "由肝脏合成", + "E": "逆转阿曲库铵的阻滞" + } + }, + { + "id": "4767b71d-dc7b-5f8a-a827-f78b91df9448", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Deliberate hypothermia and circulatory arrest is planned for clipping of a giant basilar artery aneurysm. Which of the following statements is true?", + "A": "Administration of a muscle relaxant slows the cooling process", + "B": "Anesthesia is not required if body temperature is below 31°C", + "C": "Decreasing body temperature below the level at which the EEG is isoelectric further decreases cerebral metabolic rate for oxygen", + "D": "Sinus bradycardia during cooling results from increased intracranial pressure", + "E": "T-wave inversion during cooling indicates myocardial ischemia" + }, + "zh": { + "question": "计划进行故意低温和循环停滞以夹闭巨大基底动脉瘤。以下哪项陈述是正确的？", + "A": "使用肌肉松弛剂会减缓降温过程", + "B": "如果体温低于31°C，则不需要麻醉", + "C": "将体温降低到EEG呈等电位的水平以下会进一步降低脑氧代谢率", + "D": "降温期间的窦性心动过缓是由于颅内压升高引起的", + "E": "降温期间的T波倒置表明心肌缺血" + } + }, + { + "id": "c6745193-0970-5464-ad5f-1a11448139d0", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 19-year-old college student is brought to the emergency department cyanotic and incoherent. Respiratory rate is 48/min, pulse is 140 bpm, and blood pressure is 140/85 mmHg. The only history obtainable is that he was at a party and suddenly felt sick. Cyanosis persists despite administration of pure oxygen by mask. A venous blood sample is chocolate-brown. The action most beneficial to the patient is to", + "A": "intubate the trachea and control ventilation", + "B": "perform bronchoscopy to treat foreign body aspiration", + "C": "obtain a pulmonary ventilation-perfusion scan", + "D": "administer methylene blue intravenously", + "E": "administer thiosulfate in normal saline solution intravenously" + }, + "zh": { + "question": "一名19岁的大学生被送到急诊室，表现为发绀和语无伦次。呼吸频率为48次/分钟，脉搏为140次/分钟，血压为140/85 mmHg。唯一能获得的病史是他在聚会上突然感到不适。尽管通过面罩给予纯氧，发绀仍然持续。静脉血样呈巧克力棕色。对患者最有益的措施是", + "A": "插管气管并控制通气", + "B": "进行支气管镜检查以治疗异物吸入", + "C": "进行肺通气-灌注扫描", + "D": "静脉注射亚甲蓝", + "E": "在生理盐水中静脉注射硫代硫酸盐" + } + }, + { + "id": "8157bcf7-c71e-585b-8813-ad2bdec78d33", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 32-year-old man is scheduled for hernia repair. He underwent heart transplantation for cardiomyopathy five years ago. Which of the following findings is most likely?", + "A": "Absence of coronary atherosclerosis", + "B": "Biventricular hypokinesis on echocardiography", + "C": "Down-regulation of cardiac beta-adrenergic receptors", + "D": "Increased heart rate at rest", + "E": "Right ventricular hypertrophy" + }, + "zh": { + "question": "一名32岁的男性计划进行疝气修补手术。他在五年前因心肌病接受了心脏移植。以下哪项发现最有可能？", + "A": "冠状动脉粥样硬化缺失", + "B": "超声心动图显示双心室运动减弱", + "C": "心脏β-肾上腺素能受体下调", + "D": "静息时心率增加", + "E": "右心室肥厚" + } + }, + { + "id": "02e12756-39d6-5eb3-b484-0a3cc52632b9", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Desflurane at a stable alveolar concentration of 7%", + "A": "causes bradycardia", + "B": "decreases cerebrovascular resistance", + "C": "degrades in soda lime", + "D": "increases systemic vascular resistance", + "E": "stimulates the respiratory centers" + }, + "zh": { + "question": "在稳定的肺泡浓度为7%的情况下，地氟醚", + "A": "引起心动过缓", + "B": "降低脑血管阻力", + "C": "在苏打石灰中降解", + "D": "增加全身血管阻力", + "E": "刺激呼吸中枢" + } + }, + { + "id": "d52fbf45-69aa-5e45-966d-1ecc560d49e0", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 57-year-old man has back pain, a heart rate of 90 bpm, decreased pulse in the left arm, and blood pressure of 200/110 mmHg. During infusion of nitroprusside, heart rate increases to 115 bpm and blood pressure decreases to 140/80 mmHg. The most appropriate management at this time is administration of", + "A": "droperidol", + "B": "nifedipine", + "C": "normal saline solution", + "D": "propranolol", + "E": "verapamil" + }, + "zh": { + "question": "一名57岁的男性患者有背痛，心率为90次/分钟，左臂脉搏减弱，血压为200/110 mmHg。在输注硝普钠期间，心率增加到115次/分钟，血压下降到140/80 mmHg。此时最合适的管理是给予", + "A": "氟哌利多", + "B": "硝苯地平", + "C": "生理盐水溶液", + "D": "普萘洛尔", + "E": "维拉帕米" + } + }, + { + "id": "269c2643-9b56-5523-b839-5b4e4b4b4623", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 48-year-old woman with von Willebrand's disease is scheduled for a hysterectomy. The most appropriate initial preoperative therapy to decrease bleeding is administration of", + "A": "cryoprecipitate", + "B": "desmopressin (DDAVP)", + "C": "fresh frozen plasma", + "D": "platelets", + "E": "vitamin K" + }, + "zh": { + "question": "一名48岁的患有血友病的女性计划进行子宫切除术。减少出血的最合适的初始术前治疗是给予", + "A": "冷沉淀", + "B": "去氨加压素 (DDAVP)", + "C": "新鲜冰冻血浆", + "D": "血小板", + "E": "维生素K" + } + }, + { + "id": "5ac44ecb-f0c4-55ce-b1d3-161bca562923", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A patient develops urticaria and pruritus while receiving a blood transfusion in the PACU. Blood pressure and heart rate are unchanged from pretransfusion values. The most appropriate action is administration of", + "A": "diphenhydramine", + "B": "epinephrine", + "C": "furosemide", + "D": "hydrocortisone", + "E": "mannitol" + }, + "zh": { + "question": "一名患者在术后恢复室接受输血时出现荨麻疹和瘙痒。血压和心率与输血前的数值没有变化。最合适的处理是给予", + "A": "苯海拉明", + "B": "肾上腺素", + "C": "呋塞米", + "D": "氢化可的松", + "E": "甘露醇" + } + }, + { + "id": "9423f6d4-eca4-543a-bc42-f3937a32913f", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Monitoring sensory evoked potentials may be useful in detecting functional derangement of each of the following EXCEPT", + "A": "cranial nerve pathways during posterior fossa operations", + "B": "motor pathways during anterior cervical discectomy", + "C": "dorsal column pathways during operations for spinal tumors", + "D": "visual pathways during operations on the sphenoid wing", + "E": "cortical pathways during carotid artery operations" + }, + "zh": { + "question": "监测感觉诱发电位可能有助于检测以下各项的功能紊乱，除了", + "A": "后颅窝手术期间的颅神经通路", + "B": "前颈椎间盘切除术期间的运动通路", + "C": "脊柱肿瘤手术期间的背柱通路", + "D": "蝶骨翼手术期间的视觉通路", + "E": "颈动脉手术期间的皮质通路" + } + }, + { + "id": "992bf8e4-8350-5b1f-81d6-cb969327c0e1", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements concerning the innervation of the larynx is true?", + "A": "The glossopharyngeal nerve provides motor innervation to the vocal cords", + "B": "The recurrent laryngeal nerve provides sensory innervation to the mucosa of the larynx above the vocal cords", + "C": "The hypoglossal nerve provides sensory innervation to the aryepiglottic folds", + "D": "Unilateral recurrent laryngeal nerve injury results in an abducted vocal cord on the injured side", + "E": "The vagus nerve provides innervation to all structures below the vocal cords" + }, + "zh": { + "question": "以下关于喉部神经支配的说法哪一项是正确的？", + "A": "舌咽神经为声带提供运动神经支配", + "B": "喉返神经为声带以上的喉粘膜提供感觉神经支配", + "C": "舌下神经为杓会厌襞提供感觉神经支配", + "D": "单侧喉返神经损伤导致损伤侧声带外展", + "E": "迷走神经为声带以下的所有结构提供神经支配" + } + }, + { + "id": "a61568d4-0916-5ba9-935f-e440f41aaf15", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 70-kg 22-year-old patient with head trauma and multiple fractures of the long bones is scheduled for fixation of bilateral femoral fractures. Preoperative laboratory studies show a serum sodium concentration of 150 mEq/L, a serum potassium concentration of 3.1 mEq/L, and a urine output greater than 500 ml/hr. Which of the following agents will decrease urine output?", + "A": "3% Saline solution", + "B": "5% Dextrose solution", + "C": "Glucagon", + "D": "Hydrocortisone", + "E": "Vasopressin" + }, + "zh": { + "question": "一名70公斤的22岁患者，因头部外伤和多处长骨骨折，计划进行双侧股骨骨折固定术。术前实验室检查显示血清钠浓度为150 mEq/L，血清钾浓度为3.1 mEq/L，尿量大于500 ml/hr。以下哪种药物可以减少尿量？", + "A": "3% 生理盐水", + "B": "5% 葡萄糖溶液", + "C": "胰高血糖素", + "D": "氢化可的松", + "E": "加压素" + } + }, + { + "id": "464a0c4c-30d8-598d-bb86-546f6102828a", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "An anesthetized, paralyzed patient is placed in the lateral position and mechanically ventilated. End-tidal PCO2 is 34 mmHg and PaCO2 is 43 mmHg. This gradient", + "A": "increases during spontaneous breathing", + "B": "indicates increased dead space ventilation", + "C": "is caused by increased intrapulmonary shunt", + "D": "reflects inhibition of hypoxic pulmonary vasoconstriction", + "E": "results from increased cardiac output" + }, + "zh": { + "question": "一名麻醉、瘫痪的患者被置于侧卧位并进行机械通气。呼气末二氧化碳分压为34 mmHg，动脉血二氧化碳分压为43 mmHg。这个梯度", + "A": "在自主呼吸时增加", + "B": "表明死腔通气增加", + "C": "是由肺内分流增加引起的", + "D": "反映了低氧性肺血管收缩的抑制", + "E": "是由于心输出量增加导致的" + } + }, + { + "id": "d71fa3ce-e9fa-50e3-b044-a0fc5aba73d2", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A successful celiac plexus block can be expected to", + "A": "block parasympathetic fibers to the adrenal medulla", + "B": "block sympathetic fibers to the sigmoid colon", + "C": "block somatic fibers to the pancreas", + "D": "enhance peristalsis", + "E": "inhibit ejaculation" + }, + "zh": { + "question": "成功的腹腔神经丛阻滞可以预期会", + "A": "阻断肾上腺髓质的副交感神经纤维", + "B": "阻断乙状结肠的交感神经纤维", + "C": "阻断胰腺的躯体神经纤维", + "D": "增强蠕动", + "E": "抑制射精" + } + }, + { + "id": "f3462ac2-3332-5ec3-9f32-d878e8aa93a4", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "A 65-year-old man is disoriented and has a headache and nausea in the recovery room 30 minutes after transurethral resection of the prostate with glycine irrigation performed under spinal anesthesia. Heart rate is 50 bpm and blood pressure is 180/110 mmHg. Which of the following is LEAST likely?", + "A": "Decreased serum osmolality", + "B": "Serum sodium concentration 132 mEq/L", + "C": "Increased serum ammonia concentration", + "D": "Bibasilar rales", + "E": "Jugular venous distention" + }, + "zh": { + "question": "一名65岁男性在脊椎麻醉下进行经尿道前列腺切除术后30分钟，在恢复室出现定向障碍、头痛和恶心。心率为50次/分钟，血压为180/110 mmHg。以下哪项最不可能？", + "A": "血清渗透压降低", + "B": "血清钠浓度132 mEq/L", + "C": "血清氨浓度升高", + "D": "双侧基底肺湿啰音", + "E": "颈静脉怒张" + } + }, + { + "id": "ed901543-93f6-5e8b-b4b7-12e8918643c6", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Left ventricular subendocardial perfusion pressure is best estimated by the difference between", + "A": "mean arterial and central venous pressures", + "B": "diastolic arterial and pulmonary artery occlusion pressures", + "C": "mean arterial and pulmonary artery occlusion pressures", + "D": "systolic arterial and pulmonary artery occlusion pressures", + "E": "diastolic arterial and central venous pressures" + }, + "zh": { + "question": "左心室心内膜下灌注压最好通过以下哪个差值来估计", + "A": "平均动脉压和中心静脉压", + "B": "舒张期动脉压和肺动脉阻塞压", + "C": "平均动脉压和肺动脉阻塞压", + "D": "收缩期动脉压和肺动脉阻塞压", + "E": "舒张期动脉压和中心静脉压" + } + }, + { + "id": "e9aa3e89-1765-5a25-8b38-40e32c03ec33", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is most effective in decontaminating an anesthesia machine that was splattered with HIV-contaminated blood?", + "A": "Bleach", + "B": "Deionized water", + "C": "Ethylene oxide", + "D": "Hydrogen peroxide", + "E": "Isopropyl alcohol" + }, + "zh": { + "question": "以下哪种方法最有效清除被HIV污染的血液溅到的麻醉机？", + "A": "漂白剂", + "B": "去离子水", + "C": "环氧乙烷", + "D": "过氧化氢", + "E": "异丙醇" + } + }, + { + "id": "ac9c559b-3a71-5d43-82f8-adfa9ac351eb", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A healthy 60-kg 52-year-old woman undergoing reduction mammoplasty is anesthetized with isoflurane and oxygen, and deliberate hypotension to 80/40 mmHg is induced with nitroprusside. Urine output through an indwelling urethral catheter has been 10 mL during the past hour. You should now", + "A": "administer furosemide 40 mg intravenously", + "B": "infuse normal saline solution until urine output reaches 35 mL/hr", + "C": "administer dopamine at 3 mcg/kg/min", + "D": "expect normal urine flow with restoration of normal blood pressure", + "E": "discontinue nitroprusside administration" + }, + "zh": { + "question": "一位健康的60公斤52岁女性正在接受乳房缩小术，使用异氟醚和氧气进行麻醉，并通过硝普钠诱导至80/40 mmHg的故意低血压。过去一小时通过留置导尿管的尿量为10毫升。你现在应该", + "A": "静脉注射呋塞米40毫克", + "B": "输注生理盐水直到尿量达到35毫升/小时", + "C": "以3微克/公斤/分钟的速度给予多巴胺", + "D": "期待在恢复正常血压后尿流恢复正常", + "E": "停止硝普钠的使用" + } + }, + { + "id": "2e99c94b-5be1-52a1-a38c-a8a70c7dd134", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Numbness and tingling on the lateral aspect of the thigh 24 hours after uneventful vaginal delivery is most likely a complication of", + "A": "forceps delivery", + "B": "lithotomy position", + "C": "pudendal nerve block", + "D": "lumbar epidural anesthesia", + "E": "spinal anesthesia" + }, + "zh": { + "question": "顺利的阴道分娩后24小时大腿外侧麻木和刺痛最可能是以下哪种并发症引起的", + "A": "产钳分娩", + "B": "截石位", + "C": "会阴神经阻滞", + "D": "腰椎硬膜外麻醉", + "E": "脊髓麻醉" + } + }, + { + "id": "f50bc887-76b2-5851-9e66-9232eec518d6", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 50-year-old man is scheduled to undergo emergency craniotomy for evacuation of an epidural hematoma. His Glasgow Coma Scale score is 6; heart rate is 54 bpm, and blood pressure is 190/110 mmHg. The most appropriate initial management is administration of which of the following agents?", + "A": "Atropine", + "B": "Mannitol", + "C": "Nimodipine", + "D": "Sodium nitroprusside", + "E": "Thiopental" + }, + "zh": { + "question": "一名50岁的男性计划进行紧急开颅手术以清除硬膜外血肿。他的格拉斯哥昏迷评分为6分；心率为54次/分钟，血压为190/110 mmHg。最合适的初始处理是给予以下哪种药物？", + "A": "阿托品", + "B": "甘露醇", + "C": "尼莫地平", + "D": "硝普钠", + "E": "硫喷妥钠" + } + }, + { + "id": "cea8ed7e-0fd8-51b2-8ad8-b4a4c65fb232", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following conditions is associated with autonomic hyperreflexia in patients with spinal cord injury EXCEPT", + "A": "bradycardia", + "B": "flushing below the level of injury", + "C": "headache", + "D": "sweating above the level of injury", + "E": "systolic hypertension" + }, + "zh": { + "question": "以下每种情况均与脊髓损伤患者的自主神经反射亢进有关，除了", + "A": "心动过缓", + "B": "损伤水平以下的潮红", + "C": "头痛", + "D": "损伤水平以上的出汗", + "E": "收缩压高血压" + } + }, + { + "id": "b88a9f03-3fc1-572f-934d-84cf70aa45ba", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Neurolytic block is most appropriate for", + "A": "abdominal pain secondary to hepatic carcinoma", + "B": "abdominal pain secondary to chronic pancreatitis", + "C": "persistent chest wall pain secondary to intercostal neuralgia following a thoracotomy for trauma", + "D": "reflex sympathetic dystrophy of the upper extremity with an excellent but transient response to a series of stellate ganglion blocks with local anesthetic", + "E": "a diabetic patient scheduled for surgical sympathectomy to relieve unilateral lower extremity pain secondary" + }, + "zh": { + "question": "神经溶解阻滞最适用于", + "A": "肝癌引起的腹痛", + "B": "慢性胰腺炎引起的腹痛", + "C": "创伤性开胸术后肋间神经痛引起的持续性胸壁痛", + "D": "上肢反射性交感神经营养不良，对一系列星状神经节阻滞局麻反应良好但短暂", + "E": "糖尿病患者计划进行手术交感神经切除以缓解单侧下肢痛" + } + }, + { + "id": "dc12b3d2-d4ec-5f9c-a160-9716ec57492b", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements concerning the superior laryngeal nerve is true?", + "A": "It provides sensory innervation to the subglottic surface of the vocal cord", + "B": "It provides sensory innervation to the inferior surface of the epiglottis", + "C": "It is a branch of the glossopharyngeal nerve", + "D": "It is blocked by injection of anesthetic near the lateral portion of the cricothyroid membrane", + "E": "It is the most commonly injured nerve during thyroid surgery" + }, + "zh": { + "question": "以下关于喉上神经的说法哪一项是正确的？", + "A": "它为声带的声门下表面提供感觉神经支配", + "B": "它为会厌的下表面提供感觉神经支配", + "C": "它是舌咽神经的一个分支", + "D": "通过在环甲膜侧部注射麻醉剂来阻滞它", + "E": "它是甲状腺手术中最常受损的神经" + } + }, + { + "id": "accd37cf-0b3d-5db1-9f10-ea467dc836a6", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 2-year-old child is hospitalized for exposure. Rectal temperature is 30°C. The most appropriate method of warming is to", + "A": "apply radiant heat", + "B": "increase ambient temperature to 28°C", + "C": "use a heating blanket set at 39°C", + "D": "warm and humidify inspired gases", + "E": "warm intravenous fluids to 37°C" + }, + "zh": { + "question": "一名2岁儿童因暴露而住院。直肠温度为30°C。最合适的加温方法是", + "A": "使用辐射热", + "B": "将环境温度提高到28°C", + "C": "使用设定为39°C的加热毯", + "D": "加温和加湿吸入气体", + "E": "将静脉输液加热到37°C" + } + }, + { + "id": "77e52a88-ad4a-5fbc-a68f-47ec327b6fa1", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "Which of the following is most likely to result in oxygen desaturation in a patient with Eisenmenger's syndrome who is scheduled for cesarean delivery?", + "A": "Breathing room air", + "B": "Epidural administration of lidocaine", + "C": "Intravenous administration of ketamine", + "D": "Intravenous administration of ephedrine", + "E": "Mild hypocarbia" + }, + "zh": { + "question": "以下哪项最有可能导致计划进行剖宫产的艾森曼格综合征患者出现氧饱和度下降？", + "A": "呼吸室内空气", + "B": "硬膜外注射利多卡因", + "C": "静脉注射氯胺酮", + "D": "静脉注射麻黄碱", + "E": "轻度低碳酸血症" + } + }, + { + "id": "de1dcd11-31a4-5bbb-90bb-37f0bbde92ba", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following findings best indicates complete resolution of spinal anesthesia?", + "A": "Ability to ambulate", + "B": "Ability to urinate", + "C": "Perianal pinprick sensation", + "D": "Pain at the surgical site", + "E": "Proprioception of the big toe" + }, + "zh": { + "question": "以下哪项发现最能表明脊髓麻醉已完全消退？", + "A": "能够行走", + "B": "能够排尿", + "C": "肛周针刺感觉", + "D": "手术部位疼痛", + "E": "大脚趾的本体感觉" + } + }, + { + "id": "c858d270-1e19-588c-ab14-9a790bbbcd95", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "In patients with reflex sympathetic dystrophy affecting the arm, which of the following findings indicates a therapeutic block?", + "A": "Bradycardia", + "B": "Contralateral nasal congestion", + "C": "Hoarseness", + "D": "Increased skin temperature", + "E": "Ipsilateral Horner's syndrome" + }, + "zh": { + "question": "在患有反射性交感神经营养不良影响手臂的患者中，下列哪一项发现表明治疗性阻滞？", + "A": "心动过缓", + "B": "对侧鼻塞", + "C": "声音嘶哑", + "D": "皮肤温度升高", + "E": "同侧霍纳综合征" + } + }, + { + "id": "e4c4d706-d4ad-5b91-8682-464b3c423ec1", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Following maternal epidural injection, fetal exposure to chloroprocaine is lower than fetal exposure to bupivacaine for which of the following reasons?", + "A": "Chloroprocaine is metabolized by plasma cholinesterase", + "B": "Chloroprocaine is more protein bound", + "C": "Chloroprocaine is not readily absorbed from the epidural space", + "D": "The ionized fraction of chloroprocaine in the fetal circulation is smaller", + "E": "The pKa of chloroprocaine is less than that of bupivacaine" + }, + "zh": { + "question": "在母体硬膜外注射后，胎儿接触氯普鲁卡因的程度低于接触布比卡因的原因是什么？", + "A": "氯普鲁卡因被血浆胆碱酯酶代谢", + "B": "氯普鲁卡因的蛋白结合率更高", + "C": "氯普鲁卡因不易从硬膜外腔吸收", + "D": "胎儿循环中氯普鲁卡因的离子化部分较小", + "E": "氯普鲁卡因的pKa小于布比卡因的pKa" + } + }, + { + "id": "b29096c5-7341-51f8-b49e-82a46c35bdbb", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "The acute onset of hypotension without a decrease in mixed venous oxygen saturation is most likely associated with the onset of", + "A": "hemorrhage", + "B": "myocardial infarction", + "C": "pulmonary edema", + "D": "pulmonary embolus", + "E": "sepsis" + }, + "zh": { + "question": "急性低血压的发生而没有混合静脉氧饱和度的下降最可能与以下哪种情况的发生有关", + "A": "出血", + "B": "心肌梗死", + "C": "肺水肿", + "D": "肺栓塞", + "E": "败血症" + } + }, + { + "id": "4f0eaeb4-e9c1-5d07-8d2d-7c9206f1f44b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Compared with thiopental, etomidate causes", + "A": "greater histamine release", + "B": "greater myocardial depression", + "C": "greater myoclonic activity", + "D": "increased seizure threshold", + "E": "less nausea" + }, + "zh": { + "question": "与硫喷妥相比，依托咪酯引起", + "A": "更大的组胺释放", + "B": "更大的心肌抑制", + "C": "更大的肌阵挛活动", + "D": "增加的癫痫发作阈值", + "E": "更少的恶心" + } + }, + { + "id": "6599e7a8-5804-5817-b8da-c1f276b24036", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Postdural puncture headache occurs most commonly in which of the following patients?", + "A": "Children", + "B": "Elderly persons", + "C": "Misn", + "D": "Parturients", + "E": "Persons with obesity" + }, + "zh": { + "question": "以下哪类患者最常发生硬膜穿刺后头痛？", + "A": "儿童", + "B": "老年人", + "C": "男性", + "D": "产妇", + "E": "肥胖者" + } + }, + { + "id": "21830f18-8943-5e5d-b69d-a051f4ae0873", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Delirium produced by high doses of atropine can be reversed by intravenous injection of", + "A": "diphenhydramine", + "B": "flumazenil", + "C": "naloxone", + "D": "neostigmine", + "E": "physostigmine" + }, + "zh": { + "question": "由高剂量阿托品引起的谵妄可以通过静脉注射逆转", + "A": "苯海拉明", + "B": "氟马西尼", + "C": "纳洛酮", + "D": "新斯的明", + "E": "毒扁豆碱" + } + }, + { + "id": "b8c7f0c3-7df7-5ee3-9cb7-d8ce5975be96", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 40-year-old woman has continuous nondermatomal burning pain of the distal foot four weeks after sustaining a metatarsal fracture. On examination, the foot is mildly swollen, tender, and cool. Which of the following statements concerning this condition is true?", + "A": "A radiograph of the distal bones of the painful foot will show severe osteoporosis", + "B": "A technetium scan of the distal joints of the painful foot will show decreased uptake", + "C": "Early use of opioid analgesia will prevent progression of the symptoms", + "D": "Intravenous phentolamine will relieve the pain", + "E": "The chance of spontaneous recovery within eight weeks is greater than 80%" + }, + "zh": { + "question": "一名40岁的女性在跖骨骨折四周后出现持续的非皮节性烧灼痛。检查发现，足部轻度肿胀、压痛且冰凉。关于这种情况，下列哪项陈述是正确的？", + "A": "疼痛足部远端骨骼的X光片将显示严重的骨质疏松", + "B": "疼痛足部远端关节的锝扫描将显示摄取减少", + "C": "早期使用阿片类镇痛药将防止症状进展", + "D": "静脉注射酚妥拉明将缓解疼痛", + "E": "在八周内自发恢复的机会大于80%" + } + }, + { + "id": "51087395-6136-53a6-9f8c-bd5b2d6d325b", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Intraoperative heat loss in an unclothed, undraped patient is caused primarily by", + "A": "conduction to colder objects", + "B": "convective heat loss", + "C": "insensible perspiration", + "D": "radiant heat loss to the environment", + "E": "respiratory tract water loss" + }, + "zh": { + "question": "在手术过程中，未穿衣物且未覆盖的患者的热量流失主要是由于", + "A": "与较冷物体的传导", + "B": "对流热损失", + "C": "无感蒸发", + "D": "向环境辐射热损失", + "E": "呼吸道水分流失" + } + }, + { + "id": "dce2735e-09ef-5a32-b08d-d06be7ca941e", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 40-year-old man requires brief surgical relaxation after administration of neostigmine and glycopyrrolate for reversal of vecuronium-induced neuromuscular blockade. Succinylcholine 1 mg/kg is administered intravenously. Compared with a patient who has not had prior reversal of neuromuscular blockade, which of the following characterizes the succinylcholine blockade in this patient?", + "A": "Greater antagonism with calcium chloride", + "B": "Slower onset", + "C": "Less profound", + "D": "Less likelihood of phase II neuromuscular blockade", + "E": "Prolonged duration" + }, + "zh": { + "question": "一名40岁的男性在使用新斯的明和格隆溴铵逆转维库溴铵引起的神经肌肉阻滞后，需要短暂的手术松弛。静脉注射1 mg/kg的琥珀胆碱。与未进行神经肌肉阻滞逆转的患者相比，下列哪项描述了该患者的琥珀胆碱阻滞特征？", + "A": "与氯化钙有更大的拮抗作用", + "B": "起效较慢", + "C": "不太深刻", + "D": "发生II期神经肌肉阻滞的可能性较小", + "E": "持续时间延长" + } + }, + { + "id": "a4b75875-647c-5d89-8e43-589952c98f3d", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Coughing that occurs during awake intubation is prevented by local anesthetic block of which of the following nerves?", + "A": "Glossopharyngeal", + "B": "Hypoglossal", + "C": "Recurrent laryngeal and glossopharyngeal", + "D": "Recurrent laryngeal and superior laryngeal", + "E": "Superior laryngeal and glossopharyngeal" + }, + "zh": { + "question": "在清醒插管过程中，咳嗽的发生可以通过局部麻醉阻滞以下哪一条神经来预防？", + "A": "舌咽神经", + "B": "舌下神经", + "C": "喉返神经和舌咽神经", + "D": "喉返神经和喉上神经", + "E": "喉上神经和舌咽神经" + } + }, + { + "id": "8cc4dbe9-c43e-5f47-b540-e9967e7c4f82", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The need for increased doses of nondepolarizing muscle relaxants in patients with extensive burns is best explained by", + "A": "increased protein binding", + "B": "hypermetabolism", + "C": "increased glomerular filtration rate", + "D": "proliferation of receptors on burned muscle", + "E": "decreased volume of distribution" + }, + "zh": { + "question": "需要增加非去极化肌松药剂量以治疗大面积烧伤患者的原因最好解释为", + "A": "蛋白结合增加", + "B": "高代谢", + "C": "肾小球滤过率增加", + "D": "烧伤肌肉上受体增生", + "E": "分布容积减少" + } + }, + { + "id": "5586050a-2252-5bc6-aac3-ba529f143b93", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "On routine inspection of an anesthesia machine, the nitrous oxide E cylinder pressure is 360 psi. This indicates that the", + "A": "pressure in the cylinder is 16 atm", + "B": "cylinder contains no liquid nitrous oxide", + "C": "cylinder is half full", + "D": "cylinder contains enough nitrous oxide for one hour of anesthesia at a flow rate of 3 L/min", + "E": "reducing valve is malfunctioning" + }, + "zh": { + "question": "在对麻醉机进行常规检查时，氧化亚氮E型钢瓶的压力为360 psi。这表明", + "A": "钢瓶内的压力为16个大气压", + "B": "钢瓶内不含液态氧化亚氮", + "C": "钢瓶半满", + "D": "钢瓶内的氧化亚氮足够以3 L/min的流速进行一小时的麻醉", + "E": "减压阀故障" + } + }, + { + "id": "a6fb5288-c2ef-5eab-9ebf-b1ee8f28843e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Static lung compliance is decreased by each of the following EXCEPT", + "A": "pulmonary emphysema", + "B": "congestive heart failure", + "C": "adult respiratory distress syndrome", + "D": "pulmonary fibrosis", + "E": "inhalational anesthesia" + }, + "zh": { + "question": "下列哪项不会导致静态肺顺应性下降？", + "A": "肺气肿", + "B": "充血性心力衰竭", + "C": "成人呼吸窘迫综合征", + "D": "肺纤维化", + "E": "吸入麻醉" + } + }, + { + "id": "66eab134-f019-53e0-b649-accd88bf7828", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A healthy, spontaneously breathing, supine, anesthetized patient has an arterial to end-tidal carbon dioxide tension difference of 3 mmHg. Following institution of mechanical ventilation the value increases to 12 mmHg. The most likely cause of this change is", + "A": "cephalad displacement of the diaphragm", + "B": "decreased production of carbon dioxide", + "C": "increased cardiac output", + "D": "increased shunting of blood through dependent lung zones", + "E": "increased ventilation of nondependent lung zones" + }, + "zh": { + "question": "一位健康的、自然呼吸、仰卧、麻醉的患者动脉与呼气末二氧化碳张力差为3 mmHg。在实施机械通气后，该值增加到12 mmHg。此变化最可能的原因是", + "A": "膈肌向头侧移位", + "B": "二氧化碳生成减少", + "C": "心输出量增加", + "D": "血液通过依赖性肺区的分流增加", + "E": "非依赖性肺区的通气增加" + } + }, + { + "id": "af2a0f94-b8b8-5926-9c02-8913c72a13a2", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following findings is most likely in an 85-kg 30-year-old man who is breathing spontaneously through 6-mm endotracheal tube?", + "A": "Decreased PetCO2", + "B": "Decreased SpO2", + "C": "Increased minute ventilation", + "D": "Increased respiratory rate", + "E": "Increased tidal volume" + }, + "zh": { + "question": "以下哪项发现最有可能出现在一位通过6毫米气管导管自主呼吸的85公斤30岁男性中？", + "A": "PetCO2降低", + "B": "SpO2降低", + "C": "分钟通气量增加", + "D": "呼吸频率增加", + "E": "潮气量增加" + } + }, + { + "id": "76328efa-f6f8-51fd-8859-bf8cffe4a94f", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "During induction of anesthesia in a 70-year-old man with aortic stenosis, the blood pressure decreases from 140/ 80 to 70/45 mmHg as the cardiac rhythm changes from normal sinus at 70 bpm to junctional at 120 bpm. The most appropriate initial therapy would be", + "A": "cardioversion", + "B": "esmolol", + "C": "fluid bolus", + "D": "phenylephrine", + "E": "verapamil" + }, + "zh": { + "question": "在一名70岁患有主动脉瓣狭窄的男性麻醉诱导期间，血压从140/80 mmHg下降到70/45 mmHg，同时心律从70次/分钟的正常窦性心律变为120次/分钟的交界性心律。最合适的初始治疗是", + "A": "心脏复律", + "B": "艾司洛尔", + "C": "液体推注", + "D": "去氧肾上腺素", + "E": "维拉帕米" + } + }, + { + "id": "17e340e9-5e09-5aeb-937b-60178de9ff13", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following correctly describes the anatomical location of the brachial plexus?", + "A": "Adjacent to the subclavian vein as it passes between the scalene muscles", + "B": "Between the middle and posterior scalene muscles", + "C": "Posterior to the first rib", + "D": "Posterior to the subclavian artery", + "E": "Posterior to the vertebral artery" + }, + "zh": { + "question": "以下哪项正确描述了臂丛的解剖位置？", + "A": "在斜角肌之间经过的锁骨下静脉旁边", + "B": "在中斜角肌和后斜角肌之间", + "C": "在第一肋骨后方", + "D": "在锁骨下动脉后方", + "E": "在椎动脉后方" + } + }, + { + "id": "ff6e9d76-e725-5ae4-ad55-8f8cc3865fd7", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Halothane", + "A": "has no effect on reflex hypoxic pulmonary vasoconstriction", + "B": "protects the myocardium from beta-adrenergic stimulation", + "C": "has a direct, negative chronotropic effect on the sinoatrial node", + "D": "metabolites decrease renal concentrating ability", + "E": "is unsafe for use with epinephrine-containing local anesthetics" + }, + "zh": { + "question": "氟烷", + "A": "对反射性缺氧性肺血管收缩无影响", + "B": "保护心肌免受β-肾上腺素能刺激", + "C": "对窦房结有直接的负性变时作用", + "D": "代谢产物降低肾脏浓缩能力", + "E": "与含肾上腺素的局部麻醉剂一起使用不安全" + } + }, + { + "id": "96068ad8-7754-5c21-9855-1cf7e3ebf1f7", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Mepivacaine 40 ml of a 1% solution with epinephrine 1:200,000 is injected into the brachial plexus sheath at the axilla after eliciting a paresthesia in the ulnar nerve distribution. Which of the following is most likely to remain intact?", + "A": "Adduction of the thumb", + "B": "Flexion at the wrist", + "C": "Sensation of the lateral forearm", + "D": "Sensation on the palmar surface of the lateral three and one half fingers", + "E": "Sensation on the palmar surface of the medial one and one half fingers" + }, + "zh": { + "question": "在引发尺神经分布区的感觉异常后，将40毫升1%浓度的甲哌卡因与1:200,000肾上腺素溶液注射到腋窝的臂丛鞘中。以下哪项最有可能保持完整？", + "A": "拇指内收", + "B": "手腕屈曲", + "C": "前臂外侧的感觉", + "D": "掌面外侧三个半手指的感觉", + "E": "掌面内侧一个半手指的感觉" + } + }, + { + "id": "3c3f9026-09f6-593f-92d2-7e5d89d7059e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is a known effect of propofol?", + "A": "Decreased amplitude of somatosensory evoked potentials", + "B": "Induction of malignant hyperthermia", + "C": "Inhibition of cytochrome P450", + "D": "Initiation of porphyria", + "E": "Suppression of adrenocortical function" + }, + "zh": { + "question": "以下哪项是丙泊酚的已知作用？", + "A": "降低体感诱发电位的幅度", + "B": "诱发恶性高热", + "C": "抑制细胞色素P450", + "D": "引发卟啉症", + "E": "抑制肾上腺皮质功能" + } + }, + { + "id": "f438bc24-092e-50ac-8e39-249d5710a071", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Following protamine administration, profound pulmonary hypertension is most likely initiated by release of", + "A": "epinephrine", + "B": "histamine", + "C": "leukotriene", + "D": "norepinephrine", + "E": "thromboxane" + }, + "zh": { + "question": "在给予鱼精蛋白后，严重的肺动脉高压最有可能由以下哪种物质的释放引发", + "A": "肾上腺素", + "B": "组胺", + "C": "白三烯", + "D": "去甲肾上腺素", + "E": "血栓素" + } + }, + { + "id": "732721bd-b224-5c81-ae57-627056898dd4", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "If minute ventilation remains constant, a decrease in end-expiratory carbon dioxide concentration will occur with", + "A": "a decrease in physiologic dead space", + "B": "a decrease in cardiac output", + "C": "a decrease in physiologic shunt fraction", + "D": "the development of metabolic alkalosis", + "E": "an increase in body temperature" + }, + "zh": { + "question": "如果每分钟通气量保持不变，呼气末二氧化碳浓度的降低将发生在", + "A": "生理无效腔的减少", + "B": "心输出量的减少", + "C": "生理分流分数的减少", + "D": "代谢性碱中毒的发展", + "E": "体温的升高" + } + }, + { + "id": "1b9d9fd3-57e6-5096-be1f-c67ef43923b5", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Following delivery with pudendal block, a patient requires anesthesia for removal of a retained placenta. The most appropriate anesthetic is", + "A": "epidural block", + "B": "ketamine analgesia with midazolam for amnesia", + "C": "opioid-based general endotracheal anesthetic", + "D": "potent inhaled general endotracheal anesthetic", + "E": "subarachnoid block" + }, + "zh": { + "question": "在使用会阴神经阻滞进行分娩后，患者需要麻醉以取出滞留的胎盘。最合适的麻醉方法是", + "A": "硬膜外阻滞", + "B": "氯胺酮镇痛联合咪达唑仑用于遗忘", + "C": "基于阿片类药物的全身气管内麻醉", + "D": "强效吸入性全身气管内麻醉", + "E": "蛛网膜下腔阻滞" + } + }, + { + "id": "91225942-b178-555c-b557-90ff822b9afc", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A 32-year-old man who is addicted to opioids complains of pain in the PACU one hour after fixation of a mandibular fracture. He has received intravenous morphine 30 mg during the past hour. The most appropriate management is", + "A": "continued intravenous administration of morphine until the pain resolves", + "B": "intravenous administration of nalbuphine in 5-mg increments until the pain resolves", + "C": "intramuscular administration of hydroxyzine 75 mg", + "D": "evaluation for entrapment of the mandibular nerve", + "E": "evaluation for drug-seeking behavior" + }, + "zh": { + "question": "一名32岁的男性，吸食阿片类药物成瘾，在下颌骨骨折固定术后一小时在PACU抱怨疼痛。他在过去一小时内接受了30毫克的静脉注射吗啡。最合适的处理是", + "A": "继续静脉注射吗啡直到疼痛缓解", + "B": "静脉注射纳布啡，每次5毫克，直到疼痛缓解", + "C": "肌肉注射羟嗪75毫克", + "D": "评估下颌神经受压", + "E": "评估药物寻求行为" + } + }, + { + "id": "d61dc8fd-22c7-5deb-9dbc-d88012c7a341", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is a respiratory effect of 1 MAC halothane?", + "A": "Decreased contribution of abdominal muscles to exhalation", + "B": "Decreased contribution of the chest wall to ventilation", + "C": "Decreased respiratory rate", + "D": "Decreased ratio of dead space to tidal volume", + "E": "Increased tidal volume" + }, + "zh": { + "question": "以下哪项是1 MAC氟烷的呼吸效应？", + "A": "减少腹肌对呼气的贡献", + "B": "减少胸壁对通气的贡献", + "C": "降低呼吸频率", + "D": "减少死腔与潮气量的比率", + "E": "增加潮气量" + } + }, + { + "id": "59856714-d51e-5aae-ab99-1646ae1fb338", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A computer program for hemodynamic calculations has the following input values: body surface area, arterial blood pressure, heart rate, pulmonary artery occlusion pressure, pulmonary artery pressure, and cardiac output. Each of the following values can be derived with this program EXCEPT", + "A": "cardiac index", + "B": "stroke volume index", + "C": "systemic vascular resistance", + "D": "pulmonary vascular resistance", + "E": "left ventricular stroke work index" + }, + "zh": { + "question": "一个用于血流动力学计算的计算机程序具有以下输入值：体表面积、动脉血压、心率、肺动脉楔压、肺动脉压和心输出量。以下每个值都可以通过该程序得出，除了", + "A": "心脏指数", + "B": "每搏量指数", + "C": "全身血管阻力", + "D": "肺血管阻力", + "E": "左心室每搏功指数" + } + }, + { + "id": "6c95ef48-0ffb-56e0-8057-30f630934397", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "After an uncomplicated cesarean delivery, a full-term neonate has intermittent cyanosis. Diaphragmatic effort is vigorous and respiratory distress is relieved while crying. The most likely diagnosis is", + "A": "amniotic fluid aspiration", + "B": "choanal atresia", + "C": "diaphragmatic hernia", + "D": "tetralogy of Fallot", + "E": "tracheoesophageal fistula" + }, + "zh": { + "question": "在一次无并发症的剖宫产后，足月新生儿出现间歇性发绀。膈肌活动有力，哭泣时呼吸窘迫得到缓解。最可能的诊断是", + "A": "羊水吸入", + "B": "后鼻孔闭锁", + "C": "膈疝", + "D": "法洛四联症", + "E": "气管食管瘘" + } + }, + { + "id": "a8db24a2-7cc9-59e8-be12-ee0de253a638", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "During surgery with a carbon dioxide laser, which inhaled gas mixture is LEAST likely to promote combustion of the endotracheal tube?", + "A": "Oxygen 25%-helium 75%", + "B": "Oxygen 25%-nitrogen 75%", + "C": "Oxygen 25%-nitrous oxide 75%", + "D": "Oxygen 50%-nitrogen 50%", + "E": "Oxygen 50%-nitrous oxide 50%" + }, + "zh": { + "question": "在使用二氧化碳激光进行手术时，哪种吸入气体混合物最不可能促进气管插管的燃烧？", + "A": "氧气 25%-氦气 75%", + "B": "氧气 25%-氮气 75%", + "C": "氧气 25%-氧化亚氮 75%", + "D": "氧气 50%-氮气 50%", + "E": "氧气 50%-氧化亚氮 50%" + } + }, + { + "id": "3ce8e87d-44e6-53b2-a3e6-e94eca849316", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "An adult patient with atrial fibrillation develops pulseless ventricular tachycardia wfiile undergoing synchronized electirical cardioversion. Which of the following is the most appropriate management?", + "A": "Intravenous administration of adenosine", + "B": "Intravenous administration of a bolus of lidocaine followed by electrical cardioversion", + "C": "Immediate repeat synchronized cardioversion at the same energy level", + "D": "Immediate repeat synchronized cardioversion at twice the previous energy level", + "E": "Unsynchronized electrical cardioversion" + }, + "zh": { + "question": "一名患有心房颤动的成年患者在进行同步电复律时出现无脉性室性心动过速。以下哪项是最合适的处理方法？", + "A": "静脉注射腺苷", + "B": "静脉注射利多卡因推注后进行电复律", + "C": "立即以相同能量水平重复同步电复律", + "D": "立即以两倍于先前能量水平重复同步电复律", + "E": "非同步电复律" + } + }, + { + "id": "3758ee72-0b59-54b0-b4cd-665b32cc90d3", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements best describes testing for susceptibility to malignant hyperthermia (MH)?", + "A": "Live skeletal muscle cells are required for testing", + "B": "The MH gene is located on the X chromosome", + "C": "Muscle biopsy is appropriate in children younger than 1 year", + "D": "A normal serum creatine phosphokinase concentration eliminates the need for muscle biopsy", + "E": "Succinylcholine is used to stimulate muscle obtained on biopsy for MH" + }, + "zh": { + "question": "以下哪项陈述最能描述对恶性高热（MH）易感性的测试？", + "A": "测试需要活的骨骼肌细胞", + "B": "MH基因位于X染色体上", + "C": "肌肉活检适用于1岁以下的儿童", + "D": "正常的血清肌酸磷酸激酶浓度消除了进行肌肉活检的需要", + "E": "琥珀酰胆碱用于刺激活检获得的肌肉以检测MH" + } + }, + { + "id": "c0f4c1ef-7887-51e8-8d97-00167b649434", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Hypomagnesemia is associated with", + "A": "decreased risk for digitalis toxicity", + "B": "dysrhythmias sensitive to bretylium", + "C": "hypercalcemia", + "D": "prolonged succinylcholine blockade", + "E": "surgery requiring cardiopulmonary bypass" + }, + "zh": { + "question": "低镁血症与以下哪项有关", + "A": "降低洋地黄毒性的风险", + "B": "对溴苄铵敏感的心律失常", + "C": "高钙血症", + "D": "延长琥珀胆碱阻滞", + "E": "需要心肺转流的手术" + } + }, + { + "id": "94420d76-eca8-5d99-bc02-1254a1b4a0f9", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Following completion of an ankle block, the patient reports intact sensation on the tips of the toes. Which of the following nerves was blocked inadequately?", + "A": "Deep peroneal", + "B": "Posterior tibial", + "C": "Saphenous", + "D": "Superficial peroneal", + "E": "Sural" + }, + "zh": { + "question": "在完成踝部神经阻滞后，患者报告脚趾尖的感觉完好。以下哪一条神经阻滞不充分？", + "A": "腓深神经", + "B": "胫后神经", + "C": "隐神经", + "D": "腓浅神经", + "E": "腓肠神经" + } + }, + { + "id": "fa75d957-72bd-5f47-9b42-cc8670f83d4f", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Gravid uterine blood flow is", + "A": "autoregulated", + "B": "decreased by normotensive epidural analgesia", + "C": "decreased by uterine contractions", + "D": "increased with an increase in maternal Pa02", + "E": "unaffected by alpha-adrenergic agonists" + }, + "zh": { + "question": "妊娠子宫血流是", + "A": "自我调节的", + "B": "因正常血压硬膜外镇痛而减少", + "C": "因子宫收缩而减少", + "D": "随着母体PaO2的增加而增加", + "E": "不受α-肾上腺素能激动剂影响" + } + }, + { + "id": "89949087-7dce-59aa-9ee9-7d5bf7ece6a7", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Arterial pressure in the radial artery is 155/70 mmHg measured by a correctly calibrated catheter-transducer system. At the same time, aortic pressure is 140/75 mmHg using a high-fidelity catheter tip transducer. The most likely cause of this discrepancy is", + "A": "a large amount of air in the dome of the radial artery transducer", + "B": "coarctation of the aorta", + "C": "peripheral vascular constriction produced by sympathetic stimulation", + "D": "physiologic amplification of the waveform from the aorta to the radial artery", + "E": "too high a frequency response in the catheter-transducer system" + }, + "zh": { + "question": "在使用正确校准的导管-传感器系统测量时，桡动脉的动脉压为155/70 mmHg。同时，使用高保真导管尖端传感器测量的主动脉压为140/75 mmHg。此差异最可能的原因是", + "A": "桡动脉传感器的穹顶中有大量空气", + "B": "主动脉缩窄", + "C": "交感神经刺激引起的外周血管收缩", + "D": "从主动脉到桡动脉的波形生理性放大", + "E": "导管-传感器系统的频率响应过高" + } + }, + { + "id": "9244818e-94b5-527d-98d1-b9f39b4cc3ce", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following results in the greatest increase in right-to-left shunting in an infant with cyanotic heart disease?", + "A": "Decreased pulmonary vascular resistance", + "B": "Decreased systemic vascular resistance", + "C": "Hemodilution", + "D": "Increased heart rate", + "E": "Myocardial depression" + }, + "zh": { + "question": "以下哪项会导致患有发绀型心脏病的婴儿右向左分流增加最���？", + "A": "肺血管阻力降低", + "B": "体循环血管阻力降低", + "C": "血液稀释", + "D": "心率增加", + "E": "心肌抑制" + } + }, + { + "id": "24c9a0cc-79bd-59f8-92c1-f7f04d3634a9", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 55-kg, 70-year-old woman with mild chronic renal failure is unresponsive 20 hours after an uneventful coronary artery bypass grafting procedure. Anesthetic drugs included fentanyl 3000 mcg, diazepam 35 mg, and pancuronium 20 mg. Which of the following is the most appropriate next step in management?", + "A": "Administration of edrophonium", + "B": "Administration of flumazenil", + "C": "Administration of naloxone", + "D": "CT scan of the head", + "E": "Measurement of core body temperature" + }, + "zh": { + "question": "一名55公斤、70岁的女性患有轻度慢性肾功能衰竭，在顺利进行冠状动脉旁路移植术后20小时无反应。麻醉药物包括芬太尼3000微克、地西泮35毫克和潘库溴铵20毫克。以下哪项是最合适的下一步管理措施？", + "A": "给予依酚氯铵", + "B": "给予氟马西尼", + "C": "给予纳洛酮", + "D": "进行头部CT扫描", + "E": "测量核心体温" + } + }, + { + "id": "143f4560-6f36-52ca-8c1c-baf3ad7a8488", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "Five minutes after initiating one-lung ventilation using a double-lumen endobronchial tube, a 70-year-old patient has a decrease in Sp02 from 99% to 90%. Tidal volume and respiratory rate are unchanged. Fiberoptic bronchoscopy verifies appropriate positioning of the tube. Which of the following is the most likely cause of the desaturation?", + "A": "Blood flow to the nondependent lung", + "B": "Failure of hypoxic pulmonary vasoconstriction in the dependent lung", + "C": "Inadequate filling of the bronchial cuff", + "D": "Inadequate minute ventilation", + "E": "Surgical manipulation of the nondependent lung" + }, + "zh": { + "question": "在使用双腔支气管导管进行单肺通气五分钟后，一名70岁的患者SpO2从99%下降到90%。潮气量和呼吸频率保持不变。纤维支气管镜检查证实导管位置正确。以下哪项最可能是导致脱饱和的原因？", + "A": "非依赖肺的血流", + "B": "依赖肺缺氧性肺血管收缩失败", + "C": "支气管袖带充气不足", + "D": "分钟通气量不足", + "E": "对非依赖肺的手术操作" + } + }, + { + "id": "ec0d9d06-1a4d-5cee-bd1e-f21d0c002c3e", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 10-week-old infant born at 28 weeks gestation is scheduled for elective repair of bilateral inguinal hernias. It is most appropriate to", + "A": "delay the operation until the infant is 6 months old", + "B": "transfuse blood preoperatively if hemoglobin concentration is 9 g/dl", + "C": "avoid tracheal intubation", + "D": "limit inspired oxygen concentration to less than 50%", + "E": "monitor for apnea for 24 hours postoperatively" + }, + "zh": { + "question": "一名出生于28周妊娠期的10周大婴儿计划进行双侧腹股沟疝的择期修复手术。最合适的做法是", + "A": "将手术推迟到婴儿6个月大时进行", + "B": "如果血红蛋白浓度为9 g/dl，则术前输血", + "C": "避免气管插管", + "D": "将吸入氧浓度限制在50%以下", + "E": "术后监测呼吸暂停24小时" + } + }, + { + "id": "e416d2ae-3277-5b27-892a-dc65053b37dd", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 46-year-old man is scheduled for repair of an inguinal hernia. Six years ago, he had an episode of malignant hyperthermia during cholecystectomy. Which of the following is the most appropriate perioperative management?", + "A": "Administration of a regional anesthetic", + "B": "Administration of dantrolene orally for two days prior to surgery", + "C": "Avoidance of all inhalational anesthetics except isoflurane", + "D": "Avoidance of ester local anesthetics", + "E": "Flushing the anesthesia machine with oxygen 10 L/min for a minimum of 12 hours" + }, + "zh": { + "question": "一名46岁的男性计划进行腹股沟疝修补术。六年前，他在胆囊切除术中发生了恶性高热。以下哪项是最合适的围手术期管理？", + "A": "给予区域麻醉", + "B": "术前两天口服丹曲林", + "C": "避免使用除异氟醚以外的所有吸入麻醉剂", + "D": "避免使用酯类局部麻醉剂", + "E": "用氧气10 L/min冲洗麻醉机至少12小时" + } + }, + { + "id": "badadf25-c3ee-5aab-9a9a-bc2f1d94f2d6", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "In a patient with surgically significant aortic insufficiency, cardiac output measured by thermodilution will", + "A": "be greater than right ventricular output", + "B": "be less than left ventricular output", + "C": "be less than cardiac output measured by the Fick method", + "D": "be inaccurate because of decreased signal-to-noise ratio", + "E": "underestimate net systemic arterial blood flow" + }, + "zh": { + "question": "在具有外科意义的主动脉瓣关闭不全的患者中，通过热稀释法测量的心输出量将会", + "A": "大于右心室输出量", + "B": "小于左心室输出量", + "C": "小于通过Fick法测量的心输出量", + "D": "由于信噪比降低而不准确", + "E": "低估净系统动脉血流量" + } + }, + { + "id": "48e59230-dced-50a8-8886-1e29d48b6642", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "To predict the requirement for isoflurane in milliliters of vapor per minute during closed circuit anesthesia, each of the following is necessary EXCEPT", + "A": "cardiac output", + "B": "oxygen consumption", + "C": "MAC of isoflurane", + "D": "duration of administration", + "E": "blood-gas partition coefficient" + }, + "zh": { + "question": "在闭路麻醉中预测每分钟异氟醚蒸气的需求量（以毫升计），以下每项都是必要的，除了", + "A": "心输出量", + "B": "氧气消耗量", + "C": "异氟醚的最低肺泡浓度（MAC）", + "D": "给药时间", + "E": "血气分配系数" + } + }, + { + "id": "0ad3c8f2-900f-59cb-a6e0-a385a5fe1cb1", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Local anesthetics block nerve conduction by", + "A": "closing calcium channels", + "B": "decreasing intracellular calcium concentration", + "C": "decreasing potassium conductance", + "D": "causing extrusion of intracellular potassium", + "E": "inhibiting cellular influx of sodium" + }, + "zh": { + "question": "局部麻醉药通过以下哪种方式阻断神经传导", + "A": "关闭钙通道", + "B": "降低细胞内钙浓度", + "C": "降低钾导电性", + "D": "导致细胞内钾的排出", + "E": "抑制钠的细胞内流入" + } + }, + { + "id": "c156823e-4876-5b12-b4ab-21153bd9efda", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Which of the following is the most appropriate drug to treat hypotension in patients with asymmetric septal hypertrophy (IHSS)?", + "A": "Amrinone", + "B": "Calcium chloride", + "C": "Dopamine", + "D": "Ephedrine", + "E": "Phenylephrine" + }, + "zh": { + "question": "以下哪种药物最适合治疗患有不对称性室间隔肥厚（IHSS）患者的低血压？", + "A": "氨力农", + "B": "氯化钙", + "C": "多巴胺", + "D": "麻黄碱", + "E": "去氧肾上腺素" + } + }, + { + "id": "0b55601f-085b-5fa5-855b-a423413b2734", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Oxygen 100 ml/min is bubbled through a vaporizer containing an anesthetic with a vapor pressure of 150 mmHg, and this mixture is added to a fresh gas flow of 5 L/min. The delivered anesthetic concentration is", + "A": "0.25%", + "B": "0.5%", + "C": "1%", + "D": "2.5%", + "E": "5%" + }, + "zh": { + "question": "100 ml/min 的氧气通过含有蒸气压为 150 mmHg 的麻醉剂的蒸发器，并将此混合物加入到 5 L/min 的新鲜气流中。输送的麻醉剂浓度是", + "A": "0.25%", + "B": "0.5%", + "C": "1%", + "D": "2.5%", + "E": "5%" + } + }, + { + "id": "50a7a08e-6801-53fe-b756-c62528a1ae2e", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "In patients with head trauma, which of the following factors results in a return of arterial pH toward normal levels after two days of mechanical hyperventilation?", + "A": "Decreased renal absorption of hydrogen ions", + "B": "Decreased renal blood flow", + "C": "Increased PaCO2 with constant minute ventilation", + "D": "Increased renal excretion of bicarbonate ions", + "E": "Normalized cerebrospinal fluid pH" + }, + "zh": { + "question": "在头部创伤患者中，以下哪种因素会导致在机械过度通气两天后动脉pH值恢复到正常水平？", + "A": "肾脏对氢离子的吸收减少", + "B": "肾血流量减少", + "C": "在分钟通气量恒定的情况下PaCO2增加", + "D": "肾脏对碳酸氢根离子的排泄增加", + "E": "脑脊液pH值正常化" + } + }, + { + "id": "6dc0267b-d5db-556a-a4d8-ea7913c35b85", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Anesthesia is induced with halothane in a 3-year-old girl. Sixty seconds after administration of succinylcholine 1 mg/kg intravenously, heart rate decreases rapidly from 120 to 60 bpm. The most likely cause is", + "A": "acute hyperkalemia", + "B": "failure to pretreat with a nondepolarizing relaxant", + "C": "halothane overdose", + "D": "muscarinic activity", + "E": "sympathetic ganglionic blockade" + }, + "zh": { + "question": "在一名3岁女孩中使用氟烷诱导麻醉。静脉注射琥珀胆碱1 mg/kg后60秒，心率从120 bpm迅速下降到60 bpm。最可能的原因是", + "A": "急性高钾血症", + "B": "未预先使用非去极化肌松药", + "C": "氟烷过量", + "D": "毒蕈碱活性", + "E": "交感神经节阻滞" + } + }, + { + "id": "9cc4849a-1094-5813-ad17-058fe40b0014", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Compared with dopamine, dobutamine", + "A": "is more useful in patients taking monoamine oxidase inhibitors because it depends on the release of norepinephrine for its effect", + "B": "is more useful in patients in right heart failure because it does not increase pulmonary vascular resistance", + "C": "has no positive chronotropic response", + "D": "induces diuresis without increasing cardiac output", + "E": "in doses greater than 10 mcg/kg/min increases systemic vascular resistance more than similar doses of dopamine" + }, + "zh": { + "question": "与多巴胺相比，多巴酚丁胺", + "A": "在服用单胺氧化酶抑制剂的患者中更有用，因为它依赖于去甲肾上腺素的释放来发挥作用", + "B": "在右心衰竭患者中更有用，因为它不会增加肺血管阻力", + "C": "没有正性变时反应", + "D": "在不增加心输出量的情况下诱导利尿", + "E": "在剂量大于10 mcg/kg/min时比相似剂量的多巴胺更能增加全身血管阻力" + } + }, + { + "id": "43915708-ffe7-53a2-a3b9-c08075e43aa7", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following premedicant drug combinations is most effective in preventing passive regurgitation during anesthesia?", + "A": "Cimetidine and glycopyrrolate", + "B": "Metoclopramide and atropine", + "C": "Metoclopramide and ranitidine", + "D": "Metoclopramide, atropine, and ranitidine", + "E": "Metoclopramide and sodium bicitrate" + }, + "zh": { + "question": "以下哪种术前用药组合在预防麻醉期间被动反流方面最有效？", + "A": "西咪替丁和格隆溴铵", + "B": "甲氧氯普胺和阿托品", + "C": "甲氧氯普胺和雷尼替丁", + "D": "甲氧氯普胺、阿托品和雷尼替丁", + "E": "甲氧氯普胺和碳酸氢钠柠檬酸盐" + } + }, + { + "id": "ac60fb02-45a0-58b7-966a-d41e1662ec63", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Brain stem auditory evoked potentials are most likely to be absent during which of the following?", + "A": "Anesthesia with 1.5 MAC isoflurane", + "B": "Barbiturate coma", + "C": "Hypotension to a mean arterial pressure of 50 mmHg", + "D": "Surgical retraction of the temporal lobe", + "E": "Surgical traction on the pons" + }, + "zh": { + "question": "在以下哪种情况下，脑干听觉诱发电位最有可能消失？", + "A": "1.5 MAC 异氟醚麻醉", + "B": "巴比妥类药物昏迷", + "C": "平均动脉压降至 50 mmHg 的低血压", + "D": "颞叶的手术牵拉", + "E": "对脑桥的手术牵拉" + } + }, + { + "id": "eff7c0fb-ccc7-5d44-97ab-c0cff2f04be3", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The most likely effect of a celiac plexus block for an abdominal operation is", + "A": "bowel distention", + "B": "hypotension", + "C": "incisional analgesia", + "D": "muscle relaxation", + "E": "urinary retention" + }, + "zh": { + "question": "腹腔神经丛阻滞用于腹部手术最可能的效果是", + "A": "肠胀气", + "B": "低血压", + "C": "切口镇痛", + "D": "肌肉松弛", + "E": "尿潴留" + } + }, + { + "id": "2c4e238b-52be-59ae-80f7-292a24298d00", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning absorption of carbon dioxide by soda lime in an anesthetic circuit is correct?", + "A": "A warm canister indicates reserve absorption capability", + "B": "Fresh soda lime includes calcium carbonate", + "C": "Intergranular volume of the canister should exceed the patient's tidal volume", + "D": "The color indicator is methylene blue", + "E": "The reaction removes water" + }, + "zh": { + "question": "以下关于麻醉回路中苏打石灰吸收二氧化碳的说法哪一项是正确的？", + "A": "温暖的罐子表明有备用吸收能力", + "B": "新鲜的苏打石灰含有碳酸钙", + "C": "罐子的颗粒间体积应超过患者的潮气量", + "D": "颜色指示剂是亚甲蓝", + "E": "反应去除了水" + } + }, + { + "id": "6533bcf8-6fb6-5e25-a777-e531c4c3e741", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A patient with moderate hypothyroidism and unstable angina requires urgent coronary artery bypass grafting. Which of the following is most appropriate before proceeding with the operation?", + "A": "Initiation of epinephrine infusion", + "B": "Intramuscular administration of a barbiturate", + "C": "Intravenous administration of triiodothyronine (T3)", + "D": "Intravenous administration of thyroxine (T4)", + "E": "Treatment of myocardial ischemia" + }, + "zh": { + "question": "一名患有中度甲状腺功能减退和不稳定型心绞痛的患者需要紧急进行冠状动脉旁路移植术。在进行手术前，以下哪项最为合适？", + "A": "开始肾上腺素输注", + "B": "肌肉注射巴比妥类药物", + "C": "静脉注射三碘甲腺原氨酸（T3）", + "D": "静脉注射甲状腺素（T4）", + "E": "治疗心肌缺血" + } + }, + { + "id": "bb2aaaa4-72ca-5f38-8bf6-26a7bd9f5b29", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A patient undergoes axillary block for placement of an arteriovenous shunt in the forearm. Blockade of the musculocutaneous nerve is not achieved. Injection of a local anesthetic at which of the following sites will provide the required sensory block?", + "A": "Between the tendon of the palmaris longus and flexor carpi radialis", + "B": "Body of coracpbrachialis muscle", + "C": "Medial to the brachial artery at the elbow", + "D": "Proximal to the medial epicondyle against the medial surface of the humerus", + "E": "Superficial to the pulse of the axillary artery" + }, + "zh": { + "question": "一名患者接受腋窝阻滞以在前臂放置动静脉分流。未能实现肌皮神经的阻滞。在以下哪个部位注射局部麻醉剂将提供所需的感觉阻滞？", + "A": "在掌长肌腱和桡侧腕屈肌之间", + "B": "喙肱肌肌体", + "C": "肘部肱动脉内侧", + "D": "肱骨内上髁近端靠内侧表面", + "E": "腋动脉搏动的浅表面" + } + }, + { + "id": "95264c01-0c83-5071-b657-0f79eb5171c9", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An 8-kg, 1-year-old boy is scheduled for a bilateral inguinal hernia repair. If regional anesthesia is to be used for post-operative analgesia, which of the following statements is true?", + "A": "Caudal administration of 0.25% bupivacaine will provide analgesia without evidence of motor block", + "B": "Caudal administration of 0.125% bupivacaine is as effective as caudal administration of 0.25% bupivacaine", + "C": "Caudal analgesia is more difficult to achieve in young children than in adults", + "D": "The recommended volume of local anesthetic used for caudal analgesia in children is 3 ml per year of age", + "E": "The volume of 0.25% bupivacaine required for bilateral ilioinguinal and iliohypogastric nerve blocks would be too large" + }, + "zh": { + "question": "一名8公斤、1岁男孩计划进行双侧腹股沟疝修补术。如果使用区域麻醉进行术后镇痛，以下哪项陈述是正确的？", + "A": "尾部注射0.25%布比卡因将提供镇痛效果而无运动阻滞的证据", + "B": "尾部注射0.125%布比卡因与尾部注射0.25%布比卡因同样有效", + "C": "在幼儿中实现尾部镇痛比在成人中更困难", + "D": "儿童尾部镇痛使用的局部麻醉剂推荐剂量是每岁3毫升", + "E": "双侧髂腹股沟和髂腹下神经阻滞所需的0.25%布比卡因的体积过大" + } + }, + { + "id": "984e5856-0f39-5bc7-947e-fa0274a834fa", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The pin index system", + "A": "is not used in central pipeline connections", + "B": "requires aligning four pins with four holes", + "C": "is used on all sizes of medical gas cylinders", + "D": "has been replaced by color coding of gas cylinders", + "E": "prevents overfilling of gas cylinders" + }, + "zh": { + "question": "销孔定位系统", + "A": "不用于中央管道连接", + "B": "需要将四个销与四个孔对齐", + "C": "用于所有尺寸的医用气瓶", + "D": "已被气瓶的颜色编码所取代", + "E": "防止气瓶过度充填" + } + }, + { + "id": "dec89ce1-29d4-5604-9b94-c5fedd5b9821", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A patient with metastatic carcinoma and chronic renal failure has tremors, fasciculations, mydriasis, and hyperreflexia after several days of therapy with high doses of meperidine for analgesia. Which of the following is most likely to occur if the meperidine is continued?", + "A": "Disappearance of the symptoms as tolerance to meperidine develops", + "B": "Pinpoint constriction of pupils", + "C": "Progressive hypothermia", + "D": "Progressive sedation from meperidine toxicity", + "E": "Seizures from normeperidine toxicity" + }, + "zh": { + "question": "一名患有转移性癌症和慢性肾功能衰竭的患者在使用高剂量哌替啶进行镇痛治疗数天后出现震颤、肌束颤动、瞳孔散大和反射亢进。如果继续使用哌替啶，以下哪种情况最有可能发生？", + "A": "随着对哌替啶的耐受性发展，症状消失", + "B": "瞳孔针尖样缩小", + "C": "进行性体温过低", + "D": "哌替啶毒性导致的进行性镇静", + "E": "去甲哌替啶毒性导致的癫痫发作" + } + }, + { + "id": "b4176173-2984-5d25-abe1-771452323ae4", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 22-year-old woman with severe preeclampsia vaginally delivers a 3-kg infant after 12 hours of treatment with magnesium sulfate and continuous epidural infusion of bupivacaine 0.0625% and fentanyl 1 mcg/ml at 10 ml/hr. The infant is pink and hypotonic; heart rate is 110 bpm and blood pressure is 35/25 mmHg. Which of the following is the most appropriate initial management of the infant?", + "A": "10% Dextrose in water", + "B": "Calcium gluconate", + "C": "Epinephrine", + "D": "Naloxone", + "E": "Intubation and ventilation" + }, + "zh": { + "question": "一名22岁的女性患有严重的子痫前期，在经过12小时的硫酸镁治疗和持续硬膜外输注0.0625%布比卡因和1微克/毫升芬太尼（每小时10毫升）后，阴道分娩出一名3公斤的婴儿。婴儿肤色红润但肌张力低，心率为110次/分钟，血压为35/25毫米汞柱。以下哪项是对婴儿最合适的初步处理？", + "A": "10%葡萄糖水", + "B": "葡萄糖酸钙", + "C": "肾上腺素", + "D": "纳洛酮", + "E": "插管和通气" + } + }, + { + "id": "a74b93b9-825b-5534-97f9-571f82a787a4", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "At the end of an anesthetic in which a nondepolarizing muscle relaxant was administered, the least number of receptors are blocked", + "A": "after administration of neostigmine 5 mg and glycopyrrolate 1 mg", + "B": "if the tetanus is sustained at 30 Hz", + "C": "if the patient can sustain head lift for 5 sec", + "D": "when the ratio of twitch height T1:T4 is 0.8", + "E": "when tidal volume is normal" + }, + "zh": { + "question": "在使用非去极化肌松药的麻醉结束时，受阻的受体数量最少", + "A": "给予新斯的明 5 mg 和 格隆溴铵 1 mg 后", + "B": "如果 30 Hz 的强直收缩能持续", + "C": "如果患者能持续抬头 5 秒", + "D": "当抽搐高度比 T1:T4 为 0.8 时", + "E": "当潮气量正常时" + } + }, + { + "id": "60721e9f-c669-5d49-b2dd-bcf16189a944", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A 70-year-old patient is shivering and has chest pain in the PACU following a cholecystectomy. Heart rate is 120 bpm, and blood pressure is 220/120 mmHg. SpO2 is 97% at an FiO2 of 0.4. An ECG shows ST-T wave changes, which are not affected by intravenous administration of nitroglycerin. Which of the following is the most appropriate next step?", + "A": "Administration of esmolol", + "B": "Administration of hydralazine", + "C": "Administration of nitroprusside", + "D": "Application of a warming blanket", + "E": "Increasing FiO2" + }, + "zh": { + "question": "一名70岁的患者在胆囊切除术后恢复室出现发抖和胸痛。心率为120次/分钟，血压为220/120 mmHg。在FiO2为0.4时，SpO2为97%。心电图显示ST-T波变化，静脉注射硝酸甘油后无影响。以下哪项是最合适的下一步措施？", + "A": "给予艾司洛尔", + "B": "给予肼屈嗪", + "C": "给予硝普钠", + "D": "使用加热毯", + "E": "增加FiO2" + } + }, + { + "id": "c60f8bd0-820a-59ef-9474-bf3d8b6f871b", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "During nitrous oxide anesthesia, which of the following expands most rapidly?", + "A": "Air bubble in the blood", + "B": "Air in the intestine", + "C": "Endotracheal tube cuff", + "D": "Pneumothorax", + "E": "Sulfahexafluoride bubble in the vitreal cavity" + }, + "zh": { + "question": "在使用氧化亚氮麻醉期间，下列哪一项膨胀得最快？", + "A": "血液中的气泡", + "B": "肠道中的空气", + "C": "气管导管套囊", + "D": "气胸", + "E": "玻璃体腔中的六氟化硫气泡" + } + }, + { + "id": "6c133abd-2086-5e60-a1cb-09c7e18a4e92", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Bupivacaine 30 ml injected into the inguinal perivascular space will usually block the", + "A": "femoral, lateral femoral cutaneous, and obturator nerves", + "B": "ilioinguinal, femoral, and sciatic nerves", + "C": "femoral, sciatic, and obturator nerves", + "D": "ilioinguinal, iliohypogastric, and pudendal nerves", + "E": "sciatic, femoral, and posterior femoral cutaneous nerves" + }, + "zh": { + "question": "将30毫升布比卡因注射到腹股沟血管周围空间通常会阻滞以下哪些神经？", + "A": "股神经、股外侧皮神经和闭孔神经", + "B": "髂腹股沟神经、股神经和坐骨神经", + "C": "股神经、坐骨神经和闭孔神经", + "D": "髂腹股沟神经、髂腹下神经和阴部神经", + "E": "坐骨神经、股神经和股后皮神经" + } + }, + { + "id": "c488e143-26a7-537e-9f01-15e07580c251", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 2.8-kg 8-hour-old infant undergoes laparotomy for a ruptured omphalocele. Following primary closure of the abdominal wall, arterial blood gases are PaO2 40 mmHg (FiO2 0.6), PaCO2 55 mmHg, and pH 7.1. Blood pressure is 30/20 mmHg. After increasing the FiO2, the most appropriate action would be to", + "A": "obtain a radiograph of the chest immediately", + "B": "withdraw the endotracheal tube 1 cm", + "C": "assess the patient for coexisting congenital heart disease", + "D": "administer lactated Ringer's solution 15 ml/kg", + "E": "ask the surgeon to reopen the wound" + }, + "zh": { + "question": "一名2.8公斤、8小时大的婴儿因破裂的脐膨出进行剖腹手术。腹壁初步闭合后，动脉血气为PaO2 40 mmHg（FiO2 0.6），PaCO2 55 mmHg，pH 7.1。血压为30/20 mmHg。在增加FiO2后，最合适的措施是", + "A": "立即拍摄胸部X光片", + "B": "将气管插管向外撤1厘米", + "C": "评估患者是否存在共存的先天性心脏病", + "D": "给予15 ml/kg的乳酸林格氏液", + "E": "要求外科医生重新打开伤口" + } + }, + { + "id": "17c215bb-4566-5ebc-8d36-e36cdaa5d6fe", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "In normal tissue, which property of drugs has the greatest effect on the speed of onset of a local anesthetic?", + "A": "Amide structure", + "B": "Degree of protein binding", + "C": "Intrinsic vasoconstrictor activity", + "D": "pKa", + "E": "Potency" + }, + "zh": { + "question": "在正常组织中，药物的哪个特性对局部麻醉药的起效速度影响最大？", + "A": "酰胺结构", + "B": "蛋白结合程度", + "C": "内在血管收缩活性", + "D": "pKa", + "E": "效力" + } + }, + { + "id": "e07d0793-9bcf-5467-a13a-5379325ccf15", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "A 30-year-old woman is undergoing laparoscopic tubal ligation. Thirty minutes after induction of general anesthesia, arterial oxygen saturation has decreased to 89%. Arterial blood gases at an FiO2 of 1.0 are PaO2 63 mmHg and PaCO2 40 mmHg; PetCO2 is 32 mmHg. Which of the following is the most likely cause?", + "A": "Carbon dioxide embolus", + "B": "Endobronchial intubation", + "C": "Hypoventilation", + "D": "Inadvertent application of high levels of positive end-expiratory pressure", + "E": "Leak in the capnography sampling catheter" + }, + "zh": { + "question": "一名30岁的女性正在接受腹腔镜输卵管结扎术。全身麻醉诱导30分钟后，动脉氧饱和度下降至89%。在吸入氧浓度为1.0的情况下，动脉血气分析显示PaO2为63 mmHg，PaCO2为40 mmHg；呼气末二氧化碳分压为32 mmHg。以下哪项是最可能的原因？", + "A": "二氧化碳栓塞", + "B": "支气管内插管", + "C": "通气不足", + "D": "意外应用高水平的呼气末正压", + "E": "在二氧化碳监测采样导管中有漏气" + } + }, + { + "id": "917c40e3-c1a3-5a12-aa0b-a87c38191d89", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following drugs has the shortest elimination half-life?", + "A": "Diazepam", + "B": "Flumazenil", + "C": "Flumazepam", + "D": "Lorazepam", + "E": "Midazolam" + }, + "zh": { + "question": "以下哪种药物的消除半衰期最短？", + "A": "地西泮", + "B": "氟马西尼", + "C": "氟马西泮", + "D": "劳拉西泮", + "E": "咪达唑仑" + } + }, + { + "id": "373a5c3d-f9b5-5f87-853c-0b5f13d560e5", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "An infant becomes cyanotic and hypotensive after ventilatory pressures increase to 45 cm H2O during closure of the abdominal wall at the end of a gastroschisis repair. The most appropriate next step is to", + "A": "administer a muscle relaxant", + "B": "administer 5% dextrose in lactated Ringer's solution 10 ml/kg", + "C": "change the endotracheal tube", + "D": "ask the surgeon to insert a chest tube", + "E": "ask the surgeon to reopen the abdomen" + }, + "zh": { + "question": "在进行腹壁闭合以完成腹裂修复术时，婴儿在通气压力增加到45 cm H2O后出现发绀和低血压。最合适的下一步措施是", + "A": "给予肌肉松弛剂", + "B": "给予5%葡萄糖乳酸林格氏液10 ml/kg", + "C": "更换气管插管", + "D": "请外科医生插入胸管", + "E": "请外科医生重新打开腹部" + } + }, + { + "id": "30f78f62-8dc8-564a-ab61-c1a8e11249bb", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the most sensitive indicator of impending renal failure following trauma?", + "A": "Central venous pressure", + "B": "Creatinine clearance", + "C": "Fractional excretion of sodium", + "D": "Hourly urine output", + "E": "Urine osmolality" + }, + "zh": { + "question": "以下哪项是创伤后即将发生肾衰竭的最敏感指标？", + "A": "中心静脉压", + "B": "肌酐清除率", + "C": "钠的分数排泄率", + "D": "每小时尿量", + "E": "尿渗透压" + } + }, + { + "id": "57f30e65-87f1-5802-a836-013ef7a95df1", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 30-year-old man who is breathing spontaneously has a ventilatory pattern of sustained deep inspiration and occasional expiratory gasps during emergence from general anesthesia after posterior fossa craniotomy. Which of the following is the most likely cause?", + "A": "Air in the cerebral ventricles", + "B": "Expiratory obstruction from subglottic edema", + "C": "Injury to the C3-5 nerve roots", + "D": "Injury to the pons", + "E": "Residual neuromuscular paralysis" + }, + "zh": { + "question": "一名30岁的男性在自发呼吸时，在后颅窝开颅术后从全身麻醉中苏醒时表现出持续的深吸气和偶尔的呼气喘息。以下哪项是最可能的原因？", + "A": "脑室内有空气", + "B": "声门下水肿导致的呼气性阻塞", + "C": "C3-5神经根损伤", + "D": "脑桥损伤", + "E": "残余神经肌肉麻痹" + } + }, + { + "id": "c60a432b-7824-5c41-ace6-4a3c984a1844", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Which of the following conditions decreases right-to-left shunt through a patent ductus arteriosus in a neonate?", + "A": "Arterial hypotension", + "B": "Arterial hypoxemia", + "C": "Metabolic acidemia", + "D": "Positive end-expiratory pressure", + "E": "Respiratory alkalemia" + }, + "zh": { + "question": "下列哪种情况会减少新生儿动脉导管未闭的右向左分流？", + "A": "动脉低血压", + "B": "动脉低氧血症", + "C": "代谢性酸中毒", + "D": "呼气末正压", + "E": "呼吸性碱中毒" + } + }, + { + "id": "289f4748-37e5-50e3-ab30-440633c389e4", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A patient is undergoing thoracotomy in the lateral position. Five minutes after initiation of one-lung ventilation using a double-lumen tube and 100% oxygen, SpO2 decreases from 100% to 65%. Which of the following is the most appropriate initial step in management?", + "A": "Adding continuous positive airway pressure to the nondependent lung", + "B": "Adding positive end-expiratory pressure to the dependent lung", + "C": "Increasing the tidal volume to the dependent lung", + "D": "Resuming two-lung ventilation", + "E": "Verifying the position of the double-lumen tube" + }, + "zh": { + "question": "一名患者在侧卧位下进行开胸手术。使用双腔管和100%氧气进行单肺通气5分钟后，SpO2从100%下降到65%。以下哪项是最合适的初始处理步骤？", + "A": "对非依赖肺添加持续气道正压", + "B": "对依赖肺添加呼气末正压", + "C": "增加依赖肺的潮气量", + "D": "恢复双肺通气", + "E": "验证双腔管的位置" + } + }, + { + "id": "b3e56d57-dc2f-5bb6-8984-c12316bc0d7c", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "Syringe A contains 100 ml of normal blood with a PO2 of 2 mmHg, and syringe B contains 100 ml of normal blood with a PO2 of 98 mmHg. The contents of the two syringes are mixed anaerobicaily to equilibrium. The PO2 of the resultant mixture Is", + "A": "27 mmHg", + "B": "50 mmHg", + "C": "63 mmHg", + "D": "96 mmHg", + "E": "100 mmHg" + }, + "zh": { + "question": "注射器A含有100毫升PO2为2 mmHg的正常血液，注射器B含有100毫升PO2为98 mmHg的正常血液。两支注射器的内容物在无氧条件下混合至平衡。混合物的PO2是", + "A": "27 mmHg", + "B": "50 mmHg", + "C": "63 mmHg", + "D": "96 mmHg", + "E": "100 mmHg" + } + }, + { + "id": "b34c5b40-bd0e-50dd-9aad-acd1ae78f403", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A burn is found at the site of the electrocautery pad. Which of the following is most likely?", + "A": "The electrosurgical unit was in the bipolar mode", + "B": "The electrocautery pad became partially detached", + "C": "The electrosurgical unit ground wire was severed", + "D": "The line-isolation monitor alarmed", + "E": "The patient became grounded" + }, + "zh": { + "question": "在电灼垫的位置发现烧伤。以下哪种情况最有可能？", + "A": "电外科设备处于双极模式", + "B": "电灼垫部分脱落", + "C": "电外科设备的接地线被切断", + "D": "线路隔离监测器报警", + "E": "患者接地" + } + }, + { + "id": "024f8a71-2f95-568b-9672-56af49a028ca", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "The two E oxygen cylinders on an anesthesia machine have pressure readings of 1100 psi each. At an oxygen flow of 3 L/min, there will be sufficient oxygen for approximately", + "A": "2.5 hours", + "B": "3.5 hours", + "C": "5.5 hours", + "D": "7 hours", + "E": "8 hours" + }, + "zh": { + "question": "麻醉机上的两个E型氧气瓶的压力读数均为1100 psi。在氧气流量为3 L/min的情况下，氧气大约可以维持多久？", + "A": "2.5小时", + "B": "3.5小时", + "C": "5.5小时", + "D": "7小时", + "E": "8小时" + } + }, + { + "id": "aea3d5da-06d3-5b7a-a91b-1127d535c14d", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A healthy 10-kg child is flushed and restless after premedication with meperidine 15 mg and scopolamine 0.2 mg intramuscularly. His skin is warm and dry; temperature is 38°C, pulse is 130 bpm, and blood pressure is 90/60 mmHg. The most likely cause is", + "A": "dehydration", + "B": "idiosyncratic reaction to meperidine", + "C": "malignant hyperthermia", + "D": "neuroleptic malignant syndrome", + "E": "scopolamine" + }, + "zh": { + "question": "一名健康的10公斤儿童在肌肉注射15毫克哌替啶和0.2毫克东莨菪碱后，面色潮红且烦躁不安。他的皮肤温暖干燥；体温为38°C，脉搏为130次/分钟，血压为90/60 mmHg。最可能的原因是", + "A": "脱水", + "B": "对哌替啶的特异反应", + "C": "恶性高热", + "D": "神经阻滞性恶性综合征", + "E": "东莨菪碱" + } + }, + { + "id": "b88990d7-f424-58ec-92c1-46df419816a9", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The most beneficial effect of continuous positive airway pressure in a newborn with respiratory distress syndrome is", + "A": "increased functional residual capacity", + "B": "decreased airway resistance", + "C": "promotion of surfactant formation", + "D": "increased alveolar PO2", + "E": "maintenance of functional closure of the foramen ovale" + }, + "zh": { + "question": "在患有呼吸窘迫综合征的新生儿中，持续气道正压通气的最有益效果是", + "A": "增加功能残气量", + "B": "降低气道阻力", + "C": "促进表面活性物质的形成", + "D": "增加肺泡氧分压", + "E": "维持卵圆孔的功能性闭合" + } + }, + { + "id": "76e7148c-e567-5f82-98df-e5876f574dcf", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning barbiturate protection from cerebral ischemia is true?", + "A": "It may be achieved with dosages low enough to avoid cardiovascular effects", + "B": "It is linearly dose-related", + "C": "It improves neurologic outcome following cardiac arrest", + "D": "It is most useful in patients with focal ischemia", + "E": "It is unrelated to EEG activity" + }, + "zh": { + "question": "以下关于巴比妥类药物对脑缺血保护的说法中哪一项是正确的？", + "A": "可以通过足够低的剂量来避免心血管影响", + "B": "与剂量呈线性相关", + "C": "改善心脏骤停后的神经系统结果", + "D": "对局灶性缺血患者最有用", + "E": "与脑电图活动无关" + } + }, + { + "id": "82865d4f-c826-5cf0-b983-63a5238681de", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An otherwise healthy 16-year-old girl is undergoing posterior spinal fusion for thoracolumbar scoliosis. During the procedure, the most likely cause of a marked decrease in the amplitude of the somatosensory evoked potentials after stimulation of the posterior tibial nerve is", + "A": "administration of fentanyl 30 jag /kg for induction", + "B": "administration of isoflurane 1.3 MAC for maintenance", + "C": "administration of vecuronium 0.15 mg/kg", + "D": "a decrease in body temperature from 37 to 35°C", + "E": "a decrease in cerebrospinal fluid pressure" + }, + "zh": { + "question": "一名身体健康的16岁女孩正在接受胸腰椎侧弯的后路脊柱融合手术。在手术过程中，刺激胫后神经后体感诱发电位幅度显著下降的最可能原因是", + "A": "诱导时给予芬太尼30微克/千克", + "B": "维持时给予1.3 MAC的异氟醚", + "C": "给予维库溴铵0.15毫克/千克", + "D": "体温从37°C下降到35°C", + "E": "脑脊液压力下降" + } + }, + { + "id": "9b3404ea-b131-507b-8569-ba746e38848f", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following must be considered during perioperative management of a patient on long-term lithium therapy?", + "A": "Intravenous fluids should include sodium", + "B": "Therapy should be discontinued for 14 days prior to anesthesia", + "C": "The requirement for succinylcholine is increased", + "D": "The requirement for volatile anesthetics is increased", + "E": "Urine output should be maintained with furosemide" + }, + "zh": { + "question": "在围手术期管理长期锂治疗的患者时，必须考虑以下哪项？", + "A": "静脉输液应包括钠", + "B": "治疗应在麻醉前14天停止", + "C": "琥珀酰胆碱的需求增加", + "D": "挥发性麻醉剂的需求增加", + "E": "尿量应通过呋塞米维持" + } + }, + { + "id": "676fcb8a-6dc0-5819-9489-14a94d8715a6", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 27-month-old, 14-kg infant with intestinal obstruction is anesthetized with nitrous oxide at 1 L/min, oxygen at 0.4 L/min, and halothane at 0.8% using a Bain circuit. Ventilation is controlled at a rate of 30/min. The child's temperature is 39°C, and the PaCO2 is 65 mmHg. Which of the following is most likely?", + "A": "Malignant hyperthermia", + "B": "Low gas inflow rate", + "C": "Low respiratory rate", + "D": "Pulmonary aspiration of gastric contents", + "E": "Inaccurate flowmeters" + }, + "zh": { + "question": "一名27个月大、14公斤的婴儿因肠梗阻使用Bain回路进行麻醉，使用1 L/min的氧化亚氮、0.4 L/min的氧气和0.8%的氟烷。通气以30次/分钟的速率控制。孩子的体温为39°C，PaCO2为65 mmHg。以下哪项最有可能？", + "A": "恶性高热", + "B": "气体流入率低", + "C": "呼吸频率低", + "D": "胃内容物的肺吸入", + "E": "流量计不准确" + } + }, + { + "id": "e752e720-a406-5d2f-9d82-d70dadb0ae2f", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "After termination of an inhalation anesthetic, patient-controlled analgesia will", + "A": "be effective without a loading dose of opioid if started in the immediate postanesthetic period", + "B": "be associated with greater analgesic requirements than conventional intramuscular opioid techniques", + "C": "cause addiction or dependence to opioids if continued for more than 72 hours", + "D": "produce less patient satisfaction than intermittent intravenous administration of opioids", + "E": "show a diurnal variation in analgesic requirement" + }, + "zh": { + "question": "在终止吸入麻醉后，患者自控镇痛将会", + "A": "如果在麻醉后立即开始使用，则无需阿片类药物的负荷剂量即可有效", + "B": "与传统的肌肉注射阿片类药物技术相比，镇痛需求更大", + "C": "如果持续使用超过72小时，会导致阿片类药物成瘾或依赖", + "D": "比间歇性静脉注射阿片类药物产生的患者满意度更低", + "E": "显示镇痛需求的昼夜变化" + } + }, + { + "id": "e125d01d-6b3f-5294-9484-af44fc8a9705", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "During attempted cannulation of the right internal jugular vein, the exploring needle goes lateral to the vein. Which of the following structures is most likely to be encountered?", + "A": "Carotid artery", + "B": "Vagus nerve", + "C": "Thoracic duct", + "D": "Phrenic nerve", + "E": "Long thoracic nerve" + }, + "zh": { + "question": "在尝试插入右侧颈内静脉时，探针针头偏向静脉的外侧。以下哪种结构最有可能被遇到？", + "A": "颈动脉", + "B": "迷走神经", + "C": "胸导管", + "D": "膈神经", + "E": "长胸神经" + } + }, + { + "id": "0e8b0b5c-8616-58b7-88b0-89046bdd67b4", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning pulmonary function in patients with pulmonary fibrosis is true?", + "A": "Diffusion capacity is decreased", + "B": "Pulmonary artery diastolic-to-occlusion pressure gradients are normal", + "C": "Ventilation-perfusion relationships are normal", + "D": "Static pulmonary compliance is unchanged", + "E": "Mechanical ventilation with slow rate and large tidal volume is optimal" + }, + "zh": { + "question": "以下关于肺纤维化患者肺功能的说法中哪一项是正确的？", + "A": "扩散能力降低", + "B": "肺动脉舒张压与闭塞压的梯度正常", + "C": "通气-灌注比正常", + "D": "静态肺顺应性不变", + "E": "慢速和大潮气量的机械通气是最佳的" + } + }, + { + "id": "d94a1e45-ab12-5101-8414-2d744eccea80", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "At extubation performed one week after nasotracheal intubation, each of the following is likely to occur EXCEPT", + "A": "upper airway obstruction", + "B": "aspiration after extubation", + "C": "ulceration of vocal cords", + "D": "tracheal stenosis", + "E": "sinusitis" + }, + "zh": { + "question": "在鼻气管插管一周后拔管时，以下每种情况都可能发生，除了", + "A": "上呼吸道阻塞", + "B": "拔管后误吸", + "C": "声带溃疡", + "D": "气管狭窄", + "E": "鼻窦炎" + } + }, + { + "id": "013d3195-6cd1-59a8-b008-aed2e2f5533b", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "During cardiopulmonary resuscitation (CPR) in an adult, external chest compression is being performed at the rate of 90/min with 2 inches of sternal depression and a compression-relaxation ratio of 20:80. The most appropriate action is to", + "A": "decrease the rate of compression", + "B": "increase the duration of compression", + "C": "increase the duration of relaxation", + "D": "increase the depth of sternal depression", + "E": "continue the original pattern of CPR" + }, + "zh": { + "question": "在成人心肺复苏（CPR）过程中，外部胸部按压的频率为每分钟90次，胸骨下压深度为2英寸，按压-放松比为20:80。最合适的行动是", + "A": "减少按压频率", + "B": "增加按压持续时间", + "C": "增加放松持续时间", + "D": "增加胸骨下压深度", + "E": "继续原有的CPR模式" + } + }, + { + "id": "9d9c2253-222c-5f34-90b4-5ae35fb6dc02", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Which the following findings is most hazardous in premature infants?", + "A": "Hematocrit of 55%", + "B": "Rectal temperature of 35 degrees C", + "C": "Umbilical arterial blood PO2 of 50 mmHg", + "D": "Umbilical arterial blood PCO2 of 45 mmHg", + "E": "Umbilical arterial systolic pressure of 60 mmHg" + }, + "zh": { + "question": "以下哪项发现对早产儿最危险？", + "A": "55%的血细胞比容", + "B": "直肠温度为35摄氏度", + "C": "脐动脉血氧分压为50 mmHg", + "D": "脐动脉血二氧化碳分压为45 mmHg", + "E": "脐动脉收缩压为60 mmHg" + } + }, + { + "id": "6a802889-8fb2-5a39-86c6-eafe6ed1aa8b", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "During application of continuous positive airway pressure, lung compliance increases because of", + "A": "decreased airway resistance", + "B": "decreased lung water", + "C": "decreased venous return", + "D": "increased intercostal muscle tone", + "E": "increased resting lung volume" + }, + "zh": { + "question": "在应用持续气道正压时，肺顺应性增加是因为", + "A": "气道阻力降低", + "B": "肺水减少", + "C": "静脉回流减少", + "D": "肋间肌张力增加", + "E": "静息肺容量增加" + } + }, + { + "id": "31f1df6b-15c1-51ef-91c0-2fd36923adf7", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Intraoperatively, the occurrence of prominent \"a\" waves on the central venous pressure waveform can be explained by each of the following EXCEPT", + "A": "acute right ventricular failure", + "B": "atrial flutter", + "C": "complete heart block", + "D": "onset of junctional tachycardia", + "E": "ventricular pacing" + }, + "zh": { + "question": "术中，中心静脉压波形上出现显著的“a”波可以通过以下各项解释，除了", + "A": "急性右心室衰竭", + "B": "心房扑动", + "C": "完全性心脏传导阻滞", + "D": "交界性心动过速的开始", + "E": "心室起搏" + } + }, + { + "id": "facaaaf8-48b9-56c6-8f98-0e28842ce8ff", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following drugs is LEAST likely to cross the placenta?", + "A": "Lidocaine", + "B": "Meperidine", + "C": "Midazolam", + "D": "Thiopental", + "E": "Vecuronium" + }, + "zh": { + "question": "以下哪种药物最不可能通过胎盘？", + "A": "利多卡因", + "B": "哌替啶", + "C": "咪达唑仑", + "D": "硫喷妥钠", + "E": "维库溴铵" + } + }, + { + "id": "379d4c8e-08ba-5a90-b60b-1970531db996", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements concerning ketorolac is true?", + "A": "It binds to opioid receptors", + "B": "It causes dose-related thrombocytopenia", + "C": "It decreases heart rate during isoflurane anesthesia", + "D": "It is eliminated unchanged in urine", + "E": "It reversibly inhibits cyclooxygenase" + }, + "zh": { + "question": "以下关于酮咯酸的陈述中哪一项是正确的？", + "A": "它与阿片受体结合", + "B": "它引起剂量相关的血小板减少", + "C": "它在异氟醚麻醉期间降低心率", + "D": "它以原形从尿液中排出", + "E": "它可逆地抑制环氧合酶" + } + }, + { + "id": "920258b5-664c-5130-a083-eb5e2c71a9a3", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following muscle relaxants in an ED95 dose would have the longest duration of action in a patient with renal failure?", + "A": "Atracurium", + "B": "Metocurine", + "C": "Pancuronium", + "D": "d-Tubocurarine", + "E": "Vecuronium" + }, + "zh": { + "question": "在肾功能衰竭的患者中，以下哪种肌肉松弛剂在ED95剂量下的作用持续时间最长？", + "A": "阿曲库铵", + "B": "美托库铵", + "C": "潘库溴铵", + "D": "d-筒箭毒碱", + "E": "维库溴铵" + } + }, + { + "id": "48083a60-fb9d-5aea-af90-4be46454db8b", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Compared with a semiclosed circle system, a closed system", + "A": "decreases the risk for anesthetic overdose", + "B": "decreases the risk for rebreathing carbon dioxide", + "C": "has lower resistance to gas flow", + "D": "permits calculation of oxygen consumption", + "E": "permits more rapid changes in anesthetic depth" + }, + "zh": { + "question": "与半闭合环路系统相比，闭合系统", + "A": "降低麻醉药物过量的风险", + "B": "降低二氧化碳再呼吸的风险", + "C": "对气体流动的阻力较低", + "D": "允许计算氧气消耗量", + "E": "允许更快速地改变麻醉深度" + } + }, + { + "id": "cd59ffdd-e87a-5925-8120-1bf9172f3b35", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A patient whose trachea is intubated develops partial airway obstruction two hours after induction of fentanyl, nitrous oxide, oxygen anesthesia. The anesthesiologist discontinues the nitrous oxide and controls ventilation, and there is gradual improvement during the next hour. No evidence of a respiratory disorder is found at the conclusion of the anesthetic. Which of the following is most likely?", + "A": "The endotracheal tube was in the right mainstem bronchus", + "B": "The patient had an unrecognized air embolism", + "C": "The patient had a nitrous oxide pneumothorax", + "D": "The endotracheal tube cuff narrowed the airway", + "E": "The fentanyl induced chest rigidity" + }, + "zh": { + "question": "一名气管插管的患者在使用芬太尼、氧化亚氮、氧气麻醉诱导两小时后出现部分气道阻塞。麻醉师停止使用氧化亚氮并控制通气，接下来一小时内情况逐渐改善。在麻醉结束时未发现呼吸系统疾病的证据。以下哪项最有可能？", + "A": "气管导管在右主支气管内", + "B": "患者有未被识别的空气栓塞", + "C": "患者有氧化亚氮气胸", + "D": "气管导管套囊缩小了气道", + "E": "芬太尼引起胸部僵硬" + } + }, + { + "id": "5b381199-93ca-5a78-8bef-b985c2225bd0", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "As part of a preoperative evaluation, a patient had a thallium scan showing a \"cold spot\" over the left ventricle that occurs with moderate exercise and disappears at rest. This most likely indicates", + "A": "moderate-sized aneurysm of the left ventricle", + "B": "acute myocardial ischemia", + "C": "recent myocardial infarction", + "D": "old myocardial infarction", + "E": "Prinzmetal's variant angina" + }, + "zh": { + "question": "在术前评估中，患者进行了一次铊扫描，显示左心室在中等运动时出现“冷点”，在休息时消失。这最可能表明", + "A": "左心室中等大小的动脉瘤", + "B": "急性心肌缺血", + "C": "近期心肌梗死", + "D": "陈旧性心肌梗死", + "E": "Prinzmetal变异型心绞痛" + } + }, + { + "id": "ce7f9af0-8176-5077-877c-db388587ecb4", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "During Harrington rod instrumentation for scoliosis, monitoring somatosensory evoked potentials", + "A": "is unreliable if halothane is used", + "B": "eliminates the need for a wake-up test", + "C": "accurately assesses proprioceptive integrity", + "D": "accurately assesses motor function integrity", + "E": "is unreliable if nondepolarizing muscle relaxants are used" + }, + "zh": { + "question": "在进行脊柱侧弯的Harrington杆内固定术时，监测体感诱发电位", + "A": "如果使用氟烷则不可靠", + "B": "消除了唤醒测试的需要", + "C": "准确评估本体感受完整性", + "D": "准确评估运动功能完整性", + "E": "如果使用非去极化肌肉松弛剂则不可靠" + } + }, + { + "id": "187eb2af-2cfa-58f3-8ef0-04bf7679f6ca", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "During rapid-sequence induction prior to an emergency surgical procedure, a 20-year-old patient vomits gastric contents containing particulate matter. An endotracheal tube is easily inserted and ventilation with pure oxygen is initiated. Despite the presence of bilateral breath sounds, SpO2 is 90%. Which of the following is the most appropriate next step?", + "A": "Administration of broad-spectrum antibiotics", + "B": "Intravenous administration of high-dose methylprednisolone", + "C": "Bronchial lavage with normal saline solution", + "D": "Bronchoscopy to remove particulate matter", + "E": "Cancellation of the surgical procedure" + }, + "zh": { + "question": "在紧急手术前进行快速序贯诱导时，一名20岁的患者呕吐出含有颗粒物的胃内容物。气管插管顺利插入，并开始用纯氧通气。尽管存在双侧呼吸音，SpO2为90%。以下哪项是最合适的下一步措施？", + "A": "给予广谱抗生素", + "B": "静脉注射大剂量甲泼尼龙", + "C": "用生理盐水进行支气管灌洗", + "D": "支气管镜检查以去除颗粒物", + "E": "取消手术" + } + }, + { + "id": "5feafc1a-1017-5722-8cde-80c02053fca0", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Fetal distress is noted after administration of an epidural local anesthetic during labor. Fetal scalp pH is 7.0. Compared with a fetus with a scalp pH of 7.3, in this fetus the local anesthetic is present in", + "A": "a higher concentration, with a larger fraction in the ionized form", + "B": "a higher concentration, with a larger fraction in the unionized form", + "C": "the same concentration, with a larger fraction in the ionized form", + "D": "the same concentration, with a larger fraction in the unionized form", + "E": "a lower concentration, with a larger fraction in the ionized form" + }, + "zh": { + "question": "在分娩过程中给予硬膜外局部麻醉药后出现胎儿窘迫。胎儿头皮pH值为7.0。与头皮pH值为7.3的胎儿相比，该胎儿的局部麻醉药物浓度为", + "A": "较高浓度，离子化形式的比例较大", + "B": "较高浓度，非离子化形式的比例较大", + "C": "相同浓度，离子化形式的比例较大", + "D": "相同浓度，非离子化形式的比���较大", + "E": "较低浓度，离子化形式的比例较大" + } + }, + { + "id": "6c9fd6a4-b486-5d40-b659-cc7609aae5ef", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A 1-month-old infant becomes hypoxemic faster during apnea than an adult. Which of the following is the primary cause of this difference?", + "A": "Functional residual capacity in an infant is half that of an adult", + "B": "Metabolic rate in an infant is twice that of an adult", + "C": "Resting PaO2 in an infant is lower than that in an adult", + "D": "The number of alveoli in an infant is 12% the number in an adult", + "E": "The hemoglobin dissociation curve in an infant is shifted to the right" + }, + "zh": { + "question": "1个月大的婴儿在呼吸暂停期间比成年人更快出现低氧血症。以下哪项是这种差异的主要原因？", + "A": "婴儿的功能残气量是成年人的一半", + "B": "婴儿的新陈代谢率是成年人的两倍", + "C": "婴儿的静息PaO2低于成年人", + "D": "婴儿的肺泡数量是成年人的12%", + "E": "婴儿的血红蛋白解离曲线向右移" + } + }, + { + "id": "34e7cc10-8c1a-588a-bc21-9b42f94369a4", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is an effect of ketorolac administered after vaginal hysterectomy?", + "A": "Euphoria", + "B": "Prolonged prothrombin time", + "C": "Respiratory depression", + "D": "Suppression of inflammation", + "E": "Thrombocytopenia" + }, + "zh": { + "question": "以下哪项是阴道子宫切除术后使用酮咯酸的效果？", + "A": "欣快感", + "B": "凝血酶原时间延长", + "C": "呼吸抑制", + "D": "抑制炎症", + "E": "血小板减少症" + } + }, + { + "id": "2ed343d9-c73b-52fd-b4e3-9c0e36fed93c", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning the pharmacokinetics of local anesthetics is true?", + "A": "Decreased molecular weight is associated with decreased incidence of allergic reactions", + "B": "Decreased protein binding is associated with decreased systemic toxicity", + "C": "Increased ionization is associated with increased placental transfer", + "D": "Increased lipid solubility is associated with faster onset", + "E": "Presence of an ester linkage is associated with increased duration of action" + }, + "zh": { + "question": "以下关于局部麻醉药药代动力学的说法中哪一项是正确的？", + "A": "分子量降低与过敏反应发生率降低有关", + "B": "蛋白结合减少与全身毒性降低有关", + "C": "电离增加与胎盘转移增加有关", + "D": "脂溶性增加与起效更快有关", + "E": "酯键的存在与作用时间延长有关" + } + }, + { + "id": "631f275e-8c52-5d93-abc1-fbb8600b4862", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A Fluotec vaporizer is set to administer halothane 4% using a fresh gas flow of 4 L/min. If the diluent gas flow is increased to 8 L/min, and at the same time the room temperature increases from 20 to 25°C, the approximate concentration of halothane delivered to the patient would be", + "A": "2%", + "B": "2.5%", + "C": "3%", + "D": "4%", + "E": "5%" + }, + "zh": { + "question": "Fluotec挥发器设置为使用4 L/min的新鲜气流给药4%的氟烷。如果稀释气流增加到8 L/min，同时室温从20°C升高到25°C，输送给患者的氟烷的近似浓度将是", + "A": "2%", + "B": "2.5%", + "C": "3%", + "D": "4%", + "E": "5%" + } + }, + { + "id": "66019076-2749-5e7e-bb38-13f70b98d37c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is an indication for administration of fresh frozen plasma?", + "A": "Antithrombin III deficiency", + "B": "Emergency antagonism of heparin effect", + "C": "Hemophilia A", + "D": "Transfusion of 5 units of homologous erythrocytes", + "E": "Uremic coagulopathy" + }, + "zh": { + "question": "下列哪项是新鲜冰冻血浆输注的适应症？", + "A": "抗凝血酶III缺乏", + "B": "紧急拮抗肝素作用", + "C": "甲型血友病", + "D": "输��5个单位的同种异体红细胞", + "E": "尿毒症性凝血病" + } + }, + { + "id": "b679852d-96b2-5916-b415-9e226d076fa0", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the most likely cause of the coronary steal phenomenon?", + "A": "Idiopathic hypertrophic subaortic stenosis (IHSS)", + "B": "Decreased cardiac contractility", + "C": "Dilation of coronary arterioles", + "D": "Dilation of epicardial coronary arteries", + "E": "Increased systemic vascular resistance" + }, + "zh": { + "question": "以下哪项最有可能导致冠状动脉盗血现象？", + "A": "特发性肥厚性主动脉下狭窄（IHSS）", + "B": "心肌收缩力下降", + "C": "冠状动脉小动脉扩张", + "D": "心外膜冠状动脉扩张", + "E": "全身血管阻力增加" + } + }, + { + "id": "ef775182-6f66-5dd7-8417-fcaa4cae295b", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is most responsible for the duration of action of local anesthetics?", + "A": "Concentration", + "B": "Metabolism", + "C": "Molecular weight", + "D": "Tissue protein binding", + "E": "Volume injected" + }, + "zh": { + "question": "以下哪项最能决定局部麻醉药的作用持续时间？", + "A": "浓度", + "B": "代谢", + "C": "分子量", + "D": "组织蛋白结合", + "E": "注射量" + } + }, + { + "id": "61a4d172-f5e0-5bd6-b5f6-3317e255ecae", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 75-year-old man received an uneventful epidural anesthetic for total knee arthroplasty. Twenty-four hours later he has a painless flaccid paralysis in both legs. This clinical presentation is most consistent with", + "A": "adhesive arachnoiditis", + "B": "anterior spinal artery thrombosis", + "C": "epidural abscess", + "D": "epidural hematoma", + "E": "transverse myelitis" + }, + "zh": { + "question": "一名75岁的男性接受了顺利的硬膜外麻醉以进行全膝关节置换术。24小时后，他出现了双腿无痛性弛缓性瘫痪。这种临床表现最符合", + "A": "粘连性蛛网膜炎", + "B": "前脊髓动脉血栓形成", + "C": "硬膜外脓肿", + "D": "硬膜外血肿", + "E": "横贯性脊髓炎" + } + }, + { + "id": "701c0f54-77ee-5b2f-b18d-4e7f10762725", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The induction dose of thiopental should be decreased in each of the following situations EXCEPT", + "A": "age greater than 70 years", + "B": "cardiogenic shock", + "C": "decreased hepatic blood flow", + "D": "hypoalbuminemia", + "E": "hypothyroidism" + }, + "zh": { + "question": "在以下每种情况下，硫喷妥钠的诱导剂量都应减少，除了", + "A": "年龄大于70岁", + "B": "心源性休克", + "C": "肝血流量减少", + "D": "低白蛋白血症", + "E": "甲状腺功能减退" + } + }, + { + "id": "9efb917b-7db5-534c-9e7f-28a34a4bdbd4", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A 31-year-old man received an uneventful epidural anesthetic for arthroscopy of the knee and meniscectomy. Twenty-four hours later he still has painless flaccid paralysis in both legs. This clinical presentation is most consistent with", + "A": "adhesive arachnoiditis", + "B": "anterior spinal artery thrombosis", + "C": "epidural abscess", + "D": "epidural hematoma", + "E": "transverse myelitis" + }, + "zh": { + "question": "一名31岁的男性接受了顺利的硬膜外麻醉以进行膝关节镜检查和半月板切除术。24小时后，他的双腿仍然无痛性弛缓性瘫痪。这种临床表现最符合", + "A": "粘连性蛛网膜炎", + "B": "前脊髓动脉血栓形成", + "C": "硬膜外脓肿", + "D": "硬膜外血肿", + "E": "横贯性脊髓炎" + } + }, + { + "id": "6c1ad5b0-cc98-5984-b93e-852e2910a633", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Hypothermia to 29°C will decrease", + "A": "hematocrit", + "B": "plasma fibrinogen concentration", + "C": "plasma pH", + "D": "plasma protein concentration", + "E": "platelet function" + }, + "zh": { + "question": "体温降低至29°C会减少", + "A": "红细胞比容", + "B": "血浆纤维蛋白原浓度", + "C": "血浆pH值", + "D": "血浆蛋白浓度", + "E": "血小板功能" + } + }, + { + "id": "143b754c-ba86-52e9-a126-84e97951ba3d", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the primary physiologic response in a neonate exposed to a hypothermic environment?", + "A": "Hyperventilation", + "B": "Increased 2,3-DPG concentration in erythrocytes", + "C": "Metabolism of brown fat", + "D": "Shivering", + "E": "Vasoconstriction" + }, + "zh": { + "question": "以下哪项是新生儿暴露于低温环境中的主要生理反应？", + "A": "过度换气", + "B": "红细胞中2,3-DPG浓度增加", + "C": "棕色脂肪代谢", + "D": "发抖", + "E": "血管收缩" + } + }, + { + "id": "9f6cf7ec-aa88-5060-843b-f9419b328702", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A full-term newborn has marked respiratory distress in the delivery room. Breath sounds are asymmetric and the abdomen is scaphoid. Which of the following maneuvers is most appropriate?", + "A": "Hyperventilation with bag and mask", + "B": "Intubation and ventilation with positive end-expiratory pressure", + "C": "Intubation and ventilation with zero end-expiratory pressure", + "D": "Bronchoscopy", + "E": "Insertion of a chest tube" + }, + "zh": { + "question": "一名足月新生儿在产房出现明显的呼吸窘迫。呼吸音不对称，腹部呈舟状。以下哪种操作最合适？", + "A": "使用面罩进行过度通气", + "B": "插管并进行带有呼气末正压的通气", + "C": "插管并进行零呼气末压的通气", + "D": "支气管镜检查", + "E": "插入胸管" + } + }, + { + "id": "a946de80-4197-5017-910b-13900717c771", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following opioids is vagolytic?", + "A": "Morphine", + "B": "Meperidine", + "C": "Sufentanil", + "D": "Nalbuphine", + "E": "Alfentanil" + }, + "zh": { + "question": "下列哪种阿片类药物具有迷走神经抑制作用？", + "A": "吗啡", + "B": "哌替啶", + "C": "舒芬太尼", + "D": "纳布啡", + "E": "阿芬太尼" + } + }, + { + "id": "75f54eeb-4676-5f90-97d0-fb3a1a128bf7", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements concerning use of a Bain circuit is true?", + "A": "Fresh gas flow can be as low as the patient's minute ventilation", + "B": "Heat conservation is better than with a circle system", + "C": "Lower flows can be used with controlled ventilation than with spontaneous ventilation", + "D": "Lower fresh gas flows can be used than with a Jackson-Rees system", + "E": "The concentration of inspired vapors can be changed rapidly" + }, + "zh": { + "question": "关于使用Bain回路，下列哪项陈述是正确的？", + "A": "新鲜气体流量可以低至患者的分钟通气量", + "B": "热量保持比环路系统更好", + "C": "在控制通气时可以使用比自发通气时更低的流量", + "D": "可以使用比Jackson-Rees系统更低的新鲜气体流量", + "E": "吸入蒸汽的浓度可以迅速改变" + } + }, + { + "id": "f4f8bdad-c88c-54b7-b134-4ef8bd5b067e", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following situations is most likely related to paraplegia following repair of a descending thoracic aortic aneurysm?", + "A": "Decreased cerebrospinal fluid pressure", + "B": "Epidural hematoma", + "C": "Hypertension proximal to the aortic cross clamp", + "D": "Improper placement of surgical retractors", + "E": "Prolonged aortic cross-clamp time" + }, + "zh": { + "question": "以下哪种情况最有可能与降主动脉瘤修复术后截瘫有关？", + "A": "脑脊液压力降低", + "B": "硬膜外血肿", + "C": "主动脉阻断夹近端的高血压", + "D": "手术牵开器��置不当", + "E": "主动脉阻断夹时间过长" + } + }, + { + "id": "ba29b31d-cf5e-5fe3-8fd5-f933546e992a", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "Which of the following is the most appropriate initial therapy for acute pulmonary hypertension with right ventricular dysfunction and severe systemic hypotension that occurs during anesthesia?", + "A": "Amrinone", + "B": "Epinephrine", + "C": "Isoflurane", + "D": "Isoproterenol", + "E": "Nitroglycerin" + }, + "zh": { + "question": "在麻醉期间发生的急性肺动脉高压伴右心室功能障碍和严重全身性低血压，以下哪种是最合适的初始治疗？", + "A": "氨力农", + "B": "肾上腺素", + "C": "异氟醚", + "D": "异丙肾上腺素", + "E": "硝酸甘油" + } + }, + { + "id": "d1c8e776-fd17-5549-8d5b-7dc06b0bc9d1", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following processes is primarily responsible for the decrease in core body temperature that occurs during the first hour of general anesthesia?", + "A": "Decreased production of heat", + "B": "Convective heat loss caused by cutaneous vasodilation", + "C": "Evaporative heat loss during skin preparation", + "D": "Heat loss from the respiratory tract", + "E": "Redistribution of core body heat to the periphery" + }, + "zh": { + "question": "以下哪种过程主要负责全身麻醉的第一个小时内核心体温的下降？", + "A": "产热减少", + "B": "皮肤血管扩张引起的对流散热", + "C": "皮肤准备期间的蒸发散热", + "D": "呼吸道的散热", + "E": "核心体热向外周的重新分布" + } + }, + { + "id": "46559e7a-8ef6-542e-bb18-308c874cd157", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "During general anesthesia using a modern anesthesia machine, a patient's spontaneous ventilation is manually assisted with a fresh gas flow of 5 L/min. A sudden malfunction of the pressure-relief (pop-off) valve of the circle absorption system occurs, and the valve cannot be opened. The most appropriate next step is to", + "A": "change to a smaller reservoir bag", + "B": "increase total fresh gas flow", + "C": "open the scavenger valve", + "D": "control ventilation manually", + "E": "switch to mechanical ventilatory mode" + }, + "zh": { + "question": "在使用现代麻醉机进行全身麻醉时，患者的自主通气通过5 L/min的新鲜气体流量进行手动辅助。此时，环路吸收系统的压力释放（排气）阀突然发生故障，无法打开。最合适的下一步措施是", + "A": "更换为较小的储气袋", + "B": "增加总新鲜气体流量", + "C": "打开废气排放阀", + "D": "手动控制通气", + "E": "切换到机械通气模式" + } + }, + { + "id": "00ca4cd7-4b15-5ba4-b489-fed4c4a95b3e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Microatelectasis 48 hours after abdominal surgery is most consistently manifested by", + "A": "decreased PaO2", + "B": "ground glass infiltrate on a roentgenogram of the chest", + "C": "scattered fine inspiratory rales", + "D": "increased PaCO2", + "E": "scattered areas of dullness to chest percussion" + }, + "zh": { + "question": "腹部手术后48小时微小肺不张最常表现为", + "A": "PaO2降低", + "B": "胸部X光片显示毛玻璃样浸润", + "C": "散在的细小吸气性啰音", + "D": "PaCO2升高", + "E": "胸部叩诊时散在的浊音区" + } + }, + { + "id": "e7ad4398-a7ff-5199-b6f8-c1dc16050dcb", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the effects of epidural morphine is most resistant to intravenous naloxone?", + "A": "Analgesia", + "B": "Nausea", + "C": "Pruritus", + "D": "Respiratory depression", + "E": "Urinary retention" + }, + "zh": { + "question": "硬膜外吗啡的哪些作用对静脉注射纳洛酮最具抵抗力？", + "A": "镇痛", + "B": "恶心", + "C": "瘙痒", + "D": "呼吸抑制", + "E": "尿潴留" + } + }, + { + "id": "3a2ca792-7dcf-5de2-9c79-e10235b08fb6", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A patient suddenly makes a respiratory effort during craniotomy for clipping of a cerebral aneurysm in a 15-degree head-up position with controlled ventilation. The most likely cause is", + "A": "air embolism", + "B": "cerebral hypoxia", + "C": "direct stimulation of the respiratory center", + "D": "intraventricular hemorrhage", + "E": "stimulation of the motor cortex" + }, + "zh": { + "question": "在进行颅内动脉瘤夹闭术时，患者处于15度头高位并接受控制性通气，突然出现呼吸努力。最可能的原因是", + "A": "空气栓塞", + "B": "脑缺氧", + "C": "直接刺激呼吸中枢", + "D": "脑室内出血", + "E": "刺激运动皮层" + } + }, + { + "id": "2ecca373-41bc-507f-a9a9-2ee0b800ebaf", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A woman at 39 weeks' gestation has been in labor for 12 hours. She has had nausea and vomiting for the past eight hours. Maternal arterial blood gas values are PaO1 85 mmHg, PaCO2 31 mmHg, and pH 7.50. Which of the following is the most likely cause of fetal distress occurring at this time?", + "A": "Hypocarbia-induced placental ischemia", + "B": "Impaired fetal oxyhemoglobin dissociation", + "C": "Shift to the left of the maternal oxyhemoglobin dissociation curve", + "D": "Maternal hypovolemia", + "E": "Maternal hypoxemia" + }, + "zh": { + "question": "一名孕39周的女性已经分娩12小时。她在过去的八小时里有恶心和呕吐。母体动脉血气值为PaO1 85 mmHg，PaCO2 31 mmHg，pH 7.50。以下哪项是此时胎儿窘迫最可能的原因？", + "A": "低碳酸血症引起的胎盘缺血", + "B": "胎儿氧合血红蛋白解离受损", + "C": "母体氧合血红蛋白解离曲线左移", + "D": "母体低血容量", + "E": "母体低氧血症" + } + }, + { + "id": "cc907cb4-8689-5efb-ac5d-dc40d7919569", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is characteristic of low back pain associated with myofascial pain syndrome but not of pain associated with a herniated lumbar disk?", + "A": "Loss of reflexes in the lower extremities", + "B": "Pain along the distribution of nerve roots", + "C": "Responsiveness to epidural corticosteroids", + "D": "Sensitivity to injection at trigger points", + "E": "Trophic alteration in the sympathetic nervous system" + }, + "zh": { + "question": "以下哪项是与肌筋膜疼痛综合征相关的腰痛的特征，而不是与腰椎间盘突出相关的疼痛的特征？", + "A": "下肢反射丧失", + "B": "沿神经根分布的疼痛", + "C": "对硬膜外皮质类固醇的反应", + "D": "对触发点注射的敏感性", + "E": "交感神经系统的营养性改变" + } + }, + { + "id": "0abbcc4a-bd2f-5795-9d4c-77daceaddd96", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with the adult airway, the neonatal airway has which of the following characteristics?", + "A": "More cephalad larynx", + "B": "Narrowest diameter at the vocal cords", + "C": "Relatively smaller epiglottis", + "D": "Smaller tongue relative to the size of the oral cavity", + "E": "Vocal cords perpendicular to the trachea" + }, + "zh": { + "question": "与成人气道相比，新生儿气道具有以下哪些特征？", + "A": "喉头位置更靠近头部", + "B": "声带处的直径最窄", + "C": "相对较小的会厌", + "D": "舌头相对于口腔大小较小", + "E": "声带与气管垂直" + } + }, + { + "id": "538fea75-6307-5d5d-bc5a-b617e78453dc", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Which of the following factors is LEAST likely to affect serum ionized calcium concentration following blood transfusion?", + "A": "Age of blood transfused", + "B": "Amount of blood transfused", + "C": "Body temperature", + "D": "Serum pH", + "E": "Rate of transfusion" + }, + "zh": { + "question": "以下哪项因素最不可能影响输血后血清离子化钙浓度？", + "A": "输血的血液年龄", + "B": "输血的血液量", + "C": "体温", + "D": "血清pH值", + "E": "输血速度" + } + }, + { + "id": "2da091ec-8531-5b32-a0e4-16e0bcbfb3ec", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 26-year-old patient with multiple trauma is admitted to the intensive care unit postoperatively. The early development of polyuria, hypotension, low urine sodium excretion, high serum osmolality, and normal serum creatinine concentration is best explained by", + "A": "adrenal insufficiency", + "B": "fluoride-induced high-output renal failure", + "C": "inappropriate ADH secretion", + "D": "intraoperative fluid overload", + "E": "posterior pituitary insufficiency" + }, + "zh": { + "question": "一名26岁的多发性创伤患者术后被送入重症监护室。早期出现多尿、低血压、低尿钠排泄、高血清渗透压和正常血清肌酐浓度，最可能的解释是", + "A": "肾上腺功能不全", + "B": "氟化物引起的高输出肾衰竭", + "C": "不当的抗利尿激素分泌", + "D": "术中液体过载", + "E": "后叶垂体功能不全" + } + }, + { + "id": "f4e966cb-737c-5100-8ca9-d2db26245e5a", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 70-kg man has stable 80% neuromuscular block induced with d-tubocurarine. Compared with neostigmine 3 mg, antagonism with edrophonium 70 mg will", + "A": "be of shorter duration", + "B": "be of slower onset", + "C": "be less reliable", + "D": "produce less change in heart rate", + "E": "require more anticholinergic" + }, + "zh": { + "question": "一名70公斤的男性患者被d-筒箭毒碱诱导了稳定的80%神经肌肉阻滞。与3毫克新斯的明相比，70毫克依酚氯铵的拮抗作用将", + "A": "持续时间更短", + "B": "起效更慢", + "C": "可靠性更低", + "D": "对心率的影响更小", + "E": "需要更多的抗胆碱药" + } + }, + { + "id": "b1edc76b-57d9-51b5-8196-bd92a957dbe2", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements concerning intercostal nerve block for postoperative pain is true?", + "A": "Block at the midaxillary line provides analgesia for the anterior and lateral abdominal walls", + "B": "Blood levels of local anesthetic are higher than after an axillary block", + "C": "Intravascular injection is unlikely", + "D": "Loss of resistance assures proper needle placement", + "E": "Paravertebral spread is prevented by adding epinephrine to the local anesthetic solution" + }, + "zh": { + "question": "以下关于术后疼痛的肋间神经阻滞的说法中哪一项是正确的？", + "A": "在腋中线处阻滞可为前侧和侧腹壁提供镇痛", + "B": "局部麻醉药的血液浓度高于腋窝阻滞后", + "C": "血管内注射不太可能发生", + "D": "阻力消失可确保针头放置正确", + "E": "通过在局部麻醉溶液中加入肾上腺素可以防止椎旁扩散" + } + }, + { + "id": "128156ff-ffde-5ab1-92c3-9c775ec62b9d", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 50-year-old man who takes aspirin and nifedipine is scheduled for thoracotomy with one-lung ventilation. Which of the following is associated with the greatest risk for intraoperative hypoxemia?", + "A": "Preoperative withdrawal of nifedipine therapy", + "B": "Intraoperative mild respiratory acidosis", + "C": "Intraoperative administration of isoflurane", + "D": "Intraoperative administration of nitroglycerin", + "E": "Intraoperative thoracic epidural morphine" + }, + "zh": { + "question": "一名50岁的男性，服用阿司匹林和硝苯地平，计划进行单肺通气的开胸手术。以下哪项与术中低氧血症的风险最大相关？", + "A": "术前停用硝苯地平治疗", + "B": "术中轻度呼吸性酸中毒", + "C": "术中使用异氟醚", + "D": "术中使用硝酸甘油", + "E": "术中胸段硬膜外注射吗啡" + } + }, + { + "id": "50c3e7b8-9821-561a-a4ea-588f2bddb472", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "In an Infant, spinal anesthesia to a sensory level of T8 is achieved with tetracaine administered at the L2-3 interspace. Compared with spinal anesthesia to the same sensory level in an adult, this anesthetic is associated with a", + "A": "higher risk for neurotoxicity", + "B": "higher risk for systemic toxicity", + "C": "lower risk for spinal cord injury", + "D": "more significant decrease in blood pressure", + "E": "shorter duration of action" + }, + "zh": { + "question": "在婴儿中，通过在 L2-3 间隙注射丁卡因实现的脊髓麻醉达到 T8 感觉水平。与成人达到相同感觉水平的脊髓麻醉相比，这种麻醉与以下哪种情况相关", + "A": "更高的神经毒性风险", + "B": "更高的全身毒性风险", + "C": "更低的脊髓损伤风险", + "D": "更显著的血压下降", + "E": "作用时间更短" + } + }, + { + "id": "89e03fa1-52b8-5a82-bb38-4d949fd35c91", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 32-year-old patient with end-stage renal failure has irreversible neuromuscular blockade two hours after tracheal intubation with a muscle relaxant. Which of the following is the most likely cause?", + "A": "Atracurium", + "B": "Doxacurium", + "C": "Mivacurium", + "D": "Pancuronium", + "E": "Vecuronium" + }, + "zh": { + "question": "一名32岁的终末期肾衰竭患者在使用肌肉松弛剂进行气管插管两小时后出现不可逆的神经肌肉阻滞。以下哪项是最可能的原因？", + "A": "阿曲库铵", + "B": "多索库铵", + "C": "米库氯铵", + "D": "潘库溴铵", + "E": "维库溴铵" + } + }, + { + "id": "8c153a1a-03ab-5ba2-80f1-7e0c349ae3fc", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "In patients with renal failure, which of the following muscle relaxants has the most prolonged elimination half-life?", + "A": "Atracurium", + "B": "Pancuronium", + "C": "Succinylcholine", + "D": "d-Tubocurarine", + "E": "Vecuronium" + }, + "zh": { + "question": "在肾功能衰竭的患者中，以下哪种肌肉松弛剂的消除半衰期最长？", + "A": "阿曲库铵", + "B": "潘库溴铵", + "C": "琥珀胆碱", + "D": "d-筒箭毒碱", + "E": "维库溴铵" + } + }, + { + "id": "0dee476c-4e7f-5133-9f1c-26140de77160", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "During cardiopulmonary bypass at a nasopharyngeal temperature of 28°C and a hematocrit of 20%, temperature-corrected PaCO2 is 50 mmHg and uncorrected PaCO2 is 60 mmHg. The most appropriate management is to", + "A": "administer additional opioid", + "B": "administer packed red blood cells to increase hematocrit to 25%", + "C": "further decrease the patient's temperature", + "D": "increase fresh gas flow to the oxygenator", + "E": "institute mechanical ventilation" + }, + "zh": { + "question": "在鼻咽温度为28°C和血细胞比容为20%的体外循环期间，温度校正的PaCO2为50 mmHg，未校正的PaCO2为60 mmHg。最合适的管理措施是", + "A": "给予额外的阿片类药物", + "B": "输注浓缩红细胞以将血细胞比容增加到25%", + "C": "进一步降低患者的体温", + "D": "增加氧合器的新鲜气体流量", + "E": "实施机械通气" + } + }, + { + "id": "1d084ae9-ca24-5fea-91a8-4c78ce3962ca", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Depression of cerebral oxygen requirements below the level required to create an isoelectric EEG can be achieved by", + "A": "administration of isoflurane", + "B": "administration of nimodipine", + "C": "barbiturate coma", + "D": "hyperventilation", + "E": "hypothermia" + }, + "zh": { + "question": "可以通过以下哪种方法将大脑氧需求降低到产生等电位脑电图所需的水平？", + "A": "异氟醚的使用", + "B": "尼莫地平的使用", + "C": "巴比妥类药物昏迷", + "D": "过度通气", + "E": "低温" + } + }, + { + "id": "5d50e4de-402a-5742-8f48-f888fd3c0dc3", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Pulse oximetry accurately reflects SaO2 in which of the following situations?", + "A": "Administration of indocyanine green", + "B": "Administration of methylene blue", + "C": "Carboxyhemoglobinemia", + "D": "40% fetal hemoglobin concentration", + "E": "Methemoglobinemia" + }, + "zh": { + "question": "在以下哪种情况下，脉搏血氧仪能准确反映动脉血氧饱和度（SaO2）？", + "A": "注射吲哚青绿", + "B": "注射亚甲蓝", + "C": "碳氧血红蛋白血症", + "D": "40% 胎儿血红蛋白浓度", + "E": "高铁血红蛋白血症" + } + }, + { + "id": "4ad50329-8def-5383-aa2b-6c94da71e752", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "Each of the following affects the induction dose of thiopental EXCEPT", + "A": "acute ethanol intoxication", + "B": "chronic use of barbiturates", + "C": "intravascular volume", + "D": "rate of hepatic extraction of thiopental", + "E": "serum albumin concentration" + }, + "zh": { + "question": "以下每项都会影响硫喷妥钠的诱导剂量，除了", + "A": "急性酒精中毒", + "B": "长期使用巴比妥类药物", + "C": "血管内容量", + "D": "硫喷妥钠的肝脏提取率", + "E": "血清白蛋白浓度" + } + }, + { + "id": "334460e2-ce87-5355-820b-aa7faf9865c4", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A 25-year-old woman is admitted to the hospital in the early stages of labor at term. Initial hematocrit is 33%. Which of the following is the most likely cause of the hematocrit value?", + "A": "Decreased erythropoietin activity", + "B": "Destruction of erythrocytes by the placenta", + "C": "Early placental abruption", + "D": "Increased plasma volume", + "E": "Iron deficiency" + }, + "zh": { + "question": "一名25岁的女性在足月分娩的早期阶段被送入医院。初始血细胞比容为33%。以下哪项最可能是血细胞比容值的原因？", + "A": "促红细胞生成素活性降低", + "B": "胎盘破坏红细胞", + "C": "早期胎盘早剥", + "D": "血浆容量增加", + "E": "缺铁性贫血" + } + }, + { + "id": "1e1c8c0f-9b53-5f71-803f-a56f6571ace1", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 72-year-old patient who takes levodopa and carbidopa is undergoing colon resection. Metoclopramide is administered preoperatively and anesthesia is maintained with proposal, fentanyl, and nitrous oxide, with vecuronium for muscle relaxation. Fifteen minutes after reversal of muscle relaxation with neostigmine and atropine and tracheal extubation, the patient has dyspnea and muscular rigidity. Which of the following is the most likely cause?", + "A": "Central anticholinergic syndrome", + "B": "Fentanyl-induced rigidity", + "C": "Inhibition of methionine synthetase by nitrous oxide", + "D": "Metoclopramide-induced dopamine antagonism", + "E": "Peripheral conversion of levodopa to dopamine" + }, + "zh": { + "question": "一名72岁的患者正在服用左旋多巴和卡比多巴，接受结肠切除术。术前给予甲氧氯普胺，麻醉维持使用丙泊酚、芬太尼和氧化亚氮，使用维库溴铵进行肌肉松弛。肌肉松弛用新斯的明和阿托品逆转并拔管后15分钟，患者出现呼吸困难和肌肉僵硬。以下哪项是最可能的原因？", + "A": "中枢抗胆碱能综合征", + "B": "芬太尼引起的僵硬", + "C": "氧化亚氮抑制蛋氨酸合成酶", + "D": "甲氧氯普胺引起的多巴胺拮抗作用", + "E": "左旋多巴在外周转化为多巴胺" + } + }, + { + "id": "75d77436-a667-5c03-bb42-abea2be017c9", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 28-year-old patient has severe laryngospasm after extubation of the trachea following general anesthesia. Administration of 100% oxygen using continuous positive airway pressure does not improve symptoms. SpO2 is 75%. Which of the following is the most appropriate immediate management?", + "A": "Laryngeal mask airway", + "B": "Lidocaine", + "C": "Racemic epinephrine", + "D": "Succinylcholine", + "E": "Cricothyroidotomy" + }, + "zh": { + "question": "一名28岁的患者在全身麻醉拔除气管插管后出现严重喉痉挛。使用持续正压通气给100%氧气未改善症状。SpO2为75%。以下哪项是最合适的立即处理措施？", + "A": "喉罩气道", + "B": "利多卡因", + "C": "消旋肾上腺素", + "D": "琥珀胆碱", + "E": "环甲膜切开术" + } + }, + { + "id": "2649aaa6-706f-5e8b-bc9f-9e21772f9035", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During use of the ventilator on an anesthesia machine, positive pressure is noted on the airway pressure gauge during exhalation. Positive end-expiratory pressure has not been purposefully added to the breathing circuit. Which of the following is the most likely cause?", + "A": "Closure of the pop-off valve in the circle system", + "B": "Excessive tidal volume settings on the ventilator", + "C": "Obstruction of the pressure relief valve on the scavenging system", + "D": "Overinflation of the endotracheal tube balloon", + "E": "Tension pneumothorax" + }, + "zh": { + "question": "在麻醉机的呼吸机使用过程中，呼吸道压力表在呼气时显示正压。呼吸回路中没有故意添加呼气末正压。以下哪项是最可能的原因？", + "A": "环路系统中溢流阀的关闭", + "B": "呼吸机潮气量设置过高", + "C": "排放系统中压力释放阀的阻塞", + "D": "气管导管气囊过度充气", + "E": "张力性气胸" + } + }, + { + "id": "f0d0ebbb-9053-5545-8fd9-0f9ff39f73b8", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Each of the following parameters of cerebral perfusion and metabolism is approximately equal to 50 EXCEPT", + "A": "cerebral oxygen consumption in ml O2/min for a normal adult", + "B": "lower limit of mean arterial pressure for cerebral autoregulation in mmHg", + "C": "normal cerebral blood flow in ml /100 g tissue/min", + "D": "PaO2 at which cerebral blood flow increases", + "E": "PaCO2 at which cerebral blood flow doubles" + }, + "zh": { + "question": "以下每个脑灌注和代谢参数大约等于50，除了", + "A": "正常成人的脑氧消耗量，单位为ml O2/min", + "B": "脑自动调节的平均动脉压下限，单位为mmHg", + "C": "正常脑血流量，单位为ml/100g组织/min", + "D": "脑血流量增加时的PaO2", + "E": "脑血流量加倍时的PaCO2" + } + }, + { + "id": "2c12a2d2-7d1a-51cf-8457-a1667fe77e3a", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 64-year-old man with diabetes mellitus well controlled with NPH insulin undergoes lower extremity revascularization. Following administration of protamine 10 mg, the patient has facial flushing and blood pressure of 60/30 mmHg. The most appropriate initial step in management is administration of which of the following drugs?", + "A": "Diphenhydramine", + "B": "Epinephrine", + "C": "Hydrocortisone", + "D": "Norepinephrine", + "E": "Phenylephrine" + }, + "zh": { + "question": "一名64岁患有糖尿病的男性，使用NPH胰岛素控制良好，接受下肢血管重建术。在给予10毫克鱼精蛋白后，患者出现面部潮红，血压为60/30 mmHg。最合适的初始处理步骤是给予以下哪种药物？", + "A": "苯海拉明", + "B": "肾上腺素", + "C": "氢化可的松", + "D": "去甲肾上腺素", + "E": "苯肾上腺素" + } + }, + { + "id": "f4691f0b-5389-50cd-a31b-897b4dddf873", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Unilateral or bilateral diaphragmatic paralysis is a complication of each of the following EXCEPT", + "A": "surgical ligation of a patent ductus arteriosus", + "B": "use of pericardial ice-slush for topical cardiac hypothermia", + "C": "stellate ganglion block", + "D": "interscalene brachial plexus block", + "E": "C6 cervical fracture-dislocation" + }, + "zh": { + "question": "以下每种情况均可能导致单侧或双侧膈肌麻痹，除了", + "A": "动脉导管未闭的手术结扎", + "B": "使用心包冰泥进行局部心脏低温", + "C": "星状神经节阻滞", + "D": "斜角肌间臂丛神经阻滞", + "E": "C6颈椎骨折脱位" + } + }, + { + "id": "1a8d30af-3d10-5907-b968-1ca7e3bf4800", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "An 18-month-old child with tetralogy of Fallot is anesthetized with halothane and nitrous oxide. Following intubation, oxygen saturation decreases abruptly from 85% to 45%. The most effective treatment is", + "A": "discontinuation of halothane", + "B": "hyperventilation", + "C": "intravenous epinephrine", + "D": "intravenous phenylephrine", + "E": "positive end-expiratory pressure" + }, + "zh": { + "question": "一名18个月大的法洛四联症患儿在使用氟烷和氧���亚氮麻醉后，插管后氧饱和度从85%突然下降到45%。最有效的治疗是", + "A": "停止使用氟烷", + "B": "过度通气", + "C": "静脉注射肾上腺素", + "D": "静脉注射去氧肾上腺素", + "E": "正压呼气末压力" + } + }, + { + "id": "9c3e929e-d782-5cea-8296-00c548ed7075", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 20-kg, 6-year-old boy is undergoing strabismus surgery under anesthesia with sevoflurane, nitrous oxide, and oxygen. The heart rate suddenly decreases from 85 to 40 bpm. Which of the following is the most appropriate first step in management?", + "A": "Decrease the depth of anesthesia", + "B": "Increase the depth of anesthesia", + "C": "Hyperventilate the patient", + "D": "Administer atropine", + "E": "Stop the surgical procedure" + }, + "zh": { + "question": "一名20公斤、6岁的男孩在全麻下进行斜视手术，使用七氟醚、氧化亚氮和氧气。心率突然从85降至40次/分钟。以下哪项是最合适的首要处理步骤？", + "A": "减浅麻醉深度", + "B": "加深麻醉深度", + "C": "对患者进行过度通气", + "D": "给予阿托品", + "E": "停止手术" + } + }, + { + "id": "c6f5aa3a-1f53-5a99-87d5-d84ce4d7b467", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following features is characteristic of the airway in a neonate?", + "A": "Glottis that is located at the level of the C6 vertebral body", + "B": "Larger tongue relative to the head than in an adult", + "C": "Laryngeal mucosa that is densely adherent to the cartilages", + "D": "More posterior glottis than that of an adult", + "E": "Narrowest portion of the airway that is located at the arytenoid cartilages" + }, + "zh": { + "question": "以下哪项特征是新生儿气道的特征？", + "A": "声门位于C6椎体水平", + "B": "相对于头部，舌头比成人更大", + "C": "喉粘膜紧密附着于软骨", + "D": "声门比成人更靠后", + "E": "气道最窄的部分位于杓状软骨" + } + }, + { + "id": "91c5d077-b577-5aa1-864e-91c94af4c4ae", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements is true concerning administration of 70% nitrous oxide to a patient with an unrecognized pneumothorax?", + "A": "Expansion of the pneumothorax by nitrous oxide occurs at a greater rate than expansion of bowel gas", + "B": "Expansion of the pneumothorax by nitrous oxide occurs at a linear rate", + "C": "The maximum expansion of a closed space occurs within 15 minutes", + "D": "The maximum concentration of nitrous oxide achievable within the pneumothorax is 35%", + "E": "The maximum increase in a closed gas-containing space is 100%" + }, + "zh": { + "question": "关于对未识别的气胸患者给予70%一氧化二氮，下列哪项陈述是正确的？", + "A": "一氧化二氮导致气胸扩张的速度大于肠道气体的扩张速度", + "B": "一氧化二氮导致气胸扩张的速度是线性的", + "C": "封闭空间的最大扩张在15分钟内发生", + "D": "气胸内一氧化二氮的最大浓度可达到35%", + "E": "封闭含气空间的最大增加为100%" + } + }, + { + "id": "1438a9f6-763c-5837-8695-4300d75ec8ef", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A patient receiving propranolol and nifedipine is scheduled for elective coronary artery bypass surgery. During induction with fentanyl and oxygen, heart rate decreases from 52 to 36 bpm and blood pressure decreases from 130/85 to 80/50 mmHg. Administration of atropine 2 mg intravenously has no effect. The most appropriate treatment at this time is administration of", + "A": "epinephrine", + "B": "pancuronium", + "C": "naloxone", + "D": "phenylephrine", + "E": "calcium chloride" + }, + "zh": { + "question": "一名正在接受普萘洛尔和硝苯地平治疗的患者计划进行选择性冠状动脉旁路移植手术。在使用芬太尼和氧气进行诱导期间，心率从52次/分钟下降到36次/分钟，血压从130/85 mmHg下降到80/50 mmHg。静脉注射2毫克阿托品无效。此时最合适的治疗是给予", + "A": "肾上腺素", + "B": "潘库溴铵", + "C": "纳洛酮", + "D": "苯肾上腺素", + "E": "氯化钙" + } + }, + { + "id": "66e769ec-c961-5959-a2eb-c8a24e8e5539", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 46-year-old patient who abuses intravenous drugs develops acute aortic valvular insufficiency from bacterial endocarditis. Which of the following statements concerning pressures measured through a pulmonary artery catheter is true?", + "A": "Pulmonary artery occlusion pressure will underestimate left ventricular end-diastolic pressure", + "B": "Pulmonary artery oxygen saturation will overestimate mixed venous oxygen saturation", + "C": "Thermodilution cardiac output determination will overestimate cardiac output", + "D": "Right ventricular end-diastolic pressure will equal left ventricular end-diastolic pressure", + "E": "The pulmonary artery occlusion pressure trace will most likely have large V waves" + }, + "zh": { + "question": "一名46岁的静脉药物滥用患者因细菌性心内膜炎导致急性主动脉瓣关闭不全。关于通过肺动脉导管测量的压力，下列哪项陈述是正确的？", + "A": "肺动脉楔入压将低估左心室舒张末期压", + "B": "肺动脉氧饱和度将高估混合静脉氧饱和度", + "C": "热稀释法测定的心输出量将高估心输出量", + "D": "右心室舒张末期压将等于左心室舒张末期压", + "E": "肺动脉楔入压波形很可能会有大的V波" + } + }, + { + "id": "f696ded0-31eb-5508-8b40-5154c628b445", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following muscle relaxants is most likely to result in histamine release following administration of a bolus dose sufficient to facilitate rapid endotracheal intubation?", + "A": "Atracurium", + "B": "Pancuronium", + "C": "Succinylcholine", + "D": "Rocuronium", + "E": "Vecuronium" + }, + "zh": { + "question": "以下哪种肌松药在给予足以快速气管插管的推注剂量后最有可能导致组胺释放？", + "A": "阿曲库铵", + "B": "潘库溴铵", + "C": "琥珀胆碱", + "D": "罗库溴铵", + "E": "维库溴铵" + } + }, + { + "id": "41181de5-8ee3-5ab6-af70-974a7bc5980f", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 68-year-old man has a permanent DVI pacemaker that has been functioning appropriately. Which of the following is most likely to cause conversion to VOO pacing?", + "A": "Electroconvulsive therapy", + "B": "Insertion of a pulmonary artery catheter", + "C": "Placement of a magnet over the pulse generator", + "D": "Use of electrocautery near the pacemaker", + "E": "Shivering" + }, + "zh": { + "question": "一名68岁的男性有一个永久性的DVI起搏器，并且一直运作正常。以下哪项最有可能导致转换为VOO起搏？", + "A": "电休克疗法", + "B": "插入肺动脉导管", + "C": "在脉冲发生器上放置磁铁", + "D": "在起搏器附近使用电灼术", + "E": "发抖" + } + }, + { + "id": "b67bed51-ea4f-54bd-9357-f09f96f6e46b", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 52-year-old woman undergoes facial surgery during general endotracheal anesthesia. The ventilator is set to deliver a tidal volume of 600 ml and a respiratory rate of 10/min at an FiO2 of 1.0. SpO2 is 100%, peak inspiratory pressure is 18 cmH2O, and PetCO2 is 40 mmHg. The surgeon flexes the patient's head so the chin touches the chest. Which of the following findings indicates that endobronchial intubation has NOT occurred?", + "A": "Fluctuating capnographic waveform", + "B": "Greater expiratory volume than inspiratory volume", + "C": "Unchanged SpO2", + "D": "Unchanged PetCO2", + "E": "Unchanged peak inspiratory pressure" + }, + "zh": { + "question": "一名52岁的女性在全身气管插管麻醉下接受面部手术。呼吸机设置为潮气量600毫升，呼吸频率10次/分钟，氧浓度FiO2为1.0。SpO2为100%，峰值吸气压为18 cmH2O，呼气末二氧化碳分压PetCO2为40 mmHg。外科医生将患者的头部弯曲，使下巴触碰到胸部。以下哪项发现表明未发生支气管内插管？", + "A": "波动的二氧化碳图形波形", + "B": "呼气量大于吸气量", + "C": "SpO2无变化", + "D": "PetCO2无变化", + "E": "峰值吸气压无变化" + } + }, + { + "id": "a124498f-026b-5bd0-908b-403ea6f4952b", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following chemotherapeutic drugs is a cause of pulmonary fibrosis?", + "A": "Bleomycin", + "B": "Cisplatin", + "C": "Cyclosporine", + "D": "Daunorubicin", + "E": "Vincristine" + }, + "zh": { + "question": "以下哪种化疗药物会导致肺纤维化？", + "A": "博来霉素", + "B": "顺铂", + "C": "环孢素", + "D": "柔红霉素", + "E": "长春新碱" + } + }, + { + "id": "01047263-4f76-5da3-b3ed-487c6be03089", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A patient has a decrease in heart rate from 80 to 50 bpm and a decrease in blood pressure from 140/90 to 60/40 mmHg while in the recovery room after adrenalectomy for pheochromocytoma. The most appropriate treatment is administration of", + "A": "atropine", + "B": "calcium", + "C": "hydrocortisone", + "D": "isoproterenol", + "E": "norepinephrine" + }, + "zh": { + "question": "一名患者在因嗜铬细胞瘤进行肾上腺切除术后，在恢复室中心率从80降至50次/分钟，血压从140/90降至60/40 mmHg。最合适的治疗是给予", + "A": "阿托品", + "B": "钙", + "C": "氢化可的松", + "D": "异丙肾上腺素", + "E": "去甲肾上腺素" + } + }, + { + "id": "75a2f877-c0c8-513e-80ed-3e173e8e43e1", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 65-year-old man has a history of alcohol abuse. Which of the following preoperative serum concentrations would provide the best assessment of synthetic hepatic function?", + "A": "Albumin", + "B": "Alkaline phosphatase", + "C": "Bilirubin", + "D": "Globulin", + "E": "Transaminases" + }, + "zh": { + "question": "一名65岁的男性有酗酒史。以下哪项术前血清浓度能最好地评估肝脏合成功能？", + "A": "白蛋白", + "B": "碱性磷酸酶", + "C": "胆红素", + "D": "球蛋白", + "E": "转氨酶" + } + }, + { + "id": "e73d1b73-9917-55e2-9b70-4395eafee63e", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning air embolism during intracranial operations is true?", + "A": "It does not occur in supine patients", + "B": "It is prevented by positive end-expiratory pressure", + "C": "It is confined to the right side of the heart and the pulmonary vasculature", + "D": "It is detectable by measurement of end-tidal nitrogen", + "E": "It is most efficiently treated by aspiration from a pulmonary artery catheter" + }, + "zh": { + "question": "关于颅内手术中空气栓塞的以下哪项陈述是正确的？", + "A": "仰卧位患者不会发生", + "B": "通过呼气末正压通气可以预防", + "C": "仅限于心脏右侧和肺血管", + "D": "通过测量呼气末氮气可以检测到", + "E": "通过肺动脉导管抽吸最有效地治疗" + } + }, + { + "id": "7e9965f6-730f-55dd-ac20-c2721b6bb907", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is described by the standard deviation during analysis of the results of a clinical study?", + "A": "Central tendency of the study results", + "B": "Distribution of the results of the study group", + "C": "Range of the results of the study group", + "D": "Regression analysis of the study group", + "E": "Statistical significance of the difference between the study groups" + }, + "zh": { + "question": "在分析临床研究结果时，标准差描述了以下哪一项？", + "A": "研究结果的集中趋势", + "B": "研究组结果的分布", + "C": "研究组结果的范围", + "D": "研究组的回归分析", + "E": "研究组之间差异的统计显著性" + } + }, + { + "id": "e19ebbd3-ea7c-5e4a-819a-c51795a462bf", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following is a characteristic of prostaglandin E1 (alprostadil) pharmacology in an infant EXCEPT:", + "A": "It is effective in the treatment of large left-to-right shunts", + "B": "It is a cause of apnea", + "C": "It is a potent vasodilator", + "D": "It prevents closure of the ductus arteriosus", + "E": "It is metabolized rapidly" + }, + "zh": { + "question": "以下每项都是前列腺素E1（阿普洛斯汀）在婴儿药理学中的特征，除了：", + "A": "它在治疗大左向右分流中有效", + "B": "它是呼吸暂停的原因", + "C": "它是强效的血管扩张剂", + "D": "它可以防止动脉导管闭合", + "E": "它代谢迅速" + } + }, + { + "id": "8cb15969-811c-5114-be09-6d22db608517", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 5-year-old child undergoes strabismus correction during spontaneous ventilation with halothane 1.5%, nitrous oxide and oxygen 50%. Intravenous atropine 0.2 mg is administered after inhalation induction. Ten minutes after incision, heart rate decreases from 110 bpm to 40 bpm. Which of the following is the most likely cause?", + "A": "Administration of phenylephrine eyedrops", + "B": "Inadvertent external pressure on the carotid sinus", + "C": "Paradoxical response to a small dose of atropine", + "D": "Sinoatrial nodal depression by halothane", + "E": "Traction on an extraocular muscle" + }, + "zh": { + "question": "一名5岁儿童在自发通气下接受1.5%氟烷、50%氧化亚氮和氧气的斜视矫正手术。吸入诱导后静脉注射0.2 mg阿托品。切口后十分钟，心率从110次/分钟降至40次/分钟。以下哪项是最可能的原因？", + "A": "使用苯肾上腺素滴眼液", + "B": "无意中对颈动脉窦施加外部压力", + "C": "对小剂量阿托品的矛盾反应", + "D": "氟烷对窦房结的抑制", + "E": "牵拉眼外肌" + } + }, + { + "id": "d900a12d-4196-58bb-be96-9ad2dd1a3397", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "An atrioventricular sequential demand pacemaker is placed in a patient who has abnormal atrioventricular conduction. Each of the following statements about this situation is true EXCEPT:", + "A": "Electrocautery could lead to long pauses in the paced rhythm", + "B": "Placing a magnet over the generator will convert it to an asynchronous (fixed rate) unit", + "C": "If complete heart block develops, the paced ventricular rate will be the same as the sinus node rate", + "D": "An atropine-induced increase in the sinus rate will increase the ventricular rate", + "E": "During symptomatic tachyarrhythmia, cardioversion would be contraindicated because it would alter the pacemaker's function" + }, + "zh": { + "question": "在一位房室传导异常的患者中植入了房室顺序需求起搏器。关于这种情况，以下每个陈述都是正确的，除了：", + "A": "电灼可能导致起搏节律出现长时间停顿", + "B": "将磁铁放在起搏器上方会将其转换为异步（固定速率）模式", + "C": "如果发生完全性心脏传导阻滞，起搏的心室速率将与窦房结速率相同", + "D": "阿托品引起的窦性心率增加将提高心室速率", + "E": "在症状性心动过速时，电复律是禁忌的，因为它会改变起搏器的功能" + } + }, + { + "id": "8ad9ac35-1f37-537d-8113-2bcd964b6e7d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with adults, neonates are more likely to become hypoxemic following anesthesia and extubation because of a relatively", + "A": "higher rate of oxygen consumption", + "B": "greater sensitivity to neuromuscular blockade", + "C": "larger Vd/Vt ratio", + "D": "lower blood pressure", + "E": "smaller functional residual capacity" + }, + "zh": { + "question": "与成人相比，新生儿在麻醉和拔管后更容易发生低氧血症，因为相对", + "A": "较高的氧气消耗率", + "B": "对神经肌肉阻滞剂的敏感性更高", + "C": "较大的Vd/Vt比率", + "D": "较低的血压", + "E": "较小的功能残气量" + } + }, + { + "id": "3338a552-19e8-589b-8412-7621ceb800f8", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 64-year-old, 70-kg woman treated with lithium for manic-depressive psychosis is given methohexital 90 mg and succinylcholine 35 mg intravenously for electroconvulsive therapy. Ten minutes later she remains sedated and the peripheral nerve stimulator shows a decreased twitch response. The most likely explanation is", + "A": "cerebral hypoxia", + "B": "postictal depression", + "C": "relative overdose of methohexital", + "D": "unrecognized atypical pseudocholinesterase", + "E": "residual lithium effects" + }, + "zh": { + "question": "一名64岁、70公斤的女性因躁郁症接受锂治疗，她被静脉注射90毫克甲氧氯普胺和35毫克琥珀胆碱用于电休克治疗。十分钟后，她仍然处于镇静状态，外周神经刺激器显示抽搐反应减少。最可能的解释是", + "A": "脑缺氧", + "B": "发作后抑郁", + "C": "甲氧氯普胺相对过量", + "D": "未识别的非典型假性胆碱酯酶", + "E": "锂的残留效应" + } + }, + { + "id": "ad0d0432-3408-5746-be68-5fbd23633908", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A patient is bleeding excessively after routine transurethral resection of the prostate. Re-exploration discloses diffuse oozing. The most appropriate management is administration of", + "A": "platelets", + "B": "fresh frozen plasma", + "C": "desmopressin", + "D": "epsilon-aminocaproic acid", + "E": "cryoprecipitate" + }, + "zh": { + "question": "一名患者在进行常规经尿道前列腺切除术后出血过多。重新探查发现弥漫性渗血。最合适的处理是给予", + "A": "血小板", + "B": "新鲜冰冻血浆", + "C": "去氨加压素", + "D": "ε-氨基己酸", + "E": "冷沉淀" + } + }, + { + "id": "b729489e-b3c6-5721-93fa-bcf502861ef3", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 70-kg, 47-year-old man is undergoing a repeat coronary artery bypass graft. Following sternotomy, administration of heparin 300 units/kg for anticoagulation increases the activated coagulation time from a baseline of 135 sec to 210 sec. This finding is compatible with", + "A": "antithrombin III deficiency", + "B": "heparin-induced thrombocytopenia", + "C": "normal response to this dose of heparin", + "D": "increased sensitivity to heparin", + "E": "von Willebrand's disease" + }, + "zh": { + "question": "一名70公斤、47岁的男性正在接受重复冠状动脉旁路移植术。胸骨切开后，给予300单位/公斤的肝素进行抗凝，使活化凝血时间从基线的135秒增加到210秒。这一发现与以下哪项相符？", + "A": "抗凝血酶III缺乏", + "B": "肝素诱导的血小板减少症", + "C": "对这种剂量的肝素的正常反应", + "D": "对肝素的敏感性增加", + "E": "血管性血友病" + } + }, + { + "id": "4f264bf2-6d86-5f60-9ff7-24cf8625aa69", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Prolonged respiratory depression following administration of morphine is more likely in patients with chronic renal faillure than in patients with normal kidney function because of", + "A": "decreased biotransformation", + "B": "decreased protein binding", + "C": "decreased volume of distribution", + "D": "delayed excretion of morphine metabolites", + "E": "the effect of acidosis on morphine ionization" + }, + "zh": { + "question": "与肾功能正常的患者相比，慢性肾功能衰竭患者在使用吗啡后更容易出现延长的呼吸抑制，因为", + "A": "生物转化减少", + "B": "蛋白结合减少", + "C": "分布容积减少", + "D": "吗啡代谢物的排泄延迟", + "E": "酸中毒对吗啡电离的影响" + } + }, + { + "id": "c1d5b354-8f41-57bb-a232-592eca2fcfb3", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "While checking an anesthesia machine, opening the oxygen flow-control valve yields no oxygen flow, although the wall-mounted oxygen pipeline supply gauge reads 50 psig. Opening the backup oxygen cylinder results in normal oxygen flow. The most likely cause is", + "A": "failure of the oxygen pipeline supply", + "B": "failure of the second-stage oxygen pressure regulator", + "C": "a malfunctioning check valve in the oxygen pipeline supply inlet", + "D": "a malfunctioning fail-safe valve", + "E": "a malfunctioning oxygen flow-control valve" + }, + "zh": { + "question": "在检查麻醉机时，打开氧气流量控制阀没有氧气流动，尽管墙上安装的氧气管道供应表显示50 psig。打开备用氧气瓶后氧气流动正常。最可能的原因是", + "A": "氧气管道供应故障", + "B": "二级氧气压力调节器故障", + "C": "氧气管道供应入口的止��阀故障", + "D": "故障安全阀故障", + "E": "氧气流量控制阀故障" + } + }, + { + "id": "27644be8-bff7-5440-a298-54fb566d2040", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 2500-g, 12-hour-old infant is tracheally intubated and mechanically ventilated at a rate of 20/min with an FiO2 of 0.4 and peak inspiratory pressure of 25 cmH2O. At birth, amniotic fluid was meconium stained and Apgar scores were 2 and 7. The most recent arterial blood gas levels are PaO2, 50 mmHg, PaCO2, 55 mmHg, and pH 7.20. The most appropriate management is to", + "A": "administer sodium bicarbonate", + "B": "begin intravenous infusion of prostaglandin E,", + "C": "increase FiO2", + "D": "increase ventilation", + "E": "perform bronchial lavage" + }, + "zh": { + "question": "一名2500克、出生12小时的婴儿被气管插管并以每分钟20次的频率进行机械通气，吸入氧浓度为0.4，峰值吸气压为25 cmH2O。出生时羊水被胎粪污染，阿普加评分为2和7。最近的动脉血气水平为PaO2 50 mmHg，PaCO2 55 mmHg，pH 7.20。最合适的管理措施是", + "A": "给予碳酸氢钠", + "B": "开始静脉输注前列腺素E", + "C": "增加吸入氧浓度", + "D": "增加通气量", + "E": "进行支气管灌洗" + } + }, + { + "id": "ff41f680-bdf3-5065-b2b5-fb5580090d06", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Each of the following changes is expected with deliberate hypothermia EXCEPT", + "A": "decreased unloading of oxygen from hemoglobin", + "B": "a 5% decrease in MAC for each 1°C decrease in temperature", + "C": "increased arterial oxygen and carbon dioxide contents", + "D": "a 50% decrease in cerebral metabolic rate at 28°C", + "E": "spike and dome EEG activity at temperatures below 30°C" + }, + "zh": { + "question": "以下每种变化都可以预期在故意低温时出现，除了", + "A": "血红蛋白释放氧气减少", + "B": "每降低1°C，MAC减少5%", + "C": "动脉氧和二氧化碳含量增加", + "D": "在28°C时脑代谢率降低50%", + "E": "在低于30°C时出现尖峰和圆顶的脑电图活动" + } + }, + { + "id": "b12a7ff1-5782-5aaf-a7f1-cc9895663678", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 30-year-old man is brought to the emergency department after being rescued from a house fire. With the trachea intubated and FiO2 at 1.0, arterial blood gas values are PaO2 495 mmHg, PaCO2 28 mmHg, and pH 7.28. Hemoglobin saturation measured by co-oximeter is 50%. The most appropriate next step is to", + "A": "add positive end-expiratory pressure", + "B": "add n-acetylcysteine to the inhaled gases", + "C": "administer sodium bicarbonate intravenously", + "D": "transfuse 2 units of packed red blood cells", + "E": "transfer to a hyperbaric chamber" + }, + "zh": { + "question": "一名30岁的男子在从火灾中被救出后被送到急诊室。气管插管和吸入氧浓度（FiO2）为1.0时，动脉血气值为PaO2 495 mmHg，PaCO2 28 mmHg，pH 7.28。共氧计测得的血红蛋白饱和度为50%。最合适的下一步措施是", + "A": "增加呼气末正压", + "B": "在吸入气体中加入乙酰半胱氨酸", + "C": "静脉注射碳酸氢钠", + "D": "输注2个单位的浓缩红细胞", + "E": "转移到高压氧舱" + } + }, + { + "id": "67b1305f-4a62-5a6a-9cd9-507287f4c728", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following decreases hepatic blood flow EXCEPT", + "A": "isoflurane anesthesia", + "B": "spinal anesthesia", + "C": "hypercarbia", + "D": "mechanical ventilation", + "E": "positive end-expiratory pressure" + }, + "zh": { + "question": "以下每种情况都会减少肝血流量，除了", + "A": "异氟醚麻醉", + "B": "脊髓麻醉", + "C": "高碳酸血症", + "D": "机械通气", + "E": "呼气末正压" + } + }, + { + "id": "b9fa1ed5-693d-5a30-a4f0-42dc8b1f087e", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "In a normally functioning circle anesthesia system, if the length of the inspiratory and expiratory hose is doubled, the mechanical dead space will be", + "A": "halved", + "B": "unchanged", + "C": "doubled", + "D": "quadrupled", + "E": "dependent on compression volume" + }, + "zh": { + "question": "在正常运作的环路麻醉系统中，如果吸气和呼气软管的长度加倍，机械死腔将会", + "A": "减半", + "B": "不变", + "C": "加倍", + "D": "四倍", + "E": "取决于压缩体积" + } + }, + { + "id": "fe55b255-2859-5c4d-b956-bff0f480a3fd", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The most common early indication of drug dependence in an anesthesiologist is", + "A": "a positive finding on random screening of urine", + "B": "inconsistency between anesthetic and drug control records", + "C": "change in behavior", + "D": "incapacitation due to overdose", + "E": "the presence of needle tracks on the extremities" + }, + "zh": { + "question": "麻醉医生药物依赖最常见的早期迹象是", + "A": "尿液随机筛查呈阳性", + "B": "麻醉记录与药物控制记录不一致", + "C": "行为改变", + "D": "因过量服药而丧失能力", + "E": "四肢上出现针孔痕迹" + } + }, + { + "id": "f08628b8-075a-5ce0-8343-1170a67dc12a", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "During axillary block of the brachial plexus, which nerve is most likely to be encountered if the needle is inserted through the posterior wall of the artery?", + "A": "Intercostobrachial", + "B": "Median", + "C": "Musculocutaneous", + "D": "Radial", + "E": "Ulnar" + }, + "zh": { + "question": "在腋窝阻滞臂丛时，如果针头穿过动脉的后壁，最有可能遇到哪个神经？", + "A": "肋间臂神经", + "B": "正中神经", + "C": "肌皮神经", + "D": "桡神经", + "E": "尺神经" + } + }, + { + "id": "5a6cf74e-a193-577d-a59f-b43924509b83", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is a sign of cyclosporine toxicity?", + "A": "Abnormal hepatic enzyme activity", + "B": "Decreased hemoglobin concentration", + "C": "Increased serum creatinine concentration", + "D": "Nodular density on radiograph of the chest", + "E": "ST-T wave changes on ECG" + }, + "zh": { + "question": "下列哪项是环孢素毒性的表现？", + "A": "异常的肝酶活性", + "B": "血红蛋白浓度降低", + "C": "血清肌酐浓度升高", + "D": "胸部X光片上的结节密度", + "E": "心电图上的ST-T波变化" + } + }, + { + "id": "5f8669cc-582a-59ae-90d7-d2c7aeb1ae79", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Carbon dioxide retention first occurs when the ratio of forced expiratory volume in 1 second to vital capacity (FEV1/VC) decreases below", + "A": "15%", + "B": "35%", + "C": "50%", + "D": "65%", + "E": "75%" + }, + "zh": { + "question": "当1秒钟用力呼气量与肺活量的比值（FEV1/VC）下降到以下哪个百分比以下时，首先出现二氧化碳潴留？", + "A": "15%", + "B": "35%", + "C": "50%", + "D": "65%", + "E": "75%" + } + }, + { + "id": "6fe15712-358c-5cc8-a034-599e39597d36", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The EEG begins to flatten during carotid endarterectomy when regional cerebral blood flow (in ml/min/100 g brain) decreases to", + "A": "55", + "B": "45", + "C": "30", + "D": "20", + "E": "10" + }, + "zh": { + "question": "在颈动脉内膜切除术期间，当区域性脑血流（以ml/min/100g脑组织计）减少到多少时，脑电图开始变平？", + "A": "55", + "B": "45", + "C": "30", + "D": "20", + "E": "10" + } + }, + { + "id": "e19a6a6f-4b00-5917-a9b2-cfa2a0ecc063", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "During steady-state intraoperative controlled mechanical ventilation, exhaled tidal volume will be increased by", + "A": "changing to more compliant tubing in the ventilatory circuit", + "B": "increasing fresh gas flow in the anesthesia machine", + "C": "increasing nitrous oxide concentration in the inspired mixture", + "D": "increasing ventilatory rate", + "E": "moving the volume sensor as far as possible from the patient" + }, + "zh": { + "question": "在稳态术中控制性机械通气期间，呼出潮气量将增加", + "A": "将通气回路中的管道更换为更顺应的管道", + "B": "增加麻醉机中的新鲜气体流量", + "C": "增加吸入混合气体中的氧化亚氮浓度", + "D": "增加通气频率", + "E": "将体积传感器尽可能远离患者移动" + } + }, + { + "id": "88053240-7a4b-5b30-ba87-06ef842c11e0", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "When used with morphine for premedication, which of the following drugs is most likely to cause sedation?", + "A": "Atropine", + "B": "Cephalothin", + "C": "Clonidine", + "D": "Metoclopramide", + "E": "Ranitidine" + }, + "zh": { + "question": "与吗啡一起用于术前用药时，以下哪种药物最有可能引起镇静？", + "A": "阿托品", + "B": "头孢噻吩", + "C": "可乐定", + "D": "甲氧氯普胺", + "E": "雷尼替丁" + } + }, + { + "id": "7246704f-57b6-5c73-8074-0763306f30b3", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 39-year-old patient with insulin-dependent diabetes mellitus receives thiopental 250 mg and succinylcholine 80 mg and is ventilated with 0.75% isoflurane in oxygen. Arterial pressure decreases abruptly from 140/100 to 80/50 mmHg while heart rate remains unchanged at 70 bpm. Failure of heart rate to increase most likely results from", + "A": "acute hypoglycemia", + "B": "autonomic neuropathy", + "C": "depression of sinus node function by thiopental", + "D": "depression of the baroreflex response by isoflurane", + "E": "ganglionic stimulation by succinylcholine" + }, + "zh": { + "question": "一名39岁的胰岛素依赖型糖尿病患者接受了250毫克硫喷妥钠和80毫克琥珀胆碱，并用0.75%的异氟醚在氧气中进行通气。动脉压从140/100 mmHg突然下降到80/50 mmHg，而心率保持在70次/分钟不变。心率未能增加最可能的原因是", + "A": "急性低血糖", + "B": "自主神经病变", + "C": "硫喷妥钠对窦房结功能的抑制", + "D": "异氟醚对压力反射反应的抑制", + "E": "琥珀胆碱对神经节的刺激" + } + }, + { + "id": "51cdf2dd-e943-5d23-960c-9bb2720e0ac5", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "Diffuse microvascular bleeding is noted in a patient who has received 25 units of whole blood for a liver resection. Platelet count is 40,000/mm3, prothrombin time is 18 sec, activated partial thromboplastin time is 54 sec, and serum fibrinogen concentration is 60 mg/dl. The most likely cause of the bleeding is", + "A": "abnormal platelet function", + "B": "citrate toxicity", + "C": "depressed levels of factors V and VIII", + "D": "dilutional thrombocytopenia", + "E": "disseminated intravascular coagulation" + }, + "zh": { + "question": "一名患者在进行肝切除术后接受了25个单位的全血输注，出现弥漫性微血管出血。血小板计数为40,000/mm3，凝血酶原时间为18秒，活化部分凝血活酶时间为54秒，血清纤维蛋白原浓度为60 mg/dl。出血的最可能原因是", + "A": "血小板功能异常", + "B": "枸橼酸盐中毒", + "C": "第五和第八因子水平降低", + "D": "稀释性血小板减少症", + "E": "弥散性血管内凝血" + } + }, + { + "id": "d30122ff-e6c0-5e4e-b587-1bc35daf1124", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 66-year-old man with chronic obstructive pulmonary disease who underwent colectomy 12 hours ago has been receiving an epidural infusion of fentanyl at a rate of 100 mcg/hr. Which of the following is LEAST likely to develop?", + "A": "Hypotension", + "B": "Nausea", + "C": "Pruritus", + "D": "Respiratory depression", + "E": "Urinary retention" + }, + "zh": { + "question": "一名66岁患有慢性阻塞性肺疾病的男性在12小时前接受了结肠切除术，他一直在接受每小时100微克的芬太尼硬膜外输注。以下哪项最不可能发生？", + "A": "低血压", + "B": "恶心", + "C": "瘙痒", + "D": "呼吸抑制", + "E": "尿潴留" + } + }, + { + "id": "3d64bf4f-e878-5d5d-ba07-07ce00104e00", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "In a patient with hypovolemic shock, which of the following factors is the best measure of the overall balance between oxygen supply and demand?", + "A": "Arterial oxygen content", + "B": "PetO2", + "C": "Mixed venous oxygen saturation", + "D": "PaO2", + "E": "Transcutaneous oxygen tension" + }, + "zh": { + "question": "在低血容量性休克患者中，下列哪一因素是衡量氧供需平衡的最佳指标？", + "A": "动脉氧含量", + "B": "呼气末氧分压（PetO2）", + "C": "混合静脉血氧饱和度", + "D": "动脉氧分压（PaO2）", + "E": "经皮氧分压" + } + }, + { + "id": "09a943f8-35e2-5fda-8003-e372dd7586e9", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the most likely adverse effect of prolonged intravenous administration of nitroglycerin?", + "A": "Cyanmethemoglobinemia", + "B": "Hemolysis", + "C": "Methemoglobinemia", + "D": "Neutropenia", + "E": "Thrombocytopenia" + }, + "zh": { + "question": "以下哪项是长期静脉注射硝酸甘油最可能的副作用？", + "A": "高铁氰化血红蛋白血症", + "B": "溶血", + "C": "高铁血红蛋白血症", + "D": "中性粒细胞减少症", + "E": "血小板减少症" + } + }, + { + "id": "8ea796e4-cee2-5c12-84c2-4bf85ef1cfad", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Trimethaphan causes each of the following EXCEPT", + "A": "cerebral vasodilation", + "B": "urinary retention", + "C": "pupillary cycloplegia", + "D": "histamine release", + "E": "potentiation of succinylcholine block" + }, + "zh": { + "question": "曲美他嗪引起以下哪项变化，除了", + "A": "脑血管扩张", + "B": "尿潴留", + "C": "瞳孔调节麻痹", + "D": "组胺释放", + "E": "增强琥珀胆碱阻滞作用" + } + }, + { + "id": "22389f0d-0e6e-57e6-bfa9-67962e9c2538", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "An apneic adult is receiving an oxygen flow of 4 L/min through a rigid bronchoscope. After five minutes of apnea, which of the following findings is most likely?", + "A": "A decrease in cardiac output", + "B": "A decrease in pulmonary vascular resistance", + "C": "A decrease in SpO2 from 99% to 89%", + "D": "An increase in PaCO2 of 18 mmHg", + "E": "Serum bicarbonate concentration of 30 mEq/L" + }, + "zh": { + "question": "一个无呼吸的成年人通过刚性支气管镜接收4 L/min的氧气流。在无呼吸五分钟后，以下哪项发现最有可能？", + "A": "心输出量减少", + "B": "肺血管阻力减少", + "C": "SpO2从99%下降到89%", + "D": "PaCO2增加18 mmHg", + "E": "血清碳酸氢盐浓度为30 mEq/L" + } + }, + { + "id": "e967a494-e94c-5f59-83ee-6d7b42ff1bd8", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "During anesthesia with nitrous oxide 65% in oxygen, fentanyl, and pancuronium, nitroprusside is administered to decrease arterial pressure to 85/50 mmHg. A decrease in PaO2 from 120 to 65 mmHg is most likely caused by", + "A": "cyanide toxicity", + "B": "depressed cardiac output", + "C": "mild hypercarbia", + "D": "metabolic acidosis", + "E": "pulmonary vasodilation" + }, + "zh": { + "question": "在使用65%氧化亚氮、芬太尼和潘库溴铵进行麻醉期间，给予硝普钠将动脉压降低至85/50 mmHg。PaO2从120降至65 mmHg最可能的原因是", + "A": "氰化物中毒", + "B": "心输出量下降", + "C": "轻度高碳酸血症", + "D": "代谢性酸中毒", + "E": "肺血管扩张" + } + }, + { + "id": "649899f2-3521-5c3e-8950-22b0996377b3", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A 69-year-old woman with mitral stenosis and atrial fibrillation is scheduled for mitral valve replacement and removal of a left atrial thrombus. After administration of pancuronium, heart rate increases to 140 bpm and blood pressure decreases to 70/40 mmHg. Which of the following is the LEAST appropriate treatment?", + "A": "Cardioversion", + "B": "Edrophonium", + "C": "Esmolol", + "D": "Phenylephrine", + "E": "Verapamil" + }, + "zh": { + "question": "一名69岁患有二尖瓣狭窄和心房颤动的女性计划进行二尖瓣置换术和左心房血栓清除术。注射潘库溴铵后，心率增加到140次/分钟，血压下降到70/40 mmHg。以下哪种治疗方法是最不合适的？", + "A": "心脏复律", + "B": "依酚氯铵", + "C": "艾司洛尔", + "D": "去氧肾上腺素", + "E": "维拉帕米" + } + }, + { + "id": "1342ae35-6eee-50d2-afda-f3327b49fd22", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning fetal hemoglobin is true?", + "A": "It makes up less than 50% of the total hemoglobin in the neonate", + "B": "It has less affinity for oxygen than adult hemoglobin", + "C": "It binds with greater affinity to 2,3-DPG than adult hemoglobin", + "D": "It shifts the oxyhemoglobin dissociation curve to the left", + "E": "It has a P50 of 27 mmHg" + }, + "zh": { + "question": "以下关于胎儿血红蛋白的说法哪一项是正确的？", + "A": "在新生儿中占总血红蛋白的比例小于50%", + "B": "与成人血红蛋白相比，它对氧的亲和力更低", + "C": "与成人血红蛋白相比，它与2,3-DPG的亲和力更高", + "D": "它使氧合血红蛋白解离曲线左移", + "E": "它的P50为27 mmHg" + } + }, + { + "id": "f655a128-2ef8-5ea4-bb07-2e230c7e2685", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An 8-kg, 5-month-old infant undergoes craniotomy for an arteriovenous malformation. During the procedure, severe hemorrhaging occurs and packed red blood cells 3 units are transfused rapidly. During infusion of the third unit, hypotension, nodal bigeminy, and prolongation of the QT interval are noted. The most appropriate management includes administration of", + "A": "bicarbonate", + "B": "calcium", + "C": "ephedrine", + "D": "lidocaine", + "E": "potassium" + }, + "zh": { + "question": "一名8公斤、5个月大的婴儿因动静脉畸形接受开颅手术。在手术过程中，发生严重出血，迅速输注了3个单位的浓缩红细胞。在输注第三个单位时，出现低血压、结节性二联律和QT间期延长。最合适的处理包括给予", + "A": "碳酸氢盐", + "B": "钙", + "C": "麻黄碱", + "D": "利多卡因", + "E": "钾" + } + }, + { + "id": "8f4bd4ad-07b7-5343-af86-5d80c3db566c", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 68-year-old woman who is receiving urokinase for deep venous thrombosis and pulmonary emboli requires emergency laparotomy for a bleeding gastric ulcer. Which of the following agents is most appropriate to reverse the effects of urokinase?", + "A": "Cryoprecipitate", + "B": "Factor VIII concentrate", + "C": "Fresh frozen plasma", + "D": "Platelets", + "E": "Vitamin K" + }, + "zh": { + "question": "一名68岁的女性因深静脉血栓和肺栓塞正在接受尿激酶治疗，她需要因胃溃疡出血进行紧急剖腹手术。以下哪种药物最适合逆转尿激酶的作用？", + "A": "冷沉淀", + "B": "凝血因子VIII浓缩物", + "C": "新鲜冰冻血浆", + "D": "血小板", + "E": "维生素K" + } + }, + { + "id": "37d3819e-8460-53ed-b62d-5c79f784bc7f", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A bilateral superior laryngeal nerve block performed to facilitate fiberoptic intubation will provide anesthesia of the", + "A": "base of the tongue", + "B": "larynx above the vocal cords", + "C": "superior surface of the epiglottis", + "D": "tonsillar pillars", + "E": "upper trachea" + }, + "zh": { + "question": "为了便于纤维支气管镜插管，进行双侧上喉神经阻滞将提供以下哪个部位的麻醉？", + "A": "舌根", + "B": "声带以上的喉部", + "C": "会厌的上表面", + "D": "扁桃体柱", + "E": "上气管" + } + }, + { + "id": "e1f78927-de11-5d51-a80b-244021438c5c", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A patient who is scheduled for a gastrectomy had abnormal liver function tests for four days following a prior cholecystectomy. In your consultation note, you should", + "A": "recommend sevoflurane anesthesia since abnormal postoperative liver function tests are unlikely with this drug", + "B": "recommend subarachnoid anesthesia since changes in hepatic blood flow would be less than with general anesthesia", + "C": "indicate that abnormal liver function tests are likely to follow this operation regardless of the anesthetic drugs used", + "D": "require preoperative screening for hepatitis B antigen and antibodies", + "E": "recommend avoiding halothane since it is more likely to produce hepatitis in patients who had previous upper abdominal surgery" + }, + "zh": { + "question": "一名计划进行胃切除术的患者在之前的胆囊切除术后四天出现异常的肝功能检查。在您的会诊记录中，您应该", + "A": "推荐使用七氟醚麻醉，因为这种药物不太可能导致术后肝功能异常", + "B": "推荐蛛网膜下腔麻醉，因为与全身麻醉相比，肝血流的变化会更小", + "C": "指出无论使用何种麻醉药物，此次手术后都可能出现肝功能异常", + "D": "要求术前筛查乙型肝炎抗原和抗体", + "E": "建议避免使用氟烷，因为在进行过上腹部手术的患者中，它更可能导致肝炎" + } + }, + { + "id": "fa26e5a8-e008-581c-9835-deb7f4b3701c", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 76-year-old man has a leaking abdominal aortic aneurysm. His blood pressure and pulse have remained stable for 15 minutes at 90/60 mmHg and 130 bpm, respectively. His hemoglobin concentration is 11 g/dl, and the EKG shows a left bundle branch block. Induction of anesthesia should proceed", + "A": "after a pulmonary artery catheter has been inserted and the pulmonary artery occlusion pressure is greater than 7 mmHg", + "B": "when the pulse has decreased below 130 bpm from the rapid transfusion of blood", + "C": "when systolic blood pressure has increased to more than 120 mmHg from the rapid infusion of lactated Ringer's solution", + "D": "immediately on arrival in the operating room", + "E": "when circulatory signs deteriorate or cease to improve with rapid volume expansion" + }, + "zh": { + "question": "一名76岁的男性患者出现腹主动脉瘤破裂。他的血压和脉搏在15分钟内保持稳定，分别为90/60 mmHg和130 bpm。他的血红蛋白浓度为11 g/dl，心电图显示左束支传导阻滞。麻醉诱导应在何时进行？", + "A": "在插入肺动脉导管并且肺动脉楔压大于7 mmHg后", + "B": "在快速输血使脉搏降至130 bpm以下时", + "C": "在快速输注乳酸林格氏液使收缩压升至120 mmHg以上时", + "D": "在到达手术室后立即进行", + "E": "在循环体征恶化或快速容量扩张后不再改善时" + } + }, + { + "id": "5dfab547-9fb3-5a9a-90d2-fd55b4d9e98f", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is the most common initial sign of hemolytic transfusion reaction during general anesthesia?", + "A": "Bronchospasm", + "B": "Diffuse bleeding", + "C": "Fever", + "D": "Hemoglobinuria", + "E": "Hypotension" + }, + "zh": { + "question": "在全身麻醉期间，以下哪项是溶血性输血反应最常见的初始表现？", + "A": "支气管痉挛", + "B": "弥漫性出血", + "C": "发热", + "D": "血红蛋白尿", + "E": "低血压" + } + }, + { + "id": "78450fd5-6a78-5b64-a20b-5f04ef1a0eca", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the most appropriate treatment of methemoglobinemia prior to emergency surgery?", + "A": "Hydroxocobalamin", + "B": "Methylene blue", + "C": "Oxygen by face mask", + "D": "Packed red blood cells", + "E": "Thiosulfate" + }, + "zh": { + "question": "在紧急手术前，以下哪种是治疗高铁血红蛋白血症的最合适方法？", + "A": "羟钴胺", + "B": "亚甲蓝", + "C": "面罩吸氧", + "D": "浓缩红细胞", + "E": "硫代硫酸盐" + } + }, + { + "id": "87068a2b-7ae0-5932-8e4e-61c8144f9eea", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The risk for airway fire during laser resection of a tracheal tumor is decreased by use of", + "A": "a CO2 laser rather than a YAG laser", + "B": "an inspired helium concentration greater than 60%", + "C": "an inspired nitrous oxide concentration greater than 60%", + "D": "a polyvinylchloride endotracheal tube", + "E": "halothane in the inspired mixture" + }, + "zh": { + "question": "在激光切除气管肿瘤时，使用以下哪种方法可以降低气道火灾的风险？", + "A": "使用CO2激光而不是YAG激光", + "B": "吸入氦气浓度大于60%", + "C": "吸入氧化亚氮浓度大于60%", + "D": "使用聚氯乙烯气管插管", + "E": "在吸入混合物中使用氟烷" + } + }, + { + "id": "c2e26d9e-4cf7-53f4-8831-9ac9841a6f73", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "In a patient with ventricular fibrillation refractory to repeated attempts at defibrillation and epinephrine administration, the most appropriate management is administration of", + "A": "amiodarone", + "B": "procainamide", + "C": "propranolol", + "D": "quinidine", + "E": "verapamil" + }, + "zh": { + "question": "对于反复电击除颤和肾上腺素给药无效的心室颤动患者，最合适的处理是给予", + "A": "胺碘酮", + "B": "普鲁卡因胺", + "C": "普萘洛尔", + "D": "奎尼丁", + "E": "维拉帕米" + } + }, + { + "id": "edaa657a-4f17-5ab9-b10f-bc35075b1504", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During anesthesia with nitrous oxide and isoflurane in a 70-kg, 25-year-old patient, airway resistance would be decreased by", + "A": "a decrease in lung volume", + "B": "insertion of a 9-mm endotracheal tube", + "C": "administration of atropine", + "D": "neuromuscular block with d-tubocurarine", + "E": "movement of the patient from the supine to the sitting position" + }, + "zh": { + "question": "在一名70公斤、25岁的患者使用氧化亚氮和异氟醚进行麻醉期间，气道阻力会因以下哪种情况而降低", + "A": "肺容量减少", + "B": "插入一根9毫米的气管导管", + "C": "给予阿托品", + "D": "使用d-筒箭毒碱进行神经肌肉阻滞", + "E": "将患者从仰卧位移动到坐位" + } + }, + { + "id": "7c114911-e34c-52c3-9287-cabe3e8b283c", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 67-kg, 52-year-old man is undergoing heart transplantation. After implantation of the donor heart and discontinuation of cardiopulmonary bypass, isoproterenol is administered intravenously to maintain heart rate greater than 100 bpm. During the next 10 minutes, blood pressure decreases from 105/55 mmHg to 75/40 mmHg. Heart rate is 102 bpm and cardiac output is 5.8 L/min. The most appropriate management is administration of", + "A": "amrinone", + "B": "digoxin", + "C": "dopamine", + "D": "epinephrine", + "E": "norepinephrine" + }, + "zh": { + "question": "一名67公斤、52岁的男性正在接受心脏移植手术。在植入供体心脏并停止体外循环后，静脉注射异丙肾上腺素以维持心率大于100次/分钟。在接下来的10分钟内，血压从105/55 mmHg下降到75/40 mmHg。心率为102次/分钟，心输出量为5.8 L/分钟。最合适的处理是给予", + "A": "氨力农", + "B": "地高辛", + "C": "多巴胺", + "D": "肾上腺素", + "E": "去甲肾上腺素" + } + }, + { + "id": "bc932819-16c6-5fd1-a8ef-7cbfeace8f73", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A patient with chronic obstructive pulmonary disease is undergoing spinal anesthesia to a T6 sensory level. The most pronounced effect on pulmonary function will be a decrease in", + "A": "minute ventilation", + "B": "peak expiratory flow", + "C": "physiologic dead space", + "D": "tidal volume", + "E": "vital capacity" + }, + "zh": { + "question": "一名患有慢性阻塞性肺疾病的患者正在接受脊髓麻醉，感觉水平达到T6。对肺功能最显著的影响将是减少", + "A": "每分钟通气量", + "B": "最大呼气流量", + "C": "生理无效腔", + "D": "潮气量", + "E": "肺活量" + } + }, + { + "id": "2a49a59a-0f45-56ef-aad4-b4806b90b0bb", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Following induction of general anesthesia, mask ventilation and the initial attempt at intubation is unsuccessful. Which of the following procedures is most appropriate?", + "A": "Administration of additional muscle relaxant", + "B": "Repeat attempt at intubation", + "C": "Fiberoptic intubation", + "D": "Retrograde intubation", + "E": "Cricothyroidotomy" + }, + "zh": { + "question": "在全身麻醉诱导后，面罩通气和初次插管尝试均未成功。以下哪种操作最为合适？", + "A": "给予额外的肌肉松弛剂", + "B": "重复插管尝试", + "C": "纤维支气管镜插管", + "D": "逆行插管", + "E": "环甲膜切开术" + } + }, + { + "id": "53b3155a-ce48-5d78-9c9a-d4e80c803eb7", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Pancuronium blocks the bradycardic effect of fentanyl by a direct effect on", + "A": "beta-adrenergic receptors", + "B": "cardiac muscarinic receptors", + "C": "carotid baroreceptors", + "D": "central vagal nuclei", + "E": "sympathetic ganglia" + }, + "zh": { + "question": "潘库溴铵通过直接作用于以下哪一项来阻断芬太尼的心动过缓效应？", + "A": "β-肾上腺素能受体", + "B": "心脏毒蕈碱受体", + "C": "颈动脉压力感受器", + "D": "中枢迷走神经核", + "E": "交感神经节" + } + }, + { + "id": "b033171f-9bbd-50aa-bab1-31de5c554039", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "In a spontaneously breathing patient, each of the following increases the work of breathing EXCEPT", + "A": "an increase in respiratory rate by 10/min", + "B": "a decrease in lung-thorax compliance by 10 cmH2O", + "C": "an increase in carbon dioxide production by 1 ml/kg/min", + "D": "a decrease in PaO2 from 80 to 65 mmHg", + "E": "a 0.1 increase in the ratio of dead space to tidal volume" + }, + "zh": { + "question": "在自主呼吸的患者中，以下每一项都会增加呼吸功，除了", + "A": "呼吸频率增加10次/分钟", + "B": "肺-胸廓顺应性降低10 cmH2O", + "C": "二氧化碳生成量增加1 ml/kg/min", + "D": "动脉氧分压从80降至65 mmHg", + "E": "死腔与潮气量的比值增加0.1" + } + }, + { + "id": "00a32823-2137-5ec2-930d-1e02402823a0", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "In pregnant patients, which of the following is an effect of the long-term use of cocaine?", + "A": "Decreased uterine tone", + "B": "Decreased thiopental requirement", + "C": "Increased isoflurane MAC", + "D": "Increased sensitivity to ephedrine", + "E": "Lower than expected level of block with tetracaine spinal analgesia" + }, + "zh": { + "question": "在孕妇中，长期使用可卡因的效果是以下哪一项？", + "A": "子宫张力降低", + "B": "硫喷妥钠需求减少", + "C": "异氟醚最低肺泡浓度增加", + "D": "对麻黄碱的敏感性增加", + "E": "使用丁卡因脊髓镇痛时的阻滞水平低于预期" + } + }, + { + "id": "550ffc41-46e2-5df2-8f58-dc62f6504565", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements concerning functional residual capacity is true?", + "A": "It decreases linearly during a three-hour anesthetic", + "B": "It decreases in pregnancy primarily because of a decrease in the expiratory reserve volume", + "C": "It increases in patients with a history of heavy smoking", + "D": "It increases with pulmonary contusions", + "E": "It is smaller (ml/kg) in children than in adults" + }, + "zh": { + "question": "以下关于功能残气量的说法哪一项是正确的？", + "A": "在三个小时的麻醉过程中呈线性下降", + "B": "在妊娠期主要由于呼气储备量的减少而减少", + "C": "在有长期大量吸烟史的患者中增加", + "D": "在肺挫伤时增加", + "E": "在儿童中（ml/kg）比成人小" + } + }, + { + "id": "c69098ab-dd8b-5c97-a2f6-4feb611a5de9", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following correctly describes the anatomic location of the stellate ganglion?", + "A": "Anterior to the transverse process of C5", + "B": "Anterior to the transverse process of C7", + "C": "Posterior to the prevertebral fascia", + "D": "Posterior to the vertebral artery", + "E": "Lateral to the carotid artery" + }, + "zh": { + "question": "以下哪项正确描述了星状神经节的解剖位置？", + "A": "C5横突的前方", + "B": "C7横突的前方", + "C": "椎前筋膜的后方", + "D": "椎动脉的后方", + "E": "颈动脉的外侧" + } + }, + { + "id": "9d2efce2-94e4-50d8-bca4-fe87895c623c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Equipment that is attached to a patient should have leakage current no greater than", + "A": "10 microamps", + "B": "100 microamps", + "C": "1 milliamp", + "D": "10 milliamps", + "E": "100 milliamps" + }, + "zh": { + "question": "连接到患者的设备的漏电流不应超过", + "A": "10 微安", + "B": "100 微安", + "C": "1 毫安", + "D": "10 毫安", + "E": "100 毫安" + } + }, + { + "id": "36fd71e5-f4d9-5e05-aa5b-edc14301308f", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Inhalation induction of anesthesia is more rapid in a 6-month-old infant than in an adult because infants have", + "A": "greater ratio of alveolar ventilation to functional residual capacity", + "B": "greater ratio of blood volume to body weight", + "C": "greater solubility of anesthetic in blood", + "D": "lower anesthetic requirement", + "E": "lower distribution of cardiac output to vessel-rich organs" + }, + "zh": { + "question": "在6个月大的婴儿中，吸入麻醉诱导比成人更快，因为婴儿具有", + "A": "更高的肺泡通气与功能残气量的比率", + "B": "更高的血容量与体重的比率", + "C": "更高的麻醉剂在血液中的溶解度", + "D": "更低的麻醉需求", + "E": "心输出量对富血管器官的分布更低" + } + }, + { + "id": "ad5c2ab6-44db-583b-a21f-04ed2ab62f07", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "In children with preoperative upper respiratory tract infection, which of the following is associated with the greatest risk for postoperative airway obstruction?", + "A": "Age less than 1 year", + "B": "Endotracheal intubation", + "C": "Head and neck surgery", + "D": "Inadequate airway humidification", + "E": "Surgery for more than two hours" + }, + "zh": { + "question": "在有术前上呼吸道感染的儿童中，下列哪项与术后气道阻塞的风险最大相关？", + "A": "年龄小于1岁", + "B": "气管插管", + "C": "头颈部手术", + "D": "气道湿化不足", + "E": "手术时间超过两小时" + } + }, + { + "id": "4ed70d9c-f88e-5796-88da-409c3e104e30", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Perception of pain from cutaneous sources involves each of the following EXCEPT", + "A": "frontal lobe gyri", + "B": "lateral spinothalamic tracts", + "C": "periaqueductal gray matter", + "D": "spinal dorsal horn lamina V", + "E": "unmyelinated C fibers" + }, + "zh": { + "question": "皮肤来源的疼痛感知涉及以下每一项，除了", + "A": "额叶回", + "B": "外侧脊髓丘脑束", + "C": "导水管周围灰质", + "D": "脊髓背角层V", + "E": "无髓C纤维" + } + }, + { + "id": "0ccea366-62fd-5a9a-93e6-4605e8c64373", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "In patients with pregnancy-induced hypertension, magnesium sulfate is most likely to", + "A": "decrease maternal heart rate", + "B": "decrease sensitivity to relaxants", + "C": "decrease succinylcholine-induced fasciculations", + "D": "prevent hypokalemia", + "E": "produce fetal bradycardia" + }, + "zh": { + "question": "在妊娠期高血压患者中，硫酸镁最有可能", + "A": "降低母体心率", + "B": "降低对肌松药的敏感性", + "C": "减少琥珀胆碱引起的肌束颤动", + "D": "预防低钾血症", + "E": "导致胎儿心动过缓" + } + }, + { + "id": "26cdbc4b-308a-5543-9549-600616978f5d", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements best describes the decrease in functional residual capacity that accompanies the induction of general anesthesia?", + "A": "It does not change compliance", + "B": "It is greater with spontaneous ventilation than with controlled ventilation", + "C": "It is independent of body position", + "D": "It is not corrected by application of positive end-expiratory pressure", + "E": "It occurs within the first 10 minutes of anesthesia" + }, + "zh": { + "question": "以下哪项陈述最能描述全身麻醉诱导时功能残气量的减少？", + "A": "它不会改变顺应性", + "B": "自发通气时比控制通气时更大", + "C": "与身体位置无关", + "D": "应用呼气末正压无法纠正", + "E": "发生在麻醉的前10分钟内" + } + }, + { + "id": "772672de-001f-5755-9dc0-e8002587d8a5", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements concerning carbon monoxide poisoning is true?", + "A": "Diagnosis is excluded if the PaO2 is greater than 300 mmHg while breathing 100% oxygen", + "B": "Increased inspired oxygen concentration accelerates displacement of carbon monoxide from hemoglobin", + "C": "Methylene blue decreases binding of carbon monoxide to hemoglobin", + "D": "Pulse oximetry accurately reflects hemoglobin oxygen saturation", + "E": "Tissue oxygen delivery is normal" + }, + "zh": { + "question": "以下关于一氧化碳中毒的说法哪一项是正确的？", + "A": "如果在吸入100%氧气时PaO2大于300 mmHg，则排除诊断", + "B": "增加吸入氧浓度可以加速一氧化碳从血红蛋白上的置换", + "C": "亚甲蓝减少一氧化碳与血红蛋白的结合", + "D": "脉搏血氧仪准确反映血红蛋白的氧饱和度", + "E": "组织氧输送正常" + } + }, + { + "id": "be0c5c88-52e6-5d6b-9809-d3b29014842c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which surface area of the upper extremity is most likely to be unanesthetized by an interscalene brachial plexus block?", + "A": "Hypothenar eminence", + "B": "Thenar eminence", + "C": "Dorsolateral surface of the hand", + "D": "Lateral aspect of the forearm", + "E": "Lateral surface of the upper arm" + }, + "zh": { + "question": "上肢的哪个表面积最有可能在斜角肌间隙臂丛神经阻滞后未被麻醉？", + "A": "小鱼际隆起", + "B": "大鱼际隆起", + "C": "手背外侧表面", + "D": "前臂外侧", + "E": "上臂外侧表面" + } + }, + { + "id": "2b36d2e4-98d6-5589-bf83-e6cae8aaf0d4", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements concerning cardiovascular physiology in a healthy term neonate is true?", + "A": "Heart rate is increased in response to hypoxemia", + "B": "Heart rate increases reflexly in response to hypotension", + "C": "Stroke volume increases in response to decreased systemic vascular resistance", + "D": "Stroke volume increases in response to bradycardia", + "E": "Stroke volume is near-maximal under resting conditions" + }, + "zh": { + "question": "以下关于健康足月新生儿心血管生理的说法中哪一项是正确的？", + "A": "心率在缺氧时增加", + "B": "心率在低血压时反射性增加", + "C": "在全身血管阻力降低时，搏出量增加", + "D": "在心动过缓时，搏出量增加", + "E": "在静息状态下，搏出量接近最大值" + } + }, + { + "id": "44d5cf3e-1017-50b9-b6c3-a68e2420336e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Cessation of smoking on the day prior to an operation is associated with a perioperative", + "A": "decrease in carbon monoxide in blood", + "B": "improvement in ciliary beating in the airways", + "C": "decrease in sputum volume", + "D": "decrease in the need for postoperative ventilatory support", + "E": "decrease in the risk of deep vein thrombosis" + }, + "zh": { + "question": "在手术前一天停止吸烟与围手术期相关联的是", + "A": "血液中一氧化碳的减少", + "B": "气道纤毛摆动的改善", + "C": "痰液量的减少", + "D": "术后呼吸支持需求的减少", + "E": "深静脉血栓风险的减少" + } + }, + { + "id": "415b1443-d724-5ac0-a2e0-040e70caf520", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is an effect of clonidine?", + "A": "Agitation", + "B": "Salivation", + "C": "Tachycardia", + "D": "Tachypnea", + "E": "Vasodilation" + }, + "zh": { + "question": "下列哪项是可乐定的作用？", + "A": "烦躁", + "B": "流涎", + "C": "心动过速", + "D": "呼吸急促", + "E": "血管扩张" + } + }, + { + "id": "b7f466c8-8831-517a-ada5-3581c54c440a", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following findings is characteristic of restrictive lung disease EXCEPT", + "A": "decreased elasticity of the lungs", + "B": "decreased FEV1/FVC ratio", + "C": "decreased inspiratory reserve volume", + "D": "increased work of breathing", + "E": "normal anatomic dead space" + }, + "zh": { + "question": "以下哪项是限制性肺疾病的特征，除了", + "A": "肺的弹性降低", + "B": "FEV1/FVC 比率降低", + "C": "吸气储备量减少", + "D": "呼吸功增加", + "E": "正常的解剖死腔" + } + }, + { + "id": "4bc1e110-915a-553b-819b-262288ce47c3", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "When used for irrigation during transurethral resection of the prostate, glycine 1.5% is associated with each of the following EXCEPT", + "A": "hemolysis", + "B": "hyperammonemia", + "C": "cerebral edema", + "D": "hypofibrinogencmia", + "E": "visual disturbances" + }, + "zh": { + "question": "在经尿道前列腺切除术中用于灌洗时，1.5%甘氨酸与以下各项有关，除了", + "A": "溶血", + "B": "高氨血症", + "C": "脑水肿", + "D": "低纤维蛋白原血症", + "E": "视觉障碍" + } + }, + { + "id": "40dd240f-e79b-5416-afd0-b19b87df80e3", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 35-year-old woman with severe myasthenia gravis is scheduled for thymectomy. Which of the following preoperative pulmonary function tests is most likely to be normal?", + "A": "Forced expiratory volume in 1 second (FEV1)", + "B": "Forced vital capacity (FVC)", + "C": "FEV1/FVC", + "D": "Maximum voluntary ventilation", + "E": "Peak inspiratory force" + }, + "zh": { + "question": "一名35岁的重症肌无力女性计划进行胸腺切除术。以下哪项术前肺功能检查最有可能正常？", + "A": "第一秒用力呼气量 (FEV1)", + "B": "用力肺活量 (FVC)", + "C": "FEV1/FVC", + "D": "最大自主通气量", + "E": "最大吸气力" + } + }, + { + "id": "32601239-99e5-5b73-8355-b4c0e46ad8a4", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "The concentration of bupivacaine is higher in maternal blood than in fetal blood because", + "A": "bupivacaine is metabolized in the placenta", + "B": "maternal blood has a higher pH", + "C": "maternal blood has greater plasma protein binding", + "D": "maternal hemoglobin has a higher affinity for bupivacaine", + "E": "placental transfer of bupivacaine is limited" + }, + "zh": { + "question": "布比卡因在母体血液中的浓度高于胎儿血液中的浓度，因为", + "A": "布比卡因在胎盘中代谢", + "B": "母体血液的pH值较高", + "C": "母体血液具有更高的血浆蛋白结合率", + "D": "母体血红蛋白对布比卡因的亲和力更高", + "E": "布比卡因的胎盘转运受限" + } + }, + { + "id": "0ebc85e7-1d1a-5ac3-b3d3-e42be69a18c2", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 19-year-old woman has severe nausea and vomiting following laparoscopy. After intramuscular administration of prochlorperazine 10 mg, she has muscle spasms in the face, neck, and tongue. Which of the following is the most appropriate management?", + "A": "Baclofen", + "B": "Diphenhydramine", + "C": "Epinephrine", + "D": "Hydrocortisone", + "E": "Naloxone" + }, + "zh": { + "question": "一名19岁的女性在腹腔��手术后出现严重的恶心和呕吐。在肌肉注射10毫克丙氯拉嗪后，她出现了面部、颈部和舌头的肌肉痉挛。以下哪项是最合适的处理方法？", + "A": "巴氯芬", + "B": "苯海拉明", + "C": "肾上腺素", + "D": "氢化可的松", + "E": "纳洛酮" + } + }, + { + "id": "e0895cc8-1ddb-5837-9027-e72af0f5e551", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "The newborn infant of an 18-year-old heroin addict has an initial Apgar score of 1. After intubation of the trachea and ventilation with pure oxygen, the Apgar score is 3 at five minutes. Appropriate management at this time would include administration of each of the following EXCEPT", + "A": "dextrose 10%", + "B": "epinephrine", + "C": "naloxone", + "D": "normal saline solution", + "E": "sodium bicarbonate" + }, + "zh": { + "question": "一名18岁海洛因成瘾者的新生儿初始Apgar评分为1。气管插管并用纯氧通气后，五分钟时Apgar评分为3。此时适当的管理包括给予以下各项，除了", + "A": "10%葡萄糖", + "B": "肾上腺素", + "C": "纳洛酮", + "D": "生理盐水", + "E": "碳酸氢钠" + } + }, + { + "id": "d56aacf2-8df9-5d29-bb4b-78ae39bec466", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 25-year-old man requires exploratory laparotomy following a motor vehicle accident. He is acutely intoxicated with alcohol. Which of the following is the most likely result of the alcohol ingestion?", + "A": "Hyperdynamic circulation", + "B": "Hyperglycemia", + "C": "Hyperthermia", + "D": "Increased respiratory depression from opioids", + "E": "Increased sensitivity to neuromuscular blocking drugs" + }, + "zh": { + "question": "一名25岁男性在车祸后需要进行探查性剖腹手术。他急性酒精中毒。以下哪项是最可能的酒精摄入结果？", + "A": "高动力循环", + "B": "高血糖", + "C": "高热", + "D": "阿片类药物引起的呼吸抑制增加", + "E": "对神经肌肉阻滞药物的敏感性增加" + } + }, + { + "id": "5e7fb80d-e525-571d-9453-5e81b1b44913", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "During isoflurane anesthesia, a 45-year-old patient with chronic asthma has wheezing, prolonged expiration, sinus tachycardia of 120 bpm, and premature ventricular contractions. Preoperative medication included cromolyn and theophylline. The most appropriate treatment is to administer", + "A": "albuterol aerosol", + "B": "aminophylline by intravenous infusion", + "C": "cromolyn aerosol", + "D": "halothane", + "E": "hydrocortisone by intravenous bolus" + }, + "zh": { + "question": "在异氟醚麻醉期间，一名45岁的慢性哮喘患者出现喘息、呼气延长、窦性心动过速（120次/分钟）和室性早搏。术前用药包括色甘酸钠和茶碱。最合适的治疗是给予", + "A": "沙丁胺醇气雾剂", + "B": "静脉输注氨茶碱", + "C": "色甘酸钠气雾剂", + "D": "氟烷", + "E": "静脉推注氢化可的松" + } + }, + { + "id": "72ebb2fd-ba4c-5b63-9c87-a31d7088cc77", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "Arterial pressure in the radial artery is 155/70 mmHg measured by a correctly calibrated catheter-transducer system. At the same time aortic pressure is 140/75 mmHg using a high-fidelity catheter tip transducer. The most likely cause of this discrepancy is", + "A": "a large amount of air in the dome of the radial artery transducer", + "B": "coarctation of the aorta", + "C": "peripheral vascular constriction produced by sympathetic stimulation", + "D": "physiologic amplification of the wave form from the aorta to the radial artery", + "E": "too high a frequency response in the catheter-transducer system" + }, + "zh": { + "question": "在使用正确校准的导管-传感器系统测量时，桡动脉的动脉压为155/70 mmHg。同时，使用高保真导管尖端传感器测量的主动脉压为140/75 mmHg。最可能导致这种差异的原因是", + "A": "桡动脉传感器的穹顶中有大量空气", + "B": "主动脉缩窄", + "C": "由交感神经刺激引起的外周血管收缩", + "D": "从主动脉到桡动脉的波形生理性放大", + "E": "导管-传感器系统的频率响应过高" + } + }, + { + "id": "15cc18bd-f60d-5d92-a199-67d0463cd687", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Compared with an induction dose of thiopental (4 mg/kg), an induction dose of propofol (2.5 mg/kg) produces", + "A": "better maintenance of cerebral perfusion pressure", + "B": "greater inhibition of glucocorticoid production", + "C": "higher incidence of myoclonus", + "D": "less severe hypotension", + "E": "less severe respiratory depression" + }, + "zh": { + "question": "与硫喷妥钠（4 mg/kg）的诱导剂量相比，丙泊酚（2.5 mg/kg）的诱导剂量会产生", + "A": "更好的脑灌注压维持", + "B": "更强的糖皮质激素生成抑制", + "C": "更高的肌阵挛发生率", + "D": "较轻的低血压", + "E": "较轻的呼吸抑制" + } + }, + { + "id": "c842c84d-c586-524a-a485-fcf9c46891cf", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which property of oxygen is detected by the fail-safe device on the anesthesia machine?", + "A": "Concentration", + "B": "Flow", + "C": "Pressure", + "D": "Partial pressure", + "E": "Reserve volume" + }, + "zh": { + "question": "麻醉机上的安全装置检测氧气的哪个特性？", + "A": "浓度", + "B": "流量", + "C": "压力", + "D": "分压", + "E": "储备容量" + } + }, + { + "id": "04576a53-0b6b-5211-830b-4f566ffebce8", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "During general anesthesia with spontaneous ventilation, a patient has a VD/VT of 0.5. Which of the following is most likely to decrease the ratio?", + "A": "Acute bronchospasm", + "B": "Continuous positive airway pressure", + "C": "Decreased tidal volume", + "D": "Increased cardiac output", + "E": "Pulmonary embolism" + }, + "zh": { + "question": "在全身麻醉伴随自发通气期间，患者的死腔/潮气量比为0.5。以下哪项最可能降低该比率？", + "A": "急性支气管痉挛", + "B": "持续气道正压", + "C": "潮气量减少", + "D": "心输出量增加", + "E": "肺栓塞" + } + }, + { + "id": "f0fbd88b-0a97-5291-9c87-0854a1b0c756", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Nitroprusside therapy for hypertension should be discontinued in the presence of", + "A": "acute myocardial infarction", + "B": "increasing metabolic acidosis", + "C": "methemoglobinemia", + "D": "mitral regurgitation", + "E": "renal failure" + }, + "zh": { + "question": "在出现以下哪种情况时，应停止使用硝普钠治疗高血压", + "A": "急性心肌梗死", + "B": "代谢性酸中毒加重", + "C": "高铁血红蛋白血症", + "D": "二尖瓣返流", + "E": "肾衰竭" + } + }, + { + "id": "65212e9a-d8bd-5d68-9116-f045d9ead43d", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An 18-year-old woman has knee pain during arthroscopy performed with femoral and sciatic nerve blocks for repair of a torn medial meniscus. The most appropriate management is addition of which of the following nerve blocks?", + "A": "Deep peroneal", + "B": "Obturator", + "C": "Popliteal", + "D": "Saphenous", + "E": "Superficial peroneal" + }, + "zh": { + "question": "一名18岁的女性在进行膝关节镜检查时，因股神经和坐骨神经阻滞修复撕裂的内侧半月板而感到膝盖疼痛。最合适的处理是添加以下哪种神经阻滞？", + "A": "腓深神经", + "B": "闭孔神经", + "C": "腘神经", + "D": "隐神经", + "E": "腓浅神经" + } + }, + { + "id": "ec5d86bd-1fb2-5f0a-9207-2f94078c9b3b", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A child has tachypnea immediately after reintubation for intractable laryngospasm. Oxygen saturation is 78% at an FiO2 of 1.0. A radiograph of the chest taken 15 minutes later is most likely to show", + "A": "bilateral pleural effusions", + "B": "diffuse homogenous pulmonary infiltrates", + "C": "patchy central infiltrates of the right upper lobe", + "D": "pneumothorax", + "E": "segmental atelectasis at both lung bases" + }, + "zh": { + "question": "一名儿童在因难治性喉痉挛重新插管后立即出现呼吸急促。在氧浓度为1.0时，氧饱和度为78%。15分钟后拍摄的胸部X光片最有可能显示", + "A": "双侧胸腔积液", + "B": "弥漫性均匀肺浸润", + "C": "右上叶中央斑片状浸润", + "D": "气胸", + "E": "双肺底段性肺不张" + } + }, + { + "id": "566e8c43-bbe8-5012-b4b7-5b4c5a8d40ce", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning the risk of acquiring hepatitis from a blood transfusion is true?", + "A": "Most patients with post-transfusion hepatitis become clinically jaundiced", + "B": "Most cases of post-transfusion hepatitis are caused by the hepatitis B virus", + "C": "The risk for hepatitis is less than the risk for AIDS", + "D": "The risk for post-transfusion hepatitis is less than 1% per unit transfused", + "E": "The incidence of post-transfusion hepatitis has remained unchanged over the past decade" + }, + "zh": { + "question": "以下关于输血后感染肝炎风险的说法中哪一项是正确的？", + "A": "大多数输血后肝炎患者会出现临床黄疸", + "B": "大多数输血后肝炎病例是由乙型肝炎病毒引起的", + "C": "肝炎的风险小于艾滋病的风险", + "D": "每单位输血后肝炎的风险小于1%", + "E": "输血后肝炎的发病率在过去十年中保持不变" + } + }, + { + "id": "d9e7ffb9-1252-548c-98f7-3b356b60a2c9", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "One full E-cylinder of oxygen at 20°C can deliver 2 L/min of oxygen for at most", + "A": "30 minutes", + "B": "90 minutes", + "C": "3 hours", + "D": "5 hours", + "E": "12 hours" + }, + "zh": { + "question": "在20°C时，一个满的E型氧气瓶最多可以以2 L/min的速度输送氧气", + "A": "30分钟", + "B": "90分钟", + "C": "3小时", + "D": "5小时", + "E": "12小时" + } + }, + { + "id": "9a4c48d8-ec2f-5e9e-887e-6aee1454e82b", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A patient has tonic movements of the head and neck, nystagmus, and slurred speech after receiving metoclopramide for nausea after nitrous oxide-opioid anesthesia. The most appropriate pharmacologic treatment is", + "A": "diphenhydramine", + "B": "midazolam", + "C": "naloxone", + "D": "phenytoin", + "E": "physostigmine" + }, + "zh": { + "question": "一名患者在接受氧化亚氮-阿片类药物麻醉后因恶心而使用甲氧氯普胺，随后出现头颈部强直性运动、眼球震颤和言语不清。最合适的药物治疗是", + "A": "苯海拉明", + "B": "咪达唑仑", + "C": "纳洛酮", + "D": "苯妥英", + "E": "毒扁豆碱" + } + }, + { + "id": "a3510232-bd8d-5cd9-b94e-0c55644996bf", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "Two days after total abdominal hysterectomy, a 54-year-old woman develops lethargy followed by seizures and coma. Laboratory studies show a serum sodium concentration of 108 mEq/L and serum osmolality of 225 mOsm/kg. The most appropriate next step in management is administration of which of the following?", + "A": "Desmopressin", + "B": "Furosemide only", + "C": "Saline solution 0.9% only", + "D": "Furosemide and saline solution 0.9%", + "E": "Furosemide and saline solution 3%" + }, + "zh": { + "question": "在全腹子宫切除术后两天，一名54岁的女性出现嗜睡，随后发生癫痫和昏迷。实验室检查显示血清钠浓度为108 mEq/L，血清渗透压为225 mOsm/kg。最合适的下一步处理措施是给予以下哪种药物？", + "A": "去氨加压素", + "B": "仅使用呋塞米", + "C": "仅使用0.9%生理盐水", + "D": "呋塞米和0.9%生理盐水", + "E": "呋塞米和3%生理盐水" + } + }, + { + "id": "d5b2eaa2-cf01-56ec-8451-898367408e2d", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "During repair for coarctation of the aorta in a healthy 13-year-old patient, right radial artery pressure increases from 100/60 to 105/70 mmHg after the aorta is cross clamped. This most likely indicates that", + "A": "collateral blood flow has decreased the hemodynamic consequences of cross-clamping", + "B": "left ventricular hypertrophy has decreased left ventricular compliance", + "C": "spinal cord blood flow is impaired", + "D": "the coarctation has decreased aortic diameter less than 50%", + "E": "the coarctation involves the origin of the right subclavian artery" + }, + "zh": { + "question": "在一名健康的13岁患者进行主动脉缩窄修复手术时，右侧桡动脉压力在主动脉被夹闭后从100/60 mmHg升高到105/70 mmHg。这最有可能表明", + "A": "侧支血流减少了夹闭的血流动力学后果", + "B": "左心室肥厚降低了左心室的顺应性", + "C": "脊髓血流受损", + "D": "缩窄导致的主动脉直径减少不到50%", + "E": "缩窄涉及右锁骨下动脉的起源" + } + }, + { + "id": "36f2de2b-3a01-5ac5-8232-41bbdeeef18c", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements concerning hyperkalemia after succinylcholine administration to a patient with a spinal cord injury is true?", + "A": "It is unlikely to occur if the lesion is located below T6", + "B": "It is unlikely to occur within 24 hours of the injury", + "C": "It is unlikely to occur more than 60 days after the initial injury", + "D": "It is prevented by pretreatment with small doses of a nondepolarizing agent", + "E": "It is decreased in magnitude by pretreatment with calcium chloride" + }, + "zh": { + "question": "关于琥珀胆碱给药后脊髓损伤患者出现高钾血症，下列哪项陈述是正确的？", + "A": "如果病变位于T6以下，则不太可能发生", + "B": "在损伤后24小时内不太可能发生", + "C": "在初次损伤后超过60天不太可能发生", + "D": "通过预处理小剂量非去极化药物可以预防", + "E": "通过预处理氯化钙可以减轻其程度" + } + }, + { + "id": "8620804b-f952-542c-90d8-991d44c19d4e", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "An obese, 70-year-old woman with a long history of tobacco abuse is awake and semirecumbent after uneventful anesthesia with isoflurane for a ventral hernia repair. During the first hour in the recovery room while breathing 50% oxygen by face mask, her arterial oxygen saturation decreases to 90% while other vital signs remain satisfactory. Which of the following is most likely to be effective in the management of this situation?", + "A": "Intravenous doxapram", + "B": "Racemic epinephrine by inhalation", + "C": "Continuous positive airway pressure by mask", + "D": "Reintubation of the trachea", + "E": "Coughing" + }, + "zh": { + "question": "一位70岁的肥胖女性有长期烟草滥用史，在接受异氟醚麻醉进行腹壁疝修补术后清醒并半卧位。在恢复室的第一个小时内，使用面罩吸入50%氧气时，她的动脉氧饱和度下降到90%，而其他生命体征保持满意。以下哪项最有可能有效管理这种情况？", + "A": "静脉注射多沙普仑", + "B": "吸入消旋肾上腺素", + "C": "面罩持续正压通气", + "D": "重新插管", + "E": "咳嗽" + } + }, + { + "id": "1d09e3ab-3295-5a33-a703-1d957915ec84", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "During anesthesia using the Bain circuit", + "A": "PaCO2 is independent of minute volume if fresh gas flow is greater than 17 ml/kg", + "B": "PaCO2 is independent of fresh gas flow if minute volume is greater than 100 ml/kg", + "C": "PaCO2 may be normal in the presence of rebreathing", + "D": "carbon dioxide removal is more efficient during spontaneous ventilation than during controlled ventilation", + "E": "less body heat is lost than with a circle system" + }, + "zh": { + "question": "在使用Bain回路进行麻醉期间", + "A": "如果新鲜气体流量大于17 ml/kg，PaCO2与分钟通气量无关", + "B": "如果分钟通气量大于100 ml/kg，PaCO2与新鲜气体流量无关", + "C": "在存在再呼吸的情况下，PaCO2可能正常", + "D": "在自发通气期间，二氧化碳的去除比在控制通气期间更有效", + "E": "与环路系统相比，身体热量损失较少" + } + }, + { + "id": "09bd2d11-52c0-56dc-9f4a-709d29b5428f", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Epidural block is safer at the L3-L4 interspace than at the T12-L1 interspace because of the location of the", + "A": "anterolateral epidural veins", + "B": "inferior border of the cauda equina", + "C": "inferior border of the conus medullaris", + "D": "inferior border of the subarachnoid space", + "E": "blood supply to the anterior spinal cord" + }, + "zh": { + "question": "由于以下结构的位置，硬膜外阻滞在L3-L4间隙比在T12-L1间隙更安全：", + "A": "前外侧硬膜外静脉", + "B": "马尾神经的下缘", + "C": "脊髓圆锥的下缘", + "D": "蛛网膜下腔的下缘", + "E": "前脊髓的血供" + } + }, + { + "id": "63a489b6-1cef-507e-b638-3a440ac8415f", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is most effective in preventing intraoperative hypothermia in adults?", + "A": "Heating and humidifying inspired gases", + "B": "Maintaining a warm operating room", + "C": "Using a circulating warm-water mattress", + "D": "Using reflective coverings", + "E": "Warming intravenous fluids" + }, + "zh": { + "question": "以下哪项最能有效预防成人术中低体温？", + "A": "加热和加湿吸入气体", + "B": "保持手术室温暖", + "C": "使用循环温水床垫", + "D": "使用反光覆盖物", + "E": "加热静脉输液" + } + }, + { + "id": "ad00a493-c90a-5709-829a-069d0d4012c1", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Administration of 200 mEq of sodium bicarbonate during cardiopulmonary resuscitation is associated with", + "A": "CSF alkalosis", + "B": "hypercalcemia", + "C": "hypercarbia", + "D": "hyperkalemia", + "E": "shift of the oxyhemoglobin dissociation curve to the right" + }, + "zh": { + "question": "在心肺复苏期间给予200 mEq的碳酸氢钠与以下哪项有关", + "A": "脑脊液碱中毒", + "B": "高钙血症", + "C": "高碳酸血症", + "D": "高钾血症", + "E": "氧合血红蛋白解离曲线右移" + } + }, + { + "id": "d96afc15-b61e-5e96-aba0-28795b1e499c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The correlation between anesthetic potency and lipid solubility", + "A": "suggests that the number of molecules dissolved at the site of action causes anesthesia", + "B": "applies to anesthetic agents dissolved in olive oil", + "C": "suggests that the type of molecule causes anesthesia", + "D": "is consistent with the synergistic effect of anesthetics", + "E": "is not consistent with a unitary molecular site of action of anesthetics" + }, + "zh": { + "question": "麻醉效力与脂溶性之间的相关性", + "A": "表明在作用部位溶解的分子数量导致麻醉", + "B": "适用于溶解在橄榄油中的麻醉剂", + "C": "表明分子类型导致麻醉", + "D": "与麻醉剂的协同效应一致", + "E": "与麻醉剂的单一分子作用位点不一致" + } + }, + { + "id": "b8675162-e303-5745-8a2b-804d1cb4bde6", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is a potentially beneficial effect of ketamine used for induction of anesthesia?", + "A": "Analgesia", + "B": "Attenuation of respiratory response to carbon dioxide", + "C": "Decreased cerebral metabolic rate", + "D": "Increased stroke volume in patients with hemorrhagic shock", + "E": "Preservation of laryngeal reflexes" + }, + "zh": { + "question": "以下哪项是使用氯胺酮诱导麻醉的潜在有益效果？", + "A": "镇痛", + "B": "减弱对二氧化碳的呼吸反应", + "C": "降低脑代谢率", + "D": "在失血性休克患者中增加每搏输出量", + "E": "保留喉反射" + } + }, + { + "id": "ae11274e-d617-5db8-a50b-8b986914d5cb", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The last muscle to be affected by an interscalene brachial plexus block is the", + "A": "brachialis", + "B": "brachioradialis", + "C": "biceps", + "D": "flexor carpi radialis", + "E": "interosseous" + }, + "zh": { + "question": "在斜角肌间臂丛神经阻滞中最后受影响的肌肉是", + "A": "肱肌", + "B": "肱桡肌", + "C": "肱二头肌", + "D": "桡侧腕屈肌", + "E": "骨间肌" + } + }, + { + "id": "5f72ab75-0763-50fc-b9bf-f423ed6c9f8e", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During protamine administration following separation from cardiopulmonary bypass, blood pressure decreases from 100/70 to 60/30 mmHg and peak inspiratory pressure increases from 26 to 60 cm H2O. The most appropriate next step in management is administration of", + "A": "diphenhydramine", + "B": "dopamine", + "C": "epinephrine", + "D": "methylprednisolone", + "E": "terbutaline" + }, + "zh": { + "question": "在与体外循环分离后给予鱼精蛋白期间，血压从100/70降至60/30 mmHg，峰值吸气压从26升至60 cm H2O。最合适的下一步管理措施是给予", + "A": "苯海拉明", + "B": "多巴胺", + "C": "肾上腺素", + "D": "甲泼尼龙", + "E": "特布他林" + } + }, + { + "id": "95f4f40d-4741-5b8f-bdd2-44cd1c3ba7e3", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During induction of general anesthesia in a patient with a supraglottic tumor, both intubation and subsequent ventilation via a face mask are impossible. A cricothyroidotomy is performed with a 16-gauge intravenous catheter. Which of the following statements is true?", + "A": "Application of pressures greater than 35 cmH2O to the catheter will increase the risk for pulmonary barotrauma", + "B": "PaC02 can be maintained at a normal level using a standard circle system attached to the catheter", + "C": "PaO2 greater than 100 mmHg can be maintained indefinitely using transtracheal jet ventilation with pure oxygen through the catheter", + "D": "Emergency surgical tracheostomy would have improved the likelihood of survival", + "E": "The presence of this tumor contraindicates jet ventilation via cricothyroidotomy" + }, + "zh": { + "question": "在一名患有声门上肿瘤的患者进行全身麻醉诱导期间，插管和随后通过面罩通气均无法进行。使用16号静脉导管进行环甲膜切开术。以下哪项陈述是正确的？", + "A": "对导管施加超过35 cmH2O的压力会增加肺部气压伤的风险", + "B": "使用连接到导管的标准环路系统可以将PaCO2维持在正常水平", + "C": "使用纯氧通过导管进行经气管喷射通气可以无限期地将PaO2维持在100 mmHg以上", + "D": "紧急外科气管切开术会提高生存的可能性", + "E": "该肿瘤的存在禁忌通过环甲膜切开术进行喷射通气" + } + }, + { + "id": "6d578b09-9e4e-527a-a53f-ec362ec59af0", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 50-year-old man with an 80 pack-year history of cigarette smoking has a forced expiratory volume in one second of 1.5 L and a forced vital capacity of 3.5 L. Which of the following statements concerning intraoperative anesthetic management is true?", + "A": "An I:E ratio of 1:1 will improve carbon dioxide removal more than an I:E ratio of 1:2.5", + "B": "Antagonism of neuromuscular block will most likely trigger acute bronchospasm", + "C": "Functional residual capacity will increase during an acute exacerbation of bronchospasm", + "D": "Induction with ketamine will increase airway resistance", + "E": "Nitrous oxide is contraindicated" + }, + "zh": { + "question": "一名50岁的男性有80包年吸烟史，其一秒钟用力呼气量为1.5升，用力肺活量为3.5升。以下关于术中麻醉管理的说法哪一项是正确的？", + "A": "1:1的吸呼比将比1:2.5的吸呼比更能改善二氧化碳的排出", + "B": "拮抗神经肌肉阻滞最有可能引发急性支气管痉挛", + "C": "在支气管痉挛急性加重期间，功能残气量将增加", + "D": "用氯胺酮诱导将增加气道阻力", + "E": "一氧化二氮是禁忌的" + } + }, + { + "id": "6be7f60a-40da-5666-ad8a-335d19cbbf34", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A newly developed inhalational anesthetic has a blood-gas partition coefficient of 0.2. Which of the following statements best describes this drug compared with isoflurane?", + "A": "MAC is lower", + "B": "The difference between Fa and Fl during maintenance of anesthesia is greater", + "C": "Time to emergence is shorter", + "D": "Rapid induction requires greater overpressure", + "E": "Equilibrium in a circle system with the same flow of fresh gas is slower" + }, + "zh": { + "question": "一种新开发的吸入麻醉剂的血气分配系数为0.2。与异氟醚相比，下列哪项最能描述这种药物？", + "A": "MAC较低", + "B": "在麻醉维持期间，Fa和Fl之间的差异更大", + "C": "苏醒时间更短", + "D": "快速诱导需要更大的过压", + "E": "在相同新鲜气体流量的循环系统中达到平衡的速度较慢" + } + }, + { + "id": "4b10457d-315c-512e-a6f5-949312c55e1b", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 70-kg man with ischemic heart disease is undergoing abdominal aortic aneurysm resection. At the time of infrarenal cross-clamping, 0.2-mV ST-segment depression appears on lead V5 of the ECG. Hemodynamic changes occurring at the same time are shown below. Systemic blood pressure 90/50 --> 150/90; Heart rate 80 --> 95; PAp 20/10 --> 45/24; Mean pulmonary artery occlusion pressure (mmHg) 10 --> 23; Cardiac output (L/min) 4.5 --> 3.2. Ischemia would be decreased by restoring the pre-clamp level of each of the following EXCEPT", + "A": "blood pressure", + "B": "heart rate", + "C": "pulmonary artery pressure", + "D": "pulmonary artery occlusion pressure", + "E": "cardiac output" + }, + "zh": { + "question": "一名70公斤的男性患有缺血性心脏病，正在接受腹主动脉瘤切除术。在肾下夹闭时，心电图V5导联出现0.2毫伏的ST段压低。此时发生的血流动力学变化如下。全身血压90/50 --> 150/90；心率80 --> 95；肺动脉压20/10 --> 45/24；平均肺动脉楔压（mmHg）10 --> 23；心输出量（L/min）4.5 --> 3.2。通过恢复夹闭前的每一项指标可以减少缺血，除了", + "A": "血压", + "B": "心率", + "C": "肺动脉压", + "D": "肺动脉楔压", + "E": "心输出量" + } + }, + { + "id": "c75e376a-4915-58b0-ae5f-8d57c5c91ac7", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 65-year-old woman has respiratory distress and loss of consciousness immediately following superficial and deep cervical plexus block for right carotid endarterectomy. Which of the following is the most likely cause?", + "A": "Phrenic nerve paralysis", + "B": "Pneumothorax", + "C": "Recurrent laryngeal nerve block", + "D": "Subarachnoid injection", + "E": "Vertebral artery injection" + }, + "zh": { + "question": "一名65岁女性在进行右侧颈动脉内膜切除术的浅表和深颈丛阻滞后立即出现呼吸窘迫和意识丧失。以下哪项是最可能的原因？", + "A": "膈神经麻痹", + "B": "气胸", + "C": "喉返神经阻滞", + "D": "蛛网膜下腔注射", + "E": "椎动脉注射" + } + }, + { + "id": "3cc8d0a3-45c4-5373-b5d3-3cb629943d6c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following findings on the left is most likely to be associated with an increased risk of complications with cannulation of the left internal jugular vein compared with cannulation of the right internal jugular vein?", + "A": "Longer recurrent laryngeal nerve", + "B": "Lower location of the cupola of the pleura", + "C": "More acute angle between the internal jugular and innominate veins", + "D": "More anterior location of the phrenic nerve", + "E": "Presence of the thoracic duct" + }, + "zh": { + "question": "以下哪项左侧的发现最有可能与左侧颈内静脉插管相比右侧颈内静脉插管的并发症风险增加有关？", + "A": "更长的喉返神经", + "B": "胸膜穹窿位置较低", + "C": "颈内静脉与无名静脉之间的角度更锐", + "D": "膈神经位置更靠前", + "E": "存在胸导管" + } + }, + { + "id": "3c1ff444-82a3-53f6-a211-91114ecac7e1", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following characteristics of local anesthetics is associated with long duration of action?", + "A": "High degree of lipid solubility", + "B": "High degree of protein binding", + "C": "High molecular weight", + "D": "High pKa", + "E": "Presence of ester linkage" + }, + "zh": { + "question": "以下哪项是与局部麻醉药长效作用相关的特征？", + "A": "高脂溶性", + "B": "高蛋白结合率", + "C": "高分子量", + "D": "高pKa值", + "E": "酯键的存在" + } + }, + { + "id": "7dc735f1-68dc-5863-b225-7d6cb58e8c37", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "An otherwise healthy 70-year-old man receives 12 units of packed red blood cells for persistent diffuse bleeding during suprapubic prostatectomy. Hemoglobin concentration is 11 g/dL, platelet count is 55,000/mm3, plasma fibrinogen concentration is 180 mg/dL, protime is 14 sec, and partial thromboplastin time is 35 sec. The most appropriate therapy is administration of", + "A": "cryoprecipitate", + "B": "desmopressin (DDAVP)", + "C": "epsilon-aminocaproic acid", + "D": "fresh frozen plasma", + "E": "platelets" + }, + "zh": { + "question": "一名身体健康的70岁男性在耻骨上前列腺切除术中因持续性弥漫性出血接受了12单位的浓缩红细胞输注。血红蛋白浓度为11 g/dL，血小板计数为55,000/mm3，血浆纤维蛋白原浓度为180 mg/dL，凝血酶原时间为14秒，部分凝血活酶时间为35秒。最合适的治疗是给予", + "A": "冷沉淀", + "B": "去氨加压素 (DDAVP)", + "C": "ε-氨基己酸", + "D": "新鲜冰冻血浆", + "E": "血小板" + } + }, + { + "id": "6bd3aaea-3d5c-5584-b76b-b260009135a2", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The vapor pressure of a volatile anesthetic depends on", + "A": "temperature only", + "B": "ambient pressure only", + "C": "temperature and ambient pressure", + "D": "pressure and volume of the system", + "E": "none of the above" + }, + "zh": { + "question": "挥发性麻醉剂的蒸气压取决于", + "A": "仅温度", + "B": "仅环境压力", + "C": "温度和环境压力", + "D": "系统的压力和体积", + "E": "以上都不是" + } + }, + { + "id": "c26402f0-fe44-50c6-8867-788c9ef9abc6", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Surgery is cancelled 10 minutes after initiation of intravenous regional anesthesia with 50 ml of lidocaine 0.5%. To terminate anesthesia safely, what is the most appropriate timing for deflating the tourniquet?", + "A": "Immediately if benzodiazepines have been administered", + "B": "Immediately after intravenous administration of ephedrine 10 mg", + "C": "Immediately, followed by repeated reinflation and deflation", + "D": "In no less than 20 minutes after initial injection", + "E": "In no less than 45 minutes after initial injection" + }, + "zh": { + "question": "在使用50毫升0.5%利多卡因进行静脉区域麻醉10分钟后，手术被取消。为了安全终止麻醉，最合适的止血带放气时间是什么时候？", + "A": "如果已给予苯二氮䓬类药物，则立即放气", + "B": "静脉注射10毫克麻黄碱后立即放气", + "C": "立即放气，然后反复充气和放气", + "D": "在初次注射后不少于20分钟放气", + "E": "在初次注射后不少于45分钟放气" + } + }, + { + "id": "7b539ff4-7251-5aa0-a055-b809d65c187d", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Bupivacaine is more likely than lidocaine to cause refractory cardiac arrest because bupivacaine", + "A": "has a lower rate of plasma clearance", + "B": "has a secondary blocking effect on cardiac beta,-adrenergic receptors", + "C": "dissociates more slowly from sodium channels in cardiac muscle", + "D": "inhibits spontaneous phase 4 depolarization in pacemaker cells", + "E": "preferentially blocks calcium channels in Purkinje fibers" + }, + "zh": { + "question": "与利多卡因相比，布比卡因更容易引起难治性心脏骤停，因为布比卡因", + "A": "具有较低的血浆清除率", + "B": "对心脏β-肾上腺素能受体有次要阻滞作用", + "C": "从心肌钠通道解离得更慢", + "D": "抑制起搏细胞的自发4期去极化", + "E": "优先阻断浦肯野纤维中的钙通道" + } + }, + { + "id": "ed015b48-f69e-5b00-ace5-27a5a7a5cc20", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "After brachial plexus block, a patient has sensation over the inner aspect of the upper arm. Block of which of the following nerves would obtund this sensation?", + "A": "Intercostobrachial", + "B": "Median", + "C": "Musculocutaneous", + "D": "Radial", + "E": "Ulnar" + }, + "zh": { + "question": "在臂丛神经阻滞后，患者上臂内侧仍有感觉。阻滞以下哪一条神经可以减弱这种感觉？", + "A": "肋间臂神经", + "B": "正中神经", + "C": "肌皮神经", + "D": "桡神经", + "E": "尺神经" + } + }, + { + "id": "4b468083-05e1-5f87-a120-4e4827c2645b", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Reduction of fire hazards during laser surgery of the airway is best accomplished by use of", + "A": "continuous mode laser emissions", + "B": "a nitrous oxide/opioid/relaxant anesthetic technique", + "C": "a polyvinylchloride endotracheal tube and cuff", + "D": "topical lidocaine", + "E": "saline-filled sponges over exposed tissues" + }, + "zh": { + "question": "在气道激光手术中减少火灾危险的最佳方法是使用", + "A": "连续模式激光发射", + "B": "一氧化二氮/阿片类药物/肌松剂麻醉技术", + "C": "聚氯乙烯气管插管和气囊", + "D": "局部利多卡因", + "E": "用生理盐水浸湿的海绵覆盖暴露的组织" + } + }, + { + "id": "b86347ae-5789-5263-9d52-1cfd3b5b0a32", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 20-year-old man involved in a motor vehicle accident is brought to the operating room for irrigation and debridement of open fractures of the femur and humerus. Cyanosis, decreased breath sounds on the left, increased peak airway pressure, and hypotension are noted after intubation of the trachea. The most likely cause is", + "A": "aspiration", + "B": "fat embolus", + "C": "intubation of the right mainstem bronchus", + "D": "tension pneumothorax", + "E": "unilateral bronchospasm" + }, + "zh": { + "question": "一名20岁的男性因交通事故被送到手术室进行股骨和肱骨开放性骨折的冲洗和清创术。气管插管后出现紫绀、左侧呼吸音减弱、气道峰压增加和低血压。最可能的原因是", + "A": "误吸", + "B": "脂肪栓塞", + "C": "右主支气管插管", + "D": "张力性气胸", + "E": "单侧支气管痉挛" + } + }, + { + "id": "f1b7dcfb-4a4e-54c3-b7a9-65c835295e3b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Mivacurium-induced neuromuscular blockade is prolonged for the greatest period of time in patients who have which of the following conditions?", + "A": "Ethanol-induced hepatitis", + "B": "Hemiplegia", + "C": "Pseudocholinesterase deficiency", + "D": "Renal insufficiency", + "E": "Thermal burns" + }, + "zh": { + "question": "在以下哪种情况下，米库氯铵引起的神经肌肉阻滞时间最长？", + "A": "酒精性肝炎", + "B": "偏瘫", + "C": "假性胆碱酯酶缺乏症", + "D": "肾功能不全", + "E": "热烧伤" + } + }, + { + "id": "1da73490-b326-56fb-8ddf-74fd007248d3", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "An endobronchial Robertshaw tube is inserted for resection of a midesophageal tumor under isoflurane, oxygen, pancuronium anesthesia. Forty minutes into a planned two-hour resection, arterial blood gas values are reported as PO2 45 mmHg, PCO2 45 mmHg, and pH 7.33. Ten minutes earlier, the values were PO2 210 mmHg, PCO2, 41 mmHg, and pH 7.39. The first action should be to", + "A": "reposition the Robertshaw tube", + "B": "apply positive end-expiratory pressure to the ventilated lung", + "C": "reinflate and ventilate the non ventilated lung", + "D": "increase minute ventilation", + "E": "repeat the arterial blood gas analysis" + }, + "zh": { + "question": "在异氟醚、氧气、潘库溴铵麻醉下插入支气管内Robertshaw管以切除中段食管肿瘤。计划的两小时切除术进行到四十分钟时，动脉血气值报告为PO2 45 mmHg，PCO2 45 mmHg，pH 7.33。十分钟前，数值为PO2 210 mmHg，PCO2 41 mmHg，pH 7.39。首先应采取的行动是", + "A": "重新定位Robertshaw管", + "B": "对通气的肺施加呼气末正压", + "C": "重新充气并通气未通气的肺", + "D": "增加每分钟通气量", + "E": "重复动脉血气分析" + } + }, + { + "id": "7dd206f2-3b8c-5427-ad50-5af74c3d4f97", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Awakening after a single dose of thiopental is caused by redistribution from the brain primarily to which of the following sites?", + "A": "Fat", + "B": "Heart", + "C": "Liver", + "D": "Lung", + "E": "Skeletal muscle" + }, + "zh": { + "question": "单剂量硫喷妥钠后苏醒主要是由于从大脑重新分布到以下哪个部位？", + "A": "脂肪", + "B": "心脏", + "C": "肝脏", + "D": "肺", + "E": "骨骼肌" + } + }, + { + "id": "befd2eb8-5cf6-5bb4-85d5-b2b6daa91f0b", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements concerning the volume of distribution of a drug is true?", + "A": "It is equal to the sum of the volumes of the tissue spaces into which it diffuses", + "B": "It is equal to the volume to which it is distributed outside the plasma volume", + "C": "It is unaltered by the amount bound to red blood cells and plasma proteins", + "D": "It depends on elimination from plasma", + "E": "It relates the total amount of the drug in the body to the plasma concentration" + }, + "zh": { + "question": "以下关于药物分布容积的说法中哪一项是正确的？", + "A": "它等于药物扩散到的组织空间的体积之和", + "B": "它等于分布在血浆容积之外的体积", + "C": "它不受与红细胞和血浆蛋白结合量的影响", + "D": "它取决于从血浆中的消除", + "E": "它将体内药物的总量与血浆浓度联系起来" + } + }, + { + "id": "984cc5c2-16ea-5552-a869-c181db49e454", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "After administration of a single dose of vecuronium, function returns last to which of the following muscles?", + "A": "Adductor pollicis", + "B": "Diaphragm", + "C": "Laryngeal muscles", + "D": "Orbicularis oculi", + "E": "Rectus abdominis" + }, + "zh": { + "question": "在给予一剂维库溴铵后，以下哪块肌肉的功能恢复最晚？", + "A": "拇收肌", + "B": "膈肌", + "C": "喉部肌肉", + "D": "眼轮匝肌", + "E": "腹直肌" + } + }, + { + "id": "6562a982-a37d-56b6-9121-7661f48e3950", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "A patient who is receiving ventilatory support after coronary artery bypass grafting has a PaO2 of 132 mmHg, a PaCO2 of 19 mmHg, and a pH of 7.57. Which of the following is most likely to result from this level of hypocarbia?", + "A": "Decreased airway resistance", + "B": "Increased myocardial contractility", + "C": "Hyperkalemia", + "D": "Shortened QT interval", + "E": "Cerebral ischemia" + }, + "zh": { + "question": "一名接受冠状动脉旁路移植术后通气支持的患者，其PaO2为132 mmHg，PaCO2为19 mmHg，pH为7.57。以下哪项最有可能由这种低碳酸血症水平引起？", + "A": "气道阻力降低", + "B": "心肌收缩力增强", + "C": "高钾血症", + "D": "QT间期缩短", + "E": "脑缺血" + } + }, + { + "id": "76f33fe5-eee6-54aa-a62d-d322af085d27", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A patient is in sinus rhythm but has no pulse during cardiopulmonary resuscitation. There is marked resistance to positive pressure ventilation and breath sounds are difficult to hear bilaterally. The endotracheal tube is clearly in the trachea. The most appropriate next step in management is to", + "A": "administer isoetharine by inhalation", + "B": "apply electrical countershock", + "C": "insert needles in the left and right chest", + "D": "order a roentgenogram of the chest", + "E": "start an infusion of aminophylline" + }, + "zh": { + "question": "一名患者处于窦性心律，但在心肺复苏期间没有脉搏。对正压通气有明显的抵抗，双侧呼吸音难以听到。气管插管明确在气管内。最合适的下一步处理措施是", + "A": "吸入异丙肾上腺素", + "B": "进行电击复律", + "C": "在左胸和右胸插入针头", + "D": "安排胸部X光检查", + "E": "开始氨茶碱输注" + } + }, + { + "id": "705561fa-3304-527a-8471-5196aa8cfe37", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A combined epidural and general anesthetic is used for aortofemoral bypass surgery. Just prior to extubation, the patient received morphine 5 mg through the epidural catheter. Eleven hours later, he is unresponsive while breathing 40% oxygen from a face mask. Respiratory rate is 6/min and SpO2 is 92%. Arterial blood gas analysis shows PaO2 80 mmHg, PaCO2 84 mmHg, and pH 7.16. Which of the following statements concerning this patient is true?", + "A": "Hypercarbia is contributing to the decreased level of consciousness", + "B": "Naloxone is ineffective for reversing the respiratory depression", + "C": "The oxygen saturation is higher than expected because of the pH", + "D": "The risk for respiratory depression would have been lower with subarachnoid administration of 0.5 mg morphine", + "E": "Residual local anesthetic is contributing to the respiratory depression" + }, + "zh": { + "question": "在进行髂股动脉旁路手术时，使用了硬膜外麻醉和全身麻醉联合方案。在拔管前，患者通过硬膜外导管接受了5毫克吗啡。11小时后，他在面罩吸入40%氧气时无反应。呼吸频率为6次/分钟，SpO2为92%。动脉血气分析显示PaO2为80 mmHg，PaCO2为84 mmHg，pH为7.16。关于该患者，下列哪项陈述是正确的？", + "A": "高碳酸血症导致意识水平下降", + "B": "纳洛酮对逆转呼吸抑制无效", + "C": "由于pH值，氧饱和度高于预期", + "D": "如果使用0.5毫克吗啡的蛛网膜下腔给药，呼吸抑制的风险会更低", + "E": "残留的局部麻醉剂导致了呼吸抑制" + } + }, + { + "id": "91270ad7-bfe9-556e-a2bc-ad51aaf54482", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 65-year-old patient with hypertrophic cardiomyopathy has chest pain prior to induction of anesthesia. Pulse is 80 bpm and blood pressure is 130/80 mmHg. The ECG (V5) shows sinus rhythm and new ST-segment depression. The most appropriate management is administration of", + "A": "furosemide", + "B": "metoprolol", + "C": "morphine", + "D": "nifedipine", + "E": "nitroglycerin" + }, + "zh": { + "question": "一名65岁的肥厚型心肌病患者在麻醉诱导前出现胸痛。脉搏为80次/分钟，血压为130/80 mmHg。心电图（V5）显示窦性心律和新的ST段压低。最合适的处理是给予", + "A": "呋塞米", + "B": "美托洛尔", + "C": "吗啡", + "D": "硝苯地平", + "E": "硝酸甘油" + } + }, + { + "id": "cfda1815-ab18-5539-8860-0e664d86a4de", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with intermittent positive pressure ventilation (IPPV), intermittent mandatory ventilation (IMV)", + "A": "better maintains cardiac output", + "B": "provides less than full mechanical ventilatory support", + "C": "requires a greater level of sedation", + "D": "requires a higher FlO2", + "E": "requires a lower inspiratory flow rate" + }, + "zh": { + "question": "与间歇性正压通气（IPPV）相比，间歇性强制通气（IMV）", + "A": "更好地维持心输出量", + "B": "提供的机械通气支持不足", + "C": "需要更高水平的镇静", + "D": "需要更高的氧浓度（FlO2）", + "E": "需要更低的吸气流速" + } + }, + { + "id": "5c1948fb-87dc-5332-b459-0fa73cc2fad1", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 30-year-old woman has difficulty talking 15 minutes after initiation of interscalene block for closed reduction of a dislocated shoulder. The most likely cause is", + "A": "cervical sympathetic block", + "B": "delayed systemic toxic reaction", + "C": "phrenic nerve paralysis", + "D": "pneumothorax", + "E": "recurrent laryngeal nerve block" + }, + "zh": { + "question": "一名30岁的女性在进行锁骨上神经阻滞以闭合复位肩关节脱位后15分钟出现说话困难。最可能的原因是", + "A": "颈交感神经阻滞", + "B": "延迟的全身毒性反应", + "C": "膈神经麻痹", + "D": "气胸", + "E": "喉返神经阻滞" + } + }, + { + "id": "4d7579c9-c9df-5672-af5b-12efffb499f4", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "If a patient with excessive bleeding during exploratory laparotomy has a normal activated clotting time, the LEAST likely cause of the bleeding is", + "A": "antithrombin III deficiency", + "B": "dilutional thrombocytopenia", + "C": "fibrinolysis", + "D": "administration of heparin 5000 units", + "E": "preoperative ingestion of aspirin" + }, + "zh": { + "question": "如果一名患者在探查性剖腹手术中出现过度出血，但活化凝血时间正常，最不可能的出血原因是", + "A": "抗凝血酶III缺乏", + "B": "稀释性血小板减少症", + "C": "纤溶", + "D": "给予5000单位肝素", + "E": "术前服用阿司匹林" + } + }, + { + "id": "10ba8720-7398-5af2-9cdc-b9c2aedbac2e", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An arterial blood sample is obtained from a patient undergoing hypothermic cardiopulmonary bypass at 28 C. Analysis at 37 C shows a pH of 7.40 and PaCO2 of 40 mmHg. Which of the following values are most likely if the analysis is corrected to 28 C?", + "A": "pH = 7.40; PaCO2 = 40", + "B": "pH > 7.40; PaCO2 < 40", + "C": "pH > 7.40; PaCO2 > 40", + "D": "pH < 7.40; PaCO2 < 40", + "E": "pH < 7.40; PaCO2 > 40" + }, + "zh": { + "question": "在28°C进行低温体外循环的患者中获取动脉血样本。在37°C分析显示pH为7.40，PaCO2为40 mmHg。如果分析校正到28°C，以下哪项值最有可能？", + "A": "pH = 7.40; PaCO2 = 40", + "B": "pH > 7.40; PaCO2 < 40", + "C": "pH > 7.40; PaCO2 > 40", + "D": "pH < 7.40; PaCO2 < 40", + "E": "pH < 7.40; PaCO2 > 40" + } + }, + { + "id": "d7d37ff3-b78a-53b9-b1cd-e8a97781bbc7", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "Spinal anesthesia at a T6 sensory level is most likely to improve cardiac output in patients with", + "A": "aortic stenosis", + "B": "asymmetric septal hypertrophy (IHSS)", + "C": "chronic constrictive pericarditis", + "D": "cor pulmonale", + "E": "mitral regurgitation" + }, + "zh": { + "question": "T6感觉平面脊髓麻醉最有可能改善以下哪种患者的心输出量？", + "A": "主动脉瓣狭窄", + "B": "不对称性室间隔肥厚（IHSS）", + "C": "慢性缩窄性心包炎", + "D": "肺心病", + "E": "二尖瓣关闭不全" + } + }, + { + "id": "6c2caf14-132d-52bd-9dee-6636effe248e", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "Immediately after sustaining severe head injury, a 20-year-old man has a blood pressure of 150/90 mmHg and an intracranial pressure of 35 mmHg. After one hour of thiopental infusion, blood pressure is 105/60 mmHg, intracranial pres sure is 20 mmHg, central venous pressure is 5 mmHg, and temperature is 36°C. The EEG shows slow-wave activity. The most appropriate next step is administration of", + "A": "additional thiopental", + "B": "a corticosteroid", + "C": "furosemide", + "D": "nimodipine", + "E": "phenylephrine" + }, + "zh": { + "question": "在遭受严重的头部损伤后，一名20岁的男性血压为150/90 mmHg，颅内压为35 mmHg。在输注硫喷妥钠一小时后，血压为105/60 mmHg，颅内压为20 mmHg，中心静脉压为5 mmHg，体温为36°C。脑电图显示慢波活动。最合适的下一步是给予", + "A": "额外的硫喷妥钠", + "B": "皮质类固醇", + "C": "呋塞米", + "D": "尼莫地平", + "E": "去氧肾上腺素" + } + }, + { + "id": "9d6468ec-d188-5833-a4df-4f90181c30a4", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "An axillary block is administered to a 60-kg patient using 40 ml of 0.5% bupivacaine. Ten minutes after placement of the block, the patient has a seizure. Which of the following statements is true?", + "A": "A low serum albumin concentration could have contributed to the occurrence of the seizure", + "B": "CNS hypoperfusion is the most likely cause of the seizure", + "C": "The seizure was probably secondary to an allergic reaction to the local anesthetic", + "D": "The use of an equipotent dose of lidocaine rather than bupivacaine would have decreased the likelihood of the seizure" + }, + "zh": { + "question": "对一名60公斤的患者进行腋窝阻滞，使用40毫升0.5%的布比卡因。阻滞放置十分钟后，患者出现癫痫发作。以下哪项陈述是正确的？", + "A": "低血清白蛋白浓度可能导致癫痫发作的发生", + "B": "中枢神经系统低灌注是癫痫发作的最可能原因", + "C": "癫痫发作可能��对局部麻醉药过敏反应的继发性表现", + "D": "使用等效剂量的利多卡因而不是布比卡因会降低癫痫发作的可能性" + } + }, + { + "id": "4b129b0f-7233-5ca8-9ead-0ace13feb5d9", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Following blunt trauma to the chest, a patient has tachycardia, hypotension, and markedly distended neck veins. Each of the following is expected EXCEPT", + "A": "cardiac output of 2.1 L/min", + "B": "mixed venous oxygen saturation of 75%", + "C": "pulmonary artery occlusion pressure of 25 mmHg", + "D": "pulmonary artery diastolic pressure of 25 mmHg", + "E": "right atrial pressure of 25 mmHg" + }, + "zh": { + "question": "在胸部钝性创伤后，患者出现心动过速、低血压和明显的颈静脉扩张。以下每一项都是预期的，除了", + "A": "心输出量为2.1 L/min", + "B": "混合静脉氧饱和度为75%", + "C": "肺动脉楔压为25 mmHg", + "D": "肺动脉舒张压为25 mmHg", + "E": "右心房压力为25 mmHg" + } + }, + { + "id": "83ce3281-e51e-5ef7-a5c8-5dc90cc84cb3", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A previously healthy 46-year-old woman has severe substernal chest pain one hour after receiving morphine sulfate 10 mg intramuscularly for an elective cholecystectomy. Vital signs, SpO2, and findings on a five-lead ECG on the operating room monitor are within normal limits. Which of the following is the most appropriate next step?", + "A": "Sublingual administration of nitroglycerin", + "B": "Intravenous administration of butorphanol", + "C": "Intravenous administration of naloxone", + "D": "Cardiology consultation", + "E": "Cancellation of surgery" + }, + "zh": { + "question": "一名先前健康的46岁女性在接受择期胆囊切除术时，肌肉注射10毫克硫酸吗啡后一小时出现严重的胸骨下胸痛。生命体征、血氧饱和度和手术室监护仪上的五导联心电图结果均在正常范围内。以下哪项是最合适的下一步措施？", + "A": "舌下含服硝酸甘油", + "B": "静脉注射布托啡诺", + "C": "静脉注射纳洛酮", + "D": "心脏科会诊", + "E": "取消手术" + } + }, + { + "id": "73496b04-d38a-5ee7-a1aa-ebd3c7f47bfe", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "During transurethral resection of the prostate under spinal anesthesia with a sensory level to T10, a patient has sudden onset of sharp upper abdominal pain and nausea. Arterial blood pressure increases from 120/80 to 150/90 mmHg; the patient becomes diaphoretic. Which of the following is the most likely diagnosis?", + "A": "Bladder perforation", + "B": "Hemolysis", + "C": "Hypervolemia", + "D": "Hyponatremia", + "E": "Myocardial ischemia" + }, + "zh": { + "question": "在脊髓麻醉下进行经尿道前列腺切除术，感觉平面达到T10时，患者突然出现剧烈的上腹痛和恶心。动脉血压从120/80 mmHg升高到150/90 mmHg；患者出汗。以下哪项是最可能的诊断？", + "A": "膀胱穿孔", + "B": "溶血", + "C": "血容量过多", + "D": "低钠血症", + "E": "心肌缺血" + } + }, + { + "id": "c4bf123c-3a51-53a0-b99c-9c166eff4dc1", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A normotensive 66-year-old man undergoes total hip arthroplasty. Mean arterial pressure is maintained at 60 mmHg with isoflurane and labetalol; intraoperative FiO2 is 1.0. Eight units of red blood cells are administered intraoperatively because of an injury to the femoral artery. Five days later, the patient develops jaundice. Which of the following is the most likely cause of the jaundice?", + "A": "Delayed hemolysis from transfusion", + "B": "Heart failure with hepatic congestion", + "C": "Hepatocellular injury from labetalol", + "D": "Intraoperative hypotension", + "E": "Isoflurane-associated hepatitis" + }, + "zh": { + "question": "一名66岁的血压正常的男性接受全髋关节置换术。通过异氟醚和拉贝洛尔将平均动脉压维持在60 mmHg；术中FiO2为1.0。由于股动脉损伤，术中输注了8个单位的红细胞。五天后，患者出现黄疸。以下哪项是黄疸最可能的原因？", + "A": "输血后延迟性溶血", + "B": "心力衰竭伴肝淤血", + "C": "拉贝洛尔引起的肝细胞损伤", + "D": "术中低血压", + "E": "异氟醚相关性肝炎" + } + }, + { + "id": "4fb8e16f-f333-5ac6-91ac-73db0e95fbbd", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "After tracheal extubation, a healthy 21-year-old man has a 30-second episode of laryngospasm with marked intercostal and sternal retractions, which are corrected with continuous positive airway pressure administered by mask. He now has dyspnea and tachypnea, and a roentgenogram of the chest shows diffuse bilateral interstitial edema. The most likely cause is increased", + "A": "airway reactivity", + "B": "intrapleural pressure", + "C": "left ventricular afterload", + "D": "right ventricular preload", + "E": "transpulmonary vascular pressure" + }, + "zh": { + "question": "在气管拔管后，一名健康的21岁男性出现了30秒的喉痉挛，伴有明显的肋间和胸骨回缩，这些症状通过面罩持续正压通气得到纠正。他现在出现呼吸困难和呼吸急促，胸部X光片显示弥漫性双侧间质性水肿。最可能的原因是增加了", + "A": "气道反应性", + "B": "胸膜内压", + "C": "左心室后负荷", + "D": "右心室前负荷", + "E": "肺血管跨壁压" + } + }, + { + "id": "8c565987-95f4-55d7-96eb-8f19a3b5626e", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following is a complication of stellate ganglion block EXCEPT", + "A": "brachial plexus block", + "B": "diplopia", + "C": "local anesthetic-induced seizure", + "D": "recurrent laryngeal nerve palsy", + "E": "subarachnoid block" + }, + "zh": { + "question": "以下每项都是星状神经节阻滞的并发症，除了", + "A": "臂丛神经阻滞", + "B": "复视", + "C": "局部麻醉药引起的癫痫", + "D": "喉返神经麻痹", + "E": "蛛网膜下腔阻滞" + } + }, + { + "id": "ce51c478-54a0-5d51-8ef6-e549d19cc85a", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "During open reduction of a tibial fracture, a tourniquet cuff is applied around the proximal thigh and inflated to 300 mmHg. Which of the following is most likely to prevent pain and hypertension caused by the tourniquet?", + "A": "Intravenous administration of fentanyl during subarachnoid block", + "B": "Lumbar sympathetic block", + "C": "Spinal anesthesia to a T6 sensory level", + "D": "Obturator nerve block", + "E": "General anesthesia" + }, + "zh": { + "question": "在胫骨骨折的开放复位过程中，止血带袖带被应用于大腿近端并充气至300 mmHg。以下哪项最有可能防止止血带引起的疼痛和高血压？", + "A": "蛛网膜下腔阻滞期间静脉注射芬太尼", + "B": "腰交感神经阻滞", + "C": "脊髓麻醉达到T6感觉水平", + "D": "闭孔神经阻滞", + "E": "全身麻醉" + } + }, + { + "id": "753528e6-2af8-5da4-845b-28c7d68c6cad", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Pulsus paradoxus is commonly seen during anesthesia in patients with each of the following conditions EXCEPT", + "A": "severe asthma", + "B": "right-sided heart failure", + "C": "hypovolemia", + "D": "atrial septal defect", + "E": "obesity" + }, + "zh": { + "question": "在麻醉期间，以下哪种情况的患者常见脉搏异常减弱，除了", + "A": "严重哮喘", + "B": "右心衰竭", + "C": "低血容量", + "D": "房间隔缺损", + "E": "肥胖" + } + }, + { + "id": "381ff37c-b62c-5f15-a29e-1368313eae80", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Pulmonary artery diastolic pressure increases acutely from 10 to 20 mmHg in a 28-year-old man undergoing cervical laminectomy in the sitting position. The most appropriate first step in the management of this patient is to", + "A": "administer furosemide", + "B": "aspirate from the proximal port of the pulmonary artery catheter", + "C": "inflate the balloon on the pulmonary artery catheter", + "D": "place the patient in the left lateral decubitus position", + "E": "start an infusion of nitroglycerin" + }, + "zh": { + "question": "在一名28岁男性患者进行坐位颈椎椎板切除术时，肺动脉舒张压急剧从10 mmHg升高到20 mmHg。对���患者最合适的初步处理措施是", + "A": "给予呋塞米", + "B": "从肺动脉导管的近端口抽吸", + "C": "给肺动脉导管的气囊充气", + "D": "将患者置于左侧卧位", + "E": "开始输注硝酸甘油" + } + }, + { + "id": "107a1394-aa9d-5954-aa53-6823d92f3d5e", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A patient with jaundice who has a minimally elevated SGOT (AST), markedly elevated alkaline phosphatase, and normal prothrombin time is to receive a muscle relaxant. Which of the following is most likely in this patient?", + "A": "Decreased intubating dose of pancuronium", + "B": "Increased intubating dose of atracurium", + "C": "Prolonged duration of succinylcholine effect", + "D": "Prolonged duration of vecuronium effect", + "E": "Shortened duration of d-tubocurarine effect" + }, + "zh": { + "question": "一位黄疸患者，其SGOT（AST）轻度升高，碱性磷酸酶显著升高，凝血酶原时间正常，需接受肌肉松弛剂。以下哪种情况最有可能发生在该患者身上？", + "A": "减少琥珀胆碱的插管剂量", + "B": "增加阿曲库铵的插管剂量", + "C": "琥珀胆碱作用时间延长", + "D": "维库溴铵作用时间延长", + "E": "d-筒箭毒碱作用时间缩短" + } + }, + { + "id": "06aaa910-f601-5281-9107-c006be8284fc", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Following enflurane anesthesia, serum free fluoride concentration is most likely to be increased in association with long-term use of", + "A": "diazepam", + "B": "ethanol", + "C": "isoniazid", + "D": "phenobarbital", + "E": "phenytoin" + }, + "zh": { + "question": "在恩氟烷麻醉后，血清游离氟化物浓度最有可能因长期使用哪种药物而增加？", + "A": "地西泮", + "B": "乙醇", + "C": "异烟肼", + "D": "苯巴比妥", + "E": "苯妥英" + } + }, + { + "id": "4a7c08ae-5cf5-58b0-8fc5-2257cd4cc51e", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "In a patient undergoing liver transplantation, sodium bicarbonate and calcium chloride are administered immediately before reperfusion of the transplanted liver to counteract", + "A": "coagulopathy", + "B": "decreased cardiac output", + "C": "hyperkalemia", + "D": "hypermagnesemia", + "E": "hypotension" + }, + "zh": { + "question": "在进行肝移植的患者中，碳酸氢钠和氯化钙在移植肝脏再灌注前立即给予以对抗", + "A": "凝血功能障碍", + "B": "心输出量减少", + "C": "高钾血症", + "D": "高镁血症", + "E": "低血压" + } + }, + { + "id": "9ed616ce-bd86-5b5a-ad2e-2a7c0207dd61", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "In a 65-year-old man, which of the following findings on preoperative pulmonary function testing is associated with the highest risk for respiratory insufficiency following pneumonectomy?", + "A": "Maximum voluntary ventilation at 65% of predicted", + "B": "Mean pulmonary artery pressure of 28 mmHg", + "C": "Predicted postoperative forced expiratory volume in one second (FEV1) of 800 ml", + "D": "Residual volume to total lung capacity (RV/TLC) ratio of 0.35", + "E": "Vital capacity of 3 liters" + }, + "zh": { + "question": "在一名65岁男性中，以下哪项术前肺功能测试结果与肺切除术后呼吸功能不全的最高风险相关？", + "A": "最大自主通气量为预测值的65%", + "B": "平均肺动脉压为28 mmHg", + "C": "预测术后第一秒用力呼气量（FEV1）为800毫升", + "D": "残气量与总肺容量（RV/TLC）比率为0.35", + "E": "肺活量为3升" + } + }, + { + "id": "663277e8-855f-5e2c-a5d2-08c8ac4f0b41", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 73-year-old woman with a preoperative serum creatinine concentration of 2.1 mg/dl develops oliguria during enflurane anesthesia. Urine sodium concentration is 10 mEq/L and urine osmolality is 450 mOsm/L. The most likely cause of these findings is", + "A": "acute renal failure", + "B": "chronic renal insufficiency", + "C": "decreased renal perfusion", + "D": "fluoride nephrotoxicity", + "E": "intraoperative administration of furosemide" + }, + "zh": { + "question": "一名73岁的女性，术前血清肌酐浓度为2.1 mg/dl，在乙醚麻醉期间出现少尿。尿钠浓度为10 mEq/L，尿渗透压为450 mOsm/L。最可能的原因是", + "A": "急性肾衰竭", + "B": "慢性肾功能不全", + "C": "肾灌注减少", + "D": "氟化物肾毒性", + "E": "术中使用呋塞米" + } + }, + { + "id": "d7c25220-b758-5e03-bf8e-2c614b99064f", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Measurement of blood pressure with a Doppler device involves", + "A": "reflection of ultrasound waves off blood elements", + "B": "detection of oscillations in cuff pressure", + "C": "amplification of Korotkoff sounds with a miniature microphone", + "D": "transillumination with a near infrared light", + "E": "detection of variations in blood vessel diameter" + }, + "zh": { + "question": "使用多普勒设备测量血压涉及", + "A": "超声波在血液成分上的反射", + "B": "检测袖带压力的振荡", + "C": "用微型麦克风放大柯氏音", + "D": "使用近红外光透照", + "E": "检测血管直径的变化" + } + }, + { + "id": "98329421-86f7-5ab3-af12-9eb295e42371", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "After a gastric stapling procedure, a 150-kg woman is extubated and breathing spontaneously in the recovery room at a rate of 26/min and an FiO2 of 0.5. Arterial blood gas analysis shows PaO2 96 mmHg, PaCO2 44 mmHg, and pH 7.37. The parameter most closely related to her increased alveolar-arterial oxygen tension gradient is", + "A": "decreased expiratory reserve volume", + "B": "decreased minute volume", + "C": "decreased residual volume", + "D": "decreased total lung capacity", + "E": "rapid respiratory rate" + }, + "zh": { + "question": "在胃缝合手术后，一名150公斤的女性在恢复室拔管后自主呼吸，呼吸频率为26次/分钟，吸入氧浓度为0.5。动脉血气分析显示PaO2为96 mmHg，PaCO2为44 mmHg，pH为7.37。与她增加的肺泡-动脉氧分压梯度最密切相关的参数是", + "A": "呼气储备容量减少", + "B": "分钟通气量减少", + "C": "残气量减少", + "D": "肺总容量减少", + "E": "呼吸频率快" + } + }, + { + "id": "3fe439c5-808d-554f-b45f-bb774b1334be", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "A 40-year-old woman receives alfentanil 75 mcg/kg followed by an infusion of 1.5 mcg/kg/min for a one-hour cholecystectomy and cholangiogram. This regimen could be associated with each of the following EXCEPT", + "A": "muscle rigidity", + "B": "increased biliary tract pressure", + "C": "inadequate anesthesia", + "D": "postoperative respiratory depression", + "E": "two to four hours of postoperative analgesia" + }, + "zh": { + "question": "一名40岁的女性接受了75 mcg/kg的阿芬太尼，随后以1.5 mcg/kg/min的速度进行一小时的胆囊切除术和胆管造影术输注。该方案可能与以下各项有关，除了", + "A": "肌肉僵硬", + "B": "胆道压力增加", + "C": "麻醉不足", + "D": "术后呼吸抑制", + "E": "术后两到四小时的镇痛" + } + }, + { + "id": "19b2cf50-4ad5-57c6-a4b6-00dccbe2ffa9", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "During total cardiopulmonary bypass, metabolic acidosis and decreasing mixed venous oxygen saturation are noted. The most likely cause is", + "A": "hypothermia", + "B": "hypoperfusion", + "C": "hypocarbia", + "D": "rewarming", + "E": "light anesthesia" + }, + "zh": { + "question": "在全心肺转流期间，观察到代谢性酸中毒和混合静脉氧饱和度下降。最可能的原因是", + "A": "低体温", + "B": "低灌注", + "C": "低碳酸血症", + "D": "复温", + "E": "浅麻醉" + } + }, + { + "id": "c7870298-a4ad-59be-ab44-baffb01a6a2d", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 66-year-old man with aortic regurgitation is brought to the operating room for aortic valve replacement after having received morphine, scopolamine premedication. PO2 is 40 mmHg in a sample of pulmonary artery blood drawn 10 minutes after the patient started breathing pure oxygen. This finding is compatible with", + "A": "wedging of the catheter tip", + "B": "left-to-right intracardiac shunt", + "C": "increased intrapulmonary shunting", + "D": "excessively depressed ventilation", + "E": "normal cardiac output" + }, + "zh": { + "question": "一名66岁的男性患有主动脉瓣关闭不全，在接受吗啡和东莨菪碱术前用药后被送入手术室进行主动脉瓣置换术。患者开始吸入纯氧10分钟后，抽取的肺动脉血样本中PO2为40 mmHg。这一发现与以下哪项相符？", + "A": "导管尖端楔入", + "B": "左向右心内分流", + "C": "肺内分流增加", + "D": "通气过度抑制", + "E": "正常心输出量" + } + }, + { + "id": "41c1e6d4-a690-5ce1-b719-2d66559e0b7d", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 58-year-old woman with rheumatoid arthritis and hyperactive gag reflex requires awake intubation prior to cervical spine stabilization. Which of the following regional nerve blocks is most appropriate?", + "A": "Deep cervical plexus", + "B": "Glossopharyngeal nerve", + "C": "Hypoglossal nerve", + "D": "Superior laryngeal nerve", + "E": "Trigeminal nerve" + }, + "zh": { + "question": "一名58岁患有类风湿性关节炎和过度敏感咽反射的女性需要在颈椎固定前进行清醒插管。以下哪种区域神经阻滞最为合适？", + "A": "深颈丛", + "B": "舌咽神经", + "C": "舌下神经", + "D": "上喉神经", + "E": "三叉神经" + } + }, + { + "id": "5218c63b-2be9-58fa-ae62-cdb9542bf25f", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Maternal hyperventilation to a PaCO2 of 20 mmHg during labor can result in", + "A": "decreased fetal trapping of local anesthetics", + "B": "fetal metabolic acidosis", + "C": "fetal respiratory acidosis", + "D": "increased oxygen release at the placenta", + "E": "uterine vasodilation" + }, + "zh": { + "question": "分娩期间母体过度通气至PaCO2为20 mmHg可能导致", + "A": "减少胎儿对局部麻醉药的滞留", + "B": "胎儿代谢性酸中毒", + "C": "胎儿呼吸性酸中毒", + "D": "胎盘处氧气释放增加", + "E": "子宫血管扩张" + } + }, + { + "id": "5f63a9f2-84c9-53c8-9650-2a00cacc4c41", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Ninety minutes after administration of succinylcholine 1 mg/kg to a 28-year-old woman, the train-of-four shows a T4:T1 ratio of 25%. This is most consistent with", + "A": "dibucaine number of 30", + "B": "hypersensitivity to succinylmonocholine", + "C": "pregnancy", + "D": "pretreatment with pancuronium 2 mg", + "E": "severe cirrhosis" + }, + "zh": { + "question": "在给予28岁女性琥珀酰胆碱1 mg/kg后90分钟，四联刺激显示T4:T1比率为25%。这最符合以下哪种情况？", + "A": "地布卡因数为30", + "B": "对琥珀酰单胆碱的过敏反应", + "C": "怀孕", + "D": "预处理使用了2 mg的潘库溴铵", + "E": "严重肝硬化" + } + }, + { + "id": "a3540407-3f0a-5ce5-9601-0e23af75aab9", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A patient receives an emergency transfusion of three units of O, Rh-negative blood for profuse hemorrhaging. If his blood type is AB, Rh-negative, which of the following is most appropriate for continuing transfusion?", + "A": "AB, Rh-negative whole blood", + "B": "B, Rh-negative whole blood", + "C": "O, Rh-negative whole blood", + "D": "A, Rh-negative erythrocytes", + "E": "O, Rh-negative erythrocytes" + }, + "zh": { + "question": "一名患者因大量出血接受了三单位O型Rh阴性血的紧急输血。如果他的血型是AB型Rh阴性，以下哪种是继续输血的最合适选择？", + "A": "AB型Rh阴性全血", + "B": "B型Rh阴性全血", + "C": "O型Rh阴性全血", + "D": "A型Rh阴性红细胞", + "E": "O型Rh阴性红细胞" + } + }, + { + "id": "ae3b51f8-1a90-5d15-b9f3-a05b7c85f515", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is a manifestation of preeclampsia?", + "A": "Hypovolemia", + "B": "Increased colloid osmotic pressure", + "C": "Natriuresis", + "D": "Resistance to catecholamines", + "E": "Thrombocytosis" + }, + "zh": { + "question": "以下哪项是子痫前期的表现？", + "A": "低血容量", + "B": "胶体渗透压增加", + "C": "排钠增多", + "D": "对儿茶酚胺的抵抗", + "E": "血小板增多" + } + }, + { + "id": "0ee9e40f-484f-5776-b0fe-49578642b371", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The action of dantrolene on skeletal muscle", + "A": "occurs within the neuromuscular junction", + "B": "alters electrical properties of the muscle membrane", + "C": "does not result in muscle relaxation", + "D": "decreases myoplasmic calcium concentration", + "E": "results from competitive inhibition of caffeine" + }, + "zh": { + "question": "丹曲林对骨骼肌的作用", + "A": "发生在神经肌肉接头处", + "B": "改变肌膜的电特性", + "C": "不导致肌肉松弛", + "D": "降低肌浆钙浓度", + "E": "通过竞争性抑制咖啡因实现" + } + }, + { + "id": "d8980a74-164a-5361-a46e-8a385158b0f4", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "To eliminate involuntary expulsive effort with contraction in the second stage of labor, a nerve block must include at least", + "A": "T6-T12", + "B": "T4-S5", + "C": "T8-L2", + "D": "L1-S2", + "E": "S2-S4" + }, + "zh": { + "question": "为了消除第二产程中伴随宫缩的非自主性用力，神经阻滞至少应包括", + "A": "T6-T12", + "B": "T4-S5", + "C": "T8-L2", + "D": "L1-S2", + "E": "S2-S4" + } + }, + { + "id": "9b780910-c8a1-541a-88d2-b74807dfbc54", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "One hour after an open cholecystectomy, a 42-year-old patient is hemodynamically stable and breathing spontaneously (rate 10/min and regular) at an FiO2 of 0.4. Fentanyl, isoflurane, nitrous oxide, and pancuronium were used during the procedure. Analysis of arterial blood gases (pH, pCO2, pO2) is most likely to show:", + "A": "7.18 40 100", + "B": "7.18 60 140", + "C": "7.28 50 85", + "D": "7.40 26 220", + "E": "7.40 40 40" + }, + "zh": { + "question": "在开放性胆囊切除术后一小时，一名42岁的患者血流动力学稳定，自主呼吸（频率10次/分钟且规律），吸入氧浓度为0.4。在手术过程中使用了芬太尼、异氟醚、氧化亚氮和潘库溴铵。动脉血气分析（pH值、pCO2、pO2）最有可能显示：", + "A": "7.18 40 100", + "B": "7.18 60 140", + "C": "7.28 50 85", + "D": "7.40 26 220", + "E": "7.40 40 40" + } + }, + { + "id": "1ed73bee-216a-572a-9221-7ea122f0fa8a", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "The patient at LEAST risk of pulmonary aspiration of gastric contents during induction of anesthesia is", + "A": "markedly obese and NPO for eight hours", + "B": "fed black coffee four hours before elective surgery", + "C": "scheduled for elective cesarean delivery and NPO for 20 hours", + "D": "NPO for four hours after a full meal", + "E": "scheduled for elective repair of a hiatus hernia" + }, + "zh": { + "question": "在麻醉诱导期间，最不容易发生胃内容物吸入肺部风险的患者是", + "A": "明显肥胖且禁食八小时", + "B": "在择期手术前四小时喝了黑咖啡", + "C": "计划进行择期剖宫产且禁食20小时", + "D": "在一顿饱餐后禁食四小时", + "E": "计划进行择期食管裂孔疝修补手术" + } + }, + { + "id": "4da0a395-e6eb-5e9d-bf44-c1d50d4818c3", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Forty-eight hours after thoracotomy, a patient's T6-7 epidural catheter is removed and the distal 2 cm is noted to be missing. The patient felt no pain during removal and neurologic examination shows no abnormalities. After informing the patient, which of the following is the most appropriate next step in management?", + "A": "Observation", + "B": "Culture of cerebrospinal fluid", + "C": "MRI of the thoracic spine", + "D": "Myelography", + "E": "Surgical removal of the catheter" + }, + "zh": { + "question": "开胸术后48小时，患者的T6-7硬膜外导管被移除，发现末端2厘米缺失。患者在移除过程中没有感到疼痛，神经系统检查未见异常。在告知患者后，以下哪项是最合适的下一步处理措施？", + "A": "观察", + "B": "脑脊液培养", + "C": "胸椎MRI", + "D": "脊髓造影", + "E": "手术移除导管" + } + }, + { + "id": "d8dc508f-662a-5348-8c11-9f684b35ccb5", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following changes in pulmonary function best explains the more rapid rate of rise of alveolar concentration of volatile anesthetics in pregnant women than in nonpregnant women?", + "A": "Decreased functional residual capacity", + "B": "Decreased dead space ventilation", + "C": "Increased cardiac output", + "D": "Increased oxygen consumption", + "E": "Increased pulmonary venous admixture" + }, + "zh": { + "question": "以下哪种肺功能变化最能解释妊娠妇女比非妊娠妇女挥发性麻醉剂肺泡浓度上升更快的原因？", + "A": "功能残气量减少", + "B": "无效腔通气减少", + "C": "心输出量增加", + "D": "氧耗量增加", + "E": "肺静脉混合增加" + } + }, + { + "id": "a56ebece-063f-5404-8808-3051c1e9899d", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 56-year-old woman with pulmonary fibrosis is scheduled for pneumonectomy. Which of the following parameters best predicts potential postoperative functional impairment?", + "A": "Exercise tolerance", + "B": "Flow-volume loop", + "C": "Resting arterial blood gas values", + "D": "Unilateral pulmonary artery occlusion pressure", + "E": "Vital capacity and FEV," + }, + "zh": { + "question": "一名56岁的女性患有肺纤维化，计划进行肺切除术。以下哪个参数最能预测潜在的术后功能障碍？", + "A": "运动耐量", + "B": "流量-容量环", + "C": "静息动脉血气值", + "D": "单侧肺动脉阻塞压", + "E": "肺活量和FEV1" + } + }, + { + "id": "d7d5c819-b56d-5207-9835-46e8754f4027", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 72-year-old man has massive venous hemorrhage during a radical prostatectomy. Blood pressure decreases from 110/60 to 75/30 mmHg and central venous pressure decreases from 12 to 4 mmHg. End-expiratory carbon dioxide tension decreases from 34 to 24 mmHg during constant minute ventilation. The most appropriate next step should be to", + "A": "apply positive end-expiratory pressure to the breathing circuit", + "B": "attempt to aspirate air from the central venous catheter", + "C": "expand intravascular volume", + "D": "place the patient in the Trendelenburg position", + "E": "turn the patient to the left lateral decubitus position" + }, + "zh": { + "question": "一名72岁男性在进行根治性前列腺切除术时出现大面积静脉出血。血压从110/60降至75/30 mmHg，中心静脉压从12降至4 mmHg。在恒定分钟通气量下，呼气末二氧化碳张力从34降至24 mmHg。最合适的下一步措施是", + "A": "在呼吸回路中应用呼气末正压", + "B": "尝试从中心静脉导管抽取空气", + "C": "扩充血管内容量", + "D": "将患者置于特伦德伦堡体位", + "E": "将患者转为左侧卧位" + } + }, + { + "id": "e55453bb-cb87-54f5-88c1-eeecd5b010cd", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "With direct arterial blood pressure monitoring", + "A": "systolic pressure in the aortic root exceeds that in the radial artery", + "B": "mean and diastolic pressures are lower in the dorsalis pedis artery than in the aortic root", + "C": "the dicrotic notch is not clearly found on femoral arterial waveforms", + "D": "an underdamped waveform is characteristic of bubbles in the system", + "E": "longer tubing between artery and transducer artifactually augments systolic pressure" + }, + "zh": { + "question": "在直接动脉血压监测中", + "A": "主动脉根部的收缩压高于桡动脉的收缩压", + "B": "足背动脉的平均压和舒张压低于主动脉根部", + "C": "股动脉波形上不明显出现重搏切迹", + "D": "系统中有气泡时，波形特征为欠阻尼", + "E": "动脉与传感器之间的较长导管会人为地增加收缩压" + } + }, + { + "id": "231cf06d-3b3a-520a-99ed-d59b725b0f50", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A patient has severe pain after total knee arthroplasty. Systemic opioids are most likely to modify the pain through action at which of the following sites?", + "A": "Corpus callosum", + "B": "Hippocampus", + "C": "Substantia gelatinosa", + "D": "Substantia nigra", + "E": "Ventral horn of the spinal cord" + }, + "zh": { + "question": "一名患者在全膝关节置换术后出现严重疼痛。全身性阿片类药物最有可能通过作用于以下哪个部位来缓解疼痛？", + "A": "胼胝体", + "B": "海马体", + "C": "胶状质", + "D": "黑质", + "E": "脊髓腹角" + } + }, + { + "id": "d98c8753-7b2b-5362-b300-77944eb69bd5", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Which of the following findings is most likely in a 3-year-old child who has a secundum-type atrial septal defect with a 2:1 left-to-right shunt?", + "A": "Pulmonary blood flow twice that of systemic blood flow", + "B": "Pulmonary vascular resistance twice normal", + "C": "Mean pulmonary artery pressure twice normal", + "D": "Right atrial pressure twice normal", + "E": "Hypoxemia while breathing room air" + }, + "zh": { + "question": "在一名患有继发孔型房间隔缺损且存在2:1左向右分流的3岁儿童中，以下哪项发现最有可能？", + "A": "肺血流量是体循环血流量的两倍", + "B": "肺血管阻力是正常值的两倍", + "C": "平均肺动脉压是正常值的两倍", + "D": "右心房压力是正常值的两倍", + "E": "在吸入室内空气时出现低氧血症" + } + }, + { + "id": "288eefbf-1757-579f-8199-1d39b7e1f675", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Six hours after coronary artery bypass grafting, a pulmonary artery catheter oximeter shows a mixed venous hemoglobin oxygen saturation of 50%. This value may result from each of the following EXCEPT", + "A": "anemia", + "B": "fever", + "C": "hypovolemia", + "D": "respiratory alkalosis", + "E": "shivering" + }, + "zh": { + "question": "冠状动脉旁路移植术后六小时，肺动脉导管血氧计显示混合静脉血红蛋白氧饱和度为50%。以下各项中，除了哪一项外，均可能导致这一数值", + "A": "贫血", + "B": "发热", + "C": "低血容量", + "D": "呼吸性碱中毒", + "E": "发抖" + } + }, + { + "id": "7b13cc86-edaf-54cd-b193-4459de5b31ce", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "Each of the following would be expected in an otherwise healthy 165-kg woman undergoing cholecystectomy EXCEPT", + "A": "decreased functional residual capacity", + "B": "decreased ventilatory response to carbon dioxide", + "C": "increased cardiac output", + "D": "increased gastric fluid volume", + "E": "increased metabolism of volatile anesthetics" + }, + "zh": { + "question": "在一名其他方面健康的165公斤女性进行胆囊切除术时，以下各项中除了哪一项外都可以预期", + "A": "功能残气量减少", + "B": "对二氧化碳的通气反应降低", + "C": "心输出量增加", + "D": "胃液量增加", + "E": "挥发性麻醉药的代谢增加" + } + }, + { + "id": "da2c8e47-9bd3-5473-a2b3-479193729725", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the correct sequence of anatomic structures encountered when using a paramedian approach for lumbar spinal anesthesia?", + "A": "Ligamentum flavum — dura mater — arachnoid mater", + "B": "Interspinous ligament — ligamentum flavum — dura mater — arachnoid mater", + "C": "Posterior longitudinal ligament — ligamentum flavum — dura mater — arachnoid mater", + "D": "Anterior longitudinal ligament — ligamentum flavum — dura mater — arachnoid mater", + "E": "Ligamentum flavum — dura mater — pia mater — arachnoid mater" + }, + "zh": { + "question": "以下哪一项是使用旁正中入路进行腰椎麻醉时遇到的解剖结构的正确顺序？", + "A": "黄韧带 — 硬���膜 — 蛛网膜", + "B": "棘间韧带 — 黄韧带 — 硬脊膜 — 蛛网膜", + "C": "后纵韧带 — 黄韧带 — 硬脊膜 — 蛛网膜", + "D": "前纵韧带 — 黄韧带 — 硬脊膜 — 蛛网膜", + "E": "黄韧带 — 硬脊膜 — 软脊膜 — 蛛网膜" + } + }, + { + "id": "807c0be7-3e74-53e5-9c39-ffcbfa97a887", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following abnormalities in serum is most likely to result from intraoperative discontinuation of parenteral hyperalimentation?", + "A": "Hypocalcemia", + "B": "Hypocarbia", + "C": "Hypoglycemia", + "D": "Hypokalemia", + "E": "Hyponatremia" + }, + "zh": { + "question": "以下哪种血清异常最有可能由于术中停止肠外营养而导致？", + "A": "低钙血症", + "B": "低碳酸血症", + "C": "低血糖", + "D": "低钾血症", + "E": "低钠血症" + } + }, + { + "id": "e0101d8b-b29c-558a-a034-9bc1472e58ce", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "During a right lower lobe resection, SpO2 decreases from 99% to 70% after institution of one-lung ventilation. FiO2 is 1.0. The most appropriate management is to", + "A": "administer an inhaled bronchodilator", + "B": "apply continuous positive airway pressure to the right lung", + "C": "apply positive end-expiratory pressure to the left lung", + "D": "increase tidal volume", + "E": "reinflate the right lung" + }, + "zh": { + "question": "在进行右下叶切除术时，SpO2在实施单肺通气后从99%下降到70%。FiO2为1.0。最合适的处理是", + "A": "给予吸入性支气管扩张剂", + "B": "对右肺施加持续气道正压", + "C": "对左肺施加呼气末正压", + "D": "增加潮气量", + "E": "重新充气右肺" + } + }, + { + "id": "9f9cb729-056b-59ca-a8bd-74d23d940d0a", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following factors causes a decrease in mixed venous oxygen saturation?", + "A": "Arteriovenous fistula", + "B": "Decreased hemoglobin concentration", + "C": "Decreased oxygen consumption", + "D": "Increased cardiac output", + "E": "Nitroprusside toxicity" + }, + "zh": { + "question": "下列哪项因素会导致混合静脉氧饱和度下降？", + "A": "动静脉瘘", + "B": "血红蛋白浓度降低", + "C": "氧耗量减少", + "D": "心输出量增加", + "E": "硝普钠中毒" + } + }, + { + "id": "248f7dbb-c86d-5b60-8c43-800176ce7059", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The effect of succinylcholine is terminated at postsynaptic effector cells by", + "A": "binding and uptake by effector cells", + "B": "diffusion into capillaries", + "C": "hydrolysis by junctional cholinesterase", + "D": "hydrolysis by pseudocholinesterase", + "E": "spontaneous degradation to succinylmonocholine" + }, + "zh": { + "question": "琥珀胆碱在突触后效应细胞的作用终止是通过", + "A": "效应细胞的结合和摄取", + "B": "扩散进入毛细血管", + "C": "连接胆碱酯酶的水解", + "D": "假性胆碱酯酶的水解", + "E": "自发降解为琥珀酰单胆碱" + } + }, + { + "id": "ce8b424a-6415-5470-8021-68dd9817be93", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following factors is LEAST predictive of postoperative cardiac complications?", + "A": "Congestive heart failure", + "B": "Major vascular surgery", + "C": "Premature ventricular contractions", + "D": "Preoperative hypertension", + "E": "Recent myocardial infarction" + }, + "zh": { + "question": "以下哪项因素最不预测术后心脏并发症？", + "A": "充血性心力衰竭", + "B": "重大血管手术", + "C": "室性早搏", + "D": "术前高血压", + "E": "近期心肌梗死" + } + }, + { + "id": "96fad996-5fcd-5ebe-b060-f6df026f02e4", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A healthy, but obese, 110-kg woman is scheduled for gastric stapling. Compared with that required at her ideal weight, the dose of thiopental required for anesthetic induction would likely be increased because of changes in", + "A": "blood volume", + "B": "muscle mass", + "C": "circulation time", + "D": "body fat", + "E": "metabolic rate" + }, + "zh": { + "question": "一位健康但肥胖的110公斤女性计划进行胃缝合手术。与其理想体重所需的剂量相比，麻醉诱导所需的硫喷妥钠剂量可能会增加，因为以下哪项发生了变化？", + "A": "血容量", + "B": "肌肉质量", + "C": "循环时间", + "D": "体脂", + "E": "代谢率" + } + }, + { + "id": "e1c45ba1-1677-5e0c-9439-f51dff6d555a", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 32-year-old woman is anesthetized for suboccipital craniotomy. During positioning, the capnograph shows an abrupt decrease in the slope of the expiratory upstroke. Which of the following is the most likely cause?", + "A": "Air embolism", + "B": "Incompetent expiratory valve", + "C": "Incomplete neuromuscular block", + "D": "Kinked endotracheal tube", + "E": "Tracheal extubation" + }, + "zh": { + "question": "一名32岁的女性接受枕下开颅手术的麻醉。在体位调整过程中，二氧化碳图显示呼气上升斜率突然下降。以下哪项是最可能的原因？", + "A": "空气栓塞", + "B": "呼气阀失效", + "C": "神经肌肉阻滞不完全", + "D": "气管插管扭曲", + "E": "气管拔管" + } + }, + { + "id": "d94073ca-e13c-5911-9a43-4afcc1bcfd82", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The jet ventilation technique using an injector during laryngobronchoscopy relies on", + "A": "air entrainment", + "B": "relative density of inhaled gases", + "C": "presence of an endotracheal tube", + "D": "presence of spontaneous ventilation", + "E": "use of helium-oxygen mixtures" + }, + "zh": { + "question": "在喉支气管镜检查期间使用喷射器的喷射通气技术依赖于", + "A": "空气引流", + "B": "吸入气体的相对密度", + "C": "存在气管插管", + "D": "存在自发通气", + "E": "使用氦氧混合物" + } + }, + { + "id": "d470bb2c-eec6-506d-a793-0ede301b88ad", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 72-year-old woman with stable angina is undergoing bowel resection. Anesthesia is induced with etomidate. Five minutes after starting isoflurane 1% in nitrous oxide 50%, her blood pressure decreases from 110/84 to 70/40 mmHg. The most likely cause is", + "A": "coronary steal produced by isoflurane", + "B": "direct myocardial depression produced by isoflurane", + "C": "vasodilation produced by isoflurane", + "D": "adrenocortical suppression produced by etomidate", + "E": "myocardial depression produced by etomidate" + }, + "zh": { + "question": "一名72岁的女性患有稳定型心绞痛，正在接受肠切除手术。麻醉诱导使用依托咪酯。开始使用1%异氟醚和50%氧化亚氮五分钟后，她的血压从110/84降至70/40 mmHg。最可能的原因是", + "A": "异氟醚引起的冠状动脉盗血", + "B": "异氟醚引起的直接心肌抑制", + "C": "异氟醚引起的血管扩张", + "D": "依托咪酯引起的肾上腺皮质抑制", + "E": "依托咪酯引起的心肌抑制" + } + }, + { + "id": "7689bc52-e354-532d-8b95-92c94de2ee81", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "An increased initial dose and a decreased maintenance dose of pancuronium are required in patients with", + "A": "advanced age", + "B": "burns", + "C": "cirrhosis", + "D": "chronic renal failure", + "E": "fever" + }, + "zh": { + "question": "在以下患者中，使用潘库溴铵需要增加初始剂量并减少维持剂量的是", + "A": "高龄", + "B": "烧伤", + "C": "肝硬化", + "D": "慢性肾衰竭", + "E": "发热" + } + }, + { + "id": "34090ffa-112f-5bb1-8f67-54857e52eeb7", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "If minute ventilation remains constant, which of the following changes in PetCO2 and PaCO2 will result from a decrease in cardiac output? (PetCO2, PaCO2)", + "A": "Decreased, Decreased", + "B": "Increased, Increased", + "C": "Unchanged, Unchanged", + "D": "Decreased, Increased", + "E": "Increased, Decreased" + }, + "zh": { + "question": "如果每分钟通气量保持不变，心输出量减少会导致以下哪种PetCO2和PaCO2的变化？（PetCO2, PaCO2）", + "A": "减少，减少", + "B": "增加，增加", + "C": "不变，不变", + "D": "减少，增加", + "E": "增加，减少" + } + }, + { + "id": "f5cadce5-6c45-5680-b8e1-5033925e4173", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A patient has decreased lung compliance and hypoxemia after a 30-minute episode of laryngospasm following extubation. The most likely cause is", + "A": "allergic reaction to the anesthetic", + "B": "altered alveolar-capillary membrane permeability", + "C": "anesthetic-induced lymphatic dysfunction", + "D": "increased pulmonary capillary pressure", + "E": "negative pulmonary interstitial hydrostatic pressure" + }, + "zh": { + "question": "一名患者在拔管后经历了30分钟的喉痉挛，随后出现肺顺应性下降和低氧血症。最可能的原因是", + "A": "对麻醉药的过敏反应", + "B": "肺泡-毛细血管膜通透性改变", + "C": "麻醉引起的淋巴功能障碍", + "D": "肺毛细血管压力增加", + "E": "肺间质负静水压" + } + }, + { + "id": "ab366874-fc0a-5394-bdd4-20d3a06149a2", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 26-year-old woman comes to a pain clinic because of pain, swelling and limitation of motion in the right knee for six months following a blow to the knee. Findings on knee arthroscopy and leg roentgenograms are normal. The best trial of therapy is", + "A": "right paravertebral lumbar sympathetic nerve block", + "B": "epidural administration of a steroid", + "C": "intrathecal administration of an opioid", + "D": "tricyclic antidepressants for one month", + "E": "a nonsteroidal anti-inflammatory drug for five days" + }, + "zh": { + "question": "一名26岁的女性因右膝疼痛、肿胀和活动受限六个月后到疼痛诊所就诊，此前膝盖曾受到撞击。膝关节镜检查和腿部X光片结果正常。最佳的治疗尝试是", + "A": "右侧椎旁腰交感神经阻滞", + "B": "硬膜外注射类固醇", + "C": "鞘内注射阿片类药物", + "D": "服用三环类抗抑郁药一个月", + "E": "服用非甾体抗炎药五天" + } + }, + { + "id": "23d0e63e-f76d-5b5a-977c-4b0acb626cdf", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following provides the most definitive diagnosis in a patient with suspected brain death?", + "A": "Absent bilateral somatosensory evoked potentials", + "B": "Absent cerebral blood flow during four-vessel contrast cerebral arteriography", + "C": "Intracranial pressure greater than mean arterial pressure", + "D": "Score of zero on Glasgow Coma Scale", + "E": "Two isoelectric electroencephalograms" + }, + "zh": { + "question": "以下哪项为疑似脑死亡患者提供最明确的诊断？", + "A": "双侧体感诱发电位消失", + "B": "四血管对比脑血管造影中脑血流消失", + "C": "颅内压大于平均动脉压", + "D": "格拉斯哥昏迷评分为零", + "E": "两次等电位脑电图" + } + }, + { + "id": "8ea95d4b-08f3-50ab-9f32-dc1459be5df3", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "After an axillary brachial plexus block, the patient feels pain when the surgeon clips the skin over the thenar eminence. The most likely cause is inadequate anesthesia in the distribution of the", + "A": "intercostobrachial nerve", + "B": "median nerve", + "C": "musculocutaneous nerve", + "D": "radial nerve", + "E": "ulnar nerve" + }, + "zh": { + "question": "在腋窝臂丛神经阻滞后，当外科医生夹住鱼际隆起上的皮肤时，患者感到疼痛。最可能的原因是以下哪个神经分布的麻醉不足", + "A": "肋间臂神经", + "B": "正中神经", + "C": "肌皮神经", + "D": "桡神经", + "E": "尺神经" + } + }, + { + "id": "4ba66aac-1b4a-5f5f-ba94-7c455a2538bb", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Compared with similar use in adults, routine use of succinylcholine in children is hazardous because of the increased risk for which of the following?", + "A": "Anaphylactoid reaction", + "B": "Phase II blockade", + "C": "Pseudocholinesterase deficiency", + "D": "Pulmonary aspiration", + "E": "Undiagnosed myopathy" + }, + "zh": { + "question": "与成人的类似使用相比，琥珀胆碱在儿童中的常规使用是危险的，因为增加了以下哪种风险？", + "A": "类过敏反应", + "B": "第二相阻滞", + "C": "假性胆碱酯酶缺乏", + "D": "肺部误吸", + "E": "未诊断的肌病" + } + }, + { + "id": "b005876d-bfce-5ca8-9c66-0a35f1a62a23", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following drugs increases cerebral blood flow while decreasing cerebral metabolic rate?", + "A": "Etomidate", + "B": "Fentanyl", + "C": "Isoflurane", + "D": "Lidocaine", + "E": "Midazolam" + }, + "zh": { + "question": "下列哪种药物在降低脑代谢率的同时增加脑血流量？", + "A": "依托咪酯", + "B": "芬太尼", + "C": "异氟醚", + "D": "利多卡因", + "E": "咪达唑仑" + } + }, + { + "id": "e3a7ff9e-bda5-5dea-afac-64a8c9f57af3", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 35-year-old woman undergoes a one-hour abdominal liposuction procedure under general anesthesia. During the procedure, 2000 ml of crystalloid is administered and 800 ml of fatty tissue is extracted. Thirty minutes postoperatively, blood pressure is 75/40 mmHg and heart rate is 100 bpm; SpO2 is 94% on room air. Which of the following is the most likely cause of these findings?", + "A": "Acute systemic vasodilation", + "B": "Circulating free fatty acids", + "C": "Hypocalcemia", + "D": "Inadequate intravascular volume replacement", + "E": "Venous fat embolism" + }, + "zh": { + "question": "一名35岁的女性在全身麻醉下进行了一小时的腹部抽脂手术。在手术过程中，输注了2000毫升晶体液，并抽取了800毫升脂肪组织。术后30分钟，血压为75/40 mmHg，心率为100次/分钟；在室内空气中，SpO2为94%。以下哪项最可能是这些发现的原因？", + "A": "急性全身血管扩张", + "B": "循环游离脂肪酸", + "C": "低钙血症", + "D": "血管内容量补充不足", + "E": "静脉脂肪栓塞" + } + }, + { + "id": "0abae771-3763-53e0-818c-90470b836e3d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 23-year-old man who is receiving his first anesthetic has not resumed spontaneous ventilation two hours after receiving succinylcholine. The train-of-four monitor shows no twitch response. Which of the following is the most likely cholinesterase genotype in this patient?", + "A": "Atypical : atypical", + "B": "Fluoride-resistant : fluoride-resistant", + "C": "Fluoride-resistant : silent", + "D": "Normal : normal", + "E": "Normal : silent" + }, + "zh": { + "question": "一名23岁的男性正在接受他的第一次麻醉，两小时后在接受琥珀胆碱后仍未恢复自主呼吸。四联刺激监测显示无抽搐反应。以下哪项是该患者最可能的胆碱酯酶基因型？", + "A": "非典型 : 非典型", + "B": "氟耐受 : 氟耐受", + "C": "氟耐受 : 静默", + "D": "正常 : 正常", + "E": "正常 : 静默" + } + }, + { + "id": "d9041861-672c-5775-98aa-1fd3193faab4", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Maximum current is delivered to the myocardium by a countershock for defibrillation when", + "A": "paddle contact pressure is minimal", + "B": "petroleum jelly is used under the paddles", + "C": "previous countershocks of the same power have been attempted", + "D": "the patient is grounded securely", + "E": "the shock is applied at the end of inspiration" + }, + "zh": { + "question": "当进行除颤电击时，最大电流传递到心肌的情况是", + "A": "电极板接触压力最小", + "B": "电极板下使用凡士林", + "C": "尝试过相同功率的先前电击", + "D": "患者接地良好", + "E": "电击在吸气末期施加" + } + }, + { + "id": "d6a2066d-1ff0-54a0-8991-577261bd19f2", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 4-year-old child with myelomeningocele and a ventriculoperitoneal shunt is scheduled for bladder augmentation. One year ago, hypotension and bronchospasm occurred during laparotomy for placement of a feeding gastrostomy and responded to fluids and epinephrine. At that time, anesthesia was induced with thiopental, the trachea was intubated with a polyvinyl tracheal tube following administration of succinylcholine, and anesthesia was maintained with halothane and nitrous oxide. No diagnostic tests were performed after that incident. Which of the following should be avoided during the bladder augmentation?", + "A": "Latex gloves", + "B": "Polyvinyl tracheal tubes", + "C": "Halothane", + "D": "Succinylcholine", + "E": "Thiopental" + }, + "zh": { + "question": "一名患有脊髓脊膜膨出和脑室腹腔分流的4岁儿童计划进行膀胱扩大术。一年前，在进行胃造口术的剖腹手术中发生了低血压和支气管痉挛，并对液体和肾上腺素有反应。当时，麻醉是用硫喷妥钠诱导的，继琥珀胆碱给药后用聚乙烯气管导管插管，麻醉维持用的是氟烷和氧化亚氮。事件发生后没有进行诊断测试。在膀胱扩大术中应避免以下哪项？", + "A": "乳胶手套", + "B": "聚乙烯气管导管", + "C": "氟烷", + "D": "琥珀胆碱", + "E": "硫喷妥钠" + } + }, + { + "id": "c2ee9c24-8a20-5728-9a3f-5f18371c7eb3", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Electrocautery units operate at frequencies between 300 kHz and 2 mHz to", + "A": "avoid pacemaker interference", + "B": "minimize ECG tracing interference", + "C": "minimize the likelihood of ventricular fibrillation", + "D": "optimize hemostasis", + "E": "provide the best \"cutting\" current" + }, + "zh": { + "question": "电烧灼设备在300 kHz到2 mHz的频率下工作是为了", + "A": "避免心脏起搏器干扰", + "B": "减少心电图描记干扰", + "C": "降低心室颤动的可能性", + "D": "优化止血效果", + "E": "提供最佳的“切割”电流" + } + }, + { + "id": "5610df6b-4f68-5605-818c-a770e3b48cf0", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 20-year-old woman with poorly controlled diabetes mellitus is scheduled for urgent drainage of an abdominal abscess. She received an initial dose of regular insulin 10 units followed by regular insulin 5 units/hr for the past five hours. Laboratory studies show serum sodium concentration 128 mEq/L, potassium 5.4 mEq/L, chloride 80 mEq/L, and glucose 750 mg/dl. The most appropriate perioperative management is", + "A": "addition of subcutaneous NPH insulin", + "B": "administration of sodium bicarbonate to correct metabolic acidosis", + "C": "administration of normal saline solution to correct the presumed hypovolemia", + "D": "administration of furosemide to correct hyponatremia", + "E": "infusion of 5% dextrose in 0.2% saline solution to prevent hypoglycemia" + }, + "zh": { + "question": "一名20岁的女性，糖尿病控制不佳，计划进行紧急腹部脓肿引流。她接受了初始剂量为10单位的常规胰岛素，随后在过去五小时内每小时接受5单位的常规胰岛素。实验室检查显示血清钠浓度为128 mEq/L，钾为5.4 mEq/L，氯为80 mEq/L，葡萄糖为750 mg/dl。最合适的围手术期管理是", + "A": "加用皮下注射NPH胰岛素", + "B": "给予碳酸氢钠以纠正代谢性酸中毒", + "C": "给予生理盐水以纠正假定的低血容量", + "D": "给予呋塞米以纠正低钠血症", + "E": "输注5%葡萄糖在0.2%盐水中以防止低血糖" + } + }, + { + "id": "b494d48e-8e5a-5b40-ad81-cd6dc1d82691", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following is the most reliable indicator of antagonism of nondepolarizing neuromuscular block sufficient for airway protection?", + "A": "Clinically assessed ulnar nerve train-of-four ratio of 0.75", + "B": "Peak negative pressure of 25 cmH2O", + "C": "End-tidal PC02 of 40 mmHg during spontaneous ventilation", + "D": "Sustained head lift for 5 seconds", + "E": "Vital capacity of 15 ml/kg" + }, + "zh": { + "question": "以下哪项是充分拮抗非去极化神经肌肉阻滞以保护气道的最可靠指标？", + "A": "临床评估的尺神经四联刺激比率为0.75", + "B": "峰值负压为25 cmH2O", + "C": "自主呼吸时呼气末二氧化碳分压为40 mmHg", + "D": "持续抬头5秒", + "E": "肺活量为15 ml/kg" + } + }, + { + "id": "accc3a65-56e2-5094-940e-467015ddd509", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A patient becomes flushed, dyspneic, and hypotensive during transfusion of 1 unit of packed red blood cells in the PACU. After discontinuing the transfusion, the most appropriate next step is administration of", + "A": "aminophylline", + "B": "cimetidine", + "C": "diphenhydramine", + "D": "epinephrine", + "E": "hydrocortisone" + }, + "zh": { + "question": "一名患者在PACU输注1单位浓缩红细胞时出现潮红、呼吸困难和低血压。在停止输血后，最合适的下一步是给予", + "A": "氨茶碱", + "B": "西咪替丁", + "C": "苯海拉明", + "D": "肾上腺素", + "E": "氢化可的松" + } + }, + { + "id": "751bbbec-a975-5d44-94b3-f986d6dde98c", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Positive end-expiratory pressure is effective for treatment of hypoxia resulting from each of the following EXCEPT", + "A": "cardiogenic pulmonary edema", + "B": "intraoperative Trendelenburg position", + "C": "lateral position during total hip replacement", + "D": "lung contusion", + "E": "status asthmaticus" + }, + "zh": { + "question": "呼气末正压通气对以下各项导致的低氧症的治疗有效，除了", + "A": "心源性肺水肿", + "B": "术中头低脚高位", + "C": "全髋关节置换术中的侧卧位", + "D": "肺挫伤", + "E": "哮喘持续状态" + } + }, + { + "id": "70fbad04-cea6-5db0-9787-d761e59ed058", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 70-kg 78-year-old man undergoing small-bowel resection during anesthesia with isoflurane in oxygen becomes hypotensive and develops frothy pink sputum in the endotracheal tube. Heart rate is 50 bpm, blood pressure is 75/60 mmHg, pulmonary artery occlusion pressure is 22 mmHg, and cardiac output is 1.7 L/min. The most appropriate initial step in management is administration of which of the following?", + "A": "Albumin", + "B": "Digoxin", + "C": "Dopamine", + "D": "Esmolol", + "E": "Nitroglycerin" + }, + "zh": { + "question": "一名70公斤的78岁男性在使用异氟醚和氧气进行麻醉的小肠切除术中出现低血压，并在气管导管中出现粉红色泡沫痰。心率为50次/分钟，血压为75/60 mmHg，肺动脉楔压为22 mmHg，心输出量为1.7 L/分钟。最合适的初始处理步骤是给予以下哪种药物？", + "A": "白蛋白", + "B": "地高辛", + "C": "多巴胺", + "D": "艾司洛尔", + "E": "硝酸甘油" + } + }, + { + "id": "ce967aec-b965-542f-aedd-1772d8c5049f", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 40-year-old woman with Graves' disease is undergoing thyroidectomy with 1% isoflurane, 60% nitrous oxide, and oxygen. During surgical manipulation of the thyroid, temperature increases to 38.5°C, heart rate to 160 bpm, and blood pressure to 150/100 mmHg. The most appropriate initial treatment is to", + "A": "administer dantrolene sodium", + "B": "administer potassium iodide", + "C": "administer propranolol", + "D": "administer propylthiouracil", + "E": "increase the concentration of isoflurane" + }, + "zh": { + "question": "一名40岁的女性患有Graves病，正在接受甲状腺切除术，使用1%异氟醚、60%氧化亚氮和氧气。在手术操作甲状腺期间，体温升高至38.5°C，心率升高至160次/分钟，血压升高至150/100 mmHg。最合适的初始治疗是", + "A": "给予丹曲林钠", + "B": "给予碘化钾", + "C": "给予普萘洛尔", + "D": "给予丙硫氧嘧啶", + "E": "增加异氟醚的浓度" + } + }, + { + "id": "5f9f29aa-51db-57f8-b14e-9fbb99e8930d", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "The adult oxyhemoglobin dissociation curve will resemble that of the fetus in the presence of", + "A": "increased 2,3-diphosphoglycerate concentration", + "B": "chronic anemia", + "C": "hyperthermia", + "D": "metabolic alkalemia", + "E": "hyperkalemia" + }, + "zh": { + "question": "在以下哪种情况下，成人的氧合血红蛋白解离曲线会类似于胎儿的曲线？", + "A": "2,3-二磷酸甘油酸浓度增加", + "B": "慢性贫血", + "C": "高热", + "D": "代谢性碱中毒", + "E": "高钾血症" + } + }, + { + "id": "42bb1246-83cc-5345-81f0-85253cd8fed5", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 26-year-old woman has headache, nausea, and photophobia 36 hours after cesarean delivery for chorioamnionitis using subarachnoid block. Temperature is 38.8°C and leukocyte count is 14,200/mm3. Which of the following is the most appropriate next step in management?", + "A": "Oral ibuprofen", + "B": "Intravenous caffeine sodium benzoate", + "C": "Intravenous hydration", + "D": "Epidural blood patch", + "E": "Diagnostic lumbar puncture" + }, + "zh": { + "question": "一名26岁的女性在因绒毛膜羊膜炎进行硬膜下阻滞剖宫产术后36小时出现头痛、恶心和畏光。体温为38.8°C，白细胞计数为14,200/mm3。以下哪项是最合适的下一步管理措施？", + "A": "口服布洛芬", + "B": "静脉注射咖啡因苯甲酸钠", + "C": "静脉补液", + "D": "硬膜外血补片", + "E": "诊断性腰椎穿刺" + } + }, + { + "id": "84379cdd-aec3-53d5-9c2f-e807df32309d", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following pulmonary components is altered the most in a morbidly obese patient?", + "A": "Total lung volume", + "B": "Tidal volume", + "C": "Inspiratory reserve volume", + "D": "Expiratory reserve volume", + "E": "Ratio of dead space to tidal volume" + }, + "zh": { + "question": "在病态肥胖患者中，以下哪种肺部成分的变化最大？", + "A": "肺总量", + "B": "潮气量", + "C": "吸气储备量", + "D": "呼气储备量", + "E": "死腔与潮气量的比率" + } + }, + { + "id": "f14a7820-0f99-5120-97de-c6cc7fd17988", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Arterial oxyhemoglobin desaturation develops more rapidly following apnea in a pregnant patient at term than in a nonpregnant patient with a large intra-abdominal tumor. Which of the following findings in pregnancy is the most likely cause?", + "A": "Higher cardiac output", + "B": "Higher oxygen consumption", + "C": "Larger anatomic dead space", + "D": "Smaller blood volume", + "E": "Smaller functional residual capacity" + }, + "zh": { + "question": "妊娠足月患者在呼吸暂停后动脉氧合血红蛋白去饱和比患有大腹部肿瘤的非妊娠患者发展得更快。以下哪项妊娠期的发现最可能是原因？", + "A": "心输出量更高", + "B": "氧耗量更高", + "C": "解剖无效腔更大", + "D": "血容量更小", + "E": "功能残气量更小" + } + }, + { + "id": "afc4d1b2-70ff-5384-b367-904528c73913", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A healthy, 18-year-old, 65-kg woman undergoing diagnostic laparoscopy is being monitored with a properly functioning and calibrated capnograph. The end-tidal carbon dioxide concentration is 6%, and the inspired carbon dioxide concentration is 1%. This may be caused by each of the following EXCEPT", + "A": "malfunction of the expiratory valve in a circle system", + "B": "low gas inflow with a Bain circuit", + "C": "exhausted soda lime within a circle system", + "D": "absorption of carbon dioxide from carbon dioxide laparoscopy", + "E": "carbon dioxide in the fresh gas flow" + }, + "zh": { + "question": "一名健康的18岁65公斤女性正在接受诊断性腹腔镜检查，使用功能正常且校准良好的呼气末二氧化碳监测仪进行监测。呼气末二氧化碳浓度为6%，吸入二氧化碳浓度为1%。这可能由以下原因引起，除了", + "A": "环路系统中呼气阀故障", + "B": "Bain回路中气体流入量低", + "C": "环路系统中苏打石灰耗尽", + "D": "腹腔镜手术中二氧化碳的吸收", + "E": "新鲜气流中的二氧化碳" + } + }, + { + "id": "3ab3aa21-f107-508a-bd6d-25e2d7eefc46", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 67-year-old man is undergoing total hip replacement under general anesthesia. He had a permanent endocardial VVI pacemaker placed two years ago for complete heart block, and since arrival in the operating room has been paced continuously. Use of the electrocautery causes the pacemaker to malfunction intermittently. The most appropriate management is to", + "A": "tape a magnet over the pacemaker generator and convert to asynchronous mode", + "B": "do nothing since the pacemaker is programmed to deal with this circumstance", + "C": "stop the surgeon from using the electrocautery", + "D": "limit the surgeon to 10 sec/min electrocautery bursts", + "E": "place the electrocautery indifferent lead as close as possible to the pacemaker" + }, + "zh": { + "question": "一名67岁的男性在全身麻醉下进行全髋关节置换术。两年前，他因完全性心脏传导阻滞植入了永久性心内膜VVI起搏器，自进入手术室以来一直在起搏。使用电灼器导致起搏器间歇性故障。最合适的处理方法是", + "A": "在起搏器发生器上贴一个磁铁并转换为异步模式", + "B": "不采取任何措施，因为起搏器已编程处理这种情况", + "C": "阻止外科医生使用电灼器", + "D": "限制外科医生每分钟使用电灼器10秒", + "E": "将电灼器的无关电极尽可能靠近起搏器放置" + } + }, + { + "id": "c2578935-8174-585a-9de7-4472a7502b93", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is the most frequent cause of hemorrhagic diathesis after administration of 20 units of CPD-stored blood over six hours?", + "A": "Disseminated intravascular coagulation", + "B": "Hypofibrinogenemia", + "C": "Low plasma concentrations of factors V and VIII", + "D": "Primary fibrinolysis", + "E": "Thrombocytopenia" + }, + "zh": { + "question": "在六小时内输注20单位CPD储存血后，以下哪项是出血性素质最常见的原因？", + "A": "弥散性血管内凝血", + "B": "低纤维蛋白原血症", + "C": "血浆中V因子和VIII因子浓度低", + "D": "原发性纤溶", + "E": "血小板减少症" + } + }, + { + "id": "4df7169c-fdbe-548a-bbed-e5fc5095b279", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "Postoperatively, a patient is being mechanically ventilated by a constant-flow, pressure-cycled ventilator with the following initial settings: inspiratory/expiratory (I/E) ratio of 1:2, peak inspiratory pressure (PIP) of 25 cmH2O, and rate of 10/min. One hour later, the I/E ratio is 1:4. Which of the following would ensure that the minute ventilation is the same as that initially set?", + "A": "Inflate the endotracheal tube cuff to prevent leakage", + "B": "Double the respiratory rate", + "C": "Decrease the expiratory pause until the I/E ratio is 1.0", + "D": "Increase the PIP until the I/E ratio is 1:2", + "E": "Increase the PIP to 50 cmH20" + }, + "zh": { + "question": "术后，一名患者正在使用恒流、压力循环呼吸机进行机械通气，初始设置如下：吸气/呼气（I/E）比为1:2，峰值吸气压（PIP）为25 cmH2O，频率为10次/分钟。一小时后，I/E比为1:4。以下哪项措施可以确保分钟通气量与最初设置相同？", + "A": "充气气管导管套囊以防止漏气", + "B": "将呼吸频率加倍", + "C": "减少呼气暂停时间直到I/E比为1.0", + "D": "增加PIP直到I/E比为1:2", + "E": "将PIP增加到50 cmH2O" + } + }, + { + "id": "eeb43311-52f9-52fe-9692-cb4fdac8710d", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Retrobulbar block for ophthalmologic surgery can be administered safely to patients with which of the following conditions?", + "A": "Agitation", + "B": "Bleeding disorder", + "C": "Frequent coughing spasms", + "D": "Increased intraocular pressure", + "E": "Perforated globe" + }, + "zh": { + "question": "对于眼科手术，以下哪种情况的患者可以安全地进行球后阻滞？", + "A": "烦躁不安", + "B": "出血性疾病", + "C": "频繁咳嗽痉挛", + "D": "眼内压升高", + "E": "眼球穿孔" + } + }, + { + "id": "caaf7563-0cf5-5647-bd16-3d7af8b5eb20", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "During cardiopulmonary bypass, the perfusionist notes that the mixed venous oxygen saturation has decreased from to 55%. Which of the following is the most likely cause?", + "A": "Administration of a nitroprusside bolus", + "B": "Administration of a thiopental bolus", + "C": "Decrease in rectal temperature from 34°C to 28°C", + "D": "Inadequate muscle relaxation", + "E": "Increase in pump flow" + }, + "zh": { + "question": "在体外循环期间，灌注师注意到混合静脉氧饱和度已降至55%。以下哪项是最可能的原因？", + "A": "注射硝普钠推注", + "B": "注射硫喷妥钠推注", + "C": "直肠温度从34°C降至28°C", + "D": "肌肉松弛不充分", + "E": "泵流量增加" + } + }, + { + "id": "76d641c2-3e6c-5f44-8902-70b2d8b5aeb3", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "In a patient who has undergone cholecystectomy, which of the following is the most likely pulmonary effect of systemically administered opioids?", + "A": "Decreased Qs/Qt", + "B": "Decreased dead space", + "C": "Restored vital capacity", + "D": "Restored functional residual capacity", + "E": "Shift of the carbon dioxide response curve to the right" + }, + "zh": { + "question": "在接受胆囊切除术的患者中，系统性给予阿片类药物最可能导致以下哪种肺部效应？", + "A": "Qs/Qt 减少", + "B": "死腔减少", + "C": "恢复肺活量", + "D": "恢复功能残气量", + "E": "二氧化碳反应曲线右移" + } + }, + { + "id": "4fba2294-39d1-54c2-893e-f991772e607d", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 28-year-old woman undergoes total thyroidectomy. The left recurrent laryngeal nerve is transected during the procedure. Which of the following findings is most likely postoperatively?", + "A": "Normal voice", + "B": "Aphonia", + "C": "Hoarseness", + "D": "Expiratory stridor", + "E": "Inspiratory stridor" + }, + "zh": { + "question": "一名28岁的女性接受了全甲状腺切除术。在手术过程中，左侧喉返神经被切断。术后最可能出现以下哪种情况？", + "A": "声音正常", + "B": "失音", + "C": "声音嘶哑", + "D": "呼气性喘鸣", + "E": "吸气性喘鸣" + } + }, + { + "id": "09f5b0c2-d423-5401-abd8-3d299e4de07b", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following conditions can be accurately evaluated with transesophageal echocardiography EXCEPT", + "A": "intimal tear at the aortic arch", + "B": "intracardiac air", + "C": "left atrial thrombus", + "D": "patent foramen ovale", + "E": "right atrial myxoma" + }, + "zh": { + "question": "以下每种情况都可以通过经食道超声心动图准确评估，除了", + "A": "主动脉弓内膜撕裂", + "B": "心内空气", + "C": "左心房血栓", + "D": "卵圆孔未闭", + "E": "右心房粘液瘤" + } + }, + { + "id": "7dc46002-743b-575c-85d3-e3047fbc2051", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The most common clinical viral infection following homologous blood transfusion is caused by", + "A": "cytomegalovirus", + "B": "Epstein-Barr virus", + "C": "hepatitis B virus", + "D": "human immunodeficiency virus", + "E": "non-A, non-B hepatitis virus" + }, + "zh": { + "question": "同种异体输血后最常见的临床病毒感染是由哪种病毒引起的", + "A": "巨细胞病毒", + "B": "Epstein-Barr病毒", + "C": "乙型肝炎病毒", + "D": "人类免疫缺陷病毒", + "E": "非甲非乙型肝炎病毒" + } + }, + { + "id": "e736024e-2845-52f3-bdbf-851602bc87b7", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning postherpetic neuralgia is true?", + "A": "It is effectively treated with neurolytic surgery", + "B": "It is effectively treated with sympathetic nerve blocks", + "C": "Duration is three to four weeks", + "D": "Hyperesthesia occurs in the affected area", + "E": "It occurs predominantly in adolescents" + }, + "zh": { + "question": "以下关于带状疱疹后神经痛的说法哪一项是正确的？", + "A": "通过神经���解手术有效治疗", + "B": "通过交感神经阻滞有效治疗", + "C": "持续时间为三到四周", + "D": "受影响区域出现感觉过敏", + "E": "主要发生在青少年中" + } + }, + { + "id": "3664c9be-011d-5520-b3ee-4f0ad0ef142c", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 60-kg 25-year-old woman is undergoing laparoscopy in the Trendelenburg position during general anesthesia. Five minutes after peritoneal inflation, the peak airway pressure required to deliver a tidal volume of 800 ml increases from 25 cmH2O to 60 cmH2O. SpO2 decreases from 100% to 80% and systolic blood pressure increases from 110 mmHg to 140 mmHg. Which of the following is the most likely cause?", + "A": "Acute tension pneumothorax", + "B": "Excessively steep Trendelenburg position", + "C": "Excessive ventilator tidal volume setting", + "D": "Kink in the endotracheal tube", + "E": "Massive carbon dioxide embolism" + }, + "zh": { + "question": "一名60公斤的25岁女性在全身麻醉下进行特伦德伦堡体位的腹腔镜手术。腹膜充气五分钟后，输送800毫升潮气量所需的气道峰压从25 cmH2O增加到60 cmH2O。SpO2从100%下降到80%，收缩压从110 mmHg上升到140 mmHg。以下哪项是最可能的原因？", + "A": "急性张力性气胸", + "B": "特伦德伦堡体位过于陡峭", + "C": "呼吸机潮气量设置过高", + "D": "气管导管扭曲", + "E": "大量二氧化碳栓塞" + } + }, + { + "id": "5d0b109a-be53-51a1-98de-b5f367cc5628", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 6-year-old child with asthma begins wheezing during anesthesia with halothane and nitrous oxide in oxygen. A loading dose of aminophylline is administered followed by continuous infusion. Premature ventricular contractions appear on the ECG. The most appropriate management is to", + "A": "administer fentanyl", + "B": "discontinue aminophylline", + "C": "increase exhalation time", + "D": "increase the inspired concentration of halothane", + "E": "switch the inhalational agent to isoflurane" + }, + "zh": { + "question": "一名6岁哮喘儿童在使用氟烷和氧化亚氮与氧气麻醉期间开始出现喘息。给予氨茶碱负荷剂量后进行持续输注。心电图上出现早期心室收缩。最合适的处理是", + "A": "给予芬太尼", + "B": "停止氨茶碱", + "C": "增加呼气时间", + "D": "增加吸入氟烷的浓度", + "E": "将吸入剂换成异氟醚" + } + }, + { + "id": "f0f68536-0bb1-5e04-bc5a-48d4cc43b183", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "During uncomplicated mask induction with halothane and 50% nitrous oxide in oxygen in a 6-month-old infant with a large ventricular septal defect and valvular pulmonic stenosis, SpO2 decreases from 85% (room air) to 60%; heart rate is 100 bpm and blood pressure is 62/40 mmHg. The most appropriate management is to", + "A": "administer atropine", + "B": "administer phenylephrine", + "C": "administer propranolol", + "D": "increase anesthetic depth", + "E": "intubate the trachea" + }, + "zh": { + "question": "在一名患有大型室间隔缺损和瓣膜性肺动脉狭窄的6个月大婴儿中，使用氟烷和50%氧化亚氮在氧气中的无并发症面罩诱导过程中，SpO2从85%（室内空气）下降到60%；心率为100次/分钟，血压为62/40 mmHg。最合适的处理是", + "A": "给予阿托品", + "B": "给予去氧肾上腺素", + "C": "给予普萘洛尔", + "D": "增加麻醉深度", + "E": "插管气管" + } + }, + { + "id": "b8f00c66-471a-59cf-909d-701852054160", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A newly developed volatile anesthetic has a MAC of 10% in oxygen for adults. Which of the following statements concerning this anesthetic is true?", + "A": "The expected MAC of this drug in combination with 60% nitrous oxide is 7.5%", + "B": "The dose of this drug required to anesthetize a patient with acute amphetamine intoxication is less than the dose required for a normal patient", + "C": "The potency of this drug is 25% of a drug with a MAC of 2.5%", + "D": "The dose of this drug required to suppress the hormonal response to surgical incision is less than the MAC value", + "E": "The MAC of this drug is decreased by metabolic alkalosis" + }, + "zh": { + "question": "一种新开发的挥发性麻醉剂在成人中氧气中的MAC为10%。关于这种麻醉剂，下列哪项陈述是正确的？", + "A": "该药物与60%一氧化二氮联合使用时的预期MAC为7.5%", + "B": "急性苯丙胺中毒患者所需的该药物剂量小于正常患者所需剂量", + "C": "该药物的效力是MAC为2.5%药物的25%", + "D": "抑制手术切口激素反应所需的该药物剂量小于MAC值", + "E": "代谢性碱中毒会降低该药物的MAC" + } + }, + { + "id": "d1c7860e-501c-57cf-a3d0-ab1754f9e744", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is the best method of pacing to improve cardiac output in a patient with third-degree heart block?", + "A": "VOO", + "B": "AOO", + "C": "VVI", + "D": "DVI", + "E": "Transcutaneous" + }, + "zh": { + "question": "以下哪种起搏方法最适合改善三度心脏传导阻滞患者的心输出量？", + "A": "VOO", + "B": "AOO", + "C": "VVI", + "D": "DVI", + "E": "经皮" + } + }, + { + "id": "c667ac71-e567-5548-9528-add36833dd60", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following best reflects findings of inadequate cerebral perfusion during carotid cross clamping?", + "A": "Decreased frequency on EEG", + "B": "Increased latency of brain stem auditory evoked potentials", + "C": "Increased spectral edge frequency", + "D": "Jugular bulb oxygen tension of 27 mmHg", + "E": "Stump pressure of 50 mmHg" + }, + "zh": { + "question": "以下哪项最能反映颈动脉夹闭期间脑灌注不足的发现？", + "A": "脑电图频率降低", + "B": "脑干听觉诱发电位潜伏期延长", + "C": "频谱边缘频率增加", + "D": "颈静脉球氧张力为27 mmHg", + "E": "残端压力为50 mmHg" + } + }, + { + "id": "068c5561-6e41-5ceb-bd37-0e8b4ccefa03", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 54-year-old man receives 25 ml of a 50% alcohol and 0.25% bupivacaine solution for celiac plexus block. During the next 20 minutes, blood pressure decreases from 130/75 mmHg to 85/55 mmHg. Which of the following is the most likely cause?", + "A": "Intravascular injection", + "B": "Retroperitoneal hemorrhage", + "C": "Splanchnic vasodilation", + "D": "Subarachnoid blockade", + "E": "Tension pneumothorax" + }, + "zh": { + "question": "一名54岁的男性接受了25毫升50%酒精和0.25%布比卡因溶液的腹腔神经丛阻滞。在接下来的20分钟内，血压从130/75 mmHg下降到85/55 mmHg。以下哪项是最可能的原因？", + "A": "血管内注射", + "B": "腹膜后出血", + "C": "内脏血管扩张", + "D": "蛛网膜下腔阻滞", + "E": "张力性气胸" + } + }, + { + "id": "44bb0e21-754f-50a1-9216-c5b4f135ad7f", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The physiologic function most likely to be spared when a local anesthetic differential nerve block is administered is", + "A": "sweating", + "B": "temperature sensation", + "C": "proprioception", + "D": "touch sensation", + "E": "pain sensation" + }, + "zh": { + "question": "在施行局部麻醉差异性神经阻滞时，最有可能被保留的生理功能是", + "A": "出汗", + "B": "温度感觉", + "C": "本体感觉", + "D": "触觉", + "E": "痛觉" + } + }, + { + "id": "9c390154-71b6-52c2-bf50-6f8e9df8a0d5", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Block of each of the following nerves is required for inguinal herniorrhaphy EXCEPT the", + "A": "genitofemoral", + "B": "iliohypogastric", + "C": "ilioinguinal", + "D": "obturator", + "E": "twelfth thoracic" + }, + "zh": { + "question": "以下神经的阻滞是腹股沟疝修补术所需的，除了", + "A": "生殖股神经", + "B": "髂腹下神经", + "C": "髂腹股沟神经", + "D": "闭孔神经", + "E": "第十二胸神经" + } + }, + { + "id": "73f61b47-4454-510a-b495-b9caa7faab7f", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Hemodilution is used during profound hypothermic cardiopulmonary bypass primarily because it", + "A": "decreases cold-induced coagulopathy", + "B": "decreases edema formation", + "C": "increases oxygen-carrying capacity of plasma", + "D": "increases oxygen dissociation from hemoglobin", + "E": "limits the cold-induced increase in blood viscosity" + }, + "zh": { + "question": "在深度低温体外循环中，稀释血液的主要目的是", + "A": "减少冷诱导的凝血障碍", + "B": "减少水肿形成", + "C": "增加血浆的携氧能力", + "D": "增加血红蛋白的氧解离", + "E": "限制冷诱导的血液粘度增加" + } + }, + { + "id": "2a76c4f1-f571-57a2-ba57-3fd72ce4d4e9", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following structures may participate in causing acute bradycardia during strabismus surgery EXCEPT the", + "A": "globe", + "B": "rectus muscles", + "C": "optic nerve", + "D": "trigeminal nerve", + "E": "vagus nerve" + }, + "zh": { + "question": "在斜视手术中，以下结构中可能导致急性心动过缓的有，除了", + "A": "眼球", + "B": "直肌", + "C": "视神经", + "D": "三叉神经", + "E": "迷走神经" + } + }, + { + "id": "e3fd137b-fe4d-5ff1-b4f2-566657551cb2", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Intrabiliary pressure will be increased to the greatest extent by intravenous administration of", + "A": "atropine", + "B": "glucagon", + "C": "naloxone", + "D": "fentanyl", + "E": "butorphanol" + }, + "zh": { + "question": "静脉注射哪种药物会最大程度地增加胆道内压力？", + "A": "阿托品", + "B": "胰高血糖素", + "C": "纳洛酮", + "D": "芬太尼", + "E": "布托啡诺" + } + }, + { + "id": "1d052d02-6bf1-5503-a495-f9aea7a5282f", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "During axillary brachial plexus anesthesia, motor block frequently precedes sensory block because of", + "A": "conduction velocity of motor fibers", + "B": "myelination of motor fibers", + "C": "size of motor fibers", + "D": "presence of septa between motor fibers", + "E": "peripheral location of motor fibers in the nerve bundle" + }, + "zh": { + "question": "在腋窝臂丛麻醉中，运动阻滞常常先于感觉阻滞，因为", + "A": "运动纤维的传导速度", + "B": "运动纤维的髓鞘化", + "C": "运动纤维的大小", + "D": "运动纤维之间隔膜的存在", + "E": "运动纤维在神经束中的外周位置" + } + }, + { + "id": "c2dc95cd-ef41-5250-bebf-1e9a89f4a18d", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the most common initial manifestation of malignant hyperthermia?", + "A": "Hyperkalemia", + "B": "Increased distal esophageal temperature", + "C": "Increased PETCO2", + "D": "Red discoloration of urine", + "E": "Ventricular irritability" + }, + "zh": { + "question": "以下哪项是恶性高热最常见的初始表现？", + "A": "高钾血症", + "B": "远端食管温度升高", + "C": "呼气末二氧化碳分压增加", + "D": "尿液呈红色", + "E": "心室易激惹" + } + }, + { + "id": "81bcf691-b51d-5ce4-a5dc-465145d9c94e", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "Following pneumonectomy, a paralyzed patient being mechanically ventilated has the following arterial blood gas values: PaO2 71 mmHg, PaCO2 55 mmHg, pH 7.29. SvO2 is 45%. The most likely explanation for this SvO2 is", + "A": "decreased red cell mass", + "B": "high cardiac output", + "C": "hypothermia", + "D": "peripheral left-to-right arteriovenous shunt", + "E": "ventilation / perfusion mismatch" + }, + "zh": { + "question": "在全肺切除术后，一名瘫痪的患者正在接受机械通气，其动脉血气值如下：PaO2 71 mmHg，PaCO2 55 mmHg，pH 7.29。SvO2 为 45%。这种 SvO2 最可能的解释是", + "A": "红细胞质量减少", + "B": "心输出量高", + "C": "低体温", + "D": "外���左至右动静脉分流", + "E": "通气/灌注不匹配" + } + }, + { + "id": "602b0320-db22-56d1-a324-7d6025215ca0", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Intrathecally administered opioids exert their analgesic effects primarily in the", + "A": "brain stem", + "B": "fourth ventricle", + "C": "spinal nerve roots", + "D": "spinothalamic tracts", + "E": "substantia gelatinosa" + }, + "zh": { + "question": "鞘内给药的阿片类药物主要在以下哪个部位发挥镇痛作用？", + "A": "脑干", + "B": "第四脑室", + "C": "脊神经根", + "D": "脊髓丘脑束", + "E": "胶状质" + } + }, + { + "id": "8a0658b2-33fe-5e67-898b-a33208b4186f", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with the adult airway, the airway of an infant is characterized by", + "A": "greater narrowing at the cricoid ring", + "B": "a less rigid epiglottis", + "C": "a more caudad laryngeal opening", + "D": "a relatively smaller tongue", + "E": "relatively larger tonsils" + }, + "zh": { + "question": "与成人气道相比，婴儿的气道特点是", + "A": "环状软骨处的狭窄更明显", + "B": "会厌软骨较不坚硬", + "C": "喉部开口位置更靠尾端", + "D": "相对较小的舌头", + "E": "相对较大的扁桃体" + } + }, + { + "id": "df35df73-aaab-5c81-bbde-dfafe18f0019", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning the check valve of the common gas outlet on an anesthesia gas machine is true?", + "A": "It prevents backflow into vaporizers", + "B": "It prevents delivery of a hypoxic mixture", + "C": "It prevents rebreathing", + "D": "It is located downstream from the oxygen flush valve", + "E": "It is required for proper functioning of the proportioning system" + }, + "zh": { + "question": "关于麻醉气体机上普通气体出口的止回阀，下列哪项陈述是正确的？", + "A": "它防止气体回流到蒸发器", + "B": "它防止低氧混合物的输送", + "C": "它防止再呼吸", + "D": "它位于氧气冲洗阀的下游", + "E": "它是比例系统正常运行所必需的" + } + }, + { + "id": "39c7c4e3-6cbf-5461-97e1-0224f3921e8f", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following combinations of hemoglobin, blood gases, and cardiac output provides the greatest delivery of oxygen to tissue? (Hb, PaO2, SaO2, CO)", + "A": "7.0 85 95\t7.0", + "B": "8.0\t 290 100\t8.0", + "C": "9.9\t 61 90\t9.8", + "D": "12.0 140 100 4.5", + "E": "16.0 40 75\t5.8" + }, + "zh": { + "question": "以下哪种血红蛋白、血气和心输出量的组合能提供最大的组织氧输送？（Hb, PaO2, SaO2, CO）", + "A": "7.0 85 95\t7.0", + "B": "8.0\t 290 100\t8.0", + "C": "9.9\t 61 90\t9.8", + "D": "12.0 140 100 4.5", + "E": "16.0 40 75\t5.8" + } + }, + { + "id": "4091878d-3d58-5090-a26a-15d06c7e8dc2", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following parts of the infant's airway determines the appropriate diameter of a nasotracheal tube?", + "A": "Nares", + "B": "Glottis", + "C": "Vocal cords", + "D": "Cricoid cartilage", + "E": "Third tracheal ring" + }, + "zh": { + "question": "以下哪一部分婴儿的气道决定了鼻气管插管的适当直径？", + "A": "鼻孔", + "B": "声门", + "C": "声带", + "D": "环状软骨", + "E": "第三气管环" + } + }, + { + "id": "d83b3871-09d9-59dc-ab8d-80bc01076eaf", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "Massive venous air embolism occurs in a patient who is undergoing craniotomy in the sitting position with nitrous oxide, oxygen, fentanyl anesthesia. Which of the following changes in end-tidal (ET) concentrations of carbon dioxide, nitrogen, and nitrous oxide are most likely in this patient? (ETCO2, ETN2, ETN2O)", + "A": "Increased, increased, decreased", + "B": "Decreased, decreased, increased", + "C": "Decreased, decreased, decreased", + "D": "Decreased, increased, decreased", + "E": "Increased, decreased, decreased" + }, + "zh": { + "question": "一名患者在坐位下接受颅骨切开术，并使用氧化亚氮、氧气、芬太尼麻醉时发生大量静脉空气栓塞。该患者的呼气末二氧化碳、氮气和氧化亚氮浓度最有可能出现以下哪种变化？（ETCO2, ETN2, ETN2O）", + "A": "增加，增加，减少", + "B": "减少，减少，增加", + "C": "减少，减少，减少", + "D": "减少，增加，减少", + "E": "增加，减少，减少" + } + }, + { + "id": "03f1d2ff-714f-5b5c-a01a-558db29b873c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with a patient without liver disease, a patient with cirrhosis will have", + "A": "greater accumulation of vecuronium with infusion", + "B": "increased unbound plasma vecuronium concentration", + "C": "more frequent occurrence of phase II block after succinylcholine administration", + "D": "prolonged elimination half-life of atracurium", + "E": "unchanged volume of distribution for pancuronium" + }, + "zh": { + "question": "与没有肝病的患者相比，肝硬化患者将有", + "A": "输注维库溴铵时更大的积累", + "B": "游离血浆维库溴铵浓度增加", + "C": "琥珀胆碱给药后更频繁出现II期阻滞", + "D": "阿曲库铵的消除半衰期延长", + "E": "潘库溴铵的分布容积不变" + } + }, + { + "id": "e51ff39a-f2f4-5d60-ac3c-e7a8f931ad49", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A delay in surgery for 24 to 48 hours for preoperative stabilization and preparation is acceptable in each of the following neonatal conditions EXCEPT", + "A": "biliary atresia", + "B": "diaphragmatic hernia", + "C": "meningomyelocele", + "D": "pyloric stenosis", + "E": "tracheoesophageal fistula" + }, + "zh": { + "question": "在以下每种新生儿病症中，术前稳定和准备延迟手术24至48小时是可以接受的，除了", + "A": "胆道闭锁", + "B": "膈疝", + "C": "脊膜脊髓膨出", + "D": "幽门狭窄", + "E": "气管食管瘘" + } + }, + { + "id": "c871b4ce-da4f-5fcb-a5a2-a8b269f83f89", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "During acute normovolemic hemodilution in an adult, which of the following compensatory mechanisms is most important in maintaining tissue oxygenation?", + "A": "Increased cardiac output", + "B": "Increased oxygen extraction", + "C": "Increased synthesis of erythropoietin", + "D": "Redistribution of regional blood flow", + "E": "Shift of the oxyhemoglobin dissociation curve" + }, + "zh": { + "question": "在成人急性等容血液稀释过程中，以下哪种代偿机制在维持组织氧合中最为重要？", + "A": "心输出量增加", + "B": "氧提取增加", + "C": "促红细胞生成素合成增加", + "D": "区域血流重新分配", + "E": "氧合血红蛋白解离曲线的移动" + } + }, + { + "id": "2fb08a3c-ed2c-5d97-bc6f-caa3f5b14bd5", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Each of the following improves coagulation in patients with uremia EXCEPT", + "A": "conjugated estrogens", + "B": "desmopressin", + "C": "dialysis", + "D": "epsilon-aminocaproic acid", + "E": "platelet transfusion" + }, + "zh": { + "question": "以下各项中，除了哪一项外，其他都能改善尿毒症患者的凝血功能？", + "A": "结合雌激素", + "B": "去氨加压素", + "C": "透析", + "D": "ε-氨基己酸", + "E": "血小板输注" + } + }, + { + "id": "cb4fe7d8-ce40-5865-9021-fd3e7714da7b", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The most likely cause of a fetal heart rate pattern of variable decelerations to 90 bpm is", + "A": "aortocaval compression", + "B": "compression of the fetal head", + "C": "fetal acidosis", + "D": "maternal hypotension", + "E": "umbilical cord compression" + }, + "zh": { + "question": "胎心率模式出现变异减速至90次/分钟的最可能原因是", + "A": "主动脉腔静脉压迫", + "B": "胎头受压", + "C": "胎儿酸中毒", + "D": "母体低血压", + "E": "脐带受压" + } + }, + { + "id": "edb05c0a-e0e7-55a6-8052-1e87d9415fe4", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is the most likely cause of apnea occurring after a retrobulbar block?", + "A": "Epidural injection", + "B": "Increased intracranial pressure", + "C": "Oculopontine reflex", + "D": "Ophthalmic artery injection", + "E": "Subarachnoid injection" + }, + "zh": { + "question": "以下哪项最有可能是发生在球后阻滞后呼吸暂停的原因？", + "A": "硬膜外注射", + "B": "颅内压增高", + "C": "眼桥反射", + "D": "眼动脉注射", + "E": "蛛网膜下腔注射" + } + }, + { + "id": "93ec0d02-c927-539d-9057-b566b75b713c", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A middle-aged, 70-kg man with a brain tumor is scheduled for an elective craniotomy. Preoperatively, he is alert but papilledema is present. Anesthesia is induced with thiopental 300 mg and succinylcholine 100 mg, followed by tracheal intubation. Immediately following intubation vigorous bucking occurs. The best immediate management would be to", + "A": "administer succinylcholine 100 mg intravenously", + "B": "administer fentanyl 500 jug intravenously", + "C": "hyperventilate with isoflurane 2%", + "D": "administer thiopental 400 mg intravenously", + "E": "hyperventilate and administer lidocaine 1 mg/kg intravenously" + }, + "zh": { + "question": "一名中年70公斤的男性患有脑肿瘤，计划进行择期开颅手术。术前他神志清醒，但存在视乳头水肿。麻醉诱导使用硫喷妥钠300毫克和琥珀胆碱100毫克，随后进行气管插管。插管后立即出现剧烈的呛咳。最佳的立即处理方法是", + "A": "静脉注射琥珀胆碱100毫克", + "B": "静脉注射芬太尼500微克", + "C": "用2%异氟醚进行过度通气", + "D": "静脉注射硫喷妥钠400毫克", + "E": "过度通气并静脉注射利多卡因1毫克/公斤" + } + }, + { + "id": "f2fc429e-4edd-5b59-898a-936dc53d7a2e", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 3-day-old infant is comatose 18 hours after surgical correction of transposition of the great vessels. Tracheal suctioning produces only a tachycardic response. Anesthesia included midazolam 0.5 mg/kg, fentanyl 60 mcg/kg, and pancuronium 0.3 mg/kg. Which of the following is the most appropriate first step in evaluation of this infant?", + "A": "Administration of flumazenil", + "B": "Administration of naloxone", + "C": "Train-of-four assessment", + "D": "CT scan of the head", + "E": "EEG" + }, + "zh": { + "question": "一名3天大的婴儿在大血管转位手术矫正后18小时处于昏迷状态。气管吸引仅引起心动过速反应。麻醉包括咪达唑仑0.5 mg/kg、芬太尼60 mcg/kg和潘库溴铵0.3 mg/kg。以下哪项是评估该婴儿的最合适的第一步？", + "A": "给予氟马西尼", + "B": "给予纳洛酮", + "C": "四个刺激评估", + "D": "头部CT扫描", + "E": "脑电图" + } + }, + { + "id": "62cbed71-f125-560d-ba07-153583d1565b", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 62-year-old man, who had a myocardial infarction three years ago, complicated by congestive heart failure and renal failure, is undergoing a colectomy. A pulmonary artery catheter demonstrates a cardiac output higher than measurements recorded during a cardiac catheterization two months after the infarction. Which of the following most likely contributes to the increased cardiac output?", + "A": "Creation of an arteriovenous fistula", + "B": "Increased hemoglobin concentration from 10 to 12 g/dl", + "C": "Stimulation of carotid body receptors", + "D": "Transcutaneous nitroglycerin", + "E": "Use of a beta-adrenergic blocker to prevent myocardial reinfarction" + }, + "zh": { + "question": "一名62岁的男性，三年前发生心肌梗死，伴有充血性心力衰竭和肾功能衰竭，正在接受结肠切除术。肺动脉导管显示心输出量高于心肌梗死后两个月心导管检查时的测量值。以下哪项最可能导致心输出量增加？", + "A": "动静脉瘘的形成", + "B": "血红蛋白浓度从10增加到12 g/dl", + "C": "颈动脉体感受器的刺激", + "D": "经皮硝酸甘油", + "E": "使用β-肾上腺素能阻滞剂以防止心肌再梗死" + } + }, + { + "id": "acf0b573-0623-5ab8-b9a9-29c0ff5ba8bd", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "During a reoperative total hip arthroplasty requiring transfusion of 8 units of packed red blood cells, blood begins to ooze from the operative field and intravenous catheter sites. Urine is pink. The most likely cause is", + "A": "citrate intoxication", + "B": "factor V and VIII deficiencies", + "C": "rhabdomyolysis", + "D": "thrombocytopenia", + "E": "transfusion reaction" + }, + "zh": { + "question": "在需要输注8个单位的浓缩红细胞的再次全髋关节置换术中，血液开始从手术区域和静脉导管部位渗出。尿液呈粉红色。最可能的原因是", + "A": "柠檬酸盐中毒", + "B": "因子V和VIII缺乏", + "C": "横纹肌溶解症", + "D": "血小板减少症", + "E": "输血反应" + } + }, + { + "id": "01f815d6-ac94-5f45-a8ca-0d605c253c16", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A patient is scheduled for amputation of the third metatarsal. A tourniquet will not be used during the procedure. The most effective anesthesia will be provided by block of which of the following nerves?", + "A": "Femoral", + "B": "Common peroneal and tibial", + "C": "Sural and deep peroneal", + "D": "Sural and tibial", + "E": "Tibial, saphenous, and deep peroneal" + }, + "zh": { + "question": "一名患者计划进行第三跖骨截肢手术。手术过程中不会使用止血带。最有效的麻醉将通过阻滞以下哪一条神经提供？", + "A": "股神经", + "B": "腓总神经和胫神经", + "C": "腓肠神经和腓深神经", + "D": "腓肠神经和胫神经", + "E": "胫神经、隐神经和腓深神经" + } + }, + { + "id": "e29eeab1-aabf-5009-99d7-be232acabe01", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A patient has palpitations, flushing, and light-headedness after gingival injection of a local anesthetic. This reaction is most likely caused by", + "A": "epinephrine in the local anesthetic", + "B": "local anesthetic allergy", + "C": "para-aminobenzoic acid allergy", + "D": "methylparaben reaction", + "E": "vasovagal reaction" + }, + "zh": { + "question": "患者在牙龈注射局部麻醉剂后出现心悸、潮红和头晕。这种反应最可能是由以下哪种原因引起的？", + "A": "局部麻醉剂中的肾上腺素", + "B": "局部麻醉剂过敏", + "C": "对对氨基苯甲酸的过敏", + "D": "对甲基对羟基苯甲酸酯的反应", + "E": "血管迷走神经反应" + } + }, + { + "id": "9d1f0e27-3872-5bd8-929b-346dbb8a85cc", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is an effect of nitrous oxide?", + "A": "Decreased pulmonary vascular resistance", + "B": "Depression of uterine contractility", + "C": "Inhibition of methionine synthetase", + "D": "Stimulation of lymphocyte chemotaxis", + "E": "Stimulation of myocardial contractility" + }, + "zh": { + "question": "下列哪项是笑气的作用？", + "A": "降低肺血管阻力", + "B": "抑制子宫收缩", + "C": "抑制蛋氨酸合成酶", + "D": "刺激淋巴细胞趋化", + "E": "刺激心肌收缩力" + } + }, + { + "id": "cb810603-dc25-5a68-b311-576668664473", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "One week after sustaining third-degree burns over 40% of his body surface area, a patient requires general anesthesia for debridement and skin grafting. Which of the following responses to neuromuscular blockers is most likely?", + "A": "Clinically insignificant increases in serum potassium concentration after administration of succinylcholine 1 mg/kg", + "B": "Increased risk of hyperkalemia after administration of succinylcholine 1 mg/kg", + "C": "Increased sensitivity to vecuronium", + "D": "Laudanosine toxicity after administration of atracurium 0.4 mg/kg", + "E": "Normal serum potassium concentration if administration of succinylcholine is preceded by d-tubocurarine 3 mg" + }, + "zh": { + "question": "在经历了三度烧伤覆盖40%体表面积一周后，患者需要全身麻醉进行清创和植皮。以下哪种对肌肉松弛剂的反应最有可能？", + "A": "注射1 mg/kg 琥珀胆碱后血清钾浓度临床上无显著增加", + "B": "注射1 mg/kg 琥珀胆碱后高钾血症风险增加", + "C": "对维库溴铵的敏感性增加", + "D": "注射0.4 mg/kg 阿曲库铵后劳达诺辛毒性", + "E": "如果在注射琥珀胆碱之前给予3 mg d-筒箭毒碱，血清钾浓度正常" + } + }, + { + "id": "e50542e8-2880-5adf-999d-e1b2bbdbdf07", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Blind nasotracheal intubation is contraindicated in the presence of", + "A": "a basilar skull fracture", + "B": "a comminuted mandibular fracture", + "C": "an orbital blow-out fracture", + "D": "an unstable cervical spine fracture", + "E": "a zygomatic arch fracture" + }, + "zh": { + "question": "在以下情况下，盲法鼻气管插管是禁忌的", + "A": "颅底骨折", + "B": "粉碎性下颌骨骨折", + "C": "眼眶爆裂性骨折", + "D": "不稳定的颈椎骨折", + "E": "颧弓骨折" + } + }, + { + "id": "e100fedf-86d3-5d11-a979-6fc0da88c9f8", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Four hours after open cholecystectomy, a patient who is breathing spontaneously has an SpO2 of 93% in the supine position and an SpO2 of 98% when placed in the head-up position. The most likely cause of this change is an increase in which of the following?", + "A": "Functional residual capacity", + "B": "Minute ventilation", + "C": "Pulmonary blood flow", + "D": "Residual volume", + "E": "Vital capacity" + }, + "zh": { + "question": "在开放性胆囊切除术后四小时，一名患者在自主呼吸时，仰卧位的SpO2为93%，而在抬头位时SpO2为98%。这种变化最可能的原因是以下哪一项的增加？", + "A": "功能残气量", + "B": "每分钟通气量", + "C": "肺血流量", + "D": "残气量", + "E": "肺活量" + } + }, + { + "id": "46830d20-4e95-5864-b1dc-76167947a502", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements regarding carbon monoxide poisoning is true?", + "A": "Breathing 100% oxygen at 1 atmosphere reduces the carboxyhemoglobin half-life", + "B": "Effective treatment includes administration of methylene blue", + "C": "It is commonly associated with respiratory acidosis", + "D": "It is incompatible with a normal Sp02 while breathing room air", + "E": "The oxyhemoglobin dissociation curve is shifted to the right" + }, + "zh": { + "question": "以下关于一氧化碳中毒的说法哪一项是正确的？", + "A": "在1个大气压下吸入100%氧气可减少碳氧血红蛋白的半衰期", + "B": "有效的治疗包括使用亚甲蓝", + "C": "通常与呼吸性酸中毒有关", + "D": "在吸入室内空气时与正常的SpO2不相容", + "E": "氧合血红蛋白解离曲线向右移" + } + }, + { + "id": "d3765b54-a3a9-5237-b049-bfb3b81ede96", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "During pulmonary artery catheterization, a 65-year-old man receives morphine 6 mg and scopolamine 0.4 mg intravenously. The pulse oximeter indicates desaturation, which quickly resolves with stimulation. When the drapes are removed, he has unilateral eye pain, decreased visual acuity, and dilated and irregular pupils. These eye symptoms are most likely caused by", + "A": "retinal hemorrhage", + "B": "morphine-induced oculogyric crisis", + "C": "corneal abrasion", + "D": "carotid artery embolization", + "E": "angle-closure glaucoma" + }, + "zh": { + "question": "在进行肺动脉导管插入术时，一名65岁的男性静脉注射了6毫克吗啡和0.4毫克东莨菪碱。脉搏血氧仪显示脱氧，但在刺激下迅速恢复。当移开手术单时，他出现单侧眼痛、视力下降以及瞳孔散大和不规则。这些眼部症状最可能是由以下哪种原因引起的", + "A": "视网膜出血", + "B": "吗啡引起的眼球危象", + "C": "角膜擦伤", + "D": "颈动脉栓塞", + "E": "闭角型青光眼" + } + }, + { + "id": "f6666614-1846-593c-a9dc-c08175d24b52", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 90-kg, 59-year-old man with chronic obstructive pulmonary disease is undergoing laparotomy. Mechanical ventilation is being carried out with a fresh gas flow of 2 L/min at a rate of 16/min and tidal volume of 900 ml; I:E ratio is 1:2.5. PaCO2 remains greater than 50 mmHg. Preoperative PaCO2, was normal. Which of the following is the most appropriate next step?", + "A": "Adding 10 cmH20 of positive end-expiratory pressure", + "B": "Converting to spontaneous ventilation", + "C": "Decreasing inspiratory flow rate", + "D": "Increasing exhalation time", + "E": "Increasing fresh gas flow" + }, + "zh": { + "question": "一名90公斤、59岁的慢性阻塞性肺病男性患者正在接受剖腹手术。机械通气以2 L/min的新鲜气体流量、16次/分钟的频率和900 ml的潮气量进行；吸呼比为1:2.5。PaCO2仍然大于50 mmHg。术前PaCO2正常。以下哪项是最合适的下一步措施？", + "A": "增加10 cmH2O的呼气末正压", + "B": "转换为自主呼吸", + "C": "降低吸气流速", + "D": "增加呼气时间", + "E": "增加新鲜气体流量" + } + }, + { + "id": "cac6d9d5-4d64-5680-91bf-0590524bd6ec", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements concerning isolated mitral stenosis is true?", + "A": "Afterload reduction increases cardiac output", + "B": "Pulmonary artery occlusion pressure overestimates left ventricular filling pressure", + "C": "Pulmonary hypertension is irreversible", + "D": "Tachycardia decreases the mitral transvalvular gradient", + "E": "Thermodilution cardiac output measurements are unreliable" + }, + "zh": { + "question": "以下关于孤立性二尖瓣狭窄的陈述中哪一项是正确的？", + "A": "后负荷减少增加心输出量", + "B": "肺动脉阻塞压高估左心室充盈压", + "C": "肺动脉高压是不可逆的", + "D": "心动过速降低二尖瓣跨瓣压差", + "E": "热稀释法测量心输出量不可靠" + } + }, + { + "id": "3d58a62c-197a-5003-a69c-29b80ac0627d", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Preoperative evaluation of a patient who has marked malnutrition will demonstrate each of the following EXCEPT", + "A": "decreased respiratory muscle function", + "B": "decreased serum albumin concentration", + "C": "decreased metabolic rate", + "D": "suppressed immune function", + "E": "decreased extracellular fluid volume" + }, + "zh": { + "question": "对严重营养不良患者的术前评估将显示以下各项，除了", + "A": "呼吸肌功能下降", + "B": "血清白蛋白浓度下降", + "C": "代谢率下降", + "D": "免疫功能抑制", + "E": "细胞外液量减少" + } + }, + { + "id": "6d44a69f-f83f-56a6-bce5-a1504395737b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning banked blood is true?", + "A": "Red blood cells preserved with CPDA-1 have a shelf life of approximately 21 days", + "B": "Packed red blood cells deliver oxygen normally immediately after administration", + "C": "Packed red blood cells contain most of the leukocytes present in the donated unit", + "D": "Citrate is used as a source of energy for whole blood", + "E": "Stored whole blood contains all coagulation factors except II and VIII" + }, + "zh": { + "question": "以下关于库存血液的陈述中哪一项是正确的？", + "A": "用CPDA-1保存的红细胞的保质期约为21天", + "B": "输注后，浓缩红细胞能够立即正常输送氧气", + "C": "浓缩红细胞含有捐献单位中大部分的白细胞", + "D": "柠檬酸盐被用作全血的能量来源", + "E": "储存的全血含有除II和VIII以外的所有凝血因子" + } + }, + { + "id": "e0dffc5f-4e49-52c0-a31b-6e2a281bcb8f", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Statistical analysis of 20 patients shows a mean cardiac output (CO) of 5 L/min with a standard deviation of 1 L/min. The distribution pattern in the sample population is normal. Which of the following is the most appropriate conclusion?", + "A": "Approximately 33% of the sample population would be expected to have a CO between 4 and 6 L/min", + "B": "Approximately 95% of the sample population would be expected to have a CO between 3 and 7 L/min", + "C": "Ten of the sample patients have a cardiac output greater than 5 L/min", + "D": "The mean and the median are both at the 50th percentile", + "E": "The median and the mode are the same in the sample population" + }, + "zh": { + "question": "对20名患者的统计分析显示，平均心输出量（CO）为5 L/min，标准差为1 L/min。样本人群的分布模式是正态分布。以下哪项是最合适的结论？", + "A": "大约33%的样本人群预计心输出量在4到6 L/min之间", + "B": "大约95%的样本人群预计心输出量在3到7 L/min之间", + "C": "样本中有10名患者的心输出量大于5 L/min", + "D": "平均值和中位数都在第50百分位", + "E": "样本人群中的中位数和众数相同" + } + }, + { + "id": "5dcc5eb6-ecbe-50e6-9ca5-2df0e6d21380", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The drug that causes dose-dependent EEG evidence of both central nervous system excitation and depression is", + "A": "lidocaine", + "B": "halothane", + "C": "thiopental", + "D": "nitrous oxide", + "E": "midazolam" + }, + "zh": { + "question": "引起剂量依赖性脑电图显示中枢神经系统既兴奋又抑制的药物是", + "A": "利多卡因", + "B": "氟烷", + "C": "硫喷妥钠", + "D": "一氧化二氮", + "E": "咪达唑仑" + } + }, + { + "id": "fc0937b6-f131-568b-886b-5ecdea6ac251", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Each of the following would be expected after preoperative oral administration of clonidine EXCEPT", + "A": "bradycardia in the absence of surgical stimulation", + "B": "decreased requirement for inhalational anesthetics", + "C": "decreased requirement for opioid anesthetics", + "D": "decreased response to exogenous epinephrine", + "E": "sedation" + }, + "zh": { + "question": "以下每项都是术前口服可乐定后预期的结果，除了", + "A": "在没有手术刺激的情况下出现心动过缓", + "B": "吸入麻醉药的需求减少", + "C": "阿片类麻醉药的需求减少", + "D": "对外源性肾上腺素的反应减少", + "E": "镇静" + } + }, + { + "id": "03f90816-c37f-5b7f-91f9-1c3c5eda074d", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Epidural administration of corticosteroids is most effective in relieving pain in patients with which of the following conditions?", + "A": "Back pain caused by metastatic cancer", + "B": "Postherpetic neuralgia", + "C": "Postlaminectomy syndrome", + "D": "Postural low back pain", + "E": "Radiculopathy following disk herniation" + }, + "zh": { + "question": "硬膜外注射皮质类固醇在缓解以下哪种情况的患者疼痛最有效？", + "A": "由转移性癌症引起的背痛", + "B": "带状疱疹后神经痛", + "C": "椎板切除术后综合征", + "D": "姿势性下背痛", + "E": "椎间盘突出后引起的神经根病" + } + }, + { + "id": "a87281be-752d-5747-aeba-182a6c63978d", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements concerning use of amitriptyline to treat chronic pain is true?", + "A": "It acts primarily via opioid receptors", + "B": "It increases serotonin levels in the brain", + "C": "It is rarely effective for postherpetic neuralgia", + "D": "Onset of action occurs after four to six weeks of treatment", + "E": "Response depends on reversal of depression" + }, + "zh": { + "question": "以下关于使用阿米替林治疗慢性疼痛的说法中哪一项是正确的？", + "A": "它主要通过阿片受体起作用", + "B": "它增加大脑中的血清素水平", + "C": "它对带状疱疹后神经痛很少有效", + "D": "作用开始于治疗四到六周后", + "E": "反应取决于抑郁症的逆转" + } + }, + { + "id": "b2d716f7-1f9f-5694-856a-e210c8b6fcb5", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning neuroleptic malignant syndrome is true?", + "A": "It does not respond to dantrolene therapy", + "B": "It is inherited as an autosomal trait", + "C": "It is not triggered by succinylcholine", + "D": "It occurs after long-term use of L-dopa", + "E": "The halothane-caffeine contracture test is negative in susceptible patients" + }, + "zh": { + "question": "以下关于神经阻滞性恶性综合征的说法哪一项是正确的？", + "A": "它对丹曲林治疗无反应", + "B": "它是作为常染色体性状遗传的", + "C": "它不是由琥珀胆碱引发的", + "D": "它发生在长期使用左旋多巴之后", + "E": "在易感患者中，卤烷-咖啡因收缩试验为阴性" + } + }, + { + "id": "373aefc5-4b65-548f-b3c5-945eac8b3a1e", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Compared with epidural morphine, intrathecal morphine produces", + "A": "better relief of visceral pain", + "B": "greater loss of analgesia after administration of naloxone", + "C": "less pruritus", + "D": "less urinary retention", + "E": "more respiratory depression" + }, + "zh": { + "question": "与硬膜外吗啡相比，鞘内吗啡产生", + "A": "更好的内脏疼痛缓解", + "B": "在使用纳洛酮后更大的镇痛丧失", + "C": "更少的瘙痒", + "D": "更少的尿潴留", + "E": "更多的呼吸抑制" + } + }, + { + "id": "943765eb-5621-5673-88af-6085b0cf7ac5", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A newborn infant is undergoing repair of gastroschisis. During closure of the abdominal wall, ventilatory pressures and central venous pressure increase markedly. The most appropriate management is to", + "A": "administer a bronchodilator", + "B": "decrease tidal volume and increase ventilatory rate", + "C": "increase the neuromuscular block", + "D": "increase the depth of anesthesia", + "E": "ask the surgeon to reopen the abdomen" + }, + "zh": { + "question": "一名新生儿正在进行腹裂修复手术。在关闭腹壁期间，通气压力和中心静脉压显著增加。最合适的处理是", + "A": "给予支气管扩张剂", + "B": "减少潮气量并增加通气频率", + "C": "增加神经肌肉阻滞", + "D": "加深麻醉深度", + "E": "要求外科医生重新打开腹部" + } + }, + { + "id": "8fbe76aa-d2d7-53fd-8187-37bc1eb4ddcf", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following additives accelerates the onset of lidocaine axillary block without shortening duration?", + "A": "Carbon dioxide", + "B": "Dextran", + "C": "Dextrose", + "D": "Epinephrine", + "E": "Hyaluronidase" + }, + "zh": { + "question": "以下哪种添加剂可以加速利多卡因腋窝阻滞的起效时间而不缩短其持续时间？", + "A": "二氧化碳", + "B": "右旋糖酐", + "C": "葡萄糖", + "D": "肾上腺素", + "E": "透明质酸酶" + } + }, + { + "id": "3a47daac-d0d8-5b09-b9d5-3dfc318b2541", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 25-year-old woman undergoes a difficult open cholecystectomy during anesthesia with isoflurane, nitrous oxide, fentanyl, and vecuronium. Five units of blood are administered intraoperatively. Two days later, the patient has mildly increased serum transaminase concentrations and markedly increased alkaline phosphatase and direct bilirubin concentrations. Which of the following is the most likely cause?", + "A": "Acute viral hepatitis", + "B": "Hemolysis", + "C": "Isoflurane-induced liver dysfunction", + "D": "Retained common duct stone", + "E": "Sepsis" + }, + "zh": { + "question": "一名25岁的女性在使用异氟醚、氧化亚氮、芬太尼和维库溴铵进行麻醉时接受了一次困难的开放性胆囊切除术。术中输注了五个单位的血液。两天后，患者的血清转氨酶浓度轻度升高，碱性磷酸酶和直接胆红素浓度显著升高。以下哪项是最可能的原因？", + "A": "急性病毒性肝炎", + "B": "溶血", + "C": "异氟醚引起的肝功能障碍", + "D": "残留的胆总管结石", + "E": "败血症" + } + }, + { + "id": "ab4a8c4c-e0f1-5310-ab21-454d3a53f31b", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "An otherwise healthy 20-year-old man undergoes laser surgery for vocal cord polyp removal. During jet ventilation with 100% oxygen, arterial blood gas analysis shows PaO2 90 mmHg, PaCO2 40 mmHg, and pH 7.40. Which of the following is the most likely explanation?", + "A": "Aspiration of gastric contents", + "B": "Atelectasis", + "C": "Pneumothorax", + "D": "Pulmonary embolism", + "E": "Room air entrainment" + }, + "zh": { + "question": "一名身体健康的20岁男性接受声带息肉切除的激光手术。在使用100%氧气进行喷射通气时，动脉血气分析显示PaO2 90 mmHg，PaCO2 40 mmHg，pH 7.40。以下哪项是最可能的解释？", + "A": "胃内容物吸入", + "B": "肺不张", + "C": "气胸", + "D": "肺栓塞", + "E": "室内空气吸入" + } + }, + { + "id": "059db4a2-a003-5c9b-b762-b8b2a65e57a5", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following would be most likely to result in neonatal depression when administered to a healthy parturient during an uncomplicated labor and vaginal delivery?", + "A": "Nitrous oxide 60% in oxygen supplemented with halothane 0.5% for 10 minutes before delivery", + "B": "Ketamine 20 mg intravenously 30 minutes before delivery", + "C": "Meperidine 100 mg intramuscularly 2 hours before delivery", + "D": "Thiopental 100 mg intravenously 30 minutes before delivery", + "E": "Nitrous oxide 60% in oxygen supplemented with enflurane 0.7% for 10 minutes before delivery" + }, + "zh": { + "question": "在健康的产妇进行无并发症的分娩和阴道分娩过程中，以下哪种情况最有可能导致新生儿抑制？", + "A": "在分娩前10分钟给予氧气中补充60%一氧化二氮和0.5%氟烷", + "B": "在分娩前30分钟静脉注射20毫克氯胺酮", + "C": "在分娩前2小时肌肉注射100毫克哌替啶", + "D": "在分娩前30分钟静脉注射100毫克硫喷妥钠", + "E": "在分娩前10分钟给予氧气中补充60%一氧化二氮和0.7%安氟醚" + } + }, + { + "id": "e6563715-811d-5780-8b85-b34c7d2ced98", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following perioperative interventions decreases the risk for renal insufficiency in patients undergoing aortic aneurysm repair?", + "A": "Administration of furosemide", + "B": "Administration of mannitol", + "C": "Administration of renal-dose dopamine", + "D": "Epidural anesthesia", + "E": "Preoperative volume expansion" + }, + "zh": { + "question": "以下哪项围手术期干预措施可降低接受主动脉瘤修复术患者发生肾功能不全的风险？", + "A": "给予呋塞米", + "B": "给予甘露醇", + "C": "给予肾剂量多巴胺", + "D": "硬膜外麻醉", + "E": "术前容量扩充" + } + }, + { + "id": "e59c1191-5329-5ccd-b4b0-3a95d9f686cf", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the most likely sequela of interscalene brachial plexus block?", + "A": "Cervical epidural block", + "B": "Hemidiaphragmatic paralysis", + "C": "Pneumothorax", + "D": "Seizure", + "E": "Vocal cord paralysis" + }, + "zh": { + "question": "以下哪项最可能是斜角肌间隙臂丛神经阻滞的后遗症？", + "A": "颈椎硬膜外阻滞", + "B": "半膈肌麻痹", + "C": "气胸", + "D": "癫痫发作", + "E": "声带麻痹" + } + }, + { + "id": "d560c58a-1e63-5c8e-a410-2440f88531dc", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Prompt control of seizures induced by bupivacaine is necessary because", + "A": "cerebral metabolic rate for oxygen increases more than cerebral blood flow", + "B": "cerebral blood flow is increased", + "C": "bupivacaine decreases aerobic cerebral metabolism", + "D": "cardiac failure may occur", + "E": "ventilation may be impaired" + }, + "zh": { + "question": "需要及时控制由布比卡因引起的癫痫发作，因为", + "A": "脑的氧代谢率增加超过脑血流量", + "B": "脑血流量增加", + "C": "布比卡因降低了有氧脑代谢", + "D": "可能发生心力衰竭", + "E": "通气可能受损" + } + }, + { + "id": "67fc6502-ece5-5a71-952c-537e17317181", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A patient receives remifentanil 25 mcg just before retrobulbar block with 0.25% bupivacaine 4 mL. Over the next 10 minutes, he develops apnea and loses consciousness. Which of the following is the most likely explanation?", + "A": "Effects of remifentanil", + "B": "Injection of local anesthetic into cerebrospinal fluid", + "C": "Intravascular injection of local anesthetic", + "D": "Oculocardiac reflex", + "E": "Systemic absorption of local anesthetic" + }, + "zh": { + "question": "一名患者在接受0.25%布比卡因4毫升的球后阻滞前刚刚注射了25微克瑞芬太尼。在接下来的10分钟内，他出现了呼吸暂停并失去意识。以下哪项是最可能的解释？", + "A": "瑞芬太尼的作用", + "B": "局部麻醉剂注入脑脊液", + "C": "局部麻醉剂的血管内注射", + "D": "眼心反射", + "E": "局部麻醉剂的全身吸收" + } + }, + { + "id": "e22fc47c-a60f-53aa-9606-fca3da49cf05", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A patient has severe hypotension, bronchospasm, and edema of the upper airway after injection of radiocontrast medium during cerebral angiography. The most appropriate immediate treatment is administration of", + "A": "diphenhydramine", + "B": "epinephrine", + "C": "methylprednisolone", + "D": "phenylephrine", + "E": "ranitidine" + }, + "zh": { + "question": "一名患者在脑血管造影过程中注射造影剂后出现严重低血压、支气管痉挛和上呼吸道水肿。最合适的立即治疗是给予", + "A": "苯海拉明", + "B": "肾上腺素", + "C": "甲泼尼龙", + "D": "去氧肾上腺素", + "E": "雷尼替丁" + } + }, + { + "id": "f87a3a90-bf14-53b6-abeb-0b8b2386ce42", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "During craniotomy in the sitting position, end-tidal carbon dioxide tension suddenly decreases. Ventilatory excursion of the chest is normal. Further evaluation is most likely to show a decrease in", + "A": "alveolar-to-arterial oxygen tension difference", + "B": "alveolar-to-arterial carbon dioxide tension difference", + "C": "dead space ventilation", + "D": "pulmonary artery pressure", + "E": "pulmonary artery occlusion pressure" + }, + "zh": { + "question": "在坐位开颅手术中，呼气末二氧化碳张力突然下降。胸部通气活动正常。进一步评估最可能显示减少的是", + "A": "肺泡-动脉氧张力差", + "B": "肺泡-动脉二氧化碳张力差", + "C": "无效腔通气", + "D": "肺动脉压", + "E": "肺动脉阻塞压" + } + }, + { + "id": "9a7a27b2-dcf2-56ed-851c-669bdc8d92ca", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Preoperative administration of an alpha-adrenergic blocker for 10 days to patients with pheochromocytoma will decrease", + "A": "episodic tachycardia", + "B": "hyperglycemia", + "C": "hypovolemia", + "D": "nasal stuffiness", + "E": "postural hypotension" + }, + "zh": { + "question": "对嗜铬细胞瘤患者术前给予α-肾上腺素能阻滞剂10天将减少", + "A": "阵发性心动过速", + "B": "高血糖", + "C": "低血容量", + "D": "鼻塞", + "E": "体位性低血压" + } + }, + { + "id": "12810c49-7d9f-510b-9e3a-affb192e3cdf", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "An 80-kg, 70-year-old woman is scheduled for a mastectomy. She has a history of congestive heart failure treated with digoxin 0.25 mg daily. Preoperative examination shows a sinus rhythm at 80 bpm and blood pressure of 110/70 mmHg. Laboratory studies show a serum potassium concentration of 4.2 mEq/L and a serum digoxin concentration of 1.5 mcg/ml. Five minutes after induction of general anesthesia, ventricular bigeminy is noted; blood pressure is 85/65 mmHg, SpO2 is 97%, and PetCO2, is 20 mmHg. Which of the following is the most appropriate management?", + "A": "Administration of calcium chloride", + "B": "Administration of ephedrine", + "C": "Administration of lidocaine", + "D": "Administration of potassium chloride", + "E": "Decrease in ventilation" + }, + "zh": { + "question": "一名80公斤、70岁的女性计划进行乳房切除术。她有充血性心力衰竭病史，接受地高辛0.25 mg每日治疗。术前检查显示窦性心律80次/分钟，血压110/70 mmHg。实验室检查显示血清钾浓度为4.2 mEq/L，血清地高辛浓度为1.5 mcg/ml。全身麻醉诱导五分钟后，出现室性二联律；血压为85/65 mmHg，SpO2为97%，PetCO2为20 mmHg。以下哪项是最合适的处理？", + "A": "给予氯化钙", + "B": "给予麻黄碱", + "C": "给予利多卡因", + "D": "给予氯化钾", + "E": "减少通气" + } + }, + { + "id": "7eb20ffe-385b-57e0-b487-ab02d20bd7ab", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Block of the superficial cervical plexus is performed at which location?", + "A": "At the midposterior border of the sternocleidomastoid muscle", + "B": "In the interscalene groove", + "C": "Over the mastoid process", + "D": "Over the transverse process of C4", + "E": "Over Chassaignac's tubercle" + }, + "zh": { + "question": "浅颈丛阻滞是在什么位置进行的？", + "A": "在胸锁乳突肌的中后缘", + "B": "在斜角肌间沟", + "C": "在乳突上", + "D": "在C4横突上", + "E": "在Chassaignac结节上" + } + }, + { + "id": "da91c774-d3c6-5201-89f3-b81d4e65d26c", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 5-year-old child is brought to the emergency department in considerable respiratory distress. He is sitting leaning forward and drooling. He was well until four hours ago, when temperature increased to 38.9°C and he complained of a sore throat. The most appropriate initial management is to", + "A": "administer nebulized racemic epinephrine", + "B": "gently examine the airway with a tongue blade", + "C": "obtain a lateral radiograph of the neck", + "D": "perform a rapid induction-intubation sequence", + "E": "perform inhalation induction without cricoid pressure" + }, + "zh": { + "question": "一名5岁儿童被送到急诊科，呼吸窘迫明显。他坐着向前倾并流口水。四小时前他还好，但体温升高到38.9°C，并抱怨喉咙痛。最合适的初步处理是", + "A": "给予雾化吸入的消旋肾上腺素", + "B": "用压舌板轻轻检查气道", + "C": "获取颈部侧位X光片", + "D": "进行快速诱导插管序列", + "E": "在不施加环状软骨压力的情况下进行吸入诱导" + } + }, + { + "id": "1d2eb070-b756-50e5-899c-a73d99ef5852", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 65-kg 70-year-old man in the PACU is breathing spontaneously at 20/min through an endotracheal tube connected to a T-piece with a fresh gas flow of 5 L/min. He has a tidal volume of 350 mL and an FiO2 of 0.5. SpO2 decreases from 98% to 84% over one hour, then improves to 92% with an FiO2 of 1.0. Which of the following is the most likely cause of the hypoxemia?", + "A": "Decreased functional residual capacity", + "B": "Increased dead space ventilation", + "C": "Inhibition of hypoxic pulmonary vasoconstriction", + "D": "Room air admixture during inspiration", + "E": "Shivering" + }, + "zh": { + "question": "一名70岁、65公斤的男性在术后恢复室通过连接到T型管的气管插管以5 L/min的新鲜气流自发呼吸，呼吸频率为20次/分钟。他的潮气量为350毫升，吸入氧浓度（FiO2）为0.5。SpO2在一小时内从98%下降到84%，然后在FiO2为1.0时改善到92%。以下哪项最可能是导致低氧血症的原因？", + "A": "功能残气量减少", + "B": "无效腔通气增加", + "C": "低氧性肺血管收缩抑制", + "D": "吸气时混入室内空气", + "E": "寒战" + } + }, + { + "id": "36b8597d-607c-5a21-b055-276c6e830ccc", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following landmarks is used in performing wrist block to remove a cystic mass on the fourth digit EXCEPT the", + "A": "extensor pollicis longus tendon", + "B": "ulnar artery", + "C": "palmaris longus tendon", + "D": "flexor carpi radialis tendon", + "E": "flexor carpi ulnaris tendon" + }, + "zh": { + "question": "以下哪个标志在进行腕部阻滞以去除第四指的囊性肿块时不使用", + "A": "拇长伸肌腱", + "B": "尺动脉", + "C": "掌长肌腱", + "D": "桡侧腕屈肌腱", + "E": "尺侧腕屈肌腱" + } + }, + { + "id": "86cf338a-5493-532c-9139-e22c175b12f0", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements about pulmonary function testing is true?", + "A": "Forced expiratory volume in one second (FEV1) is directly related to maximum voluntary ventilation", + "B": "FEV, is the most reliable indicator of small airways resistance", + "C": "Forced vital capacity is markedly decreased in obstructive lung disease with air-trapping", + "D": "Maximum mid-expiratory flow is less effort dependent than FEV1", + "E": "Three-second forced expiratory volume is the amount of air exhaled during the third second of exhalation" + }, + "zh": { + "question": "以下关于肺功能测试的说法哪一项是正确的？", + "A": "第一秒用力呼气量（FEV1）与最大自主通气量直接相关", + "B": "FEV1是小气道阻力的最可靠指标", + "C": "在伴有气体滞留的阻塞性肺病中，用力肺活量显著降低", + "D": "最大中段呼气流量比FEV1更不依赖于努力程度", + "E": "三秒用力呼气量是第三秒呼气时呼出的空气量" + } + }, + { + "id": "22a9b632-542b-5870-a77e-9e82173efddb", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 70-kg patient with no acute bleeding has a preoperative platelet count of 40,000/mm3. Following preoperative transfusion of platelets 10 units, the predicted platelet count would be", + "A": "50,000/mm3", + "B": "80,000/mm3", + "C": "90,000/mm3", + "D": "140,000/mm3", + "E": "190,000/mm3" + }, + "zh": { + "question": "一名70公斤的患者无急性出血，术前血小板计数为40,000/mm3。术前输注10个单位的血小板后，预计血小板计数为", + "A": "50,000/mm3", + "B": "80,000/mm3", + "C": "90,000/mm3", + "D": "140,000/mm3", + "E": "190,000/mm3" + } + }, + { + "id": "5315dcf1-3f88-5761-ad08-0da3f19d756c", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A morbidly obese patient is to undergo gastric stapling during general anesthesia. Following preoxygenation and induction, the oxygen saturation decreases after 40 seconds of laryngoscopy and attempted intubation. The rapid onset of arterial desaturation is most likely due to", + "A": "aspiration during induction", + "B": "decreased functional residual capacity", + "C": "increased cardiac output", + "D": "increased oxygen consumption", + "E": "increased ventilatory dead space" + }, + "zh": { + "question": "一名病态肥胖患者将在全身麻醉下进行胃缝合术。预氧合和诱导后，喉镜检查和插管尝试40秒后，氧饱和度下降。动脉去饱和的快速发生最可能是由于", + "A": "诱导期间的误吸", + "B": "功能残气量减少", + "C": "心输出量增加", + "D": "氧耗量增加", + "E": "通气死腔增加" + } + }, + { + "id": "0dbeb745-2173-5175-83c5-c4f0f51e6eb0", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "During insufflation of the peritoneal cavity with carbon dioxide at the start of laparoscopy, heart rate increases to 140 bpm, blood pressure decreases to 70/40 mmHg, and a loud murmur is heard through the esophageal stethoscope. The most appropriate immediate step is to", + "A": "administer a vasoconstrictor", + "B": "infuse crystalloid solution rapidly", + "C": "discontinue the inhaled anesthetic", + "D": "insert a central venous catheter", + "E": "deflate the abdomen" + }, + "zh": { + "question": "在腹腔镜手术开始时用二氧化碳充气腹腔期间，心率增加到140次/分钟，血压下降到70/40 mmHg，并通过食管听诊器听到响亮的杂音。最合适的立即措施是", + "A": "给予血管收缩剂", + "B": "快速输注晶体溶液", + "C": "停止吸入麻醉剂", + "D": "插入中心静脉导管", + "E": "放气腹部" + } + }, + { + "id": "446f276b-cccb-511f-a686-81394b0b51c8", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following best describes the relationship between cerebral perfusion pressure and cerebral blood flow in a patient with untreated chronic hypertension?", + "A": "It is constant at mean blood pressures between 50 and 150 mmHg", + "B": "It is linear for all blood pressures", + "C": "Flow versus pressure curve is hyperbolic", + "D": "Flow versus pressure curve is shifted to the right", + "E": "Flow versus pressure curve is shifted to the left" + }, + "zh": { + "question": "以下哪项最能描述未治疗的慢性高血压患者脑灌注压与脑血流之间的关系？", + "A": "在平均血压50到150 mmHg之间是恒定的", + "B": "在所有血压下是线性的", + "C": "流量与压力曲线是双曲线的", + "D": "流量与压力曲线向右移", + "E": "流量与压力曲线向左移" + } + }, + { + "id": "ef5a9160-856b-5622-8002-38c3178cc25b", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following findings is most likely in patients receiving intravenous milrinone?", + "A": "Decreased left ventricular afterload", + "B": "Decreased myocardial oxygen consumption", + "C": "Increased atrioventricular conduction", + "D": "Increased right ventricular preload", + "E": "Stimulation of beta-adrenergic receptors" + }, + "zh": { + "question": "以下哪项发现最有可能出现在接受静脉注射米力农的患者中？", + "A": "左心室后负荷减少", + "B": "心肌耗氧量减少", + "C": "房室传导增加", + "D": "右心室前负荷增加", + "E": "刺激β-肾上腺素能受体" + } + }, + { + "id": "23bb1578-78e6-50d0-b57d-0c85210cb980", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "The mortality rate of patients given drug A is 12% (8 of 66) and the mortality rate of patients given drug B is 15% (10 of 66). Which of the following tests is most appropriate to compare these mortality rates?", + "A": "t-Test for paired data", + "B": "t-Test for unpaired data", + "C": "Wilcoxon rank test", + "D": "Chi-square test", + "E": "Analysis of covariance" + }, + "zh": { + "question": "给予药物A的患者的死亡率为12%（66人中有8人），给予药物B的患者的死亡率为15%（66人中有10人）。以下哪种检验最适合比较这些死亡率？", + "A": "配对数据的t检验", + "B": "非配对数据的t检验", + "C": "Wilcoxon秩和检验", + "D": "卡方检验", + "E": "协方差分析" + } + }, + { + "id": "d58d235d-a69f-59b0-8be5-fb23092772e2", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The portion of the infant airway with the smallest cross-sectional area occurs at the level of the", + "A": "cricoid cartilage", + "B": "false vocal cords", + "C": "thoracic inlet", + "D": "tonsillar pillars", + "E": "true vocal cords" + }, + "zh": { + "question": "婴儿气道中横截面积最小的部分位于", + "A": "环状软骨", + "B": "假声带", + "C": "胸廓入口", + "D": "扁桃体柱", + "E": "真声带" + } + }, + { + "id": "6ac13eee-af4a-5e26-8cfa-bd8501f5b95d", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following should be included in the preoperative management of a 12-year-old patient with Duchenne muscular dystrophy who is unable to ambulate?", + "A": "Determination of serum creatine kinase concentration", + "B": "Determination of serum potassium concentration", + "C": "Liver function profile", + "D": "Echocardiography", + "E": "Dantrolene prophylaxis" + }, + "zh": { + "question": "以下哪项应包括在一名12岁无法行走的杜氏肌营养不良患者的术前管理中？", + "A": "测定血清肌酸激酶浓度", + "B": "测定血清钾浓度", + "C": "肝功能检查", + "D": "超声心动图", + "E": "预防性使用丹曲林" + } + }, + { + "id": "eb07a873-10af-5b7b-8f7b-9c53e7271441", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 16-year-old child has an arterial catheter inserted prior to a potentially difficult intubation for a craniofacial operation. While awake and breathing room air, arterial blood gas values are: PaO2 134 mm Hg, PaCO2 28 mm Hg, and pH 7.45. These values can be explained by", + "A": "excess heparin mixed with the arterial sample", + "B": "a patient core temperature of 38°C", + "C": "excess air entrained in the syringe during sampling", + "D": "storing the sample at room temperature for 15 minutes before processing", + "E": "anxiety and hyperventilation" + }, + "zh": { + "question": "一名16岁的儿童在颅面手术中可能需要困难插管，因此插入了动脉导管。在清醒并呼吸室内空气时，动脉血气值为：PaO2 134 mm Hg，PaCO2 28 mm Hg，pH 7.45。这些值可以通过以下原因解释", + "A": "动脉样本中混入过多肝素", + "B": "患者核心体温为38°C", + "C": "采样时注射器中混入过多空气", + "D": "在室温下存放样本15分钟后再处理", + "E": "焦虑和过度通气" + } + }, + { + "id": "b9f2a844-39ef-56cc-b261-7f9145e54ba7", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 63-year-old man with a history of congestive heart failure and left ventricular dilation is scheduled for carotid endarterectomy. During carotid cross-clamping, the surgeon requests that systolic blood pressure be increased from 100 to 160 mmHg. Compared with an identical patient with normal left ventricular size, what is the effect of this change in blood pressure on this patient's myocardial oxygen consumption?", + "A": "Equal decrease", + "B": "Greater decrease", + "C": "Lesser increase", + "D": "Equal increase", + "E": "Greater increase" + }, + "zh": { + "question": "一名63岁的男性有充血性心力衰竭和左心室扩大的病史，计划进行颈动脉内膜切除术。在颈动脉夹闭期间，外科医生要求将收缩压从100 mmHg提高到160 mmHg。与左心室大小正常的相同患者相比，这种血压变化对该患者心肌耗氧量的影响是什么？", + "A": "相同的减少", + "B": "更大的减少", + "C": "较小的增加", + "D": "相同的增加", + "E": "更大的增加" + } + }, + { + "id": "b3097374-c707-5469-a7e8-6cf79c96b7b8", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Acute epiglottitis usually", + "A": "requires a lateral radiograph of the neck for diagnosis", + "B": "occurs in children 2 to 4 years of age", + "C": "is treated effectively with racemic epinephrine", + "D": "has a viral etiology", + "E": "requires immediate awake intubation by direct laryngoscopy in the emergency department" + }, + "zh": { + "question": "急性会厌炎通常", + "A": "需要颈部侧位X光片进行诊断", + "B": "发生在2到4岁的儿童中", + "C": "用消旋肾上腺素有效治疗", + "D": "具有病毒病因", + "E": "需要在急诊科通过直接喉镜立即清醒插管" + } + }, + { + "id": "4c5ac962-4596-5ce6-9be4-e5911f0e5de4", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 57-year-old man with hepatocellular disease is scheduled to undergo a colectomy for colon cancer. Preoperative laboratory studies show a plasma albumin concentration of 2.4 g/dl (normal = 3.5 to 5.5 g/dl); prothrombin time is 16 sec (control 12 sec). Which of the following statements concerning the anesthetic management of this patient is true?", + "A": "Atracurium will have a prolonged duration of action", + "B": "The risk for perioperative hyperglycemia is increased", + "C": "Mivacurium will have a shortened duration of action", + "D": "The unbound fraction of thiopental will be increased", + "E": "Vitamin K injection will normalize the prothrombin time" + }, + "zh": { + "question": "一名57岁患有肝细胞疾病的男性计划接受结肠癌切除术。术前实验室检查显示血浆白蛋白浓度为2.4 g/dl（正常值=3.5至5.5 g/dl）；凝血酶原时间为16秒（对照12秒）。关于该患者的麻醉管理，下列哪项陈述是正确的？", + "A": "阿曲库铵的作用时间会延长", + "B": "围手术期高血糖的风险增加", + "C": "米库氯铵的作用时间会缩短", + "D": "硫喷妥钠的游离部分会增加", + "E": "注射维生素K会使凝血酶原时间正常化" + } + }, + { + "id": "a08f3318-d632-533d-bd39-e2613b7081f9", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 65-kg man is scheduled for wrist surgery with intravenous regional anesthesia with 0.5% lidocaine 50 ml. Which of the following statements is true?", + "A": "This anesthetic is contraindicated if the patient has sickle cell disease", + "B": "Mottling of the skin after injection dictates abandonment of the technique", + "C": "Tourniquet discomfort is an indication to inject more local anesthetic", + "D": "Bupivacaine 0.5% could be substituted to prolong anesthesia", + "E": "Epinephrine (1:400,000) should be added to prolong anesthesia" + }, + "zh": { + "question": "一名65公斤的男性计划进行腕部手术，使用0.5%利多卡因50毫升进行静脉区域麻醉。以下哪项陈述是正确的？", + "A": "如果患者患有镰状细胞病，这种麻醉是禁忌的", + "B": "注射后皮肤出现斑驳是放弃该技术的指征", + "C": "止血带不适是注射更多局部麻醉剂的指征", + "D": "可以用0.5%的布比卡因替代以延长麻醉时间", + "E": "应添加肾上腺素（1:400,000）以延长麻醉时间" + } + }, + { + "id": "c9c84e2c-2382-5870-962b-58d06ac5782c", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A 65-year-old patient receiving long-term clonidine therapy fails to take it one day before surgery. This would most likely", + "A": "be beneficial, since clonidine decreases cardiac output", + "B": "be of no consequence due to the long half-life of clonidine", + "C": "produce a lower anesthetic requirement than if the drug had been continued", + "D": "produce rebound hypertension", + "E": "result in seizure activity" + }, + "zh": { + "question": "一名65岁的患者长期接受可乐定治疗，但在手术前一天未服用。这最有可能", + "A": "是有益的，因为可乐定减少心输出量", + "B": "没有影响，因为可乐定的半衰期长", + "C": "产生比继续服药时更低的麻醉需求", + "D": "产生反弹性高血压", + "E": "导致癫痫活动" + } + }, + { + "id": "fdc10946-d57a-53d2-9af5-2553d96d12de", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "One hundred children who are to have strabismus surgery are enrolled in a research protocol. Fifty receive a new antiemetic and 50 receive a placebo preoperatively. Fifteen children in the treatment group and 37 children in the control group have nausea and vomiting postoperatively. Which of the following analyses is most appropriate for determining the statistical significance of the group differences?", + "A": "Analysis of variance", + "B": "Chi-square analysis", + "C": "Linear regression and correlation coefficient", + "D": "Student's t-test", + "E": "Wilcoxon's rank sum test" + }, + "zh": { + "question": "一百名即将接受斜视手术的儿童被纳入一项研究方案。五十名儿童术前接受一种新的止吐药，另外五十名儿童接受安慰剂。治疗组中有十五名儿童，控制组中有三十七名儿童术后出现恶心和呕吐。以下哪种分析最适合用于确定组间差异的统计显著性？", + "A": "方差分析", + "B": "卡方分析", + "C": "线性回归和相关系数", + "D": "学生t检验", + "E": "威尔科克森秩和检验" + } + }, + { + "id": "e7936885-da11-5f76-929d-2207e0853645", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Compared with lidocaine, bupivacaine is more likely to cause dysrhythmias because it", + "A": "enhances potassium-hydrogen ion exchange", + "B": "is less soluble in lipids", + "C": "produces more prolonged block of sodium channels", + "D": "sensitizes the myocardium to catecholamines", + "E": "sustains calcium channels open" + }, + "zh": { + "question": "与利多卡因相比，布比卡因更容易引起心律失常，因为它", + "A": "增强钾-氢离子交换", + "B": "在脂质中溶解度较低", + "C": "对钠通道的阻滞作用更持久", + "D": "使心肌对儿茶酚胺更敏感", + "E": "维持钙通道开放" + } + }, + { + "id": "fa205502-0fb3-535d-9737-6a773ec0d5b8", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Administration of magnesium sulfate for treatment of preeclampsia results in a decreased dose requirement for each of the following drugs EXCEPT", + "A": "bupivacaine", + "B": "halothane", + "C": "midazolam", + "D": "succinylcholine", + "E": "vecuronium" + }, + "zh": { + "question": "使用硫酸镁治疗子痫前期会导致以下药物的剂量需求减少，除了", + "A": "布比卡因", + "B": "氟烷", + "C": "咪达唑仑", + "D": "琥珀胆碱", + "E": "维库溴铵" + } + }, + { + "id": "c152a66b-11a7-5af1-88ac-0eafe479d150", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A woman is undergoing a repeat cesarean delivery at term following a normal pregnancy. Anesthesia consists of thiopental 250 mg, succinylcholine infusion (180 mg in 20 minutes), nitrous oxide and oxygen (7:3 L/min) until delivery. Twenty minutes after the incision a floppy newborn with a 1-minute Apgar score of 5 is delivered. The most likely explanation for the infant's condition is", + "A": "high serum thiopental concentration", + "B": "high serum succinylcholine concentration", + "C": "high serum nitrous oxide concentration", + "D": "high serum glucose concentration", + "E": "uterine hypoperfusion" + }, + "zh": { + "question": "一名女性在足月正常妊娠后进行重复剖宫产。麻醉包括硫喷妥钠250 mg、琥珀胆碱输注（20分钟内180 mg）、氧化亚氮和氧气（7:3 L/min）直至分娩。切口后20分钟，分娩出一个肌张力低下的新生儿，1分钟Apgar评分为5。婴儿状况的最可能解释是", + "A": "高血清硫喷妥钠浓度", + "B": "高血清琥珀胆碱浓度", + "C": "高血清氧化亚氮浓度", + "D": "高血清葡萄糖浓度", + "E": "子宫灌注不足" + } + }, + { + "id": "ba653fda-714c-5b25-8e76-993d02328f9e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning the retinopathy of prematurity is true?", + "A": "The initial lesion is dilation of retinal capillaries", + "B": "It can be prevented by maintaining FiO2 below 0.4", + "C": "It is less likely to develop if PaO2 is maintained below 70 mmHg", + "D": "The incidence is unrelated to birth weight", + "E": "Infants whose postconceptual age has reached 40 weeks are no longer at risk" + }, + "zh": { + "question": "以下关于早产儿视网膜病变的陈述中哪一项是正确的？", + "A": "初始病变是视网膜毛细血管扩张", + "B": "通过将FiO2维持在0.4以下可以预防", + "C": "如果将PaO2维持在70 mmHg以下，则不太可能发生", + "D": "发生率与出生体重无关", + "E": "胎龄达到40周的婴儿不再有风险" + } + }, + { + "id": "3373745c-5245-5764-98a4-d8783d76ac35", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "During induction of anesthesia for cesarean delivery, pancuronium is inadvertently substituted for succinylcholine. The neonate shows no clinical signs of muscle relaxation because pancuronium is", + "A": "highly ionized", + "B": "highly protein bound", + "C": "a large molecule", + "D": "lipid soluble", + "E": "unaffected by \"ion trapping\"" + }, + "zh": { + "question": "在剖宫产麻醉诱导期间，潘库溴铵被误用为琥珀胆碱。新生儿没有表现出肌肉松弛的临床症状，因为潘库溴铵是", + "A": "高度电离的", + "B": "高度蛋白结合的", + "C": "大分子", + "D": "脂溶性的", + "E": "不受“离子陷阱”影响的" + } + }, + { + "id": "3278c03e-c769-51ca-bcea-78eed129e0b7", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following is a complication or side effect of neurolytic celiac plexus blockade EXCEPT", + "A": "constipation", + "B": "hematuria", + "C": "orthostatic hypotension", + "D": "paraplegia", + "E": "pneumothorax" + }, + "zh": { + "question": "以下每项都是神经溶解性腹腔神经丛阻滞的并发症或副作用，除了", + "A": "便秘", + "B": "血尿", + "C": "体位性低血压", + "D": "截瘫", + "E": "气胸" + } + }, + { + "id": "6be14859-8a32-58ff-a643-1f8946224e87", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is indicated by an alarm condition in the line-isolation monitor?", + "A": "An electrical shock to the patient", + "B": "A power surge in the main hospital power supply", + "C": "Disconnection of the patient from an electrocautery grounding pad", + "D": "Overload of the operating room circuits", + "E": "The presence of a current leak between an operating room electrical device and ground" + }, + "zh": { + "question": "下列哪项由线路隔离监测器的报警状态指示？", + "A": "患者受到电击", + "B": "医院主电源的电涌", + "C": "患者与电烧灼接地垫断开", + "D": "手术室电路过载", + "E": "手术室电器设备与地面之间存在电流泄漏" + } + }, + { + "id": "4927425d-1590-544f-b255-ba70d22a7cc4", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Compared with midazolam, diazepam has which of the following characteristics?", + "A": "Greater solubility in water", + "B": "Shorter beta half-life", + "C": "More potent ventilatory depressant effect", + "D": "Lower risk for thrombophlebitis", + "E": "A pharmacologically active metabolite" + }, + "zh": { + "question": "与咪达唑仑相比，地西泮具有以下哪种特性？", + "A": "更高的水溶性", + "B": "更短的β半衰期", + "C": "更强的呼吸抑制作用", + "D": "较低的血栓性静脉炎风险", + "E": "一种药理活性代谢产物" + } + }, + { + "id": "b2892b79-1586-5668-b61c-24098c907923", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The gauge pressure on a cylinder of nitrous oxide", + "A": "varies with the size of the cylinder", + "B": "is the same for full and half-full cylinders", + "C": "is the same as that of a full cylinder of oxygen if both are full", + "D": "is independent of the temperature of the cylinder", + "E": "reliably indicates the amount of nitrous oxide in the cylinder" + }, + "zh": { + "question": "氧化亚氮气瓶的表压", + "A": "随气瓶大小而变化", + "B": "对于满瓶和半满瓶是相同的", + "C": "如果两者都满，则与满氧气瓶的相同", + "D": "与气瓶的温度无关", + "E": "可靠地指示气瓶中氧化亚氮的量" + } + }, + { + "id": "3a49c608-6791-5b80-8184-b3cf895d1476", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 24-year-old woman requires anesthesia for emergency repair of open fractures of the tibia and fibula. She used cocaine two hours ago. Blood pressure is 170/110 mmHg. Each of the following is useful in managing the hypertension EXCEPT", + "A": "hydralazine", + "B": "labetalol", + "C": "nitroprusside", + "D": "phentolamine", + "E": "propranolol" + }, + "zh": { + "question": "一名24岁的女性需要麻醉以紧急修复胫骨和腓骨的开放性骨折。她在两小时前使用了可卡因。血压为170/110 mmHg。以下每种方法对控制高血压都有用，除了", + "A": "肼屈嗪", + "B": "拉贝洛尔", + "C": "硝普钠", + "D": "酚妥拉明", + "E": "普萘洛尔" + } + }, + { + "id": "fdd11fc2-afcb-579d-a460-77eaf6084243", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 35-kg child requires mechanical ventilation with pure oxygen at a tidal volume of 350 ml and a rate of 20/min during a severe asthma attack. The most likely cause of severe hypotension after initiating mechanical ventilation is", + "A": "hypoxic circulatory depression", + "B": "inadequate expiratory time", + "C": "increased pulmonary vascular resistance", + "D": "respiratory alkalosis", + "E": "tension pneumothorax" + }, + "zh": { + "question": "一名35公斤的儿童在严重哮喘发作期间需要使用纯氧进行机械通气，潮气量为350毫升，频率为20次/分钟。启动机械通气后最可能导致严重低血压的原因是", + "A": "缺氧性循环抑制", + "B": "呼气时间不足", + "C": "肺血管阻力增加", + "D": "呼吸性碱中毒", + "E": "张力性气胸" + } + }, + { + "id": "cb7d8983-a40d-5a12-b9d0-2ab2ea0d1171", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is an effect of acetazolamide?", + "A": "Glucose intolerance", + "B": "Increased minute ventilation", + "C": "Metabolic alkalosis", + "D": "Sinus bradycardia", + "E": "Slowed intravenous anesthetic induction" + }, + "zh": { + "question": "以下哪项是乙酰唑胺的作用？", + "A": "葡萄糖耐受不良", + "B": "分钟通气量增加", + "C": "代谢性碱中毒", + "D": "窦性心动过缓", + "E": "静脉麻醉诱导减慢" + } + }, + { + "id": "242651d8-8475-5670-9190-2b0441d6cf91", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "During recovery from halothane anesthesia, an alveolar concentration of 0.1% will have the greatest effect on", + "A": "myocardial contractility", + "B": "ventilatory response to hypercarbia", + "C": "atrioventricular conduction", + "D": "ventilatory response to hypoxia", + "E": "neuromuscular transmission" + }, + "zh": { + "question": "在从氟烷麻醉恢复期间，0.1%的肺泡浓度将对以下哪项产生最大影响", + "A": "心肌收缩力", + "B": "对高碳酸血症的通气反应", + "C": "房室传导", + "D": "对低氧血症的通气反应", + "E": "神经肌肉传导" + } + }, + { + "id": "3dbc016d-d8c1-58f7-a9d7-86d41600c1e8", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "During anesthesia with nitrous oxide, oxygen, and a relaxant, the patient's lungs are being mechanically ventilated and there is a heated humidifier in the circuit. The most likely cause of an apparent increase in inspired oxygen concentration is", + "A": "a hole in the ventilator bellows", + "B": "backflow of fresh gas because of resistance in the humidifier", + "C": "decreased oxygen utilization by the patient", + "D": "heat damage to the oxygen sensor", + "E": "water condensation on the oxygen sensor" + }, + "zh": { + "question": "在使用氧化亚氮、氧气和肌肉松弛剂进行麻醉期间，患者的肺部正在进行机械通气，回路中有一个加热加湿器。吸入氧浓度明显增加的最可能原因是", + "A": "呼吸机风箱上有一个孔", + "B": "由于加湿器的阻力导致新鲜气体回流", + "C": "患者的氧气利用率降低", + "D": "氧气传感器的热损坏", + "E": "氧气传感器上的水凝结" + } + }, + { + "id": "22cd971d-1868-5eb6-a749-8dbcc842413b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 19-year-old woman receives a spinal anesthetic for a repeat cesarean delivery. Two days later she is afebrile but has severe occipital pain that is aggravated by sitting or standing and relieved by lying flat. Associated findings would likely include", + "A": "bradycardia", + "B": "difficulty swallowing", + "C": "diplopia", + "D": "facial pain", + "E": "Horner's syndrome" + }, + "zh": { + "question": "一名19岁的女性接受了脊椎麻醉以进行重复剖宫产。两天后，她没有发热，但有严重的枕部疼痛，这种疼痛在坐着或站立时加重，平躺时缓解。可能的相关发现包括", + "A": "心动过缓", + "B": "吞咽困难", + "C": "复视", + "D": "面部疼痛", + "E": "霍纳综合征" + } + }, + { + "id": "9ae5f882-5788-520a-a650-cb19609eca43", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "An elderly man has an acute dissection of the descending thoracic aorta. Which of the following antihypertensive therapies is most likely to extend the dissection?", + "A": "Esmolol infusion", + "B": "Nitroglycerin infusion", + "C": "Nitroprusside infusion", + "D": "Nitroprusside infusion combined with a beta-adrenergic blocker", + "E": "Trimethaphan infusion" + }, + "zh": { + "question": "一位老年男性患有急性降主动脉夹层。以下哪种抗高血压治疗最有可能加重夹层？", + "A": "艾司洛尔输注", + "B": "硝酸甘油输注", + "C": "硝普钠输注", + "D": "硝普钠输注联合β-肾上腺素能阻滞剂", + "E": "曲美他嗪输注" + } + }, + { + "id": "6bc10c3e-cee0-5884-9f26-04d5a8674899", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 68-year-old patient is undergoing total hip replacement during general anesthesia using positive pressure ventilation and neuromuscular blockade. Intraoperative monitoring shows a gradual decrease in end-tidal CO2, an increase in exhaled tidal volume, and an increase in measured FiO2. Which of the following is the most likely cause of these changes?", + "A": "Air entrainment around a deflated endotracheal tube cuff", + "B": "Channeling of the exhaled air through the carbon dioxide canister", + "C": "Fat embolism", + "D": "Inadequate muscle relaxation with spontaneous patient ventilation", + "E": "A small hole in the ventilator bellows" + }, + "zh": { + "question": "一名68岁的���者在全身麻醉下进行全髋关节置换术，使用正压通气和神经肌肉阻滞。术中监测显示呼气末二氧化碳逐渐下降，呼气潮气量增加，测得的吸入氧浓度增加。以下哪项最可能是这些变化的原因？", + "A": "气管导管套囊漏气导致空气进入", + "B": "呼出的空气通过二氧化碳罐流出", + "C": "脂肪栓塞", + "D": "肌肉松弛不足导致患者自发通气", + "E": "呼吸机风箱上有小孔" + } + }, + { + "id": "85961afe-5d97-5193-ba18-9da764e60a81", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 30-year-old, 70-kg woman with mitral stenosis is scheduled for elective laparoscopic sterilization. Preoperatively she is taking digoxin and an unknown medication for chronic mental depression. The EKG demonstrates atrial fibrillation. Heart rate is 68 bpm. Anesthesia is induced with thiopental followed by nitrous oxide 50%, halothane 0.75%, and a continuous succinylcholine infusion. The ventilator is set to deliver a minute volume of 5 liters through an endotracheal tube. As the carbon dioxide is being insufflated into the abdomen, the blood pressure is noted to be elevated (150/100 mmHg) and ventricular bigeminy is present. The most appropriate therapy is to", + "A": "increase the halothane concentration to 1.25%", + "B": "discontinue the succinylcholine infusion", + "C": "increase minute ventilation to 7.5 L/min", + "D": "administer potassium 5 mEq intravenously over one minute followed by propranolol 0.25 mg", + "E": "measure arterial blood gas and serum electrolyte values" + }, + "zh": { + "question": "一名30岁、70公斤的女性患有二尖瓣狭窄，计划进行择期腹腔镜绝育术。术前她服用地高辛和一种不明药物治疗慢性精神抑郁症。心电图显示心房颤动。心率为68次/分钟。麻醉诱导使用硫喷妥钠，随后使用50%氧化亚氮、0.75%氟烷和持续琥珀胆碱输注。呼吸机设置为通过气管插管输送5升的分钟通气量。当二氧化碳被充入腹腔时，血压升高（150/100 mmHg）并出现室性二联律。最合适的治疗是", + "A": "将氟烷浓度增加到1.25%", + "B": "停止琥珀胆碱输注", + "C": "将分钟通气量增加到7.5 L/min", + "D": "静脉注射5 mEq钾，持续一分钟，然后给予0.25 mg普萘洛尔", + "E": "测量动脉血气和血清电解质值" + } + }, + { + "id": "eb5b258b-46c9-59a3-85c4-5e5d3d1a1d44", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning relationships among alveolar pressure, volume, and surface tension is true?", + "A": "Surface tension of surfactant decreases as alveolar volume decreases", + "B": "Surface tensions of water and of surfactant behave similarly as volume decreases", + "C": "Changes in alveolar surface tension with volume are the same during expansion as during contraction", + "D": "Pressure in the alveolus is inversely related to surface tension", + "E": "Pressure in the alveolus is directly related to alveolar radius" + }, + "zh": { + "question": "以下关于肺泡压力、体积和表面张力之间关系的陈述中，哪一项是正确的？", + "A": "表面活性剂的表面张力随着肺泡体积的减小而减小", + "B": "水和表面活性剂的表面张力在体积减小时表现相似", + "C": "肺泡表面张力随体积变化在扩张和收缩时是相同的", + "D": "肺泡内的压力与表面张力成反比", + "E": "肺泡内的压力与肺泡半径成正比" + } + }, + { + "id": "97e56d5e-c127-512e-aa66-929ae30d58ed", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Physiologically, coronary blood flow relates most directly to", + "A": "cardiac work", + "B": "systolic blood pressure", + "C": "myocardial oxygen consumption", + "D": "heart rate", + "E": "mean arterial pressure" + }, + "zh": { + "question": "生理上，冠状动脉血流最直接与以下哪项相关", + "A": "心脏工作", + "B": "收缩压", + "C": "心肌耗氧量", + "D": "心率", + "E": "平均动脉压" + } + }, + { + "id": "842bb137-f38b-593c-878b-abbf17de65c8", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "A patient who is paraplegic secondary to spinal cord transection at T3 develops bradycardia and facial flushing during a nephrectomy under general anesthesia with nitrous oxide, fentanyl, and atracurium. The most likely cause of this response is", + "A": "release of histamine", + "B": "stimulation of the carotid sinus", + "C": "release of prostaglandins", + "D": "vagal response to peritoneal traction", + "E": "release of epinephrine" + }, + "zh": { + "question": "一名因脊髓T3截断而截瘫的患者在使用氧化亚氮、芬太尼和阿曲库铵进行全身麻醉下进行肾切除术时出现心动过缓和面部潮红。此反应最可能的原因是", + "A": "组胺释放", + "B": "颈动脉窦刺激", + "C": "前列腺素释放", + "D": "对腹膜牵拉的迷走神经反应", + "E": "肾上腺素释放" + } + }, + { + "id": "ee55104d-6895-51ca-b3f8-923df62dd68e", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "Which of the following is the most appropriate management of decreased cardiac output in patients with isolated aortic insufficiency?", + "A": "Dobutamine", + "B": "Esmolol", + "C": "Intra-aortic balloon counterpulsation", + "D": "Norepinephrine", + "E": "Positive pressure ventilation" + }, + "zh": { + "question": "以下哪项是对孤立性主动脉瓣关闭不全患者心输出量减少的最合适管理？", + "A": "多巴酚丁胺", + "B": "艾司洛尔", + "C": "主动脉内球囊反搏", + "D": "去甲肾上腺素", + "E": "正压通气" + } + }, + { + "id": "6c9aeb12-7a8f-51ab-81ff-8d9461237731", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 45-kg, 80-year-old woman undergoes pin fixation of the right hip in the lateral decubitus position under spinal anesthesia. One day after the operation, she cannot move her left ankle or foot actively. The most likely cause is", + "A": "compression of the sciatic nerve", + "B": "compression of the common peroneal nerve", + "C": "injury of the nerve root at L4-5", + "D": "stretching of the femoral nerve", + "E": "stretching of the tibial nerve" + }, + "zh": { + "question": "一名45公斤、80岁的女性在脊椎麻醉下以侧卧位进行右髋关节的钢钉固定术。手术后一天，她无法主动移动左脚踝或脚。最可能的原因是", + "A": "坐骨神经受压", + "B": "腓总神经受压", + "C": "L4-5神经根损伤", + "D": "股神经拉伸", + "E": "胫神经拉伸" + } + }, + { + "id": "531acb06-8fc0-5f4d-b675-1f4d8eca1a62", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following remains normal in an otherwise healthy patient with obesity?", + "A": "Alveolar PO2", + "B": "Expiratory reserve volume", + "C": "Functional residual capacity", + "D": "Lung compliance", + "E": "Static lung volumes" + }, + "zh": { + "question": "在其他方面健康的肥胖患者中，以下哪项保持正常？", + "A": "肺泡PO2", + "B": "呼气储备容量", + "C": "功能残气量", + "D": "肺顺应性", + "E": "静态肺容量" + } + }, + { + "id": "acc23414-12f4-58a9-b885-6a82d881441c", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "In the majority of cases, fetal heart rate decelerations in a variable pattern are associated with", + "A": "decreased uteroplacental perfusion", + "B": "fetal head compression during contractions", + "C": "umbilical cord compression", + "D": "low Apgar scores at birth", + "E": "low neurobehavioral scores eight hours post partum" + }, + "zh": { + "question": "在大多数情况下，胎心率呈现变异性减速模式与以下哪项有关", + "A": "子宫胎盘灌注减少", + "B": "宫缩期间胎头受压", + "C": "脐带受压", + "D": "出生时阿普加评分低", + "E": "产后八小时神经行为评分低" + } + }, + { + "id": "6af88dc5-f009-5017-af7c-cd5517a0c73f", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 60-year-old obese man who has an antithrombin III deficiency is scheduled for radical prostatectomy. Prior to the operation this patient should receive", + "A": "fresh frozen plasma", + "B": "vitamin K", + "C": "epsilon-aminocaproic acid", + "D": "heparin", + "E": "none of the above" + }, + "zh": { + "question": "一名60岁的肥胖男性患有抗凝血酶III缺乏症，计划进行根治性前列腺切除术。在手术前该患者应接受", + "A": "新鲜冰冻血浆", + "B": "维生素K", + "C": "ε-氨基己酸", + "D": "肝素", + "E": "以上都不是" + } + }, + { + "id": "b95c1610-932a-5cfb-810e-3bdba7826a73", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "Which of the following findings necessitates the preoperative insertion of a ventricular pacemaker in a 48-year-old man scheduled to undergo cholecystectomy?", + "A": "Atrial flutter with 3:1 atrioventricular block", + "B": "Bifascicular (right bundle branch block and left anterior hemiblock) block", + "C": "Left bundle branch block with first-degree atrioventricular block", + "D": "Second-degree (Mobitz I) atrioventricular block", + "E": "Second-degree (Mobitz II) atrioventricular block" + }, + "zh": { + "question": "以下哪项发现需要在一名计划进行胆囊切除术的48岁男性术前插入心室起搏器？", + "A": "心房扑动伴3:1房室传导阻滞", + "B": "双分支传导阻滞（右束支传导阻滞和左前分支传导阻滞）", + "C": "左束支传导阻滞伴一度房室传导阻滞", + "D": "二度（Mobitz I型）房室传导阻滞", + "E": "二度（Mobitz II型）房室传导阻滞" + } + }, + { + "id": "6c20b434-9678-5387-8725-4cb14202f0f6", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Compared with halothane, desflurane has which of the following characteristics?", + "A": "Greater potency", + "B": "A higher boiling point", + "C": "Increased blood solubility", + "D": "Less airway irritability", + "E": "Less biodegradation" + }, + "zh": { + "question": "与氟烷相比，地氟烷具有以下哪种特性？", + "A": "更高的效力", + "B": "更高的沸点", + "C": "增加的血液溶解度", + "D": "较少的气道刺激性", + "E": "较少的生物降解" + } + }, + { + "id": "1c26e9fb-aebe-525d-b350-01cfc3e8dbac", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 29-year-old man who has been nasotracheally intubated for two weeks following a motor vehicle accident has a fever (39C) and a constant headache. Leukocyte count is 18,000/mm3. The most likely cause is", + "A": "fractured nasal septum", + "B": "retropharyngeal abscess", + "C": "maxillary sinusitis", + "D": "meningitis", + "E": "rhinovirus infection" + }, + "zh": { + "question": "一名29岁的男性在发生机动车事故后已鼻气管插管两周，现出现发热（39°C）和持续性头痛。白细胞计数为18,000/mm3。最可能的原因是", + "A": "鼻中隔骨折", + "B": "咽后脓肿", + "C": "上颌窦炎", + "D": "脑膜炎", + "E": "鼻病毒感染" + } + }, + { + "id": "18fe9ba9-f815-5c32-9a81-92776b16e077", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "When evaluating a screening test, which of the following is the most appropriate term for the proportion of patients with a disease who have a positive test result?", + "A": "Accuracy", + "B": "Incidence", + "C": "Selectivity", + "D": "Sensitivity", + "E": "Specificity" + }, + "zh": { + "question": "在评估筛查测试时，下列哪一项最适合描述患有疾病的患者中测试结果为阳性的比例？", + "A": "准确性", + "B": "发病率", + "C": "选择性", + "D": "敏感性", + "E": "特异性" + } + }, + { + "id": "599cf8cd-1168-5bfd-a616-9bed2d289506", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A multiparous 24-year-old woman sustains an amniotic fluid embolism during general anesthesia. The LEAST likely clinical finding is", + "A": "increased end-tidal carbon dioxide tension", + "B": "increased uterine bleeding", + "C": "jugular venous distention", + "D": "ST and T wave abnormalities on ECG", + "E": "wheezing" + }, + "zh": { + "question": "一名24岁的经产妇在全身麻醉期间发生羊水栓塞。最不可能出现的临床表现是", + "A": "呼气末二氧化碳张力增加", + "B": "子宫出血增加", + "C": "颈静脉扩张", + "D": "心电图上的ST段和T波异常", + "E": "喘息" + } + }, + { + "id": "3020cafd-2efe-533f-809e-f4229935b935", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During general anesthesia administered through a circle system, the soda lime absorbant is exhausted. No fresh soda lime is available for use. Which of the following is the most appropriate next step to prevent hypercapnia in this patient?", + "A": "Decreasing the dead space of the circle system", + "B": "Discontinuing nitrous oxide", + "C": "Increasing the fresh gas flow", + "D": "Increasing tidal volume", + "E": "Switching to spontaneous ventilation" + }, + "zh": { + "question": "在通过环路系统进行全身麻醉期间，苏打石灰吸收剂已耗尽。没有新鲜的苏打石灰可供使用。以下哪项是防止该患者发生高碳酸血症的最合适的下一步措施？", + "A": "减少环路系统的死腔", + "B": "停止使用氧化亚氮", + "C": "增加新鲜气体流量", + "D": "增加潮气量", + "E": "切换到自主呼吸" + } + }, + { + "id": "6cdfd240-0512-5aa9-86bf-f9957f640e05", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The low fetal/maternal plasma ratio of bupivacaine compared with lidocaine is due to", + "A": "fetal tissue binding", + "B": "fetal plasma protein binding", + "C": "maternal plasma protein binding", + "D": "ionization in maternal blood", + "E": "ionization in fetal blood" + }, + "zh": { + "question": "与利多卡因相比，布比卡因的低胎儿/母体血浆比率是由于", + "A": "胎儿组织结合", + "B": "胎儿血浆蛋白结合", + "C": "母体血浆蛋白结合", + "D": "在母体血液中的电离", + "E": "在胎儿血液中的电离" + } + }, + { + "id": "8688ce56-09ef-5e96-a618-7d153aaf8604", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "You are called to a witnessed cardiac arrest where cardiopulmonary resuscitation is being performed. After successful intubation, arterial blood gas values are PaO2 86 mmHg, PaCO2 63 mmHg, and pH 7.25 at an FiO2 of 1.0. The most appropriate management at this time is to", + "A": "repeat arterial blood gas analysis using a new specimen", + "B": "administer sodium bicarbonate", + "C": "administer fluid challenge with 500 ml of normal saline solution", + "D": "hyperventilate the patient", + "E": "add positive end-expiratory pressure" + }, + "zh": { + "question": "你被叫到一个目击的心脏骤停现场，正在进行心肺复苏。在成功插管后，动脉血气值为PaO2 86 mmHg，PaCO2 63 mmHg，pH 7.25，FiO2为1.0。此时最合适的管理措施是", + "A": "使用新样本重复动脉血气分析", + "B": "给予碳酸氢钠", + "C": "给予500毫升生理盐水的液体挑战", + "D": "对患者进行过度通气", + "E": "增加呼气末正压" + } + }, + { + "id": "51786f19-75f4-58fe-858f-f65eed5ddcc3", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "A 6-year-old child with severe cerebral palsy is scheduled for general anesthesia. He is at increased risk for each of the following EXCEPT", + "A": "gastroesophageal reflux", + "B": "hypersensitivity to central nervous system depressants", + "C": "poor function of laryngeal reflexes", + "D": "postoperative pulmonary complications", + "E": "succinylcholine-induced hyperkalemia" + }, + "zh": { + "question": "一名6岁患有严重脑瘫的儿童计划进行全身麻醉。他的风险增加，以下哪项除外", + "A": "胃食管反流", + "B": "对中枢神经系统抑制剂的过敏反应", + "C": "喉反射功能差", + "D": "术后肺部并发症", + "E": "琥珀胆碱引起的高钾血症" + } + }, + { + "id": "7441b671-a3dd-5602-bce5-77bbe18a797d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following best explains the decreased effect of hyperventilation on cerebral blood flow when PaCO2 decreases below 20 mmHg?", + "A": "Maximal constriction of cerebral vessels", + "B": "Decreased cerebral perfusion pressure", + "C": "Decreased cerebral metabolic rate for oxygen", + "D": "Increased cardiac output", + "E": "Increased cerebrospinal fluid pressure" + }, + "zh": { + "question": "以下哪项最能解释当PaCO2降至20 mmHg以下时，过度通气对脑血流的影响减弱？", + "A": "脑血管的最大收缩", + "B": "脑灌注压降低", + "C": "脑氧代谢率降低", + "D": "心输出量增加", + "E": "脑脊液压力增加" + } + }, + { + "id": "586bfa0f-2a4c-5d45-bd04-e7864992338c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Proper handling of oxygen cylinders includes", + "A": "maintenance of storage room temperature above 60°F", + "B": "separate storage rooms for nitrous oxide and oxygen", + "C": "opening the cylinder valve just sufficiently to register tank pressure accurately", + "D": "storage in a room with conductive flooring", + "E": "opening the cylinder valve briefly before attachment to the anesthesia machine" + }, + "zh": { + "question": "正确处理氧气瓶包括", + "A": "保持储存室温度高于60°F", + "B": "为一氧化二氮和氧气分别设置储存室", + "C": "仅打开气瓶阀门到足以准确显示罐内压力", + "D": "储存在具有导电地板的房间", + "E": "在连接到麻醉机之前短暂打开气瓶阀门" + } + }, + { + "id": "f680a758-a2bf-5f1c-8520-01a66cf85e74", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 70-kg 58-year-old man with unstable angina is scheduled to undergo coronary artery bypass grafting. Intravenous heparin and nitroglycerin are administered for four days before surgery. Before initiating cardiopulmonary bypass, 21,000 units of heparin are administered through the central venous catheter; five minutes later, activated clotting time is 280 seconds. Which of the following is the most appropriate next step in management?", + "A": "Discontinue nitroglycerin", + "B": "Administer additional heparin", + "C": "Administer cryoprecipitate", + "D": "Administer fresh frozen plasma", + "E": "Initiate cardiopulmonary bypass" + }, + "zh": { + "question": "一名70公斤、58岁的男性患者患有不稳定型心绞痛，计划进行冠状动脉旁路移植术。术前四天给予静脉注射肝素和硝酸甘油。在开始体外循环前，通过中心静脉导管给予21,000单位的肝素；五分钟后，活化凝血时间为280秒。以下哪项是最合适的下一步管理措施？", + "A": "停止硝酸甘油", + "B": "追加肝素", + "C": "给予冷沉淀", + "D": "给予新鲜冰冻血浆", + "E": "开始体外循环" + } + }, + { + "id": "9e022a24-5519-596d-ba55-be8510c1cc6b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Of the following, the most reliable criterion for adequate clinical reversal of neuromuscular blockade is", + "A": "return of twitch height to 90% of normal", + "B": "peak inspiratory force of -20 cmH20", + "C": "T4:T1 ratio of 0.75 for train of four", + "D": "normal tidal volume", + "E": "disappearance of post-tetanic facilitation" + }, + "zh": { + "question": "以下哪项是神经肌肉阻滞临床逆转充分的最可靠标准", + "A": "抽搐高度恢复到正常的90%", + "B": "峰值吸气力为-20 cmH2O", + "C": "四个成串刺激的T4:T1比率为0.75", + "D": "正常潮气量", + "E": "后强直性易化消失" + } + }, + { + "id": "31f0b8aa-99ad-503c-a89b-7b03d6f353a0", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "Prior to occlusion of any major pulmonary blood vessels during a thoracotomy, applying positive end-expiratory pressure to ventilation through the dependent lumen of a double-lumen tube and occluding the upper lumen of the tube will", + "A": "increase blood flow to the dependent lung", + "B": "increase the alveolar-arterial oxygen tension difference", + "C": "override hypercarbic pulmonary vasoconstriction", + "D": "improve the patient's oxygenation", + "E": "increase the right ventricular dP/dt" + }, + "zh": { + "question": "在胸廓切开术中阻塞任何主要肺血管之前，通过双腔管的依赖腔施加呼气末正压通气并阻塞管的上腔将会", + "A": "增加依赖肺的血流量", + "B": "增加肺泡-动脉氧分压差", + "C": "抑制高碳酸血症引起的肺血管收缩", + "D": "改善患者的氧合", + "E": "增加右心室的dP/dt" + } + }, + { + "id": "868512b5-20e6-5721-8f3c-91bdd23604ed", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Which of the following would be most likely to increase the duration of seizures during electroconvulsive therapy using a barbiturate and succinyleholine for general anesthesia?", + "A": "Administration of atropine prior to therapy", + "B": "Changing to a benzodiazepine for induction", + "C": "Changing to etomidate for induction", + "D": "Adding phenytoin to preoperative medications", + "E": "Decreasing the dose of barbiturate used for induction" + }, + "zh": { + "question": "在使用巴比妥类药物和琥珀酰胆碱进行全身麻醉的电休克疗法中，下列哪项最有可能延长癫痫发作的持续时间？", + "A": "在治疗前给予阿托品", + "B": "改用苯二氮䓬类药物进行诱导", + "C": "改用依托咪酯进行诱导", + "D": "在术前用药中加入苯妥英", + "E": "减少用于诱导的巴比妥类药物剂量" + } + }, + { + "id": "af831b32-2e3e-553e-936e-e45665d02497", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "When succinylcholine is administered intravenously to infants, intragastric pressure", + "A": "is usually unchanged", + "B": "increases to a peak of 30 cmH20 within two minutes", + "C": "increases because of abdominal muscle fasciculations", + "D": "increases because of an acetylcholine-like effect on the vagus nerve", + "E": "peaks and subsides within five minutes" + }, + "zh": { + "question": "当琥珀胆碱静脉注射给婴儿时，胃内压力", + "A": "通常不变", + "B": "在两分钟内增加到30 cmH20的峰值", + "C": "由于腹肌抽搐而增加", + "D": "由于对迷走神经的乙酰胆碱样作用而增加", + "E": "在五分钟内达到峰值并消退" + } + }, + { + "id": "26bfb7d0-cd27-5510-b737-055c9174ed68", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A patient receiving monoamine oxidase inhibitor therapy for depression undergoes an emergency cholecystectomy. Which of the following is the best means of providing postoperative analgesia in this patient?", + "A": "Epidural analgesia using 0.25% bupivacaine", + "B": "Intravenous meperidine", + "C": "Epidural analgesia using meperidine", + "D": "Epidural analgesia using 1% lidocaine with epinephrine", + "E": "Intercostal analgesia using 1% lidocaine with epinephrine" + }, + "zh": { + "question": "一名接受单胺氧化酶抑制剂治疗抑郁症的患者进行紧急胆囊切除术。以下哪种方法是为该患者提供术后镇痛的最佳方式？", + "A": "使用0.25%布比卡因的硬膜外镇痛", + "B": "静脉注射哌替啶", + "C": "使用哌替啶的硬膜外镇痛", + "D": "使用1%利多卡因加肾上腺素的硬膜外镇痛", + "E": "使用1%利多卡因加肾上腺素的肋间镇痛" + } + }, + { + "id": "20afcc97-361d-573d-82d1-45cf406e2494", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Alveolar and inspired anesthetic concentrations equilibrate more rapidly with nitrous oxide than with desflurane because nitrous oxide", + "A": "has a higher vapor pressure", + "B": "has a lower blood gas solubility", + "C": "has a lower MAC", + "D": "is delivered at a higher inspired concentration", + "E": "produces a second gas effect" + }, + "zh": { + "question": "肺泡和吸入麻醉剂浓度与氧化亚氮相比于地氟醚更快达到平衡，因为氧化亚氮", + "A": "具有更高的蒸气压", + "B": "具有更低的血气溶解度", + "C": "具有更低的最低肺泡浓度（MAC）", + "D": "以更高的吸入浓度给药", + "E": "产生第二气体效应" + } + }, + { + "id": "cb2834ae-76fd-5591-b395-10f1d6fc1665", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 26-year-old man who sustained multiple trauma undergoes open reduction and internal fixation of bilateral tibial-fibular fractures during anesthesia with isoflurane. nitrous oxide, and oxygen with positive pressure ventilation. During the procedure, the patient has sudden onset of hypotension, jugular venous distention, deviation of the trachea to the right, and decreased ventilatory compliance. Isoflurane is discontinued and 100% oxygen is administered. Which of the following is the most appropriate next step in management?", + "A": "Chest x-ray", + "B": "Blood tranfusion", + "C": "Subxiphoid pericardiocentesis", + "D": "Fiberoptic bronchoscopy", + "E": "Left chest needle thoracostomy" + }, + "zh": { + "question": "一名26岁的男性患者因多处创伤在麻醉期间接受双侧胫腓骨骨折的切开复位和内固定手术，使用异氟醚、氧化亚氮和氧气进行正压通气。在手术过程中，患者突然出现低血压、颈静脉扩张、气管向右偏移和通气顺应性下降。停止使用异氟醚并给予100%氧气。以下哪项是最合适的下一步处理措施？", + "A": "胸部X光检查", + "B": "输血", + "C": "剑突下心包穿刺", + "D": "纤维支气管镜检查", + "E": "左侧胸部针刺胸腔减压" + } + }, + { + "id": "5567c533-51e2-5c22-9745-be16566d38ad", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is the most likely effect of intramuscular ketamine used for induction of anesthesia in a 2-year-old child undergoing elective surgery?", + "A": "Bronchoconstriction", + "B": "Decreased heart rate", + "C": "Decreased intracranial pressure", + "D": "Increased salivation", + "E": "Respiratory depression" + }, + "zh": { + "question": "在一名接受择期手术的2岁儿童中，肌肉注射氯胺酮用于麻醉诱导，以下哪项最有可能发生？", + "A": "支气管收缩", + "B": "心率下降", + "C": "颅内压下降", + "D": "唾液分泌增加", + "E": "呼吸抑制" + } + }, + { + "id": "eb06e4fe-56d9-56ce-bbc2-9f30f560e4c7", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A single dose of etomidate for induction of anesthesia will cause", + "A": "adrenal cortical suppression", + "B": "decreased skeletal muscle tone", + "C": "hypotension", + "D": "increased airway reactivity", + "E": "tachycardia" + }, + "zh": { + "question": "单次剂量的依托咪酯用于麻醉诱导将导致", + "A": "肾上腺皮质抑制", + "B": "骨骼肌张力降低", + "C": "低血压", + "D": "气道反应性增加", + "E": "心动过速" + } + }, + { + "id": "1a54bc3f-19bd-5a38-a376-a8375e52b5a7", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A patient with a fasting blood glucose concentration of 100 mg/dl undergoes a four-hour operation under general anesthesia without intraoperative administration of glucose. On emergence the most likely finding will be", + "A": "marked hypoglycemia", + "B": "mild hypoglycemia", + "C": "normoglycemia", + "D": "mild hyperglycemia", + "E": "marked hyperglycemia" + }, + "zh": { + "question": "一名空腹血糖浓度为100 mg/dl的患者在全身麻醉下进行四小时手术，术中未给予葡萄糖。苏醒时最可能的发现是", + "A": "明显低血糖", + "B": "轻度低血糖", + "C": "正常血糖", + "D": "轻度高血糖", + "E": "明显高血糖" + } + }, + { + "id": "2e700142-9ceb-5138-913a-20e61a718880", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During laparotomy for a ruptured spleen, unexplained oozing occurs after infusion of 2 liters of crystalloid and 3 units of blood. The most likely cause is", + "A": "citrate toxicity", + "B": "dilutional thrombocytopenia", + "C": "hemolytic transfusion reaction", + "D": "labile clotting factor deficiency", + "E": "leukoagglutinin reaction" + }, + "zh": { + "question": "在进行破裂脾脏的剖腹手术时，输注2升晶体液和3个单位的血液后出现无法解释的渗血。最可能的原因是", + "A": "柠檬酸盐毒性", + "B": "稀释性血小板减少症", + "C": "溶血性输血反应", + "D": "不稳定凝血因子缺乏", + "E": "白细胞凝集素反应" + } + }, + { + "id": "5e2f3981-0f2d-5f1f-a22e-2bb373dff4b0", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "During a craniotomy for a supratentorial tumor, a 28-year-old man receives isoflurane 0.75% in nitrous oxide 70% and oxygen. Ventilation is controlled to maintain PaCO2 at 25 mmHg. Nasopharyngeal temperature is 35.8°C. While the dura mater is open, the surgeon complains that the brain is bulging. The most appropriate management at this time is to", + "A": "decrease the inspired isoflurane concentration to 0.5%", + "B": "hyperventilate further to decrease PaCO2 to 20 mmHg", + "C": "discontinue nitrous oxide", + "D": "administer thiopental", + "E": "administer additional muscle relaxants" + }, + "zh": { + "question": "在进行幕上肿瘤开颅手术时，一名28岁的男性患者接受了0.75%的异氟醚与70%的氧化亚氮和氧气混合的麻醉。通气被控制以维持PaCO2在25 mmHg。鼻咽温度为35.8°C。当硬脑膜打开时，外科医生抱怨大脑膨出。此时最合适的处理是", + "A": "将吸入的异氟醚浓度降低到0.5%", + "B": "进一步过度通气以将PaCO2降低到20 mmHg", + "C": "停止使用氧化亚氮", + "D": "给予硫喷妥钠", + "E": "给予额外的肌肉松弛剂" + } + }, + { + "id": "423ff0de-2e16-5669-ad46-57da59a01440", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 157 cm (5 ft 2 in), 180-kg, 40-year-old woman has a PaO2 of 65 mmHg, a PaCO2 of 38 mmHg, and a pH of 7.43 while breathing room air preoperatively. The most likely cause of these values is", + "A": "decreased hypoxic ventilatory drive", + "B": "higher than normal oxygen extraction from blood", + "C": "lower than normal cardiac output", + "D": "lower than normal functional residual capacity", + "E": "polycythemia" + }, + "zh": { + "question": "一位身高157厘米（5英尺2英寸）、体重180公斤、40岁的女性在术前吸入室内空气时，PaO2为65 mmHg，PaCO2为38 mmHg，pH为7.43。这些数值最可能的原因是", + "A": "低氧通气驱动降低", + "B": "血液中氧气提取率高于正常", + "C": "心输出量低于正常", + "D": "功能残气量低于正常", + "E": "红细胞增多症" + } + }, + { + "id": "c79b542e-a755-51c1-bb31-68ddd5fc549f", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "In treating arterial hypertension in a patient with a head injury, the agent LEAST likely to increase intracranial pressure is", + "A": "hydralazine", + "B": "nitroprusside", + "C": "nitroglycerin", + "D": "trimethaphan", + "E": "halothane" + }, + "zh": { + "question": "在治疗伴有头部损伤的患者的动脉高血压时，最不可能增加颅内压的药物是", + "A": "肼屈嗪", + "B": "硝普钠", + "C": "硝酸甘油", + "D": "三甲胺", + "E": "氟烷" + } + }, + { + "id": "abae331a-50a1-5455-83c8-e8858aa7df13", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Cerebral blood flow is decreased by each of the following EXCEPT", + "A": "etomidate", + "B": "midazolam", + "C": "nitrous oxide", + "D": "increased minute ventilation", + "E": "positive end-expiratory pressure" + }, + "zh": { + "question": "以下每种情况都会减少脑血流量，除了", + "A": "依托咪酯", + "B": "咪达唑仑", + "C": "一氧化二氮", + "D": "增加分钟通气量", + "E": "呼气末正压" + } + }, + { + "id": "9b51b072-d881-546e-8aed-458683b03402", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following drugs exerts a vasoconstrictor effect by blocking the reuptake of norepinephrine at the neuronal synapse?", + "A": "Cocaine", + "B": "Dopamine", + "C": "Ephedrine", + "D": "Metaraminol", + "E": "Phenylephrine" + }, + "zh": { + "question": "下列哪种药物通过阻止去甲肾上腺素在神经元突触的再摄取而产生血管收缩作用？", + "A": "可卡因", + "B": "多巴胺", + "C": "麻黄碱", + "D": "美他拉明", + "E": "去氧肾上腺素" + } + }, + { + "id": "a72050c3-32d6-5574-a895-56e5137fd846", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 7-year-old, obese, 30-kg boy was anesthetized using an adult circle system containing a 3-liter bag and mask. Induction with nitrous oxide (2 liters), oxygen (1 liter), and enflurane 3% was characterized by three minutes of hyperventilation followed by apnea. Forty-five seconds later, the child moved and became difficult to control. The most likely cause of the movement is", + "A": "decreased alveolar concentration of enflurane during the period of apnea", + "B": "excessive uptake of enflurane by the child's fat", + "C": "higher fresh gas flows required with use of an adult circle system in a child", + "D": "convulsions induced by enflurane", + "E": "hypoxia developing during the period of apnea" + }, + "zh": { + "question": "一名7岁、肥胖、体重30公斤的男孩使用成人环路系统进行麻醉，该系统包含一个3升的气囊和面罩。使用笑气（2升）、氧气（1升）和3%安氟醚进行诱导，表现为三分钟的过度通气后出现呼吸暂停。45秒后，孩子开始移动并变得难以控制。最可能导致这种移动的原因是", + "A": "呼吸暂停期间安氟醚的肺泡浓度降低", + "B": "安氟醚在孩子的脂肪中过度摄取", + "C": "在儿童使用成人环路系统时需要更高的新鲜气体流量", + "D": "安氟醚诱发的抽搐", + "E": "呼吸暂停期间发生的缺氧" + } + }, + { + "id": "dcf37b7c-c174-5d72-ab55-e17cb7677b27", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Miosis, incontinence, excess salivation, and convulsions are toxic effects of", + "A": "amphetamines", + "B": "phenothiazines", + "C": "cocaine", + "D": "tricyclic antidepressants", + "E": "organophosphate insecticides" + }, + "zh": { + "question": "缩瞳、失禁、过度流涎和抽搐是以下哪种物质的毒性作用？", + "A": "苯丙胺", + "B": "吩噻嗪", + "C": "可卡因", + "D": "三环类抗抑郁药", + "E": "有机磷杀虫剂" + } + }, + { + "id": "c48c7153-6a46-59ad-bf26-1f755b18d01f", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An otherwise healthy 42-year-old woman is referred for management of pain associated with adenocarcinoma of the breast and metastasis to the anterior body of L3. She perceives the pain as moderate and currently takes no pain medication. Her oncologist estimates her life expectancy to be 18 months. The most appropriate initial management is", + "A": "a benzodiazepine as needed and at bedtime", + "B": "an oxycodone preparation as needed and a tricyclic antidepressant at bedtime", + "C": "intravenous patient-controlled analgesia", + "D": "morphine infusion via an implanted epidural catheter", + "E": "parenteral meperidine" + }, + "zh": { + "question": "一名42岁的健康女性被转诊以管理与乳腺腺癌及转移至L3前体相关的疼痛。她感知疼痛为中度，目前未服用任何止痛药。她的肿瘤科医生估计她的预期寿命为18个月。最合适的初始管理是", + "A": "按需使用苯二氮卓类药物并在睡前服用", + "B": "按需使用羟考酮制剂并在睡前服用三环类抗抑郁药", + "C": "静脉患者自控镇痛", + "D": "通过植入的硬膜外导管进行吗啡输注", + "E": "肠外给药哌替啶" + } + }, + { + "id": "175175d9-fcd1-50d5-9d9e-4bab1ad42767", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 70-kg, 50-year-old man is scheduled for muscle flap closure of a decubitus ulcer over the sacrum. He has been quadriplegic at the level of C6-7 for six years. Which of the following is most likely to result from subarachnoid anesthesia with tetracaine 10 mg for this procedure?", + "A": "Atrioventricular block", + "B": "Decreased risk for autonomic dysreflexia", + "C": "Impaired expiratory muscle function", + "D": "Impaired inspiratory muscle function", + "E": "Inadequate block of spastic movements" + }, + "zh": { + "question": "一名70公斤、50岁的男性计划进行骶骨褥疮的肌瓣闭合手术。他在C6-7水平截瘫已有六年。对于该手术，使用10毫克丁卡因蛛网膜下腔麻醉最可能导致以下哪种结果？", + "A": "房室传导阻滞", + "B": "自主神经反射亢进风险降低", + "C": "呼气肌功能受损", + "D": "吸气肌功能受损", + "E": "痉挛性运动阻滞不充分" + } + }, + { + "id": "b42f3efc-c6b4-5036-892c-c261d559fe44", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the most likely cause of the increased incidence of right ventricular failure in patients with morbid obesity?", + "A": "Chronic hypoxia", + "B": "Chronic silent pulmonary aspiration", + "C": "Chronic silent subendocardial ischemia", + "D": "Decreased vital capacity", + "E": "Increased pulmonary blood flow" + }, + "zh": { + "question": "以下哪项最有可能导致病态肥胖患者右心室衰竭发生率增加？", + "A": "慢性缺氧", + "B": "慢性无症状性肺吸入", + "C": "慢性无症状性心内膜下缺血", + "D": "肺活量减少", + "E": "肺血流量增加" + } + }, + { + "id": "202cabad-b37a-5712-83d4-7fbb303046ba", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Succinylcholine can be administered safely to a patient with", + "A": "amyotrophic lateral sclerosis", + "B": "cerebral palsy", + "C": "a pelvic crush injury sustained two weeks ago", + "D": "a 20% body surface area burn sustained 10 days ago", + "E": "hemiparesis one month after a cerebrovascular accident" + }, + "zh": { + "question": "琥珀胆碱可以安全用于以下哪种患者？", + "A": "肌萎缩侧索硬化症", + "B": "脑瘫", + "C": "两周前遭受的骨盆挤压伤", + "D": "10天前遭受的20%体表面积烧伤", + "E": "脑血管意外后一个月的偏瘫" + } + }, + { + "id": "3454a868-7fb8-507d-880a-240b122e6a6f", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The supine hypotensive syndrome of pregnancy", + "A": "begins at 32 weeks' gestation", + "B": "causes fetal distress by aortocaval compression", + "C": "is corrected by Trendelenburg's position", + "D": "is less likely following subarachnoid block than epidural block", + "E": "occurs in 90% of supine women at 38 to 40 weeks' gestation" + }, + "zh": { + "question": "妊娠仰卧低血压综合征", + "A": "始于妊娠32周", + "B": "通过主动脉腔静脉压迫引起胎儿窘迫", + "C": "通过特伦德伦堡体位纠正", + "D": "比硬膜外阻滞后发生的可能性小", + "E": "发生在90%的妊娠38至40周的仰卧女性中" + } + }, + { + "id": "133d4077-1973-50f9-ab7a-64272e70f1b6", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Ketamine decreases", + "A": "bronchomotor tone", + "B": "intracranial pressure", + "C": "intraocular pressure", + "D": "salivation", + "E": "seizure threshold" + }, + "zh": { + "question": "氯胺酮降低", + "A": "支气管运动张力", + "B": "颅内压", + "C": "眼内压", + "D": "唾液分泌", + "E": "癫痫发作阈值" + } + }, + { + "id": "c0c1b975-aaf2-5f04-a067-b5ad84ad8e5d", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Each of the following statements about the anatomy of the autonomic nervous system is true EXCEPT:", + "A": "Preganglionic cell bodies are located in the central nervous system", + "B": "Postganglionic neurons are located in outlying ganglia", + "C": "The parasympathetic ganglia are located near their target organs", + "D": "The adrenal gland is innervated only by the sympathetic nervous system", + "E": "The parasympathetic nervous system has thoracic and sacral segments" + }, + "zh": { + "question": "以下关于自主神经系统解剖的陈述中，除了哪一项外，其他都是正确的：", + "A": "节前神经元的细胞体位于中枢神经系统", + "B": "节后神经元位于外围神经节", + "C": "副交感神经节位于其靶器官附近", + "D": "肾上腺仅由交感神经系统支配", + "E": "副交感神经系统有胸段和骶段" + } + }, + { + "id": "8570f8b7-bcc4-519e-9fa6-7de62b6e00eb", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Cyanide toxicity from nitroprusside is unlikely in patients with renal dysfunction because", + "A": "renal excretion of thiosulfate is decreased", + "B": "metabolic acidosis inactivates cyanide", + "C": "anemia inhibits breakdown of nitroprusside by oxyhemoglobin", + "D": "thiocyanate is formed in the liver", + "E": "the dose of nitroprusside necessary to lower blood pressure is greatly decreased" + }, + "zh": { + "question": "由于以下原因，肾功能不全患者不太可能出现硝普钠引起的氰化物中毒", + "A": "硫代硫酸盐的肾脏排泄减少", + "B": "代谢性酸中毒使氰化物失活", + "C": "贫血抑制了硝普钠被��合血红蛋白分解", + "D": "硫氰酸盐在肝脏中形成", + "E": "降低血压所需的硝普钠剂量大大减少" + } + }, + { + "id": "f7a11762-a57d-5668-941a-b7fd0a1ce48b", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following is consistent with exposure to organophosphates EXCEPT", + "A": "bronchodilation", + "B": "muscle weakness", + "C": "salivation", + "D": "sweating", + "E": "urinary retention" + }, + "zh": { + "question": "以下每项都与接触有机磷酸酯一致，除了", + "A": "支气管扩张", + "B": "肌肉无力", + "C": "流涎", + "D": "出汗", + "E": "尿潴留" + } + }, + { + "id": "ef477dcd-d967-5b52-83ed-57bf7baee78e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following findings differentiates the pickwickian syndrome from morbid obesity?", + "A": "Carbon dioxide retention", + "B": "Upper airway obstruction", + "C": "Decreased forced expiratory volume", + "D": "Increased shunt fraction", + "E": "Increased functional residual capacity" + }, + "zh": { + "question": "下列哪一项发现可以将皮克威克综合征与病态肥胖区分开来？", + "A": "二氧化碳潴留", + "B": "上气道阻塞", + "C": "用力呼气量减少", + "D": "分流分数增加", + "E": "功能残气量增加" + } + }, + { + "id": "9d489c07-1fc1-5150-85b6-725860b0ce49", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Compared with morphine 5 mg administered epidurally at T12, morphine 5 mg administered intravenously is associated with", + "A": "greater incidence of urinary retention", + "B": "less intense analgesia", + "C": "less nausea and vomiting", + "D": "longer duration of analgesia", + "E": "longer time to maximum analgesia" + }, + "zh": { + "question": "与在T12硬膜外注射5毫克吗啡相比，静脉注射5毫克吗啡与以下哪项相关", + "A": "更高的尿潴留发生率", + "B": "镇痛效果较弱", + "C": "较少的恶心和呕吐", + "D": "更长的镇痛持续时间", + "E": "达到最大镇痛效果的时间更长" + } + }, + { + "id": "26a06716-8f19-5cbd-a065-becd7822c665", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "During induction of anesthesia, a 56-year-old man with small bowel obstruction vomits a large quantity of undigested food particles and presumably aspirates. After instituting ventilation with pure oxygen, the most appropriate management is to", + "A": "administer dexamethasone", + "B": "administer penicillin G", + "C": "perform bronchoscopy", + "D": "ventilate with positive end-expiratory pressure 15 cmH2O", + "E": "proceed with the anesthesia plan if the tracheal pH is greater than 2.5" + }, + "zh": { + "question": "在麻醉诱导期间，一名56岁患有小肠梗阻的男性呕吐出大量未消化的食物颗粒，并可能误吸。在使用纯氧进行通气后，最合适的处理是", + "A": "给予地塞米松", + "B": "给予青霉素G", + "C": "进行支气管镜检查", + "D": "以15 cmH2O的呼气末正压通气", + "E": "如果气管pH值大于2.5，则继续麻醉计划" + } + }, + { + "id": "7c650baa-9298-5c07-9049-43f5ca120d11", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements concerning anesthesia machine flowmeters is true?", + "A": "At high gas flows, viscosity is the predominant determinant of flow rate", + "B": "At low flow rates, gas density is the predominant determinant of flow rate", + "C": "Flowmeters should be upstream from the oxygen fail-safe device", + "D": "The oxygen flowmeter should be upstream from other flowmeters", + "E": "Tapered flow tubes allow a constant decrease in pressure across the float" + }, + "zh": { + "question": "以下关于麻醉机流量计的说法中哪一项是正确的？", + "A": "在高气体流量时，粘度是流量的主要决定因素", + "B": "在低流量时，气体密度是流量的主要决定因素", + "C": "流量计应位于氧气失效保护装置的上游", + "D": "氧气流量计应位于其他流量计的上游", + "E": "锥形流量管允许浮子两端的压力恒定下降" + } + }, + { + "id": "e5577db0-aae1-51f2-87cf-e911ca264686", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The condition LEAST likely to be associated with sustained pain relief following a nerve block is", + "A": "causalgia", + "B": "myofascial pain", + "C": "diabetic neuropathy", + "D": "acute herpes zoster", + "E": "reflex sympathetic dystrophy" + }, + "zh": { + "question": "以下哪种情况最不可能与神经阻滞后持续的疼痛缓解相关", + "A": "灼性神经痛", + "B": "肌筋膜疼痛", + "C": "糖尿病性神经病变", + "D": "急性带状疱疹", + "E": "反射性交感神经营养不良" + } + }, + { + "id": "1758dd6f-57df-5969-9d08-6e33c842aeef", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A 70-kg, 22-year-old man who is unconscious after a closed head injury is to undergo emergency splenectomy. He is anesthetized with thiopental, given pancuronium for paralysis, and started on nitrous oxide and oxygen 50% each with controlled ventilation (tidal volume 700 ml, rate 10/min). Pulse is 70 bpm, blood pressure is 160/100 mmHg, PaO2 is 65 mmHg, PaC02 is 45 mmHg, and pH is 7.30. In adjusting the ventilator at this time, which of the following is most appropriate?", + "A": "Add 10 cmH2O positive end-expiratory pressure (PEEP), increase respiratory rate to 14/min", + "B": "Add sufficient PEEP to increase PaO2 to 80 mmHg", + "C": "Add 10 cmH2O PEEP, increase FlO2 to 1.0", + "D": "Increase tidal volume to 1000 ml, increase FiO2 to 1.0", + "E": "Increase tidal volume to 1200 ml, decrease respiratory rate to 8/min" + }, + "zh": { + "question": "一名70公斤、22岁的男性在闭合性头部损伤后失去意识，需进行紧急脾切除术。他被用硫喷妥钠麻醉，给予潘库溴铵以瘫痪，并开始使用50%的一氧化二氮和氧气进行控制通气（潮气量700毫升，频率10次/分钟）。脉搏为70次/分钟，血压为160/100 mmHg，PaO2为65 mmHg，PaCO2为45 mmHg，pH值为7.30。在此时调整呼吸机，以下哪项最合适？", + "A": "增加10 cmH2O的呼气末正压（PEEP），将呼吸频率增加到14次/分钟", + "B": "增加足够的PEEP以将PaO2提高到80 mmHg", + "C": "增加10 cmH2O的PEEP，将FiO2增加到1.0", + "D": "将潮气量增加到1000毫升，将FiO2增加到1.0", + "E": "将潮气量增加到1200毫升，将呼吸频率降低到8次/分钟" + } + }, + { + "id": "e07766d2-168c-50c6-ad54-20290b4668e8", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A woman is in labor at 40 weeks' gestation and the fetus is in breech presentation. Which of the following will provide adequate uterine relaxation for vaginal delivery?", + "A": "Spinal anesthesia", + "B": "Epidural anesthesia", + "C": "Halothane anesthesia", + "D": "Pudendal nerve block", + "E": "Magnesium sulfate" + }, + "zh": { + "question": "一名女性在妊娠40周时分娩，胎儿为臀位。以下哪种方法可以为阴道分娩提供足够的子宫松弛？", + "A": "脊髓麻醉", + "B": "硬膜外麻醉", + "C": "氟烷麻醉", + "D": "阴部神经阻滞", + "E": "硫酸镁" + } + }, + { + "id": "88532865-cafd-525d-a1b8-b358870e9849", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following can be used as a sole criterion for brain death?", + "A": "Absence of cerebral blood flow", + "B": "Absence of doll's eye movements", + "C": "Fixed, dilated pupils", + "D": "Isoelectric EEG", + "E": "Unresponsiveness to all externally applied stimuli" + }, + "zh": { + "question": "以下哪项可以作为脑死亡的唯一标准？", + "A": "脑血流缺失", + "B": "无眼球转动反射", + "C": "瞳孔固定散大", + "D": "脑电图呈等电位", + "E": "对所有外部刺激无反应" + } + }, + { + "id": "7dc34298-265c-5aad-b9c6-091781f29982", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Severe nausea and vomiting in the PACU is most effectively treated with a drug that acts as an antagonist at which of the following receptors?", + "A": "Alpha-adrenergic", + "B": "Beta-adrenergic", + "C": "Dopamine", + "D": "GABA", + "E": "Glutamate" + }, + "zh": { + "question": "在术后恢复室（PACU）中，严重的恶心和呕吐最有效的治疗药物是作用于以下哪种受体的拮抗剂？", + "A": "α-肾上腺素能", + "B": "β-肾上腺素能", + "C": "多巴胺", + "D": "GABA", + "E": "谷氨酸" + } + }, + { + "id": "5f142ec6-7795-541f-b392-9e39770116ae", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "During postoperative indirect laryngoscopy, the vocal cords appear symmetric during quiet breathing and approximate to the left of midline during phonation. The most likely cause is", + "A": "pure abductor paralysis of the left cord", + "B": "pure abductor paralysis of the right cord", + "C": "abductor and adductor paralysis of the left cord", + "D": "abductor and adductor paralysis of the right cord", + "E": "adductor paralysis of both cords" + }, + "zh": { + "question": "在术后间接喉镜检查中，声带在安静呼吸时对称，而在发声时向左侧靠拢。最可能的原因是", + "A": "左侧声带纯外展麻痹", + "B": "右侧声带纯外展麻痹", + "C": "左侧声带外展和内收麻痹", + "D": "右侧声带外展和内收麻痹", + "E": "双侧声带内收麻痹" + } + }, + { + "id": "a941e31b-a74b-5e07-a9e6-7530f12933a3", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "In patients who have undergone cardiopulmonary bypass, administration of milrinone is most likely to result in an increase in which of the following?", + "A": "Arterial blood pressure", + "B": "Heart rate", + "C": "Pulmonary capillary wedge pressure", + "D": "Stroke volume", + "E": "Systemic vascular resistance" + }, + "zh": { + "question": "在接受体外循环的患者中，使用米力农最有可能导致以下哪一项增加？", + "A": "动脉血压", + "B": "心率", + "C": "肺毛细血管楔压", + "D": "每搏输出量", + "E": "全身血管阻力" + } + }, + { + "id": "d1fa6b3c-3573-50ac-8f10-dc1936c8ce52", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "DC shocks of 200 joules applied directly to the heart are likely to", + "A": "worsen coronary perfusion", + "B": "prevent postshock arrhythmias", + "C": "produce myocardial contractile abnormalities", + "D": "increase myocardial impedance", + "E": "decrease myocardial temperature" + }, + "zh": { + "question": "直接对心脏施加200焦耳的直流电击可能会", + "A": "加重冠状动脉灌注", + "B": "防止电击后心律失常", + "C": "产生心肌收缩异常", + "D": "增加心肌阻抗", + "E": "降低心肌温度" + } + }, + { + "id": "344bb25a-ca09-5547-9c1b-194718c1d978", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning use of temperature-corrected blood gas measurement (pH-stat) during hypothermic cardiopulmonary bypass is true?", + "A": "Blood gas analysis is performed at the patient's temperature", + "B": "Carbon dioxide should not be added to the bypass circuit", + "C": "The carbon dioxide content of the patient's blood is greater than it would be without temperature correction", + "D": "The incidence of postoperative neurologic deficits is increased compared with the alpha-stat method", + "E": "The patient's temperature should be maintained above 25°C" + }, + "zh": { + "question": "以下关于在低温体外循环中使用温度校正血气测量（pH-stat）的说法哪项是正确的？", + "A": "血气分析是在患者的体温下进行的", + "B": "不应向体外循环回路中添加二氧化碳", + "C": "患者血液中的二氧化碳含量比不进行温度校正时更高", + "D": "与alpha-stat方法相比，术后神经系统缺陷的发生率增加", + "E": "患者的体温应保持在25°C以上" + } + }, + { + "id": "f31902ac-b364-5dc3-846e-b17000f06da3", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 14-month-old child has tetralogy of Fallot with dynamic obstruction to right ventricular outflow. Which of the following is most likely to decrease cyanosis in this child?", + "A": "Calcium", + "B": "Epinephrine", + "C": "Nitroglycerin", + "D": "Nitroprusside", + "E": "Propranolol" + }, + "zh": { + "question": "一名14个月大的儿童患有法洛四联症，并伴有右心室流出道的动态梗阻。以下哪项最有可能减少该儿童的紫绀？", + "A": "钙", + "B": "肾上腺素", + "C": "硝酸甘油", + "D": "硝普钠", + "E": "普萘洛尔" + } + }, + { + "id": "510369ab-777b-571e-a5ec-1141c87f4240", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "During direct intra-arterial measurement of blood pressure", + "A": "the mean arterial pressure will be unaffected by small air bubbles in the system", + "B": "an underdamped system will overestimate the mean arterial pressure", + "C": "an underdamped system will overestimate the diastolic pressure", + "D": "long tubing from the catheter to the transducer will tend to decrease resonance in the system", + "E": "calibration of the transducer by opening a stopcock to air at the sternal angle will overestimate the mean" + }, + "zh": { + "question": "在直接动脉内测量血压时", + "A": "小气泡不会影响平均动脉压", + "B": "欠阻尼系统会高估平均动脉压", + "C": "欠阻尼系统会高估舒张压", + "D": "从导管到传感器的长导管会降低系统的共振", + "E": "在胸骨角打开三通阀进行传感器校准会高估平均值" + } + }, + { + "id": "9ed89293-0e46-5087-afbb-985f7547cf0e", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A patient has a seizure within seconds after receiving a retrobulbar injection of 0.5% bupivacaine with epinephrine 1:200,000. Which of the following is the most likely cause?", + "A": "Air embolism", + "B": "Oculocardiac reflex", + "C": "Ophthalmic artery injection", + "D": "Retrobulbar hemorrhage", + "E": "Subdural injection" + }, + "zh": { + "question": "患者在接受0.5%布比卡因与1:200,000肾上腺素的球后注射后几秒钟内发生癫痫发作。以下哪项是最可能的原因？", + "A": "空气栓塞", + "B": "眼心反射", + "C": "眼动脉注射", + "D": "球后出血", + "E": "硬膜下注射" + } + }, + { + "id": "d7a310cd-38fd-541d-9575-12e46381e371", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "After the bronchial and tracheal cuffs of a right endobronchial tube are inflated, ventilation through the tracheal lumen is not possible. This finding is most consistent with", + "A": "cuff occlusion of the right upper lobe bronchus", + "B": "intubation of the left bronchus", + "C": "left-sided tension pneumothorax", + "D": "overinflation of the bronchial cuff", + "E": "positioning of both cuffs in the trachea" + }, + "zh": { + "question": "在右侧支气管导管的支气管和气管套囊充气后，无法通过气管腔通气。这一发现最符合以下哪种情况？", + "A": "套囊阻塞右上叶支气管", + "B": "插管进入左侧支气管", + "C": "左侧张力性气胸", + "D": "支气管套囊过度充气", + "E": "两个套囊都位于气管内" + } + }, + { + "id": "78d29de8-91d7-5793-aaf0-313c198e1872", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following cardiovascular abnormalities is LEAST likely to be present in a patient with end-stage alcoholic cirrhosis?", + "A": "Decreased myocardial contractility", + "B": "High cardiac index", + "C": "High mixed venous oxygen saturation", + "D": "Increased peripheral vascular resistance", + "E": "Low blood viscosity" + }, + "zh": { + "question": "以下哪种心血管异常最不可能出现在终末期酒精性肝硬化患者中？", + "A": "心肌收缩力下降", + "B": "心脏指数高", + "C": "混合静脉氧饱和度高", + "D": "外周血管阻力增加", + "E": "血液粘度低" + } + }, + { + "id": "ac8b7075-fae1-5e4b-b384-7d98b51809d5", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning pipecuronium is true?", + "A": "It has a faster onset than pancuronium", + "B": "It increases systemic vascular resistance", + "C": "It induces tachycardia", + "D": "It is eliminated by the kidney", + "E": "It induces histamine release" + }, + "zh": { + "question": "以下关于哌库溴铵的说法哪一项是正确的？", + "A": "它的起效比潘库溴铵快", + "B": "它增加全身血管阻力", + "C": "它引起心动过速", + "D": "它通过肾脏排泄", + "E": "它引起组胺释放" + } + }, + { + "id": "eb36991e-54bf-5bc4-b20b-e6936b424f9c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "When compared with a healthy 30-year-old man, which of the following respiratory parameters is decreased in an otherwise healthy 80-year-old man?", + "A": "Alveolar to arterial oxygen gradient", + "B": "Lung compliance", + "C": "Ratio of functional residual capacity to total lung capacity", + "D": "Resting tidal volume", + "E": "Ventilatory response to carbon dioxide" + }, + "zh": { + "question": "与健康的30岁男性相比，下列哪项呼吸参数在其他方面健康的80岁男性中降低？", + "A": "肺泡到动脉的氧梯度", + "B": "肺顺应性", + "C": "功能残气量与总肺容量的比值", + "D": "静息潮气量", + "E": "对二氧化碳的通气反应" + } + }, + { + "id": "d792ca45-231d-51b2-b528-bd27cc28790a", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "In a patient who is receiving nitroglycerin intravenously after a coronary artery operation, peripheral oxygen saturation is 85% and PaO2 is 200 mmHg. The most appropriate management is administration of", + "A": "exchange transfusion", + "B": "hydroxocobalamin", + "C": "methylene blue", + "D": "pure oxygen at 3 atmospheres", + "E": "thiocyanate" + }, + "zh": { + "question": "在一位冠状动脉手术后接受静脉注射硝酸甘油的患者中，外周氧饱和度为85%，PaO2为200 mmHg。最合适的处理是给予", + "A": "换血", + "B": "羟钴胺", + "C": "亚甲蓝", + "D": "3个大气压的纯氧", + "E": "硫氰酸盐" + } + }, + { + "id": "57790b70-7d7e-5891-abb0-44ba3a6b2aee", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A 50-year-old man with alcoholism and jaundice is scheduled to undergo umbilical herniorrhaphy. An increase in which of the following best indicates impaired synthetic hepatic function?", + "A": "Prothrombin time", + "B": "Serum alanine aminotransferase concentration", + "C": "Serum albumin/globulin ratio", + "D": "Serum alkaline phosphatase concentration", + "E": "Serum bilirubin concentration" + }, + "zh": { + "question": "一名50岁的酗酒和黄疸男性计划进行脐疝修补术。以下哪一项的增加最能表明合成性肝功能受损？", + "A": "凝血酶原时间", + "B": "血清丙氨酸氨基转移酶浓度", + "C": "血清白蛋白/球蛋白比值", + "D": "血清碱性磷酸酶浓度", + "E": "血清胆红素浓度" + } + }, + { + "id": "6a1f3918-f4d1-5a9e-a1f3-d0c8ed8d6a72", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 19-year-old man is undergoing inguinal herniorrhaphy. He is anesthetized with a spinal block supplemented with midazolam and fentanyl. During the procedure, he has sudden loss of consciousness, profound hypotension, and bradycardia; systolic pressure is 40 mmHg and heart rate is 30 bpm. Cardiopulmonary resuscitation is started. The most appropriate next step is administration of", + "A": "atropine", + "B": "ephedrine", + "C": "epinephrine", + "D": "flumazenil", + "E": "naloxone" + }, + "zh": { + "question": "一名19岁男性正在接受腹股沟疝修补术。他在脊髓阻滞麻醉下进行手术，并辅以咪达唑仑和芬太尼。在手术过程中，他突然失去意识，出现严重低血压和心动过缓；收缩压为40 mmHg，心率为30 bpm。开始心肺复苏。最合适的下一步是给予", + "A": "阿托品", + "B": "麻黄碱", + "C": "肾上腺素", + "D": "氟马西尼", + "E": "纳洛酮" + } + }, + { + "id": "e283a818-9f4f-510f-ba19-1a286885de26", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "In a patient with peripheral vascular disease, the most likely result of lumbar sympathetic block is", + "A": "increased blood flow to skin and decreased blood flow to muscle", + "B": "increased blood flow to skin and unchanged blood flow to muscle", + "C": "increased blood flow to skin and muscle", + "D": "decreased blood flow to skin and muscle", + "E": "decreased blood flow to skin and unchanged blood flow to muscle" + }, + "zh": { + "question": "在患有外周血管疾病的患者中，腰交感神经阻滞最可能的结果是", + "A": "皮肤血流增加，肌肉血流减少", + "B": "皮肤血流增加，肌肉血流不变", + "C": "皮肤和肌肉血流增加", + "D": "皮肤和肌肉血流减少", + "E": "皮肤血流减少，肌肉血流不变" + } + }, + { + "id": "206743b7-512b-5054-947f-9fdd2058f604", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "Which of the following statements concerning carbon monoxide poisoning is true? A 38-year-old woman with a large goiter has undergone subtotal thyroidectomy. Airway obstruction is noted immediately after extubation despite normal vocal cord function on laryngoscopy. Which of the following is the most likely explanation?", + "A": "Arytenoid dislocation", + "B": "Hematoma", + "C": "Hypocalcemia", + "D": "Recurrent laryngeal nerve injury", + "E": "Tracheomalacia" + }, + "zh": { + "question": "关于一氧化碳中毒，下列哪项陈述是正确的？一名38岁女性患有巨大甲状腺肿，接受了次全甲状腺切除术。拔管后立即出现气道阻塞，尽管喉镜检查显示声带功能正常。以下哪项是最可能的解释？", + "A": "杓状软骨脱位", + "B": "血肿", + "C": "低钙血症", + "D": "喉返神经损伤", + "E": "气管软化" + } + }, + { + "id": "d123c244-7d86-5d32-a09b-b25718b5fc26", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 75-year-old woman with significant carotid artery stenosis is scheduled for general anesthesia for repair of a fractured hip. Which of the following is the greatest disadvantage of using propofol as an induction agent in this patient?", + "A": "Decreased arterial blood pressure", + "B": "Pain during intravenous injection", + "C": "Prolonged apnea after induction", + "D": "Prolonged awakening", + "E": "Prolonged elimination half-life" + }, + "zh": { + "question": "一名75岁的女性患有严重的颈动脉狭窄，计划进行全身麻醉以修复髋部骨折。在该患者中，使用丙泊酚作为诱导剂的最大缺点是什么？", + "A": "动脉血压下降", + "B": "静脉注射时疼痛", + "C": "诱导后呼吸暂停时间延长", + "D": "苏醒时间延长", + "E": "消除半衰期延长" + } + }, + { + "id": "6fe0c725-9910-5a6c-ad66-df7df1444e7b", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "Two opened oxygen cylinders, one full and one empty, are attached to an anesthesia machine. The check valve to the empty cylinder fails. This is expected to result in", + "A": "activation of the fail-safe device", + "B": "cessation of oxygen flow to the anesthesia circuit", + "C": "filling of the empty cylinder with a mixture of all gases supplied to the anesthesia machine", + "D": "increase in the temperature of the empty cylinder", + "E": "interruption of gas delivery from the central oxygen source" + }, + "zh": { + "question": "两个氧气瓶，一个满的，一个空的，连接到麻醉机上。空瓶的止回阀失效。这预计会导致", + "A": "启动故障安全装置", + "B": "麻醉回路的氧气流停止", + "C": "空瓶被麻醉机供应的所有气体混合物填充", + "D": "空瓶的温度升高", + "E": "中央氧气源的气体供应中断" + } + }, + { + "id": "45ccc5f1-e5e5-5b72-86d3-1a9c17bd33c2", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A 25-year-old woman is undergoing emergency appendectomy at 36 weeks' gestation. Following subarachnoid injection of hyperbaric bupivacaine and placement in the supine position, the patient has nausea; heart rate is 105 bpm and blood pressure is 90/60 mmHg. Which of the following is the most appropriate management?", + "A": "Displacement of the uterus to the left", + "B": "Immediate tracheal intubation", + "C": "Intramuscular administration of ephedrine", + "D": "Placement of the operating table in the reverse Trendelenburg position", + "E": "Ventilation by mask with 100% oxygen" + }, + "zh": { + "question": "一名25岁的女性在妊娠36周时进行紧急阑尾切除术。蛛网膜下腔注射高比重布比卡因并置于仰卧位后，患者出现恶心；心率为105次/分钟，血压为90/60 mmHg。以下哪项是最合适的处理方法？", + "A": "将子宫向左移位", + "B": "立即气管插管", + "C": "肌肉注射麻黄碱", + "D": "将手术台置于反Trendelenburg体位", + "E": "用100%氧气面罩通气" + } + }, + { + "id": "ddff903e-6424-5247-9e2a-356c4f97ca2a", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "A 64-year-old patient with chronic obstructive pulmonary disease sustained fractures of ribs 4 through 8 on the left one hour ago. Examination shows agitation, heart rate of 120 bpm, respiratory rate of 30/min, and blood pressure of 180/100 mmHg. PaO2 is 70 mmHg and PaCO2 is 35 mmHg on room air. Radiographs of the chest show no abnormalities. Which of the following is the most appropriate immediate management?", + "A": "Continuous epidural analgesia using local anesthetics", + "B": "Mechanical ventilation", + "C": "Infusion of midazolam", + "D": "Patient-controlled analgesia with morphine sulfate", + "E": "Surgical stabilization of rib fractures" + }, + "zh": { + "question": "一名64岁的慢性阻塞性肺病患者一小时前左侧第4至第8根肋骨骨折。检查显示患者烦躁不安，心率120次/分钟，呼吸频率30次/分钟，血压180/100 mmHg。在室内空气条件下，PaO2为70 mmHg，PaCO2为35 mmHg。胸部X光片未见异常。以下哪项是最合适的立即处理措施？", + "A": "使用局部麻醉剂进行持续硬膜外镇痛", + "B": "机械通气", + "C": "咪达唑仑输注", + "D": "使用硫酸吗啡的患者自控镇痛", + "E": "肋骨骨折的外科固定" + } + }, + { + "id": "609085f4-7735-587f-b198-ced12118e868", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Metoclopramide", + "A": "decreases gastric acid secretion", + "B": "decreases gastroesophageal sphincter tone", + "C": "is contraindicated in patients with Parkinson's disease", + "D": "is most effective when administered in combination with atropine", + "E": "requires an intact vagus nerve for gastrointestinal effects" + }, + "zh": { + "question": "甲氧氯普胺", + "A": "减少胃酸分泌", + "B": "降低胃食管括约肌张力", + "C": "禁用于帕金森病患者", + "D": "与阿托品联合使用时效果最佳", + "E": "需要完整的迷走神经以发挥胃肠道作用" + } + }, + { + "id": "8934fe9a-b332-5887-8f8d-08a6c76dbf4f", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is an effect of ritodrine?", + "A": "Anisocoria", + "B": "Hypocalcemia", + "C": "Hypoglycemia", + "D": "Hypokalemia", + "E": "Urinary retention" + }, + "zh": { + "question": "下列哪项是利托君的作用？", + "A": "瞳孔不等", + "B": "低钙血症", + "C": "低血糖", + "D": "低钾血症", + "E": "尿潴留" + } + }, + { + "id": "7702e931-6003-512f-b906-066496c51b23", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An obese patient and a lean patient receive halothane for the same duration and at the same inspired tension. Postoperatively, the obese patient would demonstrate", + "A": "higher serum creatinine concentration", + "B": "higher serum fluoride concentration", + "C": "lower eosinophil count", + "D": "lower serum alkaline phosphate activity", + "E": "lower serum bromide concentration" + }, + "zh": { + "question": "一名肥胖患者和一名瘦患者接受相同时间和相同吸入浓度的氟烷。术后，肥胖患者将表现出", + "A": "更高的血清肌酐浓度", + "B": "更高的血清氟化物浓度", + "C": "更低的嗜酸性粒细胞计数", + "D": "更低的血清碱性磷酸酶活性", + "E": "更低的血清溴化物浓度" + } + }, + { + "id": "e081ac0a-fed9-5162-8c70-97a7f524d709", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning interscalene brachial plexus block is true?", + "A": "The three trunks of the plexus are in the same fascial plane as the internal jugular vein", + "B": "Distal spread of anesthetic past the humeral head is accelerated by adduction of the arm", + "C": "Anesthetic solution can spread up the fascial sheaths to involve the stellate ganglion", + "D": "Ipsilateral diaphragmatic paralysis results from epidural spread", + "E": "Rich vascularity in the sheaths promotes rapid vascular uptake of anesthetic" + }, + "zh": { + "question": "以下关于斜角肌间隙臂丛阻滞的说法中哪一项是正确的？", + "A": "丛的三个干与颈内静脉位于同一筋膜平面", + "B": "通过将手臂内收可以加速麻醉剂在肱骨头远端的扩散", + "C": "麻醉溶液可以沿筋膜鞘向上扩散，涉及星状神经节", + "D": "同侧膈肌麻痹是由硬膜外扩散引起的", + "E": "鞘内丰富的血管促进了麻醉剂的快速血管吸收" + } + }, + { + "id": "b30de8f6-9bba-523b-a943-28df897efea2", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "High positive end-expiratory pressure can result in each of the following EXCEPT", + "A": "decreased venous return", + "B": "increased functional residual capacity", + "C": "a left-to-right shift of the ventricular septum", + "D": "decreased PaO2", + "E": "pulmonary barotrauma" + }, + "zh": { + "question": "高水平的呼气末正压可以导致以下每一种情况，除了", + "A": "静脉回流减少", + "B": "功能残气量增加", + "C": "心室间隔的左向右移位", + "D": "动脉氧分压降低", + "E": "肺部气压伤" + } + }, + { + "id": "616b6554-275d-5f0f-9dc6-d5ffccf25d8d", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 95-kg, 65-year-old woman receives sevoflurane and pancuronium during a laparoscopic cholecystectomy. Three minutes after administration of neostigmine 5 mg and atropine 1.2 mg, the twitch height returns to normal. Spontaneous tidal volume is 500 ml when the endotracheal tube is removed. In the PACU she reports dyspnea and appears distressed. Which of the following is the most likely cause of the respiratory distress?", + "A": "Atelectasis", + "B": "Cholinergic crisis", + "C": "Pain", + "D": "Residual enflurane", + "E": "Residual muscle paralysis" + }, + "zh": { + "question": "一名95公斤、65岁的女性在腹腔镜胆囊切除术中接受了七氟醚和潘库溴铵。给予新斯的明5毫克和阿托品1.2毫克三分钟后，肌肉抽搐高度恢复正常。拔除气管插管时，自主潮气量为500毫升。在术后恢复室，她报告呼吸困难并显得痛苦。以下哪项是呼吸窘迫最可能的原因？", + "A": "肺不张", + "B": "胆碱能危象", + "C": "疼痛", + "D": "残余乙醚", + "E": "残余肌肉麻痹" + } + }, + { + "id": "ec14ad80-f634-5a88-99a0-53a645672268", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "An advantage of CPDA-1 over CPD for storage of packed red blood cells is", + "A": "greater enhancement of red cell survival", + "B": "lesser increase in plasma hemoglobin concentration", + "C": "lesser increase in PC02 of stored blood", + "D": "better maintenance of blood pH", + "E": "better maintenance of 2,3-diphosphoglycerate concentration" + }, + "zh": { + "question": "CPDA-1 相对于 CPD 在储存浓缩红细胞方面的一个优点是", + "A": "更好地增强红细胞存活率", + "B": "血浆血红蛋白浓度增加较少", + "C": "储存血液的PCO2增加较少", + "D": "更好地维持血液pH值", + "E": "更好地维持2,3-二磷酸甘油酸浓度" + } + }, + { + "id": "b3431a29-a421-5803-b06d-07961351e2f1", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with isoflurane, desflurane", + "A": "causes higher plasma norepinephrine levels", + "B": "has greater biodegradability", + "C": "has a higher blood/gas partition coefficient", + "D": "has a lower MAC value", + "E": "has a lower vapor pressure" + }, + "zh": { + "question": "与异氟醚相比，地氟醚", + "A": "导致更高的血浆去甲肾上腺素水平", + "B": "具有更高的生物降解性", + "C": "具有更高的血/气分配系数", + "D": "具有更低的MAC值", + "E": "具有更低的蒸气压" + } + }, + { + "id": "97722ab4-0c11-516b-b938-45f03cd6597e", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "Epinephrine is less effective in prolonging epidural anesthesia with bupivacaine than epidural anesthesia with lidocaine because", + "A": "peak bupivacaine concentrations are decreased less than peak lidocaine concentrations", + "B": "the acidic pH of epinephrine decreases the concentration of the nonionized bupivacaine", + "C": "bupivacaine produces more vasoconstriction than lidocaine", + "D": "the duration of action of bupivacaine is independent of local blood flow", + "E": "bupivacaine antagonizes the vasoconstrictor activity of epinephrine" + }, + "zh": { + "question": "肾上腺素在延长布比卡因硬膜外麻醉的效果不如在延长利多卡因硬膜外麻醉的效果，因为", + "A": "布比卡因的峰值浓度比利多卡因的峰值浓度减少得更少", + "B": "肾上腺素的酸性pH值降低了非离子化布比卡因的浓度", + "C": "布比卡因比利多卡因产生更多的血管收缩", + "D": "布比卡因的作用持续时间与局部血流无关", + "E": "布比卡因拮抗肾上腺素的血管收缩活性" + } + }, + { + "id": "738ae9be-3e26-59c1-9849-b9e358a6d33f", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Which of the following results in decreased mixed venous oxygen saturation?", + "A": "Cardiogenic shock", + "B": "Decreased metabolic rate", + "C": "Increased cardiac output", + "D": "Left-to-right intracardiac shunt", + "E": "Pulmonary vasodilation" + }, + "zh": { + "question": "以下哪项会导致混合静脉氧饱和度降低？", + "A": "心源性休克", + "B": "代谢率降低", + "C": "心输出量增加", + "D": "左向右心内分流", + "E": "肺血管扩张" + } + }, + { + "id": "f17893e5-7f04-5c7e-872c-43f6f49a781f", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Compared with other volatile inhalation anesthetics, desflurane has which of the following characteristics?", + "A": "Equipotency to isoflurane", + "B": "Greater extent of biotransformation than enflurane", + "C": "Less airway irritation than halothane", + "D": "Lower blood gas solubility coefficient than enflurane", + "E": "Lower vapor pressure than isoflurane" + }, + "zh": { + "question": "与其他挥发性吸入麻醉剂相比，地氟烷具有以下哪种特性？", + "A": "与异氟烷等效", + "B": "比恩氟烷有更大的生物转化程度", + "C": "比氟烷引起的气道刺激更少", + "D": "比恩氟烷的血气分配系数更低", + "E": "比异氟烷的蒸气压更低" + } + }, + { + "id": "502f29cb-4b9d-5df0-aa3e-270ed4a0b945", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An anesthesia machine is set to deliver oxygen 2 L/min, nitrous oxide 2 L/min, and sevoflurane. After 30 minutes of stable anesthesia, which of the following, is the most likely cause of a decrease in the oxygen analyzer reading from 50% to 30%?", + "A": "A leak in the ventilator bellows", + "B": "Accumulation of water on the oxygen sensor membrane", + "C": "Calibration at 100% oxygen using less than 100% oxygen", + "D": "Disconnection of the wall oxygen hose", + "E": "Presence of the oxygen analyzer in the expiratory limb" + }, + "zh": { + "question": "麻醉机设置为输送氧气2 L/min、氧化亚氮2 L/min和七氟醚。经过30分钟的稳定麻醉后，以下哪项最有可能导致氧气分析仪读数从50%下降到30%？", + "A": "呼吸机风箱漏气", + "B": "氧气传感器膜上积水", + "C": "使用低于100%氧气进行100%氧气校准", + "D": "墙壁氧气管断开", + "E": "氧气分析仪位于呼气管路中" + } + }, + { + "id": "49d0498c-e598-5900-a6fd-10ed38c37d0f", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Diplopia following lumbar puncture with a 25-gauge, 3 1/2-inch needle is the result of", + "A": "stretching the abducens nerve", + "B": "pressure on the optic nerve", + "C": "distortion of the oculomotor nucleus from collapse of the wall of the third ventricle", + "D": "the severity of the accompanying headache", + "E": "compensatory cerebral swelling" + }, + "zh": { + "question": "使用25号、3.5英寸针进行腰椎穿刺后出现复��的原因是", + "A": "展神经的牵拉", + "B": "视神经的压力", + "C": "第三脑室壁塌陷导致动眼神经核的扭曲", + "D": "伴随头痛的严重程度", + "E": "代偿性脑肿胀" + } + }, + { + "id": "e42c3b0b-0c0b-55d0-9312-069206750e92", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A child undergoing general anesthesia is breathing spontaneously using the Jackson-Rees modification of the Ayres T-piece. Respiratory rate is 20/min and tidal volume is 75 ml. What is the minimum fresh gas flow required to prevent rebreathing?", + "A": "750 ml/min", + "B": "1500 ml/min", + "C": "2250 ml/min", + "D": "4500 ml/min", + "E": "6000 ml/min" + }, + "zh": { + "question": "一名正在接受全身麻醉的儿童使用Jackson-Rees改良的Ayres T型管进行自主呼吸。呼吸频率为20次/分钟，潮气量为75毫升。为了防止再呼吸，所需的最低新鲜气流量是多少？", + "A": "750 毫升/分钟", + "B": "1500 毫升/分钟", + "C": "2250 毫升/分钟", + "D": "4500 毫升/分钟", + "E": "6000 毫升/分钟" + } + }, + { + "id": "4f050889-e0dc-5e03-a0c2-3c7c0eb40c79", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Immediately after a retrobulbar block for cataract surgery, the eye grossly protrudes and the patient has the sensation of pressure in the eye. The most appropriate initial intervention is", + "A": "hyperventilation", + "B": "surgical drainage of a hematoma", + "C": "manual compression of the globe", + "D": "administration of atropine intravenously", + "E": "administration of mannitol intravenously" + }, + "zh": { + "question": "在白内障手术的球后阻滞麻醉后，眼球明显突出，患者感到眼内有压力。最合适的初步干预措施是", + "A": "过度通气", + "B": "手术引流血肿", + "C": "手动压迫眼球", + "D": "静脉注射阿托品", + "E": "静脉注射甘露醇" + } + }, + { + "id": "19318858-a355-5bfa-ab22-bb1e5105dcd8", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A 75-year-old man in the PACU complains of severe pain following thoracotomy. Respiratory rate is 30/min; arterial blood gas values are PaO2 70 mmHg, PaCO2 56 mmHg, and pH 7.28 at an FiO2 of 0.6. The patient has a thoracic epidural catheter and received epidural morphine 2 mg 45 minutes earlier. Which of the following is the most appropriate immediate management?", + "A": "Intravenous administration of naloxone", + "B": "Epidural administration of additional morphine", + "C": "Epidural administration of 0.125% bupivacaine", + "D": "Epidural administration of fentanyl", + "E": "Intubation of the trachea" + }, + "zh": { + "question": "一名75岁的男性在术后恢复室抱怨胸廓切开术后的剧烈疼痛。呼吸频率为30次/分钟；动脉血气值为PaO2 70 mmHg，PaCO2 56 mmHg，pH 7.28，在FiO2为0.6的情况下。患者有一个胸椎硬膜外导管，并在45分钟前接受了2 mg的硬膜外吗啡。以下哪项是最合适的立即处理措施？", + "A": "静脉注射纳洛酮", + "B": "追加硬膜外吗啡", + "C": "硬膜外注射0.125%布比卡因", + "D": "硬膜外注射芬太尼", + "E": "气管插管" + } + }, + { + "id": "0c6dbb4b-2790-51f8-9d45-5b02afe161a2", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Intractable pain due to unresectable pancreatic carcinoma is most effectively treated with", + "A": "bilateral neurolytic intercostal blocks at T10-12", + "B": "bilateral sympathetic blocks with phenol", + "C": "celiac plexus block with alcohol", + "D": "epidural block with phenol", + "E": "subarachnoid block with alcohol" + }, + "zh": { + "question": "由于不可切除的胰腺癌导致的难治性疼痛最有效的治疗方法是", + "A": "T10-12双侧神经溶解性肋间阻滞", + "B": "双侧交感神经阻滞与苯酚", + "C": "酒精腹腔神经丛阻滞", + "D": "苯酚硬膜外阻滞", + "E": "酒精蛛网膜下腔阻滞" + } + }, + { + "id": "f26edd7d-4f49-58d6-b285-678e55ed727b", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following is an effect of electroconvulsive therapy EXCEPT", + "A": "increased intracranial blood volume", + "B": "increased oxygen consumption", + "C": "inhibition of parasympathetic activity", + "D": "retrograde amnesia", + "E": "stimulation of the sympathetic nervous system" + }, + "zh": { + "question": "以下各项中，电休克疗法的影响不包括", + "A": "颅内血容量增加", + "B": "氧气消耗增加", + "C": "抑制副交感神经活动", + "D": "逆行性遗忘", + "E": "刺激交感神经系统" + } + }, + { + "id": "4c3e5a69-5176-5049-84c3-7727b7b3ca31", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "When methylmethacrylate is inserted into the femur, each of the following may occur EXCEPT", + "A": "monomer metabolic breakdown", + "B": "vasodilation", + "C": "hypercarbia", + "D": "hypoxia", + "E": "increased intramedullary pressure" + }, + "zh": { + "question": "当将甲基丙烯酸甲酯插入股骨时，以下每种情况都可能发生，除了", + "A": "单体代谢分解", + "B": "血管扩张", + "C": "高碳酸血症", + "D": "缺氧", + "E": "髓内压增加" + } + }, + { + "id": "4f0a0cfa-8489-544e-9fd2-c575345007a6", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Each of the following statements about muscle rigidity induced by opioids is true EXCEPT:", + "A": "The degree of rigidity is related to the rate of opioid administration", + "B": "It is more apparent during the administration of nitrous oxide", + "C": "Muscles of the trunk are affected more than muscles of the extremities", + "D": "It results from a direct effect of the opioid on skeletal muscles", + "E": "It can be produced by large doses of morphine" + }, + "zh": { + "question": "以下关于阿片类药物引起的肌肉僵硬的说法中，除了哪一项外，其他都是正确的：", + "A": "僵硬程度与阿片类药物的给药速度有关", + "B": "在使用氧化亚氮时更明显", + "C": "躯干肌肉比四肢肌肉受影响更大", + "D": "这是阿片类药物对骨骼肌的直接作用导致的", + "E": "大剂量吗啡可以引起这种现象" + } + }, + { + "id": "77d678bb-d549-5745-acac-c4a6d99a8cae", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Following a vaginal hysterectomy in the lithotomy position under general anesthesia, a patient has numbness of the lateral aspect of the left calf and medial half of the dorsum of the left foot. On physical examination she has footdrop and the toes cannot be extended. Which nerve is most likely to be involved?", + "A": "Common peroneal nerve", + "B": "Deep peroneal nerve", + "C": "Posterior tibial nerve", + "D": "Saphenous nerve", + "E": "Sciatic nerve" + }, + "zh": { + "question": "在全身麻醉下以截石位进行阴道子宫切除术后，患者出现左小腿外侧和左足背内侧一半的麻木。体格检查显示足下垂，脚趾不能伸展。最可能受累的神经是哪个？", + "A": "腓总神经", + "B": "腓深神经", + "C": "胫后神经", + "D": "隐神经", + "E": "坐骨神经" + } + }, + { + "id": "888c55c7-366a-5050-86ae-847f378b713c", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following indicates a hemolytic transfusion reaction in an anesthetized patient EXCEPT", + "A": "bleeding diathesis", + "B": "wheezing", + "C": "hypotension", + "D": "hemoglobinuria", + "E": "decreased serum haptoglobin concentration" + }, + "zh": { + "question": "在麻醉患者中，以下各项均表示溶血性输血反应，除了", + "A": "出血性素质", + "B": "喘息", + "C": "低血压", + "D": "血红蛋白尿", + "E": "血清结合珠蛋白浓度降低" + } + }, + { + "id": "89e618cc-1480-5ff2-a4a9-b3e09e008ebd", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A patient is anesthetized using an inhaled anesthetic with a blood/gas partition coefficient of 13.0. Recovery time depends primarily on", + "A": "oil/gas solubility of the drug", + "B": "cardiac output", + "C": "tidal volume", + "D": "duration of administration", + "E": "MAC of the drug" + }, + "zh": { + "question": "一名患者使用血/气分配系数为13.0的吸入麻醉剂进行麻醉。恢复时间主要取决于", + "A": "药物的油/气溶解度", + "B": "心输出量", + "C": "潮气量", + "D": "给药时间", + "E": "药物的最低肺泡浓度（MAC）" + } + }, + { + "id": "77b08b6f-e1ca-573d-b89d-74758c9065df", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Inhibition of labor by terbutaline causes each of the following maternal side effects EXCEPT", + "A": "hyperkalemia", + "B": "hypotension", + "C": "ventricular dysrhythmias", + "D": "hyperglycemia", + "E": "pulmonary edema" + }, + "zh": { + "question": "特布他林抑制分娩会导致以下每一种母体副作用，除了", + "A": "高钾血症", + "B": "低血压", + "C": "心室心律失常", + "D": "高血糖", + "E": "肺水肿" + } + }, + { + "id": "d7088c9b-9be2-5a79-b091-66ffedde865b", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The primary determinant of the duration of an intravenous regional block sufficient to provide surgical anesthesia of an upper extremity is", + "A": "duration of tourniquet inflation", + "B": "capacitance of the venous system of the extremity", + "C": "local anesthetic agent injected", + "D": "volume of anesthetic solution injected", + "E": "method of exsanguinating the arm" + }, + "zh": { + "question": "决定上肢静脉区域阻滞持续时间的主要因素是", + "A": "止血带充气的持续时间", + "B": "肢体静脉系统的容量", + "C": "注射的局部麻醉药", + "D": "注射的麻醉溶液的体积", + "E": "排空手臂血液的方法" + } + }, + { + "id": "e38d89d6-ecf7-5496-8e41-fca72e187341", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "Thirty-six hours after primary repair of meningomyelocele, a term newborn has frequent periods of apnea lasting 25 seconds and associated with oxygen desaturation to 80%. The most likely explanation is", + "A": "hyperglycemia", + "B": "loss of cerebrospinal fluid", + "C": "obstructive hydrocephalus", + "D": "residual anesthetic effect", + "E": "normal postoperative events" + }, + "zh": { + "question": "在脊髓脊膜膨出初次修复术后36小时，一名足月新生儿出现频繁的呼吸暂停，持续25秒，并伴有氧饱和度降至80%。最可能的解释是", + "A": "高血糖", + "B": "脑脊液丢失", + "C": "梗阻性脑积水", + "D": "麻醉药物残留效应", + "E": "正常术后事件" + } + }, + { + "id": "b403c0b9-e5d4-5426-9287-a21ae2d13589", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Administration of succinylcholine 1 mg/kg to a pregnant woman rarely causes fetal neuromuscular blockade. Which characteristic of succinylcholine best explains this phenomenon?", + "A": "High protein binding", + "B": "Ionization", + "C": "Lack of passive placental diffusion", + "D": "Lipid solubility", + "E": "Metabolism in the fetal liver" + }, + "zh": { + "question": "给孕妇给予琥珀胆碱1 mg/kg很少会导致胎儿神经肌肉阻滞。琥珀胆碱的哪个特性最好地解释了这一现象？", + "A": "高蛋白结合率", + "B": "电离", + "C": "缺乏被动胎盘扩散", + "D": "脂溶性", + "E": "在胎儿肝脏中的代谢" + } + }, + { + "id": "f2956634-111e-5504-abab-d2bd0f0c7343", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A patient has pain in the left thoracic wall associated with metastatic rib lesions. An intrathecal neurolytic block with 6% phenol in glycerin is planned for pain relief. Prior to performing the block, the patient should be placed in which of the following positions?", + "A": "Left lateral semisupine", + "B": "Right lateral semisupine", + "C": "Left lateral semiprone", + "D": "Right lateral semiprone", + "E": "Prone" + }, + "zh": { + "question": "一名患者左侧胸壁因转移性肋骨病变而感到疼痛。计划使用6%甘油酚进行鞘内神经阻滞以缓解疼痛。在进行阻滞之前，患者应被置于以下哪种体位？", + "A": "左侧卧半仰卧位", + "B": "右侧卧半仰卧位", + "C": "左侧卧半俯卧位", + "D": "右侧卧半俯卧位", + "E": "俯卧位" + } + }, + { + "id": "40a6a0a7-728e-50a2-84aa-2313f48baa11", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is the primary factor regulating normal coronary blood flow?", + "A": "Aortic diastolic pressure", + "B": "Coronary perfusion pressure", + "C": "Heart rate", + "D": "Myocardial oxygen consumption", + "E": "Systolic wall tension" + }, + "zh": { + "question": "以下哪项是调节正常冠状动脉血流的主要因素？", + "A": "主动脉舒张压", + "B": "冠状动脉灌注压", + "C": "心率", + "D": "心肌耗氧量", + "E": "收缩期壁张力" + } + }, + { + "id": "4825872b-5979-5db0-b7d6-a956f63767a3", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 1150-g, 10-day-old infant is undergoing a bowel resection for necrotizing enterocolitis. Heart rate is 200 bpm and blood pressure measured through a femoral artery catheter is 45/24 mmHg. The most appropriate next step is administration of", + "A": "calcium gluconate", + "B": "epinephrine", + "C": "esmolol", + "D": "fentanyl", + "E": "normal saline solution" + }, + "zh": { + "question": "一名1150克、10天大的婴儿正在接受坏死性小肠结肠炎的肠切除手术。心率为200次/分钟，通过股动脉导管测得的血压为45/24 mmHg。最合适的下一步是给予", + "A": "葡萄糖酸钙", + "B": "肾上腺素", + "C": "艾司洛尔", + "D": "芬太尼", + "E": "生理盐水" + } + }, + { + "id": "58f76473-a262-57c4-a32d-e2e50cc747bf", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "An obese, 35-year-old man had an episode of coughing followed by vomiting during induction of anesthesia for arthroscopy of the left knee. Intense wheezing developed bilaterally over five minutes. PaO2 is 60 mmHg, PaCO2 is 42 mmHg, and pH is 7.35. Optimal management following intubation of the trachea includes", + "A": "mechanical ventilation with positive end-expiratory pressure (PEEP), cancellation of surgery, and transfer to the intensive care unit", + "B": "saline lavage and continuation of surgery using halothane anesthesia", + "C": "cancellation of surgery and administration of corticosteroids and antibiotics", + "D": "thorough suctioning and proceeding with halothane anesthesia", + "E": "cancellation of surgery, vigorous mechanical ventilation, thorough suctioning, and administration of aminophylline" + }, + "zh": { + "question": "一名35岁的肥胖男性在进行左膝关节镜手术的麻醉诱导过程中出现咳嗽后呕吐的情况。五分钟内双侧出现剧烈喘息。PaO2为60 mmHg，PaCO2为42 mmHg，pH值为7.35。气管插管后的最佳处理包括", + "A": "使用带有呼气末正压（PEEP）的机械通气，取消手术，并转入重症监护室", + "B": "生理盐水冲洗并继续使用氟烷麻醉进行手术", + "C": "取消手术并给予皮质类固醇和抗生素", + "D": "彻底吸引并继续使用氟烷麻醉", + "E": "取消手术，进行强力机械通气，彻底吸引，并给予氨茶碱" + } + }, + { + "id": "97932750-4e38-5baf-a0b6-3d732ece0b2d", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 69-year-old man is confused and agitated one hour after preoperative intramuscular administration of scopolamine for awake fiberoptic laryngoscopy. SpO2 measured by pulse oximetry is 97%. Which of the following drugs is most appropriate for treatment of the change in mental status?", + "A": "Fentanyl", + "B": "Flumazenil", + "C": "Midazolam", + "D": "Neostigmine", + "E": "Physostigmine" + }, + "zh": { + "question": "一名69岁男性在术前肌肉注射东莨菪碱后一个小时出现意识混乱和烦躁不安，准备进行清醒纤维支气管镜喉镜检查。脉搏血氧仪测得的SpO2为97%。以下哪种药物最适合治疗精神状态的改变？", + "A": "芬太尼", + "B": "氟马西尼", + "C": "咪达唑仑", + "D": "新斯的明", + "E": "毒扁豆碱" + } + }, + { + "id": "dc4516ea-41df-5d81-9bb6-5f657c8bddad", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following muscle relaxants has a prolonged duration of action in a patient who is homozygous for atypical plasma cholinesterase?", + "A": "Atracurium", + "B": "Doxacurium", + "C": "Mivacurium", + "D": "Pipecuronium", + "E": "Vecuronium" + }, + "zh": { + "question": "在一名纯合子非典型血浆胆碱酯酶患者中，以下哪种肌肉松弛剂的作用时间延长？", + "A": "阿曲库铵", + "B": "多库铵", + "C": "米库氯铵", + "D": "哌库溴铵", + "E": "维库溴铵" + } + }, + { + "id": "daac56f4-ea7f-5d7b-8d19-4700ed3bd2f4", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Intravenous administration of mannitol during a craniotomy", + "A": "decreases intracranial pressure relative to dosage", + "B": "hastens excretion of pancuronium", + "C": "induces metabolic alkalosis", + "D": "produces a sustained increase in intravascular volume", + "E": "requires an intact blood-brain barrier to decrease brain water" + }, + "zh": { + "question": "在开颅手术中静脉注射甘露醇", + "A": "相对于剂量降低颅内压", + "B": "加速潘库溴铵的排泄", + "C": "引起代谢性碱中毒", + "D": "导致血管内容量持续增加", + "E": "需要完整的血脑屏障来减少脑水分" + } + }, + { + "id": "2dff275d-35f2-522e-aef4-3636be6a7e25", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "An 8-year-old child with chronic renal failure is scheduled for an operation to create an arteriovenous fistula. Laboratory studies include: Hemoglobin\t6.5 g/dl, Blood gases (breathing air) : PaO2 97 mmHg, PaCO2\t29 mmHg, pH\t7.30 Sodium\t129 mEq/L Potassium\t5.5 mEq/L Chloride 101 mEq/L Bicarbonate 15 mEq/L. Before inducing general anesthesia, which of the following abnormalities should be corrected?", + "A": "Anemia", + "B": "Metabolic acidosis", + "C": "Potassium concentration", + "D": "Anemia, metabolic acidosis, and potassium concentration", + "E": "None of the above" + }, + "zh": { + "question": "一名8岁患有慢性肾功能衰竭的儿童计划进行动静脉瘘手术。实验室检查结果包括：血红蛋白 6.5 g/dl，血气（呼吸空气）：PaO2 97 mmHg，PaCO2 29 mmHg，pH 7.30，钠 129 mEq/L，钾 5.5 mEq/L，氯 101 mEq/L，碳酸氢盐 15 mEq/L。在诱导全身麻醉之前，应纠正以下哪种异常？", + "A": "贫血", + "B": "代谢性酸中毒", + "C": "钾浓度", + "D": "贫血、代谢性酸中毒和钾浓度", + "E": "以上都不是" + } + }, + { + "id": "eb108ebf-8d26-5334-9007-7128cce5b9e1", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following conditions is associated with upregulation of the acetylcholine receptor at the neuromuscular junction EXCEPT", + "A": "burn injuries", + "B": "myasthenia gravis", + "C": "prolonged bed rest", + "D": "prolonged use of neuromuscular relaxants", + "E": "upper motor neuron injury" + }, + "zh": { + "question": "下列每种情况均与神经肌肉接头处乙酰胆碱受体的上调有关，除了", + "A": "烧伤", + "B": "重症肌无力", + "C": "长期卧床", + "D": "长期使用神经肌肉松弛剂", + "E": "上运动神经元损伤" + } + }, + { + "id": "2b992da9-c919-5c15-970b-acc4700a5b2a", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning the cardiovascular effects of intravenous bupivacaine is true?", + "A": "Intralipid is effective in treating bupivacaine-induced ventricular arrhythmias", + "B": "Cardiovascular toxicity is decreased during pregnancy", + "C": "Cardiovascular toxicity occurs at lower blood levels than central nervous system toxicity", + "D": "Systemic vascular resistance is unchanged", + "E": "The rate of impulse conduction through the heart is increased" + }, + "zh": { + "question": "以下关于静脉注射布比卡因对心血管影响的说法中哪一项是正确的？", + "A": "脂肪乳对治疗布比卡因引起的心室性心律失常有效", + "B": "妊娠期间心血管毒性降低", + "C": "心血管毒性发生在比中枢神经系统毒性更低的血药浓度下", + "D": "全身血管阻力不变", + "E": "心脏的冲动传导速度增加" + } + }, + { + "id": "4c4399fe-bcff-5c48-97b9-ddad63bfb01d", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A patient who had liver transplantation two years ago now requires general anesthesia for ENT surgery. Minimal rejection has occurred on a regimen of cyclosporine and prednisone. Which of the following is most likely?", + "A": "Hypoalbuminemia", + "B": "Hypocalcemia", + "C": "Episodic hypoglycemia", + "D": "Increased serum creatinine concentration", + "E": "Prolonged prothrombin time" + }, + "zh": { + "question": "一名两年前接受肝移植的患者现在需要全身麻醉进行耳鼻喉手术。在环孢素和泼尼松的治疗方案下，发生了轻微的排斥反应。以下哪项最有可能？", + "A": "低白蛋白血症", + "B": "低钙血症", + "C": "间歇性低血糖", + "D": "血清肌酐浓度升高", + "E": "凝血酶原时间延长" + } + }, + { + "id": "7864fcdc-e27a-51cc-8aef-18d6f4c7f4f0", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following is a recognized complication during a transurethral resection for which glycine is used as an irrigant EXCEPT", + "A": "disseminated intravascular coagulopathy", + "B": "hemolysis", + "C": "hyperammonemia", + "D": "shoulder pain", + "E": "transient blindness" + }, + "zh": { + "question": "在使用甘氨酸作为灌洗液的经尿道切除术中，以下哪项是公认的并发症，除了", + "A": "弥散性血管内凝血", + "B": "溶血", + "C": "高氨血症", + "D": "肩痛", + "E": "暂时性失明" + } + }, + { + "id": "ac0a9fe2-c160-5ffc-9b73-ca16d4b993ac", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The fail-safe mechanism on an anesthesia machine is activated by", + "A": "a wall-oxygen pressure of less than 25 psi", + "B": "a disconnection between the endotracheal tube and the machine", + "C": "a nitrous oxide concentration in excess of 85%", + "D": "an incompetent expiratory valve", + "E": "no oxygen flow" + }, + "zh": { + "question": "麻醉机的安全机制由以下哪项激活", + "A": "墙氧压力低于25 psi", + "B": "气管插管与机器之间的断开", + "C": "一氧化二氮浓度超过85%", + "D": "呼气阀失效", + "E": "无氧气流动" + } + }, + { + "id": "0fe60c64-de4b-5d1b-9f1c-00a890290f63", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Intraocular pressure is", + "A": "decreased by glycopyrrolate", + "B": "increased by hyperventilation", + "C": "decreased by halothane", + "D": "increased by nondepolarizing muscle relaxants", + "E": "increased by phenylephrine eye drops" + }, + "zh": { + "question": "眼内压是", + "A": "由格隆溴铵降低", + "B": "由过度通气增加", + "C": "由氟烷降低", + "D": "由非去极化肌松药增加", + "E": "由去氧肾上腺素眼药水增加" + } + }, + { + "id": "51c96382-fc02-569b-a127-7b8c4e21dd16", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following vaporizer filling errors is most likely to result in inadvertent anesthetic overdose?", + "A": "Sevoflurane in a halothane vaporizer", + "B": "Sevoflurane in an isoflurane vaporizer", + "C": "Halothane in an sevoflurane vaporizer", + "D": "Halothane in an isoflurane vaporizer", + "E": "Isoflurane in an sevoflurane vaporizer" + }, + "zh": { + "question": "以下哪种蒸发器加注错误最有可能导致意外的麻醉药过量？", + "A": "在氟烷蒸发器中加注七氟醚", + "B": "在异氟醚蒸发器中加注七氟醚", + "C": "在七氟醚蒸发器中加注氟烷", + "D": "在异氟醚蒸发器中加注氟烷", + "E": "在七氟醚蒸发器中加注异氟醚" + } + }, + { + "id": "eb0fc0ae-0dca-5329-8014-87d29afe7d62", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "During an otherwise uneventful nitrous oxide-sevoflurane anesthetic in a spontaneously breathing patient, 85% nitrous oxide is accidently administered, resulting in a PO2 of 48 mmHg. Which of the following would be expected?", + "A": "Tachycardia", + "B": "Sweating", + "C": "Tachypnea", + "D": "Hyperactive EEG", + "E": "None of the above" + }, + "zh": { + "question": "在一名自主呼吸的患者中进行的原本无特殊事件的氧化亚氮-七氟醚麻醉过程中，意外地给予了85%的氧化亚氮，导致PO2为48 mmHg。以下哪项是预期的？", + "A": "心动过速", + "B": "出汗", + "C": "呼吸急促", + "D": "脑电图过度活跃", + "E": "以上都不是" + } + }, + { + "id": "b33c2a5e-1329-5070-8333-cc3aa9a41d88", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Proper zeroing of an arterial pressure transducer attached to a supine anesthetized patient is best accomplished by", + "A": "continuous flow of fluid through the intravascular catheter", + "B": "opening the system to air at heart level", + "C": "placement of the transducer diaphragm at heart level", + "D": "proper damping of the transducer system", + "E": "zeroing the transducer during the expiration phase of mechanical ventilation" + }, + "zh": { + "question": "将动脉压力传感器连接到仰卧的麻醉患者时，正确的归零方法是", + "A": "通过血管内导管持续流动液体", + "B": "在心脏水平打开系统与空气相通", + "C": "将传感器隔膜放置在心脏水平", + "D": "正确阻尼传感器系统", + "E": "在机械通气的呼气阶段对传感器进行归零" + } + }, + { + "id": "a92b8231-4484-5a37-bd1c-64799ddf78ac", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Carbon monoxide poisoning with a carboxyhemoglobin concentration of 20% is characterized by each of the following EXCEPT", + "A": "decreased oxygen-carrying capacity of hemoglobin", + "B": "decreased PaO2", + "C": "shift of the oxyhemoglobin dissociation curve to the left", + "D": "normal minute volume of ventilation", + "E": "headache and nausea" + }, + "zh": { + "question": "一氧化碳中毒伴有20%的碳氧血红蛋白浓度，其特征是以下各项，除了", + "A": "血红蛋白的携氧能力下降", + "B": "动脉氧分压（PaO2）下降", + "C": "氧合血红蛋白解离曲线左移", + "D": "正常的通气分钟量", + "E": "头痛和恶心" + } + }, + { + "id": "df989236-b8d7-5b77-87f1-afd6803df9aa", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The flow proportioning system on an anesthesia machine", + "A": "is regulated primarily by changes in oxygen input pressure", + "B": "limits nitrous oxide flow when oxygen pressure falls below a preset value", + "C": "maintains a minimum ratio of oxygen to nitrous oxide in fresh gas flow", + "D": "precludes the use of a closed system", + "E": "regulates flows of oxygen and nitrous oxide to maintain a fixed FlO:" + }, + "zh": { + "question": "麻醉机上的流量比例系统", + "A": "主要通过改变氧气输入压力来调节", + "B": "当氧气压力低于预设值时限制氧化亚氮流量", + "C": "在新鲜气体流量中维持氧气与氧化亚氮的最低比例", + "D": "排除使用封闭系统", + "E": "调节氧气和氧化亚氮的流量以维持固定的氧气浓度" + } + }, + { + "id": "9c8d70f7-c793-52e6-a8bb-cfe339ce7cbc", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Systemic hypothermia to 30°C is accompanied by", + "A": "a shift to the right of the oxyhemoglobin dissociation curve", + "B": "a decrease in carbon dioxide dissolved in plasma", + "C": "a decrease in the glomerular filtration rate", + "D": "an increase in MAC of volatile inhalation agents", + "E": "low-voltage, high-frequency EEG pattern" + }, + "zh": { + "question": "全身性低温至30°C伴随以下哪种情况", + "A": "氧合血红蛋白解离曲线右移", + "B": "血浆中溶解的二氧化碳减少", + "C": "肾小球滤过率下降", + "D": "挥发性吸入麻醉剂的MAC增加", + "E": "低电压、高频率的脑电图模式" + } + }, + { + "id": "066d216f-db12-5bce-86c4-8de5944d0da6", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "In a patient with chronic renal failure, which of the following statements concerning muscle relaxants is true?", + "A": "Duration of action of vecuronium is prolonged", + "B": "The elimination half-life of atracurium is tripled", + "C": "Reversal with neostigmine is con train dicated", + "D": "The onset of action of mivacurium is delayed", + "E": "Succinylcholine is contraindicated" + }, + "zh": { + "question": "在慢性肾功能衰竭患者中，以下关于肌松药的说法哪一项是正确的？", + "A": "维库溴铵的作用时间延长", + "B": "阿曲库铵的消除半衰期增加三倍", + "C": "新斯的明的逆转是禁忌的", + "D": "米库氯铵的起效时间延迟", + "E": "琥珀胆碱是禁忌的" + } + }, + { + "id": "ac8a193d-dd15-55d0-9b2a-0126d2909fa1", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "During the first stage of labor, the pain of uterine contractions and cervical dilatation is transmitted via the spinal cord segments", + "A": "T6 to L1", + "B": "T6 to S5", + "C": "T10 to L1", + "D": "T10 to S1", + "E": "T10 to S5" + }, + "zh": { + "question": "在分娩的第一阶段，子宫收缩和宫颈扩张的疼痛通过脊髓节段传递", + "A": "T6 到 L1", + "B": "T6 到 S5", + "C": "T10 到 L1", + "D": "T10 到 S1", + "E": "T10 到 S5" + } + }, + { + "id": "d5438ac2-48a9-57a3-b796-ad62c73f7a64", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A 30-year-old man who is undergoing laparotomy and resection of a large kidney tumor has a decrease in SpO2 from 100% to 92% and an increase in peak airway pressure from 20 to 35 cm H2O. Plateau pressure is unchanged at 18 cm H2O. Which of the following is the most likely cause?", + "A": "Abdominal packing", + "B": "Inadequate anesthesia", + "C": "Inadequate muscle relaxation", + "D": "Obstruction of the endotracheal tube", + "E": "Pneumothorax" + }, + "zh": { + "question": "一名30岁的男性正在接受开腹手术和大型肾肿瘤切除术，SpO2从100%下降到92%，峰值气道压力从20 cm H2O增加到35 cm H2O。平台压力保持不变，为18 cm H2O。以下哪项是最可能的原因？", + "A": "腹腔填塞", + "B": "麻醉不足", + "C": "肌肉松弛不足", + "D": "气管导管阻塞", + "E": "气胸" + } + }, + { + "id": "c80f13b2-dcec-584e-bf72-589d9b78de9f", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An air/oxygen blender with E-size cylinders is supplying gas to a Mapleson D circuit being used to ventilate a neonate during transport. The air tank is full (psi= 1900/625 L) and flow is 4 L/min. The oxygen tank flow is 5 L/min and the pressure gauge indicates 500 psi. If the flow rates remain unchanged, which of the following statements is correct?", + "A": "The air tank will be empty in 90 minutes", + "B": "The oxygen tank will be empty in 30 minutes", + "C": "The concentration of oxygen in the circuit is 60%", + "D": "The oxygen tank will fill with air when the pressure gauge falls below 50 psi", + "E": "The volume of oxygen remaining can be determined only by weighing the tank" + }, + "zh": { + "question": "一个带有E型气瓶的空气/氧气混合器正在为一个Mapleson D回路提供气体，该回路用于在运输过程中为新生儿通气。空气罐是满的（psi= 1900/625 L），流量为4 L/min。氧气罐的流量为5 L/min，压力表显示500 psi。如果流量保持不变，以下哪项陈述是正确的？", + "A": "空气罐将在90分钟内用完", + "B": "氧气罐将在30分钟内用完", + "C": "回路中的氧气浓度为60%", + "D": "当压力表降至50 psi以下时，氧气罐将充满空气", + "E": "剩余的氧气量只能通过称重罐体来确定" + } + }, + { + "id": "f894a097-3efe-5e25-9b76-779b01b707fb", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is most likely to be effective in the treatment of clinically evident cerebral vasospasm occurring after subarachnoid hemorrhage?", + "A": "Administration of nimodipine", + "B": "Administration of thiopental", + "C": "Decreasing cerebral perfusion pressure", + "D": "Hypercarbia", + "E": "Hypocarbia" + }, + "zh": { + "question": "以下哪项最有可能有效治疗蛛网膜下腔出血后出现的临床明显脑血管痉挛？", + "A": "给予尼莫地平", + "B": "给予硫喷妥钠", + "C": "降低��灌注压", + "D": "高碳酸血症", + "E": "低碳酸血症" + } + }, + { + "id": "42797ce5-b9cd-5e16-8c6e-d43bd1ccf7b2", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements regarding latex allergy is true?", + "A": "Diphenhydramine is the treatment of choice for latex-induced anaphylactic reaction", + "B": "Hospital workers are at equal risk as the general population", + "C": "It is more common in patients with frequent urethral catheterizations", + "D": "Latex gloves can be rinsed free of antigens", + "E": "Skin testing should be performed immediately after an acute reaction in the operating room" + }, + "zh": { + "question": "以下关于乳胶过敏的说法哪一项是正确的？", + "A": "苯海拉明是乳胶诱发的过敏性反应的首选治疗方法", + "B": "医院工作人员与普通人群的风险相同", + "C": "在频繁进行尿道导管插入的患者中更常见", + "D": "乳胶手套可以通过冲洗去除抗原", + "E": "皮肤测试应在手术室急性反应后立即进行" + } + }, + { + "id": "e90fd454-49d5-5026-8791-2684a45dbc9b", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following drugs administered to a parturient eliminates fetal heart rate variability?", + "A": "Atropine", + "B": "Ephedrine", + "C": "Hydralazine", + "D": "Magnesium sulfate", + "E": "Terbutaline" + }, + "zh": { + "question": "以下哪种药物给产妇使用后会消除胎儿心率变异性？", + "A": "阿托品", + "B": "麻黄碱", + "C": "肼屈嗪", + "D": "硫酸镁", + "E": "特布他林" + } + }, + { + "id": "4f35548f-5add-5d89-8a49-81024b1451fe", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following factors decreases uterine blood flow EXCEPT", + "A": "aortocaval compression", + "B": "hypocarbia", + "C": "hypoxia", + "D": "sympathetic block", + "E": "uterine contractions" + }, + "zh": { + "question": "以下每个因素都会减少子宫血流量，除了", + "A": "主动脉腔静脉压迫", + "B": "低碳酸血症", + "C": "缺氧", + "D": "交感神经阻滞", + "E": "子宫收缩" + } + }, + { + "id": "9e17d60a-1f6e-5aba-8b23-2e8f44d79cef", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "The best premedication regimen for a known active narcotic addict would include", + "A": "secobarbital", + "B": "diazepam", + "C": "nalbuphine", + "D": "morphine", + "E": "droperidol" + }, + "zh": { + "question": "对于已知活跃的麻醉药成瘾者，最佳的术前用药方案包括", + "A": "司可巴比妥", + "B": "地西泮", + "C": "纳布啡", + "D": "吗啡", + "E": "氟哌利多" + } + }, + { + "id": "97ea27bf-240d-5f5c-b760-57726d534f60", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A patient who is scheduled for emergency laparotomy for bowel obstruction has had oliguria for three hours. She has had hypertension for 10 years. Which of the following laboratory findings would indicate preoperative fluid challenge?", + "A": "Urine osmolality: 300 mOsm/L", + "B": "Urine specific gravity: 1.015", + "C": "Urine sodium concentration: 35 mmol/L", + "D": "Fractional excretion of sodium: 0.5", + "E": "Ratio of urine-to-plasma creatinine concentrations: 8" + }, + "zh": { + "question": "一名计划进行肠梗阻急诊剖腹手术的患者已经出现少尿三个小时。她有10年的高血压病史。以下哪项实验室检查结果提示术前需要液体挑战？", + "A": "尿渗透压：300 mOsm/L", + "B": "尿比重：1.015", + "C": "尿钠浓度：35 mmol/L", + "D": "钠的分数排泄率：0.5", + "E": "尿肌酐与血浆肌酐浓度比：8" + } + }, + { + "id": "945028b7-3ccc-5365-9358-36a328aa49ca", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Two months ago a 68-year-old man with insulin-dependent diabetes mellitus had a transurethral resection of the prostate under spinal anesthesia with tetracaine plus epinephrine. He now has numbness and tingling in both feet and disturbance of gait. Physical examination demonstrates stocking-type hypesthesia of both feet and ankles. The most likely diagnosis is", + "A": "anterior spinal artery syndrome", + "B": "diabetic neuropathy", + "C": "adhesive arachnoiditis", + "D": "cauda equina syndrome", + "E": "peripheral nerve injury from the lithotomy position" + }, + "zh": { + "question": "两个月前，一名68岁的胰岛素依赖型糖尿病男性患者在脊髓麻醉下接受了前列腺经尿道切除术，使用了丁卡因加肾上腺素。现在他双脚有麻木和刺痛感，并且步态紊乱。体格检查显示双脚和脚踝有袜套型感觉减退。最可能的诊断是", + "A": "前脊髓动脉综合征", + "B": "糖尿病性神经病变", + "C": "粘连性蛛网膜炎", + "D": "马尾综合征", + "E": "截石位导致的周围神经损伤" + } + }, + { + "id": "e22f57aa-1e29-5eef-b657-577ba33e4aeb", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "An acutely ill 65-year-old man with sepsis has severe hypophosphatemia. Which of the following is most likely to result from this electrolyte disorder?", + "A": "Bronchospasm", + "B": "Diarrhea", + "C": "Muscle weakness", + "D": "Seizures", + "E": "Ventricular ectopy" + }, + "zh": { + "question": "一名患有败血症的65岁急性病男性患者出现严重的低磷血症。以下哪项最有可能由这种电解质紊乱引起？", + "A": "支气管痉挛", + "B": "腹泻", + "C": "肌无力", + "D": "癫痫发作", + "E": "心室异位搏动" + } + }, + { + "id": "194ffbe2-2824-566c-a466-d7823168b667", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "A 5-month-old infant with tetralogy of Fallot is scheduled for elective inguinal herniorrhaphy. Which of the following would require the operation to be postponed?", + "A": "Current propranolol therapy", + "B": "Hematocrit of 65%", + "C": "History of \"tet spells\"", + "D": "Patent ductus arteriosus", + "E": "Room air oxygen saturation of 82%" + }, + "zh": { + "question": "一名5个月大的婴儿患有法洛四联症，计划进行择期腹股沟疝修补术。以下哪项情况需要推迟手术？", + "A": "目前正在接受普萘洛尔治疗", + "B": "血细胞比容为65%", + "C": "有“蓝发作”病史", + "D": "动脉导管未闭", + "E": "室内空气氧饱和度为82%" + } + }, + { + "id": "de9129cc-d77e-5233-896e-d3a9230806e3", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "While delivering nitrous oxide 1.5 L/min, oxygen 1.5 L/min, and sevoflurane 2%, a leak in the oxygen flowmeter would most likely be detected by the", + "A": "low airway pressure alarm", + "B": "\"fail-safe\" system", + "C": "oxygen analyzer on the expiratory limb", + "D": "oxygen flowmeter reading", + "E": "mass spectrometric analysis of gases" + }, + "zh": { + "question": "在输送一氧化二氮1.5 L/min、氧气1.5 L/min和七氟醚2%时，氧气流量计的泄漏最有可能被以下哪个检测到？", + "A": "低气道压力报警", + "B": "“失效保护”系统", + "C": "呼气端的氧气分析仪", + "D": "氧气流量计读数", + "E": "气体的质谱分析" + } + }, + { + "id": "888e6d05-a51c-59b9-8401-be89c8ce8c25", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 30-kg patient with asthma is receiving general anesthesia and being mechanically ventilated with a measured tidal volume of 300 mL. Increasing the fresh gas flow from 3 L/min to 9 L/min without changing the ventilatory rate or I:E ratio will result in", + "A": "decreased physiologic dead space", + "B": "increased delivered tidal volume", + "C": "increased end-expired carbon dioxide", + "D": "unchanged delivered minute volume", + "E": "unchanged peak inspiratory pressure" + }, + "zh": { + "question": "一名30公斤的哮喘患者正在接受全身麻醉，并以300毫升的潮气量进行机械通气。在不改变通气频率或吸呼比的情况下，将新鲜气体流量从3升/分钟增加到9升/分钟将导致", + "A": "生理无效腔减少", + "B": "输送的潮气量增加", + "C": "呼气末二氧化碳增加", + "D": "输送的分钟通气量不变", + "E": "吸气峰压不变" + } + }, + { + "id": "12d57f5d-950d-516b-a981-aa03fd696019", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is a characteristic of the Bain breathing circuit?", + "A": "Condensation of moisture in inspired gases is facilitated by the circuit design", + "B": "Fresh gas flows coaxially around the exhalation limb", + "C": "Fresh gas flows need not exceed minute ventilation", + "D": "The circuit eliminates the possibility of rebreathing", + "E": "The circuit is functionally similar to the Jackson-Rees system" + }, + "zh": { + "question": "以下哪项是Bain呼吸回路的特征？", + "A": "回路设计有助于吸入气体中的水分凝结", + "B": "新鲜气体同轴流动于呼气管周围", + "C": "新鲜气体流量不需要超过分钟通气量", + "D": "该回路消除了再呼吸的可能性", + "E": "该回路在功能上类似于Jackson-Rees系统" + } + }, + { + "id": "2f578f15-06cf-539e-bf46-f9efcb2d5142", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A 20-year-old man with a history of substance abuse is undergoing preoperative evaluation. Which of the following findings suggests current use of cocaine?", + "A": "Absence of deep tendon reflexes", + "B": "Bradycardia", + "C": "Hypertension", + "D": "Hypothermia", + "E": "Pinpoint pupils" + }, + "zh": { + "question": "一名20岁的男性有药物滥用史，正在进行术前评估。以下哪项发现提示当前使用可卡因？", + "A": "深腱反射消失", + "B": "心动过缓", + "C": "高血压", + "D": "体温过低", + "E": "瞳孔缩小" + } + }, + { + "id": "4c24e05c-3248-5176-8115-6021e9036cd3", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 2.8-kg newborn undergoes repair of a moderate-sized omphalocele. Intravenous fluid is administered at 14 mL/hr. Forty-five minutes after beginning surgery and before reduction of the omphalocele, arterial blood pressure decreases from 80/40 to 55/30 mmHg. SaO2 is 98% at an FiO2 of 0.5. Breath sounds are equal bilaterally. Which of the following is the most likely explanation for the decrease in blood pressure?", + "A": "Associated congenital cardiac defect", + "B": "Compression of the lungs by the abdominal contents", + "C": "Inadequate fluid administration", + "D": "Pneumothorax", + "E": "Sepsis" + }, + "zh": { + "question": "一名2.8公斤的新生儿接受中等大小脐膨出的修复手术。静脉输液速度为14毫升/小时。手术开始45分钟后，在脐膨出还未复位前，动脉血压从80/40降至55/30毫米汞柱。FiO2为0.5时，SaO2为98%。双侧呼吸音均等。以下哪项最可能解释血压下降的原因？", + "A": "相关的先天性心脏缺陷", + "B": "腹腔内容物压迫肺部", + "C": "液体输注不足", + "D": "气胸", + "E": "败血症" + } + }, + { + "id": "c9f59ef5-0dcc-52cf-9b56-694851b9ecd9", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "During apneic oxygenation (FiO2 1.0) through a rigid bronchoscope", + "A": "duration of the procedure is limited by the increase in PaCO2", + "B": "functional residual capacity decreases 5%/min", + "C": "PaO2 remains unchanged for the first 5 minutes", + "D": "PaCO2 increases 2 to 6 mmHg/min for 15 minutes and then reaches a plateau", + "E": "PaO2 and PaCO2 equilibrate with mixed venous gases at the same rate" + }, + "zh": { + "question": "在通过硬质支气管镜进行无呼吸氧合（FiO2 1.0）期间", + "A": "手术时间受PaCO2增加的限制", + "B": "功能残气量每分钟减少5%", + "C": "PaO2在最初5分钟内保持不变", + "D": "PaCO2在15分钟内每分钟增加2到6 mmHg，然后达到平台期", + "E": "PaO2和PaCO2以相同的速率与混合静脉血气平衡" + } + }, + { + "id": "a2fcf654-7fcc-5185-a65d-acef5169e0fc", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "During prolonged labor, a fetal scalp blood sample shows a PO2 of 21 mmHg, a PCO2 of 46 mmHg, and a pH of 7.35. These findings suggest", + "A": "fetal hypoxemia", + "B": "maternal hypoventilation", + "C": "sampling of venous blood", + "D": "miscalibration of the oxygen electrode", + "E": "no abnormality" + }, + "zh": { + "question": "在长时间分娩过程中，胎儿头皮血样显示 PO2 为 21 mmHg，PCO2 为 46 mmHg，pH 为 7.35。这些结果表明", + "A": "胎儿缺氧", + "B": "母体通气不足", + "C": "采集了静脉血", + "D": "氧电极校准错误", + "E": "无异常" + } + }, + { + "id": "c8cee1be-e8a7-5712-a672-1e92c609f2e3", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "In a patient receiving an epidural analgesic infusion postoperatively, clear fluid is noted to drip back freely from the epidural catheter. Each of the following findings correctly identifies the associated fluid EXCEPT", + "A": "precipitation when mixed with an equal volume of thiopental — local anesthetic", + "B": "pH 7.1— saline solution", + "C": "glucose 55 mg/dl - CSF", + "D": "sodium 150 mEq/L - CSF", + "E": "PCO2 51 mmHg - CSF" + }, + "zh": { + "question": "在一名术后接受硬膜外镇痛输注的患者中，注意到硬膜外导管中有清液自由滴出。以下每一项发现都正确识别了相关液体，除了", + "A": "与等量的硫喷妥钠混合时沉淀——局部麻醉剂", + "B": "pH 7.1——生理盐水", + "C": "葡萄糖 55 mg/dl - 脑脊液", + "D": "钠 150 mEq/L - 脑脊液", + "E": "PCO2 51 mmHg - 脑脊液" + } + }, + { + "id": "fad06e2a-bc86-5039-bf88-6f4b4ac10103", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following statements concerning the activated clotting time (ACT) is true EXCEPT:", + "A": "The ACT is more sensitive than the activated partial thromboplastin time (APTT) to blood heparin concentration", + "B": "The ACT is prolonged if the specimen is not warmed during the assay", + "C": "The ACT should be greater than 300 sec before initiating cardiopulmonary bypass", + "D": "Hypofibrinogenemia may prolong the ACT after cardiopulmonary bypass", + "E": "Whole blood is used for measurement of the ACT" + }, + "zh": { + "question": "以下关于活化凝血时间（ACT）的陈述中，除了哪一项外，其他都是正确的：", + "A": "与活化部分凝血活酶时间（APTT）相比，ACT对血液肝素浓度更敏感", + "B": "如果在检测过程中样本未加热，ACT会延长", + "C": "在开始体外循环前，ACT应大于300秒", + "D": "低纤维蛋白原血症可能在体外循环后延长ACT", + "E": "ACT的测量使用全血" + } + }, + { + "id": "bdfe993d-e17c-5b3f-aab5-53dd32fe0f00", + "choice_num": 5, + "answer": "A", + "level": 3, + "en": { + "question": "The following hemodynamic values are obtained two hours after coronary artery bypass surgery: Cardiac index 1.7 L/min/m2; Pulm Art. Occ. Pressure 22 mmHg; MAP 60 mmHg; Urine volume 0.2 ml/kg/hr. The most appropriate management is", + "A": "dopamine infusion", + "B": "nitroprusside infusion", + "C": "norepinephrine infusion", + "D": "volume expansion", + "E": "observation without intervention" + }, + "zh": { + "question": "冠状动脉搭桥术后两小时获得以下血流动力学值：心脏指数 1.7 L/min/m2；肺动脉楔压 22 mmHg；平均动脉压 60 mmHg；尿量 0.2 ml/kg/hr。最合适的处理是", + "A": "多巴胺输注", + "B": "硝普钠输注", + "C": "去甲肾上腺素输注", + "D": "容量扩充", + "E": "观察而不干预" + } + }, + { + "id": "23c472cb-74b6-5a7f-bbde-e69520364b1c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the most likely effect of administration of magnesium sulfate in a patient with preeclampsia?", + "A": "Decreased motor end-plate sensitivity to acetylcholine", + "B": "Decreased uteroplacental blood flow", + "C": "Increased platelet aggregation", + "D": "Increased systemic vascular resistance", + "E": "Inhibited acetylcholinesterase" + }, + "zh": { + "question": "以下哪项是硫酸镁用于子痫前期患者最可能的效果？", + "A": "降低运动终板对乙酰胆碱的敏感性", + "B": "减少子宫胎盘血流", + "C": "增加血小板聚集", + "D": "增加全身血管阻力", + "E": "抑制乙酰胆碱酯酶" + } + }, + { + "id": "b3fa3e2d-042f-5cfb-a7cd-ea3f284c409c", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A neurologically intact 48-year-old woman is scheduled for removal of a parietal lobe arteriovenous malformation. The relative risk for complete resection is to be determined by a test occlusion of the feeding artery. Which of the following intraoperative monitoring techniques is most appropriate for this test?", + "A": "Brain stem auditory evoked potentials", + "B": "Cerebral blood flow using radioactive xenon", + "C": "EEG", + "D": "Evoked potentials elicited by stimulating the posterior tibial nerve", + "E": "Transcranial Doppler" + }, + "zh": { + "question": "一名神经功能完好的48岁女性计划进行顶叶动静脉畸形切除术。通过供血动脉的试验性闭塞来确定完全切除的相对风险。以下哪种术中监测技术最适合用于此测试？", + "A": "脑干听觉诱发电位", + "B": "使用放射性氙的脑血流", + "C": "脑电图（EEG）", + "D": "刺激胫后神经引发的诱发电位", + "E": "经颅多普勒超声" + } + }, + { + "id": "0c470dbc-1352-5727-89f5-747e81149f96", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The second gas effect refers to", + "A": "acceleration of rise in alveolar concentration of a gas caused by concomitantly administered nitrous oxide", + "B": "change in volatile anesthetic vaporizer output with the addition of nitrous oxide to the carrier gas mixture", + "C": "decrease in MAC of a volatile anesthetic by addition of nitrous oxide", + "D": "expansion of gas-containing spaces by addition of nitrous oxide", + "E": "rapid diffusion of nitrous oxide from pulmonary capillary blood into alveolar gas at the termination of anesthesia" + }, + "zh": { + "question": "第二气体效应是指", + "A": "伴随使用的一氧化二氮加速气体在肺泡中的浓度上升", + "B": "加入一氧化二氮到载气混合物中导致挥发性麻醉剂蒸发器输出的变化", + "C": "通过加入一氧化二氮降低挥发性麻醉剂的最低肺泡浓度（MAC）", + "D": "通过加入一氧化二氮导致含气空间的膨胀", + "E": "在麻醉结束时，一氧化二氮从肺毛细血管血液快速扩散到肺泡气体中" + } + }, + { + "id": "5f2db97c-02d6-5a45-ac5a-393fa80ed446", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Which of the following will result in the largest change in oxygen content?", + "A": "Increased hemoglobin (Hgb) concentration from 10 to 15 g/dl", + "B": "Increased PaO2 from 40 to 50 mmHg (Hgb 15 g/dl)", + "C": "Increased PaO2 from 60 to 70 mmHg (Hgb 15 g/dl)", + "D": "Increased P50 of Hgb from 27 to 37 mmHg (Hgb 15 g/dl)", + "E": "Increased pH from 7.20 to 7.40" + }, + "zh": { + "question": "以下哪项将导致氧含量的最大变化？", + "A": "血红蛋白（Hgb）浓度从10增加到15 g/dl", + "B": "动脉氧分压（PaO2）从40增加到50 mmHg（Hgb 15 g/dl）", + "C": "动脉氧分压（PaO2）从60增加到70 mmHg（Hgb 15 g/dl）", + "D": "血红蛋白的P50从27增加到37 mmHg（Hgb 15 g/dl）", + "E": "pH值从7.20增加到7.40" + } + }, + { + "id": "17b6d7c7-78c1-5d91-aff6-988de761b017", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Each of the following increases arterial to end-tidal carbon dioxide tension difference EXCEPT", + "A": "addition of positive-end expiratory pressure", + "B": "deliberate hypotension", + "C": "endobronchial intubation", + "D": "hypovolemia", + "E": "pulmonary embolism" + }, + "zh": { + "question": "下列各项中，哪一项不会增加动脉与呼气末二氧化碳分压差？", + "A": "增加呼气末正压", + "B": "故意低血压", + "C": "支气管内插管", + "D": "低血容量", + "E": "肺栓塞" + } + }, + { + "id": "46aa1b60-f82e-533e-8ef2-59b5e5a3d33f", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following is an effect of acute preoperative oral administration of clonidine EXCEPT", + "A": "sedation", + "B": "respiratory depression", + "C": "decreased intraoperative plasma catecholamine concentrations", + "D": "decreased MAC of inhalational anesthetics", + "E": "decreased perioperative opioid requirement" + }, + "zh": { + "question": "以下每项都是急性术前口服可乐定的作用，除了", + "A": "镇静", + "B": "呼吸抑制", + "C": "降低术中血浆儿茶酚胺浓度", + "D": "降低吸入麻醉剂的最低肺泡浓度（MAC）", + "E": "减少围手术期阿片类药物的需求" + } + }, + { + "id": "7482c999-510b-5b78-ac3c-ca395bff9a84", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Two hours after sustaining extensive burns of the head, neck and chest in a house fire, a patient has stridor and difficulty breathing. The most appropriate management is", + "A": "administration of aerosolized epinephrine", + "B": "administration of helium and oxygen", + "C": "endotracheal intubation", + "D": "intravenous injection of dexamethasone", + "E": "tracheostomy" + }, + "zh": { + "question": "在房屋火灾中头部、颈部和胸部严重烧伤两小时后，患者出现喘鸣和呼吸困难。最合适的处理是", + "A": "给予气雾化肾上腺素", + "B": "给予氦氧混合气", + "C": "气管插管", + "D": "静脉注射地塞米松", + "E": "气管切开术" + } + }, + { + "id": "93598bf9-e3cb-530c-95f7-94088188adc4", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Addition of 20 cm H2O positive end-expiratory pressure to a patient receiving controlled mechanical ventilation decreases cardiac output and left ventricular function by", + "A": "increasing right ventricular preload", + "B": "increasing right ventricular afterload", + "C": "increasing left ventricular preload", + "D": "increasing left ventricular afterload", + "E": "producing myocardial ischemia" + }, + "zh": { + "question": "对接受控制性机械通气的患者增加20 cm H2O的呼气末正压会通过以下哪种方式降低心输出量和左心室功能", + "A": "增加右心室前负荷", + "B": "增加右心室后负荷", + "C": "增加左心室前负荷", + "D": "增加左心室后负荷", + "E": "导致心肌缺血" + } + }, + { + "id": "d75ae1a2-8a7a-5723-823a-5a678039f4f0", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "When PaO2 is increased to 300 mmHg in a healthy parturient at term, the umbilical vein PCs will", + "A": "not change", + "B": "increase slightly", + "C": "decrease slightly", + "D": "nearly triple", + "E": "approach maternal PaO," + }, + "zh": { + "question": "当足月健康产妇的PaO2增加到300 mmHg时，脐静脉PCs将会", + "A": "不变", + "B": "略微增加", + "C": "略微减少", + "D": "几乎增加三倍", + "E": "接近母体PaO2" + } + }, + { + "id": "9adefc24-fac3-505b-8a6c-77e468c79f29", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "During liver transplantation, venovenous bypass from the femoral and portal veins to the axillary vein during cross-clamping of the inferior vena cava", + "A": "decreases urine output", + "B": "prevents hypothermia", + "C": "prevents metabolic acidosis", + "D": "requires heparinization", + "E": "supports cardiac output" + }, + "zh": { + "question": "在肝移植过程中，股静脉和门静脉到腋静脉的静脉旁路在下腔静脉交叉夹闭期间", + "A": "减少尿量", + "B": "防止体温过低", + "C": "防止代谢性酸中毒", + "D": "需要肝素化", + "E": "支持心输出量" + } + }, + { + "id": "d6530e54-8a74-505a-9dbb-1b491a6d6747", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Twenty minutes after an axillary block, the patient reports feeling over the \"back of the hand.\" Examination shows normal sensation over the lateral aspect of the dorsum of the hand and the dorsal base of the thumb and index finger. Supplementary anesthesia of this area can be provided by blocking which of the following nerves?", + "A": "Ulnar", + "B": "Musculocutaneous", + "C": "Median", + "D": "Radial", + "E": "Intercostobrachial" + }, + "zh": { + "question": "腋窝阻滞后20分钟，患者报告手背感觉异常。检查显示手背外侧和拇指及食指背基部感觉正常。可以通过阻滞以下哪一条神经来提供该区域的补充麻醉？", + "A": "尺神经", + "B": "肌皮神经", + "C": "正中神经", + "D": "桡神经", + "E": "肋间臂神经" + } + }, + { + "id": "c1461b01-5544-5881-be4e-17a71472a949", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following neural functions demonstrates the highest segmental block after spinal anesthesia?", + "A": "Afferent sympathetic activity", + "B": "Proprioception", + "C": "Sharp pain perception", + "D": "Temperature sensation", + "E": "Touch sensation" + }, + "zh": { + "question": "以下哪种神经功能在脊髓麻醉后表现出最高的节段性阻滞？", + "A": "传入交感神经活动", + "B": "本体感觉", + "C": "锐痛感知", + "D": "温度感觉", + "E": "触觉感觉" + } + }, + { + "id": "3816b57d-08f8-5637-9e96-fbd64936a589", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A 30-year-old woman undergoes thyroidectomy under general endotracheal anesthesia. Immediately after extubation while breathing spontaneously, she has laryngospasm that resolves after 60 seconds of continuous positive airway pressure applied by face mask. In the PACU, she develops shortness of breath, tachypnea, hypoxemia, and rales. Which of the following is the most likely diagnosis?", + "A": "Gastric acid aspiration", + "B": "Myocardial infarction", + "C": "Pulmonary edema", + "D": "Pulmonary embolism", + "E": "Vocal cord paralysis" + }, + "zh": { + "question": "一名30岁的女性在全身气管插管麻醉下接受甲状腺切除术。拔管后立即在自主呼吸时出现喉痉挛，经过60秒的面罩持续正压通气后缓解。在麻醉后恢复室，她出现呼吸困难、呼吸急促、低氧血症和湿啰音。以下哪项是最可能的诊断？", + "A": "胃酸吸入", + "B": "心肌梗死", + "C": "肺水肿", + "D": "肺栓塞", + "E": "声带麻痹" + } + }, + { + "id": "77b6060a-2d5d-5919-98ab-8c1595c7b1fa", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements concerning the use of epidural anesthesia for extracorporeal shock wave lithotripsy is true?", + "A": "Adequate anesthesia can be obtained with fentanyl alone", + "B": "Anesthesia decreases the incidence of hypothermia", + "C": "Anesthesia decreases the incidence of ventricular dysrhythmias", + "D": "Anesthesia is unnecessary in paraplegics with absence of sensation below T4", + "E": "\"Loss of resistance\" should be performed with fluids rather than air" + }, + "zh": { + "question": "关于使用硬膜外麻醉进行体外冲击波碎石术，下列哪项陈述是正确的？", + "A": "仅使用芬太尼即可获得足够的麻醉效果", + "B": "麻醉可减少低体温的发生率", + "C": "麻醉可减少心室心律失常的发生率", + "D": "对于感觉缺失在T4以下的截瘫患者，麻醉是不必要的", + "E": "“阻力消失”应使用液体而非空气进行" + } + }, + { + "id": "396244c3-d9bf-5f74-8e64-ab05a37b76c6", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements concerning absorption of irrigation fluid during transurethral resection of the prostate is true?", + "A": "Hydrostatic pressure has minimal effect on the amount of fluid absorbed", + "B": "Typically 10 to 30 ml of fluid per minute are absorbed", + "C": "Use of iso-osmotic solutions decreases the risk of hyponatremia", + "D": "CNS complications are independent of the type of fluid used", + "E": "Spinal anesthesia to T6 will mask the symptoms of overhydration" + }, + "zh": { + "question": "关于经尿道前列腺切除术中灌洗液吸收的下列说法中哪一项是正确的？", + "A": "静水压力对吸收液体的量影响很小", + "B": "通常每分钟吸收10到30毫升的液体", + "C": "使用等渗溶液可降低低钠血症的风险", + "D": "中枢神经系统并发症与所用液体的类型无关", + "E": "脊髓麻醉至T6会掩盖过度水合的症状" + } + }, + { + "id": "b8d4e189-50d0-5b41-936f-2dda70a77060", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An sevoflurane vaporizer is filled with isoflurane and the vaporizer dial is set at 1%. Which of the following will occur?", + "A": "Less than 1% isoflurane will be delivered", + "B": "More than 1% isoflurane will be delivered", + "C": "Thymol precipitation will prevent vaporization", + "D": "The vaporizer bypass will not open", + "E": "The vaporizer will be damaged" + }, + "zh": { + "question": "一个七氟醚蒸发器被填充了异氟醚，并且蒸发器刻度盘设置为1%。以下哪种情况会发生？", + "A": "输送的异氟醚浓度低于1%", + "B": "输送的异氟醚浓度高于1%", + "C": "百里酚沉淀会阻止蒸发", + "D": "蒸发器旁路不会打开", + "E": "蒸发器会损坏" + } + }, + { + "id": "a5c382ba-585a-5a6b-8607-eeaac2e41a65", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 67-year-old man undergoes spinal anesthesia with hyperbaric tetracaine 10 mg for transurethral resection of the prostate. At the end of the 50-minute procedure, the level of anesthesia is T6 and blood pressure is 120/70 mmHg. Within two minutes after transfer to a stretcher, the patient has nausea and blood pressure decreases to 76/42 mmHg. Which of the following is the most likely cause of the acute hypotension?", + "A": "Acute congestive heart failure", + "B": "Decreased venous return", + "C": "Dilutional hyponatremia", + "D": "Progression of sympathetic block", + "E": "Unrecognized bladder perforation" + }, + "zh": { + "question": "一名67岁的男性接受了10毫克高比重丁卡因的脊髓麻醉，以进行经尿道前列腺切除术。在50分钟的手术结束时，麻醉平面为T6，血压为120/70 mmHg。在转移到担架后的两分钟内，患者出现恶心，血压下降到76/42 mmHg。以下哪一项是急性低血压最可能的原因？", + "A": "急性充血性心力衰竭", + "B": "静脉回流减少", + "C": "稀释性低钠血症", + "D": "交感神经阻滞进展", + "E": "未识别的膀胱穿孔" + } + }, + { + "id": "9aa1b123-a847-55a0-b92a-b8b264ba0471", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is most indicative of reflex sympathetic dystrophy?", + "A": "Dry skin", + "B": "Dull pain that improves with movement", + "C": "Fasciculations", + "D": "Motor weakness", + "E": "Pallor and cyanosis" + }, + "zh": { + "question": "以下哪项最能表明反射性交感神经营养不良？", + "A": "皮肤干燥", + "B": "随着运动改善的钝痛", + "C": "肌束震颤", + "D": "运动无力", + "E": "苍白和发绀" + } + }, + { + "id": "2271c56d-5a1f-54a6-a313-131cbf573f1c", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Prilocaine is NOT recommended for obstetric regional anesthesia because it", + "A": "causes fetal methemoglobinemia", + "B": "has a very short duration of action", + "C": "is not metabolized by the newborn", + "D": "is the most toxic of the amide local anesthetics", + "E": "produces a longer motor block than sensory block" + }, + "zh": { + "question": "普鲁卡因不推荐用于产科区域麻醉，因为它", + "A": "导致胎儿高铁血红蛋白血症", + "B": "作用时间非常短", + "C": "不能被新生儿代谢", + "D": "是酰胺类局部麻醉药中毒性最大的", + "E": "产生的运动阻滞时间比感觉阻滞时间长" + } + }, + { + "id": "3b28f7c9-9f98-538b-a1b6-dd20169ae179", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following treatments is LEAST effective in patients with acute herpes zoster?", + "A": "Acyclovir", + "B": "Antidepressants", + "C": "Epidural block", + "D": "Opioids", + "E": "Sympathetic nerve block" + }, + "zh": { + "question": "以下哪种治疗对急性带状疱疹患者效果最差？", + "A": "阿昔洛韦", + "B": "抗抑郁药", + "C": "硬膜外阻滞", + "D": "阿片类药物", + "E": "交感神经阻滞" + } + }, + { + "id": "d4348e00-fabc-5b6a-a944-ed5351ef3d8f", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Five minutes after intrathecal administration of tetracaine 12 mg in hyperbaric solution, a 60-year-old man has a weak hand grasp. Respirations are normal, heart rate has decreased from 80 to 45 bpm, and blood pressure has decreased from 150/80 to 90/50 mmHg. The most appropriate management at this time is", + "A": "administration of atropine", + "B": "administration of ephedrine", + "C": "administration of phenylephrine", + "D": "placement of the patient in the head-down position", + "E": "observation" + }, + "zh": { + "question": "在鞘内注射12毫克高比重的丁卡因五分钟后，一名60岁的男性出现手握力减弱。呼吸正常，心率从80次/分钟下降到45次/分钟，血压从150/80 mmHg下降到90/50 mmHg。此时最合适的处理是", + "A": "给予阿托品", + "B": "给予麻黄碱", + "C": "给予去氧肾上腺素", + "D": "将患者置于头低位", + "E": "观察" + } + }, + { + "id": "029be89f-ed0f-5be0-b879-e0b3fc7182ef", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Compared with a person of normal weight, which of the following findings are most likely on pulmonary function testing of a patient with morbid obesity? (FVC, FEV/FVC, FRC, A-a DO2)?", + "A": "Decreased, Normal, Decreased, Normal", + "B": "Decreased, Normal, Decreased , Increased", + "C": "Decreased, Normal, Normal, Increased,", + "D": "Increased, Decreased, Normal,\tIncreased", + "E": "Increased, Decreased, Decreased, Increased" + }, + "zh": { + "question": "与正常体重的人相比，以下哪项是病态肥胖患者肺功能测试中最可能的发现？（FVC, FEV/FVC, FRC, A-a DO2）", + "A": "减少，正常，减少，正常", + "B": "减少，正常，减少，增加", + "C": "减少，正常，正常，增加", + "D": "增加，减少，正常，增加", + "E": "增加，减少，减少，增加" + } + }, + { + "id": "415b6798-47c0-599a-9afb-0db9cd704bb0", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 77-year-old woman is still intubated and breathing spontaneously following a total hip replacement. The muscle relaxant has been reversed. Tidal volume is 400 ml, end-tidal carbon dioxide tension is 45 mmHg, and SpO2 is 98% at an FiO2 of 1.0. On transfer from the operating table to the gurney, heart rate increases from 65 to 100 bpm and blood pressure decreases from 130/80 to 80/50 mmHg. End-tidal carbon dioxide tension is 30 mmHg and SpO2 is 94%. The most likely diagnosis is", + "A": "anaphylactic reaction", + "B": "bronchospasm", + "C": "myocardial infarction", + "D": "pulmonary embolism", + "E": "unreplaced blood loss" + }, + "zh": { + "question": "一名77岁的女性在全髋关节置换术后仍插管并自主呼吸。肌肉松弛剂已被逆转。潮气量为400毫升，呼气末二氧化碳分压为45 mmHg，FiO2为1.0时SpO2为98%。从手术台转移到担架时，心率从65次/分钟增加到100次/分钟，血压从130/80 mmHg下降到80/50 mmHg。呼气末二氧化碳分压为30 mmHg，SpO2为94%。最可能的诊断是", + "A": "过敏性反应", + "B": "支气管痉挛", + "C": "心肌梗死", + "D": "肺栓塞", + "E": "未补充的失血" + } + }, + { + "id": "f12cf1b5-ed2f-58d0-8d27-6258c1973655", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A patient with alcoholic cirrhosis, ascites, and gastrointestinal bleeding receives 4 units of red blood cells prior to anesthesia with isoflurane in oxygen for emergency exploratory laparotomy. After the peritoneum is opened and the fluid is drained, blood pressure decreases to 60/40 mmHg and SpO2 decreases to 90%. The most likely cause of the hypoxemia is", + "A": "acute myocardial ischemia", + "B": "decreased 2,3-diphosphoglycerate in transfused blood", + "C": "increased intrapulmonary shunting", + "D": "relative hypovolemia", + "E": "venous air embolism" + }, + "zh": { + "question": "一名患有酒精性肝硬化、腹水和胃肠道出血的患者在接受异氟醚和氧气麻醉进行紧急探查性剖腹手术前，输注了4个单位的红细胞。在打开腹膜并引流液体后，血压降至60/40 mmHg，SpO2降至90%。最可能导致低氧血症的原因是", + "A": "急性心肌缺血", + "B": "输注血液中2,3-二磷酸甘油酸减少", + "C": "肺内分流增加", + "D": "相对低血容量", + "E": "静脉空气栓塞" + } + }, + { + "id": "fae32b8e-d731-5292-818b-3ff4a09734a5", + "choice_num": 5, + "answer": "D", + "level": 3, + "en": { + "question": "A newborn is in respiratory distress. Examination shows a scaphoid abdomen, cyanosis while breathing oxygen by mask, and heart sounds in the right hemithorax. Which of the following is the most appropriate next step?", + "A": "Assisted ventilation with a bag and face mask", + "B": "Insertion of a chest tube on the left side", + "C": "Insertion of a nasogastric tube", + "D": "Tracheal intubation and assisted ventilation", + "E": "Tracheal intubation and expansion of the left lung" + }, + "zh": { + "question": "一名新生儿出现呼吸窘迫。检查显示腹部呈舟状，吸氧时出现紫绀，心音位于右侧胸腔。以下哪项是最合适的下一步措施？", + "A": "使用呼吸袋和面罩进行辅助通气", + "B": "在左侧插入胸管", + "C": "插入鼻胃管", + "D": "气管插管并进行辅助通气", + "E": "气管插管并扩张左肺" + } + }, + { + "id": "04fa51f5-fa90-5d35-b2db-f14c2331be80", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A celiac plexus block provides effective relief of pain associated with primary cancers at each of the following locations EXCEPT the", + "A": "adrenal gland", + "B": "liver", + "C": "pancreas", + "D": "sigmoid colon", + "E": "stomach" + }, + "zh": { + "question": "腹腔神经丛阻滞可有效缓解以下部位原发癌症相关的疼痛，除了", + "A": "肾上腺", + "B": "肝脏", + "C": "胰腺", + "D": "乙状结肠", + "E": "胃" + } + }, + { + "id": "62227d78-2098-56b9-914a-4aaf24be8a4a", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 68-year-old man has signs of a coagulopathy after receiving 10 units of packed erythrocytes during emergency repair of a leaking abdominal aortic aneurysm. The most likely cause is", + "A": "depletion of factor V", + "B": "disseminated intravascular coagulation", + "C": "hypothermia", + "D": "platelet dysfunction", + "E": "thrombocytopenia" + }, + "zh": { + "question": "一名68岁的男性在接受紧急修复破裂的腹主动脉瘤手术后，输注了10个单位的浓缩红细胞，出现了凝血病的迹象。最可能的原因是", + "A": "第五因子耗竭", + "B": "弥散性血管内凝血", + "C": "低体温", + "D": "血小板功能障碍", + "E": "血小板减少症" + } + }, + { + "id": "216c8c38-1101-5636-a319-0719fc5a195d", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A patient with uremia is scheduled for emergency surgery. Bleeding time is 18 minutes. The most appropriate initial treatment is", + "A": "cryoprecipitate", + "B": "desmopressin", + "C": "fresh frozen plasma", + "D": "platelets", + "E": "vitamin K" + }, + "zh": { + "question": "一名尿毒症患者计划进行紧急手术。出血时间为18分钟。最合适的初始治疗是", + "A": "冷沉淀", + "B": "去氨加压素", + "C": "新鲜冰冻血浆", + "D": "血小板", + "E": "维生素K" + } + }, + { + "id": "8f3f193a-261e-5501-8889-7175cda87f6d", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is characteristic of the airway in a 2-month-oId infant when compared with an adult airway?", + "A": "Airway is narrowest at the cricoid cartilage", + "B": "Epiglottis is broader", + "C": "Laryngeal mucosa is more tightly adherent", + "D": "Larynx is positioned lower in the neck", + "E": "Vocal cords have a more cephalad anterior attachment" + }, + "zh": { + "question": "与成人气道相比，2个月大的婴儿气道的特征是以下哪一项？", + "A": "气道在环状软骨处最窄", + "B": "会厌更宽", + "C": "喉粘膜更紧密附着", + "D": "喉位于颈部更低的位置", + "E": "声带的前部附着更靠头侧" + } + }, + { + "id": "b9909fd7-9399-5a97-afb7-3f05d85ec515", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The use of glycine as irrigating solution during transurethral resection of the prostate could be associated with each of the following EXCEPT", + "A": "ammonia toxicity", + "B": "coma", + "C": "hemolysis", + "D": "hyponatremia", + "E": "transient blindness" + }, + "zh": { + "question": "在经尿道前列腺切除术中使用甘氨酸作为冲洗液可��与以下各项有关，除了", + "A": "氨中毒", + "B": "昏迷", + "C": "溶血", + "D": "低钠血症", + "E": "暂时性失明" + } + }, + { + "id": "6a2f12df-2e97-5ef6-959f-28000d61252e", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "After inflation of both the tracheal and endobronchial cuffs of a left-sided double-lumen tube, the following are noted on auscultation of the chest: Left lumen clamped --> Breath sounds absent bilaterally; Right lumen clamped --> Breath sounds present on left only; Both lumens open --> Breath sounds present on left only. The most appropriate action is to", + "A": "decrease the endobronchial cuff volume", + "B": "decrease the tracheal cuff volume", + "C": "reinsert the tube, rotating it 180 degrees to the right", + "D": "suction both lumens", + "E": "withdraw the tube slightly and repeat the auscultory maneuvers" + }, + "zh": { + "question": "在左侧双腔管的气管和支气管套囊充气后，听诊胸部发现以下情况：夹闭左腔 --> 双侧呼吸音消失；夹闭右腔 --> 仅左侧有呼吸音；双腔开放 --> 仅左侧有呼吸音。最合适的措施是", + "A": "减少支气管套囊的容量", + "B": "减少气管套囊的容量", + "C": "重新插入导管，将其向右旋转180度", + "D": "吸引两个腔", + "E": "稍微撤回导管并重复听诊操作" + } + }, + { + "id": "d171c8a5-7df1-528e-86be-04ffdc917509", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following best explains why neonates are at greater risk than adults for hypothermia during surgical procedures?", + "A": "Greater body surface area relative to body mass", + "B": "Greater cutaneous vasodilation at equal MAC concentrations of volatile anesthetics", + "C": "Greater dependence on shivering to produce heat", + "D": "Inability to increase metabolic rate", + "E": "Less insulation by adipose tissue" + }, + "zh": { + "question": "以下哪项最能解释为什么新生儿在手术过程中比成人更容易发生低体温？", + "A": "相对于体重，身体表面积更大", + "B": "在相同MAC浓度的挥发性麻醉药下，皮肤血管扩张更大", + "C": "更依赖于颤抖来产生热量", + "D": "无法提高代谢率", + "E": "脂肪组织的绝缘作用较少" + } + }, + { + "id": "6337c6b4-2953-556f-ab45-8f7259040e10", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is a side effect of beta-adrenergic blockade?", + "A": "Cerebral vasodilation", + "B": "Decreased left ventricular filling pressures", + "C": "Hypokalemia", + "D": "Increased airway resistance", + "E": "Uterine relaxation" + }, + "zh": { + "question": "以下哪项是β-肾上腺素能阻滞的副作用？", + "A": "脑血管扩张", + "B": "左心室充盈压降低", + "C": "低钾血症", + "D": "气道阻力增加", + "E": "子宫松弛" + } + }, + { + "id": "394b7e3a-375a-58ec-8235-53c45bd1a400", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Preoperative evaluation shows a serum sodium concentration of 140 mEq/L, serum chloride concentration of 90 mEq/L, PaCO2 of 46 mmHg, and arterial pH of 7.50. These findings are most indicative of prior treatment with", + "A": "acetazolamide", + "B": "enalapril", + "C": "furosemide", + "D": "mannitol", + "E": "spironolactone" + }, + "zh": { + "question": "术前评估显示血清钠浓度为140 mEq/L，血清氯浓度为90 mEq/L，PaCO2为46 mmHg，动脉pH为7.50。这些结果最能表明先前接受过哪种治疗", + "A": "乙酰唑胺", + "B": "依那普利", + "C": "呋塞米", + "D": "甘露醇", + "E": "螺内酯" + } + }, + { + "id": "93d2c5c6-df82-5ab3-8cc3-0cbbdd04f441", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is the most likely cause of dyspnea during spinal anesthesia to a T3 sensory level?", + "A": "Decreased abdominal muscle tone", + "B": "Decreased afferent input from the thoracic wall", + "C": "Increased dead space ventilation", + "D": "Increased intrapulmonary shunting", + "E": "Partial diaphragmatic paralysis" + }, + "zh": { + "question": "以下哪项最有可能是脊髓麻醉至T3感觉平面时呼吸困难的原因？", + "A": "腹肌张力下降", + "B": "来自胸壁的传入输入减少", + "C": "无效腔通气增加", + "D": "肺内分流增加", + "E": "部分膈肌麻痹" + } + }, + { + "id": "c4513815-336a-5a5d-b47e-a55cc72ad143", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An 8-kg, 1-year-old child has a measured blood loss of 50 ml during the first two hours of a rectal pull-through operation. Preoperative hematocrit was 31%. Balanced saline solution 150 ml has been administered for replacement. Urine output has been 2 ml for the last hour, heart rate is 160 bpm, and blood pressure is 40/15 mmHg. The most appropriate fluid therapy is,", + "A": "25% albumin", + "B": "balanced salt solution", + "C": "balanced salt solution and mannitol", + "D": "5% dextrose in 0.45% saline solution", + "E": "packed red blood cells" + }, + "zh": { + "question": "一名8公斤、1岁儿童在直肠拉出术的前两小时内测得失血量为50毫升。术前血细胞比容为31%。已给予150毫升平衡盐溶液进行补充。过去一小时尿量为2毫升，心率为160次/分钟，血压为40/15毫米汞柱。最合适的液体治疗是：", + "A": "25%白蛋白", + "B": "平衡盐溶液", + "C": "平衡盐溶液和甘露醇", + "D": "5%葡萄糖在0.45%盐水中", + "E": "浓缩红细胞" + } + }, + { + "id": "e7164a39-82a1-5e95-b8ed-ae1b28fbdc74", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The Bain circuit", + "A": "provides nearly identical delivered and inspired anesthetic concentrations", + "B": "has the fresh gas flow inlet near the reservoir bag", + "C": "is a nonrebreathing circuit at any fresh gas flow rate", + "D": "is most efficient during spontaneous ventilation", + "E": "has a time constant greater than 1 minute for change in inspired anesthetic concentrations" + }, + "zh": { + "question": "Bain回路", + "A": "提供几乎相同的输送和吸入麻醉浓度", + "B": "新鲜气体流入口位于储气囊附近", + "C": "在任何新鲜气体流速下都是非再呼吸回路", + "D": "在自发通气期间最有效", + "E": "吸入麻醉浓度变化的时间常数大于1分钟" + } + }, + { + "id": "6a499a51-b2bf-598c-ba0f-501aed9f9cef", + "choice_num": 5, + "answer": "E", + "level": 3, + "en": { + "question": "A 75-year-old man with aortic stenosis and coronary artery disease has a preinduction heart rate of 68 bpm and blood pressure of 125/70 mmHg. After induction of anesthesia with fentanyl, midazolam, and pancuronium, heart rate is 90 bpm and blood pressure is 85/45 mmHg. ECG shows a new ST-segment elevation in lead II. Which of the following is the most appropriate initial management?", + "A": "Ephedrine", + "B": "Epinephrine", + "C": "Esmolol", + "D": "Nitroglycerin", + "E": "Phenylephrine" + }, + "zh": { + "question": "一名75岁男性患有主动脉瓣狭窄和冠状动脉疾病，诱导前心率为68次/分钟，血压为125/70 mmHg。使用芬太尼、咪达唑仑和潘库溴铵诱导麻醉后，心率为90次/分钟，血压为85/45 mmHg。心电图显示II导联出现新的ST段抬高。以下哪项是最合适的初始处理？", + "A": "麻黄碱", + "B": "肾上腺素", + "C": "艾司洛尔", + "D": "硝酸甘油", + "E": "去氧肾上腺素" + } + }, + { + "id": "96b35be0-166c-58b0-9e65-0812e133cc57", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Which of the following is decreased by alkalinization of a 1.5% lidocaine solution?", + "A": "Concentration of free base", + "B": "Dose required for anesthesia", + "C": "Duration of anesthesia", + "D": "Intracellular concentration of ionized lidocaine", + "E": "Time to onset of anesthesia" + }, + "zh": { + "question": "下列哪项会因1.5%利多卡因溶液的碱化而减少？", + "A": "游离碱的浓度", + "B": "麻醉所需剂量", + "C": "麻醉持续时间", + "D": "细胞内离子化利多卡因的浓度", + "E": "麻醉起效时间" + } + }, + { + "id": "35fcba72-ae2a-5947-808b-d5cc92ff4ff6", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is the most important function of temperature compensation in anesthetic vaporizers?", + "A": "Compensation for changes in the specific heat of the anesthetic during vaporization", + "B": "Delivery of diluent gas at a constant temperature regardless of flow rate", + "C": "Increase of bypass flow when the vaporizer is cooled by high fresh gas flow", + "D": "Maintenance of constant anesthetic vapor output over a range of vaporizer temperatures", + "E": "Maintenance of constant vapor concentrations at low flow rates" + }, + "zh": { + "question": "以下哪项是麻醉蒸发器中温度补偿的最重要功能？", + "A": "补偿麻醉剂在蒸发过程中比热的变化", + "B": "无论流速如何，始终以恒定温度输送稀释气体", + "C": "当蒸发器因高新鲜气体流量而冷却时增加旁路流量", + "D": "在一系列蒸发器温度下维持恒定的麻醉蒸气输出", + "E": "在低流速下维持恒定的蒸气浓度" + } + }, + { + "id": "e4ed6053-900a-5a75-bc2d-68ef39e43c42", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The test dose of local anesthetic administered through an epidural needle or catheter should be sufficient to produce", + "A": "bradycardia", + "B": "seizure activity", + "C": "hypotension", + "D": "segmental analgesia", + "E": "spinal anesthesia" + }, + "zh": { + "question": "通过硬膜外针或导管注射的局麻药试验剂量应足以产生", + "A": "心动过缓", + "B": "癫痫活动", + "C": "低血压", + "D": "节段性镇痛", + "E": "脊髓麻醉" + } + }, + { + "id": "54a8a13f-6a68-5b81-bb41-870b8f88dccf", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "During anesthesia, the ventilation/perfusion ratios change", + "A": "to preferential ventilation of the dependent portion", + "B": "due to cephalad shift of the diaphragm", + "C": "by insignificant amounts from that in the awake state", + "D": "to preferential perfusion of the superior portion", + "E": "from changes in pulmonary compliance" + }, + "zh": { + "question": "在麻醉期间，通气/灌注比率发生变化", + "A": "优先通气于依赖部分", + "B": "由于膈肌向头侧移动", + "C": "与清醒状态相比变化不显著", + "D": "优先灌注于上部", + "E": "由于肺顺应性的变化" + } + }, + { + "id": "fd37e468-c1df-590b-a574-1b8f0a5e91fd", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "In clinical anesthesia practice, the term \"informed consent\" is best described as a legal concept in which patients", + "A": "agree to anesthesia care based on full disclosure of facts needed to make the decision intelligently", + "B": "are told of all possible risks of anesthesia and anesthetic procedures", + "C": "delegate all decisions regarding anesthesia care to the anesthesiologist", + "D": "release the physicians from liability", + "E": "sign global consent forms for surgical procedures that cover the administration of anesthesia care" + }, + "zh": { + "question": "在临床麻醉实践中，“知情同意”一词最好被描述为一种法律概念，其中患者", + "A": "基于对做出明智决定所需事实的充分披露，同意接受麻醉护理", + "B": "被告知所有可能的麻醉和麻醉程序的风险", + "C": "将所有关于麻醉护理的决定委托给麻醉师", + "D": "解除医生的责任", + "E": "签署涵盖麻醉护理的手术程序的全面同意书" + } + }, + { + "id": "0b128936-d741-5dee-85c0-6d09ac043e3e", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 14-year-old girl with status asthmaticus is receiving oxygen 3 L/min through nasal prongs. Heart rate is 110 bpm. Arterial blood gas values are PaO2 90 mmHg, PaCO2 32 mmHg, and pH 7.46. If ventilation appears unchanged, which of the following is the most reliable sign of impending respiratory failure?", + "A": "PaO2 of 80 mmHg", + "B": "PaCO2 of 39 mmHg", + "C": "Heart rate of 140 bpm", + "D": "Increased wheezing", + "E": "Deterioration of mental status" + }, + "zh": { + "question": "一名14岁女孩患有哮喘持续状态，正在通过鼻导管以3 L/min的速度吸氧。心率为110次/分钟。动脉血气值为PaO2 90 mmHg，PaCO2 32 mmHg，pH 7.46。如果通气情况没有变化，以下哪项是呼吸衰竭即将发生的最可靠征兆？", + "A": "PaO2为80 mmHg", + "B": "PaCO2为39 mmHg", + "C": "心率为140次/分钟", + "D": "喘息加重", + "E": "精神状态恶化" + } + }, + { + "id": "6f7890a7-f9b3-5222-9b49-3719ee0e25ef", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is characteristic of soda lime and Baralyme carbon dioxide absorption canisters used in circle systems?", + "A": "Calcium carbonate is a major end product", + "B": "Carbon dioxide absorption cools the anesthetic gases", + "C": "Flushing the canister with oxygen for six hours will regenerate 50% of the spent Baralyme", + "D": "Gases lose water vapor as they pass through the canisters", + "E": "Soda lime and Baralyme depend on silica as a binding agent" + }, + "zh": { + "question": "以下哪项是用于环路系统的苏打石灰和Baralyme二氧化碳吸收罐的特征？", + "A": "碳酸钙是主要的最终产物", + "B": "二氧化碳吸收会冷却麻醉气体", + "C": "用氧气冲洗罐子六小时将再生50%的用过的Baralyme", + "D": "气体通过罐子时会失去水蒸气", + "E": "苏打石灰和Baralyme依赖于二氧化硅作为粘合剂" + } + }, + { + "id": "c461e63f-85bc-5eb6-948d-f047c7f0a579", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning the use of epidural opioids during labor is true?", + "A": "Fentanyl decreases the concentration of epidural bupivacaine required for satisfactory analgesia", + "B": "Fentanyl is an effective analgesic for the second stage of labor", + "C": "Sufentanil is an unsatisfactory analgesic for labor", + "D": "The addition of epinephrine to morphine prolongs the duration of analgesia", + "E": "The duration of analgesia with fentanyl is six to ten hours" + }, + "zh": { + "question": "以下关于分娩期间使用硬膜外阿片类药物的说法哪一项是正确的？", + "A": "芬太尼降低了硬膜外布比卡因达到满意镇痛所需的浓度", + "B": "芬太尼是分娩第二阶段的有效镇痛药", + "C": "舒芬太尼是分娩时不理想的镇痛药", + "D": "在吗啡中加入肾上腺素可延长镇痛时间", + "E": "芬太尼的镇痛时间为六到十小时" + } + }, + { + "id": "c82f4713-f1e4-5deb-9d09-3fac4e9b1a5d", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Following transfusion of packed red blood cells during general anesthesia, the patient's blood pressure decreases, heart rate and temperature increase, and hemoglobinuria and diffuse oozing are observed. Which of the following is the most appropriate first step in management?", + "A": "Administration of hydrocortisone", + "B": "Administration of fresh frozen plasma", + "C": "Administration of epsilon-aminocaproic acid", + "D": "Rapid infusion of crystalloid", + "E": "Transfusion of platelet concentrates" + }, + "zh": { + "question": "在全身麻醉期间输注浓缩红细胞后，患者的血压下降，心率和体温升高，出现血红蛋白尿和弥漫性渗血。以下哪项是最合适的首要处理步骤？", + "A": "给予氢化可的松", + "B": "给予新鲜冰冻血浆", + "C": "给予ε-氨基己酸", + "D": "快速输注晶体液", + "E": "输注血小板浓缩物" + } + }, + { + "id": "e6614686-4c80-5bb5-bd5f-af5cab9f3c0f", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is increased in patients with chronic anemia?", + "A": "Mixed venous oxygen content", + "B": "P50", + "C": "Pulmonary vascular resistance", + "D": "Systemic vascular resistance", + "E": "Blood viscosity" + }, + "zh": { + "question": "以下哪项在慢性贫血患者中增加？", + "A": "混合静脉氧含量", + "B": "P50", + "C": "肺血管阻力", + "D": "全身血管阻力", + "E": "血液粘度" + } + }, + { + "id": "aa6979ef-f897-5e12-9395-9be05e14d1c9", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning brain stem auditory evoked responses is true?", + "A": "They monitor cortical function", + "B": "They are not affected by changes in carbon dioxide tension", + "C": "They are not affected by mild hypothermia (34°C)", + "D": "They are more resistant to anesthetic effects than somatosensory evoked responses", + "E": "They are abolished coincident with flattening of the EEG" + }, + "zh": { + "question": "以下关于脑干听觉诱发反应的说法中哪一项是正确的？", + "A": "它们监测皮层功能", + "B": "它们不受二氧化碳张力变化的影响", + "C": "它们不受轻度低温（34°C）的影响", + "D": "它们比体感诱发反应更能抵抗麻醉的影响", + "E": "它们在脑电图平坦时被消除" + } + }, + { + "id": "33cffad4-f2f9-5fea-a6a7-554722003f95", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "You are called to anesthetize a patient for an emergency pericardial window for a large pericardial effusion. Which of the following drugs is most appropriate for initiation of anesthesia?", + "A": "Alfentanil", + "B": "Ketamine", + "C": "Midazolam", + "D": "Propofol", + "E": "Thiopental" + }, + "zh": { + "question": "你被叫去为一名因大量心包积液需要紧急心包窗手术的患者进行麻醉。以下哪种药物最适合用于麻醉的开始？", + "A": "阿芬太尼", + "B": "氯胺酮", + "C": "咪达唑仑", + "D": "丙泊酚", + "E": "硫喷妥钠" + } + }, + { + "id": "2f249c15-a71b-52e8-b8ce-0c3b9544bca8", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The most sensitive means of detecting venous air embolism is", + "A": "precordial Doppler stethoscope", + "B": "transesophageal echocardiography", + "C": "end-tidal carbon dioxide measurement", + "D": "pulmonary artery pressure measurement", + "E": "central venous pressure measurement" + }, + "zh": { + "question": "检测静脉空气栓塞最敏感的方法是", + "A": "胸前多普勒听诊器", + "B": "经食道超声心动图", + "C": "呼气末二氧化碳测量", + "D": "肺动脉压测量", + "E": "中心静脉压测量" + } + }, + { + "id": "ee55db4c-cbae-521c-ad67-a4efc406cba4", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "A 40-year-old patient has pain following injection of 8 ml of thiopental 2.5% through a right radial artery catheter. His hand remains pink. Which of the following is the most appropriate next step?", + "A": "Injection of lidocaine through the catheter", + "B": "Injection of nitroglycerin through the catheter", + "C": "Injection of papaverine through the catheter", + "D": "Right stellate ganglion block", + "E": "No intervention" + }, + "zh": { + "question": "一名40岁的患者在通过右桡动脉导管注射8毫升2.5%的硫喷妥钠后感到疼痛。他的手仍然是粉红色的。以下哪项是最合适的下一步措施？", + "A": "通过导管注射利多卡因", + "B": "通过导管注射硝酸甘油", + "C": "通过导管注射罂粟碱", + "D": "右侧星状神经节阻滞", + "E": "不进行干预" + } + }, + { + "id": "79f1d264-f243-5ea1-993f-42f9a5f7bc2c", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Five minutes after a stellate ganglion block is performed, a patient becomes restless, then apneic. The most likely cause is", + "A": "paratracheal hematoma", + "B": "phrenic nerve block", + "C": "recurrent laryngeal nerve block", + "D": "subarachnoid injection", + "E": "vertebral artery injection" + }, + "zh": { + "question": "在进行星状神经节阻滞五分钟后，患者变得不安，然后出现呼吸暂停。最可能的原因是", + "A": "气管旁血肿", + "B": "膈神经阻滞", + "C": "喉返神经阻滞", + "D": "蛛网膜下腔注射", + "E": "椎动脉注射" + } + }, + { + "id": "4e60871e-8d1c-573e-9538-a754727dd87c", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "During controlled ventilation, which of the following will cause an increase in end-tidal carbon dioxide tension with a normal waveform on the capnograph?", + "A": "Bronchospasm", + "B": "Rapid blood loss", + "C": "Ventricular fibrillation", + "D": "Endobronchial migration of the endotracheal tube", + "E": "Release of a thigh tourniquet" + }, + "zh": { + "question": "在控制通气期间，下列哪项会导致呼气末二氧化碳张力增加，而在二氧化碳图上显示正常波形？", + "A": "支气管痉挛", + "B": "快速失血", + "C": "心室颤动", + "D": "气管插管的支气管内移位", + "E": "大腿止血带的释放" + } + }, + { + "id": "7520d17a-6870-540c-94d7-bd41f9b27cbf", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Nonsteroidal analgesics such as aspirin decrease pain by", + "A": "decreasing axonal transmission of pain stimuli through a local anesthetic mechanism", + "B": "directly competing with substance P for receptor occupancy", + "C": "inhibiting enzymatic breakdown of met-enkephalin", + "D": "inhibiting production of prostaglandin E2", + "E": "potentiating the action of endorphin in the substantia gelantinosa of the spinal cord" + }, + "zh": { + "question": "非甾体类镇痛药如阿司匹林通过以下哪种方式减轻疼痛", + "A": "通过局部麻醉机制减少疼痛刺激的轴突传导", + "B": "直接与P物质竞争受体占据", + "C": "抑制甲-脑啡肽的酶解", + "D": "抑制前列腺素E2的生成", + "E": "增强脊髓胶状质中内啡肽的作用" + } + }, + { + "id": "5e6c083f-0f3d-596c-821e-70d17466e4e7", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following should be included in the preoperative management of a 12-year-old patient with Duchenne's muscular dystrophy who is unable to ambulate?", + "A": "Determination of serum creatine kinase concentration", + "B": "Determination of serum potassium concentration", + "C": "Liver function profile", + "D": "Echocardiography", + "E": "Dantrolene prophylaxis" + }, + "zh": { + "question": "以下哪项应包括在一名12岁无法行走的杜氏肌营养不良患者的术前管理中？", + "A": "测定血清肌酸激酶浓度", + "B": "测定血清钾浓度", + "C": "肝功能检查", + "D": "超声心动图", + "E": "丹曲林预防" + } + }, + { + "id": "ac301552-26b1-5d70-b04d-58fbc713b197", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the LEAST likely cause of a prolonged prothrombin time?", + "A": "Chronic warfarin therapy", + "B": "Disseminated intravascular coagulation", + "C": "Hemophilia A", + "D": "Systemic heparinization", + "E": "Vitamin K deficiency" + }, + "zh": { + "question": "以下哪一项最不可能导致凝血酶原时间延长？", + "A": "慢性华法林治疗", + "B": "弥散性血管内凝血", + "C": "甲型血友病", + "D": "全身肝素化", + "E": "维生素K缺乏" + } + }, + { + "id": "a644849d-33da-56b6-a7bb-12c7051f49fd", + "choice_num": 5, + "answer": "B", + "level": 3, + "en": { + "question": "In a patient with 20% pulmonary shunt and a PaO2 of 60 mmHg, cardiac output suddenly decreases from 5 L/min to 3 L/min. Oxygen consumption is unchanged. As a result, the PaO2 will", + "A": "increase slightly because of decreased shunt blood flow", + "B": "decrease slightly because of decreased mixed venous PO2", + "C": "increase because of decreased affinity of hemoglobin for oxygen", + "D": "decrease because of an increased dead space to tidal volume ratio", + "E": "increase because of increased pulmonary oxygen uptake per milliliter of blood" + }, + "zh": { + "question": "在一名具有20%肺分流且动脉氧分压（PaO2）为60 mmHg的患者中，心输出量突然从5 L/min降至3 L/min。氧气消耗量不变。结果，PaO2将会", + "A": "略微增加，因为分流血流减少", + "B": "略微减少，因为混合静脉氧分压（PO2）降低", + "C": "增加，因为血红蛋白对氧的亲和力降低", + "D": "减少，因为死腔与潮气量的比率增加", + "E": "增加，因为每毫升血液的肺氧摄取量增加" + } + }, + { + "id": "a8c7f798-0653-563e-9ece-cedd1f593f8e", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Tingling in the fifth finger during spinal anesthesia is associated with anesthesia at which of the following dermatomes?", + "A": "C4", + "B": "C6", + "C": "C8", + "D": "T2", + "E": "T4" + }, + "zh": { + "question": "在脊髓麻醉期间，小指的刺痛感与以下哪个皮节的麻醉有关？", + "A": "C4", + "B": "C6", + "C": "C8", + "D": "T2", + "E": "T4" + } + }, + { + "id": "6a47397e-4506-54d8-9207-c5c1c377f620", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The short clinical duration of action of a single dose of fentanyl is a result of its", + "A": "small volume of distribution", + "B": "large volume of distribution", + "C": "low lipid solubility", + "D": "rapid redistribution", + "E": "short elimination half-life" + }, + "zh": { + "question": "芬太尼单次剂量的短临床作用时间是由于其", + "A": "小的分布容积", + "B": "大的分布容积", + "C": "低脂溶性", + "D": "快速再分布", + "E": "短的消除半衰期" + } + }, + { + "id": "4c29d7b1-9307-53e5-8be8-88658cf26ca7", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Fresh frozen plasma is indicated in each of the following situations EXCEPT", + "A": "after rapid transfusion of 1.5 L CPD-stored red blood cells", + "B": "antithrombin III deficiency", + "C": "replacement of factor VIII", + "D": "reversal of warfarin effect", + "E": "thrombotic thrombocytopenic purpura" + }, + "zh": { + "question": "新鲜冰冻血浆适用于以下情况，除了", + "A": "快速输注1.5升CPD储存的红细胞后", + "B": "抗凝血酶III缺乏", + "C": "替代因子VIII", + "D": "逆转华法林的作用", + "E": "血栓性血小板减少性紫癜" + } + }, + { + "id": "3ff9959b-90fb-578f-a404-2db6e29ec602", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Nausea and vomiting in pediatric outpatients are", + "A": "directly related to postoperative pain", + "B": "unrelated to the length of the procedure", + "C": "eliminated by preoperative administration of droperidol", + "D": "eliminated by intraoperative nasogastric drainage", + "E": "more frequent than in adults" + }, + "zh": { + "question": "小儿门诊患者的恶心和呕吐是", + "A": "与术后疼痛直接相关", + "B": "与手术时间长短无关", + "C": "通过术前给予氟哌利多消除", + "D": "通过术中胃管引流消除", + "E": "比成人更频繁" + } + }, + { + "id": "42886f8e-420a-577c-86a6-14888d903c38", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A healthy 24-year-old woman is undergoing knee arthroscopy with spinal anesthesia to a level of T4. Which of the following findings is LEAST likely?", + "A": "Decreased heart rate", + "B": "Decreased hepatic blood flow", + "C": "Decreased mean arterial pressure", + "D": "Decreased tidal volume", + "E": "Hyperperistalsis" + }, + "zh": { + "question": "一名健康的24岁女性正在接受膝关节镜检查，使用脊髓麻醉至T4水平。以下哪项发现最不可能出现？", + "A": "心率下降", + "B": "肝血流量减少", + "C": "平均动脉压下降", + "D": "潮气量减少", + "E": "肠蠕动亢进" + } + }, + { + "id": "ed37e08d-9d14-58d8-bc5d-0407efa5e865", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following laboratory studies is the best indicator of reversal of the effects of warfarin?", + "A": "Activated clotting time", + "B": "Activated partial thromboplastin time", + "C": "Bleeding time", + "D": "Plasma fibrinogen concentration", + "E": "Prothrombin time" + }, + "zh": { + "question": "以下哪项实验室研究是华法林作用逆转的最佳指标？", + "A": "活化凝血时间", + "B": "活化部分凝血活酶时间", + "C": "出血时间", + "D": "血浆纤维蛋白原浓度", + "E": "凝血酶原时间" + } + }, + { + "id": "309e10c8-4417-5ed7-bcec-7c830fcfbe6e", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following physiologic changes occurs with immersion in water during extracorporeal shock wave lithotripsy?", + "A": "Decreased cardiac output", + "B": "Decreased central venous pressure", + "C": "Increased expiratory reserve volume", + "D": "Increased functional residual capacity", + "E": "Increased stroke volume" + }, + "zh": { + "question": "在体外冲击波碎石术中浸入水中时，下列哪项生理变化会发生？", + "A": "心输出量减少", + "B": "中心静脉压降低", + "C": "呼气储备量增加", + "D": "功能残气量增加", + "E": "每搏输出量增加" + } + }, + { + "id": "43013bc8-b090-5c51-b4e8-68661d6065b0", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The use of droperidol as a preanesthetic medication has been associated with each of the following EXCEPT", + "A": "acute anxiety", + "B": "anterograde amnesia", + "C": "hypotension", + "D": "extrapyramidal signs", + "E": "catalepsy" + }, + "zh": { + "question": "使用氟哌利多作为术前用药与以下各项有关，除了", + "A": "急性焦虑", + "B": "顺行性遗忘", + "C": "低血压", + "D": "锥体外系症状", + "E": "强直性昏厥" + } + }, + { + "id": "a0d06f9f-c8a9-5d06-98cf-51d3804b1f97", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Which of the following will most closely mimic the effects of stellate ganglion block?", + "A": "Axillary perivascular block with 25 mL of 1.5% lidocaine", + "B": "Cervical nerve block at C2-5 with 2 mL of 1.5% lidocaine", + "C": "Supraclavicular block at the level of the first rib with 25 mL of 1.5% lidocaine", + "D": "Block of the median, radial, ulnar, musculocutaneous, and intercostobrachial nerves", + "E": "Excision of thoracic sympathetic ganglia Tl-4" + }, + "zh": { + "question": "以下哪项最接近模拟星状神经节阻滞的效果？", + "A": "使用25毫升1.5%利多卡因进行腋窝周围血管阻滞", + "B": "在C2-5进行颈神经阻滞，使用2毫升1.5%利多卡因", + "C": "在第一肋骨水平进行锁骨上阻滞，使用25毫升1.5%利多卡因", + "D": "阻滞正中神经、桡神经、尺神经、肌皮神经和肋间臂神经", + "E": "切除胸交感神经节T1-4" + } + }, + { + "id": "f8216d21-5c5a-5573-857b-1c0eb260bd40", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Initiation of positive pressure mechanical ventilation is LEAST likely to decrease cardiac output in patients with which of the following conditions?", + "A": "Abdominal distention with decreased lung volume", + "B": "Acute cardiogenic pulmonary edema", + "C": "Chronic obstructive pulmonary disease", + "D": "Flail chest following an automobile accident", + "E": "20% Right pneumothorax" + }, + "zh": { + "question": "在以下哪种情况下，开始正压机械通气最不可能导致心输出量减少？", + "A": "腹部膨胀伴随肺容量减少", + "B": "急性心源性肺水肿", + "C": "慢性阻塞性肺疾病", + "D": "车祸后连枷胸", + "E": "20%右侧气胸" + } + }, + { + "id": "d6fa787e-46b8-5c7d-b6e7-cead45150461", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The MAC of a volatile anesthetic agent is greatest when administered to which of the following groups of healthy patients?", + "A": "Neonates", + "B": "Infants", + "C": "Adolescents", + "D": "Men 30 years of age", + "E": "Parturients" + }, + "zh": { + "question": "挥发性麻醉剂的最低肺泡浓度（MAC）在以下哪组健康患者中最大？", + "A": "新生儿", + "B": "婴儿", + "C": "青少年", + "D": "30岁的男性", + "E": "产妇" + } + }, + { + "id": "5beb24df-229d-5fad-9b21-1c790a27173c", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The carbon dioxide/ventilation response curve", + "A": "is primarily a measure of the integrity of the peripheral chemoreceptors", + "B": "shows parallel displacement to the left in the presence of opioids", + "C": "is linear between a PaCO2 of 20 and 120 mmHg", + "D": "shows progressive changes in slope with increased doses of halogenated anesthetics", + "E": "is unaffected by a decrease in PaO2 to 60 mmHg" + }, + "zh": { + "question": "二氧���碳/通气反应曲线", + "A": "主要是外周化学感受器完整性的测量", + "B": "在存在阿片类药物时显示向左平行位移", + "C": "在PaCO2为20至120 mmHg之间呈线性", + "D": "随着卤代麻醉剂剂量的增加，显示斜率的渐进变化", + "E": "PaO2下降到60 mmHg时不受影响" + } + }, + { + "id": "e8f364b0-c701-54c9-9f19-ab9b9e3c5414", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following best describes cardiomyopathy following therapy with doxorubicin (Adriamycin)?", + "A": "The initial presentation is concentric hypertrophy", + "B": "The diagnosis is confirmed by a shortened QT interval", + "C": "It is exacerbated by hyperoxia", + "D": "It is resistant to inotropic agents", + "E": "It: may persist for years after therapy is discontinued" + }, + "zh": { + "question": "以下哪项最能描述多柔比星（阿霉素）治疗后发生的心肌病？", + "A": "最初表现为向心性肥厚", + "B": "通过缩短的QT间期确诊", + "C": "在高氧情况下加重", + "D": "对正性肌力药物无反应", + "E": "在治疗停止后可能持续多年" + } + }, + { + "id": "dd4aeb25-7b00-53a5-8ccd-11b8dfe7c948", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following neurophysiologic monitoring modalities is LEAST affected by administration of volatile anesthetic agents?", + "A": "Brain stem auditory evoked potentials", + "B": "Electroencephalogram", + "C": "Motor evoked potentials", + "D": "Somatosensory evoked potentials", + "E": "Visual evoked potentials" + }, + "zh": { + "question": "以下哪种神经生理监测方式最不受挥发性麻醉药物影响？", + "A": "脑干听觉诱发电位", + "B": "脑电图", + "C": "运动诱发电位", + "D": "体感诱发电位", + "E": "视觉诱发电位" + } + }, + { + "id": "8e823120-ffd6-5291-bcb3-2a313db1b2fc", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 75-year-old patient in the intensive care unit (ICU) is extubated after recovering from acute respiratory distress syndrome (ARDS). He has a history of previous myocardial infarction, congestive heart failure, and pneumonia. He has an A-line, pulmonary artery (PA) catheter and is receiving oxygen by nasal cannula. Which of the following techniques is LEAST accurate for assessing an intravascular fluid challenge?", + "A": "Central venous pressure (CVP)", + "B": "PA occlusion pressure", + "C": "Transesophageal echocardiography (TEE)", + "D": "Measurement of pulse pressure variation (PPV)" + }, + "zh": { + "question": "一名75岁的患者在重症监护病房（ICU）因急性呼吸窘迫综合征（ARDS）康复后拔管。他有心肌梗死、充血性心力衰竭和肺炎的病史。他有动脉导管、肺动脉（PA）导管，并通过鼻导管吸氧。以下哪种技术对评估血管内液体挑战的准确性最低？", + "A": "中心静脉压（CVP）", + "B": "肺动脉阻塞压", + "C": "经食道超声心动图（TEE）", + "D": "脉压变异度（PPV）的测量" + } + }, + { + "id": "c8609977-7852-5e4f-a18f-b8a07ac955fa", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Select the correct statement regarding color Doppler imaging.", + "A": "It is a form of M-mode echocardiography", + "B": "The technology is based on continuous wave Doppler", + "C": "By convention, motion toward the ultrasound probe is red and motion away from the probe is blue", + "D": "Two ultrasound crystals are used: one for transmission of the ultrasound signal and one for reception of the returning wave" + }, + "zh": { + "question": "选择关于彩色多普勒成像的正确陈述。", + "A": "它是一种M型超声心动图", + "B": "该技术基于连续波多普勒", + "C": "按照惯例，朝向超声探头的运动显示为红色，远离探头的运动显示为蓝色", + "D": "使用两个超声波晶体：一个用于传输超声信号，另一个用于接收返回的波" + } + }, + { + "id": "7dbf6288-9108-5b99-bbb9-ac26965a3157", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When the pressure gauge on a size \"E\" compressed-gas cylinder containing N2O begins to fall from its previous constant pressure of 750 psi, approximately how many liters of gas will remain in the cylinder?", + "A": "200 L", + "B": "400 L", + "C": "600 L", + "D": "Cannot be calculated" + }, + "zh": { + "question": "当一个装有N2O的E型压缩气体钢瓶的压力表从之前的恒定压力750 psi开始下降时，钢瓶中大约还剩多少升气体？", + "A": "200升", + "B": "400升", + "C": "600升", + "D": "无法计算" + } + }, + { + "id": "a67d8ba0-8edf-5d09-91ef-b3a2c67a2aef", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "What percent desflurane is present in the *vaporizing chamber* of a desflurane vaporizer (pressurized to 1500 mm Hg and heated to 23° C)?", + "A": "Nearly 100%", + "B": "85%", + "C": "65%", + "D": "45%" + }, + "zh": { + "question": "在加压至1500 mm Hg并加热至23°C的地氟醚挥发器的*挥发室*中，地氟醚的百分比是多少？", + "A": "接近100%", + "B": "85%", + "C": "65%", + "D": "45%" + } + }, + { + "id": "02b9c310-fdcb-5008-bf69-13c3d10efb40", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "If the internal diameter of an intravenous catheter were doubled, flow through the catheter would be", + "A": "Decreased by a factor of 2", + "B": "Decreased by a factor of 4", + "C": "Increased by a factor of 8", + "D": "Increased by a factor of 16" + }, + "zh": { + "question": "如果静脉导管的内径加倍，通过导管的流量将会", + "A": "减少2倍", + "B": "减少4倍", + "C": "增加8倍", + "D": "增加16倍" + } + }, + { + "id": "d427561b-acbf-599e-b760-42161652ab06", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A size \"E\" compressed-gas cylinder completely filled with N2O contains how many liters?", + "A": "1160 L", + "B": "1470 L", + "C": "1590 L", + "D": "1640 L" + }, + "zh": { + "question": "一个完全充满N2O的E型压缩气瓶包含多少升？", + "A": "1160 L", + "B": "1470 L", + "C": "1590 L", + "D": "1640 L" + } + }, + { + "id": "76ef8163-4e48-5faa-8949-113878acee0c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following methods can be used to detect all leaks in the low-pressure circuit of all contemporary anesthesia machines?", + "A": "Negative-pressure leak test", + "B": "Common gas outlet occlusion test", + "C": "Traditional positive-pressure leak test", + "D": "None of the above" + }, + "zh": { + "question": "以下哪种方法可用于检测所有现代麻醉机低压回路中的所有泄漏？", + "A": "负压泄漏测试", + "B": "公共气体出口闭塞测试", + "C": "传统的正压泄漏测试", + "D": "以上都不是" + } + }, + { + "id": "89010f19-ab84-513f-9f1f-5ecfd4300c47", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following valves prevents transfilling between compressedgas cylinders?", + "A": "Fail-safe valve", + "B": "Check valve", + "C": "Pressure-sensor shutoff valve", + "D": "Adjustable pressure-limiting valve" + }, + "zh": { + "question": "以下哪种阀门可以防止压缩气瓶之间的气体互流？", + "A": "失效保护阀", + "B": "止回阀", + "C": "压力传感器关闭阀", + "D": "可调压力限制阀" + } + }, + { + "id": "b912c3cb-dc02-5551-87c6-76d9eb402b6e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The driving force of the ventilator (Datex-Ohmeda 7000, 7810, 7100, and 7900) on the anesthesia workstation is accomplished with", + "A": "Compressed oxygen", + "B": "Compressed air", + "C": "Electricity alone", + "D": "Electricity and compressed oxygen" + }, + "zh": { + "question": "麻醉工作站上的呼吸机（Datex-Ohmeda 7000、7810、7100 和 7900）的驱动力是通过以下哪种方式实现的", + "A": "压缩氧气", + "B": "压缩空气", + "C": "仅电力", + "D": "电力和压缩氧气" + } + }, + { + "id": "50ecb5fc-5a59-5bfa-ac2b-15551ebfe750", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "The pressure gauge on a size \"E\" compressed-gas cylinder containing O2 reads 1600 psi. How long could O2 be delivered from this cylinder at a rate of 2 L/min?", + "A": "90 minutes", + "B": "140 minutes", + "C": "250 minutes", + "D": "320 minutes" + }, + "zh": { + "question": "一个装有 O2 的 E 型压缩气瓶的压力表读数为 1600 psi。在 2 L/min 的速率下，该气瓶中的 O2 可以输送多长时间？", + "A": "90 分钟", + "B": "140 分钟", + "C": "250 分钟", + "D": "320 分钟" + } + }, + { + "id": "1125d0b6-7e5e-5d61-a8ec-cceb5052a439", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 25-year-old healthy patient is anesthetized for a femoral hernia repair. Anesthesia is maintained with isoflurane and N2O 50% in O2 , and the patient's lungs are mechanically ventilated. Suddenly, the \"low-arterial saturation\" warning signal on the pulse oximeter gives an alarm. After the patient is disconnected from the anesthesia machine, he undergoes ventilation with an Ambu bag with 100% O2 without difficulty, and the arterial saturation quickly improves. During inspection of your anesthesia equipment, you notice that the bobbin in the O2 rotameter is not rotating. This most likely indicates", + "A": "Flow of O2 through the O2 rotameter", + "B": "No flow of O2 through the O2 rotameter", + "C": "A leak in the O2 rotameter below the bobbin", + "D": "A leak in the O2 rotameter above the bobbin" + }, + "zh": { + "question": "一名25岁的健康患者接受股疝修补手术的麻醉。麻醉维持使用异氟醚和50%的N2O在O2中，患者的肺部进行机械通气。突然，脉搏血氧仪发出“低动脉饱和度”警报。患者从麻醉机上断开后，用100% O2的Ambu袋进行通气，没有困难，动脉饱和度迅速改善。在检查麻醉设备时，您注意到O2流量计中的转子没有旋转。这最可能表明", + "A": "O2通过O2流量计的流动", + "B": "O2没有通过O2流量计的流动", + "C": "O2流量计在转子下方的泄漏", + "D": "O2流量计在转子上方的泄漏" + } + }, + { + "id": "eee07c2a-30d9-579c-8cbd-377d66f00d20", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The O2 pressure-sensor shutoff valve requires what O2 pressure to remain open and allow N2O to flow into the N2O rotameter?", + "A": "10 psi", + "B": "30 psi", + "C": "50 psi", + "D": "100 psi" + }, + "zh": { + "question": "氧气压力传感器截止阀需要多少氧气压力才能保持开启并允许一氧化二氮流入一氧化二氮流量计？", + "A": "10 psi", + "B": "30 psi", + "C": "50 psi", + "D": "100 psi" + } + }, + { + "id": "3354f0ce-d1b6-5041-b48f-69ed8bc05f80", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 78-year-old patient is anesthetized for resection of a liver tumor. After induction and tracheal intubation, a 20-gauge arterial line is placed and connected to a transducer that is located 20 cm below the level of the heart. The system is zeroed at the stopcock located at the wrist while the patient's arm is stretched out on an arm board. How will the arterial line pressure compare with the true blood pressure (BP)?", + "A": "It will be 20 mm Hg higher", + "B": "It will be 15 mm Hg higher", + "C": "It will be the same", + "D": "It will be 15 mm Hg lower" + }, + "zh": { + "question": "一名78岁的患者因肝肿瘤切除术接受麻醉。诱导和气管插管后，放置了一根20号动脉导管，并连接到一个位于心脏水平以下20厘米的传感器。系统在患者手臂伸展在手臂板上的手腕处的三通阀处归零。动脉导管的压力与真实的血压（BP）相比如何？", + "A": "会高出20 mm Hg", + "B": "会高出15 mm Hg", + "C": "会相同", + "D": "会低15 mm Hg" + } + }, + { + "id": "3c9ebb57-6330-5e65-8da1-c11a187ccbd7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The second-stage O2 pressure regulator delivers a constant O2 pressure to the rotameters of", + "A": "4 psi", + "B": "8 psi", + "C": "16 psi", + "D": "32 psi" + }, + "zh": { + "question": "二级氧气压力调节器向流量计提供恒定的氧气压力为", + "A": "4 psi", + "B": "8 psi", + "C": "16 psi", + "D": "32 psi" + } + }, + { + "id": "56cf37eb-7ffe-5365-acda-3b8c87756f24", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "You are called to assist a colleague who notes a large gas leak in the anesthesia circuit. Very high oxygen flows (15 L/minute) are being used, but the ventilator bellows do not fill during the ventilator cycle. You then attempt to manually ventilate the patient, but the reservoir bag does not fill. You then disconnect the patient from the anesthesia machine and attempt to ventilate the patient with an anesthesia bag (connected to separate oxygen source), but high oxygen flows are still required to achieve even a low positive pressure for ventilation. The most appropriate step would be", + "A": "Deflate cuff and reinflate until there is a good seal", + "B": "Pull out nasogastric tube", + "C": "Reintubate the patient", + "D": "Reconnect the endotracheal tube to the anesthesia machine circuit with 15 L/minute flow O2 plus 15 L/flow air" + }, + "zh": { + "question": "您被叫去协助一位同事，他注意到麻醉回路中有大量气体泄漏。使用了非常高的氧气流量（15升/分钟），但在呼吸机循环期间，呼吸机的风箱没有充满。然后您尝试手动为患者通气，但储气袋没有充满。您随后将患者与麻醉机断开连接，并尝试使用麻醉袋（连接到单独的氧气源）为患者通气，但仍需要高氧气流量才能实现低正压通气。最合适的步骤是", + "A": "放气袖带并重新充气直到密封良好", + "B": "拔出鼻胃管", + "C": "重新插管", + "D": "将气管导管重新连接到麻醉机回路，使用15升/分钟的氧气流量加15升/分钟的空气流量" + } + }, + { + "id": "85228fe1-95f5-5e15-966b-c125a3798d62", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A sevoflurane vaporizer will deliver an accurate concentration of an unknown volatile anesthetic if the latter shares which property with sevoflurane?", + "A": "Molecular weight", + "B": "Oil/gas partition coefficient", + "C": "Vapor pressure", + "D": "Blood/gas partition coefficient" + }, + "zh": { + "question": "如果一种未知挥发性麻醉剂与七氟醚共享哪种特性，七氟醚蒸发器将提供该麻醉剂的准确浓度？", + "A": "分子量", + "B": "油/气分配系数", + "C": "蒸气压", + "D": "血/气分配系数" + } + }, + { + "id": "681163c7-cfe0-5c49-a828-0cc23ef9e433", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 58-year-old patient has severe shortness of breath and \"wheezing.\" On examination, the patient is found to have inspiratory and expiratory stridor. Further evaluation reveals marked extrinsic compression of the midtrachea by a tumor. The type of airflow at the point of obstruction within the trachea is", + "A": "Laminar flow", + "B": "Turbulent flow", + "C": "Undulant flow", + "D": "Stenotic flow" + }, + "zh": { + "question": "一名58岁的患者有严重的呼吸急促和“喘息”。检查发现患者有吸气和呼气的喘鸣。进一步评估显示中气管被肿瘤显著外部压迫。气管内阻塞点的气流类型是", + "A": "层流", + "B": "湍流", + "C": "波动流", + "D": "狭窄流" + } + }, + { + "id": "c8e7ba93-adeb-572b-ba00-da5706b7c3e5", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Concerning the patient in Question 17, administration of 70% helium in O2 instead of 100% O2 will decrease the resistance to airflow through the stenotic region within the trachea because", + "A": "Helium decreases the viscosity of the gas mixture", + "B": "Helium decreases the friction coefficient of the gas mixture", + "C": "Helium decreases the density of the gas mixture", + "D": "Helium increases the Reynolds number of the gas mixture" + }, + "zh": { + "question": "关于问题17中的患者，使用70%氦气和氧气的混合物代替100%氧气会降低气流通过气管狭窄区域的阻力，因为", + "A": "氦气降低了气体混合物的粘度", + "B": "氦气降低了气体混合物的摩擦系数", + "C": "氦气降低了气体混合物的密度", + "D": "氦气增加了气体混合物的雷诺数" + } + }, + { + "id": "83fb213d-34e3-50a9-95da-9fdf468bfc37", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 56-year-old patient is brought to the operating room (OR) for elective replacement of a stenotic aortic valve. An awake 20-gauge arterial catheter is placed into the right radial artery and is then connected to a transducer located at the same level as the patient's left ventricle. The entire system is zeroed at the transducer. Several seconds later, the patient raises both arms into the air until his right wrist is 20 cm above his heart. As he is doing this the BP on the monitor reads 120/80 mm Hg. What would this patient's true BP be at this time?", + "A": "140/100 mm Hg", + "B": "135/95 mm Hg", + "C": "120/80 mm Hg", + "D": "105/65 mm Hg" + }, + "zh": { + "question": "一名56岁的患者被送到手术室进行择期狭窄主动脉瓣置换术。在清醒状态下，将一根20号动脉导管置入右桡动脉，然后连接到与患者左心室同一水平的传感器。整个系统在传感器处归零。几秒钟后，患者将双臂举到空中，直到他的右手腕高于心脏20厘米。当他这样做时，监视器上的血压读数为120/80 mm Hg。此时该患者的真实血压是多少？", + "A": "140/100 mm Hg", + "B": "135/95 mm Hg", + "C": "120/80 mm Hg", + "D": "105/65 mm Hg" + } + }, + { + "id": "4b32029b-e544-52c5-88aa-bf9d9bd2f30f", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "An admixture of room air in the waste gas disposal system during an appendectomy in a paralyzed, mechanically ventilated patient under general volatile anesthesia can best be explained by which mechanism of entry?", + "A": "Positive-pressure relief valve", + "B": "Negative-pressure relief valve", + "C": "Soda lime canister", + "D": "Ventilator bellows" + }, + "zh": { + "question": "在全身挥发性麻醉下进行阑尾切除术的瘫痪、机械通气患者中，废气处理系统中混入室内空气的机制最可能是通过哪种进入机制解释的？", + "A": "正压释放阀", + "B": "负压释放阀", + "C": "苏打石灰罐", + "D": "呼吸机风箱" + } + }, + { + "id": "470ce84f-c1a4-52e3-a183-8cfc120637d4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Automated noninvasive blood pressure (ANIBP) devices calculate which of the following using proprietary algorithms?", + "A": "Systolic BP", + "B": "Diastolic BP", + "C": "Mean arterial BP", + "D": "Both systolic and diastolic BPs" + }, + "zh": { + "question": "自动化无创血压（ANIBP）设备使用专有算法计算以下哪项？", + "A": "收缩压", + "B": "舒张压", + "C": "平均动脉压", + "D": "收缩压和舒张压" + } + }, + { + "id": "89969c1a-e521-5dab-962c-ab44b1a6903a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Currently, the commonly used vaporizers (e.g., GE-Datex-Ohmeda Tec 4, Tec 5, Tec 7; Dräger Vapor 19.n and 2000 series) are described as having all of the following features EXCEPT", + "A": "Agent specificity", + "B": "Variable bypass", + "C": "Bubble through", + "D": "Temperature compensated" + }, + "zh": { + "question": "目前，常用的蒸发器（例如，GE-Datex-Ohmeda Tec 4、Tec 5、Tec 7；Dräger Vapor 19.n 和 2000 系列）被描述为具有以下所有特征，除了", + "A": "特定药剂", + "B": "可变旁路", + "C": "气泡通过", + "D": "温度补偿" + } + }, + { + "id": "a3d7c6a1-bfb0-5a9f-a93a-bb230e770c87", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "For any given concentration of volatile anesthetic, the splitting ratio is dependent on which of the following characteristics of that volatile anesthetic?", + "A": "Vapor pressure", + "B": "Molecular weight", + "C": "Specific heat", + "D": "Minimum alveolar concentration (MAC) at 1 atmosphere" + }, + "zh": { + "question": "对于任何给定浓度的挥发性麻醉剂，分流比取决于该挥发性麻醉剂的以下哪种特性？", + "A": "蒸气压", + "B": "分子量", + "C": "比热", + "D": "在1个大气压下的最低肺泡浓度（MAC）" + } + }, + { + "id": "70639b04-5e60-531a-a5f5-20f35d3c7932", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "On Monday morning the absorbent granules in your anesthesia machine, which was not used in the last 48 hours, are violet. In addition to rebreathing CO2 when exhausted, this form of absorbent also carries the risk of", + "A": "Channeling", + "B": "Fire", + "C": "Compound A formation", + "D": "Carbon monoxide production" + }, + "zh": { + "question": "在周一早上，你的麻醉机在过去48小时内未使用，其吸收剂颗粒呈紫色。除了在耗尽时会重新吸入CO2外，这种形式的吸收剂还存在以下风险", + "A": "通道效应", + "B": "火灾", + "C": "A化合物形成", + "D": "一氧化碳生成" + } + }, + { + "id": "b3431ca2-e226-58af-85a4-203d5a1165f0", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "During the pre-anesthesia checkout (PAC) of the anesthesia delivery system, the mounted oxygen E cylinder is shown to have a pressure of 1200 psi. Before proceeding with the next case, the most appropriate action would be:", + "A": "Leave cylinder valve open and proceed with case", + "B": "Close cylinder valve and proceed with case", + "C": "Replace the cylinder, open valve to check pressure, then close and proceed with case", + "D": "Replace the cylinder, open valve to check pressure, and proceed with case" + }, + "zh": { + "question": "在麻醉输送系统的麻醉前检查（PAC）中，安装的氧气E瓶显示压力为1200 psi。在进行下一个病例之前，最合适的操作是：", + "A": "打开气瓶阀门并继续进行病例", + "B": "关闭气瓶阀门并继续进行病例", + "C": "更换气瓶，打开阀门检查压力，然后关闭并继续进行病例", + "D": "更换气瓶，打开阀门检查压力，并继续进行病例" + } + }, + { + "id": "f0d6a408-9188-53f4-abd6-80d2a671d6e9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "ECG monitors utilize high- and low-frequency filters to reduce noise (artifact). Which of the following are reduced with low-frequency filtering?", + "A": "Muscle fasciculation", + "B": "Respirations", + "C": "Tremor", + "D": "Electromagnetic interference from other devices" + }, + "zh": { + "question": "心电图监测仪使用高频和低频滤波器来减少噪声（伪影）。以下哪项是通过低频滤波减少的？", + "A": "肌肉抽搐", + "B": "呼吸", + "C": "震颤", + "D": "来自其他设备的电磁干扰" + } + }, + { + "id": "bc3375b4-a277-5d6e-abce-705a22de466b", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "If the anesthesia machine is discovered Monday morning to have run with 5 L/min of oxygen all weekend long, the most reasonable course of", + "A": "Administer 100% oxygen for the first hour of the next case", + "B": "Place humidifier in line with the expiratory limb", + "C": "Avoid use of sevoflurane", + "D": "Change the CO2 absorbent" + }, + "zh": { + "question": "如果在周一早上发现麻醉机整个周末都以5 L/min的氧气运行，最合理的做法是", + "A": "在下一个病例的第一个小时内给予100%氧气", + "B": "在呼气管路中放置加湿器", + "C": "避免使用七氟醚", + "D": "更换CO2吸收剂" + } + }, + { + "id": "ed79b886-a872-51bf-a98c-ac1c05df8445", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "According to National Institute for Occupational Safety and Health (NIOSH) regulations, the highest concentration of volatile anesthetic contamination allowed in the OR atmosphere when administered in conjunction with N2O is", + "A": "0.5 ppm", + "B": "2 ppm", + "C": "5 ppm", + "D": "25 ppm" + }, + "zh": { + "question": "根据国家职业安全与健康研究所（NIOSH）的规定，当与N2O联合使用时，手术室空气中允许的挥发性麻醉剂污染的最高浓度是", + "A": "0.5 ppm", + "B": "2 ppm", + "C": "5 ppm", + "D": "25 ppm" + } + }, + { + "id": "5fce774e-5d25-547d-9f07-7cab05f8c586", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A ventilator pressure-relief valve stuck in the closed position can result in", + "A": "Barotrauma", + "B": "Hypoventilation", + "C": "Hyperventilation", + "D": "Low breathing circuit pressure" + }, + "zh": { + "question": "呼吸机压力释放阀卡在关闭位置可能导致", + "A": "压��伤", + "B": "通气不足", + "C": "通气过度", + "D": "呼吸回路压力低" + } + }, + { + "id": "2b6c2863-e244-5da7-9fe4-1db4f6fecb04", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A mixture of 1% isoflurane, 70% N2O, and 30% O2 is administered to a patient for 30 minutes. The expired isoflurane concentration measured is 1%. N2O is shut off, and a mixture of 30% O2 and 70% N2 with 1% isoflurane is administered. The expired isoflurane concentration measured 1 minute after the start of this new mixture is 2.3%. The best explanation for this observation is", + "A": "Intermittent back pressure (pumping effect)", + "B": "Diffusion hypoxia", + "C": "Concentration effect", + "D": "Effect of N2O solubility in isoflurane" + }, + "zh": { + "question": "给患者吸入1%异氟醚、70% N2O和30% O2的混合气体30分钟。测得呼出气中异氟醚浓度为1%。关闭N2O，改为吸入30% O2和70% N2的混合气体，异氟醚浓度仍为1%。在开始吸入新混合气体1分钟后，测得呼出气中异氟醚浓度为2.3%。对此观察的最佳解释是", + "A": "间歇性背压（泵效应）", + "B": "扩散性缺氧", + "C": "浓度效应", + "D": "N2O在异氟醚中的溶解性效应" + } + }, + { + "id": "ae9d262b-5c63-55e1-a240-ae573716b19c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Select the FALSE statement.", + "A": "If a Magill forceps is used for a nasotracheal intubation, the right nares is preferable for insertion of the nasotracheal tube", + "B": "Extension of the neck can convert an endotracheal intubation to an endobronchial intubation", + "C": "Bucking signifies the return of the coughing reflex", + "D": "Postintubation pharyngitis is more likely to occur in female patients" + }, + "zh": { + "question": "选择错误的陈述。", + "A": "如果使用Magill镊子进行鼻气管插管，右鼻孔是插入鼻气管导管的首选", + "B": "颈部伸展可以将气管插管转变为支气管插管", + "C": "呛咳表示咳嗽反射的恢复", + "D": "插管后咽炎更可能发生在女性患者中" + } + }, + { + "id": "48d78a4e-d5ef-5be7-a8ff-edf70ca3e492", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Gas from an N2O compressed-gas cylinder enters the anesthesia", + "A": "60 psi", + "B": "45 psi", + "C": "30 psi", + "D": "15 psi" + }, + "zh": { + "question": "来自N2O压缩气瓶的气体进入麻醉机的压力是", + "A": "60 psi", + "B": "45 psi", + "C": "30 psi", + "D": "15 psi" + } + }, + { + "id": "f1bddcd5-040f-5c27-bd8c-6f538401cf58", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Eye protection for OR staff is needed when laser surgery is performed. Clear wraparound goggles or glasses are adequate with which kind of", + "A": "Argon laser", + "B": "Nd:YAG (neodymium:yttrium-aluminum-garnet) laser", + "C": "CO2 laser", + "D": "None of the above" + }, + "zh": { + "question": "在进行激光手术时，手术室工作人员需要眼部保护。哪种情况下透明的包覆式护目镜或眼镜是足够的？", + "A": "氩激光", + "B": "Nd:YAG（钕：钇铝石榴石）激光", + "C": "CO2激光", + "D": "以上都不是" + } + }, + { + "id": "364097ce-88c2-5fd2-ba72-bbabd9d9ccf9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following systems prevents attachment of gasadministering equipment to the wrong type of gas line?", + "A": "Pin index safety system", + "B": "Diameter index safety system", + "C": "Fail-safe system", + "D": "Proportion-limiting control system" + }, + "zh": { + "question": "以下哪种系统可以防止气体输送设备连接到错误类型的气体管线？", + "A": "销孔安全系统", + "B": "直径索引安全系统", + "C": "失效保护系统", + "D": "比例限制控制系统" + } + }, + { + "id": "ded20345-c460-5549-979e-607b6777263b", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 59-year-old pacemaker-dependent patient comes to surgery with the pacemaker programmed in the DDD mode. Extracorporeal shock wave lithotripsy (ESWL) is scheduled for fragmentation of several 3- to 5-mm kidney stones. What preparation is needed before undertaking ESWL in this setting to avoid inappropriate firing of the lithotripter?", + "A": "Program pacemaker to DVI", + "B": "Program pacemaker to VVI", + "C": "Program pacemaker to DOO", + "D": "Proceed with the case" + }, + "zh": { + "question": "一名59岁的依赖起搏器的患者来进行手术，起搏器被编程为DDD模式。计划进行体外冲击波碎石术（ESWL）以碎解几颗3到5毫米的肾结石。在这种情况下，为避免碎石机的不当触发，需要在进行ESWL之前做哪些准备？", + "A": "将起搏器编程为DVI", + "B": "将起搏器编程为VVI", + "C": "将起搏器编程为DOO", + "D": "继续进行手术" + } + }, + { + "id": "6f313712-0226-579e-a0da-d383b96525fe", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "The dial of an isoflurane-specific, variable bypass, temperaturecompensated, flowover, out-of-circuit vaporizer (i.e., modern vaporizer) is set on 2%, and the infrared spectrometer measures 2% isoflurane vapor from the common gas outlet. The flowmeter is set at a rate of 700 mL/min during this measurement. The output measurements are repeated with the flowmeter set at 100 mL/min and 15 L/min (vapor dial still set on 2%). How will these two measurements compare with the first measurement taken?", + "A": "Output will be less than 2% in both cases", + "B": "Output will be greater than 2% in both cases", + "C": "Output will be 2% at 100 mL/min O2 flow and less than 2% at 15 L/min flow", + "D": "Output will be less than 2% at 100 mL/min and 2% at 15 L/min" + }, + "zh": { + "question": "一个异氟醚专用、可变旁路、温度补偿、流过、回路外的挥发器（即现代挥发器）的刻度设置为2%，红外光谱仪测量到来自公共气体出口的2%异氟醚蒸气。在此测量期间，流量计设置为700 mL/min。将流量计设置为100 mL/min和15 L/min（挥发器刻度仍设置为2%）重复输出测量。这两次测量与第一次测量相比如何？", + "A": "两种情况下输出都将小于2%", + "B": "两种情况下输出都将大于2%", + "C": "在100 mL/min氧气流量时输出为2%，在15 L/min流量时输出小于2%", + "D": "在100 mL/min时输出小于2%，在15 L/min时输出为2%" + } + }, + { + "id": "004ccdc1-76b4-5870-bfb2-6a090677dcf6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following would result in the greatest decrease in the arterial hemoglobin saturation (Spo2 ) value measured by the dualwavelength pulse oximeter?", + "A": "Intravenous injection of indigo carmine", + "B": "Intravenous injection of indocyanine green", + "C": "Intravenous injection of methylene blue", + "D": "Elevation of bilirubin" + }, + "zh": { + "question": "以下哪项会导致双波长脉搏血氧仪测量的动脉血红蛋白饱和度（Spo2）值最大幅度的下降？", + "A": "静脉注射靛胭脂", + "B": "静脉注射吲哚菁绿", + "C": "静脉注射亚甲蓝", + "D": "胆红素升高" + } + }, + { + "id": "631aceab-f2c1-5334-bf7a-e2d1b660c4fc", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 45-year-old patient recovering in the ICU after a motor vehicle accident is continuously being assessed with transcutaneous O2 and CO2 monitoring. Compared with conventional arterial blood gas values, those for transcutaneous oxygen (Ptco2 ) and transcutaneous carbon", + "A": "Higher (both)", + "B": "Ptco2 lower, Ptcco2 higher", + "C": "Ptco2 higher, Ptcco2 lower", + "D": "Lower (both)" + }, + "zh": { + "question": "一名45岁的患者在经历车祸后正在ICU恢复，持续进行经皮氧气和二氧化碳监测。与传统的动脉血气值相比，经皮氧气（Ptco2）和经皮二氧化碳的值", + "A": "更高（两者）", + "B": "Ptco2更低，Ptcco2更高", + "C": "Ptco2更高，Ptcco2更低", + "D": "更低（两者）" + } + }, + { + "id": "2da3cfd5-7116-59f0-943a-4f7143cf3ab8", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following combinations would result in delivery of a lower-than-expected concentration of volatile anesthetic to the patient?", + "A": "Sevoflurane vaporizer filled with desflurane", + "B": "Isoflurane vaporizer filled with sevoflurane", + "C": "Sevoflurane vaporizer filled with isoflurane", + "D": "All of the above would result in less than the dialed concentration" + }, + "zh": { + "question": "以下哪种组合会导致输送给患者的挥发性麻醉药浓度低于预期？", + "A": "将七氟醚蒸发器装入地氟醚", + "B": "将异氟醚蒸发器装入七氟醚", + "C": "将七氟醚蒸发器装入异氟醚", + "D": "以上所有情况都会导致浓度低于设定值" + } + }, + { + "id": "8c7eb745-c647-5cba-8ed6-a2c561fe0496", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A patient presents for knee arthroscopy and tells his anesthesiologist that he has a VDD pacemaker. Select the true statement regarding this pacemaker.", + "A": "It senses and paces only the ventricle", + "B": "It paces only the ventricle", + "C": "Its response to a sensed event is always inhibition", + "D": "It is not useful in a patient with atrioventricular (AV) nodal block" + }, + "zh": { + "question": "一名患者因膝关节镜检查就诊，并告诉麻醉师他有一个VDD起搏器。选择关于该起搏器的正确陈述。", + "A": "它仅感知和起搏心室", + "B": "它仅起搏心室", + "C": "它对感知事件的反应总是抑制", + "D": "它对房室结（AV）阻滞的患者无用" + } + }, + { + "id": "b8d65058-3546-5628-a909-7b7778e8304b", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "All of the following would result in less trace gas pollution of the OR", + "A": "Use of a high gas flow in a circular system", + "B": "Tight mask seal during mask induction", + "C": "Use of a scavenging system", + "D": "Allow patient to breathe 100% O2 as long as possiblebefore extubation" + }, + "zh": { + "question": "以下所有措施都可以减少手术室的痕量气体污染", + "A": "在循环系统中使用高气流", + "B": "面罩诱导时保持面罩密封", + "C": "使用废气收集系统", + "D": "在拔管前尽可能长时间让患者吸入100%氧气" + } + }, + { + "id": "1b3bfa47-8864-5d23-b5fb-b0c928f1d0f0", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The greatest source for contamination of the OR atmosphere is leakage of volatile anesthetics", + "A": "Around the anesthesia mask", + "B": "At the vaporizer", + "C": "At the CO2 absorber", + "D": "At the endotracheal tube" + }, + "zh": { + "question": "手术室空气污染的最大来源是挥发性麻醉剂的泄漏", + "A": "在麻醉面罩周围", + "B": "在蒸发器处", + "C": "在二氧化碳吸收器处", + "D": "在气管插管处" + } + }, + { + "id": "17e61f75-dd3d-5cbb-9a42-2da27e5851eb", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Uptake of sevoflurane from the lungs during the first minute of general anesthesia is 50 mL. How much sevoflurane would be taken up from the lungs between the 16th and 36th minutes?", + "A": "25 mL", + "B": "50 mL", + "C": "100 mL", + "D": "500 mL" + }, + "zh": { + "question": "在全身麻醉的第一分钟内，七氟醚从肺部的摄取量为50毫升。在第16到第36分钟之间，七氟醚从肺部的摄取量是多少？", + "A": "25毫升", + "B": "50毫升", + "C": "100毫升", + "D": "500毫升" + } + }, + { + "id": "9eb127ed-001f-561d-88e5-7c538687b40b", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the drugs below would have the LEAST impact on somatosensory evoked potentials (SSEPs) monitoring in a 15-year-old patient undergoing scoliosis surgery?", + "A": "Midazolam", + "B": "Propofol", + "C": "Isoflurane", + "D": "Vecuronium" + }, + "zh": { + "question": "以下哪种药物对15岁患者进行脊柱侧弯手术时的体感诱发电位（SSEPs）监测影响最小？", + "A": "咪达唑仑", + "B": "丙泊酚", + "C": "异氟醚", + "D": "维库溴铵" + } + }, + { + "id": "49cc9efa-d329-531d-9f39-e7fad176ffd6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is NOT found in the low-pressure circuit on an anesthesia machine?", + "A": "Oxygen supply failure alarm", + "B": "Flowmeters", + "C": "Vaporizers", + "D": "Vaporizer check valve" + }, + "zh": { + "question": "以下哪项不在麻醉机的低压回路中？", + "A": "氧气供应故障报警", + "B": "流量计", + "C": "挥发器", + "D": "挥发器止回阀" + } + }, + { + "id": "7e7089f9-8176-5332-9327-d4f44afc1de1", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Frost develops on the outside of an N2O compressed-gas cylinder during general anesthesia. This phenomenon indicates that", + "A": "The saturated vapor pressure of N2O within the cylinder israpidly increasing", + "B": "The cylinder is almost empty", + "C": "There is a rapid transfer of heat to the cylinder", + "D": "The flow of N2O from the cylinder into the anesthesiamachine is rapid" + }, + "zh": { + "question": "在全身麻醉期间，N2O压缩气瓶的外部出现霜冻。这种现象表明", + "A": "气瓶内N2O的饱和蒸气压正在迅速增加", + "B": "气瓶几乎空了", + "C": "有热量迅速传递到气瓶", + "D": "N2O从气瓶流入麻醉机的速度很快" + } + }, + { + "id": "5b2ec827-cf96-5fa5-9fe7-1e497a4a2465", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The LEAST reliable site for central temperature monitoring is the", + "A": "PA", + "B": "Skin on the forehead", + "C": "Distal third of the esophagus", + "D": "Nasopharynx" + }, + "zh": { + "question": "最不可靠的中心温度监测部位是", + "A": "肺动脉", + "B": "前额皮肤", + "C": "食管远端三分之一", + "D": "鼻咽" + } + }, + { + "id": "3feb772f-3dec-57e2-834e-41d94428625b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Of the following medical lasers, which laser light penetrates tissues the most?", + "A": "Argon laser", + "B": "Helium–neon laser (He–Ne)", + "C": "Nd:YAG laser", + "D": "CO2 laser" + }, + "zh": { + "question": "在以下医学激光中，哪种激光光线穿透组织最深？", + "A": "氩激光", + "B": "氦氖激光 (He–Ne)", + "C": "Nd:YAG 激光", + "D": "CO2 激光" + } + }, + { + "id": "360450a8-f873-5f10-8d21-a43779fabea5", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following supraglottic airway devices features a built-in bite block, a channel for nasogastric suctioning, and a cuff modified to extend to the posterior surface of the mask?", + "A": "LMA Fastrach", + "B": "LMA Supreme", + "C": "Air-Q", + "D": "I-Gel" + }, + "zh": { + "question": "以下哪种声门上气道装置具有内置咬块、用于鼻胃吸引的通道以及延伸到面罩后表面的改良气囊？", + "A": "LMA Fastrach", + "B": "LMA Supreme", + "C": "Air-Q", + "D": "I-Gel" + } + }, + { + "id": "7d8264c0-2c82-5eeb-af60-4bd8b917bb2d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The maximum Fio2 that can be delivered by a nasal cannula is", + "A": "0.30", + "B": "0.35", + "C": "0.40", + "D": "0.45" + }, + "zh": { + "question": "鼻导管可以提供的最大吸入氧浓度（Fio2）是", + "A": "0.30", + "B": "0.35", + "C": "0.40", + "D": "0.45" + } + }, + { + "id": "107bb364-f889-57e2-a26f-dc00b9ecbaa6", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "General anesthesia is administered to an otherwise healthy 38-year-old patient undergoing repair of a right inguinal hernia. During mechanical ventilation, the anesthesiologist notices that the scavenging system reservoir bag is distended during inspiration. The most likely cause of this is", + "A": "An incompetent pressure-relief valve in the mechanical ventilator", + "B": "An incompetent pressure-relief valve in the patient's breathing circuit", + "C": "An incompetent inspiratory unidirectional valve in thepatient's breathing circuit", + "D": "An incompetent expiratory unidirectional valve in the patient's breathing circuit" + }, + "zh": { + "question": "全身麻醉用于一名健康的38岁患者进行右侧腹股沟疝修补术。在机械通气期间，麻醉师注意到废气排放��统的储气袋在吸气时膨胀。最可能的原因是", + "A": "机械呼吸机的压力释放阀失效", + "B": "患者呼吸回路的压力释放阀失效", + "C": "患者呼吸回路的吸气单向阀失效", + "D": "患者呼吸回路的呼气单向阀失效" + } + }, + { + "id": "572f02ba-de95-5737-a7e8-3291c7da8208", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which color of nail polish would have the greatest effect on the accuracy of dual-wavelength pulse oximeters?", + "A": "Red", + "B": "Yellow", + "C": "Blue", + "D": "Green" + }, + "zh": { + "question": "哪种颜色的指甲油对双波长脉搏血氧仪的准确性影响最大？", + "A": "红色", + "B": "黄色", + "C": "蓝色", + "D": "绿色" + } + }, + { + "id": "d0bd202b-603e-555d-8525-7179470e86aa", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Kinking or occlusion of the transfer tubing from the patient's breathing circuit to the closed scavenging system interface can result in", + "A": "Barotrauma", + "B": "Hypoventilation", + "C": "Hypoxia", + "D": "Hyperventilation" + }, + "zh": { + "question": "从患者呼吸回路到封闭式废气收集系统接口的传输管道发生扭曲或阻塞可能导致", + "A": "气压伤", + "B": "通气不足", + "C": "缺氧", + "D": "通气过度" + } + }, + { + "id": "b4ff93df-416b-5532-9534-59e2084645d5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The reason a patient is not burned by the return of energy from the patient to the ESU (electrosurgical unit, Bovie) is that", + "A": "The coagulation side of this circuit is positive relative to the ground side", + "B": "Resistance in the patient's body attenuates the energy", + "C": "The exit current density is much less than…?", + "D": "The exit current density is much less than that at the handpiece" + }, + "zh": { + "question": "患者不会因能量从患者返回到电外科设备（ESU，Bovie）而被烧伤的原因是", + "A": "该电路的凝固侧相对于接地侧为正", + "B": "患者体内的电阻衰减了能量", + "C": "出口电流密度远小于……？", + "D": "出口电流密度远小于手柄处的电流密度" + } + }, + { + "id": "6290773c-b47c-51be-b296-88aa959cddc1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Select the FALSE statement regarding noninvasive arterial BP monitoring devices.", + "A": "If the width of the BP cuff is too narrow, the measured BPwill be falsely lowered", + "B": "The width of the BP cuff should be 40% of the circumference of the patient's arm", + "C": "If the BP cuff is wrapped around the arm too loosely, the measured BP will be falsely elevated", + "D": "Frequent cycling of automated BP monitoring devices can result in edema distal to the cuff" + }, + "zh": { + "question": "选择关于无创动脉血压监测设备的错误陈述。", + "A": "如果血压袖带的宽度太窄，测得的血压将被错误地降低", + "B": "血压袖带的宽度应为患者手臂周长的40%", + "C": "如果血压袖带缠绕在手臂上太松，测得的血压将被错误地升高", + "D": "自动血压监测设备的频繁循环可能导致袖带远端的水肿" + } + }, + { + "id": "109c7c8f-a0b7-5004-a92e-74416a84fef0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When electrocardiogram (ECG) electrodes are placed for a patient undergoing a magnetic resonance imaging (MRI) scan, which of the following is true?", + "A": "Electrodes should be as close as possible and in the periphery of the magnetic field", + "B": "Electrodes should be as close as possible and in the center of the magnetic field", + "C": "Placement of electrodes relative to field is not important as long as they are far apart", + "D": "ECG cannot be monitored during an MRI scan" + }, + "zh": { + "question": "当为接受磁共振成像（MRI）扫描的患者放置心电图（ECG）电极时，下列哪项是正确的？", + "A": "电极应尽可能靠近并位于磁场的外围", + "B": "电极应尽可能靠近并位于磁场的中心", + "C": "只要电极间距较大，电极相对于磁场的放置并不重要", + "D": "在MRI扫描期间无法监测心电图" + } + }, + { + "id": "16eb4c82-c885-5b70-a789-b86746323c54", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The most frequent cause of mechanical failure of the anesthesia delivery", + "A": "Attachment of the wrong compressed-gas cylinder to the O2 yoke", + "B": "Improperly assembled O2 rotameter", + "C": "Fresh-gas line disconnection from the anesthesia machine to the in-line hosing", + "D": "Disconnection of the O2 supply system from the patient" + }, + "zh": { + "question": "麻醉输送系统机械故障最常见的原因是", + "A": "将错误的压缩气瓶连接到氧气支架上", + "B": "氧气流量计组装不当", + "C": "新鲜气体管线从麻醉机到管道的连接断开", + "D": "氧气供应系统与患者的连接断开" + } + }, + { + "id": "006fbbbb-5c2b-55a3-ad3a-8e32f16affa4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The esophageal detector device", + "A": "Uses a negative-pressure bulb", + "B": "Is especially useful in children younger than 1 year of age", + "C": "Requires a cardiac output to function appropriately", + "D": "Is reliable in morbidly obese patients and parturients" + }, + "zh": { + "question": "食管探测器装置", + "A": "使用负压球囊", + "B": "在1岁以下儿童中特别有用", + "C": "需要心输出量才能正常工作", + "D": "在病态肥胖患者和产妇中可靠" + } + }, + { + "id": "5bd4bf86-69ea-529d-bdc6-07dfdeb48ce2", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The reason CO2 measured by capnometer is less than the arterial Paco2 value measured simultaneously is", + "A": "Use of ion-specific electrode for blood gas determination", + "B": "Alveolar capillary gradient", + "C": "One-way values", + "D": "Alveolar dead space" + }, + "zh": { + "question": "通过呼气末二氧化碳监测仪测量的CO2值低于同时测量的动脉Paco2值的原因是", + "A": "使用离子选择电极进行血气测定", + "B": "肺泡毛细血管梯度", + "C": "单向值", + "D": "肺泡无效腔" + } + }, + { + "id": "adfbd4b2-db6a-5972-b7de-de785a176f8c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following arrangements of rotameters on the anesthesia machine manifold is safest with left-to-right gas flow?", + "A": "\\O_{2},\\C O_{2},\\N_{2}O,\\a i r}$$$$\\mathrm{", + "B": "\\CO_{2},\\O_{2},\\N_{2}O,\\a i r}$$$$\\mathrm{", + "C": "\\Air,\\CO_{2},\\O_{2},\\N_{2}O}$$", + "D": "Air, CO2 , N2O, O2" + }, + "zh": { + "question": "在麻醉机歧管上，以下哪种流量计的排列方式在从左到右的气体流动中是最安全的？", + "A": "O_{2}, CO_{2}, N_{2}O, air", + "B": "CO_{2}, O_{2}, N_{2}O, air", + "C": "Air, CO_{2}, O_{2}, N_{2}O", + "D": "Air, CO_{2}, N_{2}O, O_{2}" + } + }, + { + "id": "4d8f0de9-0395-5d58-a432-ff4bcc57cc62", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A Datex-Ohmeda Tec 4 vaporizer is tipped over while being attached to the anesthesia machine but is placed upright and installed. The soonest it can be safely used is", + "A": "After 30 minutes of flushing with dial set to \"off\"", + "B": "After 6 hours of flushing with dial set to \"off\"", + "C": "After 30 minutes with dial turned on", + "D": "Immediately" + }, + "zh": { + "question": "在安装到麻醉机时，Datex-Ohmeda Tec 4 蒸发器被倾倒，但被放正并安装。它可以安全使用的最早时间是", + "A": "关闭刻度盘后冲洗30分钟", + "B": "关闭刻度盘后冲洗6小时", + "C": "打开刻度盘后30分钟", + "D": "立即" + } + }, + { + "id": "b691639f-8631-5143-b896-8f0bb7616601", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "In the event of misfilling, what percent sevoflurane would be delivered from an isoflurane vaporizer set at 1%?", + "A": "0.6%", + "B": "0.8%", + "C": "1.0%", + "D": "1.2%" + }, + "zh": { + "question": "如果填充错误，设置为 1% 的异氟醚蒸发器将输送多少百分比的七氟醚？", + "A": "0.6%", + "B": "0.8%", + "C": "1.0%", + "D": "1.2%" + } + }, + { + "id": "3c1740cb-ff83-5d90-97b8-91ab6617dfa4", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "How long would a vaporizer (filled with 150 mL volatile) deliver 2% isoflurane if total flow is set at 4.0 L/min?", + "A": "2 hours", + "B": "4 hours", + "C": "6 hours", + "D": "8 hours" + }, + "zh": { + "question": "如果总流量设置为4.0 L/min，一个装有150 mL挥发物的蒸发器将提供2%异氟醚多长时间？", + "A": "2小时", + "B": "4小时", + "C": "6小时", + "D": "8小时" + } + }, + { + "id": "2be25c7a-66db-588e-b314-00bc274ac0a7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Raising the frequency of an ultrasound transducer used for line placement or regional anesthesia (e.g., from 3 MHz to 10 MHz) will result in", + "A": "Higher penetration of tissue with lower resolution", + "B": "Higher penetration of tissue with higher resolution", + "C": "Lower penetration of tissue with higher resolution", + "D": "Higher resolution with no change in tissue penetration" + }, + "zh": { + "question": "提高用于导管置入或区域麻醉的超声换能器的频率（例如，从3 MHz提高到10 MHz）将导致", + "A": "更高的组织穿透力但分辨率较低", + "B": "更高的组织穿透力且分辨率较高", + "C": "较低的组织穿透力但分辨率较高", + "D": "分辨率更高但组织穿透力不变" + } + }, + { + "id": "d4eceaa0-c702-5193-bd2b-ab51d528e8d5", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The fundamental difference between microshock and macroshock is related to", + "A": "Location of shock", + "B": "Duration", + "C": "Voltage", + "D": "Lethality" + }, + "zh": { + "question": "微电击和宏电击之间的根本区别与什么有关", + "A": "电击位置", + "B": "持续时间", + "C": "电压", + "D": "致命性" + } + }, + { + "id": "49b1da00-13c2-5f56-af78-647c15cf379e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Intraoperative awareness under general anesthesia can be eliminated by closely monitoring", + "A": "Electroencephalogram", + "B": "BP/heart rate", + "C": "Bispectral index (BIS)", + "D": "None of the above" + }, + "zh": { + "question": "通过密切监测可以消除全身麻醉下的术中意识", + "A": "脑电图", + "B": "血压/心率", + "C": "双频指数（BIS）", + "D": "以上都不是" + } + }, + { + "id": "d1f88d57-e1fb-5106-a0a4-b1a52c9af534", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A mechanically ventilated patient is transported from the OR to the ICU using a portable ventilator that consumes 2 L/min of oxygen to run the mechanically controlled valves and drive the ventilator. The transport cart is equipped with an \"E\" cylinder with a gauge pressure of 2000 psi. The patient receives a tidal volume (VT ) of 500 mL at a rate of 10 breaths/min. If the ventilator requires 200 psi to operate, how long could the patient be mechanically ventilated?", + "A": "20 minutes", + "B": "40 minutes", + "C": "60 minutes", + "D": "80 minutes" + }, + "zh": { + "question": "一名机械通气的患者使用消耗2 L/min氧气的便携式呼吸机从手术室转运到ICU，以运行机械控制的阀门和驱动呼吸机。转运车配备了一个表压为2000 psi的“E”型氧气瓶。患者以每分钟10次呼吸的频率接收500 mL的潮气量（VT）。如果呼吸机需要200 psi才能运行，患者可以被机械通气多长时间？", + "A": "20分钟", + "B": "40分钟", + "C": "60分钟", + "D": "80分钟" + } + }, + { + "id": "f96d8ab9-6c9c-5275-9577-254b74e262f6", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 135-kg man is ventilated at a rate of 14 breaths/min with a VT of 600 mL and positive end-expiratory pressure (PEEP) of 5 cm H2O during a laparoscopic banding procedure. Peak airway pressure is 50 cm H2O, and the patient is fully relaxed with a nondepolarizing neuromuscular blocking agent. How can peak airway pressure be reduced without a loss of alveolar ventilation?", + "A": "Increase the inspiratory flow rate", + "B": "Take off PEEP", + "C": "Reduce the I:E ratio (e.g., change from 1:3 to 1:2)", + "D": "Decrease VT to 300 and increase rate to 28" + }, + "zh": { + "question": "一名135公斤的男性在腹腔镜束带手术中以每分钟14次的呼吸频率、潮气量600毫升和5厘米水柱的呼气末正压（PEEP）进行通气。气道峰压为50厘米水柱，患者使用非去极化神经肌肉阻滞剂完全放松。如何在不损失肺泡通气的情况下降低气道峰压？", + "A": "增加吸气流速", + "B": "去掉PEEP", + "C": "减少I:E比率（例如，从1:3改为1:2）", + "D": "将潮气量减少到300并将频率增加到28" + } + }, + { + "id": "adbf1178-c312-5575-9a8e-399aee66f9ef", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The pressure and volume per minute delivered from the central hospital oxygen supply are", + "A": "2100 psi and 650 L/min", + "B": "1600 psi and 100 L/min", + "C": "75 psi and 100 L/min", + "D": "50 psi and 50 L/min" + }, + "zh": { + "question": "从中央医院氧气供应系统输送的压力和每分钟体积是", + "A": "2100 psi 和 650 L/min", + "B": "1600 psi 和 100 L/min", + "C": "75 psi 和 100 L/min", + "D": "50 psi 和 50 L/min" + } + }, + { + "id": "03d65210-860d-5cfc-9d87-bc94b7b6fec5", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "During normal laminar airflow, resistance is dependent on which characteristic of oxygen?", + "A": "Density", + "B": "Viscosity", + "C": "Molecular weight", + "D": "Temperature" + }, + "zh": { + "question": "在正常的层流气流中，阻力依赖于氧气的哪个特性？", + "A": "密度", + "B": "粘度", + "C": "分子量", + "D": "温度" + } + }, + { + "id": "884b6fcf-8dac-51a0-bfee-f1dfc767d2d2", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "If the oxygen cylinder were being used as the source of oxygen at a remote anesthetizing location and the oxygen flush valve on an anesthesia machine were pressed and held down, as during an emergency situation, each of the items below would be bypassed during 100% oxygen delivery EXCEPT", + "A": "O2 flowmeter", + "B": "First-stage regulator", + "C": "Vaporizer check valve", + "D": "Vaporizers" + }, + "zh": { + "question": "如果在一个偏远的麻醉地点使用氧气瓶作为氧气来源，并且在紧急情况下按下并按住麻醉机上的氧气冲洗阀，则在100%氧气输送过程中，以下各项中除了哪一项外，其他都会被绕过", + "A": "氧气流量计", + "B": "一级调节器", + "C": "蒸发器止回阀", + "D": "蒸发器" + } + }, + { + "id": "24e4d733-353a-541a-a30e-e6f5c1dedc32", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "After induction and intubation with confirmation of tracheal placement, the O2 saturation begins to fall. The O2 analyzer shows 4% inspired oxygen. The oxygen line pressure is 65 psi. The O2 tank on the back of the anesthesia machine has a pressure of 2100 psi and is turned on. The oxygen saturation continues to fall. The next step should be to", + "A": "Exchange the tank", + "B": "Replace pulse oximeter probe", + "C": "Disconnect O2 line from hospital source", + "D": "Extubate and start mask ventilation" + }, + "zh": { + "question": "诱导和插管确认气管位置后，氧饱和度开始下降。氧气分析仪显示吸入氧气为4%。氧气管线压力为65 psi。麻醉机后面的氧气罐压力为2100 psi，并已打开。氧饱和度继续下降。下一步应该是", + "A": "更换氧气罐", + "B": "更换脉搏血氧仪探头", + "C": "断开医院氧气管线", + "D": "拔管并开始面罩通气" + } + }, + { + "id": "1e874551-a9a5-583e-8cbb-262b8cce8203", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The correct location for placement of the V5 lead is", + "A": "Midclavicular line, third intercostal space", + "B": "Anterior axillary line, fourth intercostal space", + "C": "Midclavicular line, fifth intercostal space", + "D": "Anterior axillary line, fifth intercostal space" + }, + "zh": { + "question": "V5导联的正确放置位置是", + "A": "锁骨中线，第三肋间隙", + "B": "前腋线，第四肋间隙", + "C": "锁骨中线，第五肋间隙", + "D": "前腋线，第五肋间隙" + } + }, + { + "id": "d23806d6-a00a-5951-b6c7-5e2750407271", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The diameter index safety system refers to the interface between", + "A": "Pipeline source and anesthesia machine", + "B": "Gas cylinders and anesthesia machine", + "C": "Vaporizers and refilling connectors attached to bottles of volatile anesthetics", + "D": "Both pipeline and gas cylinders interface with anesthesia machine" + }, + "zh": { + "question": "直径指数安全系统是指以下哪种接口", + "A": "管道气源和麻醉机", + "B": "气瓶和麻醉机", + "C": "挥发性麻醉剂瓶的蒸发器和加注连接器", + "D": "管道和气瓶均与麻醉机接口" + } + }, + { + "id": "f963c69a-7696-5efd-9595-ca5d037f3f81", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following is cited as an advantage of calcium hydroxide lime (Amsorb Plus, Drägersorb) over soda lime EXCEPT", + "A": "Compound A is not formed", + "B": "CO is not formed", + "C": "More absorptive capacity per 100 g of granules", + "D": "It does not contain NaOH or KOH" + }, + "zh": { + "question": "以下每项都被认为是氢氧化钙石灰（Amsorb Plus, Drägersorb）相对于苏打石灰的优点，除了", + "A": "不形成化合物A", + "B": "不形成CO", + "C": "每100克颗粒的吸收能力更强", + "D": "不含NaOH或KOH" + } + }, + { + "id": "7f38dad2-aa63-5d31-a875-6ce7d5ddc0de", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "During a laparoscopic cholecystectomy, exhaled CO2 is 6%, but inhaled CO2 is 1%. Which explanation could NOT account for the 1% inhaled CO2?", + "A": "Channeling through soda lime", + "B": "Faulty expiratory valve", + "C": "Exhausted soda lime", + "D": "Absorption of CO2 through peritoneum# Anesthesia Equipment and Physics" + }, + "zh": { + "question": "在腹腔镜胆囊切除术中，呼出的CO2为6%，但吸入的CO2为1%。以下哪种解释不能说明1%的吸入CO2？", + "A": "通过苏打石灰的通道", + "B": "呼气阀故障", + "C": "苏打石灰耗尽", + "D": "通过腹膜吸收CO2" + } + }, + { + "id": "bdb09808-ca5b-5cc6-ac7f-b24d2947a9f8", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 29-year-old man is admitted to the intensive care unit (ICU) after a drug overdose. The patient is placed on a ventilator with a set tidal volume (Vt) of 750 mL at a rate of 10 breaths/min. The patient is making no inspiratory effort. The measured minute ventilation is 6 L, and the peak airway pressure is 30 cm H2O. What is the compression factor for this ventilator delivery circuit?", + "A": "$$\\mathrm{~2~mL/(cm~H_{2}O)}$$", + "B": "$$\\mathrm{~3~mL/(cm~H_{2}O)}$$", + "C": "$$\\mathrm{~4~mL/(cm~H_{2}O)}$$", + "D": "$$\\mathrm{~3~mL/(cm~H_{2}O)}$$" + }, + "zh": { + "question": "一名29岁男性因药物过量被送入重症监护室（ICU）。患者被置于呼吸机上，设定潮气量（Vt）为750 mL，呼吸频率为10次/分钟。患者没有做出吸气努力。测得的分钟通气量为6 L，峰值气道压力为30 cm H2O。该呼吸机输送回路的压缩因子是多少？", + "A": "$$\\mathrm{~2~mL/(cm~H_{2}O)}$$", + "B": "$$\\mathrm{~3~mL/(cm~H_{2}O)}$$", + "C": "$$\\mathrm{~4~mL/(cm~H_{2}O)}$$", + "D": "$$\\mathrm{~3~mL/(cm~H_{2}O)}$$" + } + }, + { + "id": "67679114-7d88-5fb4-9c27-7211a92d92a3", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 65-year-old patient is mechanically ventilated in the intensive care unit (ICU) after an open nephrectomy. How far should the suction catheter be inserted into the endotracheal tube for suctioning?", + "A": "To the midlevel of the endotracheal tube", + "B": "To the tip of the endotracheal tube", + "C": "Just proximal to the carina", + "D": "Past the carina" + }, + "zh": { + "question": "一名65岁的患者在进行开放性肾切除术后，在重症监护室（ICU）接受机械通气。吸痰导管应插入气管插管多深进行吸痰？", + "A": "到气管插管的中部", + "B": "到气管插管的尖端", + "C": "刚好到达隆突近端", + "D": "超过隆突" + } + }, + { + "id": "9e1d1784-9352-51d2-87be-1a467a4e3a5b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Maximizing which of the following lung parameters is the most important factor in prevention of postoperative pulmonary complications?", + "A": "Tidal volume (Vt)", + "B": "Inspiratory reserve volume", + "C": "Vital capacity", + "D": "Functional residual capacity (FRC)" + }, + "zh": { + "question": "最大化以下哪个肺参数是预防术后肺部并发症的最重要因素？", + "A": "潮气量 (Vt)", + "B": "吸气储备量", + "C": "肺活量", + "D": "功能残气量 (FRC)" + } + }, + { + "id": "b2f43a5e-f00c-54c1-9d21-b351b8caefc8", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "An 83-year-old woman is admitted to the ICU after coronary artery surgery. A pulmonary artery catheter is in place and yields the following data: central venous pressure (CVP) 5 mm Hg, cardiac output (CO) 4.0 L/min, mean arterial pressure (MAP) 90 mm Hg, mean pulmonary artery pressure (PAP) 20 mm Hg, pulmonary artery occlusion pressure (PAOP) 12 mm Hg, and heart rate 90. Calculate this patient's pulmonary vascular resistance (PVR).", + "A": "40 dyne-sec/cm5", + "B": "80 dyne-sec/cm5", + "C": "160 dyne-sec/cm5", + "D": "200 dyne-sec/cm5" + }, + "zh": { + "question": "一名83岁的女性在冠状动脉手术后被送入ICU。肺动脉导管已置入并提供以下数据：中心静脉压（CVP）5 mm Hg，心输出量（CO）4.0 L/min，平均动脉压（MAP）90 mm Hg，平均肺动脉压（PAP）20 mm Hg，肺动脉楔压（PAOP）12 mm Hg，心率90。计算该患者的肺血管阻力（PVR）。", + "A": "40 dyne-sec/cm5", + "B": "80 dyne-sec/cm5", + "C": "160 dyne-sec/cm5", + "D": "200 dyne-sec/cm5" + } + }, + { + "id": "979b648e-cea6-596b-b27a-452a2dfcc5d0", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 72-year-old man with a history of myocardial infarction 12 months earlier is scheduled to undergo elective repair of a 6-cm abdominal aortic aneurysm under general anesthesia. When would this patient be at highest risk for another myocardial infarction?", + "A": "During placement of the aortic cross-clamp", + "B": "Upon release of the aortic cross-clamp", + "C": "24 hours postoperatively", + "D": "On the third postoperative day" + }, + "zh": { + "question": "一名72岁的男性患者，12个月前有心肌梗死病史，计划在全身麻醉下进行6厘米腹主动脉瘤的择期修复手术。该患者何时发生再次心肌梗死的风险最高？", + "A": "在放置主动脉交叉夹期间", + "B": "在释放主动脉交叉夹时", + "C": "术后24小时", + "D": "术后第三天" + } + }, + { + "id": "1bd2d8ad-66ac-53c5-9440-e37cd792fea8", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Calculate the body mass index (BMI) of a man 200 cm (6 feet 6 inches) tall who weighs 100 kg (220 lb).", + "A": "20", + "B": "25", + "C": "30", + "D": "35" + }, + "zh": { + "question": "计算一名身高200厘米（6英尺6英寸）、体重100公斤（220磅）的男性的身体质量指数（BMI）。", + "A": "20", + "B": "25", + "C": "30", + "D": "35" + } + }, + { + "id": "98ec5b5d-7297-52eb-95e1-9bf484436352", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The normal FEV1 /FVC ratio is", + "A": "0.99", + "B": "0.80", + "C": "0.60", + "D": "0.50" + }, + "zh": { + "question": "正常的FEV1/FVC比率是", + "A": "0.99", + "B": "0.80", + "C": "0.60", + "D": "0.50" + } + }, + { + "id": "309e832b-1eca-5db0-806e-4232de081d1f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Direct current (DC) cardioversion is not useful and, therefore, NOT indicated in an unstable patient with which of the following?", + "A": "Supraventricular tachycardia in a patient with Wolff-- Parkinson-White syndrome", + "B": "Atrial flutter", + "C": "Multifocal atrial tachycardia (MAT)", + "D": "New-onset atrial fibrillation" + }, + "zh": { + "question": "直流电（DC）复律在以下哪种情况下对不稳定患者无用，因此不适用？", + "A": "伴有沃尔夫-帕金森-怀特综合征的室上性心动过速患者", + "B": "心房扑动", + "C": "多灶性房性心动过速（MAT）", + "D": "新发心房颤动" + } + }, + { + "id": "b192cff7-2e15-5f1d-9540-59ceec61b64b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "During the first minute of apnea, the Paco2 will rise", + "A": "2 mm Hg/min", + "B": "4 mm Hg/min", + "C": "6 mm Hg/min", + "D": "8 mm Hg/min" + }, + "zh": { + "question": "在无呼吸的第一分钟内，Paco2 将上升", + "A": "2 mm Hg/分钟", + "B": "4 mm Hg/分钟", + "C": "6 mm Hg/分钟", + "D": "8 mm Hg/分钟" + } + }, + { + "id": "bd6df80b-ec30-517e-9664-3f19cb804f25", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Potential complications associated with total parenteral nutrition (TPN) include all of the following EXCEPT", + "A": "Ketoacidosis", + "B": "Hyperglycemia", + "C": "Hypoglycemia", + "D": "Hypophosphatemia" + }, + "zh": { + "question": "与全肠外营养（TPN）相关的潜在并发症包括以下所有情况，除了", + "A": "酮症酸中毒", + "B": "高血糖", + "C": "低血糖", + "D": "低磷酸盐血症" + } + }, + { + "id": "3cb6259e-f26f-5f6c-aa51-e0b313903155", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "O2 requirement for a 70-kg adult is", + "A": "150 mL/min", + "B": "250 mL/min", + "C": "350 mL/min", + "D": "450 mL/min" + }, + "zh": { + "question": "70公斤成人的氧气需求量是", + "A": "150 毫升/分钟", + "B": "250 毫升/分钟", + "C": "350 毫升/分钟", + "D": "450 毫升/分钟" + } + }, + { + "id": "c26775bd-38ef-58c6-9d18-08ecd9dbbf60", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The FRC is composed of the", + "A": "Expiratory reserve volume and residual volume", + "B": "Inspiratory reserve volume and residual volume", + "C": "Inspiratory capacity and vital capacity", + "D": "Expiratory capacity and Vt" + }, + "zh": { + "question": "FRC由以下组成", + "A": "呼气储备量和残气量", + "B": "吸气储备量和残气量", + "C": "吸气量和肺活量", + "D": "呼气量和潮气量" + } + }, + { + "id": "4a6eae29-b6ce-53b6-b30c-aaf50fff2af7", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Which of the following statements correctly defines the relationship between minute ventilation , dead space ventilation and Paco2?", + "A": "If is constant and increases, then Paco2 will increase", + "B": "If is constant and increases, then Paco2 will decrease", + "C": "If is constant and increases, then Paco2 will increase", + "D": "If is constant and decreases, then Paco2 will decrease" + }, + "zh": { + "question": "以下哪项陈述正确地定义了分钟通气量、无效腔通气量和Paco2之间的关系？", + "A": "如果分钟通气量不变而无效腔通气量增加，则Paco2会增加", + "B": "如果分钟通气量不变而无效腔通气量增加，则Paco2会减少", + "C": "如果无效腔通气量不变而分钟通气量增加，则Paco2会增加", + "D": "如果无效腔通气量不变而分钟通气量减少，则Paco2会减少" + } + }, + { + "id": "070d7325-fdbb-56fd-b6a0-d4f10bab4a57", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 22-year-old patient who sustained a closed head injury is brought to the operating room (OR) from the ICU for placement of a dural bolt. Hemoglobin has been stable at 15 g/dL. Blood gas analysis immediately before induction reveals a Pao2 of 120 mm Hg and an arterial saturation of 100%. After induction, the Pao2 rises to 150 mm Hg and the", + "A": "It has increased by 10%", + "B": "It has increased by 5%", + "C": "It has increased by less than 1%", + "D": "Cannot be determined without Paco2" + }, + "zh": { + "question": "一名22岁的患者因闭合性头部损伤从ICU被送到手术室进行硬膜螺栓的放置。血红蛋白稳��在15 g/dL。诱导前的血气分析显示Pao2为120 mm Hg，动脉饱和度为100%。诱导后，Pao2上升到150 mm Hg并且", + "A": "增加了10%", + "B": "增加了5%", + "C": "增加了不到1%", + "D": "没有Paco2无法确定" + } + }, + { + "id": "d803828b-8002-5e3b-a6fa-e32623c07810", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Inhalation of CO2 increases by", + "A": "0.5 L/min/mm Hg increase in Paco2", + "B": "1 to 1.5 L/min/mm Hg increase in Paco2", + "C": "2 to 2.5 L/min/mm Hg increase in Paco2", + "D": "Greater than 3 L/min/mm Hg increase in Paco2" + }, + "zh": { + "question": "吸入CO2的增加量为", + "A": "Paco2每增加1 mm Hg，增加0.5 L/min", + "B": "Paco2每增加1 mm Hg，增加1到1.5 L/min", + "C": "Paco2每增加1 mm Hg，增加2到2.5 L/min", + "D": "Paco2每增加1 mm Hg，增加超过3 L/min" + } + }, + { + "id": "9ebfcb99-8099-540a-905f-d42f211fece9", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The RIFLE criteria are designed to predict mortality from", + "A": "Renal failure", + "B": "Sepsis", + "C": "Hepatic failure", + "D": "Acute respiratory distress syndrome" + }, + "zh": { + "question": "RIFLE标准旨在预测哪种情况的死亡率", + "A": "肾衰竭", + "B": "败血症", + "C": "肝衰竭", + "D": "急性呼吸窘迫综合征" + } + }, + { + "id": "974e448e-cb4f-5880-b12a-34951a0cde64", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "In the diagram above, curve \"D\" represents", + "A": "Emphysema", + "B": "Chronic bronchitis", + "C": "Normal lungs", + "D": "Fibrotic lungs" + }, + "zh": { + "question": "在上图中，曲线“D”代表", + "A": "肺气肿", + "B": "慢性支气管炎", + "C": "正常肺", + "D": "纤维化肺" + } + }, + { + "id": "4befeb4f-1add-587f-80f8-0499abb4f9ce", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The P50 for normal adult hemoglobin is approximately", + "A": "15 mm Hg", + "B": "25 mm Hg", + "C": "35 mm Hg", + "D": "45 mm Hg" + }, + "zh": { + "question": "正常成人血红蛋白的P50大约是", + "A": "15 mm Hg", + "B": "25 mm Hg", + "C": "35 mm Hg", + "D": "45 mm Hg" + } + }, + { + "id": "d2eb695c-b0bb-5302-872a-5e3e6a3bc5f1", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "During a normal VT (500-mL) breath, the transpulmonary pressure increases from 0 to 5 cm H2O. The product of transpulmonary pressure and Vt is 2500 cm H2O-mL. This expression of the pressure-volume relationship during breathing determines what parameter of respiratory mechanics?", + "A": "Lung compliance", + "B": "Airway resistance", + "C": "Pulmonary elastance", + "D": "Work of breathing" + }, + "zh": { + "question": "在一次正常的潮气量（500毫升）呼吸过程中，跨肺压从0增加到5厘米水柱。跨肺压与潮气量的乘积为2500厘米水柱-毫升。这种在呼吸过程中压力-体积关系的表达决定了呼吸力学的哪个参数？", + "A": "肺顺应性", + "B": "气道阻力", + "C": "肺弹性", + "D": "呼吸功" + } + }, + { + "id": "09df25d3-f2f6-512a-965d-a59486d48b32", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Select the true statement regarding palliative care", + "A": "It increases in-hospital cost", + "B": "It is reserved for patients with life expectancy less than 6 months", + "C": "It is not appropriate for patients in the ICU", + "D": "It can be used in conjunction with \"aggressive\" care" + }, + "zh": { + "question": "选择关于姑息治疗的正确陈述", + "A": "它增加住院费用", + "B": "它仅适用于预期寿命少于6个月的患者", + "C": "它不适用于ICU患者", + "D": "它可以与“积极”治疗同时使用" + } + }, + { + "id": "0e241120-54c7-54a0-a56d-8fe3f69261b8", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The normal vital capacity for a 70-kg man is", + "A": "1 L", + "B": "2 L", + "C": "5 L", + "D": "7 L" + }, + "zh": { + "question": "一个70公斤男性的正常肺活量是", + "A": "1升", + "B": "2升", + "C": "5升", + "D": "7升" + } + }, + { + "id": "1cc2af1d-5d1f-582b-a90e-f89054af083b", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 32-year-old man is found unconscious by the fire department in a room where he has inhaled 0.1% carbon monoxide for a prolonged period. His respiratory rate is 42 breaths/min, but he is not cyanotic. Carbon monoxide has increased this patient's minute ventilation by which of the following mechanisms?", + "A": "Shifting the O2 hemoglobin dissociation curve to the left", + "B": "Increasing CO2 production", + "C": "Causing lactic acidosis", + "D": "Decreasing Pao2" + }, + "zh": { + "question": "一名32岁的男子被消防部门发现昏迷在一个吸入了0.1%一氧化碳的房间里，时间较长。他的呼吸频率为42次/分钟，但没有发绀。一氧化碳通过以下哪种机制增加了该患者的分钟通气量？", + "A": "使氧合血红蛋白解离曲线左移", + "B": "增加二氧化碳的产生", + "C": "引起乳酸性酸中毒", + "D": "降低动脉氧分压（Pao2）" + } + }, + { + "id": "b1fafbe6-7816-53c6-97fb-16723829be61", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "An acute increase in Paco2 of 10 mm Hg will result in a decrease in pH", + "A": "0.01 pH unit", + "B": "0.02 pH unit", + "C": "0.04 pH unit", + "D": "0.08 pH unit" + }, + "zh": { + "question": "Paco2急性增加10 mm Hg将导致pH值下降", + "A": "0.01 pH单位", + "B": "0.02 pH单位", + "C": "0.04 pH单位", + "D": "0.08 pH单位" + } + }, + { + "id": "5c30d07a-21b4-598e-b39e-a6105b52cb0e", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 22-year-old college student with a history of complex regional pain syndrome (CRPS) in the left foot and ankle after a football injury is anesthetized for laparoscopic cholecystectomy. He reports allergy to penicillin and is treated for chronic pain with paroxetine (Paxil) and gabapentin (Neurontin) and indomethacin prn. He received fentanyl as the primary narcotic during his operation to facilitate early discharge. In the PACU he is shivering and has BP 183/98 mm Hg with pulse 121. He receives 15 mg meperidine; shivering persists. He reports minimal 3/10 pain. The best option at this juncture would be", + "A": "Repeat meperidine", + "B": "Labetalol", + "C": "Lorazepam (Ativan)", + "D": "Dantrolene" + }, + "zh": { + "question": "一名22岁的大学生在足球受伤后左脚和脚踝出现复杂性区域疼痛综合征（CRPS），现接受腹腔镜胆囊切除术的麻醉。他报告对青霉素过敏，并用帕罗西汀（Paxil）、加巴喷丁（Neurontin）和吲哚美辛按需治疗慢性疼痛。在手术中，他主要使用芬太尼作为麻醉药物以便于早期出院。在PACU中，他出现寒战，血压183/98 mm Hg，脉搏121。他接受了15 mg的哌替啶，但寒战仍然存在。他报告疼痛为3/10。此时最佳的选择是", + "A": "重复使用哌替啶", + "B": "拉贝洛尔", + "C": "劳拉西泮（阿普唑仑）", + "D": "丹曲林" + } + }, + { + "id": "7e32c495-30ae-5090-b07e-81a16d2baceb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The following blood gases would best be explained by which disorder?", + "A": "Aspirin overdose", + "B": "Nasogastric suction", + "C": "Chloride wasting diarrhea", + "D": "Hyperaldosteronism" + }, + "zh": { + "question": "以下血气最能由哪种疾病解释？", + "A": "阿司匹林过量", + "B": "鼻胃管抽吸", + "C": "氯丢失性腹泻", + "D": "醛固酮增多症" + } + }, + { + "id": "bdca201e-7bde-5c8d-97a3-72793e7465bc", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 78-year-old man with a 125-pack-year smoking history is brought to", + "A": "Bag mask or laryngeal mask airway until help arrives", + "B": "Attempt to intubate with GlideScope or direct laryngoscopy", + "C": "Oral or nasal fiberoptic intubation", + "D": "Remove tracheostomy tube and intubate laryngectomy stoma with an endotracheal tube" + }, + "zh": { + "question": "一名有125包年吸烟史的78岁男性被送到", + "A": "使用面罩或喉罩通气，直到援助到达", + "B": "尝试使用GlideScope或直接喉镜插管", + "C": "口腔或鼻腔纤维支气管镜插管", + "D": "移除气管造口管并用气管导管插入喉切开造口" + } + }, + { + "id": "e57d257a-c2c6-5f76-b625-234e52d8c372", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The P50 of sickle cell hemoglobin is", + "A": "19 mm Hg", + "B": "26 mm Hg", + "C": "31 mm Hg", + "D": "35 mm Hg" + }, + "zh": { + "question": "镰状细胞血红蛋白的P50是", + "A": "19 mm Hg", + "B": "26 mm Hg", + "C": "31 mm Hg", + "D": "35 mm Hg" + } + }, + { + "id": "59968382-870a-59cc-b839-f9523513bef7", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Data from the ARDS network trial (ARDSNet) showed increased mortality from", + "A": "Atelectrauma", + "B": "Volutrauma", + "C": "Barotrauma", + "D": "Inhaled nitric oxide" + }, + "zh": { + "question": "ARDS网络试验（ARDSNet）的数据显示，以下哪种情况导致死亡率增加", + "A": "肺不张损伤", + "B": "容量损伤", + "C": "压力损伤", + "D": "吸入一氧化氮" + } + }, + { + "id": "67622d0b-8bb9-5f8a-b473-12539956cbdc", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following is decreased in elderly patients compared with their younger counterparts EXCEPT", + "A": "Closing volume", + "B": "FEV1", + "C": "Ventilatory response to hypercarbia", + "D": "Vital capacity" + }, + "zh": { + "question": "与年轻患者相比，老年患者中以下哪项没有减少", + "A": "闭合容积", + "B": "FEV1", + "C": "对高碳酸血症的通气反应", + "D": "肺活量" + } + }, + { + "id": "cf86b44a-8028-51be-bd21-31c872e9e67b", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Calculate the VD/Vt ratio (physiologic dead space ventilation) based on the following data: Paco2 45 mm Hg, mixed expired CO2 tension (PEco2 ) 30 mm Hg.", + "A": "0.1", + "B": "0.2", + "C": "0.3", + "D": "0.4" + }, + "zh": { + "question": "根据以下数据计算VD/Vt比率（生理死腔通气）：Paco2 45 mm Hg，混合呼气末二氧化碳张力（PEco2）30 mm Hg。", + "A": "0.1", + "B": "0.2", + "C": "0.3", + "D": "0.4" + } + }, + { + "id": "a3b4276d-1233-5bf0-af29-74e04f749f31", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements concerning the distribution of O2 and CO2 in the upright lungs is TRUE?", + "A": "Pao2 is greater at the apex than at the base", + "B": "Paco2 is greater at the apex than at the base", + "C": "Both Pao2 and Paco2 are greater at the apex than at the base", + "D": "Both Pao2 and Paco2 are greater at the base than at the apex" + }, + "zh": { + "question": "关于直立状态下肺内氧气和二氧化碳分布的下列说法中，哪一项是正确的？", + "A": "Pao2 在肺尖比在肺底更高", + "B": "Paco2 在肺尖比在肺底更高", + "C": "Pao2 和 Paco2 在肺尖都比在肺底更高", + "D": "Pao2 和 Paco2 在肺底都比在肺尖更高" + } + }, + { + "id": "a74f611d-4941-5328-9ede-4749a9cb4f7f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following acid-base disturbances is the least wellcompensated?", + "A": "Metabolic alkalosis", + "B": "Respiratory alkalosis", + "C": "Increased anion gap metabolic acidosis", + "D": "Normal anion gap metabolic acidosis" + }, + "zh": { + "question": "以下哪种酸碱失衡的代偿能力最差？", + "A": "代谢性碱中毒", + "B": "呼吸性碱中毒", + "C": "增高阴离子间隙代谢性酸中毒", + "D": "正常阴离子间隙代谢性酸中毒" + } + }, + { + "id": "73991c40-130d-5b1b-a16b-a3d5605a3a3a", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "What is the (calculated) Pao2 of a patient on room air in Denver,", + "A": "80 mm Hg", + "B": "90 mm Hg", + "C": "100 mm Hg", + "D": "110 mm Hg" + }, + "zh": { + "question": "在丹佛，吸入室内空气的患者的（计算）Pao2是多少？", + "A": "80 mm Hg", + "B": "90 mm Hg", + "C": "100 mm Hg", + "D": "110 mm Hg" + } + }, + { + "id": "fe2e571c-8ecf-5462-85e0-6ea7a21573e2", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A venous blood sample from which of the following sites would correlate most reliably with Pao2 and Paco2?", + "A": "Jugular vein", + "B": "Subclavian vein", + "C": "Antecubital vein", + "D": "Vein on posterior surface of a warmed hand" + }, + "zh": { + "question": "以下哪个部位的静脉血样本与Pao2和Paco2的相关性最可靠？", + "A": "颈静脉", + "B": "锁骨下静脉", + "C": "肘前静脉", + "D": "温暖手背的静脉" + } + }, + { + "id": "9a2610e3-bd5c-5987-8017-27ddcc4ff0dc", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following pulmonary function tests is LEAST dependent on patient effort?", + "A": "Forced expiratory volume in 1 second (FEV1 )", + "B": "Forced vital capacity (FVC)", + "C": "FEF 800 to 1200", + "D": "FEF 25% to 75%" + }, + "zh": { + "question": "以下哪项肺功能测试最不依赖于患者的努力程度？", + "A": "第1秒用力呼气量 (FEV1)", + "B": "用力肺活量 (FVC)", + "C": "FEF 800到1200", + "D": "FEF 25%到75%" + } + }, + { + "id": "818be8a4-f52a-5a9a-8336-97cde7481eb6", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 33-year-old woman with 20% carboxyhemoglobin is brought to the ER for treatment of smoke inhalation. Which of the following is", + "A": "Cyanosis", + "B": "Pao2 105 mm Hg, oxygen saturation 80% on initial room air arterial blood gases (ABGs)", + "C": "98% oxygen saturation on dual-wavelength pulse oximeter", + "D": "Oxyhemoglobin dissociation curve shifted far to the left" + }, + "zh": { + "question": "一名33岁的女性，碳氧血红蛋白为20%，因吸入烟雾被送到急诊室治疗。以下哪项是", + "A": "紫绀", + "B": "初始室内空气动脉血气（ABGs）显示Pao2 105 mm Hg，氧饱和度80%", + "C": "双波长脉搏血氧仪显示氧饱和度98%", + "D": "氧合血红蛋白解离曲线明显左移" + } + }, + { + "id": "480137ab-9218-5ac4-bb9f-64e1b200fe8b", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "The PAO2 − PaO2 of a patient breathing 100% O2 is 240 mm Hg. The", + "A": "5%", + "B": "12%", + "C": "17%", + "D": "20%" + }, + "zh": { + "question": "一名患者在吸入100%氧气时的PAO2 − PaO2为240 mm Hg。", + "A": "5%", + "B": "12%", + "C": "17%", + "D": "20%" + } + }, + { + "id": "ea5996f3-0796-599b-8dd8-5ed56b0a3bcc", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Each of the following will alter the position or slope of the CO2 ventilatory response curve EXCEPT", + "A": "Hypoxemia", + "B": "Fentanyl", + "C": "N2O", + "D": "Ketamine" + }, + "zh": { + "question": "下列各项中，除了哪一项都会改变CO2通气反应曲线的位置或斜率", + "A": "低氧血症", + "B": "芬太尼", + "C": "N2O", + "D": "氯胺酮" + } + }, + { + "id": "8f9239dd-e336-5c6c-a005-342a0b3dcaa0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning the distribution of alveolar ventilation ( ) in the upright lungs is TRUE?", + "A": "The distribution of is not affected by body posture", + "B": "Alveoli at the apex of the lungs (nondependent alveoli) are better ventilated than those at the base", + "C": "All areas of the lungs are ventilated equally", + "D": "Alveoli at the base of the lungs (dependent alveoli) are better ventilated than those at the apex" + }, + "zh": { + "question": "关于直立状态下肺泡通气分布的下列说法中，哪一项是正确的？", + "A": "通气分布不受身体姿势的影响", + "B": "肺尖（非���赖性肺泡）的肺泡比肺底的通气更好", + "C": "肺的所有区域通气均等", + "D": "肺底（依赖性肺泡）的肺泡比肺尖的通气更好" + } + }, + { + "id": "eb3ff5a1-8f51-5950-ad53-195b41ad00d8", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In the resting adult, what percentage of total body O2 consumption is due to the work of breathing?", + "A": "2%", + "B": "5%", + "C": "10%", + "D": "20%" + }, + "zh": { + "question": "在静息状态下的成年人中，呼吸工作占总身体氧气消耗的百分比是多少？", + "A": "2%", + "B": "5%", + "C": "10%", + "D": "20%" + } + }, + { + "id": "f0c5e319-f794-5d5b-a651-85c33ebf6a76", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The anatomic dead space in a 70-kg man is", + "A": "50 mL", + "B": "150 mL", + "C": "250 mL", + "D": "500 mL" + }, + "zh": { + "question": "70公斤男性的解剖死腔是", + "A": "50毫升", + "B": "150毫升", + "C": "250毫升", + "D": "500毫升" + } + }, + { + "id": "ff140226-eade-5b6d-96f9-61cd791deaf1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The most important buffering system in the body is", + "A": "Hemoglobin", + "B": "Plasma proteins", + "C": "Phosphate", + "D": "[HCO3 − ]" + }, + "zh": { + "question": "人体内最重要的缓冲系统是", + "A": "血红蛋白", + "B": "血浆蛋白", + "C": "磷酸盐", + "D": "[HCO3 − ]" + } + }, + { + "id": "a25e278d-0191-5802-a393-e3757e047c37", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A decrease in pH of 0.1 unit will result in", + "A": "A decrease in serum potassium concentration [K+ ] of 0.1 mEq/L", + "B": "A decrease in [K+ ] of 1.0 mEq/L", + "C": "An increase in [K+ ] of 1.0 mEq/L", + "D": "An increase in [K+ ] of 2.0 mEq/L" + }, + "zh": { + "question": "pH值下降0.1单位将导致", + "A": "血清钾浓度[K+]下降0.1 mEq/L", + "B": "[K+]下降1.0 mEq/L", + "C": "[K+]增加1.0 mEq/L", + "D": "[K+]增加2.0 mEq/L" + } + }, + { + "id": "5ba6e88b-d66e-5504-8865-e562a6cf0174", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 45-year-old man is rescued from a house fire and brought to the ER. He is noted to have major burns involving 45% of his body, with singed skin on the forehead and tip of his nose and painful burned hands. His", + "A": "Fluids to preserve renal function", + "B": "Beta blockade and analgesics", + "C": "Oxygen therapy with humidification", + "D": "Securing the airway" + }, + "zh": { + "question": "一名45岁的男子从火灾中被救出并送到急诊室。他被发现有45%的身体严重烧伤，前额和鼻尖的皮肤被烧焦，双手烧伤疼痛。他的", + "A": "输液以维持肾功能", + "B": "β受体阻滞剂和镇痛药", + "C": "加湿氧疗", + "D": "确保气道通畅" + } + }, + { + "id": "3f55f994-979a-589f-824a-1a3f258bbfb5", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 28-year-old, 70-kg woman with ulcerative colitis is receiving a general anesthetic for a colon resection and ileostomy. The patient's lungs are mechanically ventilated with the following parameters: 5000 mL and respiratory rate 10 breaths/min. Assuming no change in , how would change if the respiratory rate were increased from 10 to 20 breaths/min?", + "A": "Increase by 500 mL", + "B": "Increase by 1000 mL", + "C": "Decrease by 750 mL", + "D": "Decrease by 1500 mL" + }, + "zh": { + "question": "一名28岁、70公斤的女性患有溃疡性结肠炎，正在接受结肠切除术和回肠造口术的全身麻醉。患者的肺部通过机械通气，参数如下：5000毫升和呼吸频率10次/分钟。在假设没有变化的情况下，如果呼吸频率从10次/分钟增加到20次/分钟，会如何变化？", + "A": "增加500毫升", + "B": "增加1000毫升", + "C": "减少750毫升", + "D": "减少1500毫升" + } + }, + { + "id": "1a469abe-2e52-540a-9fc0-62cccc8cd03a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following will shift the oxyhemoglobin dissociation curve to the right EXCEPT", + "A": "Volatile anesthetics", + "B": "Decreased Pao2", + "C": "Decreased pH", + "D": "Increased temperature" + }, + "zh": { + "question": "下列每一项都会使氧合血红蛋白解离曲线右移，除了", + "A": "挥发性麻醉剂", + "B": "动脉氧分压降低", + "C": "pH值降低", + "D": "温度升高" + } + }, + { + "id": "b49305e4-8648-5a66-a1a9-9f4d1690c7fd", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The half-life of carboxyhemoglobin in a patient breathing 100% O2 is", + "A": "5 minutes", + "B": "1 hour", + "C": "2 hours", + "D": "4 hours" + }, + "zh": { + "question": "在吸入100%氧气的患者中，一氧化碳血红蛋白的半衰期是", + "A": "5分钟", + "B": "1小时", + "C": "2小时", + "D": "4小时" + } + }, + { + "id": "a9184a94-a376-5cdb-abf1-a605a2c2c6b3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A disadvantage of using propofol for prolonged sedation (days) of intubated patients in the ICU is potential", + "A": "Alkalosis", + "B": "Hypokalemia", + "C": "Hypolipidemia", + "D": "Bradycardia" + }, + "zh": { + "question": "在ICU中对插管患者进行长时间（数天）镇静时使用丙泊酚的一个缺点是可能导致", + "A": "碱中毒", + "B": "低钾血症", + "C": "低脂血症", + "D": "心动过缓" + } + }, + { + "id": "73c1a04b-8b0a-5467-a7c7-fee46402fc91", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 17-year-old type 1 diabetic with history of renal failure is in the preoperative holding area awaiting an operation for acute appendicitis.", + "A": "Renal tubular acidosis", + "B": "Lactic acidosis", + "C": "Diabetic ketoacidosis", + "D": "Aspirin overdose" + }, + "zh": { + "question": "一名17岁的1型糖尿病患者有肾功能衰竭病史，目前在术前等待区等待急性阑尾炎手术。", + "A": "肾小管性酸中毒", + "B": "乳酸性酸中毒", + "C": "糖尿病酮症酸中毒", + "D": "阿司匹林过量" + } + }, + { + "id": "087b9e50-1b86-5144-96b5-165b3552fac4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Methods to decrease the incidence of central venous catheter infections include all of the following EXCEPT", + "A": "Changing the central catheter every 3 to 4 days over a guidewire", + "B": "Using minocycline/rifampin impregnated catheters over chlorhexidine/silver sulfadiazine impregnated catheters for suspected long-term use", + "C": "Using the subclavian over the internal jugular route for access", + "D": "Using a single lumen over a multilumen catheter" + }, + "zh": { + "question": "以下哪项不是减少中心静脉导管感染发生率的方法", + "A": "每3到4天通过导丝更换中心导管", + "B": "在怀疑长期使用时，使用米诺环素/利福平浸渍导管而不是氯己定/磺胺嘧啶银浸渍导管", + "C": "选择锁骨下静脉而不是颈内静脉途径进行置管", + "D": "使用单腔导管而不是多腔导管" + } + }, + { + "id": "7f582ea5-1c74-5ece-9e30-ee9bda21dad2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Signs of Sarin nerve gas poisoning include all of the following EXCEPT", + "A": "Diarrhea", + "B": "Urination", + "C": "Mydriasis", + "D": "Lacrimation" + }, + "zh": { + "question": "沙林神经毒气中毒的症状包括以下所有症状，除了", + "A": "腹泻", + "B": "排尿", + "C": "瞳孔散大", + "D": "流泪" + } + }, + { + "id": "cf20ecb9-622c-5916-97aa-15c18aba13c1", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Which of the following conditions would be associated with the LEAST risk of venous air embolism during removal of a central line?", + "A": "Spontaneous breathing, head up", + "B": "Spontaneous breathing, flat", + "C": "Spontaneous breathing, Trendelenburg", + "D": "Mechanical ventilation, Trendelenburg" + }, + "zh": { + "question": "以下哪种情况在拔除中心静脉导管时与静脉空气栓塞的风险最小相关？", + "A": "自主呼吸，头高位", + "B": "自主呼吸，平卧位", + "C": "自主呼吸，特伦德伦堡位", + "D": "机械通气，特伦德伦堡位" + } + }, + { + "id": "e6752ed6-4511-5d32-a8f5-4e6a9191ed7f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following adverse effects is NOT attributable to", + "A": "Increased intracranial pressure", + "B": "Peripheral vasoconstriction", + "C": "Increased pulmonary vascular resistance", + "D": "Increased serum potassium concentration" + }, + "zh": { + "question": "以下哪种不良反应不归因于", + "A": "颅内压增高", + "B": "外周血管收缩", + "C": "肺血管阻力增加", + "D": "血清钾浓度升高" + } + }, + { + "id": "77404f82-a065-5b63-ba7c-63d51e173c8f", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following maneuvers is LEAST likely to raise arterial", + "A": "Inflating the pulmonary artery catheter balloon (in the left pulmonary artery)", + "B": "Raising hemoglobin from 8 to 12 mg/dL", + "C": "Raising Fio2 from 0.8 to 1.0", + "D": "Increasing cardiac output from 2 to 5 L/min" + }, + "zh": { + "question": "以下哪种操作最不可能提高动脉压？", + "A": "充气肺动脉导管气囊（在左肺动脉中）", + "B": "将血红蛋白从8 mg/dL提高到12 mg/dL", + "C": "将吸入氧浓度从0.8提高到1.0", + "D": "将心输出量从2 L/min提高到5 L/min" + } + }, + { + "id": "ca9de464-9ab3-5915-8d55-8cf3ab823b32", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 100-kg man is 24 hours status post four-vessel coronary artery bypass graft. Which of the following pulmonary parameters would be compatible with successful extubation in this patient?", + "A": "Vital capacity 2.5 L", + "B": "Paco2 44 mm Hg", + "C": "Maximum inspiratory pressure −38 cm H2O", + "D": "All of the above" + }, + "zh": { + "question": "一名100公斤的男性在四支冠状动脉搭桥术后24小时。以下哪项肺功能参数与该患者成功拔管相符？", + "A": "肺活量2.5升", + "B": "动脉二氧化碳分压44毫米汞柱", + "C": "最大吸气压−38厘米水柱", + "D": "以上全部" + } + }, + { + "id": "d393608a-a667-5bd0-b2e0-ae915bf34091", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following can cause a rightward shift of the oxyhemoglobin dissociation curve?", + "A": "Methemoglobinemia", + "B": "Carboxyhemoglobinemia", + "C": "Hypothermia", + "D": "Pregnancy" + }, + "zh": { + "question": "下列哪项可以导致氧合血红蛋白解离曲线右移？", + "A": "高铁血红蛋白血症", + "B": "碳氧血红蛋白血症", + "C": "低体温", + "D": "妊娠" + } + }, + { + "id": "8b6346a8-c6b1-56a1-8ebd-675e4c97bad3", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 24-year-old man is brought to the operating room 1 hour after a motor vehicle accident. He has C7 spinal cord transection and ruptured spleen. Regarding his neurologic injury, anesthetic concerns include", + "A": "Risk of hyperkalemia with succinylcholine administration", + "B": "Risk of autonomic hyper-reflexia with urinary catheter insertion", + "C": "Increased risk of hypothermia", + "D": "All of the above" + }, + "zh": { + "question": "一名24岁的男性在车祸后1小时被送入手术室。他有C7脊髓横断和脾脏破裂。关于他的神经损伤，麻醉方面的关注包括", + "A": "使用琥珀胆碱可能导致高钾血症的风险", + "B": "插入导尿管可能导致自主神经反射亢进的风险", + "C": "低体温风险增加", + "D": "以上所有" + } + }, + { + "id": "550f13a0-1b53-5b70-a5d5-b5b648a8a985", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "After sustaining traumatic brain injury, a 37-year-old patient in the ICU develops polyuria and a plasma sodium concentration of 159 mEq/L. What pathologic condition is associated with these clinical findings?", + "A": "Syndrome of inappropriate antidiuretic hormone (SIADH)", + "B": "Diabetes mellitus", + "C": "Diabetes insipidus", + "D": "Cerebral salt wasting syndrome" + }, + "zh": { + "question": "在遭受创伤性脑损伤后，一名37岁的ICU患者出现多尿和血浆钠浓度为159 mEq/L。与这些临床发现相关的病理状况是什么？", + "A": "抗利尿激素分泌不当综合征 (SIADH)", + "B": "糖尿病", + "C": "尿崩症", + "D": "脑性盐耗损综合征" + } + }, + { + "id": "d391c658-2f6e-568e-9ac5-4a3ca8fa3bfe", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Which of the following drugs is the best choice for treating hypotension in the setting of severe acidemia?", + "A": "Norepinephrine", + "B": "Epinephrine", + "C": "Phenylephrine", + "D": "Vasopressin" + }, + "zh": { + "question": "在严重酸中毒的情况下，以下哪种药物是治疗低血压的最佳选择？", + "A": "去甲肾上腺素", + "B": "肾上腺素", + "C": "苯肾上腺素", + "D": "加压素" + } + }, + { + "id": "2021ac00-6e64-50ed-bbb9-d81626a4c24b", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "The end-tidal CO2 measured by an infrared spectrometer is 35 mm Hg.", + "A": "Morbid obesity", + "B": "Pulmonary embolism", + "C": "Intrapulmonary shunt", + "D": "Chronic obstructive pulmonary disease (COPD)" + }, + "zh": { + "question": "通过红外光谱仪测量的呼气末二氧化碳为35 mm Hg。", + "A": "病态肥胖", + "B": "肺栓塞", + "C": "肺内分流", + "D": "慢性阻塞性肺疾病 (COPD)" + } + }, + { + "id": "20fb5600-daf4-5ef6-a23e-69dc7ee1781f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A transfusion-related, acute lung injury (TRALI) reaction is suspected in a 48-year-old man in the ICU after a 10-hour operation for scoliosis during which multiple units of blood and factors were administered. Which of the following items is inconsistent with the diagnosis of a TRALI reaction?", + "A": "Fever", + "B": "Alveolar-to-arterial (A–a) oxygen gradient of 25 mm Hg", + "C": "Acute rise in neutrophil count after onset of symptoms", + "D": "Bilateral pulmonary infiltrates" + }, + "zh": { + "question": "在ICU中，一名48岁男性在进行10小时的脊柱侧弯手术后，怀疑发生了输血相关的急性肺损伤（TRALI）反应。在手术过程中，输注了多单位的血液和凝血因子。以下哪一项与TRALI反应的诊断不一致？", + "A": "发热", + "B": "肺泡-动脉（A–a）氧梯度为25 mm Hg", + "C": "症状出现后中性粒细胞计数急剧上升", + "D": "双侧肺浸润" + } + }, + { + "id": "501f9e11-a187-5dd4-bf96-8c8bf332a60e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "If a central line located in the superior vena cava (SVC) is withdrawn such that the tip of the catheter is just proximal to the SVC, it would be located in which vessel?", + "A": "Subclavian vein", + "B": "Brachiocephalic vein", + "C": "Cephalic vein", + "D": "Internal jugular vein" + }, + "zh": { + "question": "如果位于上腔静脉（SVC）的中心静脉导管被撤回，使得导管尖端刚好位于SVC的近端，它将位于哪个血管中？", + "A": "锁骨下静脉", + "B": "头臂静脉", + "C": "头静脉", + "D": "颈内静脉" + } + }, + { + "id": "e7aeff23-c401-524f-8059-000e8d985efe", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The time course of anticoagulation therapy is variable after different percutaneous coronary interventions (PCIs). Arrange the interventions in order, starting with the one requiring the shortest course of aspirin and clopidogrel (Plavix) therapy to the one requiring the longest course.", + "A": "Bare-metal stent, percutaneous transluminal coronaryangioplasty (PTCA), drug-eluting stent", + "B": "Drug-eluting stent, bare-metal stent, PTCA", + "C": "PTCA, drug-eluting stent, bare-metal stent", + "D": "PTCA, bare-metal stent, drug-eluting stent" + }, + "zh": { + "question": "不同经皮冠状动脉介入治疗（PCI）后的抗凝治疗时间是不同的。请按顺序排列这些介���治疗，从需要最短阿司匹林和氯吡格雷（Plavix）治疗时间的开始，到需要最长治疗时间的结束。", + "A": "裸金属支架，经皮腔内冠状动脉成形术（PTCA），药物洗脱支架", + "B": "药物洗脱支架，裸金属支架，PTCA", + "C": "PTCA，药物洗脱支架，裸金属支架", + "D": "PTCA，裸金属支架，药物洗脱支架" + } + }, + { + "id": "9d79f4d1-5769-54e8-87b8-3d42615c34fa", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 75-year-old patient in the ICU is intubated and ventilated on AC 12, Vt 500, and \"some\" PEEP. In a 60-second period, he initiates two spontaneous breaths. The peak airway pressure alarm has not sounded. His minute ventilation would be", + "A": "Incalculable without knowledge of PEEP value", + "B": "Incalculable without knowing dead space", + "C": "Incalculable without knowing magnitude of the two spontaneous breaths", + "D": "Seven liters" + }, + "zh": { + "question": "ICU中的一名75岁患者已插管并在AC 12、Vt 500和某些PEEP下通气。在60秒内，他自主呼吸了两次。峰值气道压力警报未响起。他的每分钟通气量将是", + "A": "在不知道PEEP值的情况下无法计算", + "B": "在不知道死腔的情况下无法计算", + "C": "在不知道两次自主呼吸的大小的情况下无法计算", + "D": "七升" + } + }, + { + "id": "62284627-0f88-570e-8961-1a7bc51b3003", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the features below is suggestive of weaponized anthrax exposure as opposed to a common flu-like viral illness?", + "A": "Widened mediastinum", + "B": "Fever, chills, myalgia", + "C": "Severe cough", + "D": "Pharyngitis" + }, + "zh": { + "question": "以下哪一项特征提示暴露于武器化炭疽而非普通流感样病毒性疾病？", + "A": "纵隔增宽", + "B": "发热、寒战、肌痛", + "C": "严重咳嗽", + "D": "咽炎" + } + }, + { + "id": "a9509a79-a0fd-541f-8fdc-31771f4fac22", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following factors could not explain a Pao2 of 48 mm Hg in a patient breathing a mixture of nitrous oxide and oxygen?", + "A": "Hypoxic gas mixture", + "B": "Eisenmenger syndrome", + "C": "Profound anemia", + "D": "Hypercarbia" + }, + "zh": { + "question": "下列哪项因素不能解释患者吸入一氧化二氮和氧气混合物时Pao2为48 mm Hg？", + "A": "低氧气体混合物", + "B": "艾森门格综合征", + "C": "严重贫血", + "D": "高碳酸血症" + } + }, + { + "id": "ba9aa064-d0e4-54e4-a3e9-414300df8fba", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "During a left hepatectomy under general isoflurane anesthesia, arterial blood gases are: O2 138, CO2 39, pH 7.38, saturation 99%. At the same time, CO2 on infrared spectrometer is 26 mm Hg. The most plausible explanation for the difference between CO2 measured with infrared spectrometer versus arterial blood gas gradient is", + "A": "Mainstem intubation", + "B": "Atelectasis", + "C": "Shunting through thebesian veins", + "D": "Hypovolemia" + }, + "zh": { + "question": "在全身异氟醚麻醉下进行左肝切除术时，动脉血气为：O2 138，CO2 39，pH 7.38，饱和度99%。同时，红外光谱仪测得的CO2为26 mm Hg。红外光谱仪测得的CO2与动脉血气梯度之间差异的最合理解释是", + "A": "主支气管插管", + "B": "肺不张", + "C": "通过心脏小静脉的分流", + "D": "低血容量" + } + }, + { + "id": "89d1ed5e-e976-5688-87c3-75606aaa37e1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Under which set of circumstances would energy expenditure per day be the greatest?", + "A": "Sepsis with fever", + "B": "60% burn", + "C": "Multiple fractures", + "D": "1 hour status post liver transplantation" + }, + "zh": { + "question": "在以下哪种情况下，每日能量消耗最大？", + "A": "败血症伴发热", + "B": "60%烧伤", + "C": "多处骨折", + "D": "肝移植术后1小时" + } + }, + { + "id": "e79bf1e3-3bfa-59f4-a4ff-5ac07e7ebf76", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Select the FALSE statement regarding amiodarone (Cordarone).", + "A": "It is shown to decrease mortality after myocardial infarction", + "B": "It is indicated for ventricular tachycardia and fibrillation refractory to electrical defibrillation", + "C": "Adverse effects include pulmonary fibrosis and thyroid dysfunction", + "D": "It is useful in treatment of torsades de pointes" + }, + "zh": { + "question": "选择关于胺碘酮（Cordarone）的错误陈述。", + "A": "已显示可降低心肌梗死后的死亡率", + "B": "适用于对电除颤无反应的室性心动过速和心室颤动", + "C": "不良反应包括肺纤维化和甲状腺功能障碍", + "D": "在治疗尖端扭转型室速中有用" + } + }, + { + "id": "692ba259-61a8-51ac-adb2-d2177b502d46", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A 58-year-old woman is awaiting orthotopic liver transplantation for primary biliary cirrhosis in the ICU. An oximetric pulmonary artery catheter is placed, and an Svo2 of 90% is measured. Which of the following blood pressure interventions is the LEAST appropriate for treatment of hypotension in this patient?", + "A": "Milrinone", + "B": "Norepinephrine", + "C": "Vasopressin", + "D": "Phenylephrine" + }, + "zh": { + "question": "一名58岁的女性因原发性胆汁性肝硬化在ICU等待原位肝移植。放置了一个氧饱和度肺动脉导管，测得Svo2为90%。以下哪种血压干预措施对该患者的低血压治疗最不合适？", + "A": "米力农", + "B": "去甲肾上腺素", + "C": "加压素", + "D": "苯肾上腺素" + } + }, + { + "id": "ce5d4ef9-0c46-58a4-ac27-a72eafc08af7", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 73-year-old patient is on a ventilator after an MVA. Rate is set at AC 16, Vt 450 with 5 cm H2O PEEP. The respiratory therapist notes that the measured PEEP is greater than 15 cm H2O and that the patient is not breathing above the set rate. Which option below is most reasonable for reducing the measured PEEP?", + "A": "Increase the respiratory rate", + "B": "Increase inspiratory flow rate", + "C": "Reverse the I to E ratio", + "D": "Paralyze the patient" + }, + "zh": { + "question": "一名73岁的患者在MVA后使用呼吸机。设定的频率为AC 16，潮气量450，PEEP为5 cm H2O。呼吸治疗师注意到测得的PEEP大于15 cm H2O，并且患者没有超过设定频率的呼吸。以下哪个选项最合理地减少测得的PEEP？", + "A": "增加呼吸频率", + "B": "增加吸气流速", + "C": "反转吸呼比", + "D": "使患者瘫痪" + } + }, + { + "id": "6e229814-fa65-514f-bbf0-be6b4c075489", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 55-year-old man with polycystic liver disease undergoes an 8-hour right hepatectomy. The patient receives 5 units of packed red cells, 1000 mL albumin, and 6 L normal saline. The patient is extubated and taken to a postanesthesia care unit (PACU) where ABGs are: Pao2 135,", + "A": "Lactic acid", + "B": "Use of normal saline", + "C": "Diabetic ketoacidosis", + "D": "Polyethylene glycol from bowel prep" + }, + "zh": { + "question": "一名55岁的多囊肝病男性患者接受了8小时的右半肝切除术。患者接受了5个单位的浓缩红细胞、1000毫升白蛋白和6升生理盐水。患者拔管后被送往麻醉后监护室（PACU），动脉血气分析结果为：Pao2 135，", + "A": "乳酸", + "B": "使用生理盐水", + "C": "糖尿病酮症酸中毒", + "D": "肠道准备中的聚乙二醇" + } + }, + { + "id": "7e066027-4ae8-5dc0-afcc-7163195be8cf", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the LEAST appropriate use of noninvasive", + "A": "Acute respiratory distress syndrome (ARDS)", + "B": "COPD exacerbation", + "C": "Obstructive sleep apnea", + "D": "Multiple sclerosis exacerbation" + }, + "zh": { + "question": "以下哪项是非侵入性使用最不合适的情况？", + "A": "急性呼吸窘迫综合征 (ARDS)", + "B": "慢性阻塞性肺病 (COPD) 急性加重", + "C": "阻塞性睡眠呼吸暂停", + "D": "多发性硬化症急性加重" + } + }, + { + "id": "3f0c9a86-c6ae-50e4-895b-4deff1fcc7d0", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 68-year-old asthmatic drunk driver comes into the ER after being in a motor vehicle accident. After a difficult intubation, you fail to observe end-tidal CO2 on the monitor. Reasons for this include all of the following EXCEPT", + "A": "You intubated the esophagus by mistake", + "B": "You forgot to ventilate the patient", + "C": "The connection between the circuit and monitor has become disconnected", + "D": "The patient also has a pneumothorax, and high airway pressures are needed to adequately ventilate the patient" + }, + "zh": { + "question": "一名68岁的哮喘醉酒司机在发生机动车事故后进入急诊室。经过困难的插管后，你未能在监视器上观察到呼气末二氧化碳。以下所有原因均可能导致这种情况，除了", + "A": "你错误地插入了食道", + "B": "你忘记给病人通气", + "C": "回路与监视器之间的连接已断开", + "D": "病人还有气胸，需要高气道压力才能充分通气" + } + }, + { + "id": "04b35252-b08d-5b8a-a43e-046379ff94b9", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 30-year-old woman has undergone a 2-hour abdominal surgical procedure and is sent to the ICU intubated for postoperative monitoring, due to suspected sepsis. Three hours later, the ventilator malfunctions and the resident disconnects the patient from the ventilator and hand ventilates the patient with 100% oxygen. The patient has good bilateral breath sounds, the chest rises nicely, and moisture is seen in the ETT. Shortly thereafter, the patient's heart rate slows to 30 beats/min and the blood pressure is 50 mm Hg systolic. The next intervention that should be done, in addition to chest compressions, is", + "A": "Administer atropine", + "B": "Start epinephrine", + "C": "Confirm ETT position", + "D": "Apply external pacemaker# Respiratory Physiology and Critical Care Medicine###" + }, + "zh": { + "question": "一名30岁的女性接受了2小时的腹部手术，由于怀疑败血症，术后插管送入ICU进行监测。三小时后，呼吸机发生故障，住院医师将患者从呼吸机上断开，并用100%氧气手动通气。患者双侧呼吸音良好，胸部起伏良好，气管插管内可见湿气。不久之后，患者心率减慢至30次/分钟，收缩压为50 mm Hg。除了进行胸外按压外，接下来应进行的干预是", + "A": "给予阿托品", + "B": "开始使用肾上腺素", + "C": "确认气管插管位置", + "D": "使用外部起搏器" + } + }, + { + "id": "6c4e621f-82dc-593c-8c6c-c99b355622bf", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following muscle relaxants is eliminated the most by renal excretion?", + "A": "Pancuronium", + "B": "Vecuronium", + "C": "Atracurium", + "D": "Rocuronium" + }, + "zh": { + "question": "以下哪种肌松药主要通过肾脏排泄？", + "A": "潘库溴铵", + "B": "维库溴铵", + "C": "阿曲库铵", + "D": "罗库溴铵" + } + }, + { + "id": "d4ae8963-a913-5603-977f-b4f05ddc2b58", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following conditions may develop when using propofol for prolonged sedation in the intensive care unit (ICU) EXCEPT", + "A": "Pancreatitis", + "B": "Hyperlipidemia", + "C": "Metabolic acidosis", + "D": "Adrenal suppression" + }, + "zh": { + "question": "在重症监护病房（ICU）使用丙泊酚进行长期镇静时，可能出现以下所有情况，除了", + "A": "胰腺炎", + "B": "高脂血症", + "C": "代谢性酸中毒", + "D": "肾上腺抑制" + } + }, + { + "id": "74e3e7cb-465b-5488-b8f0-6b0c743e38e6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Under which scenario should dantrolene be withheld in a patient in whom malignant hyperthermia (MH) is suspected?", + "A": "Concomitant treatment with a calcium channel blocker", + "B": "History of previous uneventful anesthetic with volatileanesthetic", + "C": "History of negative genetic test for ryanodine mutation", + "D": "Never" + }, + "zh": { + "question": "在怀疑恶性高热（MH）的患者中，在哪种情况下应停止使用丹曲林？", + "A": "与钙通道阻滞剂同时治疗", + "B": "有使用挥发性麻醉剂的麻醉无不良反应的病史", + "C": "有雷诺定受体突变基因检测阴性的病史", + "D": "从不" + } + }, + { + "id": "95b71f1f-7e7d-564c-8856-9eb248e42002", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 78-year-old patient with Parkinson disease undergoes a cataract operation under general anesthesia. In the recovery room, the patient has two episodes of emesis and complains of severe nausea. Which of the following antiemetics would be the best choice for treatment of nausea in this patient?", + "A": "Droperidol", + "B": "Promethazine", + "C": "Ondansetron", + "D": "Metoclopramide" + }, + "zh": { + "question": "一名78岁的帕金森病患者在全身麻醉下接受白内障手术。在恢复室中，患者出现两次呕吐并抱怨严重的恶心。以下哪种止吐药是治疗该患者恶心的最佳选择？", + "A": "氟哌利多", + "B": "异丙嗪", + "C": "昂丹司琼", + "D": "甲氧氯普胺" + } + }, + { + "id": "50de533f-3f14-5ad5-9d33-134e822cc026", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following diseases is associated with increased resistance to neuromuscular blockade with succinylcholine?", + "A": "Myasthenia gravis", + "B": "Myasthenic syndrome", + "C": "Huntington chorea", + "D": "Polymyositis" + }, + "zh": { + "question": "下列哪种疾病与琥珀胆碱的神经肌肉阻滞抵抗增加有关？", + "A": "重症肌无力", + "B": "肌无力综合征", + "C": "亨廷顿舞蹈病", + "D": "多发性肌炎" + } + }, + { + "id": "ec7fa703-42e1-5de4-aae8-7efdd09de397", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Sedation with which of the following drugs is most likely to resemble normal sleep?", + "A": "Propofol", + "B": "Midazolam", + "C": "Dexmedetomidine", + "D": "Ketamine" + }, + "zh": { + "question": "以下哪种药物的镇静效果最可能类似于正常睡眠？", + "A": "丙泊酚", + "B": "咪达唑仑", + "C": "右美托咪定", + "D": "氯胺酮" + } + }, + { + "id": "615ba2d4-d0d4-50fc-bacd-b59c385265d3", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following intravenous anesthetics is converted from a water-soluble to a lipid-soluble drug after exposure to the bloodstream?", + "A": "Propofol", + "B": "Midazolam", + "C": "Ketamine", + "D": "None of the above" + }, + "zh": { + "question": "以下哪种静脉麻醉药在进入血液后从水溶性转变为脂溶性药物？", + "A": "丙泊酚", + "B": "咪达唑仑", + "C": "氯胺酮", + "D": "以上都不是" + } + }, + { + "id": "7b833594-7b9e-554b-bdb9-ec96ed91e78a", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 33-year-old, 70-kg patient is brought to the operating room for resection of an anterior pituitary prolactin-secreting tumor. Anesthesia is induced with sevoflurane, nitrous oxide, and oxygen. The patient is intubated, and nitrous oxide is discontinued. Anesthesia is maintained with 1.2 minimum alveolar concentration (MAC) sevoflurane in oxygen. The surgeon plans to inject epinephrine into the nasal mucosa to minimize bleeding. What is the maximum volume of a 1:100,000", + "A": "55 mL", + "B": "45 mL", + "C": "35 mL", + "D": "25 mL" + }, + "zh": { + "question": "一名33岁、70公斤的患者被送入手术室进行垂体前叶泌乳素分泌肿瘤的切除术。麻醉诱导使用七氟醚、氧化亚氮和氧气。患者被插管，氧化亚氮被停止。麻醉维持在1.2最低肺泡浓度（MAC）的七氟醚和氧气中。外科医生计划向鼻粘膜注射肾上腺素以减少出血。1:100,000浓度的肾上腺素最大注射量是多少？", + "A": "55毫升", + "B": "45毫升", + "C": "35毫升", + "D": "25毫升" + } + }, + { + "id": "b22e75d9-98d5-59d4-a9e1-d405cfe79171", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Patients receiving antihypertensive therapy with propranolol are at increased risk for each of the following EXCEPT", + "A": "Blunted response to hypoglycemia", + "B": "Bronchoconstriction", + "C": "Rebound tachycardia after discontinuation", + "D": "Orthostatic hypotension" + }, + "zh": { + "question": "接受普萘洛尔降压治疗的患者增加了以下各项风险，除了", + "A": "对低血糖反应减弱", + "B": "支气管收缩", + "C": "停药后反弹性心动过速", + "D": "体位性低血压" + } + }, + { + "id": "bb150dbf-29ec-59b8-ae4f-38a486bd7578", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Atropine causes each of the following EXCEPT", + "A": "Decreased gastric acid secretion", + "B": "Inhibition of salivary secretion", + "C": "Increased lower esophageal sphincter tone", + "D": "Mydriasis" + }, + "zh": { + "question": "阿托品会导致以下每一种情况，除了", + "A": "减少胃酸分泌", + "B": "抑制唾液分泌", + "C": "增加下食道括约肌张力", + "D": "瞳孔散大" + } + }, + { + "id": "10019042-8561-5c8a-b190-84e981e29c53", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following drugs is capable of crossing the blood-brain barrier?", + "A": "Neostigmine", + "B": "Pyridostigmine", + "C": "Edrophonium", + "D": "Physostigmine" + }, + "zh": { + "question": "下列哪种药物能够穿过血脑屏障？", + "A": "新斯的明", + "B": "吡啶斯的明", + "C": "依酚氯铵", + "D": "毒扁豆碱" + } + }, + { + "id": "9fae8d6c-f8dc-5287-9b0a-42d29763c776", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which drug exerts its main central nervous system (CNS) action by inhibiting the *N*-methyl-D-aspartate (NMDA) receptors?", + "A": "Propofol", + "B": "Midazolam", + "C": "Etomidate", + "D": "Ketamine" + }, + "zh": { + "question": "哪种药物通过抑制N-甲基-D-天冬氨酸（NMDA）受体来发挥其主要的中枢神经系统（CNS）作用？", + "A": "丙泊酚", + "B": "咪达唑仑", + "C": "依托咪酯", + "D": "氯胺酮" + } + }, + { + "id": "497e4587-715d-5418-bc22-5b1218ca95d8", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following opioid-receptor agonists has anticholinergic properties?", + "A": "Morphine", + "B": "Hydromorphone", + "C": "Sufentanil", + "D": "Meperidine" + }, + "zh": { + "question": "以下哪种阿片受体激动剂具有抗胆碱能特性？", + "A": "吗啡", + "B": "氢吗啡酮", + "C": "舒芬太尼", + "D": "哌替啶" + } + }, + { + "id": "2c0c2f5e-a98c-5ab6-acc6-3626519ed8b5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements about ketamine is FALSE?", + "A": "In the United States it is a racemic mixture of two isomers", + "B": "It is a potent cerebral vasodilator and can increase intracranial pressure (ICP)", + "C": "Respiratory depression rarely occurs with induction doses", + "D": "Its metabolite norketamine is more potent than the parent compound" + }, + "zh": { + "question": "以下关于氯胺酮的说法中哪一项是错误的？", + "A": "在美国，它是两种异构体的外消旋混合物", + "B": "它是一种强效的脑血管扩张剂，可以增加颅内压（ICP）", + "C": "诱导剂量很少引起呼吸抑制", + "D": "其代谢产物去甲氯胺酮比母化合物更强效" + } + }, + { + "id": "9fdb04fa-04b2-574e-9a37-94decd901864", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following vasopressor agents increases systemic blood pressure (BP) indirectly by stimulating the release of norepinephrine from sympathetic nerve fibers and directly by binding to adrenergic receptors?", + "A": "Vasopressin", + "B": "Ephedrine", + "C": "Epinephrine", + "D": "Phenylephrine" + }, + "zh": { + "question": "以下哪种升压药通过刺激交感神经纤维释放去甲肾上腺素间接增加全身血压（BP），并通过与肾上腺素能受体结合直接增加全身血压？", + "A": "加压素", + "B": "麻黄碱", + "C": "肾上腺素", + "D": "去氧肾��腺素" + } + }, + { + "id": "05f06f3d-45bf-5288-aba5-82521d2e929f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Methadone-induced constipation could be reversed without loss of analgesic effect with which of the following opioid antagonists?", + "A": "Naloxone", + "B": "Nalmefene", + "C": "Naltrexone", + "D": "Methylnaltrexone" + }, + "zh": { + "question": "美沙酮引起的便秘可以通过以下哪种阿片类拮抗剂逆转而不失去镇痛效果？", + "A": "纳洛酮", + "B": "纳美芬", + "C": "纳曲酮", + "D": "甲基纳曲酮" + } + }, + { + "id": "112a57cf-a362-5be1-bb58-286cb688f15e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The treatment of patients with human immunodeficiency virus (HIV) may include indinavir, nelfinavir, or ritonavir. What anesthetic consideration is significant with these drugs?", + "A": "Decreased platelet function", + "B": "Increased sensitivity to midazolam", + "C": "Hypoglycemia", + "D": "Hyperkalemia" + }, + "zh": { + "question": "治疗人类免疫缺陷病毒（HIV）患者可能包括茚地那韦、奈非那韦或利托那韦。使用这些药物时，哪种麻醉考虑是重要的？", + "A": "血小板功能降低", + "B": "对咪达唑仑的敏感性增加", + "C": "低血糖", + "D": "高钾血症" + } + }, + { + "id": "66c00097-a0a8-5d74-b140-e264e33eb7d2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Neurokinin-1 (NK1) antagonists such as aprepitant have all the following properties EXCEPT", + "A": "Anxiolytic", + "B": "Antidepressant", + "C": "Analgesic", + "D": "Antiemetic" + }, + "zh": { + "question": "神经激肽-1（NK1）拮抗剂如阿瑞匹坦具有以下所有特性，除了", + "A": "抗焦虑", + "B": "抗抑郁", + "C": "镇痛", + "D": "止吐" + } + }, + { + "id": "e6ffbad5-149d-539b-a07e-87b063af615a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following drugs should be administered with caution to patients receiving echothiophate for the treatment of glaucoma?", + "A": "Atropine", + "B": "Succinylcholine", + "C": "Ketamine", + "D": "Remifentanil" + }, + "zh": { + "question": "下列哪种药物在给予接受依可硫磷治疗青光眼的患者时应谨慎使用？", + "A": "阿托品", + "B": "琥珀胆碱", + "C": "氯胺酮", + "D": "瑞芬太尼" + } + }, + { + "id": "a35b6496-30a3-5e00-9aef-4e803e267fa1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "When one of four thumb twitches in the train-of-four (TOF) stimulation of the ulnar nerve can be elicited, how much suppression would there be if you were measuring a single twitch?", + "A": "20 to 25", + "B": "45 to 55", + "C": "75 to 80", + "D": "90 to 95" + }, + "zh": { + "question": "当在尺神经的四连发（TOF）刺激中可以引出四次拇指抽搐中的一次时，如果测量单次抽搐，会有多少抑制？", + "A": "20到25", + "B": "45到55", + "C": "75到80", + "D": "90到95" + } + }, + { + "id": "859eabbc-9cc4-52e5-b690-2b8815bf2a1f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following muscle relaxants causes slight histamine release at two to three times the ED95 (effective dose in 95% of subjects) dose?", + "A": "Rocuronium", + "B": "Pancuronium", + "C": "Atracurium", + "D": "Cisatracurium" + }, + "zh": { + "question": "以下哪种肌松药在两到三倍ED95（95%受试者的有效剂量）时会引起轻微的组胺释放？", + "A": "罗库溴铵", + "B": "潘库溴铵", + "C": "阿曲库铵", + "D": "西酞库铵" + } + }, + { + "id": "76c904ff-8732-55d3-9bb4-978e5b778147", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Termination of action of the neurotransmitter norepinephrine is achieved predominately by which mechanism?", + "A": "Reuptake into postganglionic sympathetic nerve endings (uptake 1)", + "B": "Dilution by diffusion away from receptors", + "C": "Metabolism by catechol-*O*-methyltransferase (COMT)", + "D": "Metabolism by monoamine oxidase (MAO)" + }, + "zh": { + "question": "去甲肾上腺素神经递质的作用终止主要通过哪种机制实现？", + "A": "再摄取到交感神经节后神经末梢（摄取1）", + "B": "通过扩散稀释远离受体", + "C": "由儿茶酚-O-甲基转移酶（COMT）代谢", + "D": "由单胺氧化酶（MAO）代谢" + } + }, + { + "id": "73fa0cb5-b65c-5787-8e69-958d26fd65f1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The incidence of unpleasant dreams associated with emergence from ketamine anesthesia can be reduced by the administration of", + "A": "Caffeine", + "B": "Droperidol", + "C": "Physostigmine", + "D": "Midazolam" + }, + "zh": { + "question": "与从氯胺酮麻醉中苏醒相关的不愉快梦境的发生率可以通过以下药物的使用来减少", + "A": "咖啡因", + "B": "氟哌利多", + "C": "毒扁豆碱", + "D": "咪达唑仑" + } + }, + { + "id": "9d2cdd27-6ce9-57fc-9198-f470ecbe4693", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The principal advantage of Ryanodex over conventional formulations of dantrolene is", + "A": "Cost", + "B": "Speed of reconstitution and administration", + "C": "Absence of large amounts of mannitol", + "D": "Need for lower dose" + }, + "zh": { + "question": "Ryanodex 相较于传统丹曲林制剂的主要优势是", + "A": "成本", + "B": "重组和给药速度", + "C": "不含大量甘露醇", + "D": "需要较低剂量" + } + }, + { + "id": "c178cf61-3d2b-5ab4-8035-ac409042b23a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Eplerenone (Inspra) inhibits the renin-angiotensin-aldosterone system by which mechanism?", + "A": "Blocks aldosterone receptor", + "B": "Blocks conversion angiotensinogen to angiotensin I", + "C": "Blocks angiotensin receptor", + "D": "Prevents formation of renin" + }, + "zh": { + "question": "依普利酮（Inspra）通过哪种机制抑制肾素-血管紧张素-醛固酮系统？", + "A": "阻断醛固酮受体", + "B": "阻断血管紧张素原转化为血管紧张素I", + "C": "阻断血管紧张素受体", + "D": "阻止肾素的形成" + } + }, + { + "id": "8e6516f7-0882-528f-9468-2ef5b863e27a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following drugs can enhance the neuromuscular blockade produced by nondepolarizing muscle relaxants EXCEPT", + "A": "Calcium", + "B": "Aminoglycoside antibiotics", + "C": "Magnesium", + "D": "Intravenous lidocaine" + }, + "zh": { + "question": "以下每种药物都可以增强非去极化肌松药产生的神经肌肉阻滞，除了", + "A": "钙", + "B": "氨基糖苷类抗生素", + "C": "镁", + "D": "静脉注射利多卡因" + } + }, + { + "id": "33e7181e-c1a6-54e5-a290-35ba510dfd83", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The primary site of action of lisinopril is", + "A": "Heart", + "B": "Lungs", + "C": "Kidney", + "D": "Metarterioles" + }, + "zh": { + "question": "赖诺普利的主要作用部位是", + "A": "心脏", + "B": "肺", + "C": "肾脏", + "D": "小动脉" + } + }, + { + "id": "0f9c3b89-63da-5eaa-9733-137a4b245d1b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Circulating BNP (B-type natriuretic peptide) is a powerful biomarker predicting outcomes of which of the following?", + "A": "Heart", + "B": "CNS", + "C": "Kidneys", + "D": "Organ rejection" + }, + "zh": { + "question": "循环BNP（B型利钠肽）是预测以下哪种结果的强大生物标志物？", + "A": "心脏", + "B": "中枢神经系统", + "C": "肾脏", + "D": "器官排斥" + } + }, + { + "id": "e80a19b6-4103-57ae-a455-17103da77f92", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Hyperkalemia is NOT a risk for patients receiving succinylcholine with which of the following?", + "A": "Multiple sclerosis (MS)", + "B": "Myasthenia gravis", + "C": "Guillain-Barré syndrome", + "D": "Becker muscular dystrophy" + }, + "zh": { + "question": "高钾血症不是接受琥珀胆碱的患者的风险，以下哪种情况除外？", + "A": "多发性硬化症 (MS)", + "B": "重症肌无力", + "C": "格林-巴利综合征", + "D": "贝克肌营养不良症" + } + }, + { + "id": "69b9b3ae-0113-5e16-8112-f83731559203", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the antibiotics below does NOT augment neuromuscular blockade?", + "A": "Clindamycin", + "B": "Neomycin", + "C": "Streptomycin", + "D": "Erythromycin" + }, + "zh": { + "question": "以下哪种抗生素不会增强神经肌肉阻滞？", + "A": "克林霉素", + "B": "新霉素", + "C": "链霉素", + "D": "红霉素" + } + }, + { + "id": "0879d068-d07c-57c9-bf79-450fe869013d", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 43-year-old woman with ascites, hepatopulmonary syndrome, and bleeding esophageal varices is admitted to the ICU. Which of the therapies below is LEAST likely to improve symptoms associated with hepatic encephalopathy (HE)?", + "A": "Amino acid–rich total parenteral nutrition (TPN)", + "B": "Neomycin", + "C": "Lactulose", + "D": "Flumazenil" + }, + "zh": { + "question": "一名43岁的女性患有腹水、肝肺综合征和食管静脉曲张出血，被送入ICU。以下哪种治疗方法最不可能改善与肝性脑病（HE）相关的症状？", + "A": "富含氨基酸的全肠外营养（TPN）", + "B": "新霉素", + "C": "乳果糖", + "D": "氟马西尼" + } + }, + { + "id": "971362e3-a68a-510c-85db-8671b9fb3f93", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "100 mg succinylcholine is administered to a 70-kg anesthetized man before intubation. The patient remains paralyzed for 20 minutes. Which of the parameters below is NOT consistent with this finding?", + "A": "Dibucaine number 70", + "B": "Heterozygous for atypical cholinesterase", + "C": "Incidence of 1/480", + "D": "Presence of fasciculations with this dose" + }, + "zh": { + "question": "在插管前，给一名70公斤的麻醉男子注射了100毫克琥珀胆碱。患者持续瘫痪20分钟。以下哪个参数与这一发现不一致？", + "A": "地布卡因数值70", + "B": "非典型胆碱酯酶杂合子", + "C": "发病率为1/480", + "D": "该剂量下出现肌束颤动" + } + }, + { + "id": "94436d1f-8b2d-51b2-ad2f-1ce4d0d88348", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "In which of the following situations is succinylcholine most likely to cause severe hyperkalemia?", + "A": "24 hours after a right hemisphere stroke", + "B": "14 days after a severe burn injury", + "C": "24 hours after a midthoracic spinal cord transection", + "D": "2 days with a severe abdominal infection" + }, + "zh": { + "question": "在以下哪种情况下，琥珀胆碱最有可能导致严重的高钾血症？", + "A": "右半球中风后24小时", + "B": "严重烧伤后14天", + "C": "中胸段脊髓横断后24小时", + "D": "严重腹部感染2天" + } + }, + { + "id": "19aa9aa2-6af7-5bee-bf24-b76fa7c9810a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The most common minor side effect reported after flumazenil administration in anesthesia is", + "A": "Nausea and/or vomiting", + "B": "Dizziness", + "C": "Tremors", + "D": "Hypertension" + }, + "zh": { + "question": "在麻醉中使用氟马西尼后报告的最常见轻微副作用是", + "A": "恶心和/或呕吐", + "B": "头晕", + "C": "震颤", + "D": "高血压" + } + }, + { + "id": "6efbd3bc-516e-5fb6-839f-8655b304a202", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Ketorolac", + "A": "Is a selective cyclooxygenase-2 (COX-2) inhibitor", + "B": "Does not inhibit thromboxane A2 (TXA2 )", + "C": "Does not inhibit prostaglandin I2", + "D": "Exhibits a dose ceiling effect with regard to analgesia" + }, + "zh": { + "question": "酮咯酸", + "A": "是选择性环氧合酶-2 (COX-2) 抑制剂", + "B": "不抑制血栓素 A2 (TXA2)", + "C": "不抑制前列腺素 I2", + "D": "在镇痛方面表现出剂量封顶效应" + } + }, + { + "id": "fbb91c41-cbbe-5e77-9dff-a69197f9ae03", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 37-year-old patient with a history of acute intermittent porphyria is scheduled for knee arthroscopy under general anesthesia. Which of the following drugs is contraindicated in this patient?", + "A": "Fentanyl", + "B": "Isoflurane", + "C": "Propofol", + "D": "Etomidate" + }, + "zh": { + "question": "一名37岁的患者有急性间歇性卟啉病史，计划在全身麻醉下进行膝关节镜检查。以下哪种药物在该患者中禁用？", + "A": "芬太尼", + "B": "异氟醚", + "C": "丙泊酚", + "D": "依托咪酯" + } + }, + { + "id": "0115eb0e-592f-5337-b3f4-04a0836cb003", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 57-year-old male is discharged after tooth extraction of two molars. His only medication is paroxetine (Paxil), which he takes for depression. Codeine is a poor analgesic choice for this patient because", + "A": "It is likely to be ineffective", + "B": "It is likely to cause extreme sedation", + "C": "He is at increased risk for nausea", + "D": "He is at increased risk for serotonin syndrome" + }, + "zh": { + "question": "一名57岁的男性在拔除两颗磨牙后出院。他唯一的药物是帕罗西汀（Paxil），用于治疗抑郁症。可待因对该患者来说是一个不好的镇痛选择，因为", + "A": "它可能无效", + "B": "它可能导致极度镇静", + "C": "他有增加恶心的风险", + "D": "他有增加患上血清素综合征的风险" + } + }, + { + "id": "217201f7-64a7-5aaa-8a6f-946f9aa446b5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "If etomidate were accidentally injected into a left-sided radial arterial line, the most appropriate step to take would be", + "A": "Left stellate ganglion block", + "B": "Administer intra-arterial clonidine", + "C": "Slowly inject dilute (0.1 mEq/L) [HCO3 - ]", + "D": "Observe" + }, + "zh": { + "question": "如果依托咪酯意外注入左侧桡动脉导管，最合适的措施是", + "A": "左侧星状神经节阻滞", + "B": "动脉内给予可乐定", + "C": "缓慢注射稀释的 (0.1 mEq/L) [HCO3 - ]", + "D": "观察" + } + }, + { + "id": "a218bac5-0c9d-5332-80a6-35ee35b27324", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The most important reason for the more rapid onset and shorter duration of action of fentanyl with single dose compared with morphine is the difference in", + "A": "Volume of distribution", + "B": "Hepatic clearance", + "C": "Protein binding", + "D": "Lipid solubility" + }, + "zh": { + "question": "与吗啡相比，芬太尼单次给药起效更快且作用时间更短的最重要原因是两者在以下哪方面的差异", + "A": "分布容积", + "B": "肝脏清除率", + "C": "蛋白结合", + "D": "脂溶性" + } + }, + { + "id": "64a6182c-aa00-59a5-b7e5-089e82dda9a5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A narcotic infusion is initiated in a patient without a bolus (loading dose). Of the following drugs, which would reach steady state after 2 hours or less of continuous infusion (fentanyl, remifentanil, alfentanil, and morphine)?", + "A": "All of these", + "B": "Remifentanil and alfentanil", + "C": "Alfentanil only", + "D": "Remifentanil only" + }, + "zh": { + "question": "在没有给予推注（负荷剂量）的情况下开始对患者进行麻醉药物输注。在以下药物中，哪一种在连续输注2小时或更短时间后会达到稳态（芬太尼、瑞芬太尼、阿芬太尼和吗啡）？", + "A": "所有这些", + "B": "瑞芬太尼和阿芬太尼", + "C": "仅阿芬太尼", + "D": "仅瑞芬太尼" + } + }, + { + "id": "ce5ffd84-46f6-52d6-85b2-633eced6c614", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The period of vulnerability after three courses of bleomycin for testicular cancer is", + "A": "1 month", + "B": "1 year", + "C": "Lifelong", + "D": "No vulnerability with just three courses" + }, + "zh": { + "question": "睾丸癌接受三疗程博来霉素治疗后的脆弱期是", + "A": "1个月", + "B": "1年", + "C": "终生", + "D": "仅三疗程没有脆弱期" + } + }, + { + "id": "b661d165-28dc-52e9-9e3e-aa2c0725647d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The unique advantage of rocuronium over other muscle relaxants is its", + "A": "Short duration of action", + "B": "Metabolism by pseudocholinesterase", + "C": "Onset of action", + "D": "Lack of need for reversal" + }, + "zh": { + "question": "罗库溴铵相较于其他肌肉松弛剂的独特优势是其", + "A": "作用时间短", + "B": "由假胆碱酯酶代谢", + "C": "起效快", + "D": "无需逆转" + } + }, + { + "id": "becd7d2b-3c36-56ac-b8b4-3b86691d7bf2", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements regarding the efficacy of neuromuscular blockade in the setting of acute hypokalemia is correct?", + "A": "There is no effect with depolarizing or nondepolarizing muscle relaxants", + "B": "There is resistance to effects of both depolarizing and nondepolarizing muscle relaxants", + "C": "There is increased sensitivity to effects of both depolarizing and nondepolarizing muscle relaxants", + "D": "There is resistance to depolarizing muscle relaxants and increased sensitivity to nondepolarizing muscle relaxants" + }, + "zh": { + "question": "关于急性低钾血症情况下神经肌肉阻滞的疗效，下列哪项陈述是正确的？", + "A": "去极化和非去极化肌肉松弛剂均无影响", + "B": "对去极化和非去极化肌肉松弛剂均有抵抗", + "C": "对去极化和非去极化肌肉松弛剂的敏感性增加", + "D": "对去极化肌肉松弛剂有抵抗，对非去极化肌肉松弛剂的敏感性增加" + } + }, + { + "id": "caecd4ea-ec00-5375-a734-41c5bc268d45", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A patient undergoing which of the following operations would be at highest risk for operative recall?", + "A": "Laparoscopic cholecystectomy with total intravenous anesthesia (TIVA) (no volatile)", + "B": "Cervical spine fusion with MEP (motor evoked potentials) monitoring", + "C": "Pneumonectomy with one-lung ventilation", + "D": "Emergency splenectomy after falling from a ladder" + }, + "zh": { + "question": "以下哪种手术的患者最有可能发生术中知晓？", + "A": "全静脉麻醉（TIVA）（无挥发性麻醉）下的腹腔镜胆囊切除术", + "B": "伴有MEP（运动诱发电位）监测的颈椎融合术", + "C": "单肺通气下的肺叶切除术", + "D": "从梯子上摔下后的急诊脾切除术" + } + }, + { + "id": "5fe175ed-ab96-5ecf-838c-28951575d779", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 58-year-old patient is brought to the emergency room with the following symptoms: miosis, abdominal cramping, salivation, loss of bowel and bladder control, bradycardia, ataxia, and skeletal muscle weakness. The most likely diagnosis is", + "A": "Central anticholinergic syndrome", + "B": "Malignant neuroleptic syndrome", + "C": "Anticholinesterase poisoning", + "D": "Serotonin syndrome" + }, + "zh": { + "question": "一名58岁的患者被送到急诊室，症状如下：瞳孔缩小、腹部绞痛、流涎、失去肠道和膀胱控制、心动过缓、共济失调和骨骼肌无力。最可能的诊断是", + "A": "中枢抗胆碱能综合征", + "B": "恶性神经阻滞综合征", + "C": "抗胆碱酯酶中毒", + "D": "血清素综合征" + } + }, + { + "id": "6a83906d-dbc4-52d4-b36d-a705e6ea1941", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Flumazenil", + "A": "Is contraindicated in narcotic addicts", + "B": "Can be given orally as well as intravenously", + "C": "Can produce seizures in chronic benzodiazepine users", + "D": "Has a longer elimination half-life compared with midazolam" + }, + "zh": { + "question": "氟马西尼", + "A": "在麻醉药成瘾者中禁用", + "B": "可以口服或静脉注射", + "C": "可在慢性苯二氮䓬类药物使用者中引发癫痫", + "D": "与咪达唑仑相比，具有更长的消除半衰期" + } + }, + { + "id": "46c08be3-a92b-5145-97e8-cef5c1c6de59", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What percentage of neuromuscular receptors could be blocked and still allow patients to carry out a 5-second head lift?", + "A": "5%", + "B": "15%", + "C": "25%", + "D": "50%" + }, + "zh": { + "question": "阻断多少百分比的神经肌肉受体仍能让患者进行5秒钟的抬头动作？", + "A": "5%", + "B": "15%", + "C": "25%", + "D": "50%" + } + }, + { + "id": "28e4ae69-9718-587e-92cf-ee20d44394a4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 25-year-old woman undergoes thyroidectomy under general", + "A": "Aprepitant", + "B": "Granisetron", + "C": "Promethazine", + "D": "Droperidol" + }, + "zh": { + "question": "一名25岁的女性在全身麻醉下接受甲状腺切除术", + "A": "阿瑞匹坦", + "B": "格拉司琼", + "C": "异丙嗪", + "D": "氟哌利多" + } + }, + { + "id": "eb0bd4e6-e6c4-515f-a955-8ebbbeb30f36", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following drugs can prevent tachyarrhythmias in patients with Wolff-Parkinson-White (WPW) syndrome?", + "A": "Droperidol", + "B": "Pancuronium", + "C": "Ketamine", + "D": "Verapamil" + }, + "zh": { + "question": "以下哪种药物可以预防沃尔夫-帕金森-怀特（WPW）综合征患者的心动过速性心律失常？", + "A": "氟哌利多", + "B": "潘库溴铵", + "C": "氯胺酮", + "D": "维拉帕米" + } + }, + { + "id": "12a413a9-3fdb-55ae-86a8-d62f2c5e64b2", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The half-life of pseudocholinesterase is", + "A": "1 hour", + "B": "12 hours", + "C": "1 week", + "D": "2 weeks" + }, + "zh": { + "question": "假性胆碱酯酶的半衰期是", + "A": "1小时", + "B": "12小时", + "C": "1周", + "D": "2周" + } + }, + { + "id": "da36f61e-d120-5c31-9515-1a682da1aa0a", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient with CYP2D6 polymorphism is tested and shown to be an ultrarapid metabolizer. Which of the following statements regarding PONV prophylaxis with serotonin receptor antagonists is true?", + "A": "Neither granisetron nor ondansetron would likely be efficacious", + "B": "Granisetron would likely be more efficacious than ondansetron", + "C": "Ondansetron would likely be more efficacious than granisetron", + "D": "Both would likely be efficacious" + }, + "zh": { + "question": "一名具有CYP2D6多态性的患者被检测为超快速代谢者。以下关于使用5-HT3受体拮抗剂进行PONV预防的说法哪一项是正确的？", + "A": "格拉司琼和昂丹司琼都可能无效", + "B": "格拉司琼可能比昂丹司琼更有效", + "C": "昂丹司琼可能比格拉司琼更有效", + "D": "两者都可能有效" + } + }, + { + "id": "5b4f646f-c7ae-5652-9cc4-547e9d23349d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following equals the anti-inflammatory activity of 50 mg of prednisone (Deltasone)?", + "A": "100 mg cortisol (Solu-Cortef)", + "B": "80 mg methylprednisolone (Solu-Medrol)", + "C": "7.5 mg dexamethasone (Decadron)", + "D": "4 mg betamethasone (Celestone)" + }, + "zh": { + "question": "下列哪项的抗炎活性等于50毫克泼尼松（Deltasone）？", + "A": "100毫克氢化可的松（Solu-Cortef）", + "B": "80毫克甲泼尼龙（Solu-Medrol）", + "C": "7.5毫克地塞米松（Decadron）", + "D": "4毫克倍他米松（Celestone）" + } + }, + { + "id": "df7fbfd0-516b-5731-9eb7-47c90ee7a558", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The recovery index (RI) of which of the following nondepolarizing muscle relaxants is NOT altered by aging?", + "A": "Atracurium", + "B": "Vecuronium", + "C": "Rocuronium", + "D": "Pancuronium" + }, + "zh": { + "question": "以下哪种非去极化肌松药的恢复指数（RI）不受年龄影响？", + "A": "阿曲库铵", + "B": "维库溴铵", + "C": "罗库溴铵", + "D": "潘库溴铵" + } + }, + { + "id": "c8aa8a13-3e8f-59bc-948e-fbe93f320059", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Side effects associated with cyclosporine therapy include each of the following EXCEPT", + "A": "Nephrotoxicity", + "B": "Pulmonary toxicity", + "C": "Seizures", + "D": "Limb paresthesias" + }, + "zh": { + "question": "与环孢素治疗相关的副作用包括以下各项，除了", + "A": "肾毒性", + "B": "肺毒性", + "C": "癫痫发作", + "D": "肢体感觉异常" + } + }, + { + "id": "2c8970a5-cfd9-5002-a0f7-be8225644bf1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the predominant mechanism for succinylcholine-induced tachycardia in adults?", + "A": "Direct sympathomimetic effect at postjunctional muscarinic receptors", + "B": "Stimulation of nicotinic receptors at autonomic ganglia", + "C": "Blockade of nicotinic receptors at autonomic ganglia", + "D": "Direct vagolytic effect at postjunctional muscarinic receptors" + }, + "zh": { + "question": "琥珀胆碱引起成人心动过速的主要机制是什么？", + "A": "在突触后肌肉型受体的直接拟交感作用", + "B": "刺激自主神经节的烟碱型受体", + "C": "阻断自主神经节的烟碱型受体", + "D": "在突触后肌肉型受体的直接迷走神经抑制作用" + } + }, + { + "id": "beb7c198-cc50-5a7a-afb5-6129c259644d", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 72-year-old patient with a history of type 2 diabetes and hypertension is brought to the ICU after aortobifemoral bypass grafting. The patient is up 3 kilograms since surgery, and diuretic therapy is initiated to enhance urine output. Which of the choices below is LEAST likely to cause hypokalemic, hypochloremic metabolic acidosis?", + "A": "Triamterene", + "B": "Furosemide", + "C": "Bumetanide", + "D": "Oral thiazide" + }, + "zh": { + "question": "一名72岁的患者有2型糖尿病和高血压病史，在接受主动脉股动脉旁路移植术后被送入ICU。手术后患者体重增加了3公斤，开始使用利尿剂治疗以增加尿量。以下哪种选择最不可能导致低钾、低氯性代谢性酸中毒？", + "A": "氨苯蝶啶", + "B": "呋塞米", + "C": "布美他尼", + "D": "口服噻嗪类" + } + }, + { + "id": "19b2095d-ade9-541e-a2ff-58a04a50156f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the commonly used drugs below is NOT metabolized by nonspecific esterases?", + "A": "Propofol", + "B": "Esmolol", + "C": "Atracurium", + "D": "Remifentanil" + }, + "zh": { + "question": "以下常用药物中哪一种不是由非特异性酯酶代谢的？", + "A": "丙泊酚", + "B": "艾司洛尔", + "C": "阿曲库铵", + "D": "瑞芬太尼" + } + }, + { + "id": "4cfd675e-3bf2-5407-962d-3fbd71a32d97", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Succinylcholine is contraindicated for routine tracheal intubation in children because of an increased incidence of which of the following side effects?", + "A": "Hyperkalemia", + "B": "Malignant hyperthermia", + "C": "Masseter spasm", + "D": "Sinus bradycardia" + }, + "zh": { + "question": "由于以下哪种副作用的发生率增加，琥珀胆碱在儿童常规气管插管中禁用？", + "A": "高钾血症", + "B": "恶性高热", + "C": "咬肌痉挛", + "D": "窦性心动过缓" + } + }, + { + "id": "7404ccdc-ed86-5bb3-9c62-1f7df96bba98", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "From MOST to LEAST rapid, select the correct temporal sequence of neuromuscular blockade in the adductor of the thumb, the orbicularis oculi, and the diaphragm after administration of an intubating dose of vecuronium to an otherwise healthy patient.", + "A": "Diaphragm, orbicularis oculi, thumb", + "B": "Orbicularis oculi, diaphragm, thumb", + "C": "Orbicularis oculi, thumb, diaphragm", + "D": "Orbicularis oculi same as diaphragm, thumb" + }, + "zh": { + "question": "从最快到最慢，选择在给予一剂插管剂量的维库溴铵后，拇指内收肌、眼轮匝肌和膈肌的神经肌肉阻滞的正确时间顺序。", + "A": "膈肌，眼轮匝肌，拇指", + "B": "眼轮匝肌，膈肌，拇指", + "C": "眼轮匝肌，拇指，膈肌", + "D": "眼轮匝肌与膈肌相同，拇指" + } + }, + { + "id": "299c3162-be5a-51fd-94a2-375818d63da6", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Select the TRUE statement regarding interaction of nondepolarizing neuromuscular blocking drugs when durations of action are dissimilar.", + "A": "If a long-acting drug is administered after an intermediateacting drug, the duration of the long-acting drug will be longer than normal", + "B": "If a long-acting drug is administered after an intermediateacting drug, the duration of the long-acting drug will be about the same as expected", + "C": "If an intermediate-acting drug is administered after a longacting drug, the duration of the intermediate-acting drug will be about the same as expected", + "D": "If an intermediate-acting drug is administered after a longacting drug, the duration of action of the intermediate-acting drug will be longer than expected" + }, + "zh": { + "question": "选择关于非去极化神经肌肉阻滞药物在作用时间不同情况下相互作用的正确陈述。", + "A": "如果在中效药物之后给予长效药物，长效药物的作用时间将比正常时间更长", + "B": "如果在中效药物之后给予长效药物，长效药物的作用时间将与预期大致相同", + "C": "如果在长效药物之后给予中效药物，中效药物的作用时间将与预期大致相同", + "D": "如果在长效药物之后给予中效药物，中效药物的作用时间将比预期更长" + } + }, + { + "id": "fc834ce0-8bd7-5f81-a7fb-295e986bedf5", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Select the correct statement regarding the effects of volatile anesthetics on nondepolarizing neuromuscular blocking drugs and the reversal agents.", + "A": "Volatile anesthetics potentiate neuromuscular blockade but retard reversal agents", + "B": "Volatile anesthetics potentiate both neuromuscular blocking drugs and reversal agents", + "C": "Volatile anesthetics retard both neuromuscular blocking drugs and reversal agents", + "D": "Volatile anesthetics retard neuromuscular blocking drugs but potentiate reversal agents" + }, + "zh": { + "question": "选择关于挥发性麻醉药对非去极化神经肌肉阻滞药和拮抗剂影响的正确陈述。", + "A": "挥发性麻醉药增强神经肌肉阻滞作用但延缓拮抗剂的作用", + "B": "挥发性麻醉药同时增强神经肌肉阻滞药和拮抗剂的作用", + "C": "挥发性麻醉药同时延缓神经肌肉阻滞药和拮抗剂的作用", + "D": "挥发性麻醉药延缓神经肌肉阻滞药但增强拮抗剂的作用" + } + }, + { + "id": "08ac173d-edfb-5be6-8653-0d797b485fa1", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Meperidine is contraindicated in patients taking which of the following", + "A": "Bromocriptine", + "B": "Trihexyphenidyl (Artane)", + "C": "Selegiline (Eldepryl)", + "D": "Amantadine (Symmetrel)" + }, + "zh": { + "question": "哌替啶在服用下列哪种药物的患者中禁忌使用", + "A": "溴隐亭", + "B": "苯海索 (Artane)", + "C": "司来吉兰 (Eldepryl)", + "D": "金刚烷胺 (Symmetrel)" + } + }, + { + "id": "df8a5bdf-ed37-5955-a7f5-23c27d51e20b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Emergence delirium (ED) occurs most often with", + "A": "Sevoflurane", + "B": "Desflurane", + "C": "Ketamine", + "D": "Propofol" + }, + "zh": { + "question": "苏醒期谵妄（ED）最常发生于", + "A": "七氟醚", + "B": "地氟醚", + "C": "氯胺酮", + "D": "丙泊酚" + } + }, + { + "id": "115a3920-a623-5c7e-a4c2-628fb234db4b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The most common reason for patients to rate anesthesia with etomidate as unsatisfactory is", + "A": "PONV", + "B": "Pain on injection", + "C": "Recall of intubation", + "D": "Postoperative hiccups" + }, + "zh": { + "question": "患者对依托咪酯麻醉评价不满意的最常见原因是", + "A": "术后恶心呕吐", + "B": "注射时疼痛", + "C": "插管回忆", + "D": "术后打嗝" + } + }, + { + "id": "66c7489f-ffd7-544f-b207-6a593f36948c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following muscle relaxants inhibits the reuptake of norepinephrine by the adrenergic nerves?", + "A": "Pancuronium", + "B": "Vecuronium", + "C": "Rocuronium", + "D": "Atracurium" + }, + "zh": { + "question": "以下哪种肌松剂通过肾上腺素能神经抑制去甲肾上腺素的再摄取？", + "A": "潘库溴铵", + "B": "维库溴铵", + "C": "罗库溴铵", + "D": "阿曲库铵" + } + }, + { + "id": "5aacfb19-00cd-5619-82d0-78013109c6b8", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The most common side effect of oral dantrolene used to prevent MH is", + "A": "Nausea and vomiting", + "B": "Muscle weakness", + "C": "Blurred vision", + "D": "Tachycardia" + }, + "zh": { + "question": "口服丹曲林用于预防恶性高热的最常见副作用是", + "A": "恶心和呕吐", + "B": "肌肉无力", + "C": "视力模糊", + "D": "心动过速" + } + }, + { + "id": "decd7aba-a383-5f43-8d86-c82f16473fc7", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 65-year-old patient is admitted for right upper quadrant pain. Acute cholecystitis is diagnosed, and laparoscopic cholecystectomy planned. The patient has no major medical problems other than type 2 diabetes, for which she takes metformin, and depression, for which she takes paroxetine (selective serotonin reuptake inhibitor [SSRI]). Which of the following best describes the rationale for discontinuation of metformin 48 hours before surgery?", + "A": "Risk of metabolic acidosis", + "B": "Risk of hypoglycemia", + "C": "Risk of serotonin syndrome", + "D": "None of the above" + }, + "zh": { + "question": "一名65岁的患者因右上腹痛入院。诊断为急性胆囊炎，计划进行腹腔镜胆囊切除术。除2型糖尿病（服用二甲双胍）和抑郁症（服用帕罗西汀，选择性5-羟色胺再摄取抑制剂[SSRI]）外，患者没有其他重大健康问题。以下哪项最能描述在手术前48小时停用二甲双胍的理由？", + "A": "代谢性酸中毒的风险", + "B": "低血糖的风险", + "C": "5-羟色胺综合征的风险", + "D": "以上都不是" + } + }, + { + "id": "422a6fd0-7ff0-5d88-ad8a-798b7c6bedb0", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 37-year-old man is brought to the operating room for repair of a broken mandible sustained in a motor vehicle accident. No other injuries are significant. The patient has been in treatment for alcohol abuse and takes disulfiram and naltrexone. Which of the following would be the best technique for management of this patient's postoperative pain?", + "A": "Continue naltrexone with round-the-clock low-dose methadone", + "B": "Continue naltrexone with small doses of morphine every 4 hours as needed", + "C": "Continue naltrexone with small doses of nalbuphine every 4 hours as needed", + "D": "Discontinue naltrexone and treat pain with morphine as needed" + }, + "zh": { + "question": "一名37岁的男性因在机动车事故中下颌骨骨折被送入手术室进行修复。没有其他显著伤害。患者正在接受酒精滥用治疗，并服用双硫仑和纳曲酮。以下哪种方法是管理该患者术后疼痛的最佳技术？", + "A": "继续使用纳曲酮，并全天候低剂量使用美沙酮", + "B": "继续使用纳曲酮，并每4小时根据需要小剂量使用吗啡", + "C": "继续使用纳曲酮，并每4小时根据需要小剂量使用纳布啡", + "D": "停止使用纳曲酮，并根据需要使用吗啡治疗疼痛" + } + }, + { + "id": "3d7627cc-edab-54be-8ee4-86e11b6e4cd4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Context sensitive half-time for a pharmacologic agent is most closely related its", + "A": "Lipid solubility", + "B": "Duration of administration", + "C": "Concentration", + "D": "Route of administration" + }, + "zh": { + "question": "药理剂的上下文敏感半衰期最密切相关于其", + "A": "脂溶性", + "B": "给药持续时间", + "C": "浓度", + "D": "给药途径" + } + }, + { + "id": "3d51b85b-2759-54fe-8449-e8dfe048447e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The neuromuscular effects of an intubation dose of vecuronium are terminated by", + "A": "Diffusion from the neuromuscular junction back into the plasma", + "B": "Nonspecific plasma cholinesterases", + "C": "The kidneys", + "D": "The liver" + }, + "zh": { + "question": "插管剂量的维库溴铵的神经肌肉效应终止于", + "A": "从神经肌肉接头扩散回血浆", + "B": "非特异性血浆胆碱酯酶", + "C": "肾脏", + "D": "肝脏" + } + }, + { + "id": "e351ad31-8204-58fd-aa93-da6874fcce8d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Respiratory depression produced by which of the following analgesics is not readily reversed by administration of naloxone?", + "A": "Meperidine", + "B": "Methadone", + "C": "Hydromorphone", + "D": "Buprenorphine" + }, + "zh": { + "question": "下列哪种镇痛药引起的呼吸抑制不易通过纳洛酮逆转？", + "A": "哌替啶", + "B": "美沙酮", + "C": "氢吗啡酮", + "D": "丁丙诺啡" + } + }, + { + "id": "91e7ccb2-efc1-50d1-9705-140c258e3dc1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following intravenous anesthetic agents is associated with the highest incidence of nausea and vomiting?", + "A": "Midazolam", + "B": "Etomidate", + "C": "Ketamine", + "D": "Propofol" + }, + "zh": { + "question": "以下哪种静脉麻醉药与最高的恶心和呕吐发生率相关？", + "A": "咪达唑仑", + "B": "依托咪酯", + "C": "氯胺酮", + "D": "丙泊酚" + } + }, + { + "id": "ec1c6c8e-fde9-5509-99b4-7484ba989e37", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "If naloxone were administered to a patient who is receiving ketorolac for postoperative pain, the most likely result would be", + "A": "Bradycardia", + "B": "Hypotension", + "C": "Pain", + "D": "None of the above" + }, + "zh": { + "question": "如果对正在接受酮咯酸治疗术后疼痛的患者给予纳洛酮，最可能的结果是", + "A": "心动过缓", + "B": "低血压", + "C": "疼痛", + "D": "以上都不是" + } + }, + { + "id": "df2d4e7a-fe8b-527c-a69d-7a9fdd10772f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which drug produces strong pulmonary arterial dilation with the least amount of systemic artery dilation?", + "A": "Nitroprusside", + "B": "Prostaglandin E1", + "C": "Phentolamine", + "D": "Nitric oxide" + }, + "zh": { + "question": "哪种药物在引起强烈的肺动脉扩张的同时，导致全身动脉扩张最少？", + "A": "硝普钠", + "B": "前列腺素E1", + "C": "酚妥拉明", + "D": "一氧化氮" + } + }, + { + "id": "88184fc0-b7a4-5779-a813-ba93247be320", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The action of succinylcholine at the neuromuscular junction is terminated by which mechanism?", + "A": "Hydrolysis by pseudocholinesterase", + "B": "Diffusion into extracellular fluid", + "C": "Reuptake into nerve tissue", + "D": "Reuptake into muscle tissue" + }, + "zh": { + "question": "琥珀胆碱在神经肌肉接头的作用是通过哪种机制终止的？", + "A": "假性胆碱酯酶水解", + "B": "扩散到细胞外液", + "C": "重新摄取到神经组织", + "D": "重新摄取到肌肉组织" + } + }, + { + "id": "a42d7642-c060-5c96-bd35-f55fdf4d808d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The LEAST likely side effect of dexmedetomidine in a healthy patient", + "A": "Respiratory arrest", + "B": "Bradycardia", + "C": "Sinus arrest", + "D": "Hypotension" + }, + "zh": { + "question": "在健康患者中，右美托咪定最不可能出现的副作用是", + "A": "呼吸骤停", + "B": "心动过缓", + "C": "窦性停搏", + "D": "低血压" + } + }, + { + "id": "c899f28d-52ed-5906-bad3-9f38ce1f6fcf", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following signs is NOT seen in patients suffering from thyrotoxicosis in whom thyroid storm is suspected", + "A": "Tachycardia", + "B": "Altered consciousness", + "C": "Hypothermia", + "D": "Weakness" + }, + "zh": { + "question": "在怀疑甲状腺危象的甲亢患者中，以下哪一项不是常见症状？", + "A": "心动过速", + "B": "意识改变", + "C": "体温过低", + "D": "无力" + } + }, + { + "id": "161e3c7d-43f1-5a26-bb64-4a0178e0ffa5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following features of chronic morphine therapy is NOT subject to tolerance?", + "A": "Analgesia", + "B": "Respiratory depression", + "C": "Constipation", + "D": "All are subject to tolerance" + }, + "zh": { + "question": "以下哪项是慢性吗啡治疗不产生耐受性的特征？", + "A": "镇痛", + "B": "呼吸抑制", + "C": "便秘", + "D": "所有都产生耐受性" + } + }, + { + "id": "7fe35591-b10c-5a37-b96b-fe0dbc1f1341", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 78-year-old woman with a history of reactive airway disease takes cimetidine (Tagamet) 400 mg at night. An additional dose is given IV 30 minutes before induction of anesthesia for an exploratory laparotomy. Possible side effects associated with this drug include all of the following EXCEPT", + "A": "Bradycardia", + "B": "Delayed awakening", + "C": "Confusion", + "D": "Increased metabolism of diazepam" + }, + "zh": { + "question": "一名78岁的女性有反应性气道疾病史，晚上服用西咪替丁（Tagamet）400 mg。在麻醉诱导前30分钟，额外剂量通过静脉注射给药，用于探查性剖腹手术。与该药物相关的可能副作用包括以下所有情况，除了", + "A": "心动过缓", + "B": "苏醒延迟", + "C": "意识混乱", + "D": "地西泮代谢增加" + } + }, + { + "id": "0229d493-9767-5823-aeb8-f717c0a7837f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Intraoperative allergic reactions are LEAST common after patient exposure to", + "A": "Ketamine", + "B": "Latex", + "C": "Muscle relaxants", + "D": "Hydroxyethyl starch" + }, + "zh": { + "question": "术中过敏反应最不常见于患者接触以下哪种物质后", + "A": "氯胺酮", + "B": "乳胶", + "C": "肌肉松弛剂", + "D": "羟乙基淀粉" + } + }, + { + "id": "f6e847da-a045-54a1-a242-9e6e572ff9e9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following medications would be useful in the definitive treatment of sarin nerve gas poisoning?", + "A": "Sodium nitroprusside", + "B": "Methylene blue", + "C": "Atropine", + "D": "All the above are useful" + }, + "zh": { + "question": "以下哪种药物可用于沙林神经毒气中毒的最终治疗？", + "A": "硝普钠", + "B": "亚甲蓝", + "C": "阿托品", + "D": "以上都是有用的" + } + }, + { + "id": "266f183c-34ea-5596-9918-ff645f47a386", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Alfentanil", + "A": "Has a more rapid onset of action compared with fentanyl", + "B": "Has a longer duration of action compared with fentanyl", + "C": "Is 250 times more potent than fentanyl", + "D": "Is excreted unchanged in the urine" + }, + "zh": { + "question": "阿芬太尼", + "A": "与芬太尼相比，起效更快", + "B": "与芬太尼相比，作��时间更长", + "C": "效力是芬太尼的250倍", + "D": "以原形从尿液中排出" + } + }, + { + "id": "3a26e7c7-09e0-5d75-bd9f-1712d0ca6799", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following medications is NOT useful in the immediate management of status asthmaticus?", + "A": "Terbutaline", + "B": "Subcutaneous (SQ) epinephrine", + "C": "Magnesium sulfate", + "D": "Cromolyn" + }, + "zh": { + "question": "以下哪种药物在哮喘持续状态的即时处理上无效？", + "A": "特布他林", + "B": "皮下注射肾上腺素", + "C": "硫酸镁", + "D": "色甘酸钠" + } + }, + { + "id": "2c36df4f-e115-5f8f-836b-9021b9404073", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Clonidine", + "A": "Is an α2 blocker", + "B": "Increases CNS sympathetic response to painful stimuli", + "C": "Can be given orally as well as intravenously, but notepidurally or intrathecally", + "D": "Decreases postanesthetic shivering" + }, + "zh": { + "question": "可乐定", + "A": "是α2受体阻滞剂", + "B": "增加中枢神经系统对疼痛刺激的交感反应", + "C": "可以口服或静脉注射，但不能硬膜外或鞘内注射", + "D": "减少术后寒战" + } + }, + { + "id": "d6001d54-702d-5223-b53d-9f2911b5b323", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The plasma half-time of which of the following drugs is prolonged in patients with end-stage cirrhotic liver disease?", + "A": "Diazepam", + "B": "Pancuronium", + "C": "Alfentanil", + "D": "All are prolonged" + }, + "zh": { + "question": "以下哪种药物在终末期肝硬化患者中血浆半衰期延长？", + "A": "地西泮", + "B": "潘库溴铵", + "C": "阿芬太尼", + "D": "以上均延长" + } + }, + { + "id": "314cafa0-c2e5-52ac-a6cd-e6afe7b9da14", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 24-year-old, 100-kg patient is brought to the emergency room by the fire department after suffering smoke inhalation and third-degree burns on the abdomen, chest, and thighs 30 minutes earlier. The best muscle relaxant choice for the most rapid intubation would be", + "A": "2 mg vecuronium followed by succinylcholine", + "B": "1 mg of vecuronium, then 2 to 4 minutes later, 9 mg vecuronium", + "C": "Rocuronium", + "D": "Succinylcholine" + }, + "zh": { + "question": "一名24岁、100公斤的患者在30分钟前因吸入烟雾和腹部、胸部及大腿的三度烧伤被消防部门送到急诊室。为了实现最快速的插管，最佳的肌肉松弛剂选择是", + "A": "2毫克维库溴铵后接琥珀胆碱", + "B": "1毫克维库溴铵，然后2到4分钟后，9毫克维库溴铵", + "C": "罗库溴铵", + "D": "琥珀胆碱" + } + }, + { + "id": "372190c4-1a90-53b3-a91b-0f4d43881a45", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Clonidine is useful in each of the following applications EXCEPT", + "A": "Reducing BP with pheochromocytoma", + "B": "Treatment of postoperative shivering", + "C": "Protection against perioperative myocardial ischemia", + "D": "As an agent for prolonging a bupivacaine spinal" + }, + "zh": { + "question": "可乐定在以下应用中均有用，除了", + "A": "降低嗜铬细胞瘤患者的血压", + "B": "治疗术后寒战", + "C": "预防围手术期心肌缺血", + "D": "作为延长布比卡因脊髓麻醉的药物" + } + }, + { + "id": "09c08768-f279-55d4-a779-113c28ec532d", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 79-year-old man is brought to the operating room for elective repair of bilateral inguinal hernias. The patient has a history of awareness during general anesthesia and refuses regional anesthesia. The patient is preoxygenated before induction of general anesthesia; 5 mg of midazolam and 250 mg of fentanyl are administered. One minute later the patient loses consciousness, and chest wall stiffness develops to the extent that positive-pressure ventilation is very difficult. The most appropriate therapy for reversal of chest wall stiffness at this point could include", + "A": "Flumazenil", + "B": "Naloxone", + "C": "Succinylcholine", + "D": "Albuterol" + }, + "zh": { + "question": "一名79岁的男性被送入手术室进行双侧腹股沟疝的择期修复。患者有全身麻醉期间意识清醒的病史，并拒绝区域麻醉。患者在全身麻醉诱导前进行了预氧化；给予5毫克咪达唑仑和250毫克芬太尼。一分钟后，患者失去意识，并出现胸壁僵硬，以至于正压通气非常困难。此时逆转胸壁僵硬的最合适疗法可能包括", + "A": "氟马西尼", + "B": "纳洛酮", + "C": "琥珀胆碱", + "D": "沙丁胺醇" + } + }, + { + "id": "a5d42527-aa97-5609-932d-5813f485957b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Respiratory depression is LEAST after the induction dose of which of the following drugs?", + "A": "Etomidate", + "B": "Ketamine", + "C": "Fentanyl", + "D": "Propofol" + }, + "zh": { + "question": "在以下哪种药物的诱导剂量后，呼吸抑制最少？", + "A": "依托咪酯", + "B": "氯胺酮", + "C": "芬太尼", + "D": "丙泊酚" + } + }, + { + "id": "863eeecd-61ad-5b94-8e0e-b7ec38b24fc3", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 64-year-old man with colon cancer is anesthetized for hepatic resection of liver metastases. Medical history is significant for ileal conduit surgery for bladder cancer, diabetes treated with glyburide, 50 pack-per-year smoking history, and family history of Malignant hyperthermia. Anesthesia is provided with morphine, midazolam, oxygen, and a propofol infusion. After a 3-unit packed red blood cell (RBC) transfusion and 8 hours of surgery, the following blood gas values are recorded: pH 7.2, CO2 34, [HCO3 − ] 14, base deficit −13, [Na + ] 135, [K+ ] 5, [Cl − ] 95, glucose 240 mg/dL. The most likely cause of this patient's acidosis is", + "A": "Excessive infusion of normal saline", + "B": "Renal tubular acidosis", + "C": "Propofol infusion syndrome", + "D": "Diabetic ketoacidosis (DKA)" + }, + "zh": { + "question": "一名64岁的结肠癌男性患者因肝转移进行肝切除术而接受麻醉。病史包括因膀胱癌进行的回肠导管手术、使用格列本脲治疗的糖尿病、50包/年的吸烟史，以及恶性高热的家族史。麻醉使用吗啡、咪达唑仑、氧气和丙泊酚输注。在输注3个单位的浓缩红细胞（RBC）和8小时的手术后，记录的血气值如下：pH 7.2，CO2 34，[HCO3 − ] 14，碱剩余 −13，[Na + ] 135，[K+ ] 5，[Cl − ] 95，葡萄糖 240 mg/dL。该患者酸中毒的最可能原因是", + "A": "过量输注生理盐水", + "B": "肾小管性酸中毒", + "C": "丙泊酚输注综合征", + "D": "糖尿病酮症酸中毒（DKA）" + } + }, + { + "id": "997c4b45-e59d-568a-a615-37da0fe3d18e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Treatment of neuroleptic malignant syndrome (NMS) may be carried out with administration of the following drugs EXCEPT", + "A": "Amantadine", + "B": "Dantrolene", + "C": "Bromocriptine", + "D": "Physostigmine" + }, + "zh": { + "question": "治疗神经阻滞剂恶性综合征（NMS）可以通过以下药物进行，除了", + "A": "金刚烷胺", + "B": "丹曲林", + "C": "溴隐亭", + "D": "毒扁豆碱" + } + }, + { + "id": "21ef59ab-9b7e-5517-8d5a-66c363ffc7c7", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient with a normal quantity of pseudocholinesterase (plasma cholinesterase) has a dibucaine number of 57. A 1 mg/kg dose of intravenous succinylcholine would likely result in", + "A": "Hyperkalemic cardiac arrest", + "B": "Paralysis lasting 5 to 10 minutes", + "C": "Paralysis lasting 20 to 30 minutes", + "D": "Paralysis lasting more than 1 to 3 hours" + }, + "zh": { + "question": "一名患者具有正常数量的假胆碱酯酶（血浆胆碱酯酶），其地布卡因数为57。1 mg/kg剂量的静脉注射琥珀胆碱可能导致", + "A": "高钾性心脏骤停", + "B": "瘫痪持续5到10分钟", + "C": "瘫痪持续20到30分钟", + "D": "瘫痪持续超过1到3小时" + } + }, + { + "id": "cb600a06-cac4-5da9-a8fe-4793198b09b7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Aprepitant exerts its pharmacologic effect by interaction with which receptor?", + "A": "Neurokinin-1 (NK1 )", + "B": "5-HT3", + "C": "Histamine (H1 )", + "D": "Dopamine (D2 )" + }, + "zh": { + "question": "阿瑞匹坦通过与哪种受体相互作用来发挥其药理作用？", + "A": "神经激肽-1 (NK1)", + "B": "5-HT3", + "C": "组胺 (H1)", + "D": "多巴胺 (D2)" + } + }, + { + "id": "6e7c0435-76ba-537e-972f-44583b7bc08c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A prolonged neuromuscular block with succinylcholine can be seen in all of the following patients EXCEPT those", + "A": "Chronically exposed to malathion", + "B": "Treated with echothiophate for glaucoma", + "C": "Treated with cyclophosphamide for metastatic cancer", + "D": "Having a C5 isoenzyme variant" + }, + "zh": { + "question": "以下患者中，除了哪一类患者外，其他患者都可能出现琥珀胆碱引起的延长神经肌肉阻滞？", + "A": "长期接触马拉硫磷", + "B": "因青光眼接受依可硫磷治疗", + "C": "因转移性癌症接受环磷酰胺治疗", + "D": "具有C5同工酶变异" + } + }, + { + "id": "c557efe4-8c04-5872-9a76-c49e63a305dd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning midazolam is FALSE?", + "A": "Midazolam has greater amnestic than sedative properties", + "B": "Its breakdown is inhibited by cimetidine", + "C": "It produces retrograde amnesia", + "D": "It facilitates the actions of the inhibitory neurotransmitter γaminobutyric acid (GABA) in the CNS" + }, + "zh": { + "question": "以下关于咪达唑仑的陈述中哪一项是错误的？", + "A": "咪达唑仑的遗忘作用大于镇静作用", + "B": "西咪替丁抑制其分解", + "C": "它会产生逆行性遗忘", + "D": "它促进中枢神经系统中抑制性神经递质γ-氨基丁酸（GABA）的作用" + } + }, + { + "id": "d8563270-6af2-5574-a59d-96e80bd2d0ca", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "After a 2-hour vertical gastric banding procedure under desflurane, oxygen, and remifentanil anesthesia, the trocar is removed and the wound is closed. Upon emergence, the most likely scenario is", + "A": "Adequate analgesia for 2 hours", + "B": "Delayed emergence from narcotic", + "C": "Pain", + "D": "Respiratory depression in postanesthesia care unit (PACU)" + }, + "zh": { + "question": "在使用地氟醚、氧气和瑞芬太尼麻醉进行2小时的垂直胃束带手术后，取出套管并关闭伤口。苏醒时，最可能的情况是", + "A": "2小时的充分镇痛", + "B": "麻醉药物导致的苏醒延迟", + "C": "疼痛", + "D": "在麻醉后护理单元（PACU）出现呼吸抑制" + } + }, + { + "id": "1d8d3d58-2ec6-5c84-8fe2-0e3eab1089e9", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "An oral surgeon is about to perform a full mouth extraction on a 70-kg, 63-year-old man under conscious sedation. What is the maximum dose of lidocaine with epinephrine that he can safely infiltrate?", + "A": "200 mg", + "B": "300 mg", + "C": "400 mg", + "D": "500 mg" + }, + "zh": { + "question": "一位口腔外科医生即将在一名70公斤、63岁的男性患者身上进行全口拔牙手术，并采用清醒镇静。该医生可以安全浸润的利多卡因与肾上腺素的最大剂量是多少？", + "A": "200 毫克", + "B": "300 毫克", + "C": "400 毫克", + "D": "500 毫克" + } + }, + { + "id": "20fcb5e4-48c8-5f77-9a9f-f27d5d15d2c1", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Postanesthetic shivering can be treated with all of the following EXCEPT", + "A": "Naloxone", + "B": "Physostigmine", + "C": "Magnesium sulfate", + "D": "Dexmedetomidine" + }, + "zh": { + "question": "术后寒战可以用以下所有方法治疗，除了", + "A": "纳洛酮", + "B": "毒扁豆碱", + "C": "硫酸镁", + "D": "右美托咪定" + } + }, + { + "id": "25d5b321-0618-51ba-8962-40eb4469ab03", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The main disadvantage of Sugammadex compared with neostigmine is", + "A": "Recurarization", + "B": "Contraindicated with renal failure", + "C": "Not effective with benzylisoquinolinium relaxants", + "D": "High incidence of allergic reactions" + }, + "zh": { + "question": "与新斯的明相比，舒更葡糖的主要缺点是", + "A": "再麻醉", + "B": "肾功能衰竭时禁用", + "C": "对苄基异喹啉类肌松药无效", + "D": "过敏反应发生率高" + } + }, + { + "id": "cf95aba4-7432-5290-879a-38b5c0863af9", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the biologic substances listed below is by itself the greatest determinant of serum osmolality?", + "A": "AVP (arginine vasopressin)", + "B": "Angiotensin I", + "C": "Aldosterone", + "D": "Renal prostaglandins (PGE2 )" + }, + "zh": { + "question": "在下列生物物质中，哪一种本身是血清渗透压的最大决定因素？", + "A": "AVP（精氨酸加压素）", + "B": "血管紧张素 I", + "C": "醛固酮", + "D": "肾脏前列腺素（PGE2）" + } + }, + { + "id": "59c6e720-3bc7-50b9-9c71-73546bd4a3cf", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Remimazolam", + "A": "Is less potent than its main metabolite", + "B": "Is suitable for patients with liver disease", + "C": "Is metabolized rapidly by amine precursor uptake and decarboxylation (APUD) cells in the gastrointestinal (GI) tract", + "D": "Is a commercially available mixture of remifentanil plus midazolam" + }, + "zh": { + "question": "瑞米唑仑", + "A": "比其主要代谢产物效力低", + "B": "适用于肝病患者", + "C": "在胃肠道的胺前体摄取和脱羧（APUD）细胞中快速代谢", + "D": "是瑞芬太尼和咪达唑仑的商业混合物" + } + }, + { + "id": "3850ea58-6275-538f-a433-4c3afbc5f51e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Important interactions involving chlorpromazine include all of the", + "A": "Potentiation of the depressant effects of narcotics", + "B": "Lowering of the seizure threshold", + "C": "Prolongation of the QT interval", + "D": "Potentiation of neuromuscular blockade" + }, + "zh": { + "question": "氯丙嗪的重要相互作用包括以下所有选项", + "A": "增强麻醉药的抑制作用", + "B": "降低癫痫发作阈值", + "C": "延长QT间期", + "D": "增强神经肌肉阻滞作用" + } + }, + { + "id": "aa84ae40-9a68-5a9e-95e3-4bdb28488b5d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Amrinone", + "A": "Is a positive inotropic drug", + "B": "Is antagonized by esmolol", + "C": "Is a vasoconstrictor", + "D": "All the above" + }, + "zh": { + "question": "氨力农", + "A": "是一种正性肌力药", + "B": "被艾司洛尔拮抗", + "C": "是一种血管收缩剂", + "D": "以上全部" + } + }, + { + "id": "39a9a323-83de-548c-916c-aa110e2ea99c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which statement concerning tricyclic antidepressants in patients receiving general anesthesia is TRUE?", + "A": "They should be discontinued 2 weeks before elective operations", + "B": "They may decrease the requirement for volatile anesthetics (decrease MAC)", + "C": "Meperidine may produce hyperpyrexia in patients taking tricyclic antidepressants", + "D": "They may exaggerate the response to ephedrine" + }, + "zh": { + "question": "关于接受全身麻醉的患者使用三环类抗抑郁药，以下哪项陈述是正确的？", + "A": "应在择期手术前2周停用", + "B": "可能会减少挥发性麻醉药的需求（降低MAC）", + "C": "哌替啶可能在服用三环类抗抑郁药的患者中引起高热", + "D": "可能会加重对麻黄碱的反应" + } + }, + { + "id": "d9282a8c-09ee-57e3-95ff-4461b9070272", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following types of insulin preparations has the fastest onset of action if administered subcutaneously?", + "A": "Glargine (Lantus)", + "B": "Lispro (Humalog)", + "C": "Regular (Humulin-R)", + "D": "NPH (Humulin-N)" + }, + "zh": { + "question": "以下哪种胰岛素制剂皮下注射后起效最快？", + "A": "甘精胰岛素（来得时）", + "B": "赖脯胰岛素（优泌乐）", + "C": "常规胰岛素（优泌林-R）", + "D": "NPH胰岛素（优泌林-N）" + } + }, + { + "id": "c0c616b7-28db-5efe-a7de-429faefce398", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following mechanisms best explains the anticoagulative properties of tirofiban?", + "A": "Cyclooxygenase (COX) inhibition", + "B": "Interaction with von Willebrand factor (vWF)", + "C": "Interaction with antithrombin III", + "D": "Enhanced anti-Xa activity" + }, + "zh": { + "question": "下列哪种机制最能解释替罗非班的抗凝特性？", + "A": "环氧合酶（COX）抑制", + "B": "与血管性血友病因子（vWF）相互作用", + "C": "与抗凝血酶III相互作用", + "D": "增强抗Xa活性" + } + }, + { + "id": "b8adc1fd-8918-5568-bd91-79a7910cc261", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The duration of action of remifentanil is attributable to which mode of metabolism?", + "A": "Spontaneous degradation in blood (Hofmann elimination)", + "B": "Hydrolysis by nonspecific plasma esterases", + "C": "Hydrolysis by pseudocholinesterase", + "D": "Rapid metabolism in the large intestine" + }, + "zh": { + "question": "瑞芬太尼的作用持续时间归因于哪种代谢方式？", + "A": "在血液中自发降解（霍夫曼消除）", + "B": "由非特异性血浆酯酶水解", + "C": "由假胆碱酯酶水解", + "D": "在大肠中快速代谢" + } + }, + { + "id": "e8c06a11-417b-591e-a557-ebd39bdad474", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Pain at the intravenous site is LEAST with which IV drug?", + "A": "Diazepam", + "B": "Etomidate", + "C": "Ketamine", + "D": "Propofol" + }, + "zh": { + "question": "哪种静脉注射药物在注射部位引起的疼痛最少？", + "A": "地西泮", + "B": "依托咪酯", + "C": "氯胺酮", + "D": "丙泊酚" + } + }, + { + "id": "c4e89e85-6cfa-5f5b-9ce8-76a0f8aff96b", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 35-year-old patient with a history of grand mal seizures is anesthetized for thyroid biopsy under general anesthesia consisting of 4 mg midazolam with infusion of propofol (150 μg/kg/min) and remifentanil (1 μg/kg/min). The patient takes phenytoin for control of seizures. After 30 minutes, the infusion is stopped and the patient is transported intubated to the recovery room, where he is arousable but not breathing. The most reasonable course of action would be", + "A": "Administer naloxone", + "B": "Administer flumazenil", + "C": "Administer naloxone and flumazenil", + "D": "Ventilate by hand" + }, + "zh": { + "question": "一名35岁的患者有大发作癫痫病史，在全身麻醉下进行甲状腺活检，麻醉方案包括4毫克咪达唑仑、丙泊酚（150 μg/kg/min）和瑞芬太尼（1 μg/kg/min）的输注。患者服用苯妥英钠控制癫痫发作。30分钟后，停止输注，患者被插管转运到恢复室，在那里他可以被唤醒但没有呼吸。最合理的行动方案是", + "A": "给予纳洛酮", + "B": "给予氟马西尼", + "C": "给予纳洛酮和氟马西尼", + "D": "手动通气" + } + }, + { + "id": "9421461c-9c7a-5fa1-8650-77672a6763cb", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following α-antagonists produces an irreversible blockade?", + "A": "Phentolamine", + "B": "Prazosin", + "C": "Phenoxybenzamine", + "D": "Labetalol" + }, + "zh": { + "question": "以下哪种α-拮抗剂产生不可逆阻滞？", + "A": "酚妥拉明", + "B": "哌唑嗪", + "C": "苯氧苄胺", + "D": "拉贝洛尔" + } + }, + { + "id": "1bfd296f-a27b-5bfa-a7b0-c64b3ff11312", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following drugs should NOT be used in the treatment of severe bradycardia induced by an excess of the beta-adrenergic receptor blockade as a result from a propranolol overdose?", + "A": "Atropine", + "B": "Isoproterenol", + "C": "Dopamine", + "D": "Glucagon" + }, + "zh": { + "question": "以下哪种药物不应用于治疗因普萘洛尔过量导致的β-肾上腺素能受体阻滞引起的严重心动过缓？", + "A": "阿托品", + "B": "异丙肾上腺素", + "C": "多巴胺", + "D": "胰高血糖素" + } + }, + { + "id": "29f04fcd-303e-5a38-919a-7a3192aa875e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A dose of 150 mg of IV dantrolene is administered to a 24-year-old, 75 kg man in whom incipient MH is suspected. An expected consequence of this therapy would be", + "A": "Muscle spasticity in the postoperative period", + "B": "Hypothermia", + "C": "Cardiac dysrhythmias", + "D": "Diuresis" + }, + "zh": { + "question": "对一名24岁、75公斤的男性怀疑发生早期恶性高热，给予150毫克静脉注射丹曲林。此治疗的预期后果是", + "A": "术后肌肉痉挛", + "B": "体温过低", + "C": "心律失常", + "D": "利尿" + } + }, + { + "id": "fa401710-3e9e-5771-9171-bcc9e459962d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Atracurium differs from cisatracurium in which way?", + "A": "Molecular weight", + "B": "Formation of laudanosine", + "C": "Histamine release", + "D": "No renal metabolism" + }, + "zh": { + "question": "阿曲库铵与顺式阿曲库铵有何不同？", + "A": "分子量", + "B": "劳丹苷的形成", + "C": "组胺释放", + "D": "无肾脏代谢" + } + }, + { + "id": "4fb34f12-ce67-5344-88de-86f45ea108a2", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Signs and symptoms of opioid withdrawal include all of the following", + "A": "Increased BP and heart rate", + "B": "Seizures", + "C": "Abdominal cramps", + "D": "Jerking of the legs# Pharmacology and Pharmacokinetics of Intravenous Drugs" + }, + "zh": { + "question": "阿片类药物戒断的体征和症状包括以下所有选项", + "A": "血压和心率增加", + "B": "癫痫发作", + "C": "腹部痉挛", + "D": "腿部抽动# 静脉药物的药理学和药代动力学" + } + }, + { + "id": "e114f219-e519-53a4-8b4e-be506fc87f8d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The minimum alveolar concentration (MAC) is highest in neonates (0- 30 days old) versus other age groups with which of the following?", + "A": "Isoflurane", + "B": "Sevoflurane", + "C": "Desflurane", + "D": "N2O" + }, + "zh": { + "question": "与其他年龄组相比，新生儿（0-30天）的最低肺泡浓度（MAC）在哪种情况下最高？", + "A": "异氟醚", + "B": "七氟醚", + "C": "地氟醚", + "D": "氧化亚氮" + } + }, + { + "id": "84b37e0b-f283-535e-b96c-0a0880d29842", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The rate of increase in the alveolar concentration of a volatile anesthetic relative to the inspired concentration (FA/FI) plotted against time is steep during the first moments of inhalation, with all volatile anesthetics. The reason for this observation is that", + "A": "Volatile anesthetics reduce alveolar ventilation (Va)", + "B": "There is minimal anesthetic uptake from the alveoli into pulmonary venous blood", + "C": "Volatile anesthetics increase cardiac output initially", + "D": "The volume of the anesthetic breathing circuit is small" + }, + "zh": { + "question": "挥发性麻醉剂的肺泡浓度相对于吸入浓度（FA/FI）的增加速率在吸入的最初时刻随着时间的推移而陡峭，这种现象在所有挥发性麻醉剂中都存在。对此观察的原因是", + "A": "挥发性麻醉剂减少了肺泡通气量（Va）", + "B": "从肺泡到肺静脉血的麻醉剂摄取量很小", + "C": "挥发性麻醉剂最初增加心输出量", + "D": "麻醉呼吸回路的体积很小" + } + }, + { + "id": "6f226fcd-ac13-5090-a85b-183e08868b8e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "During spontaneous breathing, volatile anesthetics", + "A": "Increase tidal volume (Vt) and decrease respiratory rate", + "B": "Increase Vt and increase respiratory rate", + "C": "Decrease Vt and decrease respiratory rate", + "D": "Decrease Vt and increase respiratory rate" + }, + "zh": { + "question": "在自主呼吸期间，挥发性麻醉剂", + "A": "增加潮气量 (Vt) 并减少呼吸频率", + "B": "增加 Vt 并增加呼吸频率", + "C": "减少 Vt 并减少呼吸频率", + "D": "减少 Vt 并增加呼吸频率" + } + }, + { + "id": "2281c08e-dd1b-5221-ad57-c9aa59b5a1f1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following can NOT be considered an advantage of lowflow anesthesia?", + "A": "Conservation of fossil fuel", + "B": "Less ozone depletion", + "C": "Reduced room pollution", + "D": "Conservation of absorbent" + }, + "zh": { + "question": "以下哪项不能被视为低流量麻醉的优点？", + "A": "化石燃料的节约", + "B": "减少臭氧层破坏", + "C": "减少房间污染", + "D": "吸收剂的节约" + } + }, + { + "id": "99d0dc09-de47-5e14-9170-5a4ff529b902", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The main reason desflurane is not used for inhalation induction in clinical practice is because of", + "A": "Its low blood/gas partition coefficient", + "B": "Its propensity to produce hypertension in high concentrations", + "C": "Its propensity to produce airway irritability", + "D": "Its propensity to produce tachyarrhythmias" + }, + "zh": { + "question": "地氟醚在临床实践中不用于吸入诱导的主要原因是", + "A": "其低血/气分配系数", + "B": "其在高浓度下易引起高血压", + "C": "其易引起气道刺激", + "D": "其易引起心动过速性心律失常" + } + }, + { + "id": "c6fcd356-1155-558a-b126-26e9732cf9fd", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 24-year-old is undergoing open reduction of an ankle fracture under general anesthesia with sevoflurane, N2O, and O2 through a laryngeal mask airway (LMA). Just after the vaporizer dial is turned up to 2%, the patient begins spontaneously breathing, but the inspiratory valve is not fully closing. The likely result of this (malfunctioning valve) is an increase in the inspired concentration of", + "A": "N2O", + "B": "CO2", + "C": "O2", + "D": "All of the above" + }, + "zh": { + "question": "一名24岁的患者在全身麻醉下通过喉罩（LMA）进行踝关节骨折的开放复位，使用七氟醚、N2O和O2。就在蒸发器旋钮调至2%后，患者开始自主呼吸，但吸气阀未完全关闭。这种（阀门故障）的可能结果是吸入浓度增加的是", + "A": "N2O", + "B": "CO2", + "C": "O2", + "D": "以上全部" + } + }, + { + "id": "16dc4d35-f1c0-566e-b2ac-8310f4623b8c", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Select the TRUE statement regarding blood pressure when 1.5 MAC N2O-isoflurane is substituted for 1.5 MAC isoflurane-oxygen.", + "A": "Blood pressure is less than awake value but greater than that seen with isoflurane-O2", + "B": "Blood pressure is equal to awake value", + "C": "Blood pressure is greater than awake value", + "D": "Blood pressure is less than isoflurane-O2 pressure" + }, + "zh": { + "question": "选择关于当1.5 MAC N2O-异氟醚替代1.5 MAC 异氟醚-氧气时血压的正确陈述。", + "A": "血压低于清醒值但高于异氟醚-氧气时的值", + "B": "血压等于清醒值", + "C": "血压高于清醒值", + "D": "血压低于异氟醚-氧气时的血压" + } + }, + { + "id": "fc8e1026-5da9-5be1-bc7a-5d601acd20d6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following volatile anesthetics decreases systemic vascular resistance?", + "A": "Sevoflurane", + "B": "Isoflurane", + "C": "Desflurane", + "D": "All of the above" + }, + "zh": { + "question": "以下哪种挥发性麻醉剂可降低全身血管阻力？", + "A": "七氟醚", + "B": "异氟醚", + "C": "地氟醚", + "D": "以上全部" + } + }, + { + "id": "b959174d-1569-55df-9cc3-59d795833c86", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "With which of the following inhalational agents is cardiac output moderately increased?", + "A": "N2O", + "B": "Sevoflurane", + "C": "Desflurane", + "D": "Isoflurane" + }, + "zh": { + "question": "下列哪种吸入性麻醉剂会使心输出量适度增加？", + "A": "N2O", + "B": "七氟醚", + "C": "地氟醚", + "D": "异氟醚" + } + }, + { + "id": "0f52df3c-7cc4-5ea9-8507-2ece3262269e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Select the FALSE statement about isoflurane (≤ 1 MAC).", + "A": "May attenuate bronchospasm", + "B": "Increases right atrial pressure", + "C": "Decreases mean arterial pressure", + "D": "Decreases cardiac output" + }, + "zh": { + "question": "选择关于异氟醚（≤ 1 MAC）的错误陈述。", + "A": "可能减轻支气管痉挛", + "B": "增加右心房压力", + "C": "降低平均动脉压", + "D": "降低心输出量" + } + }, + { + "id": "f5c8b44f-9c71-5733-9b88-702e9c603cb4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Abrupt and large increases in the delivered concentration of which of the following inhalational anesthetics may produce transient increases in systemic blood pressure and heart rate?", + "A": "Desflurane", + "B": "Isoflurane", + "C": "Sevoflurane", + "D": "N2O" + }, + "zh": { + "question": "以下哪种吸入性麻醉剂的浓度突然大幅增加可能会导致全身血压和心率的短暂升高？", + "A": "地氟烷", + "B": "异氟烷", + "C": "七氟烷", + "D": "N2O" + } + }, + { + "id": "f7cd9e0f-2e00-53bb-adaa-bea772b8dbb2", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Discontinuation of 1 MAC of which volatile anesthetic followed by immediate introduction of 1 MAC of which second volatile anesthetic would temporarily result in the greatest combined anesthetic potency?", + "A": "Isoflurane followed by desflurane", + "B": "Sevoflurane followed by desflurane", + "C": "Desflurane followed by isoflurane", + "D": "Desflurane followed by sevoflurane" + }, + "zh": { + "question": "停止使用1 MAC的哪种挥发性麻醉剂后，立即引入1 MAC的哪种第二挥发性麻醉剂会暂时导致最大的联合麻醉效力？", + "A": "异氟醚后接七氟醚", + "B": "七氟醚后接地氟醚", + "C": "地氟醚后接异氟醚", + "D": "地氟醚后接七氟醚" + } + }, + { + "id": "2013028b-8fcf-5830-9f64-25ff853e9e64", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Cardiogenic shock has the greatest impact on the rate of increase in Fa/Fi for which of the following volatile anesthetics?", + "A": "Isoflurane", + "B": "Desflurane", + "C": "Sevoflurane", + "D": "N2O" + }, + "zh": { + "question": "心源性休克对下列哪种挥发性麻醉药的Fa/Fi增加率影响最大？", + "A": "异氟醚", + "B": "地氟醚", + "C": "七氟醚", + "D": "笑气" + } + }, + { + "id": "4d262d28-1c2a-5a4c-9857-c7e33b2d5547", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The vessel-rich group receives what percent of the cardiac output?", + "A": "45%", + "B": "60%", + "C": "75%", + "D": "90%" + }, + "zh": { + "question": "富血管组织群接收心输出量的百分比是多少？", + "A": "45%", + "B": "60%", + "C": "75%", + "D": "90%" + } + }, + { + "id": "c5645fcb-714e-55f5-a06e-520a24d71eb7", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "What percent desflurane is present in the vaporizing chamber of a desflurane vaporizer (pressurized to 1500 mm Hg and heated to 23° C)?", + "A": "Nearly 100%", + "B": "85%", + "C": "65%", + "D": "45%" + }, + "zh": { + "question": "在加压至1500 mm Hg并加热至23°C的地氟醚挥发器的挥发室中，地氟醚的百分比是多少？", + "A": "接近100%", + "B": "85%", + "C": "65%", + "D": "45%" + } + }, + { + "id": "f6fa22dd-1c4b-519c-b3e7-958e970a0199", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 25-year-old man is undergoing lymph node dissection for testicular cancer under general anesthesia. He has received four courses of bleomycin. The sevoflurane vaporizer is set at 1.8%, the oxygen at 100 mL/min, and air at 900/mL/min. The Fio2 of the fresh gas flow is", + "A": "26%", + "B": "29%", + "C": "34%", + "D": "41%" + }, + "zh": { + "question": "一名25岁男性在全身麻醉下进行睾丸癌淋巴结清扫术。他已接受四个疗程的博来霉素治疗。七氟醚蒸发器设定为1.8%，氧气流量为100 mL/min，空气流量为900 mL/min。新鲜气体流的Fio2是", + "A": "26%", + "B": "29%", + "C": "34%", + "D": "41%" + } + }, + { + "id": "f33e2c2c-16c8-50d1-9f74-23680ab224aa", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "How would a right mainstem intubation affect the rate of increase in arterial partial pressure of volatile anesthetics?", + "A": "It would be reduced to the same degree for all volatile anesthetics", + "B": "It would be accelerated to the same degree for all volatile anesthetics", + "C": "It would be reduced the most for highly soluble agents", + "D": "It would be reduced the most for poorly soluble agents" + }, + "zh": { + "question": "右主支气管插管如何影响挥发性麻醉药物在动脉中的分压增加速率？", + "A": "所有挥发性麻醉药物的增加速率都会同等程度地降低", + "B": "所有挥发性麻醉药物的增加速率都会同等程度地加快", + "C": "高溶解性药物的增加速率降低最多", + "D": "低溶解性药物的增加速率降低最多" + } + }, + { + "id": "15b80bbc-fbd2-5891-83bd-0e0a58b58d51", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "During a breast biopsy with the patient under general anesthesia, the end-tidal carbon dioxide (ETCO2 ) is 25 mm Hg on infrared", + "A": "Mainstem intubation", + "B": "Enormous dead space", + "C": "Incipient cardiac arrest", + "D": "Overventilation" + }, + "zh": { + "question": "在患者全身麻醉下进行乳房活检期间，红外线监测的呼气末二氧化碳（ETCO2）为25 mm Hg", + "A": "主支气管插管", + "B": "巨大的死腔", + "C": "即将发生的心脏骤停", + "D": "过度通气" + } + }, + { + "id": "52ee1336-834c-5df7-a172-384639b98afb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Isoflurane, when administered to healthy patients in concentrations less than 1.0 MAC, will decrease all of the following EXCEPT", + "A": "Cardiac output", + "B": "Myocardial contractility", + "C": "Stroke volume", + "D": "Systemic vascular resistance" + }, + "zh": { + "question": "异氟醚在给健康患者的浓度低于1.0 MAC时，以下哪项不会减少", + "A": "心输出量", + "B": "心肌收缩力", + "C": "搏出量", + "D": "全身血管阻力" + } + }, + { + "id": "b62d5115-92f9-5e88-9817-f19be7eace2d", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Increased Va will accelerate the rate of rise of the Fa/Fi ratio the MOST for", + "A": "Desflurane", + "B": "Sevoflurane", + "C": "Isoflurane", + "D": "N2O" + }, + "zh": { + "question": "增加肺泡通气量（Va）将最显著加速Fa/Fi比率上升的药物是", + "A": "地氟烷", + "B": "七氟烷", + "C": "异氟烷", + "D": "一氧化二氮" + } + }, + { + "id": "4786b08e-ca39-5382-a812-016ba19dd5ff", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Select the correct order from greatest to least for anesthetic requirement.", + "A": "Adults > infants > neonates", + "B": "Adults > neonates > infants", + "C": "Infants > neonates > adults", + "D": "Neonates > adults > infants" + }, + "zh": { + "question": "选择麻醉需求从大到小的正确顺序。", + "A": "成人 > 婴儿 > 新生儿", + "B": "成人 > 新生儿 > 婴儿", + "C": "婴儿 > 新生儿 > 成人", + "D": "新生儿 > 成人 > 婴儿" + } + }, + { + "id": "64c66ed3-a85b-57ce-a3cf-50bbe22f5063", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following MOST closely determines anesthetic effect?", + "A": "Volume percent administered to patient", + "B": "Partial pressure at the level of the central nervous system (CNS)", + "C": "Solubility in blood", + "D": "End-tidal concentration" + }, + "zh": { + "question": "以下哪项最能决定麻醉效果？", + "A": "给予患者的体积百分比", + "B": "中枢神经系统（CNS）水平的分压", + "C": "在血液中的溶解度", + "D": "呼气末浓度" + } + }, + { + "id": "63e61cb0-7419-527f-a607-f815b7a6905d", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 31-year-old moderately obese woman is receiving a general anesthetic for cervical spinal fusion. After induction and intubation, the patient is mechanically ventilated with isoflurane at a vaporizer setting of 2.4%. The N2O flow is set at 500 mL/min, and the oxygen flowmeter is set at 250 mL/min. The infrared spectrometer displays an inspired isoflurane concentration of 1.7% and an expired isoflurane concentration of 0.6%. Approximately how many MAC of anesthesia would be represented by the alveolar concentration of anesthetic gases?", + "A": "0.85 MAC", + "B": "1.1 MAC", + "C": "1.8 MAC", + "D": "2.1 MAC" + }, + "zh": { + "question": "一名31岁的中度肥胖女性正在接受颈椎融合手术的全身麻醉。诱导和插管后，患者使用蒸发器设置为2.4%的异氟醚进行机械通气。N2O流量设置为500 mL/min，氧气流量计设置为250 mL/min。红外光谱仪显示吸入的异氟醚浓度为1.7%，呼出的异氟醚浓度为0.6%。大约多少MAC的麻醉由麻醉气体的肺泡浓度表示？", + "A": "0.85 MAC", + "B": "1.1 MAC", + "C": "1.8 MAC", + "D": "2.1 MAC" + } + }, + { + "id": "9c20b4b8-ef1a-5183-a9f5-0acc90c58723", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "The rate of induction of anesthesia with isoflurane would be slower than expected in patients", + "A": "With anemia", + "B": "With chronic renal failure", + "C": "In shock", + "D": "With a right-to-left intracardiac shunt" + }, + "zh": { + "question": "异氟醚麻醉诱导速度在以下患者中会比预期慢", + "A": "贫血患者", + "B": "慢性肾衰竭患者", + "C": "休克患者", + "D": "有右向左心内分流的患者" + } + }, + { + "id": "b57f6b35-3af7-59c7-91ef-06f44625c3dd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the antihypertensives below reduces MAC?", + "A": "Lisinopril (Zestril)", + "B": "Losartan (Cozaar)", + "C": "Triamterene (Dyrenium)", + "D": "Verapamil (Calan SR)" + }, + "zh": { + "question": "以下哪种抗高血压药物可以降低MAC？", + "A": "赖诺普利（Zestril）", + "B": "氯沙坦（Cozaar）", + "C": "氨苯蝶啶（Dyrenium）", + "D": "维拉帕米（Calan SR）" + } + }, + { + "id": "ae1e7fc1-b048-5a70-96c8-a984c5d7838f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A left-to-right tissue shunt, such as arteriovenous fistula, physiologically most resembles which of the following?", + "A": "A left-to-right intracardiac shunt", + "B": "A right-to-left intracardiac shunt", + "C": "Ventilation of unperfused alveoli", + "D": "A pulmonary embolism" + }, + "zh": { + "question": "左向右的组织分流，如动静脉瘘，生理上最类似于以下哪一项？", + "A": "左向右的心内分流", + "B": "右向左的心内分流", + "C": "无灌注肺泡的通气", + "D": "肺栓塞" + } + }, + { + "id": "fb892898-944d-501c-8ae3-46de27d15122", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A fresh gas flow rate of 2 L/min or greater is recommended for administration of sevoflurane because", + "A": "The vaporizer cannot accurately deliver the volatile at lesser flow rates", + "B": "It prevents the formation of fluoride ions", + "C": "It prevents the formation of compound A", + "D": "It diminishes rebreathing" + }, + "zh": { + "question": "推荐使用2 L/min或更高的新鲜气流速率来给药七氟醚，因为", + "A": "蒸发器无法在较低流速下准确输送挥发物", + "B": "它可以防止氟离子的形成", + "C": "它可以防止A化合物的形成", + "D": "它减少了再呼吸" + } + }, + { + "id": "0428f289-3224-53ac-8f13-2773b756791c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Select the true statement regarding the arrangement of the reservoir (sump) and bypass chamber in the Datex-Ohmeda Anesthesia Delivery Unit.", + "A": "All volatiles share a common sump and separate bypass chambers", + "B": "Sevoflurane and isoflurane share a common sump and bypass chamber, and desflurane has its own", + "C": "Sevoflurane and desflurane share a common sump and bypass chamber, and isoflurane has its own", + "D": "All volatiles have independent sumps but share a common bypass chamber" + }, + "zh": { + "question": "选择关于Datex-Ohmeda麻醉输送装置中储液罐（油底壳）和旁路室布置的正确陈述。", + "A": "所有挥发性物质共享一个公共油底壳和独立的旁路室", + "B": "七氟醚和异氟醚共享一个公共油底壳和旁路室，而地氟醚有自己的", + "C": "七氟醚和地氟醚共享一个公共油底壳和旁路室，而异氟醚有自己的", + "D": "所有挥发性物质都有独立的油底壳，但共享一个公共旁路室" + } + }, + { + "id": "ab77497f-a6b5-5bff-9f69-a952c3804a8d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Smokers are MOST likely to show a mild but transient increase in airway resistance after intubation and general anesthesia with which of the following?", + "A": "Isoflurane", + "B": "Sevoflurane", + "C": "Halothane", + "D": "Desflurane" + }, + "zh": { + "question": "吸烟者在插管和全身麻醉后，最有可能出现轻微但短暂的气道阻力增加的是以下哪种麻醉药？", + "A": "异氟醚", + "B": "七氟醚", + "C": "氟烷", + "D": "地氟醚" + } + }, + { + "id": "cb55d95c-f768-5068-ab2c-49702c06a3bb", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "If a patient is anesthetized with 6% desflurane in a hyperbaric chamber at 1 atm and the pressure is increased to 2 atm, the desflurane dial should be set to which setting if the anesthesia provider wishes to maintain the anesthetic at the same level?", + "A": "3%", + "B": "6%", + "C": "12%", + "D": "Cannot be determined without knowledge of Fio2" + }, + "zh": { + "question": "如果患者在1个大气压的高压舱中使用6%地氟醚进行麻醉，并且压力增加到2个大气压，如果麻醉提供者希望维持相同水平的麻醉，地氟醚刻度盘应设置为哪个设置？", + "A": "3%", + "B": "6%", + "C": "12%", + "D": "无法在不知道Fio2的情况下确定" + } + }, + { + "id": "d7a1a332-0c1b-53dc-9b7f-080b8a18cf5c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following organs is NOT considered a member of the vessel-rich group?", + "A": "Lungs", + "B": "Brain", + "C": "Heart", + "D": "Kidney" + }, + "zh": { + "question": "下列哪个器官不被认为是富血管组的成员？", + "A": "肺", + "B": "大脑", + "C": "心脏", + "D": "肾脏" + } + }, + { + "id": "ea43b5b3-7962-5256-a1ac-b8b20421fc18", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "In isovolumic normal human subjects, 1 MAC of isoflurane anesthesia depresses mean arterial pressure by approximately 25%. The single BEST explanation for this is", + "A": "Reduction in heart rate", + "B": "Venous pooling", + "C": "Myocardial depression", + "D": "Decreased systemic vascular resistance" + }, + "zh": { + "question": "在等容正常人中，1 MAC 的异氟醚麻醉使平均动脉压降低约 25%。对此的最佳解释是", + "A": "心率降低", + "B": "静脉血液淤积", + "C": "心肌抑制", + "D": "全身血管阻力降低" + } + }, + { + "id": "6da67c87-03b5-5823-8803-35de7ca57284", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "If cardiac output and Va are doubled, the effect on the rate of rise of Fa/Fi for isoflurane compared with that which existed immediately before these interventions will be", + "A": "Doubled", + "B": "Somewhat increased", + "C": "Unchanged", + "D": "Somewhat decreased" + }, + "zh": { + "question": "如果心输出量和肺泡通气量（Va）加倍，与这些干预措施之前相比，异氟醚的Fa/Fi上升速率的影响将是", + "A": "加倍", + "B": "有所增加", + "C": "不变", + "D": "有所减少" + } + }, + { + "id": "e7b11f9f-a017-592a-8663-1e4e1f563e70", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following characteristics of inhaled anesthetics most closely correlates with recovery from inhaled anesthesia?", + "A": "Blood/gas partition coefficient", + "B": "Brain/blood partition coefficient", + "C": "Fat/blood partition coefficient", + "D": "MAC" + }, + "zh": { + "question": "下列哪项吸入性麻醉剂的特性与从吸入性麻醉中恢复的相关性最密切？", + "A": "血/气分配系数", + "B": "脑/血分配系数", + "C": "脂肪/血分配系数", + "D": "最低肺泡浓度（MAC）" + } + }, + { + "id": "5d1f5a75-38a8-5539-89f7-251f02ee50de", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "After a 12-hour 60% N2O-desflurane anesthetic, evidence of N2O can be best detected by histologic examination of", + "A": "Bone marrow", + "B": "Renal tubules", + "C": "Hepatocytes", + "D": "None of the above" + }, + "zh": { + "question": "在经历12小时60% N2O-地氟醚麻醉后，N2O的证据可以通过组织学检查最好地检测到于", + "A": "骨髓", + "B": "肾小管", + "C": "肝细胞", + "D": "以上都不是" + } + }, + { + "id": "478be4c6-0e05-5c2f-a8cd-28197cca55ec", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "An unconscious, spontaneously breathing patient is brought to the operating room (OR) from the intensive care unit for wound débridement. Which of the following maneuvers would serve to slow induction of inhalational anesthesia through the tracheostomy?", + "A": "Using isoflurane instead of sevoflurane (using MACequivalent inspired concentrations)", + "B": "Increasing fresh gas flow from 2 to 6 L/min", + "C": "Esmolol 30 mg intravenously", + "D": "None of the above" + }, + "zh": { + "question": "一名无意识、自然呼吸的患者从重症监护室被送到手术室进行伤口清创。以下哪种操作可以减缓通过气管切开术吸入麻醉的诱导？", + "A": "使用等效MAC浓度的异氟醚代替七氟醚", + "B": "将新鲜气体流量从2升/分钟增加到6升/分钟", + "C": "静脉注射30毫克艾司洛尔", + "D": "以上都不是" + } + }, + { + "id": "aaddbb38-c8c0-596b-9262-90cb2ec33450", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the settings below would give the highest arterial oxygen concentration during inhalation induction of general anesthesia with sevoflurane?", + "A": "| Oxygen 0L/min | Air 2L/min | N2O 0L/min |", + "B": "| Oxygen 2L/min | Air 0L/min | N2O 2L/min |", + "C": "| Oxygen 2L/min | Air 2L/min | N2O 9L/min |", + "D": "| Oxygen 2L/min | Air 3.5L/min | N2O 0L/min |" + }, + "zh": { + "question": "在使用七氟醚进行全身麻醉吸入诱导时，以下哪种设置会提供最高的动脉氧浓度？", + "A": "| 氧气 0L/分钟 | 空气 2L/分钟 | N2O 0L/分钟 |", + "B": "| 氧气 2L/分钟 | 空气 0L/分钟 | N2O 2L/分钟 |", + "C": "| 氧气 2L/分钟 | 空气 2L/分钟 | N2O 9L/分钟 |", + "D": "| 氧气 2L/分钟 | 空气 3.5L/分钟 | N2O 0L/分钟 |" + } + }, + { + "id": "d2f9d1e5-71fd-57e7-bb2b-b590c45ddbd3", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "If a patient were anesthetized 90 minutes with 1.25 MAC isoflurane followed by 30 minutes of 1.25 MAC sevoflurane anesthesia, wake-up would be", + "A": "The same as 2 hours of isoflurane anesthesia", + "B": "The same as 2 hours of sevoflurane anesthesia", + "C": "Less than 2 hours of isoflurane anesthesia, but greater than 2 hours of sevoflurane", + "D": "Greater than 2 hours of isoflurane anesthesia" + }, + "zh": { + "question": "如果一名患者接受了90分钟1.25 MAC的异氟醚麻醉，随后又接受了30分钟1.25 MAC的七氟醚麻醉，苏醒时间将是", + "A": "与2小时的异氟醚麻醉相同", + "B": "与2小时的七氟醚麻醉相同", + "C": "少于2小时的异氟醚麻醉，但多于2小时的七氟醚麻醉", + "D": "多于2小时的异氟醚麻醉" + } + }, + { + "id": "d51449f4-1a9c-51e1-9686-4c10915fd029", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "An anesthesia circuit is primed in preparation for an inhalation induction (with open adjustable pressure-limiting valve). The anesthesia hose is occluded with a flow of 6 L/min. The anesthesia circuit (canisters, hoses, mask, anesthesia bag) contains 6 L. A machine malfunction allows administration of 100% N2O. Approximately how much N2O would there be in the circuit when the malfunction is discovered at the 1-minute mark?", + "A": "32%", + "B": "48%", + "C": "63%", + "D": "86%" + }, + "zh": { + "question": "麻醉回路在准备吸入诱导时已充满（开放可调压力限制阀）。麻醉软管以6 L/min的流量被阻塞。麻醉回路（罐、软管、面罩、麻醉袋）包含6 L。当机器故障允许100% N2O的输送时，大约在1分钟时发现故障，回路中会有多少N2O？", + "A": "32%", + "B": "48%", + "C": "63%", + "D": "86%" + } + }, + { + "id": "b893871a-0736-55fc-958e-6ffb69e66887", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following factors lowers MAC for volatile anesthetics?", + "A": "Serum sodium 151 mEq/L", + "B": "Red hair", + "C": "Body temperature 38° C", + "D": "Acute ethanol ingestion" + }, + "zh": { + "question": "下列哪项因素会降低挥发性麻醉药的最低肺泡浓度（MAC）？", + "A": "血清钠 151 mEq/L", + "B": "红头发", + "C": "体温 38°C", + "D": "急性乙醇摄入" + } + }, + { + "id": "7be65dd3-4ebc-5352-b2f2-9d99fd5e7790", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Each of the following factors can influence the partial pressure gradient necessary for the achievement of anesthesia EXCEPT", + "A": "Inspired anesthetic concentration", + "B": "Cardiac output", + "C": "Va", + "D": "Ventilation of nonperfused alveoli (dead space)" + }, + "zh": { + "question": "下列每个因素都可以影响实现麻醉所需的分压梯度，除了", + "A": "吸入麻醉药浓度", + "B": "心输出量", + "C": "肺泡通气量", + "D": "无灌注肺泡的通气（死腔）" + } + }, + { + "id": "72f4877a-0170-5ec3-b4a4-e264340ffa3f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following volatile anesthetics is unique in containing preservative?", + "A": "Sevoflurane", + "B": "Desflurane", + "C": "Isoflurane", + "D": "None of the above" + }, + "zh": { + "question": "以下哪种挥发性麻醉剂含有防腐剂是独特的？", + "A": "七氟醚", + "B": "地氟醚", + "C": "异氟醚", + "D": "以上都不是" + } + }, + { + "id": "236e3024-5d25-55e1-a16e-f928334029f1", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "If the alveolar-to-venous partial pressure difference of a volatile anesthetic (PA − Pv) is positive (i.e., PA > Pv) and the arterial-to-venous partial pressure difference (Pa − Pv) is negative (i.e., Pv > Pa), which of the following scenarios is MOST likely to be true?", + "A": "The vaporizer has been shut off at the end of the case", + "B": "Induction has just started", + "C": "Steady state has been achieved", + "D": "The vaporizer was shut off during emergence, then turned back on" + }, + "zh": { + "question": "如果挥发性麻醉剂的肺泡到静脉的分压差（PA − Pv）为正（即PA > Pv），而动脉到静脉的分压差（Pa − Pv）为负（即Pv > Pa），以下哪种情况最有可能是真的？", + "A": "在手术结束时关闭了蒸发器", + "B": "刚刚开始诱导", + "C": "已达到稳态", + "D": "在苏醒期间关闭了蒸发器，然后又打开了" + } + }, + { + "id": "ef05abef-c604-548c-b041-555668866fa9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Anesthetic loss to the plastic and rubber components of the anesthetic circuit, hindering achievement of an adequate inspired concentration, is a factor with which of the following anesthetics?", + "A": "Desflurane", + "B": "Isoflurane", + "C": "Sevoflurane", + "D": "N2O" + }, + "zh": { + "question": "麻醉剂在麻醉回路的塑料和橡胶部件中损失，妨碍达到足够的吸入浓度，这与以下哪种麻醉剂有关？", + "A": "地氟醚", + "B": "异氟醚", + "C": "七氟醚", + "D": "N2O" + } + }, + { + "id": "388991b7-92a9-5673-aa12-7aa16f704e1b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Factors predisposing to formation and/or rebreathing of compound A include each of the following EXCEPT", + "A": "Low fresh gas flow", + "B": "Use of calcium hydroxide lime versus soda lime", + "C": "High absorbent temperatures", + "D": "Fresh absorbent" + }, + "zh": { + "question": "促成A化合物形成和/或再吸入的因素包括以下各项，除了", + "A": "低新鲜气体流量", + "B": "使用氢氧化钙石灰而非苏打石灰", + "C": "高吸收剂温度", + "D": "新鲜吸收剂" + } + }, + { + "id": "e4b80b1f-1e9e-5a43-b797-1bef7efc6158", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The following volatile agents are correctly matched with their degree of metabolism (determined by metabolite recovery):", + "A": "Sevoflurane 2%", + "B": "Isoflurane 0.2%", + "C": "Desflurane 0.02%", + "D": "All are correctly matched" + }, + "zh": { + "question": "以下挥发性麻醉剂与其代谢程度（通过代谢产物回收确定）正确匹配的是：", + "A": "七氟醚 2%", + "B": "异氟醚 0.2%", + "C": "地氟醚 0.02%", + "D": "全部正确匹配" + } + }, + { + "id": "fa4ada1f-698c-5e24-9cd2-59498bfcbd87", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the components below is NOT considered in the process of \"washin\" of the anesthesia circuit at the onset of administration?", + "A": "Infrared spectrometer tubing and reservoir", + "B": "Expiratory limb", + "C": "Anesthesia bag", + "D": "CO2 absorber" + }, + "zh": { + "question": "在麻醉回路开始给药时的“洗入”过程中，以下哪个组件不被考虑？", + "A": "红外光谱仪管道和储存器", + "B": "呼气肢", + "C": "麻醉袋", + "D": "CO2 吸收器" + } + }, + { + "id": "1680c731-fd07-5d38-9a0c-dd4c992ad34c", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Which of the following maneuvers would NOT increase the rate of an inhalation induction?", + "A": "Giving the patient an inotropic infusion", + "B": "Substituting sevoflurane for isoflurane", + "C": "Overpressurizing", + "D": "Carrying out the induction in San Diego instead of Denver" + }, + "zh": { + "question": "以下哪种操作不会增加吸入诱导的速度？", + "A": "给患者输注正性肌力药", + "B": "用七氟醚代替异氟醚", + "C": "过度加压", + "D": "在圣地亚哥而不是丹佛进行诱导" + } + }, + { + "id": "87a5e5a4-e6b2-57ef-86ad-6dc438373ff8", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following anesthetics would undergo 90% elimination the most rapidly after a 6-hour Whipple procedure under 1 MAC for the", + "A": "Isoflurane", + "B": "Sevoflurane", + "C": "Desflurane", + "D": "Sevoflurane and desflurane are tied" + }, + "zh": { + "question": "以下哪种麻醉药在 1 MAC 下进行 6 小时 Whipple 手术后，90% 的消除速度最快？", + "A": "异氟醚", + "B": "七氟醚", + "C": "地氟醚", + "D": "七氟醚和地氟醚并列" + } + }, + { + "id": "f8929926-01df-509e-bc06-604d2e3f8270", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "After induction and intubation of a healthy patient and institution of a ventilator, the sevoflurane vaporizer is set at 2%, and fresh gas flow is 1 L/min (50% N2O and 50% O2 ). The inspired concentration on the infrared spectrometer 1 minute later is 1.4%. The MAIN reason for the difference between the dial setting and the concentration shown on the infrared spectrometer is", + "A": "Rapid uptake of sevoflurane", + "B": "Insufficient fresh gas flow for correct vaporizer function", + "C": "Second gas effect", + "D": "Dilution" + }, + "zh": { + "question": "在对一名健康患者进行诱导和插管并使用呼吸机后，七氟醚蒸发器设置为2%，新鲜气体流量为1 L/min（50% N2O和50% O2）。1分钟后红外光谱仪显示的吸入浓度为1.4%。红外光谱仪显示的浓度与刻度设置之间差异的主要原因是", + "A": "七氟醚的快速摄取", + "B": "新鲜气体流量不足以正确运行蒸发器", + "C": "第二气体效应", + "D": "稀释" + } + }, + { + "id": "688399c0-3f15-5f5e-af9e-f12919d18a50", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "After cessation of general anesthesia that consisted of air, oxygen, and a volatile agent only, the patient is given 100% oxygen. Each of the following serves as a reservoir for volatile anesthesia and may delay emergence EXCEPT", + "A": "Rebreathed exhaled gases", + "B": "The absorbent", + "C": "The patient", + "D": "Gases emerging from the common gas outlet" + }, + "zh": { + "question": "在停止由空气、氧气和挥发性麻醉剂组成的全身麻醉后，患者被给予100%氧气。以下每一项都可以作为挥发性麻醉剂的储存库，并可能延迟苏醒，除了", + "A": "重复吸入的呼出气体", + "B": "吸收剂", + "C": "患者", + "D": "从公共气体出口排出的气体" + } + }, + { + "id": "d118e692-e187-5445-a9e5-bb8c2e3dfcd3", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following characteristics of volatile anesthetics is necessary for calculation of the time constant?", + "A": "Blood/gas partition coefficient", + "B": "Brain/blood partition coefficient", + "C": "Oil/gas partition coefficient", + "D": "All of the above" + }, + "zh": { + "question": "下列哪项挥发性麻醉剂的特性是计算时间常数所必需的？", + "A": "血/气分配系数", + "B": "脑/血分配系数", + "C": "油/气分配系数", + "D": "以上所有" + } + }, + { + "id": "59c02103-3431-53c9-8881-ec30c50365da", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The concept of \"context sensitive half-time\" emphasizes the importance of the relationship between half-time and", + "A": "Va", + "B": "Blood solubility", + "C": "Concentration", + "D": "Duration" + }, + "zh": { + "question": "“情境敏感半衰期”概念强调半衰期与什么之间关系的重要性", + "A": "Va", + "B": "血液溶解度", + "C": "浓度", + "D": "持续时间" + } + }, + { + "id": "5f90c270-1ac0-52fc-a138-d3a517d71b94", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Select the FALSE statement regarding pharmacokinetics for volatile anesthetics. After three time constants", + "A": "6 to 12 minutes have elapsed for \"modern anesthetics\"", + "B": "The arterial-to-venous partial pressure difference (for the volatile) for the brain is very small", + "C": "The expired volatile concentration will rise much less slowly than in the preceding 12 minutes", + "D": "The venous blood will contain 95% of volatile content of arterial blood#### Directions(Questions 378 through 381): Match the inhalational agents with the characteristics to which they most closely correspond. Each lettered heading (A through D) may be selected once, more than once, or not at all." + }, + "zh": { + "question": "选择关于挥发性麻醉药药代动力学的错误陈述。经过三个时间常数后", + "A": "“现代麻醉药”已经经过了6到12分钟", + "B": "大脑的动脉与静脉之间的挥发性麻醉药分压差非常小", + "C": "呼出的挥发性麻醉药浓度上升速度将比前12分钟慢得多", + "D": "静脉血将含有动脉血中95%的挥发性麻醉药含量" + } + }, + { + "id": "a985d88a-f509-5a2b-8ac6-9330e1ae42d5", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following treatments might be useful in decreasing a prolonged prothrombin time (PT) EXCEPT", + "A": "Recombinant factor VIII", + "B": "Vitamin K", + "C": "Fresh frozen plasma (FFP)", + "D": "Cryoprecipitate" + }, + "zh": { + "question": "以下哪种治疗可能对减少延长的凝血酶原时间（PT）有用，除了", + "A": "重组因子VIII", + "B": "维生素K", + "C": "新鲜冰冻血浆（FFP）", + "D": "冷沉淀" + } + }, + { + "id": "b1c5c9eb-cf48-5175-98a0-598c4c762873", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following practices for releasing platelets is most beneficial in avoiding future hemolytic reactions (from alloantibodies) in the recipient?", + "A": "Serologic crossmatch", + "B": "Extended phenotype matching", + "C": "RhD matching", + "D": "ABO matching" + }, + "zh": { + "question": "以下哪种释放血小板的做法最有助于避免受者未来发生溶血反应（来自同种异体抗体）？", + "A": "血清学交叉配型", + "B": "扩展表型匹配", + "C": "RhD匹配", + "D": "ABO匹配" + } + }, + { + "id": "a1dc0cd9-f00d-5c2e-a83e-e108fea85b43", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the fluids below has the greatest osmolality?", + "A": "Normal saline", + "B": "Lactated Ringer solution", + "C": "D5 ½NS normal saline", + "D": "5% Albumin" + }, + "zh": { + "question": "以下哪种液体的渗透压最大？", + "A": "生理盐水", + "B": "乳酸林格氏液", + "C": "5%葡萄糖1/2生理盐水", + "D": "5%白蛋白" + } + }, + { + "id": "2dc927a6-0c7d-558c-983f-4b9547648e27", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "In a 70-kg patient, 1 dose of platelets (1 apheresis platelet or six pooled units of whole blood–derived platelets) should increase the platelet count by", + "A": "12,000 to 30,000/mm3", + "B": "30,000 to 60,000/mm3", + "C": "90,000 to 120,000/mm3", + "D": "120,000 to 150,000/mm3" + }, + "zh": { + "question": "对于一名70公斤的患者，1剂量的血小板（1个单采血小板或6个全血来源的混合单位血小板）应使血小板计数增加", + "A": "12,000到30,000/mm3", + "B": "30,000到60,000/mm3", + "C": "90,000到120,000/mm3", + "D": "120,000到150,000/mm3" + } + }, + { + "id": "e207ce8b-37cc-54b3-b6fd-d0365c2a9936", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 68-year-old patient receives a 1-unit transfusion of packed red blood cells (RBCs) in the recovery room after a laparoscopic prostatectomy. As the blood is slowly dripping into his peripheral intravenous line, the patient complains of itching on his chest and arms, but his vital signs remain stable. The antibody most likely responsible for this is directed against", + "A": "Rh", + "B": "ABO", + "C": "MN, P, and Lewis", + "D": "None of the above" + }, + "zh": { + "question": "一名68岁的患者在腹腔镜前列腺切除术后恢复室接受1单位的浓缩红细胞（RBCs）输血。当血液缓慢滴入他的外周静脉输液管时，患者抱怨胸部和手臂发痒，但生命体征保持稳定。最可能负责的抗体是针对", + "A": "Rh", + "B": "ABO", + "C": "MN、P和Lewis", + "D": "以上都不是" + } + }, + { + "id": "fe3aa550-acd0-5e38-aeef-5ffad84121ba", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The likelihood of a clinically significant hemolytic transfusion reaction resulting from administration of type-specific blood is less than", + "A": "1 in 250", + "B": "1 in 500", + "C": "1 in 1000", + "D": "1 in 10,000" + }, + "zh": { + "question": "输注特定血型的血液导致临床显著溶血性输血反应的可能性小于", + "A": "1/250", + "B": "1/500", + "C": "1/1000", + "D": "1/10,000" + } + }, + { + "id": "821a316f-2b25-533a-837b-64e3c1aec7c3", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is NOT tested in the first or immediate phase of blood crossmatching?", + "A": "ABO", + "B": "Rh", + "C": "MN", + "D": "Lewis" + }, + "zh": { + "question": "以下哪项不在血液交叉配型的第一或即时阶段进行测试？", + "A": "ABO", + "B": "Rh", + "C": "MN", + "D": "Lewis" + } + }, + { + "id": "8a3a99a9-7f63-5d12-b6e3-eee179d23d3d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following clotting factors has the shortest half-life?", + "A": "Factor II", + "B": "Factor V", + "C": "Factor VII", + "D": "Factor IX" + }, + "zh": { + "question": "以下哪种凝血因子的半衰期最短？", + "A": "凝血因子 II", + "B": "凝血因子 V", + "C": "凝血因子 VII", + "D": "凝血因子 IX" + } + }, + { + "id": "8500754e-5a15-5daa-82da-646c9f7c7db6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the measures below does NOT reduce the incidence of transfusion-related acute lung injury (TRALI)?", + "A": "Exclusion of female donors", + "B": "Use of autologous blood", + "C": "Leukocyte reduction", + "D": "Use of blood less than 14 days old" + }, + "zh": { + "question": "以下哪项措施不能减少输血相关急性肺损伤（TRALI）的发生率？", + "A": "排除女性献血者", + "B": "使用自体血", + "C": "白细胞减少", + "D": "使用少于14天的新鲜血液" + } + }, + { + "id": "769dacbb-a0b3-5950-a107-f683adac5a4e", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 42-year-old woman is anesthetized for resection of a large (22-kg),", + "A": "Packed RBCs", + "B": "Cryoprecipitate", + "C": "Platelets", + "D": "FFP" + }, + "zh": { + "question": "一名42岁的女性因切除一个大型（22公斤）的肿瘤而接受麻醉，", + "A": "浓缩红细胞", + "B": "冷沉淀", + "C": "血小板", + "D": "新鲜冰冻血浆" + } + }, + { + "id": "d49eb96e-2409-52e1-bf8a-31e054a7e0ab", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Blood is routinely tested for", + "A": "Hepatitis A", + "B": "Severe acute respiratory syndrome (SARS)", + "C": "West Nile virus", + "D": "Bovine spongiform encephalitis (BSE, or mad cow disease)" + }, + "zh": { + "question": "血液常规检测项目是", + "A": "甲型肝炎", + "B": "严重急性呼吸综合征 (SARS)", + "C": "西尼罗病毒", + "D": "牛海绵状脑病 (BSE，或疯牛病)" + } + }, + { + "id": "89c9cccf-5f69-5709-b15f-6491a17aca56", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The blood volume of a 10-kg, 1-year-old infant is", + "A": "600 mL", + "B": "800 mL", + "C": "1000 mL", + "D": "1300 mL" + }, + "zh": { + "question": "一名10公斤、1岁婴儿的血容量是", + "A": "600毫升", + "B": "800毫升", + "C": "1000毫升", + "D": "1300毫升" + } + }, + { + "id": "2e9ea9cd-90f4-5a41-87f1-bab9b0d77386", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the infections below has the highest risk of causing a transfusion-transmitted infection?", + "A": "Human T-cell lymphotropic virus (HTLV)-II", + "B": "Hepatitis B", + "C": "Hepatitis C", + "D": "Human immunodeficiency virus (HIV)" + }, + "zh": { + "question": "以下哪种感染具有最高的输血传播感染风险？", + "A": "人类T细胞淋巴病毒(HTLV)-II", + "B": "乙型肝炎", + "C": "丙型肝炎", + "D": "人类免疫缺陷病毒(HIV)" + } + }, + { + "id": "06a3b7d9-47d9-518a-ab8b-34920acaef9d", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 40-year-old, 78-kg patient with hemophilia A is scheduled for a right total knee arthroplasty. His laboratory test results show a hematocrit of 40, a factor VIII level of 0%, and no inhibitors to factor VIII. How much factor VIII concentrate do you need to give him to bring his factor VIII level to 100%?", + "A": "3000 units", + "B": "2500 units", + "C": "2000 units", + "D": "1500 units" + }, + "zh": { + "question": "一名40岁、78公斤的A型血友病患者计划进行右侧全膝关节置换术。他的实验室检查结果显���，红细胞比容为40，因子VIII水平为0%，且无因子VIII抑制物。你需要给他多少因子VIII浓缩物才能将因子VIII水平提高到100%？", + "A": "3000单位", + "B": "2500单位", + "C": "2000单位", + "D": "1500单位" + } + }, + { + "id": "a9b6ded0-6282-5dee-8e96-4710d5b4193d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 38-year-old man is undergoing a total colectomy under general", + "A": "Offset the effects of increased antidiuretic hormone (ADH)", + "B": "Improve renal blood flow", + "C": "Convert oliguric renal failure to nonoliguric renal failure", + "D": "Offset the effects of increased renin" + }, + "zh": { + "question": "一名38岁的男性正在全身麻醉下进行全结肠切除术", + "A": "抵消抗利尿激素（ADH）增加的影响", + "B": "改善肾血流量", + "C": "将少尿性肾衰竭转变为非少尿性肾衰竭", + "D": "抵消肾素增加的影响" + } + }, + { + "id": "9ef81354-9a47-5ee4-a07d-cbbe7f78df70", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "A 65-year-old man involved in a motor vehicle accident (MVA) is brought to the emergency room with a blood pressure of 60 mm Hg systolic. He is transfused with 4 units of type O, Rh-negative whole blood and 4 L of normal saline solution. After the patient is brought to the operating room, his blood type is determined to be A positive. Which of the following is the most appropriate blood type for further intraoperative transfusions?", + "A": "Type A, Rh-positive whole blood", + "B": "Type O, Rh-negative RBCs", + "C": "Type A, Rh-positive RBCs", + "D": "Type O, Rh-negative whole blood" + }, + "zh": { + "question": "一名65岁的男性在一起机动车事故中受伤，被送到急诊室时收缩压为60 mm Hg。他接受了4个单位的O型Rh阴性全血和4升生理盐水输注。在病人被送到手术室后，确定他的血型为A型阳性。以下哪种血型最适合进一步的术中输血？", + "A": "A型，Rh阳性全血", + "B": "O型，Rh阴性红细胞", + "C": "A型，Rh阳性红细胞", + "D": "O型，Rh阴性全血" + } + }, + { + "id": "052a81e0-f89c-5514-96a7-ed190cd828c2", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The criterion used to determine how long blood can be stored before transfusion is", + "A": "90% of transfused erythrocytes must remain in circulation for 24 hours", + "B": "70% of transfused erythrocytes must remain in circulation for 24 hours", + "C": "70% of transfused erythrocytes must remain in circulation for 72 hours", + "D": "75% of transfused erythrocytes must remain in circulation for 7 days" + }, + "zh": { + "question": "用于确定输血前血液可以储存多长时间的标准是", + "A": "90%的输注红细胞必须在24小时内留在循环中", + "B": "70%的输注红细胞必须在24小时内留在循环中", + "C": "70%的输注红细胞必须在72小时内留在循环中", + "D": "75%的输注红细胞必须在7天内留在循环中" + } + }, + { + "id": "e8287f52-0ad6-5c83-8cd0-2ca01211eaba", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The rationale for storage of platelets at room temperature (22° C) is", + "A": "There is less splenic sequestration", + "B": "It preserves platelet survival", + "C": "It reduces the chance for infection", + "D": "It decreases the incidence of allergic reactions" + }, + "zh": { + "question": "将血小板储存在室温（22°C）的理由是", + "A": "减少脾脏的隔离", + "B": "保持血小板的存活", + "C": "降低感染的几率", + "D": "减少过敏反应的发生率" + } + }, + { + "id": "a09e8194-55a2-50ef-a0ae-386822046104", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "An 18-year-old woman involved in an MVA is brought to the emergency room in shock. She is transfused with 10 units of type O, Rh-negative whole blood over 30 minutes. After infusion of the first 5 units, bleeding is controlled, and her blood pressure rises to 85/51 mm Hg. During the", + "A": "Citrate toxicity", + "B": "Hyperkalemia", + "C": "Hemolytic transfusion reaction", + "D": "Tension pneumothorax" + }, + "zh": { + "question": "一名18岁的女性因车���被送到急诊室，处于休克状态。她在30分钟内输注了10个单位的O型Rh阴性全血。在输注前5个单位后，出血得到控制，她的血压升至85/51 mm Hg。在此期间", + "A": "柠檬酸盐中毒", + "B": "高钾血症", + "C": "溶血性输血反应", + "D": "张力性气胸" + } + }, + { + "id": "5d9e560f-d227-510e-aca4-c7ad6557f0f5", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 20-kg, 5-year-old child with a hematocrit of 40% could lose how much blood and still maintain a hematocrit of 30%?", + "A": "140 mL", + "B": "250 mL", + "C": "350 mL", + "D": "450 mL" + }, + "zh": { + "question": "一个体重20公斤、5岁的儿童，血细胞比容为40%，可以失去多少血液而仍然保持血细胞比容为30%？", + "A": "140毫升", + "B": "250毫升", + "C": "350毫升", + "D": "450毫升" + } + }, + { + "id": "1c7adc77-5ae9-5bb6-89ef-b0adf57a8fac", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 68-year-old man with recent cardiac stent placement is taking 75 mg clopidogrel (Plavix) daily. He is scheduled for retinal surgery, and a thromboelastogram (TEG) is ordered before surgery. The likely result of the TEG will show", + "A": "Increased R + K", + "B": "Increased alpha", + "C": "Increased MA 30", + "D": "Normal TEG" + }, + "zh": { + "question": "一名68岁的男性最近接受了心脏支架植入手术，每天服用75毫克氯吡格雷（Plavix）。他计划进行视网膜手术，术前安排了血栓弹力图（TEG）检查。TEG的可能结果将显示", + "A": "R + K增加", + "B": "α角增加", + "C": "MA 30增加", + "D": "TEG正常" + } + }, + { + "id": "f4a4131e-5448-54b0-b959-b7983f9cec12", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Paramedics respond to an MVA site and immediately stabilize the neck, secure the airway, and place an intravenous line into a 19-year-old, 70 kg man lying in a pool of blood. Before the infusion is started, 3 mL of blood are withdrawn for hemoglobin and drug screening. The first responders estimate that the patient has lost one half of his entire blood volume. Given a starting value of 18 g/dL, the new value would likely be", + "A": "9 g/dL", + "B": "11 g/dL", + "C": "14 g/dL", + "D": "17 g/dL" + }, + "zh": { + "question": "急救人员到达车祸现场，立即稳定颈部，确保气道通畅，并为一名躺在血泊中的19岁、70公斤的男子建立静脉通路。在输液开始之前，抽取3毫升血液进行血红蛋白和药物筛查。急救人员估计患者已经失去了一半的血容量。假设起始值为18 g/dL，新值可能是", + "A": "9 g/dL", + "B": "11 g/dL", + "C": "14 g/dL", + "D": "17 g/dL" + } + }, + { + "id": "f28ccc1f-9245-5790-a450-dd2f0444e996", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 23-year-old woman who has been receiving total parenteral nutrition (TPN) (15% dextrose, 5% amino acids, and intralipids) for 3 weeks is", + "A": "Place a chest tube", + "B": "Change the single-lumen to a double-lumen endotracheal tube", + "C": "Start a dopamine infusion", + "D": "Check the blood glucose level" + }, + "zh": { + "question": "一名23岁的女性已经接受全肠外营养（TPN）（15%葡萄糖、5%氨基酸和脂肪乳）3周", + "A": "放置胸腔引流管", + "B": "将单腔气管导管更换为双腔气管导管", + "C": "开始多巴胺输注", + "D": "检查血糖水平" + } + }, + { + "id": "6c268e92-2b40-525d-b375-a8c5c399453f", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "In an emergency when there is a limited supply of type O-negative RBCs, type O-positive RBCs are preferable for transfusion for each of the following patients EXCEPT", + "A": "A 60-year-old woman with diabetes who was involved in an MVA", + "B": "A 23-year-old man who sustained a gunshot wound to the upper abdomen", + "C": "An 84-year-old man with a ruptured abdominal aortic aneurysm", + "D": "A 21-year-old, gravida 2, para 1 woman with placenta previa who is bleeding profusely" + }, + "zh": { + "question": "在紧急情况下，当O型阴性红细胞供应有限时，O型阳性红细胞更适合输给以下患者，除了", + "A": "一名60岁患有糖尿病的女性，卷入了一场车祸", + "B": "一名23岁男性，腹部上方中枪", + "C": "一名84岁男性，腹主动脉瘤破裂", + "D": "一名21岁，怀孕2次，生产1次的女性，前置胎盘并大量出血" + } + }, + { + "id": "31895ad5-727c-5685-9650-af835efa7e3a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Hetastarch exerts an anticoagulative effect through interference with the function of", + "A": "Antithrombin III", + "B": "Factor VIII", + "C": "Fibrinogen", + "D": "Prostacyclin" + }, + "zh": { + "question": "羟乙基淀粉通过干扰以下哪种物质的功能来发挥抗凝作用？", + "A": "抗凝血酶 III", + "B": "凝血因子 VIII", + "C": "纤维蛋白原", + "D": "前列环素" + } + }, + { + "id": "cf827e1b-98b8-5dba-8863-0ef0f8ce4fd4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following characterize packed RBCs that have been stored for 35 days at 4° C in citrate phosphate dextrose adenine-1 (CPDA-1) anticoagulant preservative EXCEPT", + "A": "Serum potassium greater than 70 mEq/L", + "B": "pH less than 7.0", + "C": "Blood glucose less than 100 mg/dL", + "D": "P50 of 28" + }, + "zh": { + "question": "以下所有选项均描述了在柠檬酸磷酸葡萄糖腺嘌呤-1 (CPDA-1) 抗凝保存液中于4°C储存35天的浓缩红细胞，除了", + "A": "血清钾大于70 mEq/L", + "B": "pH值小于7.0", + "C": "血糖小于100 mg/dL", + "D": "P50为28" + } + }, + { + "id": "eaef7c12-76c3-52dd-8f24-83a8c4a07777", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements about coagulation factor Xa (FXa)", + "A": "It is used only to reverse the FXa inhibitors (apixaban and rivaroxaban)", + "B": "It is used only if the patient has life-threatening or uncontrolled bleeding", + "C": "Urinary tract infections and pneumonia occur in > 5% of patients", + "D": "Thromboembolic risks are rare (< 2%) and usually occur within 24 hours" + }, + "zh": { + "question": "以下关于凝血因子Xa（FXa）的说法哪一项是正确的？", + "A": "它仅用于逆转FXa抑制剂（阿哌沙班和利伐沙班）", + "B": "仅在患者出现危及生命或无法控制的出血时使用", + "C": "尿路感染和肺炎发生在超过5%的患者中", + "D": "血栓栓塞风险很少见（<2%），通常在24小时内发生" + } + }, + { + "id": "8f4445f9-a424-552e-a756-8215848bcae0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "In the adult, the liver is the primary organ for", + "A": "Hemoglobin synthesis", + "B": "Hemoglobin degradation", + "C": "Factor VIII synthesis", + "D": "Antithrombin III synthesis" + }, + "zh": { + "question": "在成人中，肝脏是主要负责的器官是", + "A": "血红蛋白合成", + "B": "血红蛋白降解", + "C": "凝血因子VIII合成", + "D": "抗凝血酶III合成" + } + }, + { + "id": "66c5128f-f0c9-5674-8bc6-28557b0f795c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Anticoagulation with low-molecular-weight heparin (LMWH) can be best monitored through which of the following laboratory tests?", + "A": "Activated partial thromboplastin time (aPTT)", + "B": "Anti-Xa assay", + "C": "Thrombin time", + "D": "Reptilase test" + }, + "zh": { + "question": "使用低分子量肝素（LMWH）进行抗凝治疗时，以下哪项实验室检查是最佳的监测方法？", + "A": "活化部分凝血活酶时间（aPTT）", + "B": "抗Xa因子测定", + "C": "凝血酶时间", + "D": "蛇酶试验" + } + }, + { + "id": "6045395f-eb44-5a91-965e-25981522876a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Heparin resistance is likely in patients with which of the following heritable conditions?", + "A": "Factor V Leiden mutation", + "B": "Prothrombin *G20210A* gene mutation", + "C": "Protein S deficiency", + "D": "Antithrombin or antithrombin III (AT3) deficiency" + }, + "zh": { + "question": "在以下哪种遗传性疾病的患者中，肝素抵抗最有可能发生？", + "A": "因子V莱顿突变", + "B": "凝血酶原G20210A基因突变", + "C": "蛋白S缺乏", + "D": "抗凝血酶或抗凝血酶III（AT3）缺乏" + } + }, + { + "id": "b92eaf29-0478-52f4-b3ad-d78ae1c5cb8b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Type 1 von Willebrand disease (vWD) could be treated by any of the following EXCEPT", + "A": "Cryoprecipitate", + "B": "Desmopressin (DDAVP)", + "C": "FFP", + "D": "Recombinant factor VIII" + }, + "zh": { + "question": "1型血友病（vWD）可以通过以下任何一种方法治疗，除了", + "A": "冷沉淀", + "B": "去氨加压素（DDAVP）", + "C": "新鲜冰冻血浆（FFP）", + "D": "重组第八因子" + } + }, + { + "id": "a6dd5c71-567f-53de-959a-e946f8d24786", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The significance of immunoglobulin A (IgA) antibodies in transfusion medicine is related to", + "A": "Allergic reaction", + "B": "Febrile reaction", + "C": "Delayed hemolytic reaction (immune extravascularreaction)", + "D": "Diagnosis of TRALI reaction" + }, + "zh": { + "question": "免疫球蛋白A（IgA）抗体在输血医学中的意义与以下哪项有关", + "A": "过敏反应", + "B": "发热反应", + "C": "延迟性溶血反应（免疫性血管外反应）", + "D": "延迟性溶血反应（免疫性血管外反应)" + } + }, + { + "id": "f6bea6e9-eb84-50fd-b506-45df4a90f868", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The most common cause of mortality associated with administration of blood is", + "A": "TRALI", + "B": "Non-ABO hemolytic transfusion reaction", + "C": "Microbial infection", + "D": "Anaphylactic reaction" + }, + "zh": { + "question": "与输血相关的最常见死亡原因是", + "A": "输血相关急性肺损伤（TRALI）", + "B": "非ABO溶血性输血反应", + "C": "微生物感染", + "D": "过敏反应" + } + }, + { + "id": "1cfbf198-823d-5618-81f6-257951f2fd9b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Fluid resuscitation during major abdominal surgery with which of the following agents is associated with the BEST survival data?", + "A": "5% Albumin", + "B": "6% Hydroxyethyl starch", + "C": "Dextran 70", + "D": "None of the above# Blood Products, Transfusion, and Fluid Therapy#" + }, + "zh": { + "question": "在重大腹部手术期间，使用以下哪种药物进行液体复苏与最佳生存数据相关？", + "A": "5% 白蛋白", + "B": "6% 羟乙基淀粉", + "C": "70% 右旋糖酐", + "D": "以上皆不是# 血液制品、输血和液体治疗#" + } + }, + { + "id": "8a7fa05f-087d-536d-b9ff-95cc8c8acd5e", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "A 78-year-old patient with a history of hypertension and adult-onset diabetes for which she takes chlorpropamide (Diabinese) is admitted for elective cholecystectomy. On the day of admission, blood glucose is noted to be 270 mg/dL, and the patient is treated with 15 units of regular insulin subcutaneously (SQ) in addition to her regular dose of chlorpropamide. Twenty-four hours later after overnight fasting, the patient is brought to the operating room (OR) without her daily dose of chlorpropamide and is anesthetized. A serum glucose is measured and found to be 35 mg/dL. The MOST likely explanation for this is", + "A": "Insulin", + "B": "Chlorpropamide", + "C": "Hypovolemia", + "D": "Effect of general anesthesia" + }, + "zh": { + "question": "一名78岁的患者有高血压和成人发病的糖尿病病史，她服用氯磺丙脲（Diabinese）进行治疗，现因择期胆囊切除术入院。在入院当天，血糖被记录为270 mg/dL，患者在常规剂量的氯磺丙脲之外接受了15单位的常规胰岛素皮下注射。24小时后，经过一夜禁食，患者在未服用每日剂量的氯磺丙脲的情况下被送入手术室并接受麻醉。测得的血清葡萄糖为35 mg/dL。对此最可能的解释是", + "A": "胰岛素", + "B": "氯磺丙脲", + "C": "低血容量", + "D": "全身麻醉的影响" + } + }, + { + "id": "a5f78a37-12b3-5eef-96cc-94d691401d2f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Select the TRUE statement.", + "A": "Dibucaine is an ester-type local anesthetic", + "B": "A dibucaine number of 20 is normal", + "C": "The dibucaine number represents the quantity of normal pseudocholinesterase", + "D": "None of the above" + }, + "zh": { + "question": "选择正确的陈述。", + "A": "地布卡因是一种酯类局部麻醉剂", + "B": "地布卡因数为20是正常的", + "C": "地布卡因数代表正常假性胆碱酯酶的数量", + "D": "以上都不是" + } + }, + { + "id": "d86c117b-fe7f-5d71-950e-68baa0c91f15", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 56-year-old patient with a history of liver disease and osteomyelitis is anesthetized for tibial débridement. After induction and intubation, the wound is inspected and débrided with a total blood loss of 300 mL. The patient is transported intubated to the recovery room, at which time the systolic blood pressure falls to 50 mm Hg. Heart rate is 120 beats/min,", + "A": "Hypovolemia", + "B": "Congestive heart failure (CHF)", + "C": "Cardiac tamponade", + "D": "Sepsis with acute respiratory distress syndrome (ARDS)" + }, + "zh": { + "question": "一名56岁的患者有肝病和骨髓炎病史，正在接受胫骨清创的麻醉。在诱导和插管后，检查并清创伤口，总失血量为300毫升。患者被插管运送到恢复室，此时收缩压降至50 mm Hg。心率为120次/分钟。", + "A": "低血容量", + "B": "充血性心力衰竭 (CHF)", + "C": "心脏压塞", + "D": "伴有急性呼吸窘迫综合征 (ARDS) 的败血症" + } + }, + { + "id": "fb2c8672-644d-5f89-99db-8af43677f6b8", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Normal tracheal capillary pressure is", + "A": "10 to 15 mm Hg", + "B": "15 to 20 mm Hg", + "C": "25 to 30 mm Hg", + "D": "35 to 40 mm Hg" + }, + "zh": { + "question": "正常气管毛细血管压力是", + "A": "10到15毫米汞柱", + "B": "15到20毫米汞柱", + "C": "25到30毫米汞柱", + "D": "35到40毫米汞柱" + } + }, + { + "id": "3ea9ec06-fa05-5194-96bc-7353fad9c91a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How many hours should elapse before performing a single-shot spinal anesthetic in a patient who is receiving 1 mg/kg enoxaparin (Lovenox) twice a day for the treatment of a deep vein thrombosis?", + "A": "6 hours", + "B": "12 hours", + "C": "24 hours", + "D": "48 hours" + }, + "zh": { + "question": "对于接受1 mg/kg依诺肝素（Lovenox）每日两次治疗深静脉血栓的患者，在进行单次脊髓麻醉前应间隔多少小时？", + "A": "6小时", + "B": "12小时", + "C": "24小时", + "D": "48小时" + } + }, + { + "id": "da7717ae-64b3-58f3-895a-ee67e1f3c45e", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 46-year-old female with low back pain and left-sided L4 radiculopathy presents for an L4/L5 lumbar discectomy. Her past medical history includes hypothyroidism, insulin-dependent diabetes type 1, and chronic low back pain, for which she is maintained on sublingual buprenorphine/naloxone, with the last dose having been received the morning of surgery.", + "A": "DECREASED response due to upregulation of the cytochrome P450 system", + "B": "DECREASED response secondary to opioid receptor antagonism by naloxone", + "C": "DECREASED response due to high-affinity binding of buprenorphine to the opioid receptor", + "D": "No DIFFERENCE in response IF an opioid agonist with a high binding affinity is administered" + }, + "zh": { + "question": "一名46岁的女性因下背痛和左侧L4神经根病前来进行L4/L5腰椎间盘切除术。她的既往病史包括甲状腺功能减退症、胰岛素依赖型1型糖尿病和慢性下背痛，为此她维持使用舌下丁丙诺啡/纳洛酮，最后一次服用是在手术当天早晨。", + "A": "由于细胞色素P450系统的上调，反应减弱", + "B": "由于纳洛酮对阿片受体的拮抗作用，反应减弱", + "C": "由于丁丙诺啡对阿片受体的高亲和力结合，反应减弱", + "D": "如果给予具有高结合亲和力的阿片激动剂，反应无差异" + } + }, + { + "id": "546cf858-77bb-5652-82ee-1c459364571c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the most plausible explanation for the lack of analgesia with codeine administration?", + "A": "Lack of CYP2D6 enzyme", + "B": "VKORC1 polymorphism", + "C": "CYP3A4 polymorphism", + "D": "Lack of μ receptors" + }, + "zh": { + "question": "以下哪项是解释可待因给药后缺乏镇痛效果的最合理原因？", + "A": "缺乏CYP2D6酶", + "B": "VKORC1多态性", + "C": "CYP3A4多态性", + "D": "缺乏μ受体" + } + }, + { + "id": "03b34005-eea0-5125-9bc7-9346ce5a4373", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 62-year-old patient with a bare-metal stent in the mid portion of the left anterior descending artery is scheduled for rotator cuff repair under general anesthesia. The stent was placed 6 weeks before surgery, and the patient is on dual therapy (aspirin and clopidogrel). Which of the paradigms below would be best for managing his anticoagulation before surgery?", + "A": "Continue both up to the day of surgery", + "B": "Stop both 7 to 10 days before surgery", + "C": "Stop aspirin and continue clopidogrel", + "D": "Stop clopidogrel and continue aspirin" + }, + "zh": { + "question": "一名62岁的患者在左前降支中段植入了裸金属支架，计划在全身麻醉下进行肩袖修复手术。支架是在手术前6周放置的，患者正在接受双重治疗（阿司匹林和氯吡格雷）。以下哪种方案最适合在手术前管理他的抗凝治疗？", + "A": "手术当天继续服用两种药物", + "B": "手术前7到10天停止服用两种药物", + "C": "停止服用阿司匹林，继续服用氯吡格雷", + "D": "停止服用氯吡格雷，继续服用阿司匹林" + } + }, + { + "id": "98052853-5b6a-53e8-a0c4-ea2bca24853b", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient with which of the following eye diseases would be at greatest risk for retinal damage from hypotension during surgery?", + "A": "Strabismus", + "B": "Open eye injury", + "C": "Glaucoma", + "D": "Severe myopia" + }, + "zh": { + "question": "以下哪种眼病的患者在手术期间因低血压而导致视网膜损伤的风险最大？", + "A": "斜视", + "B": "开放性眼外伤", + "C": "青光眼", + "D": "高度近视" + } + }, + { + "id": "dc435ce7-d0b8-57c7-ab81-a307f2e206bb", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Naltrexone is", + "A": "A narcotic with local anesthetic properties", + "B": "An opioid agonist-antagonist similar to nalbuphine", + "C": "A pure opioid antagonist with a shorter duration of action than naloxone", + "D": "An opioid antagonist used for treatment of previously detoxified heroin addicts" + }, + "zh": { + "question": "纳曲酮是", + "A": "具有局部麻醉特性的麻醉药", + "B": "类似于纳布啡的阿片类激动-拮抗剂", + "C": "作用时间比纳洛酮短的纯阿片拮抗剂", + "D": "用于治疗已戒毒的海洛因成瘾者的阿片拮抗剂" + } + }, + { + "id": "0fc4ff53-d231-566b-a40c-e227d0c54b72", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following mechanisms is most frequently responsible for hypoxia in the recovery room?", + "A": "Ventilation/perfusion mismatch", + "B": "Hypoventilation", + "C": "Hypoxic gas mixture", + "D": "Intracardiac shunt" + }, + "zh": { + "question": "以下哪种机制最常导致恢复室中的低氧症？", + "A": "通气/灌注不匹配", + "B": "通气不足", + "C": "低氧气体混合物", + "D": "心内分流" + } + }, + { + "id": "b41a2c50-fa60-5275-92e4-24428d38651b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Hypoparathyroidism secondary to the inadvertent surgical resection of the parathyroid glands during total thyroidectomy typically results in", + "A": "1 to 2 hours", + "B": "3 to 12 hours", + "C": "12 to 24 hours", + "D": "24 to 72 hours" + }, + "zh": { + "question": "在全甲状腺切除术中不慎切除甲状旁腺导致的甲状旁腺功能减��通常会导致", + "A": "1到2小时", + "B": "3到12小时", + "C": "12到24小时", + "D": "24到72小时" + } + }, + { + "id": "c386c191-5503-5110-90e4-284446a23dc4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Damage to which nerve may lead to wrist drop?", + "A": "Radial", + "B": "Axillary", + "C": "Median", + "D": "Ulnar" + }, + "zh": { + "question": "损伤哪个神经可能导致腕下垂？", + "A": "桡神经", + "B": "腋神经", + "C": "正中神经", + "D": "尺神经" + } + }, + { + "id": "d5a5aab5-1296-52e4-9254-d83e507e9b74", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 25-year-old woman with a body mass index (BMI) 42 kg/m2 is to be anesthetized for laparoscopic bariatric surgery. She has a history of knee pain while walking. She has no medication allergies and takes multivitamins and an oral contraceptive. Her American Society of Anesthesiologists (ASA) designation should be", + "A": "ASA I", + "B": "ASA II", + "C": "ASA III", + "D": "ASA IV" + }, + "zh": { + "question": "一名25岁的女性，体重指数（BMI）为42 kg/m2，计划接受腹腔镜减肥手术。她有行走时膝盖疼痛的病史。她没有药物过敏史，服用多种维生素和口服避孕药。她的美国麻醉医师协会（ASA）分级应为", + "A": "ASA I", + "B": "ASA II", + "C": "ASA III", + "D": "ASA IV" + } + }, + { + "id": "415b0d39-9787-51c5-8d93-a7770a015243", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 6-year-old child is transported to the recovery room after a tonsillectomy. The patient was anesthetized with isoflurane, fentanyl, and N2O. Twenty minutes before emergence and tracheal extubation, droperidol was administered. The anesthesiologist is called to the recovery room because the patient is \"making strange eye movements.\" The patient's eyes are rolled back into his head, and his neck is twisted and rigid. The most appropriate drug for treatment of these symptoms is", + "A": "Dantrolene", + "B": "Diazepam", + "C": "Glycopyrrolate", + "D": "Diphenhydramine" + }, + "zh": { + "question": "一名6岁的儿童在扁桃体切除术后被送到恢复室。患者接受了异氟醚、芬太尼和N2O的麻醉。在苏醒和气管拔管前20分钟，给予了氟哌利多。麻醉师被叫到恢复室，因为患者“做出奇怪的眼球运动”。患者的眼睛翻白，脖子扭曲且僵硬。治疗这些症状最合适的药物是", + "A": "丹曲林", + "B": "地西泮", + "C": "东莨菪碱", + "D": "苯海拉明" + } + }, + { + "id": "d379024c-2206-5056-baaf-6f6f6b1aa2ce", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 22-year-old with multiple medical problems lists 5-HT3 antagonists on her allergy band. With which of the medications listed below was this allergy most likely discovered?", + "A": "Granisetron (Kytril)", + "B": "Paroxetine (Paxil)", + "C": "Milrinone", + "D": "Cyproheptadine (Periactin)" + }, + "zh": { + "question": "一名22岁的患者有多种医疗问题，她的过敏手环上列出了5-HT3拮抗剂。以下哪种药物最有可能发现这种过敏？", + "A": "格拉司琼 (Kytril)", + "B": "帕罗西汀 (Paxil)", + "C": "米力农", + "D": "赛庚啶 (Periactin)" + } + }, + { + "id": "6b30a94e-c11f-5238-90d2-e286652cf9d9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Pheochromocytoma would be MOST likely to coexist with which of the following?", + "A": "Insulinoma", + "B": "Pituitary adenoma", + "C": "Primary hyperaldosteronism (Conn syndrome)", + "D": "Medullary carcinoma of the thyroid" + }, + "zh": { + "question": "嗜铬细胞瘤最有可能与下列哪项共存？", + "A": "胰岛素瘤", + "B": "垂体腺瘤", + "C": "原发性醛固酮增多症（康恩综合征）", + "D": "甲状腺髓样癌" + } + }, + { + "id": "4c2d6c5c-22b4-59f6-a9e3-f91418ac67a7", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following oral antidiabetic drugs is unique in that it does NOT produce hypoglycemia when administered to a fasting patient?", + "A": "Glyburide (Micronase)", + "B": "Glipizide (Glucotrol)", + "C": "Tolbutamide (Orinase)", + "D": "Metformin (Glucophage)" + }, + "zh": { + "question": "以下哪种口服降糖药的独特之处在于其在给禁食患者服用时不会引起低血糖？", + "A": "格列本脲（Micronase）", + "B": "格列吡嗪（Glucotrol）", + "C": "甲苯磺丁脲（Orinase）", + "D": "二甲双胍（Glucophage）" + } + }, + { + "id": "72d82014-1e11-5665-a6ae-d5595bf4335d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The onset of delirium tremens (DTs) after abstinence from alcohol usually occurs in", + "A": "8 to 24 hours", + "B": "24 to 48 hours", + "C": "2 to 4 days", + "D": "4 to 7 days" + }, + "zh": { + "question": "戒酒后震颤性谵妄（DTs）的发作通常发生在", + "A": "8到24小时", + "B": "24到48小时", + "C": "2到4天", + "D": "4到7天" + } + }, + { + "id": "010bbc6b-5e57-55cd-81ce-d676d5945b6d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 78-year-old retired coal miner with an intraluminal tracheal tumor is scheduled for tracheal resection. Which of the following is a relative contraindication for tracheal resection?", + "A": "Need for postoperative mechanical ventilation for underlying lung disease", + "B": "Tumor located at the carina", + "C": "Documented liver metastases", + "D": "Ischemic heart disease with a history of CHF" + }, + "zh": { + "question": "一名78岁的退休煤矿工人患有管腔内气管肿瘤，计划进行气管切除术。以下哪项是气管切除术的相对禁忌症？", + "A": "因基础肺病需要术后机械通气", + "B": "肿瘤位于隆突处", + "C": "已记录的肝转移", + "D": "有充血性心力衰竭病史的缺血性心脏病" + } + }, + { + "id": "be11c44c-09b3-552e-a816-7c7469a14665", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 78-year-old patient with multiple myeloma is admitted to the intensive care unit (ICU) for treatment of hypercalcemia. The primary risk associated with anesthetizing patients with hypercalcemia (levels of 14-16 mg/dL) is", + "A": "Coagulopathy", + "B": "Cardiac dysrhythmias", + "C": "Hypotension", + "D": "Laryngospasm" + }, + "zh": { + "question": "一名78岁的多发性骨髓瘤患者因高钙血症入院至重症监护病房（ICU）接受治疗。对高钙血症（钙水平为14-16 mg/dL）患者进行麻醉的主要风险是", + "A": "凝血功能障碍", + "B": "心律失常", + "C": "低血压", + "D": "喉痉挛" + } + }, + { + "id": "0d597fb6-f533-534d-839a-dadea32c0f9d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Just before induction of general anesthesia for an 85-year-old demented man with an ischemic bowel, he mentions to you that he forgot to take his green-capped eye drops. He states that not taking it daily will result", + "A": "NaCl drops used to prevent his eye from drying out", + "B": "Antibiotic drops", + "C": "Steroids", + "D": "Used to produce miosis" + }, + "zh": { + "question": "在为一名85岁患有缺血性肠道的痴呆老人进行全身麻醉诱导之前，他告诉你他忘记使用绿色瓶盖的眼药水。他说不每天使用会导致", + "A": "用于防止眼睛干燥的氯化钠滴眼液", + "B": "抗生素滴眼液", + "C": "类固醇", + "D": "用于缩瞳" + } + }, + { + "id": "15f2f646-37f0-5765-a13d-e38b6ea79d2a", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A normal, healthy 3-year-old child was involved in a motor vehicle accident (MVA). He is coming emergently to the OR. Drug doses need to be calculated, but his weight is not known. What value should be used to estimate the 3-year-old child's weight?", + "A": "8 kg", + "B": "10 kg", + "C": "12 kg", + "D": "14 kg" + }, + "zh": { + "question": "一名正常健康的3岁儿童卷入了一场机动车事故（MVA）。他紧急被送往手术室。需要计算药物剂量，但不知道他的体重。应该使用什么数值来估算这名3岁儿童的体重？", + "A": "8公斤", + "B": "10公斤", + "C": "12公斤", + "D": "14公斤" + } + }, + { + "id": "1dc81dce-3455-5ea0-a5ea-d7b333f03c5e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 16-year-old patient presents for extraction of multiple teeth. In her history, it is noted that she is on a ketogenic diet. The likely reason for this is history of", + "A": "Phenylketonuria (PKU)", + "B": "Mitochondrial myopathies", + "C": "Intractable seizures", + "D": "Glycogen storage disease" + }, + "zh": { + "question": "一名16岁的患者前来拔除多颗牙齿。在她的病史中，注意到她正在进行生酮饮食。其可能的原因是有以下病史", + "A": "苯丙酮尿症 (PKU)", + "B": "线粒体肌病", + "C": "难治性癫痫", + "D": "糖原贮积病" + } + }, + { + "id": "8b6cb8b6-d176-5dd9-932c-85fbd8fb4f72", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 28-year-old obese patient has diminished breath sounds bilaterally at the lung bases 18 hours after an emergency appendectomy under general anesthesia. Which of the following maneuvers would be LEAST effective in preventing postoperative pulmonary complications in this patient?", + "A": "Coughing", + "B": "Voluntary deep breathing", + "C": "Performing a forced vital capacity (FVC)", + "D": "Use of incentive spirometry" + }, + "zh": { + "question": "一名28岁的肥胖患者在全身麻醉下进行紧急阑尾切除术后18小时，双侧肺底呼吸音减弱。以下哪种措施对预防该患者术后肺部并发症最不有效？", + "A": "咳嗽", + "B": "自主深呼吸", + "C": "进行用力肺活量（FVC）测定", + "D": "使用激励性肺量计" + } + }, + { + "id": "0f6fe6ab-a9e6-55b5-99c2-c8f3af566017", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Easily discernable improvement in patient outcomes can be observed through which measure of quality improvement?", + "A": "Process measure (e.g., timing of antibiotics with incision)", + "B": "Structural measures (e.g., electronic medical record)", + "C": "Outcome measures (e.g., incidence of wound infection)", + "D": "None of the above" + }, + "zh": { + "question": "通过哪种质量改进措施可以观察到患者结果的明显改善？", + "A": "过程措施（例如，抗生素与切口的时间安排）", + "B": "结构措施（例如，电子病历）", + "C": "结果措施（例如，伤口感染发生率）", + "D": "以上都不是" + } + }, + { + "id": "4df5c5fa-f1e4-56cf-8236-153fe95d8e3e", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 67-year-old patient is mechanically ventilated in the ICU 2 days after repair of a ruptured abdominal aortic aneurysm. To maintain PaO2 in the", + "A": "Tension pneumothorax", + "B": "Decreased venous return to the heart", + "C": "Increased afterload on the right side of the heart", + "D": "Increased afterload on the left side of the heart" + }, + "zh": { + "question": "一名67岁的患者在修复破裂的腹主动脉瘤后2天，在ICU中接受机械通气。为了维持PaO2在", + "A": "张力性气胸", + "B": "静脉回流减少", + "C": "右心的后负荷增加", + "D": "左心的后负荷增加" + } + }, + { + "id": "9cd2ea07-7a22-5e21-8461-56a192e4a2c5", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The mechanism of action of clopidogrel is", + "A": "Adenosine diphosphate (ADP) receptor blockade (P2Y12 )", + "B": "Platelet glycoprotein IIB/IIIa antagonism", + "C": "Cyclooxygenase COX-1 and COX-2 inhibition", + "D": "Direct thrombin inhibition" + }, + "zh": { + "question": "氯吡格雷的作用机制是", + "A": "腺苷二磷酸 (ADP) 受体阻断 (P2Y12)", + "B": "血小板糖蛋白 IIB/IIIa 拮抗", + "C": "环氧合酶 COX-1 和 COX-2 抑制", + "D": "直接凝血酶抑制" + } + }, + { + "id": "0f0e43cc-1956-5010-8116-df83ae65e7dc", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is most closely associated with minimum alveolar concentration (MAC)?", + "A": "Blood/gas partition coefficient", + "B": "Oil/gas partition coefficient", + "C": "Vapor pressure", + "D": "Brain/blood partition coefficient" + }, + "zh": { + "question": "以下哪项与最低肺泡浓度（MAC）最密切相关？", + "A": "血/气分配系数", + "B": "油/气分配系数", + "C": "蒸气压", + "D": "脑/血分配系数" + } + }, + { + "id": "dd1bf381-de88-581d-a86b-443fcacb4085", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "By federal law, any breach in protected health information (PHI) must be disclosed to", + "A": "Department of Health and Human Services (HHS)", + "B": "Department of Justice (DOJ)", + "C": "Joint Commission on Accreditation of Healthcare Organizations (JCAHO)", + "D": "American Accreditation HealthCareCommission/Utilization Review Accreditation Commission (AAHC/URAC)" + }, + "zh": { + "question": "根据联邦法律，任何受保护健康信息（PHI）的泄露必须向谁披露？", + "A": "卫生与公众服务部（HHS）", + "B": "司法部（DOJ）", + "C": "医疗机构评审联合委员会（JCAHO）", + "D": "美国健康护理认证委员会/利用审查认证委员会（AAHC/URAC）" + } + }, + { + "id": "f68b1281-6a50-5538-8c0f-7d19a9fa41ff", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Scopolamine should not be given as a premedication in patients with which of the following neurologic diseases?", + "A": "Parkinson disease", + "B": "Alzheimer disease", + "C": "Multiple sclerosis", + "D": "Narcolepsy" + }, + "zh": { + "question": "下列哪种神经系统疾病的患者不应给予东莨菪碱作为术前用药？", + "A": "帕金森病", + "B": "阿尔茨海默病", + "C": "多发性硬化症", + "D": "发作性睡病" + } + }, + { + "id": "ad501910-82f0-5416-be04-a810b0f6decc", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A 45-year-old female patient with a history of depression and previous intraoperative awareness is anesthetized for gastric bypass. A 2-mg dose", + "A": "Sympathetic listening, apology, offer counseling", + "B": "Avoid contact with patient until legal advice has been sought", + "C": "Immediate psychiatric evaluation", + "D": "Sympathetic listening with nondefensive explanation that recall would be essentially impossible under these circumstances" + }, + "zh": { + "question": "一名45岁的女性患者有抑郁症和术中意识的病史，现接受胃旁路手术的麻醉。2毫克剂量", + "A": "同情倾听，致歉，提供心理咨询", + "B": "在寻求法律建议之前避免与患者接触", + "C": "立即进行精神科评估", + "D": "同情倾听，并非防御性地解释在这种情况下回忆几乎是不可能的" + } + }, + { + "id": "489291fb-881c-524f-a9bb-a36c987a9981", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 53-year-old woman with endometrial cancer is undergoing an abdominal hysterectomy under general anesthesia with desflurane. During the first hour of anesthesia, urine output is 100 mL. Blood loss is minimal. When the patient is placed in the Trendelenburg position, the urine output declines to virtually zero. The most likely explanation for this sudden decrease in urine output in this patient is", + "A": "Pooling of urine in the dome of the bladder", + "B": "Increased central venous pressure", + "C": "Increased antidiuretic hormone (ADH) production from surgical stimulation", + "D": "Hypovolemia" + }, + "zh": { + "question": "一名53岁的子宫内膜癌女性患者在全身麻醉下使用地氟醚进行腹式子宫切除术。在麻醉的第一个小时内，尿量为100毫升。失血量很少。当患者被置于特伦德伦堡体位时，尿量几乎降至零。该患者尿量突然减少的最可能原因是", + "A": "尿液积聚在膀胱穹顶", + "B": "中心静脉压升高", + "C": "手术刺激导致抗利尿激素（ADH）分泌增加", + "D": "低血容量" + } + }, + { + "id": "e7672693-a843-5f92-8177-2b43ccbe77a6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following diseases is NOT associated with a decrease in DLCO?", + "A": "Emphysema", + "B": "Obesity", + "C": "Pulmonary emboli", + "D": "Anemia" + }, + "zh": { + "question": "以下哪种疾病与DLCO下降无关？", + "A": "肺气肿", + "B": "肥胖", + "C": "肺栓塞", + "D": "贫血" + } + }, + { + "id": "274047ee-7a2b-5d35-85d9-7cdc21ee48c5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following postoperative complications of thyroid surgery can result in upper airway obstruction EXCEPT", + "A": "Cervical hematoma", + "B": "Tetany", + "C": "Bilateral superior laryngeal nerve injury", + "D": "Bilateral recurrent laryngeal nerve injury" + }, + "zh": { + "question": "以下每种甲状腺手术后的并发症都可能导致上呼吸道阻塞，除了", + "A": "颈部血肿", + "B": "手足搐搦症", + "C": "双侧上喉神经损伤", + "D": "双侧喉返神经损伤" + } + }, + { + "id": "fe6d872e-0578-5352-a5af-7f733bacf22b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The MOST sensitive early sign of malignant hyperthermia (MH) during", + "A": "Tachycardia", + "B": "Hypertension", + "C": "Fever", + "D": "Increased end-expiratory CO2 tension (PECO2 )" + }, + "zh": { + "question": "恶性高热（MH）最早期的最敏感征兆是", + "A": "心动过速", + "B": "高血压", + "C": "发热", + "D": "呼气末二氧化碳分压（PECO2）增加" + } + }, + { + "id": "b0e52779-b673-594d-af2c-7a5231193c5a", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 78-year-old woman is anesthetized for a right hemicolectomy for 3 hours. At the end of the operation the patient's blood pressure is 130/85 mm Hg, heart rate is 84 beats/min, core body temperature is 35.4° C, and PECO2 on infrared spectrometer is 38 mm Hg. Which of the following would be the LEAST plausible reason for prolonged apnea in this patient?", + "A": "Residual neuromuscular blockade", + "B": "Narcotic overdose", + "C": "Unrecognized obstructive pulmonary disease and high baseline PaCO2", + "D": "Persistent intraoperative hyperventilation" + }, + "zh": { + "question": "一名78岁的女性接受右半结肠切除术麻醉3小时。手术结束时，患者的血压为130/85 mm Hg，心率为84次/分钟，核心体温为35.4°C，红外光谱仪测得的呼气末二氧化碳分压为38 mm Hg。以下哪一项最不可能是该患者呼吸暂停延长的原因？", + "A": "残余神经肌肉阻滞", + "B": "麻醉药物过量", + "C": "未被识别的阻塞性肺病和高基础PaCO2", + "D": "持续的术中过度通气" + } + }, + { + "id": "d8cfb00d-cb9b-5f68-8eef-96f3ca98500d", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 68-year-old woman with severe rheumatoid arthritis undergoes pulmonary function evaluation before an elective abdominal surgery. Forced expiratory volume in 1 second (FEV1 ) and FVC are within normal limits; however, the maximum voluntary ventilation (MVV) is only 40% of predicted. The next step in the pulmonary function evaluation of this patient should be to", + "A": "Obtain ABGs on room air", + "B": "Obtain a flow-volume loop", + "C": "Obtain a measurement of peak flow", + "D": "Obtain a ventilation/perfusion scan" + }, + "zh": { + "question": "一名68岁的女性患有严重的类风湿性关节炎，在择期腹部手术前进行肺功能评估。第一秒用力呼气量（FEV1）和用力肺活量（FVC）在正常范围内；然而，最大自主通气量（MVV）仅为预测值的40%。该患者肺功能评估的下一步应该是", + "A": "在室内空气中获取动脉血气分析", + "B": "获取流量-容量环", + "C": "测量峰流量", + "D": "进行通气/灌注扫描" + } + }, + { + "id": "ddcff4e4-976d-5848-941f-7f4e2dd82279", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is NOT a component of the postanesthetic discharge scoring system (PADSS) used to evaluate the suitability of a patient to be discharged from an ambulatory surgical facility?", + "A": "Drinking", + "B": "Ambulation", + "C": "Absence of nausea and vomiting", + "D": "Pain control" + }, + "zh": { + "question": "以下哪项不是用于评估患者从门诊手术设施出院适宜性的术后麻醉出院评分系统（PADSS）的组成部分？", + "A": "饮水", + "B": "行走能力", + "C": "无恶心和呕吐", + "D": "疼痛控制" + } + }, + { + "id": "10182cf3-a6a5-599c-bbd6-baf2621d8fc5", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "During emergency repair of a mandibular jaw fracture in an otherwise healthy 19-year-old man, the patient's temperature is noted to rise from 37° C on induction to 38° C after 2 hours of surgery. Which of the", + "A": "Normal heart rate and blood pressure", + "B": "History of negative caffeine-halothane contracture test carried out 6 months earlier", + "C": "History of an uncomplicated general anesthetic at age 16 years with halothane and succinylcholine", + "D": "Normal ABGs drawn when the patient's temperature reached 38° C" + }, + "zh": { + "question": "在一名身体健康的19岁男性进行下颌骨骨折的紧急修复手术期间，患者的体温从诱导时的37°C上升到手术2小时后的38°C。以下哪项是", + "A": "正常的心率和血压", + "B": "6个月前进行的咖啡因-氟烷收缩试验结果为阴性", + "C": "16岁时使用氟烷和琥珀胆碱进行全身麻醉无并发症的病史", + "D": "当患者体温达到38°C时抽取的正常动脉血气分析" + } + }, + { + "id": "033568cb-b4c6-5eb3-8f00-635d5a311021", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following drugs is useful in the treatment of asthma by specifically interfering with the leukotriene pathway?", + "A": "Fluticasone (Flovent)", + "B": "Ipratropium bromide (Atrovent)", + "C": "Triamcinolone (Azmacort)", + "D": "Montelukast (Singulair)" + }, + "zh": { + "question": "以下哪种药物通过特异性干扰白三烯途径对哮喘的治疗有用？", + "A": "氟替卡松 (Flovent)", + "B": "异丙托溴铵 (Atrovent)", + "C": "曲安奈德 (Azmacort)", + "D": "孟鲁司特 (Singulair)" + } + }, + { + "id": "3cd9244b-875e-5376-abdb-85052ebef77c", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 68-year-old, 100-kg patient is undergoing a transurethral resection of the prostate gland under general anesthesia. Upon arrival in the recovery room, the patient appears restless and confused. Serum sodium is checked and found to be 110 mEq/L. How many mEq of sodium are needed to raise the serum [Na + ] to 120 mEq/L?", + "A": "300 mEq", + "B": "400 mEq", + "C": "500 mEq", + "D": "600 mEq" + }, + "zh": { + "question": "一名68岁、100公斤的患者在全身麻醉下进行经尿道前列腺切除术。到达恢复室时，患者显得不安和困惑。检查血清钠，发现为110 mEq/L。需要多少mEq的钠才能将血清[Na +]提高到120 mEq/L？", + "A": "300 mEq", + "B": "400 mEq", + "C": "500 mEq", + "D": "600 mEq" + } + }, + { + "id": "6c2f6582-6086-5de4-bf95-2773167e176f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the intravenous (IV) anesthetics below is LEAST useful in the treatment of status epilepticus?", + "A": "Phenobarbital", + "B": "Dexmedetomidine", + "C": "Propofol", + "D": "Midazolam" + }, + "zh": { + "question": "以下哪种静脉麻醉药对治疗癫痫持续状态最不有用？", + "A": "苯巴比妥", + "B": "右美托咪定", + "C": "丙泊酚", + "D": "咪达唑仑" + } + }, + { + "id": "e720670b-968c-5856-bffb-bdeb6973d050", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "A 45-year-old man is brought to the OR emergently for repair of a ruptured abdominal aortic aneurysm. Anesthesia is induced with ketamine 2 mg/kg IV, and tracheal intubation is facilitated with succinylcholine 1.5 mg/kg IV. Immediately after tracheal intubation, the patient's blood pressure falls from 110/80 to 50/20 mm Hg. What is the MOST likely cause of the sudden severe hypotension in this patient?", + "A": "Hypovolemia", + "B": "Direct myocardial depression from ketamine", + "C": "Vasovagal response to direct laryngoscopy", + "D": "Arteriolar vasodilation from succinylcholine-mediated histamine release" + }, + "zh": { + "question": "一名45岁的男性因腹主动脉瘤破裂被紧急送入手术室进行修复。麻醉诱导使用氯胺酮2 mg/kg静脉注射，气管插管使用琥珀胆碱1.5 mg/kg静脉注射。气管插管后，患者的血压从110/80降至50/20 mm Hg。该患者突然严重低血压的最可能原因是什么？", + "A": "低��容量", + "B": "氯胺酮直接导致的心肌抑制", + "C": "直接喉镜检查引起的迷走神经反应", + "D": "琥珀胆碱介导的组胺释放导致的小动脉扩张" + } + }, + { + "id": "9b0a97e0-90bd-53b0-89e8-6f16e135b47f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "MH is believed to involve a generalized disorder of membrane permeability to", + "A": "Sodium", + "B": "Potassium", + "C": "Calcium", + "D": "Magnesium" + }, + "zh": { + "question": "MH 被认为涉及膜通透性的一般性障碍", + "A": "钠", + "B": "钾", + "C": "钙", + "D": "镁" + } + }, + { + "id": "397878e9-f783-51f3-87db-42fe3e75cbda", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 25-year-old man with a history of testicular cancer is scheduled to undergo an exploratory laparotomy under general anesthesia. He has received bleomycin for metastatic disease. Which of the following is an important consideration concerning the pulmonary toxicity of bleomycin?", + "A": "N2O should not be used", + "B": "Preoperative pulmonary function tests should be obtained", + "C": "The patient should be ventilated at a slow rate and inspiratory-to-expiratory (I:E) ratio of 1:3", + "D": "FIO2 should be less than 0.3" + }, + "zh": { + "question": "一名25岁有睾丸癌病史的男性计划在全身麻醉下进行探查性剖腹手术。他因转移性疾病接受了博来霉素治疗。以下哪项是关于博来霉素肺毒性的重要考虑因素？", + "A": "不应使用N2O", + "B": "应进行术前肺功能检查", + "C": "患者应以较慢的速率和1:3的吸呼比进行通气", + "D": "FIO2应小于0.3" + } + }, + { + "id": "59086aaa-d8ba-5a05-bb38-bb6042a9e505", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 39-year-old obese woman undergoes an abdominal hysterectomy under general anesthesia. Induction of anesthesia is uneventful. SaO2 is 98% during the first 15 minutes of the operation, with 50% oxygen and 50% N2O. Then, at the request of the surgeon, N2O is discontinued (now 50% oxygen, 50% N2 ), the head is flexed, and the patient is placed in the Trendelenburg position to improve surgical exposure, and SaO2 falls to 90%. The MOST likely explanation for this desaturation is", + "A": "Diffusion hypoxia", + "B": "Decreased functional residual capacity (FRC)", + "C": "Mainstem intubation", + "D": "Decreased cardiac output" + }, + "zh": { + "question": "一名39岁的肥胖女性在全身麻醉下接受腹部子宫切除术。麻醉诱导顺利。手术的前15分钟内，患者在50%氧气和50%氧化亚氮的情况下，血氧饱和度（SaO2）为98%。然后，应外科医生的要求，停止使用氧化亚氮（现在是50%氧气，50%氮气），头部屈曲，患者被置于特伦德伦堡体位以改善手术视野，SaO2降至90%。这种脱饱和的最可能解释是", + "A": "扩散性低氧", + "B": "功能残气量（FRC）减少", + "C": "主支气管插管", + "D": "心输出量减少" + } + }, + { + "id": "64599e0f-f87a-5854-87d3-63b7fd42a4dc", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How long after intravitreal injection of sulfur hexafluoride and air can N2O be used without risk of increasing intraocular pressure?", + "A": "1 hour", + "B": "24 hours", + "C": "10 days", + "D": "1 month" + }, + "zh": { + "question": "在玻璃体内注射六氟化硫和空气后多长时间可以使用N2O而不会增加眼内压的风险？", + "A": "1小时", + "B": "24小时", + "C": "10天", + "D": "1个月" + } + }, + { + "id": "4ec7da92-0f64-5ded-81ab-241ae9ec105d", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 54-year-old woman is undergoing a total thyroidectomy under general anesthesia. The patient is awakened in the OR, the mouth and pharynx are suctioned, and after intact laryngeal reflexes are demonstrated, the endotracheal tube is removed. Two days later, the anesthesiologist is consulted because the patient has severe stridor and upper airway obstruction. The most likely cause of airway obstruction in this patient is", + "A": "Damage to the recurrent laryngeal nerve", + "B": "Hematoma", + "C": "Tracheomalacia", + "D": "Hypocalcemia" + }, + "zh": { + "question": "一名54岁的女性在全身麻醉下接受全甲状腺切除术。患者在手术室被唤醒，口腔和咽部被吸引清理，并在显示喉反射完整后，拔除气管插管。两天后，麻醉师被咨询，因为患者出现严重的喘鸣和上呼吸道阻塞。该患者气道阻塞的最可能原因是", + "A": "喉返神经损伤", + "B": "血肿", + "C": "气管软化", + "D": "低钙血症" + } + }, + { + "id": "8f15bf5c-078c-5553-88a9-e1eb599f0923", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 27-year-old obese woman is scheduled to undergo foot surgery under general anesthesia. She underwent a subtotal thyroidectomy 3 years ago and takes levothyroxine (Synthroid). Which of the following laboratory tests would be the MOST useful in evaluating whether this patient is euthyroid?", + "A": "Total plasma thyroxine (T4 )", + "B": "Total plasma triiodothyronine (T3 )", + "C": "Thyroid-stimulating hormone (TSH)", + "D": "Resin triiodothyronine uptake" + }, + "zh": { + "question": "一名27岁的肥胖女性计划在全身麻醉下进行足部手术。她在3年前接受了次全甲状腺切除术，并服用左旋甲状腺素（Synthroid）。以下哪项实验室检查对评估该患者是否为甲状腺功能正常最有用？", + "A": "总血浆甲状腺素（T4）", + "B": "总血浆三碘甲状腺原氨酸（T3）", + "C": "促甲状腺激素（TSH）", + "D": "树脂三碘甲状腺原氨酸摄取率" + } + }, + { + "id": "d468ab08-0470-5ad4-a2c9-2e52ae7d2de8", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "An 85-year-old man with no previous medical history except for cataracts is undergoing a transurethral resection of the prostate gland under spinal anesthesia. Twenty minutes into the procedure the patient becomes restless. Over the next 20 minutes, his blood pressure increases from 110/70 to 140/90 mm Hg and his heart rate slows from 90 to 50 beats/min. The patient is noted to have some difficulty breathing. The most likely cause of these symptoms in this patient is", + "A": "Volume overload", + "B": "Hyponatremia", + "C": "High spinal", + "D": "Bladder perforation" + }, + "zh": { + "question": "一名85岁男性，除白内障外无其他病史，正在接受脊椎麻醉下的经尿道前列腺切除术。手术进行20分钟后，患者变得烦躁不安。在接下来的20分钟内，他的血压从110/70 mm Hg升至140/90 mm Hg，心率从90次/分钟降至50次/分钟。患者被注意到有一些呼吸困难。该患者这些症状最可能的原因是", + "A": "容量超负荷", + "B": "低钠血症", + "C": "高位脊椎麻醉", + "D": "膀胱穿孔" + } + }, + { + "id": "753360f8-7993-59e7-9efd-6b712764eb07", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 17-year-old patient with third-degree burns over 30% of his body is scheduled for débridement and skin grafting 12 days after sustaining a thermal injury. Select the TRUE statement regarding the use of depolarizing and nondepolarizing muscle relaxants in this patient, compared with normal patients.", + "A": "Sensitivity to both depolarizing and nondepolarizing muscle relaxants is increased", + "B": "Sensitivity to both depolarizing and nondepolarizing muscle relaxants is decreased", + "C": "Sensitivity to depolarizing muscle relaxants is increased while sensitivity to nondepolarizing muscle relaxants is decreased", + "D": "Sensitivity to depolarizing muscle relaxants is decreased while sensitivity to nondepolarizing muscle relaxants is increased" + }, + "zh": { + "question": "一名17岁的患者在身体30%面积上有三度烧伤，计划在热损伤后12天进行清创和植皮手术。与正常患者相比，选择关于在该患者中使用去极化和非去极化肌肉松弛剂的正确陈述。", + "A": "对去极化和非去极化肌肉松弛剂的敏感性均增加", + "B": "对去极化和非去极化肌肉松弛剂的敏感性均降低", + "C": "对去极化肌肉松弛剂的敏感性增加，而对非去极化肌肉松弛剂的敏感性降低", + "D": "对去极化肌肉松弛剂的敏感性降低，而对非去极化肌肉松弛剂的敏感性增加" + } + }, + { + "id": "024ad1f1-1d24-5bfa-9db0-cf0018244ed8", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A patient undergoes parotid gland removal under general anesthesia. Each of the following assesses facial nerve function EXCEPT", + "A": "Clenching teeth", + "B": "Closing eyes", + "C": "Pursing lips", + "D": "Eyebrow lift" + }, + "zh": { + "question": "患者在全身麻醉下进行腮腺切除术。以下每项都评估面神经功能，除了", + "A": "咬紧牙关", + "B": "闭眼", + "C": "撅嘴", + "D": "抬眉" + } + }, + { + "id": "640ff256-e11d-53f8-a69b-4f2818a89342", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 65-year-old patient with a history of chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) undergoes a laparoscopic nephrectomy uneventfully under general desflurane anesthesia. In the recovery room, ABGs are as follows: PaO2 60 mm Hg, PaCO2 50 mm Hg, pH 7.35, and hemoglobin 8.1 g/dL. Which of the following steps would produce the greatest increase in O2 delivery to the myocardium?", + "A": "Administration of 100% O2 with a close-fitting mask", + "B": "Administration of 35% O2 with a Venturi mask", + "C": "Administer 1 ampule of HCO3", + "D": "Transfuse with 2 units of packed red blood cells (RBCs)" + }, + "zh": { + "question": "一名65岁的患者有慢性阻塞性肺病（COPD）和冠状动脉疾病（CAD）的病史，在全身七氟醚麻醉下顺利接受了腹腔镜肾切除术。在恢复室，动脉血气分析结果如下：PaO2 60 mm Hg，PaCO2 50 mm Hg，pH 7.35，血红蛋白8.1 g/dL。以下哪一步骤将最大程度地增加心肌的氧气输送？", + "A": "使用紧密贴合的面罩给予100%氧气", + "B": "使用文丘里面罩给予35%氧气", + "C": "给予1安瓿的HCO3", + "D": "输注2个单位的浓缩红细胞（RBCs）" + } + }, + { + "id": "66084e01-d0c0-556d-a213-53071fb46c24", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Allergic reactions occurring during the immediate perioperative period are MOST commonly attributable to administration of", + "A": "Muscle relaxants", + "B": "Local anesthetics", + "C": "Antibiotics", + "D": "Opioids" + }, + "zh": { + "question": "在围手术期立即发生的过敏反应最常归因于以下哪种药物的使用？", + "A": "肌肉松弛剂", + "B": "局部麻醉剂", + "C": "抗生素", + "D": "阿片类药物" + } + }, + { + "id": "591e2cc0-473e-5aa8-8fb7-0ef659f15d62", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Caution is advised when using succinylcholine in patients with Huntington chorea because", + "A": "They are at increased risk for MH", + "B": "Potassium release may be excessive", + "C": "They may have a decreased concentration of pseudocholinesterase", + "D": "There may be adverse interactions between succinylcholine and phenothiazine" + }, + "zh": { + "question": "在使用琥珀胆碱治疗亨廷顿舞蹈症患者时应谨慎，因为", + "A": "他们患有恶性高热的风险增加", + "B": "钾释放可能过多", + "C": "他们可能有假性胆碱酯酶浓度降低", + "D": "琥珀胆碱和吩噻嗪之间可能有不良相互作用" + } + }, + { + "id": "bfcd5ee3-6e75-5d28-abb9-e391e6b1c403", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Which of the following would NOT result in an increase in intraocular pressure?", + "A": "Increase in PaCO2 from 35 to 40 mm Hg", + "B": "100 mg intramuscular (IM) succinylcholine", + "C": "Acute rise in venous pressure from coughing", + "D": "100 mg IV succinylcholine in a patient in whom eye muscles have been detached from the globe" + }, + "zh": { + "question": "以下哪项不会导致眼内压升高？", + "A": "PaCO2从35增加到40 mm Hg", + "B": "100 mg 肌肉注射琥珀胆碱", + "C": "咳嗽引起的静脉压急剧升高", + "D": "在眼外肌已从眼球分离的患者中静脉注射100 mg琥珀胆碱" + } + }, + { + "id": "2ce4afbb-7cfd-5af9-8155-9f47b8a3f8ad", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "An apnea-hypopnea index (AHI) of 30 means", + "A": "Episodes of hypopnea are 30 times more common than apnea", + "B": "Apnea/hypopnea episodes occur at a rate of 30 per sleep cycle", + "C": "Episodes of apnea and hypopnea occur at a rate of 30 per hour", + "D": "Apnea/hypopnea episodes last 30 seconds" + }, + "zh": { + "question": "呼吸暂停-低通气指数（AHI）为30意味着", + "A": "低通气事件比呼吸暂停多30倍", + "B": "呼吸暂停/低通气事件以每个睡眠周期30次的频率发生", + "C": "呼吸暂停和低通气事件以每小时30次的频率发生", + "D": "呼吸暂停/低通气事件持续30秒" + } + }, + { + "id": "1528f9a4-0547-5f1f-a052-c4913be97992", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 26-year-old man is undergoing an emergency exploratory laparotomy under general anesthesia with isoflurane. SaO2 is 89% on the pulse oximeter. PaO2 on ABGs is 77 mm Hg. The patient's core body temperature is 35° C. What is the corrected PaO2?", + "A": "68 mm Hg", + "B": "72 mm Hg", + "C": "77 mm Hg", + "D": "86 mm Hg" + }, + "zh": { + "question": "一名26岁的男性在全身麻醉下使用异氟醚进行紧急探查性剖腹手术。脉搏血氧仪显示SaO2为89%。动脉血气分析显示PaO2为77 mm Hg。患者的核心体温为35°C。校正后的PaO2是多少？", + "A": "68 mm Hg", + "B": "72 mm Hg", + "C": "77 mm Hg", + "D": "86 mm Hg" + } + }, + { + "id": "3fdef834-dae8-524a-a3ba-3e061a98e9a8", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 27-year-old patient with a 10-year history of Crohn disease is scheduled to undergo drainage of a rectal abscess under general", + "A": "Presence of sulfhemoglobin", + "B": "Presence of methemoglobin", + "C": "Presence of cyanhemoglobin", + "D": "Presence of carboxyhemoglobin" + }, + "zh": { + "question": "一名27岁的患者有10年的克罗恩病史，计划在全身麻醉下进行直肠脓肿引流手术", + "A": "存在硫化血红蛋白", + "B": "存在高铁血红蛋白", + "C": "存在青紫血红蛋白", + "D": "存在碳氧血红蛋白" + } + }, + { + "id": "e51598a7-a498-5057-9eff-7c9c3837ee98", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Low-molecular-weight heparin (LMWH)", + "A": "Is as likely to cause heparin-induced thrombocytopenia (HIT) as unfractionated heparin", + "B": "Should be monitored with partial thromboplastin time (PTT) for clinical effect", + "C": "Can be fully reversed with protamine", + "D": "LMWH has a longer plasma half-life than unfractionated heparin" + }, + "zh": { + "question": "低分子量肝素（LMWH）", + "A": "与普通肝素一样容易引起肝素诱导的血小板减少症（HIT）", + "B": "应通过部分凝血活酶时间（PTT）监测其临床效果", + "C": "可以用鱼精蛋白完全逆转", + "D": "LMWH 的血浆半衰期比普通肝素长" + } + }, + { + "id": "fa4627c6-4d6c-51ff-9fd1-da4da364b0dc", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "In a given patient, if a creatinine of 1.0 corresponds to a glomerular filtration rate (GFR) of 120 mL/min, a creatinine of 4.0 would correspond to", + "A": "20 mL/min", + "B": "30 mL/min", + "C": "40 mL/min", + "D": "50 mL/min" + }, + "zh": { + "question": "在某位患者中，如果肌酐为1.0对应的肾小球滤过率（GFR）为120 mL/min，那么肌酐为4.0对应的肾小球滤过率为", + "A": "20 mL/min", + "B": "30 mL/min", + "C": "40 mL/min", + "D": "50 mL/min" + } + }, + { + "id": "0b9524b1-7a1a-5bd9-84a1-bcaa8dd77bd8", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The incidence of each of the following is increased in patients with Down syndrome (trisomy 21) EXCEPT", + "A": "MH", + "B": "Congenital heart disease", + "C": "Smaller trachea", + "D": "Occipito-atlantoaxial instability" + }, + "zh": { + "question": "在以下每种情况中，唐氏综合征（21三体）患者的发病率均增加，除了", + "A": "恶性高热", + "B": "先天性心脏病", + "C": "气管较小", + "D": "枕-寰-枢椎不稳定" + } + }, + { + "id": "81514478-8cab-5936-b4eb-3e73cdbe80a5", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 55-year-old man is to undergo a laparoscopic cholecystectomy under general anesthesia. The patient has a 40-pack-per-year smoking history and a history of CHF. The patient receives metoclopramide and scopolamine preoperatively. General anesthesia is induced with", + "A": "Emergence delirium from ketamine anesthesia", + "B": "Effect of scopolamine", + "C": "Effect of Trendelenburg position", + "D": "Corneal abrasion" + }, + "zh": { + "question": "一名55岁的男性将在全身麻醉下接受腹腔镜胆囊切除术。患者有40包/年的吸烟史和充血性心力衰竭史。患者术前接受了甲氧氯普胺和东莨菪碱。全身麻醉诱导是通过", + "A": "氯胺酮麻醉引起的苏醒期谵妄", + "B": "东莨菪碱的作用", + "C": "特伦德伦堡体位的影响", + "D": "角膜擦伤" + } + }, + { + "id": "b41d584d-93b6-5b55-8320-b8669a82046b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "MH and neuroleptic malignant syndrome share each of the following characteristics EXCEPT", + "A": "Generalized muscular rigidity", + "B": "Hyperthermia", + "C": "Effectively treated with dantrolene", + "D": "Flaccid paralysis after administration of vecuronium" + }, + "zh": { + "question": "恶性高热和神经阻滞性恶性综合征具有以下每个特征，除了", + "A": "全身肌肉僵硬", + "B": "高热", + "C": "用丹曲林有效治疗", + "D": "使用维库溴铵后出现弛缓性麻痹" + } + }, + { + "id": "dfd07f09-681a-5265-95a1-ed786aa6eb6b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What of the following statements about vasopressin is true?", + "A": "It has a potent vasopressor effect at high doses in normal subjects", + "B": "Plasma levels are inappropriately high in patients immediately after cardiopulmonary bypass", + "C": "Plasma levels are inappropriately low in the setting of septic shock", + "D": "It causes pulmonary vasoconstriction secondary to inhibition of endothelial nitric oxide release" + }, + "zh": { + "question": "以下关于加压素的说法哪一项是正确的？", + "A": "在正常人中，高剂量时具有强效的升压作用", + "B": "在体外循环术后患者中，血浆水平不适当地升高", + "C": "在脓毒性休克的情况下，血浆水平不适当地降低", + "D": "通过抑制内皮一氧化氮释放导致肺血管收缩" + } + }, + { + "id": "de747cef-8514-5a26-930d-eb4db464e398", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Remifentanil is metabolized primarily by", + "A": "Kidneys", + "B": "Liver", + "C": "Nonspecific esterases", + "D": "Pseudocholinesterase" + }, + "zh": { + "question": "瑞芬太尼主要通过什么代谢", + "A": "肾脏", + "B": "肝脏", + "C": "非特异性酯酶", + "D": "假胆碱酯酶" + } + }, + { + "id": "8a67ab16-d1b2-528d-80b6-1b050b66de14", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A term infant with good muscle tone and strong cry has an 83% saturation on room air 5 minutes after delivery. The MOST appropriate action at this point would be", + "A": "Bag and mask ventilation with 100% oxygen", + "B": "Intubate and ventilate with 100% oxygen", + "C": "Spontaneous breathing with 100% oxygen", + "D": "Observe" + }, + "zh": { + "question": "一名足月新生儿肌张力良好且哭声洪亮，出生5分钟后在室内空气中的血氧饱和度为83%。此时最合适的措施是", + "A": "使用100%氧气进行面罩通气", + "B": "插管并使用100%氧气进行通气", + "C": "自发呼吸并使用100%氧气", + "D": "观察" + } + }, + { + "id": "825dbce1-705f-5f0a-ad72-58d66b66076a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Patients who undergo extracorporeal shock wave lithotripsy are at increased risk for", + "A": "Venous air embolism", + "B": "Pneumothorax", + "C": "Hypotension with regional anesthesia at the end of the procedure", + "D": "Postdural puncture headache with spinal anesthesia" + }, + "zh": { + "question": "接受体外冲击波碎石术的患者面临增加的风险是", + "A": "静脉空气栓塞", + "B": "气胸", + "C": "在手术结束时使用区域麻醉导致的低血压", + "D": "脊髓麻醉后硬膜穿刺头痛" + } + }, + { + "id": "daf11f50-801d-57af-ab79-604f3ebea8d6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The most common reason for admitting outpatients to the hospital following general anesthesia is", + "A": "Nausea and vomiting", + "B": "Inability to void", + "C": "Inability to ambulate", + "D": "Surgical pain" + }, + "zh": { + "question": "全身麻醉后将门诊病人收治入院的最常见原因是", + "A": "恶心和呕吐", + "B": "无法排尿", + "C": "无法行走", + "D": "手术疼痛" + } + }, + { + "id": "97695799-6984-5d4e-9cbc-22e3f85df8c4", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A 37-year-old man with myasthenia gravis arrives in the emergency room confused and agitated after a 2-day history of weakness and increased difficulty breathing. ABGs on room air are PaO2 60 mm Hg,", + "A": "Tracheal intubation and mechanical ventilation", + "B": "Repeat the test dose of edrophonium", + "C": "Administer neostigmine", + "D": "Administer atropine for cholinergic crisis" + }, + "zh": { + "question": "一名37岁的重症肌无力男性患者在经历了2天的无力和呼吸困难加重后，神志不清和烦躁地来到急诊室。室内空气下的动脉血气分析显示PaO2为60 mm Hg，", + "A": "气管插管和机械通气", + "B": "重复使用依酚氯铵试验剂量", + "C": "给予新斯的明", + "D": "给予阿托品以应对胆碱能危象" + } + }, + { + "id": "09f593cf-2fb1-527c-a618-7d41efba2dba", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Select the FALSE statement regarding tramadol (Ultram).", + "A": "Ondansetron may interfere with part of tramadol's analgesia", + "B": "Tramadol is associated with seizures in patients taking selective serotonin reuptake inhibitors (SSRIs)", + "C": "It is relatively safe in patients whose pain makes them suicidal", + "D": "Its analgesic effects are partially antagonized by naloxone" + }, + "zh": { + "question": "选择关于曲马多（Ultram）的错误陈述。", + "A": "昂丹司琼可能会干扰曲马多的部分镇痛作用", + "B": "曲马多与服用选择性5-羟色胺再摄取抑制剂（SSRIs）的患者发生癫痫有关", + "C": "对于因疼痛而有自杀倾向的患者来说，它相对安全", + "D": "其镇痛效果部分被纳洛酮拮抗" + } + }, + { + "id": "8cca68e1-d858-5b31-b606-9c31f0af4138", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In statistical hypothesis testing, if the *P* value is less than the", + "A": "The observed result is unlikely under the null hypothesis", + "B": "The observed result is unlikely under an alternative hypothesis", + "C": "The sample size is too small", + "D": "The predetermined power is too low" + }, + "zh": { + "question": "在统计假设检验中，如果*P*值小于", + "A": "在零假设下观察到的结果不太可能", + "B": "在备择假设下观察到的结果不太可能", + "C": "样本量太小", + "D": "预定的效能太低" + } + }, + { + "id": "c13e4393-e6bf-5640-a739-095844c67f00", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 72-year-old man undergoes emergency repair of an abdominal aortic aneurysm. In the first hour after release of the suprarenal cross-clamp, urine output is only 10 mL. After administration of furosemide 20 mg IV, urine output increases to 100 mL/hr. Urine [Na + ] is 43 mEq/L, and urine osmolality is 210 mOsm/L. The MOST likely cause of the initial oliguria is", + "A": "Increased ADH", + "B": "Renal hypoperfusion", + "C": "Acute tubular necrosis", + "D": "Impossible to differentiate" + }, + "zh": { + "question": "一名72岁的男性接受腹主动脉瘤的紧急修复手术。在释放肾上交叉夹后的第一个小时，尿量仅为10毫升。静脉注射20毫克呋塞米后，尿量增加到100毫升/小时。尿钠浓度为43 mEq/L，尿渗透压为210 mOsm/L。最可能导致初始少尿的原因是", + "A": "抗利尿激素增加", + "B": "肾脏低灌注", + "C": "急性肾小管坏死", + "D": "无法区分" + } + }, + { + "id": "2dc4d702-8cc7-505e-8076-c401e2e1fc18", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Brice Questionnaire is used to estimate", + "A": "Risk of sleep apnea", + "B": "Intraoperative awareness", + "C": "Postoperative nausea and vomiting (PONV)", + "D": "Suitability for postanesthesia care unit (PACU) discharge" + }, + "zh": { + "question": "Brice问卷用于评估", + "A": "睡眠呼吸暂停的风险", + "B": "术中知晓", + "C": "术后恶心呕吐 (PONV)", + "D": "适合从麻醉后监护病房 (PACU) 出院" + } + }, + { + "id": "e6fe2e8e-fe0d-5380-9954-6c0bd3b38a4a", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 40-year-old man is undergoing a left inguinal hernia repair under general anesthesia in San Diego, California. N2O is administered at 3 L/min, O2 at 1 L/min, and isoflurane at 0.85%. What MAC is this patient receiving?", + "A": "0.8", + "B": "1.25", + "C": "1.50", + "D": "1.75" + }, + "zh": { + "question": "一名40岁的男性在加利福尼亚州圣地亚哥接受全身麻醉下的左侧腹股沟疝修补术。N2O以3 L/min的速度给药，O2以1 L/min的速度给药，异氟醚浓度为0.85%。该患者接受的MAC是多少？", + "A": "0.8", + "B": "1.25", + "C": "1.50", + "D": "1.75" + } + }, + { + "id": "8eeb584b-f6ae-50d3-ad72-a6d1589445d2", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "An otherwise healthy 140-kg, 24-year-old man is scheduled for vocal cord surgery under general anesthesia. Which of the following statements concerning his cardiac output at 140 kg compared with his cardiac output at his ideal body weight (70 kg) is CORRECT?", + "A": "Cardiac output is the same", + "B": "Cardiac output is increased by 10%", + "C": "Cardiac output is increased by 50%", + "D": "Cardiac output is doubled" + }, + "zh": { + "question": "一名身体健康的140公斤、24岁男性计划在全身麻醉下进行声带手术。关于他在140公斤时的心输出量与其理想体重（70公斤）时的心输出量相比，下列哪项陈述是正确的？", + "A": "心输出量相同", + "B": "心输出量增加10%", + "C": "心输出量增加50%", + "D": "心输出量翻倍" + } + }, + { + "id": "85e394c1-e802-5d39-a612-075db7f33d92", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "After a single 150-mg dose of propofol to a 75-kg healthy patient, which of the following statements is FALSE?", + "A": "The peak plasma concentration is reached in < 1 minute", + "B": "The peak plasma concentration of propofol is 7 to 8 μg/mL", + "C": "The therapeutic plasma concentration range for propofol is 1.5-5 μg/mL", + "D": "It takes about 15 to 20 minutes for the drug level to fall to a subtherapeutic level" + }, + "zh": { + "question": "对于一名75公斤的健康患者，单次给予150毫克剂量的丙泊酚后，以下哪项陈述是错误的？", + "A": "峰值血浆浓度在小于1分钟内达到", + "B": "丙泊酚的峰值血浆浓度为7到8 μg/mL", + "C": "丙泊酚的治疗血浆浓度范围为1.5-5 μg/mL", + "D": "药物水平下降到亚治疗水平大约需要15到20分钟" + } + }, + { + "id": "412fe940-5c4e-5c94-b239-86900fe4f053", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 58-year-old hemophiliac is scheduled for total knee arthroplasty. His factor VIII levels are 35% of normal. Which of the following would be the most appropriate therapy before surgery?", + "A": "Administer sufficient cryoprecipitate to raise factor VIII levels to 50% normal", + "B": "Administer factor VIII concentrates to achieve levels of 100% normal", + "C": "Transfuse fresh frozen plasma until factor VIII levels are 100% normal", + "D": "None of the above" + }, + "zh": { + "question": "一名58岁的血友病患者计划进行全膝关节置换术。他的第VIII因子水平为正常的35%。以下哪种治疗在手术前最合适？", + "A": "给予足够的冷沉淀以将第VIII因子水平提高到正常的50%", + "B": "给予第VIII因子浓缩物以达到正常的100%水平", + "C": "输注新鲜冰冻血浆直到第VIII因子水平达到正常的100%", + "D": "以上都不是" + } + }, + { + "id": "50ed1df7-f2af-5ea1-9d6a-412fcc4bf201", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 16-year-old boy whose maternal uncle has hemophilia A is scheduled for wisdom tooth extraction. Which test below would be the best screening test for hemophilia A?", + "A": "PTT", + "B": "Prothrombin time (PT)", + "C": "Thrombin time", + "D": "Bleeding time" + }, + "zh": { + "question": "一名16岁男孩，其母系叔叔患有血友病A，计划进行智齿拔除。以下哪项测试是筛查血友病A的最佳测试？", + "A": "PTT", + "B": "凝血酶原时间 (PT)", + "C": "凝血酶时间", + "D": "出血时间" + } + }, + { + "id": "5f63f959-b2ba-5b4b-aee7-5c43ee427a88", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Five minutes after a single 150-mg dose of propofol to a 75-kg patient, which of the following is most likely regarding the cytosol", + "A": "The concentration in the brain would be rising", + "B": "The concentration in the spinal cord would be rising", + "C": "The concentration in the leg muscles would be falling", + "D": "The concentration in fat would be rising" + }, + "zh": { + "question": "在给一名75公斤的患者单次注射150毫克丙泊酚后五分钟，以下哪项最有可能与细胞质有关？", + "A": "大脑中的浓度会上升", + "B": "脊髓中的浓度会上升", + "C": "腿部肌肉中的浓度会下降", + "D": "脂肪中的浓度会上升" + } + }, + { + "id": "ebb5b8d0-edd3-54ae-99ad-e52c4ac0b042", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 57-year-old man is undergoing a right eye enucleation under general anesthesia. The patient has no history of cardiac disease. During the operation, 5-mm ST-segment elevation is noted on lead II, and the patient develops complete heart block. The coronary artery most likely affected is", + "A": "Circumflex coronary artery", + "B": "Right coronary artery", + "C": "Left main coronary artery", + "D": "Left anterior descending coronary artery" + }, + "zh": { + "question": "一名57岁的男性在全身麻醉下进行右眼摘除术。患者无心脏病史。手术过程中，在导联II上观察到5毫米的ST段抬高，患者出现完全性心脏传导阻滞。最可能受影响的冠状动脉是", + "A": "回旋冠状动脉", + "B": "右冠状动脉", + "C": "左主冠状动脉", + "D": "左前降支冠状动脉" + } + }, + { + "id": "84c9db7c-2c1f-5c00-adbf-0cbf18be6701", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following may increase MAC for volatile anesthetics EXCEPT", + "A": "Cocaine", + "B": "Hyperthyroidism", + "C": "Hypernatremia", + "D": "Tricyclic antidepressants" + }, + "zh": { + "question": "下列各项中，除哪一项外均可增加挥发性麻醉药的MAC", + "A": "可卡因", + "B": "甲状腺功能亢进", + "C": "高钠血症", + "D": "三环类抗抑郁药" + } + }, + { + "id": "9cc01dd8-bafe-5c08-a375-f2d6824b0735", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 37-year-old patient with a history of manic-depressive illness is scheduled to undergo surgery for removal of an intramedullary rod in the left tibia. Which of the following statements regarding potential untoward effects of lithium therapy is NOT true?", + "A": "Long-term administration may be associated with nephrogenic diabetes insipidus", + "B": "Administration of succinylcholine to patients treated with lithium may result in hyperkalemia", + "C": "Long-term therapy may be associated with hypothyroidism", + "D": "Duration of action of vecuronium may be prolonged" + }, + "zh": { + "question": "一名37岁的患者有躁郁症病史，计划进行左胫骨髓内钉的移除手术。关于锂治疗的潜在不良影响，下列哪项陈述是不正确的？", + "A": "长期使用可能与肾性尿崩症有关", + "B": "对接受锂治疗的患者使用琥珀酰胆碱可能导致高钾血症", + "C": "长期治疗可能与甲状腺功能减退有关", + "D": "维库溴铵的作用时间可能延长" + } + }, + { + "id": "e65f974d-fbac-563b-913e-8311c533581d", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Treatment of hypotension in a patient anesthetized for resection of metastatic carcinoid would be best accomplished with", + "A": "Epinephrine", + "B": "Ephedrine", + "C": "Vasopressin (DDAVP)", + "D": "Octreotide" + }, + "zh": { + "question": "在接受转移性类癌切除术的麻醉患者中，低血压的最佳治疗方法是", + "A": "肾上腺素", + "B": "麻黄碱", + "C": "加压素 (DDAVP)", + "D": "奥曲肽" + } + }, + { + "id": "76720ba3-c139-55c8-904f-774af1aad8bc", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "You are asked to evaluate a patient in the recovery room after having undergone an exploratory laparotomy for a colonic perforation. Which of the following factors in the quick Sequential Organ Failure Assessment (qSOFA) would be associated with an in-hospital mortality of 10%?", + "A": "Respiratory rate of 24/min; confusion; blood pressure of 110/60", + "B": "Lactate of 3.0 mmol/L; confusion; blood pressure of 110/60", + "C": "Lactate of 5.0 mmol/L; confusion; blood pressure of 110/60", + "D": "Respiratory rate of 24/min; awake, in pain; blood pressure of 110/60" + }, + "zh": { + "question": "在恢复室中评估一名接受结肠穿孔探查性剖腹手术的患者。以下哪项快速序贯器官衰竭评估（qSOFA）因素与10%的住院死亡率相关？", + "A": "呼吸频率24次/分钟；意识模糊；血压110/60", + "B": "乳酸3.0 mmol/L；意识模糊；血压110/60", + "C": "乳酸5.0 mmol/L；意识模糊；血压110/60", + "D": "呼吸频率24次/分钟；清醒，疼痛；血压110/60" + } + }, + { + "id": "e0249eb6-7fe5-557d-98bc-abc2c59c4a5c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 31-year-old patient has been in the ICU on a ventilator for 24 hours after an MVA. The patient does not open his eyes to any stimulus and has no verbal or motor response. The Glasgow Coma Scale corresponding to this patient would be", + "A": "0", + "B": "1", + "C": "2", + "D": "3" + }, + "zh": { + "question": "一名31岁的患者在发生车祸后已在ICU使用呼吸机24小时。患者对任何刺激都不睁眼，也没有语言或运动反应。该患者的格拉斯哥昏迷评分为", + "A": "0", + "B": "1", + "C": "2", + "D": "3" + } + }, + { + "id": "e7e86113-0760-5027-907f-0f9eef66866f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Hypoglycemia is more likely to occur in the diabetic surgical patient with which of the following diseases?", + "A": "Renal disease", + "B": "Rheumatoid arthritis requiring high-dosage prednisone", + "C": "Chronic obstructive lung disease treated with a terbutaline inhaler and aminophylline", + "D": "Manic-depressive disorder treated with lithium" + }, + "zh": { + "question": "在以下哪种疾病的情况下，糖尿病手术患者更容易发生低血糖？", + "A": "肾病", + "B": "需要大剂量泼尼松治疗的类风湿性关节炎", + "C": "使用特布他林吸入剂和氨茶碱治疗的慢性阻塞性肺病", + "D": "使用锂治疗的躁郁症" + } + }, + { + "id": "1d67a492-ba68-51d0-85fd-50207f589fc6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is most likely to be associated with a falsely elevated SaO2 as measured by pulse oximetry (dual wave)?", + "A": "Hemoglobin F", + "B": "Carboxyhemoglobin", + "C": "Methylene blue dye", + "D": "Fluorescein dye" + }, + "zh": { + "question": "以下哪项最有可能与脉搏血氧仪（双波）测量的SaO2虚高有关？", + "A": "胎儿血红蛋白", + "B": "碳氧血红蛋白", + "C": "亚甲蓝染料", + "D": "荧光素染料" + } + }, + { + "id": "a37eb58b-4a81-5c05-8772-66cd93e79931", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Select the FALSE statement regarding clinical performance and sleep deprivation", + "A": "A period of vulnerability has been identified between 2 AM and 7 AM", + "B": "There is an increased incidence of MVAs in post-call house staff", + "C": "When patient simulation was used to study sleep deprivation in anesthesia residents, no reduction in clinical performance was demonstrable", + "D": "After inception of restriction of resident work hours in July 2003, a reduction in patient death rates was shown to be less in hospitals with large numbers of resident physicians versus those with fewer" + }, + "zh": { + "question": "选���关于临床表现和睡眠剥夺的错误陈述", + "A": "已确定在凌晨2点到7点之间存在一个脆弱期", + "B": "值班后医务人员的交通事故发生率增加", + "C": "当使用患者模拟来研究麻醉住院医师的睡眠剥夺时，未显示临床表现的下降", + "D": "自2003年7月开始限制住院医师工作时间后，住院医师人数多的医院与人数少的医院相比，患者死亡率的减少较少" + } + }, + { + "id": "c0f4976e-1eea-5d12-813b-91fa7fc261fe", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Gabapentin (Neurontin) as used in the treatment of chronic pain belongs to the same broad class of drugs as", + "A": "Carbamazepine", + "B": "Imipramine", + "C": "Clonidine", + "D": "Fluoxetine (Prozac)" + }, + "zh": { + "question": "用于治疗慢性疼痛的加巴喷丁（Neurontin）属于与以下哪种药物相同的大类药物", + "A": "卡马西平", + "B": "丙咪嗪", + "C": "可乐定", + "D": "氟西汀（百忧解）" + } + }, + { + "id": "5bf86227-3f8e-55a7-9fce-61dc21e305c8", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 72-year-old man with a history of smoking, hypertension, and CHF undergoes a colonoscopy under sedation. The night before the procedure, he took his bowel prep but omitted his metoprolol and", + "A": "PEEP", + "B": "Furosemide", + "C": "Increase FIO2", + "D": "Esmolol" + }, + "zh": { + "question": "一名72岁的男性，有吸烟、高血压和充血性心力衰竭病史，在镇静下进行结肠镜检查。手术前一晚，他进行了肠道准备，但遗漏了他的美托洛尔和", + "A": "呼气末正压（PEEP）", + "B": "呋塞米", + "C": "增加吸入氧浓度（FIO2）", + "D": "艾司洛尔" + } + }, + { + "id": "47cba30e-1fb9-5a78-ace3-b8b292c71baf", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 47-year-old morbidly obese patient develops bilateral blindness (only able to perceive light) after a 6-hour, three-segment laminectomy and fusion. The patient received 6 units of blood and 5 L of lactated Ringer solution. A mean arterial blood pressure was maintained at 50 to 60 mm Hg. The MOST likely structure involved in this visual loss is", + "A": "Central retinal artery", + "B": "Optic nerve", + "C": "Retina", + "D": "Cerebral cortex" + }, + "zh": { + "question": "一名47岁的病态肥胖患者在接受6小时的三节椎板切除术和融合术后出现双侧失明（仅能感知光）。患者接受了6个单位的血液和5升乳酸林格氏液。平均动脉血压维持在50到60 mm Hg。最有可能导致这种视力丧失的结构是", + "A": "中央视网膜动脉", + "B": "视神经", + "C": "视网膜", + "D": "大脑皮层" + } + }, + { + "id": "5f88629c-3ef1-560a-9220-149490ff85fc", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Each of the following statements regarding postoperative shivering is true EXCEPT", + "A": "It may increase metabolism and oxygen consumption significantly", + "B": "It may be treated with meperidine", + "C": "It may be treated with droperidol", + "D": "It does not occur in the absence of hypothermia" + }, + "zh": { + "question": "以下关于术后寒战的说法均正确，除了", + "A": "它可能显著增加代谢和氧气消耗", + "B": "可以用哌替啶治疗", + "C": "可以用氟哌利多治疗", + "D": "在没有低体温的情况下不会发生" + } + }, + { + "id": "674dbe3b-1c49-5b52-abcf-0e9c77d3dece", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "ECG changes associated with hyperkalemia include", + "A": "Increased P-wave amplitude", + "B": "Shortened PR interval", + "C": "Narrowed and peaked T waves", + "D": "Increase in U-wave amplitude" + }, + "zh": { + "question": "与高钾血症相关的心电图变化包括", + "A": "P波振幅增加", + "B": "PR间期缩短", + "C": "T波变窄且尖峰", + "D": "U波振幅增加" + } + }, + { + "id": "7d439f87-6fa6-5faa-9075-f4d7928a966c", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 53-year-old woman presents to the preoperative evaluation clinic before a scheduled pancreaticoduodenectomy. She complains of a 6 month history of dyspnea on exertion, fatigue, palpitations, chest discomfort, and occasionally feeling \"like she is about to faint.\" She has a 40-pack-year history of smoking and a long history of COPD. She receives oxygen by nasal cannula at night. Jugular venous distention,", + "A": "Absence of P2 heart sounds during auscultation of chest", + "B": "Left axis deviation in 12-lead ECG tracing", + "C": "Enlarged aorta in chest x-ray", + "D": "Partial systolic closure of the pulmonary valve during transesophageal echocardiograph (TEE) evaluation" + }, + "zh": { + "question": "一名53岁的女性在计划进行胰十二指肠切除术前到术前评估诊所就诊。她抱怨有6个月的劳力性呼吸困难、疲劳、心悸、胸部不适，并偶尔感到“像是要晕倒”。她有40包年吸烟史和长期慢性阻塞性肺病史。她晚上通过鼻导管吸氧。颈静脉怒张，", + "A": "胸部听诊时P2心音缺失", + "B": "12导联心电图示左轴偏移", + "C": "胸部X光显示主动脉增大", + "D": "经食道超声心动图（TEE）评估时肺动脉瓣部分收缩期关闭" + } + }, + { + "id": "d0939fe9-6a9b-5ad2-9132-be73cfffb0ac", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Each of the following is associated with acromegalic patients undergoing transsphenoidal hypophysectomy EXCEPT", + "A": "Enlargement of the tongue and epiglottis", + "B": "Narrowing of the glottic opening", + "C": "Nasal turbinate enlargement", + "D": "Continuous positive airway pressure (CPAP) should be used postoperatively because obstructive sleep apnea (OSA) is common" + }, + "zh": { + "question": "下列各项中，除哪一项外，均与进行经蝶窦垂体切除术的肢端肥大症患者相关", + "A": "舌头和会厌增大", + "B": "声门开口变窄", + "C": "鼻甲增大", + "D": "术后应使用持续气道正压通气（CPAP），因为阻塞性睡眠呼吸暂停（OSA）很常见" + } + }, + { + "id": "f814ff52-68b8-54a8-9b61-fd0ffe823551", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Evidence of an anaphylactic reaction to atracurium 1 to 2 hours after the episode could be best established by measuring blood levels of", + "A": "Tryptase", + "B": "Laudanosine", + "C": "Histamine", + "D": "Bradykinin" + }, + "zh": { + "question": "在发生过敏性反应1到2小时后，最能确立阿曲库铵过敏反应的证据是测量血液中的哪种物质水平？", + "A": "胰蛋白酶", + "B": "劳达诺辛", + "C": "组胺", + "D": "缓激肽" + } + }, + { + "id": "078082d7-edf7-5211-814a-407cede1b5df", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "Which of the following findings is NOT consistent with a diagnosis of MH?", + "A": "PaCO2 150 mm Hg", + "B": "MVO2 50 mm Hg", + "C": "pH 6.9", + "D": "Onset of symptoms an hour after end of operation" + }, + "zh": { + "question": "以下哪项发现与MH的诊断不一致？", + "A": "PaCO2 150 mm Hg", + "B": "MVO2 50 mm Hg", + "C": "pH 6.9", + "D": "症状在手术结束后一小时出现" + } + }, + { + "id": "fcf5e84a-3eef-5e22-87b1-c98350ca161a", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 52-year-old business executive undergoes a radical retropubic prostatectomy uneventfully under general isoflurane anesthesia. He takes fluoxetine (Prozac) for depression. Upon discharge, which of the following analgesics would be the best choice for postoperative pain management in this patient?", + "A": "Oxycodone plus aspirin (Percodan)", + "B": "Hydrocodone with acetaminophen (Vicodin)", + "C": "Codeine with acetaminophen (Tylenol No. 3)", + "D": "Hydromorphone (Dilaudid)" + }, + "zh": { + "question": "一位52岁的企业高管在全身异氟醚麻醉下顺利接受了根治性耻骨后前列腺切除术。他因抑郁症服用氟西汀（Prozac）。出院时，下列哪种镇痛药是该患者术后疼痛管理的最佳选择？", + "A": "羟考酮加阿司匹林（Percodan）", + "B": "氢可酮与对乙酰氨基酚（Vicodin）", + "C": "可待因与对乙酰氨基酚（Tylenol No. 3）", + "D": "氢吗啡酮（Dilaudid）" + } + }, + { + "id": "7bd4b9f2-6cd0-52cb-8acc-244c14c6ce63", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The phase of liver transplantation where the greatest degree of hemodynamic instability is expected is", + "A": "Induction", + "B": "Dissection phase", + "C": "Anhepatic phase", + "D": "Reperfusion phase" + }, + "zh": { + "question": "肝移植过程中预期血流动力学不稳定程度最大的阶段是", + "A": "诱导期", + "B": "解剖期", + "C": "无肝期", + "D": "再灌注期" + } + }, + { + "id": "06e4e53c-943e-59e4-84b8-7abf128f8868", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "After closure of the incision for an open hemicolectomy, an abdominal x-ray is performed in the OR that shows a piece of gauze remaining in the abdomen. The surgeon requests neuromuscular blockade to facilitate retrieval of the retained surgical object. You used rocuronium for the case, which you subsequently reversed with sugammadex at closure. Which of the following statements is most likely true?", + "A": "Administering cisatracurium would result in a faster-thannormal onset and more potent blockade", + "B": "No neuromuscular blocking agent other than succinylcholine will be effective at this time", + "C": "Administering rocuronium or vecuronium would result in the most potent neuromuscular blockade", + "D": "Sugammadex forms inclusion complexes with benzylisoquinolinium neuromuscular blockers" + }, + "zh": { + "question": "在开放性半结肠切除术切口关闭后，在手术室进行的腹部X光显示腹腔内遗留了一块纱布。外科医生要求使用神经肌肉阻滞剂以便取出遗留的手术物品。您在手术中使用了罗库溴铵，并在关闭时用舒更葡糖钠进行了逆转。以下哪项陈述最有可能为真？", + "A": "使用西酞铵会导致比正常更快的起效和更强的阻滞作用", + "B": "此时除了琥珀胆碱外，没有其他神经肌肉阻滞剂会有效", + "C": "使用罗库溴铵或维库溴铵会导致最强的神经肌肉阻滞", + "D": "舒更葡糖钠与苯基异喹啉类神经肌肉阻滞剂形成包合物" + } + }, + { + "id": "29358418-b03c-59b8-aea9-f6ae3cd2d017", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the factors in adults listed below is the strongest independent predictor of PONV in most studies?", + "A": "Female gender", + "B": "History of PONV", + "C": "History of migraines", + "D": "History of cigarette smoking" + }, + "zh": { + "question": "在大多数研究中，以下哪项因素是成人PONV最强的独立预测因子？", + "A": "女性性别", + "B": "PONV病史", + "C": "偏头痛病史", + "D": "吸烟史" + } + }, + { + "id": "0717e525-f892-5eeb-8e50-e8aef14f6404", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Near the end of a 3-hour colectomy, the surgeon complains that the patient is not relaxed. Two twitch monitors placed at different locations show only one twitch of a train-of-four. Blood gases are reported to be pH 6.9, CO2 82, K 4.6. The most appropriate action would be", + "A": "Administer more vecuronium", + "B": "Administer bicarbonate", + "C": "Increase minute ventilation", + "D": "Administer dantrolene" + }, + "zh": { + "question": "在进行3小时的结肠切除术接近尾声时，外科医生抱怨患者没有放松。放置在不同位置的两个刺激监测器显示四连刺激中只有一次抽搐。血气报告为pH 6.9，CO2 82，K 4.6。最合适的措施是", + "A": "给予更多的维库溴铵", + "B": "给予碳酸氢钠", + "C": "增加分钟通气量", + "D": "给予丹曲林" + } + }, + { + "id": "0b4e6262-2c23-51d3-872e-8100ee5d856e", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 22-year-old parturient is anesthetized for an emergency laparoscopic cholecystectomy. She is in the twenty-fourth week of gestation and receives general sevoflurane anesthesia and has received rocuronium for muscle relaxation. Just before emergence, muscle relaxation is reversed with glycopyrrolate and neostigmine. Three minutes later, the fetal heart rate falls to 88 beats/min. The MOST likely cause of this is", + "A": "Fetal head compression", + "B": "Uteroplacental insufficiency", + "C": "Fetal hypoxia", + "D": "Reversal agents" + }, + "zh": { + "question": "一名22岁的产妇因急诊腹腔镜胆囊切除术接受麻醉。她处于妊娠第24周，接受七氟醚全身麻醉，并已使用罗库溴铵进行肌肉松弛。在苏醒前，使用东莨菪碱和新斯的明逆转肌肉松弛。三分钟后，胎心率降至88次/分钟。最可能的原因是", + "A": "胎头受压", + "B": "子宫胎盘功能不全", + "C": "胎儿缺氧", + "D": "逆转剂" + } + }, + { + "id": "d5c57e2f-cee3-5062-9311-4fde8c200410", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 43-year-old woman with end-stage liver disease is admitted to the ICU. Which therapy is LEAST likely to improve symptoms associated with hepatic encephalopathy (HE)?", + "A": "Amino acid–rich total parenteral nutrition (TPN)", + "B": "Neomycin", + "C": "Lactulose", + "D": "Flumazenil" + }, + "zh": { + "question": "一名43岁的终末期肝病女性患者被送入ICU。哪种治疗最不可能改善与肝性脑病（HE）相关的症状？", + "A": "富含氨基酸的全肠外营养（TPN）", + "B": "新霉素", + "C": "乳果糖", + "D": "氟马西尼" + } + }, + { + "id": "97478064-97f3-5aaf-8dad-d78bc0005f66", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Ketorolac is contraindicated in patients undergoing scoliosis surgery because of", + "A": "Renal effects", + "B": "Risk of postoperative hemorrhage", + "C": "Effects on bone healing", + "D": "Effects on pulmonary function" + }, + "zh": { + "question": "酮咯酸在进行脊柱侧弯手术的患者中禁用是因为", + "A": "肾脏影响", + "B": "术后出血风险", + "C": "对骨愈合的影响", + "D": "对肺功能的影响" + } + }, + { + "id": "6a8c63f4-50a3-5a99-9aaf-8de119abc492", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Genetic records show a patient has glucose-6-phosphate deficiency.Which of the drugs below should be avoided during cholecystectomy?", + "A": "Propofol", + "B": "Fentanyl", + "C": "Benzocaine", + "D": "Bupivacaine" + }, + "zh": { + "question": "基因记录显示患者有葡萄糖-6-磷酸酶缺乏症。以下哪种药物在胆囊切除术中应避免使用？", + "A": "丙泊酚", + "B": "芬太尼", + "C": "苯佐卡因", + "D": "布比卡因" + } + }, + { + "id": "2809d232-6053-579f-befb-c88f2e2b41a1", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following factors is the greatest predictor of sleep apneas in an adult?", + "A": "Neck circumference", + "B": "Micrognathia", + "C": "Weight", + "D": "BMI" + }, + "zh": { + "question": "以下哪项因素是预测成人睡眠呼吸暂停的最大指标？", + "A": "颈围", + "B": "小下颌", + "C": "体重", + "D": "体重指数（BMI）" + } + }, + { + "id": "7da8c8a7-7bb2-53fb-9854-4c8a858f0574", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The greatest number of malpractice claims made against", + "A": "Eye injury", + "B": "Brain damage", + "C": "Nerve damage", + "D": "Death" + }, + "zh": { + "question": "针对以下哪种情况的医疗事故索赔最多？", + "A": "眼部损伤", + "B": "脑损伤", + "C": "神经损伤", + "D": "死亡" + } + }, + { + "id": "b65e86dc-c4ca-5841-a2f0-b54de9da6107", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Resynchronization therapy", + "A": "Is indicated for short QRS complexes", + "B": "Is contraindicated in patients with CAD", + "C": "Requires pacemaker implantation", + "D": "Is usually accomplished with biphasic defibrillator" + }, + "zh": { + "question": "再同步治疗", + "A": "适用于短QRS波群", + "B": "在冠心病患者中禁忌", + "C": "需要植入起搏器", + "D": "通常通过双相除颤器完成" + } + }, + { + "id": "3da29b1e-cd5d-5563-8b7e-73e077a0404b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The underlying feature in patients with syndrome X is", + "A": "Hypertension", + "B": "Morbid obesity", + "C": "Hypoglycemia", + "D": "Insulin resistance" + }, + "zh": { + "question": "X综合征患者的基本特征是", + "A": "高血压", + "B": "病态肥胖", + "C": "低血糖", + "D": "胰岛素抵抗" + } + }, + { + "id": "6251573a-e115-516b-ab93-567be07fb404", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 65-year-old hospitalized patient is being treated for pain from pancreatic cancer and is well controlled on 30 mg IV morphine per day. What is the equivalent total oral daily dosage of morphine in this patient for discharge planning?", + "A": "10 mg", + "B": "30 mg", + "C": "90 mg", + "D": "120 mg" + }, + "zh": { + "question": "一名65岁的住院患者因胰腺癌引起的疼痛正在接受治疗，并且每天使用30毫克静脉注射吗啡控制良好。为了出院计划，该患者的等效口服每日吗啡剂量是多少？", + "A": "10毫克", + "B": "30毫克", + "C": "90毫克", + "D": "120毫克" + } + }, + { + "id": "ba285f60-9a0e-5891-98b6-3fa001576773", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A 64-year-old patient is brought to the PACU after a 7-hour cosmetic surgery operation under 1.7% sevoflurane anesthesia for the entire case. Which of the following describes the sevoflurane concentration in the", + "A": "VRG: falling, MG: falling, VPG: rising", + "B": "VRG: falling, MG: rising, VPG: rising", + "C": "VRG: rising, MG: falling, VPG: falling", + "D": "All three compartments (VRG, MG, and VPG) falling" + }, + "zh": { + "question": "一名64岁的患者在接受了7小时的整容手术后被送到PACU，整个手术过程中使用了1.7%的七氟醚麻醉。以下哪项描述了七氟醚浓度在", + "A": "VRG：下降，MG：下降，VPG：上升", + "B": "VRG：下降，MG：上升，VPG：上升", + "C": "VRG：上升，MG：下降，VPG：下降", + "D": "三个隔室（VRG、MG和VPG）都在下降" + } + }, + { + "id": "167c6138-34ee-599e-b376-d27941ceb2c4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "You have been asked to see a 13-year-old boy in the preoperative area scheduled for tooth extraction under general anesthesia. The nurse caring for him in the preoperative area has noted that the boy is arguing with his parents and repeatedly stating that he does not want to have surgery. Upon your arrival, the parents say to you, \"Don't listen to him; he's just being a baby! He is having his surgery today no matter what he says. We want him to have the surgery.\" The boy states that he \"doesn't need his teeth removed. They're fine!\" After some discussion you find out that the boy is nervous about needles. You patiently explain the different methods to establish an IV, and the boy eventually expresses understanding and agrees to proceed. What is the most accurate term for the type of cooperation obtained from your patient?", + "A": "Informed consent", + "B": "Distraction", + "C": "Coercion", + "D": "Informed assent" + }, + "zh": { + "question": "您被要求在术前区域查看一名计划在全身麻醉下进行拔牙手术的13岁男孩。负责术前区域的护士注意到男孩正在与父母争吵，并反复表示他不想做手术。您到达后，父母对您说：“别听他的，他只是小孩子脾气！无论他说什么，他今天都要做手术。我们希望他做手术。”男孩表示他“不需要拔牙。它们很好！”经过一些讨论，您发现男孩对针头感到紧张。您耐心地解释了建立静脉通路的不同方法，男孩最终表示理解并同意继续。您从患者那里获得的合作类型最准确的术语是什么？", + "A": "知情同意", + "B": "分散注意力", + "C": "强迫", + "D": "知情同意" + } + }, + { + "id": "ff166983-f386-5a86-a1f6-9cb0cd6d17f7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following nerves is NOT derived from a cranial nerve?", + "A": "Great auricular", + "B": "Infraorbital", + "C": "Supratrochlear", + "D": "Supraorbital" + }, + "zh": { + "question": "以下哪一条神经不是源自颅神经？", + "A": "大耳神经", + "B": "眶下神经", + "C": "滑车上神经", + "D": "眶上神经" + } + }, + { + "id": "05a768bd-e3f2-58f4-8fc5-06f8487c4abe", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 45-year-old woman is experiencing progressive mental deterioration over a 6-hour period, 5 days after emergency evacuation of a large subarachnoid hemorrhage and clipping of a middle cerebral artery aneurysm. The MOST likely cause for deterioration is", + "A": "Cerebral edema", + "B": "Improper placement of the aneurysm clip", + "C": "Recurrent cerebral hemorrhage", + "D": "Vasospasm" + }, + "zh": { + "question": "一名45岁的女性在紧急清除大面积蛛网膜下腔出血并夹闭大脑中动脉动脉瘤5天后，经历了6小时内的进行性精神恶化。最可能的恶化原因是", + "A": "脑水肿", + "B": "动脉瘤夹位置不当", + "C": "脑出血复发", + "D": "血管痉挛" + } + }, + { + "id": "2fc3a7fa-5547-5420-a7a3-32d9df2702fd", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The most common adverse cardiac event in the pediatric population is", + "A": "Hypotension", + "B": "Bradycardia", + "C": "Tachycardia", + "D": "Bigeminy" + }, + "zh": { + "question": "儿科人群中最常见的不良心脏事件是", + "A": "低血压", + "B": "心动过缓", + "C": "心动过速", + "D": "二联律" + } + }, + { + "id": "117fc0bb-9b73-5020-bb18-39cf3c90eaa7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following is a predictor of difficulty with mask ventilation EXCEPT", + "A": "Presence of beard", + "B": "BMI greater than 26", + "C": "Presence of teeth", + "D": "Age greater than 55" + }, + "zh": { + "question": "以下每项都是面罩通气困难的预测因素，除了", + "A": "有胡须", + "B": "BMI大于26", + "C": "有牙齿", + "D": "年龄大于55岁" + } + }, + { + "id": "4e171f2f-1c20-5322-91ce-9a9bd119ad38", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In a patient with compartment syndrome, which of the following signs would be the last to appear?", + "A": "Pulselessness", + "B": "Pain", + "C": "Paresthesia", + "D": "Paralysis" + }, + "zh": { + "question": "在患有筋膜室综合征的患者中，以下哪种体征最晚出现？", + "A": "无脉搏", + "B": "疼痛", + "C": "感觉异常", + "D": "瘫痪" + } + }, + { + "id": "88626bab-b686-56bf-b58d-45a100090b0a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Select the TRUE statement regarding the dose per kilogram of body weight and duration, respectively, of local anesthetics for spinals in infants compared with adults.", + "A": "Greater dose and longer duration", + "B": "Greater dose and shorter duration", + "C": "Greater dose and duration is the same", + "D": "Smaller dose and longer duration" + }, + "zh": { + "question": "选择关于婴儿与成人相比，脊髓麻醉局部麻醉药每公斤体重剂量和持续时间的正确陈述。", + "A": "更大剂量和更长持续时间", + "B": "更大剂量和更短持续时间", + "C": "更大剂量和持续时间相同", + "D": "更小剂量和更长持续时间" + } + }, + { + "id": "e10402fa-f11d-5ea0-a898-7eeb6ecc655a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A number 6 endotracheal tube indicates which size?", + "A": "6-mm internal diameter (ID)", + "B": "6-mm external diameter", + "C": "6-mm external circumference", + "D": "6-mm internal circumference" + }, + "zh": { + "question": "6号气管导管表示哪种尺寸？", + "A": "6毫米内径", + "B": "6毫米外径", + "C": "6毫米外周长", + "D": "6毫米内周长" + } + }, + { + "id": "b3e6ed6f-83c6-5b79-ac76-427e91ac657d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "If a patient were to become trapped in the magnetic resonance imaging (MRI) scanner by a metal object and the engineers decided to quench the magnet, the greatest hazard to the patient would be", + "A": "Heat", + "B": "Cold", + "C": "Fire", + "D": "Noise" + }, + "zh": { + "question": "如果一名患者被金属物体困在磁共振成像（MRI）扫描仪中，工程师决定消磁，患者面临的最大危险是", + "A": "热", + "B": "冷", + "C": "火", + "D": "噪音" + } + }, + { + "id": "a50145d3-0e20-530f-9911-04dece38c73a", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 25-year-old black man is brought to the emergency room unconscious. Supplemental oxygen is administered, and a pulse oximeter is placed on his finger and a reading of 98% is recorded. Arterial gas sampling at the same time shows PaO2 of 190 mm Hg, pH", + "A": "Methemoglobin (HbMet)", + "B": "Sickle cell hemoglobin", + "C": "Carboxyhemoglobin (HbCO)", + "D": "Hemoglobin shifted to right" + }, + "zh": { + "question": "一名25岁的黑人男性被送到急诊室时已失去意识。给予补充氧气，并在他的手指上放置了脉搏血氧仪，记录的读数为98%。同时进行的动脉血气采样显示PaO2为190 mm Hg，pH", + "A": "高铁血红蛋白 (HbMet)", + "B": "镰状细胞血红蛋白", + "C": "碳氧血红蛋白 (HbCO)", + "D": "血红蛋白右移" + } + }, + { + "id": "356b9967-6e30-54ae-b52f-7bd7315e7000", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "During surgery for correction of scoliosis, somatosensory evoked potential (SSEP) monitoring is employed. An increase in SSEP latency and a decrease in amplitude could be explained by each of the following EXCEPT", + "A": "Anterior spinal artery syndrome", + "B": "Propofol infusion (200 μg/kg/min)", + "C": "Hypotension", + "D": "2 MAC isoflurane anesthesia" + }, + "zh": { + "question": "在脊柱侧凸矫正手术中，使用体感诱发电位（SSEP）监测。SSEP潜伏期增加和振幅减少可以通过以下各项解释，除了", + "A": "前脊髓动脉综合征", + "B": "丙泊酚输注（200 μg/kg/min）", + "C": "低血压", + "D": "2 MAC异氟醚麻醉" + } + }, + { + "id": "9451f516-0ecb-59af-8ae3-4adc407a8745", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "In which of the following conditions would the response to atropine be MOST pronounced?", + "A": "Diabetic autonomic neuropathy", + "B": "Brain death", + "C": "Status post heart transplant", + "D": "High (C8) spinal anesthesia# General Anesthesia#" + }, + "zh": { + "question": "在下列哪种情况下，对阿托品的反应最为明显？", + "A": "糖尿病自主神经病变", + "B": "脑死亡", + "C": "心脏移植术后状态", + "D": "高位（C8）脊髓麻醉# 全身麻醉#" + } + }, + { + "id": "9d450e55-d0b9-5ec1-822a-f75948b15d44", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A previously healthy 3.5-kg, 1-month-old infant with a strong family history of sickle cell anemia is brought to the emergency room with an incarcerated inguinal hernia. Which of the following should be carried out before surgery?", + "A": "Hemoglobin electrophoresis", + "B": "Peripheral smear", + "C": "Hematology consultation", + "D": "None of the above" + }, + "zh": { + "question": "一名先前健康的3.5公斤、1个月大的婴儿，有强烈的镰状细胞贫血家族史，被送到急诊室，因腹股沟疝气嵌顿。以下哪项应在手术前进行？", + "A": "血红蛋白电泳", + "B": "外周血涂片", + "C": "血液科会诊", + "D": "以上都不是" + } + }, + { + "id": "b3007e00-0d8f-5c1f-badb-c2f1e27eea91", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In the premature newborn, the glottis is at which level relative to the cervical spine?", + "A": "C3", + "B": "C4", + "C": "C5", + "D": "C6" + }, + "zh": { + "question": "在早产新生儿中，声门相对于颈椎的哪个水平？", + "A": "C3", + "B": "C4", + "C": "C5", + "D": "C6" + } + }, + { + "id": "c66fcfd3-206e-5603-9464-09d68ea78b10", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 5-month-old infant is scheduled for an elective operative reduction of a right inguinal hernia. Spinal anesthesia is performed. The first sign of a high spinal block in this patient would be", + "A": "Decrease in blood pressure", + "B": "Increase in heart rate", + "C": "Decrease in oxygen saturation", + "D": "Asystole" + }, + "zh": { + "question": "一名5个月大的婴儿计划进行右侧腹股沟疝的择期手术复位。进行了脊髓麻醉。该患者高位脊髓阻滞的第一个征兆是", + "A": "血压下降", + "B": "心率增加", + "C": "氧饱和度下降", + "D": "心脏停搏" + } + }, + { + "id": "4ea7e7b4-97cc-51cf-8c04-0d035d05fe02", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What percentage of a term newborn's total body weight consists of water?", + "A": "45%", + "B": "60%", + "C": "75%", + "D": "90%" + }, + "zh": { + "question": "足月新生儿的总体重中有多少百分比是由水组成的？", + "A": "45%", + "B": "60%", + "C": "75%", + "D": "90%" + } + }, + { + "id": "65ab321f-c22d-5376-bcfa-6eddba056930", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Which of the following patients is LEAST likely to develop retinopathy of prematurity (ROP)?", + "A": "A term infant, 46 weeks' postmenstrual age (PMA), exposed to 100% oxygen for 6 hours", + "B": "A premature infant, 29 weeks' PMA, exposed to a Pao2 of 150 mm Hg for 1 hour", + "C": "A premature infant, 28 weeks' PMA, never exposed to supplemental oxygen", + "D": "A cyanotic infant with tetralogy of Fallot, 34 weeks' PMA, receiving supplemental oxygen" + }, + "zh": { + "question": "以下哪位患者最不可能发生早产儿视网膜病变（ROP）？", + "A": "足月婴儿，矫正胎龄46周，暴露于100%氧气6小时", + "B": "早产婴儿，矫正胎龄29周，暴露于150 mm Hg的动脉氧分压1小时", + "C": "早产婴儿，矫正胎龄28周，从未接触过补充氧气", + "D": "患有法洛四联症的发绀婴儿，矫正胎龄34周，正在接受补充氧气" + } + }, + { + "id": "d18af32c-dc1d-550b-af16-c764fa73e408", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 4-week-old male infant is brought to the emergency room with projectile vomiting. At the time of admission, the patient is lethargic, with a respiratory rate of 16 breaths/min and has had no urine output in the preceding 3 hours. A diagnosis of pyloric stenosis is made, and the infant is brought emergently to the operating room (OR) for pyloromyotomy. The MOST appropriate anesthetic management would be", + "A": "Awake intubation after placing an oral gastric tube", + "B": "Inhalation induction with sevoflurane with cricoid pressure after placing an oral gastric tube", + "C": "Awake saphenous IV catheter or an intraosseous needle placement followed by a rapid-sequence induction with ketamine, atropine, and rocuronium after placing an oral gastric tube", + "D": "Postpone surgery" + }, + "zh": { + "question": "一名4周大的男性婴儿因喷射性呕吐被送到急诊室。入院时，患者昏昏欲睡，呼吸频率为16次/分钟，并且在过去3小时内没有尿液排出。诊断为幽门狭窄，婴儿被紧急送往手术室进行幽门肌切开术。最合适的麻醉管理是", + "A": "放置口腔胃管后清醒插管", + "B": "放置口腔胃管后使用七氟醚吸入诱导并施加环状软骨压迫", + "C": "放置口腔胃管后清醒下进行隐静脉导管或骨内针置入，然后快速序贯诱导使用氯胺酮、阿托品和罗库溴铵", + "D": "推迟手术" + } + }, + { + "id": "4c274cbc-2b39-5379-b332-5f6f61bfa639", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The predicted blood volume in a 3-kg term newborn is", + "A": "100 mL", + "B": "150 mL", + "C": "250 mL", + "D": "300 mL" + }, + "zh": { + "question": "预计3公斤足月新生儿的血容量是", + "A": "100毫升", + "B": "150毫升", + "C": "250毫升", + "D": "300毫升" + } + }, + { + "id": "832ba56f-c14d-5d7b-9f4d-d245f8d1e0c9", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "An 11-month-old infant is to undergo a craniosynostosis repair. The surgeon and anesthesiologist agreed to start transfusing blood when the hemoglobin fell to 8 g/dL (hematocrit [Hct] of 24%). Using the transfusion threshold of a hemoglobin of 8, what is the maximum allowable blood loss (MABL) for this 10-kg infant whose initial Hct is 32 and the minimal acceptable Hct is 24?", + "A": "180 mL", + "B": "200 mL", + "C": "320 mL", + "D": "Cannot be calculated without additional information" + }, + "zh": { + "question": "一名11个月大的婴儿将接受颅缝早闭修复手术。外科医生和麻醉师同意当血红蛋白降至8 g/dL（血细胞比容[Hct]为24%）时开始输血。使用血红蛋白为8的输血阈值，这个初始Hct为32且最低可接受Hct为24的10公斤婴儿的最大允许失血量（MABL）是多少？", + "A": "180 mL", + "B": "200 mL", + "C": "320 mL", + "D": "无法计算，因为缺少额外信息" + } + }, + { + "id": "7b5d7709-9c43-5ca0-afd4-7ffaa5bd37c8", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "What volume of packed red blood cells (PRBCs) with an Hct of 60 is needed to raise the Hct from 18 to 24 in a 10-kg 11-month-old?", + "A": "40 mL", + "B": "80 mL", + "C": "120 mL", + "D": "Cannot be calculated without additional information" + }, + "zh": { + "question": "需要多少体积的红细胞压积为60的浓缩红细胞（PRBCs）来将一个10公斤11个月大的孩子的红细胞压积从18提高到24？", + "A": "40毫升", + "B": "80毫升", + "C": "120毫升", + "D": "没有额外信息无法计算" + } + }, + { + "id": "f78a9811-1cab-5d32-bc1f-beabd8f640ea", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Reasons for selecting a cuffed endotracheal tube (ETT) over an uncuffed ETT include all of the following EXCEPT", + "A": "Fewer intubations and ETTs are needed", + "B": "Less chance for airway fires", + "C": "Spontaneous breathing is easier", + "D": "Aspiration of gastric contents is less likely" + }, + "zh": { + "question": "选择带套囊的气管导管（ETT）而不是不带套囊的ETT的原因包括以下所有选项，除了", + "A": "需要的插管和ETT更少", + "B": "气道火灾的可能性更小", + "C": "自发呼吸更容易", + "D": "胃内容物误吸的可能性更小" + } + }, + { + "id": "b263caf5-d040-50fc-8653-ed3c10da2a24", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "An otherwise healthy 4-year-old male patient is undergoing elective tonsillectomy. Before induction of general anesthesia, the patient is breathing at a rate of 20 breaths/min. An inhalation induction is begun with 8% sevoflurane, 50% nitrous oxide, and oxygen. Sixty seconds later, the patient is noted to breathe at a rate of 40 breaths/min, and the heart rate is 160. This rapid respiratory rate with tachycardia most likely represents", + "A": "Severe hypoxia", + "B": "Hypercarbia and early development of malignant hyperthermia (MH)", + "C": "The excitement stage of anesthesia", + "D": "Aspiration of gastric contents" + }, + "zh": { + "question": "一名身体健康的4岁男性患者正在接受择期扁桃体切除术。在全身麻醉诱导前，患者的呼吸频率为20次/分钟。吸入诱导开始时使用8%七氟醚、50%氧化亚氮和氧气。60秒后，患者的呼吸频率为40次/分钟，心率为160。这种快速呼吸率伴随心动过速最可能代表", + "A": "严重缺氧", + "B": "高碳酸血症和恶性高热（MH）的早期发展", + "C": "麻醉的兴奋期", + "D": "胃内容物吸入" + } + }, + { + "id": "5e85f827-e7ac-5911-96cb-49ae50308a4c", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A healthy 3-kg, 1-month-old neonate is anesthetized for an inguinal hernia repair. An inhalation induction with sevoflurane is carried out, and the patient is intubated. Before the surgical incision, the systolic blood pressure is noted to be 65 mm Hg and the heart rate is 150 beats/min. The most appropriate intervention for this patient's blood pressure would be", + "A": "Administration of ephedrine", + "B": "Administration of phenylephrine", + "C": "50-mL fluid bolus", + "D": "None of the above" + }, + "zh": { + "question": "一名健康的3公斤、1个月大的新生儿接受腹股沟疝修补术的麻醉。使用七氟醚进行吸入诱导，并为患者插管。在手术切口前，收缩压为65 mm Hg，心率为150次/分钟。对于该患者的血压，最合适的干预措施是", + "A": "给予麻黄碱", + "B": "给予去氧肾上腺素", + "C": "50毫升液体推注", + "D": "以上都不是" + } + }, + { + "id": "75403904-e21a-5ee0-9131-48b92a6674b5", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 5-year-old boy is anesthetized for elective repair of an umbilical hernia. General anesthesia is induced and maintained with sevoflurane, nitrous oxide, and oxygen via an anesthesia mask. At the conclusion of the operation, the patient is taken to the recovery room and subsequently discharged to the outpatient ward. Before discharge, the patient's mother notes that the urine appears dark brown (cola-colored). The most appropriate action at this time would be", + "A": "Discharge the patient with instructions to return if urine color does not normalize", + "B": "Discharge the patient in 3 hours if no other signs or symptoms are manifested", + "C": "Obtain serum creatinine and blood urea nitrogen (BUN) levels and discharge the patient if they are normal", + "D": "Evaluate the patient for MH" + }, + "zh": { + "question": "一名5岁男孩因脐疝修复手术接受麻醉。通过麻醉面罩使用七氟醚、氧化亚氮和氧气诱导和维持全身麻醉。在手术结束时，患者被送到恢复室，随后出院到门诊病房。出院前，患者的母亲注意到尿液呈深棕色（可乐色）。此时最合适的行动是", + "A": "让患者出院，并指示如果尿液颜色没有恢复正常则返回", + "B": "如果没有其他体征或症状，在3小时后让患者出院", + "C": "获取血清肌酐和血尿素氮（BUN）水平，如果正常则让患者出院", + "D": "评估患者是否有恶性高热（MH）" + } + }, + { + "id": "bca31b17-24f8-522e-bf58-40e4620dd30d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "At what maximum inspiratory pressure should a cuffed ETT leak in a child (leak test)?", + "A": "5 to 15 cm H2O", + "B": "15 to 25 cm H2O", + "C": "25 to 35 cm H2O", + "D": "None of the above" + }, + "zh": { + "question": "在儿童中，带套管的气管导管应在何种最大吸气压下漏气（漏气测试）？", + "A": "5 到 15 cm H2O", + "B": "15 到 25 cm H2O", + "C": "25 到 35 cm H2O", + "D": "以上都不是" + } + }, + { + "id": "55dcb91f-43e4-5b1a-a86d-4d625a4dca5e", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A premature newborn delivered at 32 weeks of gestation is brought to the OR 5 days after delivery for repair of a left-sided congenital diaphragmatic hernia (CDH). The newborn has a nasogastric tube in place, is intubated, and is stable with mechanical ventilation at peak airway pressures < 25 cm H2O. 30 minutes after induction of general anesthesia, the anesthesiologist notes significant difficulty with adequate ventilation. The Sao2 subsequently falls to 65%, and the heart rate decreases to 50 beats/min. What would be the most appropriate step to take at this time?", + "A": "Pull the ETT from the right mainstem bronchus", + "B": "Ventilate with positive end-expiratory pressure (PEEP) and administer furosemide", + "C": "Place a chest tube on the right side after confirming a tension pneumothorax", + "D": "Pull out the ETT, mask ventilate, and reintubate the patient" + }, + "zh": { + "question": "一名在32周妊娠期出生的早产新生儿在出生5天后被送到手术室进行左侧先天性膈疝（CDH）的修复。新生儿放置了鼻胃管，已插管，并在机械通气下稳定，气道峰压<25 cm H2O。全身麻醉诱导30分钟后，麻醉师注意到通气困难显著。随后Sao2下降至65%，心率降至50次/分钟。此时最合适的措施是什么？", + "A": "将气管导管从右主支气管拔出", + "B": "使用呼气末正压（PEEP）通气并给予呋塞米", + "C": "在确认张力性气胸后在右侧放置胸管", + "D": "拔出气管导管，面罩通气，然后重新插管患者" + } + }, + { + "id": "1266d46f-6e41-58f8-86d5-d0012ce757a6", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "An 8-year-old boy, who weighs 30 kg, was found at the site of a motor vehicle accident (MVA). He has arrived in the OR for exploratory laparotomy. He has not received any sedation or pain medication because he appeared \"confused and lethargic.\" He has a normal blood pressure, is tachycardic with thready distal pulses, and has cold extremities. In spite of a 20 mL/kg fluid bolus, the patient has produced only 5 mL of urine. What is the approximate percentage of blood volume loss in this patient?", + "A": "< 20%", + "B": "25%", + "C": "40%", + "D": "Cannot determine" + }, + "zh": { + "question": "一名8岁男孩，体重30公斤，在一起机动车事故现场被发现。他已到达手术室进行探查性剖腹手术。他没有接受任何镇静或止痛药，因为他看起来“困惑和嗜睡”。他的血压正常，心动过速，远端脉搏细弱，四肢冰冷。尽管给予了20毫升/公斤的液体推注，患者仅产生了5毫升尿液。该患者的血容量丢失大约百分比是多少？", + "A": "< 20%", + "B": "25%", + "C": "40%", + "D": "无法确定" + } + }, + { + "id": "c761b507-3fea-563a-8ee7-b56288c3f07c", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "In a 6-year-old child, the distance an oral ETT should be placed (from the gums to the midtrachea) most often is", + "A": "10 cm", + "B": "13 cm", + "C": "15 cm", + "D": "20 cm" + }, + "zh": { + "question": "在一名6岁儿童中，口腔气管导管应放置的距离（从牙龈到气管中部）通常是", + "A": "10 厘米", + "B": "13 厘米", + "C": "15 厘米", + "D": "20 厘米" + } + }, + { + "id": "17bd8bf3-e7ee-5cb2-a145-d4caaeddde9f", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following is the most suitable intraoperative replacement fluid for a 3-year-old, 14-kg child who has been NPO for 10 hours and will be undergoing repair of clubfeet?", + "A": "D5W", + "B": "D5 in 0.2 NaCl", + "C": "D5 in 0.45 NaCl", + "D": "Lactated Ringer solution" + }, + "zh": { + "question": "以下哪种是最适合一名3岁、14公斤的儿童在禁食10小时后进行马蹄足修复手术时的术中补液？", + "A": "5%葡萄糖水", + "B": "5%葡萄糖在0.2%氯化钠中", + "C": "5%葡萄糖在0.45%氯化钠中", + "D": "乳酸林格氏液" + } + }, + { + "id": "b5031483-3ce4-53b0-854c-f20e54e6d0be", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "An otherwise healthy 14-day-old neonate is transported to the OR well hydrated for surgery for a bowel obstruction. A rapid-sequence induction is planned. Compared with the adult dose, the intravenous (IV) dose of succinylcholine administered to this patient should be", + "A": "Diminished because of the immature nervous system", + "B": "The same as the adult dose", + "C": "Decreased because of decreased acetylcholine receptors", + "D": "Increased because of a greater volume of distribution" + }, + "zh": { + "question": "一名其他方面健康的14天大的新生儿被送往手术室，准备进行肠梗阻手术，水分充足。计划进行快速序贯诱导。与成人剂量相比，给予该患者的琥珀胆碱静脉注射剂量应", + "A": "由于神经系统不成熟而减少", + "B": "与成人剂量相同", + "C": "由于乙酰胆碱受体减少而降低", + "D": "由于分布体积较大而增加" + } + }, + { + "id": "d332f457-7d20-55cb-926a-94a1ae97448c", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "You receive a call from the preoperative nurse stating that the child you will be caring for with type 1 diabetes mellitus has a preoperative blood glucose value of 300 mg/dL. He has been NPO for the morning and has not had any rapid-onset or short-acting insulin. The child typically uses a total of 30 units of insulin a day. How much rapid-onset or shortacting insulin should you give the child to reduce the blood sugar to 150 mg/dL?", + "A": "1 unit", + "B": "3 units", + "C": "5 units", + "D": "10 units" + }, + "zh": { + "question": "您接到术前护士的电话，称您将要照顾的1型糖尿病儿童术前血糖值为300 mg/dL。他早上禁食，未使用任何速效或短效胰岛素。该儿童通常每天使用总共30单位的胰岛素。您应该给孩子多少速效或短效胰岛素以将血糖降低到150 mg/dL？", + "A": "1单位", + "B": "3单位", + "C": "5单位", + "D": "10单位" + } + }, + { + "id": "86f0980b-936d-5532-bf58-479a3432d7e2", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 10-week-old infant born at 31 weeks' gestation is anesthetized for repair of an inguinal hernia. General anesthesia is induced by mask with sevoflurane, an ETT is placed, and anesthesia is maintained with", + "A": "Caudal block with 0.25% bupivacaine, 1 mL/kg, and admitted to a pediatric ward for overnight observation", + "B": "Caudal block with 0.25% bupivacaine, 2 mL/kg, and admitted to a pediatric ward for overnight observation", + "C": "Oral pain medication (acetaminophen) and discharged home", + "D": "Fentanyl (1 mL = 50 μg IV), and admitted to a pediatric ward for overnight observation" + }, + "zh": { + "question": "一名出生于31周孕龄的10周大婴儿因修复腹股沟疝而接受麻醉。通过面罩使用七氟醚诱导全身麻醉，插入气管导管，并维持麻醉", + "A": "尾部阻滞使用0.25%布比卡因，1 mL/kg，并入院至儿科病房过夜观察", + "B": "尾部阻滞使用0.25%布比卡因，2 mL/kg，并入院至儿科病房过夜观察", + "C": "口服止痛药（对乙酰氨基酚）并出院回家", + "D": "芬太尼（1 mL = 50 μg 静脉注射），并入院至儿科病房过夜观察" + } + }, + { + "id": "686a76ae-8ec7-58f6-a89e-018d081cdf0b", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 6-year-old, 20-kg girl develops pulseless ventricular tachycardia (pVT) after induction of general anesthesia for a tonsillectomy. The anesthesiologist intubates the child, administers 100% oxygen, and starts chest compressions. When the biphasic defibrillator quickly arrives in the OR and is attached to the child, the defibrillator should be charged to what energy level for the initial shock?", + "A": "10-20 joules (J)", + "B": "20-30 joules (J)", + "C": "40-80 joules (J)", + "D": "120-200 joules (J)" + }, + "zh": { + "question": "一名6岁、20公斤的女孩在进行扁桃体切除术的全身麻醉诱导后出现无脉性室性心动过速（pVT）。麻醉师为孩子插管，给予100%氧气，并开始胸外按压。当双相除颤器迅速到达手术室并连接到孩子身上时，除颤器应充电到什么能量水平进行初次电击？", + "A": "10-20 焦耳（J）", + "B": "20-30 焦耳（J）", + "C": "40-80 焦耳（J）", + "D": "120-200 焦耳（J）" + } + }, + { + "id": "abb0cb36-9cd1-5852-8c3b-ec1f17c9296a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The spinal cord of newborns extends to the", + "A": "L1 vertebra", + "B": "L2-L3 vertebrae", + "C": "L4-L5 vertebrae", + "D": "S1 vertebra" + }, + "zh": { + "question": "新生儿的脊髓延伸到", + "A": "L1 椎骨", + "B": "L2-L3 椎骨", + "C": "L4-L5 椎骨", + "D": "S1 椎骨" + } + }, + { + "id": "33029417-0bbc-509f-b498-96fdb6b92656", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The most common initial symptom of esophageal atresia (EA) or tracheoesophageal fistula (TEF) is", + "A": "Respiratory distress at delivery (e.g., retractions, tachypnea)", + "B": "Projectile vomiting", + "C": "Hypoxia", + "D": "Coughing and regurgitation during first feeding" + }, + "zh": { + "question": "食管闭锁（EA）或气管食管瘘（TEF）的最常见初始症状是", + "A": "出生时的呼吸窘迫（例如，胸廓回缩、呼吸急促）", + "B": "喷射性呕吐", + "C": "缺氧", + "D": "第一次喂养时的咳嗽和反流" + } + }, + { + "id": "97eb5cfe-9365-592d-8857-655796d671dd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 4.5-kg, 3-hour-old newborn with Beckwith-Wiedemann syndrome is scheduled for surgical repair of an omphalocele. Which of the following is NOT part of this syndrome?", + "A": "Large fontanelles", + "B": "Macroglossia", + "C": "Polycythemia", + "D": "Hyperglycemia" + }, + "zh": { + "question": "一名4.5公斤、出生3小时的新生儿患有Beckwith-Wiedemann综合征，计划进行脐膨出修复手术。以下哪项不属于该综合征的一部分？", + "A": "大囟门", + "B": "巨舌", + "C": "红细胞增多症", + "D": "高血糖" + } + }, + { + "id": "6fa25e99-2438-5aca-a0d6-0302eee1901e", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following is the LEAST appropriate technique for induction of general anesthesia in a newborn for surgical repair of a TEF?", + "A": "Awake tracheal intubation", + "B": "Sedated tracheal intubation (e.g., fentanyl)", + "C": "Inhalation induction with spontaneous ventilation and tracheal intubation", + "D": "Inhalation induction with cisatracurium as a muscle relaxant and positive-pressure bag and mask ventilation and tracheal intubation" + }, + "zh": { + "question": "以下哪种方法最不适合用于新生儿进行TEF手术修复时的全身麻醉诱导？", + "A": "清醒气管插管", + "B": "镇静气管插管（例如，使用芬太尼）", + "C": "吸入诱导，自主呼吸和气管插管", + "D": "吸入诱导，使用西酞库铵作为肌肉松弛剂，正压面罩通气和气管插管" + } + }, + { + "id": "f496c477-21a1-55f4-b0eb-f24b6282a8e1", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 3-year-old with cough, sore throat, and temperature of 102° F, is scheduled for hydrocele repair. Physical examination reveals wheezing and rhonchi. Chest x-ray reveals small left lower lobe (LLL) infiltrate. The best course of action would be", + "A": "Administer IV steroids and proceed", + "B": "Administer acetaminophen and if the temperature goes below 100° F, proceed", + "C": "Postpone surgery for at least 4 weeks", + "D": "Proceed, because the temperature will return to normal during anesthesia" + }, + "zh": { + "question": "一名3岁儿童有咳嗽、喉咙痛和102°F的体温，计划进行鞘膜积液修复。体格检查显示有喘息和干啰音。胸部X光显示左下叶（LLL）有小的浸润。最佳的处理方案是", + "A": "给予静脉注射类固醇并继续手术", + "B": "给予对乙酰氨基酚，如果体温降到100°F以下，则继续手术", + "C": "将手术推迟至少4周", + "D": "继续手术，因为麻醉期间体温会恢复正常" + } + }, + { + "id": "4e40da06-1bf8-5bc3-839f-75b6eb69dba3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements regarding teeth is INCORRECT?", + "A": "Primary teeth start to erupt around 6 to 9 months of age", + "B": "There are 20 primary teeth, and all are usually present by 3 years of age", + "C": "Permanent teeth start to erupt at 4 years of age", + "D": "There are 32 permanent teeth, and most are present by 12 years of age, except for the third molars, which erupt at 15 to 25 years of age" + }, + "zh": { + "question": "以下关于牙齿的说法哪一项是不正确的？", + "A": "乳牙大约在6到9个月大时开始萌出", + "B": "乳牙共有20颗，通常在3岁时全部长齐", + "C": "恒牙在4岁时开始萌出", + "D": "恒牙共有32颗，除了第三磨牙在15到25岁时萌出外，大多数在12岁时已长齐" + } + }, + { + "id": "1f85caf1-18c4-5c21-af99-cbe85c001c14", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The pulmonary vascular resistance (PVR) in newborns decreases to that of adults by age", + "A": "1 to 2 days", + "B": "1 to 2 weeks", + "C": "1 to 2 months", + "D": "1 year" + }, + "zh": { + "question": "新生儿的肺血管阻力（PVR）在多大年龄时降至成人水平", + "A": "1到2天", + "B": "1到2周", + "C": "1到2个月", + "D": "1年" + } + }, + { + "id": "1c7b04fa-580c-5ccb-b545-1e6cc6646ebb", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 10-month-old infant is undergoing elective repair of a left testicular hydrocele under general anesthesia with isoflurane, nitrous oxide, oxygen, and fentanyl. All of the following are effective and reasonable", + "A": "Placement of an infrared heater over the operating table and prewarming the OR", + "B": "Covering the OR table with a heating blanket", + "C": "Wrapping the extremities with sheet wadding and covering the head with a cloth cap", + "D": "Ventilating the patient with a Mapleson D circuit at low gas flows (e.g., 50 mL/kg/min)" + }, + "zh": { + "question": "一名10个月大的婴儿正在接受左侧睾丸鞘膜积液的择期修复手术，使用异氟醚、氧化亚氮、氧气和芬太尼进行全身麻醉。以下所有措施都是有效且合理的", + "A": "在手术台上方放置红外线加热器并预热手术室", + "B": "用加热毯覆盖手术台", + "C": "用棉絮包裹四肢并用布帽覆盖头部", + "D": "使用Mapleson D回路以低气流（例如50 mL/kg/min）为患者通气" + } + }, + { + "id": "8adcbff8-67b8-5fef-a916-d35eb83d1944", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Postoperative mechanical ventilation is common after repair of the following lesions. Which of the following is MOST likely to result in central postoperative depression of spontaneous ventilation in a term newborn?", + "A": "Gastroschisis", + "B": "Omphalocele", + "C": "TEF", + "D": "Pyloric stenosis" + }, + "zh": { + "question": "以下病变修复后，术后机械通气很常见。以下哪种情况最有可能导致足月新生儿术后自发通气的中枢抑制？", + "A": "腹裂", + "B": "脐膨出", + "C": "气管食管瘘", + "D": "幽门狭窄" + } + }, + { + "id": "27f9facf-ae5a-5e92-9d6b-5baaa60dcf45", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A premature male neonate born at 36 weeks of gestation is scheduled to undergo repair of a left-sided diaphragmatic hernia. Which of the following vessels could be cannulated for preductal arterial blood sampling?", + "A": "Femoral artery", + "B": "Umbilical artery", + "C": "Right radial artery", + "D": "Left radial artery" + }, + "zh": { + "question": "一名36周早产的男性新生儿计划进行左侧膈疝修补术。以下哪一条血管可以用于导管插入以进行动脉导管前的血液采样？", + "A": "股动脉", + "B": "脐动脉", + "C": "右桡动脉", + "D": "左桡动脉" + } + }, + { + "id": "b40a9b40-d082-5d33-adde-0f9b61125d90", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "In which of the following patients would the minimum alveolar concentration (MAC) for isoflurane be the greatest?", + "A": "A premature infant 30 weeks' postconceptual age (PCA)", + "B": "Full-term neonate", + "C": "3-month-old infant", + "D": "13-year-old adolescent" + }, + "zh": { + "question": "在以下哪位患者中，异氟醚的最低肺泡浓度（MAC）最大？", + "A": "30周胎龄的早产婴儿", + "B": "足月新生儿", + "C": "3个月大的婴儿", + "D": "13岁青少年" + } + }, + { + "id": "79d484b5-2685-566b-87f2-6c8a7aee2dd2", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 40-kg, 10-year-old child sustains a thermal injury to his legs, buttocks, and back. The estimated area involved is 50%. Using only crystalloid fluids, how much fluid should be administered during the first 24 hours after the burn?", + "A": "2.5 L", + "B": "5.5 L", + "C": "8.0 L", + "D": "10.0 L" + }, + "zh": { + "question": "一名40公斤、10岁的儿童腿部、臀部和背部遭受热损伤。估计受伤面积为50%。仅使用晶体液，在烧伤后的前24小时内应给予多少液体？", + "A": "2.5 升", + "B": "5.5 升", + "C": "8.0 升", + "D": "10.0 升" + } + }, + { + "id": "535705b6-967c-5f92-984e-cc642f2b1f25", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "An otherwise healthy 3-month-old black female infant who had a hemoglobin value of 19 mg/dL at birth presents for elective repair of an inguinal hernia. Her preoperative hemoglobin is 10 mg/dL. Her father has a history of polycystic kidney disease. The most likely explanation for this patient's anemia is", + "A": "Sickle cell anemia", + "B": "Iron deficiency", + "C": "Undiagnosed polycystic kidney disease", + "D": "It is a normal finding" + }, + "zh": { + "question": "一名原本健康的3个月大黑人女婴，出生时血红蛋白值为19 mg/dL，现因腹股沟疝气需进行择期修复手术。她的术前血红蛋白为10 mg/dL。她的父亲有多囊肾病史。该患者贫血的最可能解释是", + "A": "镰状细胞性贫血", + "B": "缺铁性贫血", + "C": "未诊断的多囊肾病", + "D": "这是正常现象" + } + }, + { + "id": "db869d42-6880-5280-aa80-0e66f02ffdb1", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "The anesthesiologist is called to the emergency room by the pediatrician to help manage a 3-year-old boy with a high fever and upper airway obstruction. His mother stated that earlier that afternoon, he complained of a sore throat and hoarseness. The patient is sitting erect and leaning forward; has inspiratory stridor, tachypnea, and sternal retractions; and is drooling. Which of the following is the MOST appropriate management of airway obstruction in this patient?", + "A": "Aerosolized racemic epinephrine", + "B": "Awake tracheal intubation in the emergency room or the OR if time permits", + "C": "Transfer to the OR, inhalation induction, and tracheal intubation", + "D": "Transfer to the OR, IV induction, paralysis with succinylcholine, and tracheal intubation" + }, + "zh": { + "question": "麻醉医生被儿科医生叫到急诊室，帮助管理一名3岁男孩的高烧和上呼吸道阻塞。他的母亲说，当天下午早些时候，他抱怨喉咙痛和声音嘶哑。患者坐直并向前倾，出现吸气性喉鸣、呼吸急促和胸骨回缩，并流口水。以下哪项是该患者气道阻塞的最合适管理方法？", + "A": "气雾化消旋肾上腺素", + "B": "在急诊室或如果时间允许在手术室进行清醒气管插管", + "C": "转移到手术室，吸入诱导和气管插管", + "D": "转移到手术室，静脉诱导，用琥珀胆碱麻痹和气管插管" + } + }, + { + "id": "6702886c-829f-55f2-9105-46b74514bd5c", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 2-year-old child with cerebral palsy (CP) and known severe gastroesophageal reflux (with frequent nightly aspiration) and a seizure disorder is scheduled to undergo iliopsoas release under general anesthesia. Which of the following would be the preferred technique for inducing general anesthesia in this patient?", + "A": "Inhalation induction with sevoflurane followed by tracheal intubation", + "B": "IV induction with propofol followed by laryngeal mask airway", + "C": "IV induction with etomidate and vecuronium followed by tracheal intubation", + "D": "Rapid-sequence induction with propofol and succinylcholine followed by tracheal intubation" + }, + "zh": { + "question": "一名2岁患有脑瘫（CP）和已知严重胃食管反流（伴有频繁的夜间误吸）以及癫痫病的儿童计划在全身麻醉下进行髂腰肌松解术。以下哪种方法是为该患者诱导全身麻醉的首选技术？", + "A": "使用七氟醚吸入诱导后进行气管插管", + "B": "使用丙泊酚静脉诱导后使用喉罩", + "C": "使用依托咪酯和维库溴铵静脉诱导后进行气管插管", + "D": "使用丙泊酚和琥珀胆碱快速诱导后进行气管插管" + } + }, + { + "id": "d9af4bf7-a207-500b-bf58-e155d1377ffa", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 7-week-old male infant is admitted to the pediatric intensive care unit (ICU) with a bowel obstruction. His laboratory values are sodium 120 mEq/L, chloride 85 mEq/L, glucose 85 mg/dL, and potassium 2.0 mEq/L. Respiratory rate is 40 breaths/min, heart rate is 220 beats/minute, and blood pressure is 50/32. According to the patient's mother, urine output has been zero for the last 4 hours. The most appropriate initial fluid for resuscitation of this patient would be", + "A": "D2.5W with 0.45 sodium chloride and 20 mEq/L potassium chloride", + "B": "0.45% sodium chloride", + "C": "0.9% sodium chloride with 30 mEq/L potassium chloride", + "D": "0.9% sodium chloride" + }, + "zh": { + "question": "一名7周大的男性婴儿因肠梗阻被送入儿科重症监护病房（ICU）。他的实验室检查值为：钠120 mEq/L，氯化物85 mEq/L，葡萄糖85 mg/dL，钾2.0 mEq/L。呼吸频率为40次/分钟，心率为220次/分钟，血压为50/32。据患者母亲称，过去4小时尿量为零。对该患者进行复苏的最合适的初始液体是", + "A": "D2.5W加0.45%氯化钠和20 mEq/L氯化钾", + "B": "0.45%氯化钠", + "C": "0.9%氯化钠加30 mEq/L氯化钾", + "D": "0.9%氯化钠" + } + }, + { + "id": "b36f268e-b0d4-5a11-8f11-732db3697b9d", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 24-hour-old, 1200-g neonate, 30 weeks' estimated gestational age (EGA), is noted in the ICU to begin making twitching movements. Blood pressure is 45/30, heart rate is 160, oxygen saturation is 88%, blood glucose is 50 mg/dL, total calcium level is 4 mg/dL, and urine output is 5 mL/hr. The MOST appropriate course of action to take at this point would be", + "A": "Administer calcium gluconate (1 mL of 10% solution) over 5 to 10 minutes", + "B": "Administer glucose 200 mg/kg (D10W) IV over 5 minutes", + "C": "Hyperventilate with 100% O2", + "D": "Administer a 10-mL/kg bolus of 5% albumin" + }, + "zh": { + "question": "一名24小时大的新生儿，体重1200克，估计胎龄30周，在ICU中被注意到开始出现抽搐动作��血压为45/30，心率为160，氧饱和度为88%，血糖为50 mg/dL，总钙水平为4 mg/dL，尿量为5 mL/hr。此时最适当的处理措施是", + "A": "在5到10分钟内给予1 mL的10%葡萄糖酸钙", + "B": "在5分钟内静脉注射200 mg/kg的葡萄糖（D10W）", + "C": "用100%氧气进行过度通气", + "D": "给予10 mL/kg的5%白蛋白快速注射" + } + }, + { + "id": "ea1a5c4b-0160-597c-8df8-b3e37266142c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A Eutectic Mixture of Local Anesthetics (EMLA) cream is a mixture of which local anesthetics?", + "A": "Lidocaine 2.5% and prilocaine 2.5%", + "B": "Lidocaine 2.5% and benzocaine 2.5%", + "C": "Prilocaine 2% and benzocaine 2%", + "D": "Lidocaine 4%" + }, + "zh": { + "question": "局部麻醉药的共晶混合物 (EMLA) 霜是由哪些局部麻醉药组成的？", + "A": "利多卡因 2.5% 和 丙胺卡因 2.5%", + "B": "利多卡因 2.5% 和 苯佐卡因 2.5%", + "C": "丙胺卡因 2% 和 苯佐卡因 2%", + "D": "利多卡因 4%" + } + }, + { + "id": "f930c2dd-6002-5c7e-9960-fd7bf3273cd0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Advantages of catheterization of the umbilical artery versus the umbilical vein in a newborn include all of the following EXCEPT", + "A": "It allows assessment of oxygenation", + "B": "Hepatic damage from hypertonic infusion is avoided", + "C": "It permits assessment of systemic blood pressure", + "D": "It is easier to cannulate" + }, + "zh": { + "question": "在新生儿中，脐动脉导管插入术相对于脐静脉导管插入术的优点包括以下所有选项，除了", + "A": "它允许评估氧合情况", + "B": "避免了高渗输液引起的肝损伤", + "C": "它允许评估全身血压", + "D": "更容易插管" + } + }, + { + "id": "9f7112d0-cbea-538c-9f32-aa37d434d168", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The TRUE statement concerning thermoregulation in neonates is which of the following?", + "A": "A significant proportion of their heat loss can be accounted for by their small surface area*–*to-weight ratio", + "B": "They compensate for hypothermia by shivering", + "C": "The principal method of heat production is metabolism of brown fat", + "D": "Heat loss through conduction can be reduced by humidification of inspired gases" + }, + "zh": { + "question": "关于新生儿体温调节的正确陈述是以下哪一项？", + "A": "它们的热量损失很大一部分可以归因于其小的表面积与体重比", + "B": "它们通过颤抖来补偿体温过低", + "C": "主要的产热方式是棕色脂肪的代谢", + "D": "通过加湿吸入气体可以减少传导性热量损失" + } + }, + { + "id": "b39dfec7-4a51-5ed6-9586-d6040148dfe2", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 10-year-old child was climbing a tree and fell, sustaining a lower cervical neck injury. He is unable to move his legs but can move his arms somewhat and is scheduled for an MRI scan. All of the following are signs of neurogenic shock EXCEPT", + "A": "Hypotension", + "B": "Narrow pulse pressure", + "C": "Hypothermia", + "D": "Normal heart rate" + }, + "zh": { + "question": "一名10岁的儿童在爬树时摔下，导致下颈部受伤。他无法移动双腿，但可以稍微移动手臂，并计划进行MRI扫描。以下所有都是神经源性休克的表现，除了", + "A": "低血压", + "B": "脉压窄", + "C": "体温过低", + "D": "心率正常" + } + }, + { + "id": "2db56e0f-839e-577c-8aae-4e3e77151123", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 5-year-old child undergoing strabismus surgery under general anesthesia suddenly develops sinus bradycardia and intermittent ventricular escape beats but is hemodynamically stable. Which initial therapy is appropriate for treating this arrhythmia?", + "A": "Tell the surgeon to stop pulling on the eye muscle", + "B": "Tell the surgeon to do a retrobulbar block", + "C": "Decrease the depth of the volatile anesthetic", + "D": "Administer atropine" + }, + "zh": { + "question": "一名5岁儿童在全身麻醉下进行斜视手术时突然出现窦性心动过缓和间歇��心室逸搏，但血流动力学稳定。哪种初始治疗适合治疗这种心律失常？", + "A": "告诉外科医生停止牵拉眼肌", + "B": "告诉外科医生进行球后阻滞", + "C": "减少挥发性麻醉药的深度", + "D": "给予阿托品" + } + }, + { + "id": "79e34989-875f-5c67-a61e-21ad32f47604", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following respiratory indices is increased in healthy neonates compared with healthy adults?", + "A": "Tidal volume (mL/kg)", + "B": "Minute ventilation (mL/kg/min)", + "C": "Functional residual capacity (mL/kg)", + "D": "Paco2" + }, + "zh": { + "question": "以下哪项呼吸指标在健康新生儿中比健康成人增加？", + "A": "潮气量 (mL/kg)", + "B": "每分钟通气量 (mL/kg/min)", + "C": "功能残气量 (mL/kg)", + "D": "动脉二氧化碳分压 (Paco2)" + } + }, + { + "id": "28603776-6631-5e75-ad5c-e77371329bd4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 16-year-old girl with neurofibromatosis is anesthetized for resection of an acoustic neuroma. Each of the following may potentially complicate the anesthetic management of this patient EXCEPT", + "A": "Presence of a pheochromocytoma", + "B": "Upper airway obstruction from a laryngeal neurofibroma", + "C": "Intracranial hypertension", + "D": "Increased risk for MH" + }, + "zh": { + "question": "一名16岁患有神经纤维瘤病的女孩接受听神经瘤切除术的麻醉。以下每一项都可能使该患者的麻醉管理复杂化，除了", + "A": "存在嗜铬细胞瘤", + "B": "喉部神经纤维瘤导致的上呼吸道阻塞", + "C": "颅内高压", + "D": "恶性高热的风险增加" + } + }, + { + "id": "6e04b030-9493-5ea2-940c-183372e3cf23", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "With which of the following congenital anomalies is right-to-left", + "A": "Tracheoesophageal fistula (TEF)", + "B": "Gastroschisis", + "C": "Omphalocele", + "D": "Congenital diaphragmatic hernia (CDH)" + }, + "zh": { + "question": "以下哪种先天性异常与右向左分流有关？", + "A": "气管食管瘘（TEF）", + "B": "腹裂", + "C": "脐膨出", + "D": "先天性膈疝（CDH）" + } + }, + { + "id": "88cd853b-9818-5fee-82ef-373746357966", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is NOT CONSISTENT with an infant who suffers from severe dehydration?", + "A": "15% weight loss", + "B": "Normal respirations", + "C": "Urine output < 0.5 mL/kg/hr", + "D": "Tachycardia" + }, + "zh": { + "question": "以下哪项与严重脱水的婴儿不一致？", + "A": "体重减轻15%", + "B": "呼吸正常", + "C": "尿量 < 0.5 mL/kg/hr", + "D": "心动过速" + } + }, + { + "id": "e479f76c-bdbc-5ada-b02b-673e99087040", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Postoperative bleeding following tonsillectomy occurs most commonly", + "A": "By the first 6 hours", + "B": "6 to 24 hours after surgery", + "C": "On the third postoperative day", + "D": "On the seventh postoperative day" + }, + "zh": { + "question": "扁桃体切除术后出血最常发生在何时？", + "A": "术后前6小时", + "B": "术后6到24小时", + "C": "术后第三天", + "D": "术后第七天" + } + }, + { + "id": "79c07847-2b69-5050-85be-a20e83862372", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 9-year-old undergoing sinus surgery is treated with an unmeasured amount of 0.5% phenylephrine by the surgeon, and the patient develops a blood pressure of 250/150. The most appropriate treatment for this would be", + "A": "Administer verapamil", + "B": "Administer esmolol", + "C": "Administer labetalol", + "D": "Administer phentolamine" + }, + "zh": { + "question": "一名9岁儿童在进行鼻窦手术时，外科医生使用了未测量剂量的0.5%去氧肾上腺素，患者出现血压250/150。最合适的治疗方法是", + "A": "给予维拉帕米", + "B": "给予艾司洛尔", + "C": "给予拉贝洛尔", + "D": "给予酚妥拉明" + } + }, + { + "id": "99e080db-59ee-53d4-8a73-c8abc378e05a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 5-kg, 3-month-old male infant undergoes a left inguinal herniorrhaphy with a spinal anesthetic. Typically, how long would 1 mL of a 0.5% bupivacaine (5 mg) isobaric solution last?", + "A": "Less than 30 minutes", + "B": "30 to 60 minutes", + "C": "60 to 80 minutes", + "D": "90 to 100 minutes" + }, + "zh": { + "question": "一名5公斤、3个月大的男性婴儿接受左侧腹股沟疝修补术，使用脊髓麻醉。通常情况下，1毫升0.5%布比卡因（5毫克）等渗溶液的麻醉效果会持续多长时间？", + "A": "少于30分钟", + "B": "30到60分钟", + "C": "60到80分钟", + "D": "90到100分钟" + } + }, + { + "id": "da15a022-c3b2-5f9f-a0d2-01b1902cdb9b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following combination of drug and dose used alone is INCORRECT for preoperative sedation for an anxious child?", + "A": "Midazolam 0.1 mg/kg orally", + "B": "Clonidine 2 to 5 μg/kg orally", + "C": "Dexmedetomidine 1 to 2 μg/kg nasally", + "D": "Ketamine 3 to 7 mg/kg intramuscular (IM)" + }, + "zh": { + "question": "以下哪种药物和剂量的组合单独用于焦虑儿童的术前镇静是错误的？", + "A": "咪达唑仑 0.1 mg/kg 口服", + "B": "可乐定 2 至 5 μg/kg 口服", + "C": "右美托咪定 1 至 2 μg/kg 鼻用", + "D": "氯胺酮 3 至 7 mg/kg 肌肉注射 (IM)" + } + }, + { + "id": "83ade90d-118d-5533-8495-4d2f13ee016e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements regarding resuscitation of the infant by health care providers is NOT correct?", + "A": "Mouth-to-mouth or mouth-to-nose ventilation at a rate of 12 to 20 breaths/min is performed when breathing is inadequate but an adequate pulse is present", + "B": "Start chest compressions when the pulse is less than 60 beats/min and there are signs of poor tissue perfusion", + "C": "Chest compression depth is 1/5 the anteroposterior diameter of the chest (about 1 cm)", + "D": "Compression-to-ventilation ratio is 30:2 for one-person and 15:2 for two-person cardiopulmonary resuscitation (CPR)" + }, + "zh": { + "question": "以下关于医护人员对婴儿复苏的说法中哪一项是不正确的？", + "A": "当呼吸不足但脉搏充足时，进行每分钟12到20次的口对口或口对鼻通气", + "B": "当脉搏少于每分钟60次且有组织灌注不良的迹象时，开始胸外按压", + "C": "胸外按压的深度为胸部前后径的1/5（约1厘米）", + "D": "单人心肺复苏（CPR）的按压与通气比为30:2，双人心肺复苏为15:2" + } + }, + { + "id": "66a33122-b0e9-55c7-a9e3-92cd56a037ca", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "All of the following are true statements concerning the physiology of newborns compared with that of adults EXCEPT", + "A": "Newborns have a greater percentage of total body water compared with adults", + "B": "Newborns have a higher glomerular filtration rate (GFR) than adults", + "C": "Newborns' hearts are relatively noncompliant compared with adults' hearts", + "D": "Newborns' diaphragms have a lower proportion of type I muscle fibers (i.e., fatigue-resistant, highly oxidative fibers)" + }, + "zh": { + "question": "以下关于新生儿与成人生理学的比较，除了哪一项外，其他都是正确的？", + "A": "新生儿的总体水分百分比比成人高", + "B": "新生儿的肾小球滤过率（GFR）比成人高", + "C": "新生儿的心脏相对于成人的心脏较不顺应", + "D": "新生儿的膈肌中I型肌纤维（即抗疲劳、高氧化纤维）的比例较低" + } + }, + { + "id": "a423568c-9eb3-5a80-818b-e7aa82c334f0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements concerning the anatomy of the infant and the adult airway is INCORRECT?", + "A": "The larynx is in a more cephalic position in infants than in adults", + "B": "The infant's epiglottis is narrower and \"omega\" shaped, whereas the adult epiglottis is flat and broad", + "C": "The vocal cords are in a more perpendicular position to the trachea in infants and in a more diagonal position to the larynx and trachea in adults", + "D": "The narrowest part of the infant and adult larynx is at the level of the cricoid cartilage" + }, + "zh": { + "question": "关于婴儿和成人气道解剖的以下陈述中哪一项是不正确的？", + "A": "婴儿的喉位于比成人更靠头侧的位置", + "B": "婴儿的会厌较窄且呈“Ω”形，而成人的会厌是扁平且宽的", + "C": "婴儿的声带与气管呈更垂直的位置，而成人的声带与喉和气管呈更对角的位置", + "D": "婴儿和成人喉部最狭窄的部分是在环状软骨水平" + } + }, + { + "id": "7991b6ec-7ff8-542c-8d21-7c0ff1e6f723", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following operations would be associated with the LEAST incidence of postoperative nausea and vomiting (PONV) in a 5-year-old boy?", + "A": "Tonsillectomy", + "B": "Strabismus surgery", + "C": "Myringotomy tube placement", + "D": "Orchiopexy" + }, + "zh": { + "question": "以下哪种手术与5岁男孩术后恶心呕吐（PONV）的发生率最低相关？", + "A": "扁桃体切除术", + "B": "斜视手术", + "C": "鼓膜切开术置管", + "D": "睾丸固定术" + } + }, + { + "id": "45326e95-95d7-5503-96c6-9a5a2f4aea63", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Anomalies and features associated with Down syndrome include", + "A": "Smaller tracheas", + "B": "Atlanto-occipital instability", + "C": "Thyroid hypofunction", + "D": "All of the above" + }, + "zh": { + "question": "与唐氏综合症相关的异常和特征包括", + "A": "较小的气管", + "B": "枕寰不稳定", + "C": "甲状腺功能减退", + "D": "以上所有" + } + }, + { + "id": "809d9bf2-053b-5685-a49d-60968eb19754", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Congenital syndromes frequently associated with cardiac abnormalities include all of the following EXCEPT", + "A": "Tracheoesophageal fistula (TEF)", + "B": "Meningomyelocele", + "C": "Omphalocele", + "D": "Gastroschisis" + }, + "zh": { + "question": "先天性综合征通常与心脏异常相关，包括以下所有选项，除了", + "A": "气管食管瘘（TEF）", + "B": "脊髓脊膜膨出", + "C": "脐膨出", + "D": "腹裂" + } + }, + { + "id": "218c1573-49b1-5abe-8517-b024c486294d", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Appropriate management of a neonate born with congenital diaphragmatic hernia (CDH) should include", + "A": "Insertion of an orogastric or nasogastric tube", + "B": "Expansion of the hypoplastic lung with positive-pressure ventilation", + "C": "Hyperventilation to keep the PaCO2 below 40 and the pH greater than 7.40", + "D": "Rapid transport to the OR for surgical correction" + }, + "zh": { + "question": "对患有先天性膈疝（CDH）的新生儿进行适当管理应包括", + "A": "插入口胃管或鼻胃管", + "B": "通过正压通气扩张发育不全的肺", + "C": "过度通气以保持PaCO2低于40和pH值大于7.40", + "D": "快速转运至手术室进行手术矫正" + } + }, + { + "id": "dd72d18a-33f8-5758-adf1-317fd4a67179", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Select the TRUE statement regarding complex regional pain syndrome (CRPS) in children", + "A": "More common in males than females", + "B": "Upper extremity is more frequently involved than the lower extremity", + "C": "Best treated with sympathetic blocks", + "D": "Often associated with depression and anxiety" + }, + "zh": { + "question": "选择关于儿童复杂性区域疼痛综合征（CRPS）的正确陈述", + "A": "男性比女性更常见", + "B": "上肢比下肢更常受累", + "C": "最佳治疗方法是交感神经阻滞", + "D": "常与抑郁和焦虑相关" + } + }, + { + "id": "70faf36d-5d2a-51ea-96be-3538b864731c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements regarding perioperative cardiac arrest in children is NOT correct?", + "A": "Cardiac arrest is more common in neonates than in infants or older children", + "B": "\"Equipment related\" causes occur in more than 25% of cardiac arrests", + "C": "Resuscitation is more often successful if the cause is anesthesia related rather than nonanesthesia related", + "D": "Emergency surgery is associated with greater than four times the chance of a cardiac arrest" + }, + "zh": { + "question": "以下关于儿童围手术期心脏骤停的说法中哪一项是不正确的？", + "A": "心脏骤停在新生儿中比在婴儿或较大儿童中更常见", + "B": "“设备相关”原因占心脏骤停的比例超过25%", + "C": "如果心脏骤停的原因与麻醉有关而非与麻醉无关，复苏更容易成功", + "D": "急诊手术与心脏骤停的几率增加超过四倍相关" + } + }, + { + "id": "6876028a-969f-56cc-8408-6ae0d9a24194", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "Which of the following represents the greatest risk for postoperative apnea in an infant?", + "A": "PCA of 60 weeks", + "B": "Hemoglobin 10 g/dL", + "C": "Recovery in the postanesthesia care unit (PACU) after pyloric stenosis repair", + "D": "20th weight percentile on growth chart" + }, + "zh": { + "question": "以下哪项对婴儿术后呼吸暂停的风险最大？", + "A": "矫正胎龄60周", + "B": "血红蛋白10 g/dL", + "C": "幽门狭窄修复术后在麻醉后监护室（PACU）恢复", + "D": "生长图表上的体重百分位数为第20位" + } + }, + { + "id": "7f7c7b12-bf49-5594-8e20-5c21ee3ec697", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements regarding the Mapleson D breathing circuit is FALSE?", + "A": "It has a proximal fresh gas inflow and a distal overflow valve", + "B": "With an inspiratory-to-expiratory (I:E) breathing ratio of 1:2, rebreathing is eliminated with spontaneous ventilation when the fresh gas flow is three times the minute ventilation", + "C": "The Mapleson D circuit requires lower fresh gas flows with spontaneous ventilation compared with controlled ventilation", + "D": "The Bain circuit is a modification of the Mapleson D circuit" + }, + "zh": { + "question": "以下关于Mapleson D呼吸回路的说法中哪一项是错误的？", + "A": "它具有近端新鲜气体流入和远端溢流阀", + "B": "在吸气与呼气（I:E）比为1:2的情况下，当新鲜气体流量是分钟通气量的三倍时，自主通气时可消除再呼吸", + "C": "与控制通气相比，Mapleson D回路在自主通气时需要较低的新鲜气体流量", + "D": "Bain回路是Mapleson D回路的改进版" + } + }, + { + "id": "737577b1-fb53-5ed6-9a78-70a71c94e319", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Which of the following is LEAST likely to reduce the incidence of postoperative apnea in preterm infants undergoing surgery for inguinal hernia repair?", + "A": "Delaying operation until 60 weeks' PCA", + "B": "Preoperative correction of anemia", + "C": "Caffeine administration", + "D": "Spinal anesthetic with ketamine sedation" + }, + "zh": { + "question": "以下哪项最不可能减少早产儿进行腹股沟疝修补术后呼吸暂停的发生率？", + "A": "将手术推迟到矫正胎龄60周", + "B": "术前纠正贫血", + "C": "咖啡因给药", + "D": "脊髓麻醉联合氯胺酮镇静" + } + }, + { + "id": "0b552a43-5451-58d5-a70b-3f31da9824b5", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 32-week-EGA, 2-kg newborn born a few hours ago is to undergo a repair of his gastroschisis under general anesthesia. Which of the following sizes of uncuffed ETTs should you use, and how far should it be positioned to most likely be properly placed in the trachea (gums to midtrachea distance)?", + "A": "2.0-internal diameter (ID) ETT placed at 6 cm", + "B": "2.5-internal diameter (ID) ETT placed at 8 cm", + "C": "3.0-internal diameter (ID) ETT placed at 10 cm", + "D": "3.5-internal diameter (ID) ETT placed at 12 cm" + }, + "zh": { + "question": "一名32周胎龄、体重2公斤的新生儿出生几小时后需在全身麻醉下进行腹裂修补术。以下哪种尺寸的无袖套气管导管（ETT）应使用，并且应放置多远以最有可能正确置于气管中（从牙龈到气管中��的距离）？", + "A": "2.0内径（ID）ETT放置在6厘米", + "B": "2.5内径（ID）ETT放置在8厘米", + "C": "3.0内径（ID）ETT放置在10厘米", + "D": "3.5内径（ID）ETT放置在12厘米" + } + }, + { + "id": "01abb434-3e33-57bc-abb4-0412b1d6941e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Induction of general anesthesia for an elective operation should be", + "A": "2 hours", + "B": "4 hours", + "C": "6 hours", + "D": "No fasting needed because breast milk is OK" + }, + "zh": { + "question": "择期手术的全身麻醉诱导应为", + "A": "2小时", + "B": "4小时", + "C": "6小时", + "D": "不需要禁食，因为母乳是可以的" + } + }, + { + "id": "3a457653-a56f-59be-846d-17c78ed71ee7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "In the infant, hypothermia would LEAST likely manifest as", + "A": "Metabolic acidosis", + "B": "Prolonged duration of action of nondepolarizing muscle relaxants", + "C": "Hyperglycemia", + "D": "Impaired coagulation" + }, + "zh": { + "question": "在婴儿中，低体温最不可能表现为", + "A": "代谢性酸中毒", + "B": "非去极化肌松药作用时间延长", + "C": "高血糖", + "D": "凝血功能障碍" + } + }, + { + "id": "5193a5f3-ead0-5e7c-8b88-ea63a5842622", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Necrotizing enterocolitis (NEC) has all of the following characteristics EXCEPT", + "A": "Most have thrombocytopenia (< 70,000/mm3 ) and a prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT)", + "B": "Commonly associated with decreased cardiac output in the presence of fetal asphyxia or postnatal respiratory complications", + "C": "Umbilical artery catheters are useful to assess acid-base status", + "D": "Occurs in 10% to 20% of newborns weighing less than 1500 g" + }, + "zh": { + "question": "坏死性小肠结肠炎（NEC）具有以下所有特征，除了", + "A": "大多数有血小板减少症（< 70,000/mm3）和延长的凝血酶原时间（PT）和活化部分凝血活酶时间（aPTT）", + "B": "常与胎儿窒息或产后呼吸并发症时心输出量减少有关", + "C": "脐动脉导管有助于评估酸碱状态", + "D": "发生在体重小于1500克的新生儿中的10%到20%" + } + }, + { + "id": "41205312-44f1-5d91-872d-d719b9bcbdd0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements concerning codeine is INCORRECT?", + "A": "Codeine is a weak opioid and is used for the treatment of mild to moderate pain", + "B": "Peak blood level after oral or IM administration is about 30 minutes", + "C": "Codeine is metabolized to morphine", + "D": "Codeine is the postoperative analgesic of choice, after acetaminophen, for the treatment of pain after tonsillectomy in children < 12 years of age" + }, + "zh": { + "question": "以下关于可待因的陈述中哪一项是不正确的？", + "A": "可待因是一种弱阿片类药物，用于治疗轻度至中度疼痛", + "B": "口服或肌肉注射后约30分钟达到血药峰值", + "C": "可待因代谢为吗啡", + "D": "在12岁以下儿童扁桃体切除术后的疼痛治疗中，可待因是继对乙酰氨基酚之后的首选术后镇痛药" + } + }, + { + "id": "4043ba9f-773f-55c5-ad65-0fc19f57bd13", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following drugs is LEAST likely to be used for a 4-yearold receiving proton beam radiation treatment for his medulloblastoma?", + "A": "EMLA cream", + "B": "Propofol", + "C": "Rocuronium", + "D": "Dexmedetomidine" + }, + "zh": { + "question": "以下哪种药物最不可能用于接受质子束放射治疗的4岁髓母细胞瘤患儿？", + "A": "EMLA乳膏", + "B": "丙泊酚", + "C": "罗库溴铵", + "D": "右美托咪定" + } + }, + { + "id": "93cd66d5-4d5b-56cd-af41-aa6367354f8a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 5-year-old girl with hemolytic-uremic syndrome (HUS) is brought to the OR for placement of a dialysis catheter. Medical issues typical for this disease include", + "A": "Thrombocytopenia", + "B": "Increased intracranial pressure", + "C": "Pancreatitis", + "D": "All of the above" + }, + "zh": { + "question": "一名5岁女孩患有溶血尿毒综合征（HUS），被送到手术室放置透析导管。该疾病的典型医学问题包括", + "A": "血小板减少症", + "B": "颅内压增高", + "C": "胰腺炎", + "D": "以上所有" + } + }, + { + "id": "bcea7431-9e20-503d-bc49-181c27b98d91", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 3-year-old child status post resection of Wilms tumor at age 2 years is receiving doxorubicin (Adriamycin) and cyclophosphamide for metastatic disease. The patient is scheduled for placement of a Hickman catheter for continued chemotherapy. Anesthetic concerns related to this patient's chemotherapeutic treatment include each of the following EXCEPT", + "A": "Thrombocytopenia", + "B": "Inhibition of plasma cholinesterase", + "C": "Cardiac depression", + "D": "Pulmonary toxicity" + }, + "zh": { + "question": "一名3岁儿童在2岁时接受了肾母细胞瘤切除术，目前因转移性疾病正在接受多柔比星（阿霉素）和环磷酰胺治疗。患者计划放置Hickman导管以继续化疗。与该患者化疗相关的麻醉关注点包括以下各项，除了", + "A": "血小板减少", + "B": "血浆胆碱酯酶抑制", + "C": "心脏抑制", + "D": "肺毒性" + } + }, + { + "id": "d295a5c9-be67-5964-b5bd-25ce4686c9e1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Hypotension in children is characterized by a systolic blood pressure", + "A": "Less than 60 mm Hg for the term neonate (0-28 days old)", + "B": "Less than 70 mm Hg for infants 1 to 12 months old", + "C": "Less than 70 mm Hg + (2 × age in years) mm Hg for children 1 to 10 years old", + "D": "All of the above" + }, + "zh": { + "question": "儿童低血压的特征是收缩压", + "A": "足月新生儿（0-28天）低于60 mm Hg", + "B": "1至12个月婴儿低于70 mm Hg", + "C": "1至10岁儿童低于70 mm Hg + （2 × 年龄）mm Hg", + "D": "以上所有" + } + }, + { + "id": "16111876-3470-5d9b-a669-76d2286918b0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What percent of the adult's glomerular filtration rate, or GFR, does a 1 year-old possess?", + "A": "30%", + "B": "50%", + "C": "75%", + "D": "100%" + }, + "zh": { + "question": "1岁儿童的肾小球滤过率（GFR）占成人的百分比是多少？", + "A": "30%", + "B": "50%", + "C": "75%", + "D": "100%" + } + }, + { + "id": "c029ee82-c4ac-5768-9e22-f7b659706ba8", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Each of the following results in a reduction of the incidence of postoperative vomiting (POV) in children undergoing strabismus surgery EXCEPT", + "A": "IV hydration of 30 mL/kg/hr", + "B": "Dexamethasone 0.15-0.5 mg/kg IV", + "C": "Ondansetron 50 to 200 μg/kg IV", + "D": "Anticholinergics (atropine 10-20 μg/kg or glycopyrrolate 10 μg/kg)# Pediatric Physiology and Anesthesia" + }, + "zh": { + "question": "以下每种方法均可减少接受斜视手术的儿童术后呕吐（POV）的发生率，除了", + "A": "静脉补液 30 mL/kg/hr", + "B": "地塞米松 0.15-0.5 mg/kg 静脉注射", + "C": "昂丹司琼 50 至 200 μg/kg 静脉注射", + "D": "抗胆碱能药物（阿托品 10-20 μg/kg 或 醋甲胆碱 10 μg/kg）# 儿科生理学与麻醉" + } + }, + { + "id": "8e189cf5-b6f0-5218-af12-c84a6876b91c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following drugs does NOT pass the placenta easily?", + "A": "Etomidate", + "B": "Ephedrine", + "C": "Atropine", + "D": "Glycopyrrolate" + }, + "zh": { + "question": "下列哪种药物不易通过胎盘？", + "A": "依托咪酯", + "B": "麻黄碱", + "C": "阿托品", + "D": "东莨菪碱" + } + }, + { + "id": "e98ce3c4-c686-5d2d-88c8-27700e142622", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 38-year-old obese patient is receiving subcutaneous low-molecularweight heparin (LMWH) for thromboprophylaxis. Her epidural for an elective cesarean delivery was placed 14 hours after the heparin was stopped. She developed Horner syndrome on the left side 30 minutes after placement of the epidural. On physical examination, a T4 anesthetic level is noted, but aside from the Horner syndrome no other findings are revealed. The most appropriate course of action at this time would be to", + "A": "Remove the epidural", + "B": "Consult a neurosurgeon", + "C": "Obtain a computed tomographic scan", + "D": "None of the above" + }, + "zh": { + "question": "一名38岁的肥胖患者正在接受皮下低分子量肝素（LMWH）以预防血栓。她在停用肝素14小时后进行了择期剖宫产的硬膜外麻醉。硬膜外麻醉置入30分钟后，她出现了左侧霍纳综合征。体格检查显示麻醉平面为T4，但除了霍纳综合征外没有其他发现。此时最合适的处理措施是", + "A": "移除硬膜外导管", + "B": "咨询神经外科医生", + "C": "进行计算机断层扫描", + "D": "以上都不是" + } + }, + { + "id": "af2e7c62-ddf6-5774-9166-3991631883ba", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What percentage of all pregnancies is affected by hypertension?", + "A": "3%-5%", + "B": "7%-10%", + "C": "15%", + "D": "20%" + }, + "zh": { + "question": "高血压影响了多少百分比的妊娠？", + "A": "3%-5%", + "B": "7%-10%", + "C": "15%", + "D": "20%" + } + }, + { + "id": "51fb83a0-c975-5114-baaf-8e8e0812525a", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 16-year-old, anxious, preeclamptic patient in active labor develops back pain after the placement of an epidural for labor analgesia. The", + "A": "Inject a higher concentration of a local anesthetic or add intravenous (IV) narcotics", + "B": "Replace the epidural and use epidural narcotics to decrease the motor weakness", + "C": "Reassure her that she will get better with delivery", + "D": "Consult a neurosurgeon" + }, + "zh": { + "question": "一名16岁的焦虑、患有先兆子痫的患者在分娩镇痛的硬膜外麻醉后出现背痛。", + "A": "注射更高浓度的局部麻醉剂或添加静脉注射（IV）麻醉药", + "B": "更换硬膜外麻醉并使用硬膜外麻醉药以减少运动无力", + "C": "安慰她，告诉她分娩后会好转", + "D": "咨询神经外科医生" + } + }, + { + "id": "cc24970a-ebf4-54b5-8045-82060d55e998", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Magnesium sulfate (MgSO4 ) is used as an anticonvulsant in patients with preeclampsia and for fetal neuroprotection and sometimes for short-term tocolysis. MgSO4 may produce any of the following effects", + "A": "Sedation", + "B": "Respiratory paralysis", + "C": "Inhibition of acetylcholine (ACh) release at the myoneural junction", + "D": "Hypertension when used with nifedipine" + }, + "zh": { + "question": "硫酸镁 (MgSO4) 用作子痫前期患者的抗惊厥药以及胎儿神经保护，有时用于短期抑制宫缩。MgSO4 可能产生以下任何效果", + "A": "镇静", + "B": "呼吸麻痹", + "C": "抑制肌神经接头处乙酰胆碱 (ACh) 的释放", + "D": "与硝苯地平合用时引起高血压" + } + }, + { + "id": "f23b8e4f-741d-592c-a512-a325acb15c61", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Normal fetal heart rate (FHR) is", + "A": "60 to 100 beats/min", + "B": "90 to 130 beats/min", + "C": "110 to 160 beats/min", + "D": "150 to 200 beats/min" + }, + "zh": { + "question": "正常胎心率（FHR）是", + "A": "60到100次/分钟", + "B": "90到130次/分钟", + "C": "110到160次/分钟", + "D": "150到200次/分钟" + } + }, + { + "id": "95078886-95de-5f24-952a-5201d3a4b4e2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the MOST likely cause of pregnancy-related deaths in the United States (2011-2013)?", + "A": "Anesthesia complications", + "B": "Hemorrhage", + "C": "Cardiovascular disease", + "D": "Hypertensive disorders of pregnancy" + }, + "zh": { + "question": "以下哪项是美国（2011-2013年）与妊娠相关死亡的最可能原因？", + "A": "麻醉并发症", + "B": "出血", + "C": "心血管疾病", + "D": "妊娠期高血压疾病" + } + }, + { + "id": "991b877d-cc82-5eff-b243-13d19aed57ae", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Drugs useful in the treatment of uterine atony in an asthmatic patient with severe preeclampsia include", + "A": "Oxytocin (Pitocin) only", + "B": "Ergonovine (Ergotrate) or methylergonovine (Methergine) only", + "C": "15-Methyl prostaglandin F2α (PGF2α ) (Carboprost, Hemabate) only", + "D": "All of the above are safe and can be used alone or in combination with the others" + }, + "zh": { + "question": "适用于治疗患有严重子痫前期的哮喘患者子宫无力的药物包括", + "A": "仅催产素（Pitocin）", + "B": "仅麦角新碱（Ergotrate）或甲基麦角新碱（Methergine）", + "C": "仅15-甲基前列腺素F2α（PGF2α）（Carboprost, Hemabate）", + "D": "以上所有药物都是安全的，可以单独使用或与其他药物联合使用" + } + }, + { + "id": "9c2cd3e0-cbf4-5845-9002-3aac329472d7", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the P50 of fetal hemoglobin at term?", + "A": "12 mm Hg", + "B": "18 mm Hg", + "C": "24 mm Hg", + "D": "30 mm Hg" + }, + "zh": { + "question": "足月胎儿血红蛋白的P50是多少？", + "A": "12 mm Hg", + "B": "18 mm Hg", + "C": "24 mm Hg", + "D": "30 mm Hg" + } + }, + { + "id": "a7aed22a-9943-5a63-912e-14c603adc69c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Side effects of terbutaline include all of the following EXCEPT", + "A": "Hypertension", + "B": "Hyperglycemia", + "C": "Pulmonary edema", + "D": "Hypokalemia" + }, + "zh": { + "question": "特布他林的副作用包括以下所有选项，除了", + "A": "高血压", + "B": "高血糖", + "C": "肺水肿", + "D": "低钾血症" + } + }, + { + "id": "febb7327-1d72-56d9-8828-16b5eda08877", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Cardiac output increases dramatically during pregnancy and delivery. The cardiac output returns to nonpregnant values by how long postpartum?", + "A": "12 hours", + "B": "1 day", + "C": "2 weeks", + "D": "6 months" + }, + "zh": { + "question": "在妊娠和分娩期间，心输出量显著增加。心输出量在产后多久恢复到非妊娠值？", + "A": "12小时", + "B": "1天", + "C": "2周", + "D": "6个月" + } + }, + { + "id": "b3a021e8-1b1c-57e1-af15-c16317dd17a9", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 32-year-old parturient with a history of spinal fusion, severe asthma, and hypertension (blood pressure 180/110) is brought to the operating room wheezing. She needs an emergency cesarean section under general anesthesia for a prolapsed umbilical cord. Which of the following induction agents would be MOST appropriate for her induction?", + "A": "Sevoflurane", + "B": "Midazolam", + "C": "Ketamine", + "D": "Propofol" + }, + "zh": { + "question": "一名32岁的产妇有脊柱融合、严重哮喘和高血压（血压180/110）的病史，被送到手术室时喘息。由于脐带脱垂，她需要在全身麻醉下进行紧急剖宫产。以下哪种诱导剂最适合她的诱导？", + "A": "七氟醚", + "B": "咪达唑仑", + "C": "氯胺酮", + "D": "丙泊酚" + } + }, + { + "id": "9b75c2d6-4104-54a9-8966-a6adeaf30eda", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Uterine blood flow at term pregnancy typically increases to about", + "A": "100 mL/min", + "B": "250 mL/min", + "C": "500 mL/min", + "D": "750 mL/min" + }, + "zh": { + "question": "足月妊娠时子宫血流量通常增加到约", + "A": "100 毫升/分钟", + "B": "250 毫升/分钟", + "C": "500 毫升/分钟", + "D": "750 毫升/分钟" + } + }, + { + "id": "f937982b-d93f-514b-95c0-bb1e5fbcea57", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which one of the following statements is TRUE regarding human immunodeficiency virus (HIV) infected parturients?", + "A": "Central neurologic blockade and epidural blood patches increase the chance of neurologic complications", + "B": "Ninety percent of newborns of untreated HIV-seropositive mothers become infected in utero, during vaginal delivery,or with breastfeeding", + "C": "The pharmacologic effects of benzodiazepines and narcotics are prolonged in patients taking protease inhibitors", + "D": "The risk of seroconversion after percutaneous exposure to HIV-infected blood is about 5%" + }, + "zh": { + "question": "关于人类免疫缺陷病毒（HIV）感染的产妇，下列哪项陈述是正确的？", + "A": "中央神经阻滞和硬膜外血补片增加神经并发症的机会", + "B": "未治疗的HIV抗体阳性母亲所生的新生儿中有90%在子宫内、阴道分娩期间或通过母乳喂养感染", + "C": "服用蛋白酶抑制剂的患者，苯二氮卓类药物和麻醉药的药理作用时间延长", + "D": "经皮暴露于HIV感染血液后血清转化的风险约为5%" + } + }, + { + "id": "b8064eaa-4ad2-58c1-8a62-700057afb66d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following cardiovascular parameters is decreased at term?", + "A": "Central venous pressure", + "B": "Pulmonary capillary wedge pressure", + "C": "Systemic vascular resistance", + "D": "Left ventricular end-systolic volume" + }, + "zh": { + "question": "下列哪项心血管参数在足月时减少？", + "A": "中心静脉压", + "B": "肺毛细血管楔压", + "C": "全身血管阻力", + "D": "左心室收缩末期容积" + } + }, + { + "id": "b3bc590c-81da-56a8-8c1b-000316f4119b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following signs and symptoms is NOT associated with amniotic fluid embolism (AFE)?", + "A": "Chest pain", + "B": "Bleeding (disseminated intravascular coagulation [DIC])", + "C": "Pulmonary vasospasm with severe pulmonary hypertension and right heart failure", + "D": "Left ventricular failure and pulmonary edema" + }, + "zh": { + "question": "以下哪项体征和症状与羊水栓塞（AFE）无关？", + "A": "胸痛", + "B": "出血（弥散性血管内凝血 [DIC]）", + "C": "肺血管痉挛伴严重肺动脉高压和右心衰竭", + "D": "左心室衰竭和肺水肿" + } + }, + { + "id": "cbc57c92-c89f-5565-93e4-0277e2dda81c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When is the fetus most susceptible to the effects of teratogenic agents?", + "A": "1 to 2 weeks of gestation", + "B": "3 to 8 weeks of gestation", + "C": "9 to 14 weeks of gestation", + "D": "15 to 20 weeks of gestation" + }, + "zh": { + "question": "胎儿在何时最容易受到致畸因子的影响？", + "A": "妊娠1到2周", + "B": "妊娠3到8周", + "C": "妊娠9到14周", + "D": "妊娠15到20周" + } + }, + { + "id": "e2e6553e-0fe8-52bb-b927-f6e548eb94da", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 28-week estimated gestational age (EGA), 1000-g male infant is born to a 24-year-old mother who is addicted to heroin. The mother admits taking an extra \"hit\" of heroin before coming to the hospital because she was nervous. The infant's respiratory depression would be best managed by", + "A": "0.1 mg/kg naloxone intramuscularly (IM) in the newborn's thigh muscle", + "B": "0.1 mg/kg naloxone down the endotracheal tube", + "C": "0.4 mg naloxone IM to the mother during the second stage of labor", + "D": "None of the above" + }, + "zh": { + "question": "一名28周估计胎龄（EGA）、1000克的男性婴儿出生于一位24岁的母亲，该母亲对海洛因上瘾。母亲承认在来医院之前因为紧张而多吸了一次海洛因。婴儿的呼吸抑制最好通过以下哪种方式管理", + "A": "在新生儿的大腿肌肉中肌肉注射0.1 mg/kg的纳洛酮", + "B": "通过气管插管给予0.1 mg/kg的纳洛酮", + "C": "在分娩第二阶段给母亲肌肉注射0.4 mg的纳洛酮", + "D": "以上都不是" + } + }, + { + "id": "80db68b8-9539-5cef-bc64-70a185992908", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Cardiac output is GREATEST", + "A": "During the first trimester of pregnancy", + "B": "During the third trimester of pregnancy", + "C": "During labor", + "D": "Immediately after delivery of the newborn" + }, + "zh": { + "question": "心输出量最大的是", + "A": "怀孕的第一孕期", + "B": "怀孕的第三孕期", + "C": "分娩期间", + "D": "新生儿出生后立即" + } + }, + { + "id": "2c99aaba-4eb4-5de9-bf51-abdb25628b10", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 1000-g, 27-week EGA boy is born with a heart rate of 80 beats/min. He has slow irregular respiratory efforts, grimaces when a suction catheter is inserted into the mouth and nose for suctioning, and flexes his limbs some but is totally cyanotic. The umbilical cord has only two vessels. The 1-minute Apgar score would be", + "A": "3", + "B": "4", + "C": "6", + "D": "7" + }, + "zh": { + "question": "一个1000克、胎龄27周的男婴出生时心率为80次/分钟。他的呼吸努力缓慢且不规律，当吸引导管插入口腔和鼻腔进行吸引时，他会做出痛苦的表情，并有一些肢体屈曲，但全身发绀。脐带只有两根血管。1分钟的阿普加评分是", + "A": "3", + "B": "4", + "C": "6", + "D": "7" + } + }, + { + "id": "fff85a0a-3c53-5794-9676-86deeb257684", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following respiratory parameters is NOT increased in the parturient?", + "A": "Minute ventilation (MV)", + "B": "Tidal volume (Vt)", + "C": "Arterial Pao2", + "D": "Serum bicarbonate" + }, + "zh": { + "question": "以下哪项呼吸参数在妊娠期妇女中没有增加？", + "A": "每分钟通气量 (MV)", + "B": "潮气量 (Vt)", + "C": "动脉氧分压 (Pao2)", + "D": "血清碳酸氢盐" + } + }, + { + "id": "b7df4541-0c4a-56a3-8807-2b9914da6f0f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following drugs should NOT be used during transvaginal oocyte retrieval (TVOR) for assisted reproductive technology (ART)?", + "A": "Propofol", + "B": "Ketamine", + "C": "Midazolam", + "D": "All are safe and can be used" + }, + "zh": { + "question": "以下哪种药物不应在辅助生殖技术（ART）的经阴道卵母细胞采集（TVOR）过程中使用？", + "A": "丙泊酚", + "B": "氯胺酮", + "C": "咪达唑仑", + "D": "以上都安全，可以使用" + } + }, + { + "id": "9cc1df7b-9c70-57ab-a22b-03a7e48bdcfb", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following conditions is associated with increased bleeding during pregnancy?", + "A": "Lupus anticoagulant", + "B": "Factor V Leiden mutation", + "C": "Protein C deficiency", + "D": "None of the above" + }, + "zh": { + "question": "以下哪种情况与妊娠期出血增加有关？", + "A": "狼疮抗凝剂", + "B": "第五因子莱顿突变", + "C": "蛋白C缺乏", + "D": "以上都不是" + } + }, + { + "id": "de3b483c-22e1-52da-b60d-cb301111ffee", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "What is the BEST way to prevent autonomic hyperreflexia in a quadriplegic woman who is to undergo induction of labor? The complete spinal cord lesion occurred 2 years ago.", + "A": "Only IV drugs should be used; spinal and epidural anesthesia are contraindicated", + "B": "Spinal or epidural lumbar local anesthetics such as bupivacaine alone are effective", + "C": "Spinal or epidural narcotics such as fentanyl alone are effective", + "D": "Autonomic hyperreflexia appears only when the complete spinal cord lesion is below T6, so there is no need to worry" + }, + "zh": { + "question": "对于一名即将进行引产的四肢瘫痪女性，预防自主神经反射亢进的最佳方法是什么？完全性脊髓损伤发生在2年前。", + "A": "只应使用静脉注射药物；脊髓和硬膜外麻醉是禁忌的", + "B": "单独使用布比卡因等脊髓或硬膜外腰部局部麻醉剂是有效的", + "C": "单独使用芬太尼等脊髓或硬膜外��醉药是有效的", + "D": "自主神经反射亢进仅在完全性脊髓损伤位于T6以下时出现，因此无需担心" + } + }, + { + "id": "2098d859-c60d-54fc-b966-343cb72ff124", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 24-year-old gravida 2, para 1 parturient is anesthetized for emergency cesarean section. On emergence from general anesthesia, the endotracheal tube is removed and the patient becomes cyanotic. Oxygen is administered by positive-pressure bag and mask ventilation. High airway pressures are necessary to ventilate the patient, and wheezing is noted over both lung fields, along with hypoxemia. The patient's blood pressure falls from 120/80 to 90/60 mm Hg, and heart rate increases from 105 to 150 beats/min. The MOST likely cause of these manifestations is", + "A": "Amniotic fluid embolus (AFE)", + "B": "Mucus plug in trachea", + "C": "Tension pneumothorax", + "D": "Aspiration" + }, + "zh": { + "question": "一名24岁的孕妇，孕2产1，因紧急剖宫产接受麻醉。在全身麻醉苏醒时，拔除气管插管后，患者出现发绀。通过正压袋和面罩通气给予氧气。需要高气道压力才能通气，双肺野听诊到喘鸣，并伴有低氧血症。患者的血压从120/80降至90/60 mm Hg，心率从105增加到150次/分钟。这些表现最可能的原因是", + "A": "羊水栓塞 (AFE)", + "B": "气管内粘液栓", + "C": "张力性气胸", + "D": "过敏性休克" + } + }, + { + "id": "934661fb-518e-574b-a6d6-aeaacff039c2", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 29-year-old gravida 1, para 0 woman at 8 weeks of gestation is to undergo an emergency appendectomy under general anesthesia with isoflurane, N2O, and oxygen. Which of the following is a proven", + "A": "Congenital heart disease", + "B": "Cleft palate", + "C": "Behavioral defects", + "D": "None of the above" + }, + "zh": { + "question": "一名29岁的孕妇，孕1产0，怀孕8周，需在全身麻醉下进行紧急阑尾切除术，使用异氟醚、N2O和氧气。以下哪项是已被证实的", + "A": "先天性心脏病", + "B": "腭裂", + "C": "行为缺陷", + "D": "以上皆非" + } + }, + { + "id": "0aa6b0d7-258c-5188-b49b-56d8769da26f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A lumbar epidural is placed in a 24-year-old gravida 1, para 0 parturient with myasthenia gravis (MG) for labor. Select the TRUE statement regarding neonatal MG.", + "A": "The newborn is almost always affected with myasthenia", + "B": "The newborn is affected by maternal immunoglobulin M (IgM) antibodies", + "C": "The newborn may require anticholinesterase therapy for up to 4 weeks", + "D": "The newborn will need lifelong treatment" + }, + "zh": { + "question": "一名24岁的初产妇患有重症肌无力（MG），在分娩时接受了腰椎硬膜外麻醉。选择关于新生儿重症肌无力的正确陈述。", + "A": "新生儿几乎总是受到重症肌无力的影响", + "B": "新生儿受到母体免疫球蛋白M（IgM）抗体的影响", + "C": "新生儿可能需要抗胆碱酯酶治疗长达4周", + "D": "新生儿将需要终生治疗" + } + }, + { + "id": "91462985-036e-5930-8458-02d77e9c3fa3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A patient having which of the following conditions is LEAST likely to develop DIC?", + "A": "Severe preeclampsia", + "B": "Placental abruption", + "C": "Placenta previa (bleeding)", + "D": "Dead fetus syndrome" + }, + "zh": { + "question": "以下哪种情况的患者最不可能发展为DIC？", + "A": "重度子痫前期", + "B": "胎盘早剥", + "C": "前置胎盘（出血）", + "D": "死胎综合征" + } + }, + { + "id": "835e3f61-5ea0-53c6-affd-afbd6b95f440", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 28-year-old gravida 1, para 0 parturient with Eisenmenger syndrome (pulmonary hypertension with an intracardiac right-to-left or bidirectional shunt) is to undergo placement of a lumbar epidural for analgesia during labor. It may be wise to avoid a local anesthetic with epinephrine in this patient because it", + "A": "Lowers pulmonary vascular resistance", + "B": "Lowers systemic vascular resistance", + "C": "Increases heart rate", + "D": "Causes excessive increases in systolic blood pressure (SBP)" + }, + "zh": { + "question": "一名28岁的初产妇，妊娠1次，未产，患有艾森门格综合征（伴有心内右向左或双向分流的肺动脉高压），计划在分娩期间进行腰椎硬膜外镇痛。对于该患者，避免使用含肾上腺素的局部麻醉剂可能是明智的，因为它", + "A": "降低肺血管阻力", + "B": "降低全身血管阻力", + "C": "增加心率", + "D": "导致收缩压（SBP）过度升高" + } + }, + { + "id": "ef166ff9-aa93-5221-b765-72eab8c777c6", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "Which of the following patients is MOST likely to need an emergency hysterectomy for uncontrolled bleeding at the time of delivery?", + "A": "Patient undergoing cesarean section after an unsuccessful trial of labor after cesarean (TOLAC)", + "B": "Patient with quadruplets", + "C": "Patient with a placenta previa (not bleeding) for an elective repeat cesarean section", + "D": "Patient with an abdominal pregnancy" + }, + "zh": { + "question": "以下哪位患者在分娩时最有可能因无法控制的出血而需要紧急子宫切除术？", + "A": "在剖宫产后试产（TOLAC）失败后进行剖宫产的患者", + "B": "四胞胎患者", + "C": "因前置胎盘（无出血）进行择期重复剖宫产的患者", + "D": "腹腔妊娠的患者" + } + }, + { + "id": "08624a03-6afa-541c-aaea-5591a25f97fc", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The MOST common injury recorded in the American Society of Anesthesiologists' (ASA's) Closed Claims Project regarding obstetric anesthetic claims is", + "A": "Pain during anesthesia", + "B": "Maternal nerve damage", + "C": "Headache", + "D": "Aspiration pneumonitis" + }, + "zh": { + "question": "美国麻醉医师学会（ASA）关于产科麻醉索赔的封闭索赔项目中记录的最常见损伤是", + "A": "麻醉期间的疼痛", + "B": "母体神经损伤", + "C": "头痛", + "D": "吸入性肺炎" + } + }, + { + "id": "47e2e7b7-f524-5a6f-b30e-97f7e413f265", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements about chorioamnionitis is FALSE?", + "A": "Chorioamnionitis occurs in about 1% of all pregnancies", + "B": "Clinical signs include temperature higher than 38° C, maternal and fetal tachycardia, and uterine tenderness", + "C": "Antibiotics are administered only after delivery, because intrapartum antibiotics may \"obscure the results of neonatal blood cultures\"", + "D": "Epidural anesthesia can be safely administered" + }, + "zh": { + "question": "以下关于绒毛膜羊膜炎的陈述中哪一项是错误的？", + "A": "绒毛膜羊膜炎发生在大约1%的妊娠中", + "B": "临床症状包括体温高于38°C、母体和胎儿心动过速以及子宫压痛", + "C": "抗生素仅在分娩后给予，因为分娩期抗生素可能会“掩盖新生儿血培养的结果”", + "D": "硬膜外麻醉可以安全实施" + } + }, + { + "id": "542a739b-7751-5571-b97a-8851efd3a930", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements regarding newborns with thick meconium-stained amniotic fluid is TRUE?", + "A": "Only oral or nasal suctioning with a bulb syringe is needed in newborns that are vigorous", + "B": "Intubation is required for all such newborns", + "C": "Antibiotics and steroids are often needed to treat the infection", + "D": "Respiratory distress syndrome (RDS) is common" + }, + "zh": { + "question": "关于羊水中有浓厚胎粪的新生儿，下列哪项陈述是正确的？", + "A": "对于活力良好的新生儿，只需用球囊吸引器进行口腔或鼻腔吸引", + "B": "所有这样的新生儿都需要插管", + "C": "通常需要使用抗生素和类固醇来治疗感染", + "D": "呼吸窘迫综合征（RDS）很常见" + } + }, + { + "id": "9c1a218a-d67f-5f11-802c-fc05653c3940", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 38-year-old primiparous patient with placenta previa and active vaginal bleeding arrives in the operating room with a systolic blood pressure (SBP) of 85 mm Hg. A cesarean section is planned. The patient is lightheaded and scared. Which of the following anesthetic induction plans would be most appropriate for this patient?", + "A": "Spinal anesthetic with 12 to 15 mg bupivacaine", + "B": "General anesthetic induction with 2 to 2.8 mg/kg propofol and paralysis with 1 to 1.5 mg/kg succinylcholine", + "C": "General anesthesia induction with 0.75 to 1 mg/kg ketamine and paralysis with 1 to 1.5 mg/kg succinylcholine", + "D": "Replace lost blood volume first, then use any anesthetic the patient wishes" + }, + "zh": { + "question": "一名38岁的初产妇患者患有前置胎盘并伴有活动性阴道出血，入手术室时收缩压（SBP）为85 mm Hg。计划进行剖宫产。患者感到头晕和害怕。以下哪种麻醉诱导方案最适合该患者？", + "A": "使用12至15 mg布比卡因的脊髓麻醉", + "B": "使用2至2.8 mg/kg丙泊酚进行全身麻醉诱导，并使用1至1.5 mg/kg琥珀胆碱进行麻痹", + "C": "使用0.75至1 mg/kg氯胺酮进行全身麻醉诱导，并使用1至1.5 mg/kg琥珀胆碱进行麻痹", + "D": "先补充失去的血容量，然后使用患者希望的任何麻醉剂" + } + }, + { + "id": "7fbb0335-3188-529d-aee3-3943552b6f09", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following lung volumes or capacities change the LEAST during pregnancy?", + "A": "Tidal volume (Vt)", + "B": "Functional residual capacity (FRC)", + "C": "Expiratory reserve volume (ERV)", + "D": "Vital capacity (VC)" + }, + "zh": { + "question": "以下哪种肺容量或肺活量在怀孕期间变化最小？", + "A": "潮气量 (Vt)", + "B": "功能残气量 (FRC)", + "C": "呼气储备量 (ERV)", + "D": "肺活量 (VC)" + } + }, + { + "id": "3536d425-e527-5f94-9d4d-9581b433338a", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "General anesthesia is induced in a 35-year-old patient for elective cesarean section. No part of the glottic apparatus is visible after two unsuccessful attempts to intubate, but mask ventilation is adequate. The most appropriate step at this point would be to", + "A": "Wake up the patient", + "B": "Attempt a blind nasal intubation", + "C": "Continue mask ventilation and cricoid pressure", + "D": "Use a laryngeal mask airway" + }, + "zh": { + "question": "一名35岁的患者在进行择期剖宫产时被诱导全身麻醉。经过两次插管失败后，声门装置的任何部分都不可见，但面罩通气是充分的。此时最合适的步骤是", + "A": "唤醒患者", + "B": "尝试盲法鼻插管", + "C": "继续面罩通气并施加环状软骨压力", + "D": "使用喉罩" + } + }, + { + "id": "486942ac-8bc4-5ec8-9862-0fcd13e4a163", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which patients describe their labor pain as being the MOST intense?", + "A": "Primipara patients attending prepared childbirth classes", + "B": "Primipara patients not attending prepared childbirth classes", + "C": "Multipara patients attending prepared childbirth classes", + "D": "Multipara patients not attending prepared childbirth classes" + }, + "zh": { + "question": "哪些患者描述她们的分娩疼痛最为剧烈？", + "A": "参加过分娩准备课程的初产妇", + "B": "未参加分娩准备课程的初产妇", + "C": "参加过分娩准备课程的经产妇", + "D": "未参加分娩准备课程的经产妇" + } + }, + { + "id": "4bab1db3-1088-5478-b5fa-6aa1be508cf3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Cigarette smoking is associated with an increase of each of the following EXCEPT", + "A": "Spontaneous fetal loss", + "B": "Placental abruption", + "C": "Preeclampsia", + "D": "Sudden infant death syndrome (SIDS)" + }, + "zh": { + "question": "吸烟与以下每一项的增加有关，除了", + "A": "自然流产", + "B": "胎盘早剥", + "C": "子痫前期", + "D": "婴儿猝死综合症 (SIDS)" + } + }, + { + "id": "96eaf1b4-3fbf-5ace-839d-8eb2be0d03e9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "All of the following are TRUE regarding the use of nitrous oxide for labor analgesia EXCEPT", + "A": "Significant anxiolysis occurs", + "B": "Do not need to have an IV line in place", + "C": "Needs to be administered by anesthesia personnel", + "D": "Only the patient can hold the mask or mouthpiece" + }, + "zh": { + "question": "关于使用一氧化二氮进行分娩镇痛，下列哪项是错误的？", + "A": "会产生显著的抗焦虑作用", + "B": "不需要放置静脉输液管", + "C": "需要由麻醉人员进行管理", + "D": "只有患者可以拿着面罩或口器" + } + }, + { + "id": "d81188b5-f6c8-5924-87b9-5ba028ffebcd", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "When performing a rapid-sequence induction (RSI) for an emergency cesarean delivery, which of the following muscle relaxants is LEAST desirable to use after the IV general anesthetic is administered?", + "A": "Atracurium", + "B": "Rocuronium", + "C": "Succinylcholine", + "D": "Vecuronium" + }, + "zh": { + "question": "在进行紧急剖宫产的快速序贯诱导（RSI）时，以下哪种肌肉松弛剂在静脉全身麻醉药物给药后最不理想？", + "A": "阿曲库铵", + "B": "罗库溴铵", + "C": "琥珀胆碱", + "D": "维库溴铵" + } + }, + { + "id": "394c3194-8a0c-5d80-a651-72c847df50b8", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "True statements regarding inclusion of intrathecal morphine, fentanyl, or sufentanil in obstetric anesthesia practice include each of the following EXCEPT", + "A": "The chief site of action is the substantia gelatinosa of the dorsal horn of the spinal column", + "B": "There is no motor and no sympathetic blockade", + "C": "Pain relief is adequate for the second stage of labor", + "D": "Lipophilic narcotics are associated with less respiratory depression than nonlipophilic narcotics" + }, + "zh": { + "question": "关于在产科麻醉实践中使用鞘内吗啡、芬太尼或舒芬太尼的正确陈述包括以下各项，除了", + "A": "主要作用部位是脊柱背角的胶状质", + "B": "没有运动和交感神经阻滞", + "C": "疼痛缓解足以应对分娩第二阶段", + "D": "亲脂性麻醉药与非亲脂性麻醉药相比，呼吸抑制较少" + } + }, + { + "id": "301cbb2c-662f-522e-a614-19ae5d035d68", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The MOST common side effect of intraspinal narcotics in the obstetric population is", + "A": "Pruritus", + "B": "Nausea and vomiting", + "C": "Respiratory depression", + "D": "Urinary retention" + }, + "zh": { + "question": "在产科人群中，椎管内麻醉药物最常见的副作用是", + "A": "瘙痒", + "B": "恶心和呕吐", + "C": "呼吸抑制", + "D": "尿潴留" + } + }, + { + "id": "16f71641-fba2-592f-bc8f-781f50ba7b99", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 110-kg (242-lb), gravida 1, para 0 woman has a blood pressure of 180/95 during an office visit at the 16th week of gestation and 175/90 1 week later. She has some ankle but no facial edema, and no protein detected in her urine. Her serum creatinine is 1.2. These findings would be classified as", + "A": "Preeclampsia", + "B": "Chronic hypertension", + "C": "Chronic hypertension with superimposed preeclampsia", + "D": "Gestational hypertension" + }, + "zh": { + "question": "一位体重110公斤（242磅），初孕未产的女性在妊娠16周的门诊访问中血压为180/95，一周后为175/90。她有一些踝部水肿但没有面部水肿，尿液中未检测到蛋白。她的血清肌酐为1.2。这些发现将被分类为", + "A": "子痫前期", + "B": "慢性高血压", + "C": "慢性高血压伴重叠子痫前期", + "D": "妊娠期高血压" + } + }, + { + "id": "0d332e14-47c9-5ed6-ac51-e1ed7c3d29ec", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "An epidural is placed into a 32-year-old parturient in active labor receiving magnesium therapy for preeclampsia. Five minutes after administration of the test dose, the loading dose of bupivacaine and fentanyl is administered. The patient becomes panic-stricken, wrestles briefly with the reassuring nurses, gasps for air, seizes, and develops cardiovascular collapse. During resuscitation, blood is oozing from the IV sites and a pink froth is noted in the endotracheal tube. The MOST likely diagnosis is", + "A": "Amniotic fluid embolism", + "B": "High spinal", + "C": "Intravascular bupivacaine injection", + "D": "Eclampsia" + }, + "zh": { + "question": "一名32岁的产妇在接受镁治疗以控制子痫前期时，正在积极分娩中被置入硬膜外麻醉。测试剂量给药五分钟后，给予布比卡因和芬太尼的负荷剂量。患者变得惊慌失措，与安抚她的护士短暂挣扎，喘不过气来，发生癫痫，并出现心血管崩溃。在复苏过程中，静脉注射部位有血液渗出，气管插管中出现粉红色泡沫。最可能的诊断是", + "A": "羊水栓塞", + "B": "高位脊麻", + "C": "布比卡因血管内注射", + "D": "子痫" + } + }, + { + "id": "71b8150b-bc50-53b5-83fb-e870f7183dcd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following narcotics has the LONGEST duration of action when added during a cesarean section under epidural anesthesia?", + "A": "50 to 100 μg fentanyl", + "B": "10 to 20 μg sufentanil", + "C": "3 to 4 mg morphine", + "D": "50 to 75 mg meperidine" + }, + "zh": { + "question": "在硬膜外麻醉下进行剖宫产时，以下哪种麻醉药物加入后作用时间最长？", + "A": "50到100微克芬太尼", + "B": "10到20微克舒芬太尼", + "C": "3到4毫克吗啡", + "D": "50到75毫克哌替啶" + } + }, + { + "id": "4010ca38-d129-5c2f-b9c1-afd7596a35d2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is NOT increased during pregnancy?", + "A": "Renal plasma flow", + "B": "Creatinine clearance", + "C": "Blood urea nitrogen (BUN)", + "D": "Glucose excretion" + }, + "zh": { + "question": "以下哪项在怀孕期间不会增加？", + "A": "肾血浆流量", + "B": "肌酐清除率", + "C": "血尿素氮 (BUN)", + "D": "葡萄糖排泄" + } + }, + { + "id": "fb719c0e-8cd5-5bfe-ae26-b423caf4971a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which inhalation anesthetic does NOT produce uterine relaxation?", + "A": "Isoflurane", + "B": "Sevoflurane", + "C": "Nitrous oxide", + "D": "All produce uterine relaxation" + }, + "zh": { + "question": "哪种吸入麻醉剂不会引起子宫松弛？", + "A": "异氟醚", + "B": "七氟醚", + "C": "一氧化二氮", + "D": "所有都会引起子宫松弛" + } + }, + { + "id": "ad17dd7a-6d44-50f3-a98f-b519a5b41b5d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Passive diffusion of substances across the placenta is enhanced by all of the following EXCEPT", + "A": "Low molecular weight of the substance", + "B": "High water solubility of the substance", + "C": "Low degree of ionization of the substance", + "D": "Large concentration gradient of the drug" + }, + "zh": { + "question": "以下所有因素均可增强物质通过胎盘的被动扩散，除了", + "A": "物质的低分子量", + "B": "物质的高水溶性", + "C": "物质的低电离度", + "D": "药物的高浓度梯度" + } + }, + { + "id": "401a9ab4-474b-5e7e-8066-b0e82c83de90", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Cesarean delivery is associated with a blood loss of about", + "A": "250 mL", + "B": "500 mL", + "C": "750 mL", + "D": "1000 mL" + }, + "zh": { + "question": "剖宫产手术通常伴随约多少的失血量", + "A": "250 mL", + "B": "500 mL", + "C": "750 mL", + "D": "1000 mL" + } + }, + { + "id": "4a0aa139-3d17-52ad-a234-b860d9dd3ab0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements is CORRECT in describing differences between fetal and maternal blood during labor?", + "A": "Fetal blood has a lower hemoglobin concentration than does maternal blood", + "B": "Fetal placental blood flow is twice maternal placental blood flow", + "C": "Fetal hemoglobin has a greater affinity for O2 than does maternal hemoglobin", + "D": "The fetal oxyhemoglobin dissociation curve is shifted to the right of the maternal oxyhemoglobin dissociation curve" + }, + "zh": { + "question": "以下哪项陈述正确描述了分娩期间胎儿和母体血液的差异？", + "A": "胎儿血液的血红蛋白浓度低于母体血液", + "B": "胎儿胎盘血流量是母体胎盘血流量的两倍", + "C": "胎儿血红蛋白对氧的亲和力大于母体血红蛋白", + "D": "胎儿氧合血红蛋白解离曲线相对于母体氧合血红蛋白解离曲线向右偏移" + } + }, + { + "id": "199c6c09-240d-5c3a-b4ad-2cde815af7e0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "In general, morbidly obese patients have a higher incidence of all of the following EXCEPT", + "A": "Cesarean deliveries", + "B": "Postdural puncture headaches (PDPHs)", + "C": "Preeclampsia", + "D": "Thromboembolic diseases" + }, + "zh": { + "question": "一般来说，病态肥胖患者的以下所有情况的发生率都较高，除了", + "A": "剖宫产", + "B": "硬膜穿刺后头痛（PDPH）", + "C": "子痫前期", + "D": "血栓栓塞性疾病" + } + }, + { + "id": "0e07613a-a2d4-57a6-be2a-fcf87d5040bd", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A term infant with good muscle tone and a strong cry has an oxygen saturation of 83%, breathing room air 5 minutes after delivery. The MOST appropriate action at this point would be", + "A": "Supplemental increased oxygen concentration with a blender up to 50% by a face mask", + "B": "Spontaneous breathing with 100% oxygen by face mask", + "C": "Positive-pressure ventilation with 100% oxygen", + "D": "Observation" + }, + "zh": { + "question": "一名足月新生儿肌张力良好且哭声洪亮，出生5分钟后在室内空气中氧饱和度为83%。此时最合适的措施是", + "A": "通过面罩使用混合器将氧浓度增加至50%", + "B": "通过面罩自发呼吸100%氧气", + "C": "使用100%氧气进行正压通气", + "D": "观察" + } + }, + { + "id": "af8fecdb-52c2-5d58-baa6-e589ffd0a2db", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which condition BEST describes the third-trimester maternal condition with the following signs and symptoms: new-onset vaginal bleeding that stops, no pain, no fetal distress?", + "A": "Placental abruption", + "B": "Placenta previa", + "C": "Uterine rupture", + "D": "Vasa previa" + }, + "zh": { + "question": "以下哪个情况最能描述第三孕期母体的以下体征和症状：新发阴道出血后停止，无疼痛，无胎儿窘迫？", + "A": "胎盘早剥", + "B": "前置胎盘", + "C": "子宫破裂", + "D": "血管前置" + } + }, + { + "id": "57d182bd-2442-5bc9-bdc9-e74d5e2de60e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "During the second stage of labor, complete pain relief can be obtained with", + "A": "Paracervical block", + "B": "Neuraxial block with fentanyl and morphine", + "C": "Pudendal nerve block", + "D": "Lumbar epidural block with bupivacaine and no narcotic" + }, + "zh": { + "question": "在分娩的第二阶段，可以通过以下哪种方法获得完全的疼痛缓解", + "A": "宫颈旁阻滞", + "B": "神经轴阻滞联合芬太尼和吗啡", + "C": "阴部神经阻滞", + "D": "腰椎硬膜外阻滞联合布比卡因且不含麻醉药" + } + }, + { + "id": "d9f0637e-d36e-5c4f-bb8a-ddcc53abc6ca", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Anesthetic considerations for open fetal surgery include all of the following EXCEPT", + "A": "Uterine relaxation is essential", + "B": "Maternal hypotension (mean blood pressure < 65 mm Hg) can be treated with phenylephrine or ephedrine", + "C": "Vecuronium at the ED95 dose of 0.04 mg/kg should be administered IM or IV by the obstetrician or surgeon if fetal muscle relaxation is needed", + "D": "Normal fetal oxygen saturation is 50% to 70%" + }, + "zh": { + "question": "开放性胎儿手术的麻醉考虑因素包括以下所有内容，除了", + "A": "子宫松弛是必要的", + "B": "母体低血压（平均血压 < 65 mm Hg）可以用去氧肾上腺素或麻黄碱治疗", + "C": "如果需要胎儿肌肉松弛，产科医生或外科医生应以ED95剂量0.04 mg/kg的维库溴铵进行肌肉注射或静脉注射", + "D": "正常胎儿氧饱和度为50%至70%" + } + }, + { + "id": "edd1cf86-28b0-50f4-b9e0-31db402081be", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "15-Methyl PGF2α is administered directly into the myometrium to treat uterine atony in a 28-year-old mother. Possible effects from treatment with this drug include", + "A": "Nausea and vomiting", + "B": "Bronchospasm", + "C": "Hypoxia", + "D": "All of the above" + }, + "zh": { + "question": "将15-甲基PGF2α直接注入子宫肌层以治疗28岁母亲的子宫无力。该药物治疗可能的效果包括", + "A": "恶心和呕吐", + "B": "支气管痉挛", + "C": "缺氧", + "D": "以上所有" + } + }, + { + "id": "2ddfe911-d131-5673-8490-5a177423034d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements regarding MgSO4 therapy for preeclampsia is TRUE?", + "A": "The therapeutic range for serum magnesium is 10 to 15 mEq/L", + "B": "High serum magnesium levels can be estimated by changes in deep tendon patellar reflexes in a patient with an epidural anesthetic loaded for a cesarean section", + "C": "Excessive serum magnesium levels cause widening of the QRS complex", + "D": "As soon as delivery occurs, the chance for eclampsia no longer exists and the magnesium should be reversed so that postpartum bleeding is less likely to occur" + }, + "zh": { + "question": "关于用于子痫前期的硫酸镁治疗，下列哪项陈述是正确的？", + "A": "血清镁的治疗范围是10到15 mEq/L", + "B": "在为剖宫产加载硬膜外麻醉的患者中，可以通过深腱反射的变化来估计高血清镁水平", + "C": "过高的血清镁水平会导致QRS波群增宽", + "D": "一旦分娩发生，子痫的可能性不再存在，应逆转镁以减少产后出血的可能性" + } + }, + { + "id": "e273efe3-c4e7-5878-98c6-b48416eaf497", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "While moving a parturient from the birthing room to the operating room for an emergency cesarean section for a prolapsed umbilical cord, the patient develops cough, wheezing, and stridor and becomes cyanotic.", + "A": "Intravenous lidocaine to suppress the cough", + "B": "Glucocorticoids", + "C": "100% oxygen and positive end-expiratory pressure (PEEP)", + "D": "Saline lavage" + }, + "zh": { + "question": "在将一名产妇从产房转移到手术室进行紧急剖宫产以处理脐带脱垂时，患者出现咳嗽、喘息和喘鸣，并变得发绀。", + "A": "静脉注射利多卡因以抑制咳嗽", + "B": "糖皮质激素", + "C": "100%氧气和呼气末正压（PEEP）", + "D": "生理盐水冲洗" + } + }, + { + "id": "ad13c2d1-3ad6-5932-8ed3-53e2418017d4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Aortocaval compression starts to become significant in a normal pregnancy at how many weeks EGA?", + "A": "10 weeks", + "B": "15 weeks", + "C": "20 weeks", + "D": "25 weeks" + }, + "zh": { + "question": "在正常妊娠中，主动脉腔静脉压迫在多少周妊娠期开始变得显著？", + "A": "10周", + "B": "15周", + "C": "20周", + "D": "25周" + } + }, + { + "id": "9c80f21c-1aeb-51dd-a916-a120d20f53c7", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which agent is the MOST useful for raising the gastric pH just before induction of general anesthesia for emergency cesarean section?", + "A": "Ranitidine", + "B": "Sodium citrate", + "C": "Metoclopramide", + "D": "Magnesium hydroxide and aluminum hydroxide" + }, + "zh": { + "question": "在紧急剖宫产全身麻醉诱导前，哪种药物最有助于提高胃液pH值？", + "A": "雷尼替丁", + "B": "枸橼酸钠", + "C": "甲氧氯普胺", + "D": "氢氧化镁和氢氧化铝" + } + }, + { + "id": "468702f4-1b58-5900-8f81-5e3cda2b0b8c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Causes of fetal bradycardia include all of the following EXCEPT", + "A": "Maternal smoking of cigarettes", + "B": "Neostigmine and glycopyrrolate reversal of neuromuscular blockers", + "C": "Acidosis", + "D": "Umbilical cord compression" + }, + "zh": { + "question": "胎儿心动过缓的原因包括以下所有情况，除了", + "A": "母亲吸烟", + "B": "新斯的明和格隆溴铵逆转神经肌肉阻滞剂", + "C": "酸中毒", + "D": "脐带受压" + } + }, + { + "id": "3d5fb97c-7dc0-5094-bec5-1998816e2b57", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Most cases of cerebral palsy (CP) are due to conditions during", + "A": "Antepartum", + "B": "Labor", + "C": "Delivery", + "D": "The first 30 days of life" + }, + "zh": { + "question": "大多数脑瘫（CP）病例是由于以下哪个时期的情况引起的", + "A": "产前", + "B": "分娩", + "C": "出生", + "D": "生命的前30天" + } + }, + { + "id": "3d62821d-ad1f-59d2-9df3-aaca93738ff4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "All of the following statements regarding pregnant diabetic patients are true EXCEPT", + "A": "Gestational diabetes mellitus (DM) occurs in about 7% of all pregnancies in the United States", + "B": "Insulin readily crosses the placenta and causes larger babies", + "C": "Cesarean section is more common in diabetic pregnancies", + "D": "Diabetic ketoacidosis (DKA) occurs in 1% to 2% of Type- 1 DM pregnancies" + }, + "zh": { + "question": "关于妊娠期糖尿病患者，以下陈述均正确，除了", + "A": "妊娠期糖尿病（DM）发生在美国约7%的妊娠中", + "B": "胰岛素容易通过胎盘并导致婴儿体型较大", + "C": "剖宫产在糖尿病妊娠中更为常见", + "D": "糖尿病酮症酸中毒（DKA）发生在1%到2%的1型糖尿病妊娠中" + } + }, + { + "id": "0f4ef80c-ae0d-5618-8982-b7ddfe883231", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "In addition to the postural component of a postdural puncture headache (PDPH), signs and symptoms may include any of the following EXCEPT", + "A": "Double vision", + "B": "Hearing changes", + "C": "Neck stiffness", + "D": "Fever" + }, + "zh": { + "question": "除了硬膜穿刺后头痛（PDPH）的体位成分外，体征和症状可能包括以下任何一项，除了", + "A": "复视", + "B": "听力变化", + "C": "颈部僵硬", + "D": "发热" + } + }, + { + "id": "36232e30-4d32-515b-b0d0-2abc0a37b2bb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Early decelerations may occur in response to", + "A": "Fetal head compression", + "B": "Uteroplacental insufficiency", + "C": "Maternal hypotension", + "D": "Umbilical cord compression" + }, + "zh": { + "question": "早期减速可能是对以下哪种情况的反应", + "A": "胎头受压", + "B": "子宫胎盘功能不全", + "C": "母体低血压", + "D": "脐带受压" + } + }, + { + "id": "b849c55b-4f4b-55d9-8f02-b13605b676e2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Agents that are useful for decreasing the incidence of shivering during cesarean section under regional anesthesia or for treating shivering include all of the following EXCEPT", + "A": "Administration of intrathecal local anesthetic with fentanyl and/or morphine", + "B": "Intravenous magnesium sulfate", + "C": "Administration of epidural local anesthetic solutions with epinephrine", + "D": "Intravenous meperidine" + }, + "zh": { + "question": "在区域麻醉下进行剖宫产时，以下药物中，除了哪一种以外，均可用于减少寒战发生率或治疗寒战？", + "A": "鞘内局部麻醉药与芬太尼和/或吗啡的联合使用", + "B": "静脉注射硫酸镁", + "C": "含肾上腺素的硬膜外局部麻醉药溶液", + "D": "静脉注射哌替啶" + } + }, + { + "id": "f032bed0-9ccb-5ed8-864c-16f5584436a4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "An umbilical arterial blood gas sample at the time of an emergency cesarean delivery shows a Po2 of 20 mm Hg, a Pco2 of 50 mm Hg, a", + "A": "Severe hypoxemia", + "B": "Respiratory acidosis", + "C": "Metabolic acidosis", + "D": "Normal values" + }, + "zh": { + "question": "在紧急剖宫产时，脐动脉血气样本显示 Po2 为 20 mm Hg，Pco2 为 50 mm Hg，以下哪项是正确的？", + "A": "严重低氧血症", + "B": "呼吸性酸中毒", + "C": "代谢性酸中毒", + "D": "正常值" + } + }, + { + "id": "e797e0e7-67f9-5862-8ea4-6ae7ab2e909b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which is the MOST frequent condition requiring blood transfusions during or after a cesarean delivery?", + "A": "Multiple gestations", + "B": "Placental abruption", + "C": "Placenta previa", + "D": "Postpartum hemorrhage" + }, + "zh": { + "question": "在剖宫产手术期间或之后，最常需要输血的情况是哪一种？", + "A": "多胎妊娠", + "B": "胎盘早剥", + "C": "前置胎盘", + "D": "产后出血" + } + }, + { + "id": "15658b8a-30ca-5d25-9e03-638fbe3ebdec", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "All of the following are appropriate techniques or drug doses to be used in resuscitating a depressed term newborn EXCEPT", + "A": "Begin ventilation with air rather than 100% oxygen", + "B": "If the heart rate is less than 60 beats/min, start chest compressions (ratio of chest compressions to ventilations is 3:1)", + "C": "After adequate ventilation and chest compressions, administer 0.1 mg/kg of epinephrine IV", + "D": "After 10 minutes of no detectable heart rate, it may be reasonable to discontinue resuscitation efforts" + }, + "zh": { + "question": "以下所有方法或药物剂量均适用于复苏抑郁的足月新生儿，除了", + "A": "开始通气时使用空气而不是100%氧气", + "B": "如果心率低于60次/分钟，开始胸外按压（胸外按压与通气的比例为3:1）", + "C": "在充分通气和胸外按压后，静脉注射0.1 mg/kg的肾上腺素", + "D": "在10分钟内没有检测到心率后，可能合理地停止复苏努力" + } + }, + { + "id": "7c88978e-11aa-5f8e-986e-6968295e2dde", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "After a vaginal delivery under epidural anesthesia, a healthy 8-lb baby is born. The 23-year-old now gravida 1, para 1 woman is noted to have a temperature of 38.2° C. A leukocyte count is obtained and is", + "A": "Get a blood culture", + "B": "Start antibiotics", + "C": "Administer a sedative", + "D": "Observe" + }, + "zh": { + "question": "在硬膜外麻醉下进行阴道分娩后，出生了一个健康的8磅重的婴儿。这位23岁的初产妇女体温为38.2°C。获得的白细胞计数是", + "A": "进行血液培养", + "B": "开始使用抗生素", + "C": "给予镇静剂", + "D": "观察" + } + }, + { + "id": "e574a396-8aaa-590a-b09b-fa8f7684dd31", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Compared with a healthy 25-year-old primigravida, which of the following conditions is NOT associated with a significantly higher incidence of hypertensive disorders of pregnancy?", + "A": "Multiple gestations", + "B": "Cigarette smoking (> 1 pack/day)", + "C": "Obesity", + "D": "Placental abruption" + }, + "zh": { + "question": "与健康的25岁初产妇相比，下列哪种情况与妊娠期高血压疾病的发生率显著增加无关？", + "A": "多胎妊娠", + "B": "吸烟（> 1包/天）", + "C": "肥胖", + "D": "胎盘早剥" + } + }, + { + "id": "7e9ef673-1038-56dc-918d-b832aee88353", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Adverse effects (on the mother) associated with aortocaval compression by the gravid uterus include", + "A": "Nausea and vomiting", + "B": "Changes in cerebration", + "C": "Fetal distress", + "D": "All of the above" + }, + "zh": { + "question": "与妊娠子宫对主动脉腔静脉压迫相关的母体不良反应包括", + "A": "恶心和呕吐", + "B": "意识改变", + "C": "胎儿窘迫", + "D": "以上所有" + } + }, + { + "id": "1d0ad9e0-aba3-503d-8043-e7dbe06e149c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements regarding a pregnant patient abusing cocaine is FALSE?", + "A": "Hypertension, arrhythmias, myocardial ischemia, and tachycardia may occur with the rapid-sequence induction of general anesthesia in the acutely intoxicated patient", + "B": "The minimum alveolar concentration (MAC) for general anesthetics is increased in chronic cocaine addicts", + "C": "Some states consider in utero drug exposure to be a form of child abuse and require physicians to report these patients", + "D": "If a vasopressor is needed to treat hypotension, phenylephrine is preferred over ephedrine" + }, + "zh": { + "question": "关于滥用可卡因的孕妇，下列哪项陈述是错误的？", + "A": "在急性中毒患者中，快速诱导全身麻醉可能导致高血压、心律失常、心肌缺血和心动过速", + "B": "慢性可卡因成瘾者的全身麻醉最低肺泡浓度（MAC）增加", + "C": "一些州认为子宫内药物暴露是一种虐待儿童的形式，并要求医生报告这些患者", + "D": "如果需要升压药来治疗低血压，优先选择苯肾上腺素而不是麻黄碱" + } + }, + { + "id": "702deaec-4a0e-5462-ad7f-4dbe62a016a2", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Each of the following is correct when advising the surgeon to perform infiltration anesthesia for an emergency cesarean delivery when general and neuraxial anesthesia are contraindicated EXCEPT", + "A": "A midline incision is most desirable", + "B": "The rectus muscle should be injected to provide good skin analgesia", + "C": "Bupivacaine with bicarbonate is the local anesthetic of choice", + "D": "Mild sedation with ketamine and midazolam is permissible" + }, + "zh": { + "question": "在全身麻醉和椎管内麻醉禁忌的情况下，建议外科医生为紧急剖宫产实施浸润麻醉时，以下每项都是正确的，除了", + "A": "正中切口是最理想的", + "B": "应注射腹直肌以提供良好的皮肤镇痛", + "C": "碳酸氢钠与布比卡因是首选的局部麻醉药", + "D": "可以使用氯胺酮和咪达唑仑进行轻度镇静" + } + }, + { + "id": "bf5b6382-3869-5111-b652-798182c3c1d8", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 24-year-old primiparous woman is undergoing an elective cesarean section (breech position). After prehydration with 1500 mL of saline, a spinal anesthetic is performed; 5 minutes later, the blood pressure is noted to be 80/40 mm Hg and the heart rate is 110 beats/min. The BEST treatment (best fetal pH) after ensuring that adequate left uterine displacement is performed would be", + "A": "Phenylephrine", + "B": "Ephedrine", + "C": "Epinephrine", + "D": "1000 mL 5% dextrose in lactated Ringer solution" + }, + "zh": { + "question": "一位24岁的初产妇正在接受选择性剖宫产（臀位）。在用1500毫升生理盐水预水化后，进行脊髓麻醉；5分钟后，血压为80/40 mm Hg，心率为110次/分钟。在确保左侧子宫移位充分后，最佳的治疗（最佳胎儿pH）是", + "A": "去氧肾上腺素", + "B": "麻黄碱", + "C": "肾上腺素", + "D": "1000毫升5%葡萄糖乳酸林格氏液" + } + }, + { + "id": "7ef9368f-55e9-5661-ba53-8883228d79f6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A woman has been admitted for a dilation and evacuation (D&E) at 10 weeks' EGA. She has some persistent bleeding and cramping after the expulsion of some tissue. Her obstetric condition is called", + "A": "A threatened abortion", + "B": "An inevitable abortion", + "C": "A complete abortion", + "D": "An incomplete abortion" + }, + "zh": { + "question": "一名女性在妊娠10周时接受了扩张和清宫术（D&E）。在排出一些组织后，她出现了一些持续的出血和痉挛。她的产科情况被称为", + "A": "先兆流产", + "B": "难免流产", + "C": "完全流产", + "D": "不完全流产" + } + }, + { + "id": "60619cae-b9c8-50b3-ae53-13c387ab024c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following treatments has proven effective in decreasing the incidence of PDPHs after an accidental dural puncture with an epidural needle?", + "A": "Bed rest", + "B": "Prophylactic hydration", + "C": "Prophylactic epidural blood patch after delivery", + "D": "None of the above" + }, + "zh": { + "question": "以下哪种治疗已被证明能有���减少硬膜外针意外穿刺后 PDPH 的发生率？", + "A": "卧床休息", + "B": "预防性补液", + "C": "分娩后预防性硬膜外血补片", + "D": "以上都不是" + } + }, + { + "id": "651ce2fb-bcca-5d0f-b24a-caa6317a05a9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Factors associated with advanced molar pregnancy (i.e., > 14 to 16 week size uterus) include all of the following EXCEPT", + "A": "Hypertensive disorders of pregnancy", + "B": "Hypothyroidism", + "C": "Acute cardiopulmonary distress", + "D": "Hyperemesis gravidarum" + }, + "zh": { + "question": "与晚期葡萄胎（即子宫大小超过14到16周）相关的因素包括以下所有因素，除了", + "A": "妊娠期高血压疾病", + "B": "甲状腺功能减退", + "C": "急性心肺窘迫", + "D": "妊娠剧吐" + } + }, + { + "id": "e2958dfc-6a1a-5efe-8836-36bbce87957c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Refractory cardiac arrest is MOST likely after the rapid unintentional IV injection of which of the following local anesthetics?", + "A": "Lidocaine", + "B": "Bupivacaine", + "C": "Ropivacaine", + "D": "Chloroprocaine" + }, + "zh": { + "question": "快速意外静脉注射以下哪种局麻药后最有可能发生顽固性心脏骤停？", + "A": "利多卡因", + "B": "布比卡因", + "C": "罗哌卡因", + "D": "氯普鲁卡因" + } + }, + { + "id": "83650d57-d4d2-59eb-8bda-4f9fd432f1c0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "American Society of Regional Anesthesia (ASRA) guidelines for the treatment of local anesthetic systemic toxicity (LAST) for cardiac arrhythmias include the use of Intralipid and the AVOIDANCE of all of the following drugs EXCEPT", + "A": "Vasopressin", + "B": "β-Blockers", + "C": "Calcium channel blockers", + "D": "Low-dose epinephrine (< 1 μg/kg)" + }, + "zh": { + "question": "美国区域麻醉学会（ASRA）关于局部麻醉药全身毒性（LAST）心律失常治疗的指南包括使用Intralipid，并避免使用以下所有药物，除了", + "A": "加压素", + "B": "β-受体阻滞剂", + "C": "钙通道阻滞剂", + "D": "低剂量肾上腺素（< 1 μg/kg）" + } + }, + { + "id": "c0eb56bf-27fb-55d5-86f3-147c0a639de4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Transient neurologic syndrome (TNS) is MOST commonly seen after the spinal anesthetic injection of which local anesthetic?", + "A": "Lidocaine", + "B": "Bupivacaine", + "C": "Prilocaine", + "D": "Tetracaine" + }, + "zh": { + "question": "短暂性神经综合征（TNS）最常见于哪种局麻药的脊髓麻醉注射后？", + "A": "利多卡因", + "B": "布比卡因", + "C": "丙胺卡因", + "D": "丁卡因" + } + }, + { + "id": "cdd026b0-0855-5df4-8642-507ce54b0407", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "You have a well-working T10 labor epidural in a woman with a questionable difficult airway and have just been informed that an urgent cesarean section is needed for a nonreassuring FHR tracing. Which of the following local anesthetics would give you the SLOWEST onset of surgical anesthesia?", + "A": "3% chloroprocaine with freshly added epinephrine (1:200,000)", + "B": "2% lidocaine with freshly added epinephrine (1:200,000)", + "C": "2% lidocaine and epinephrine with added bicarbonate", + "D": "0.5% levobupivacaine with fentanyl" + }, + "zh": { + "question": "你为一位可能有困难气道的女性实施了一个有效的T10分娩硬膜外麻醉，并刚刚被告知需要紧急剖宫产，因为胎心率监测结果不佳。以下哪种局部麻醉药会导致手术麻醉的起效时间最慢？", + "A": "3%氯普鲁卡因，加入新鲜肾上腺素（1:200,000）", + "B": "2%利多卡因，加入新鲜肾上腺素（1:200,000）", + "C": "2%利多卡因和肾上腺素，加入碳酸氢钠", + "D": "0.5%左布比卡因，加入芬太尼" + } + }, + { + "id": "8d49b35c-2e8f-5ba1-918c-66cbdbafeab2", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which local anesthetic has the SHORTEST plasma half-life after being injected into the epidural space?", + "A": "Bupivacaine", + "B": "Chloroprocaine", + "C": "Lidocaine", + "D": "Ropivacaine# Obstetric Physiology and Anesthesia" + }, + "zh": { + "question": "哪种局部麻醉药在注入硬膜外腔后具有最短的血浆半衰期？", + "A": "布比卡因", + "B": "氯普鲁卡因", + "C": "利多卡因", + "D": "罗哌卡因# 产科生理学与麻醉学" + } + }, + { + "id": "a8888356-d99e-51a5-91f6-16353a402b45", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 59-year-old man with a subarachnoid hemorrhage (SAH) is admitted to the intensive care unit (ICU). His serum sodium is 115 mEq/L, 24 hour urine sodium collection is 350 mmol, and central venous pressure (CVP) is 1 mm Hg. The MOST likely cause of these findings is", + "A": "Acute tubular necrosis (ATN)", + "B": "Diabetes insipidus (DI)", + "C": "Cerebral salt-wasting syndrome (CSWS)", + "D": "Syndrome of inappropriate antidiuretic hormone (SIADH)" + }, + "zh": { + "question": "一名59岁的男性因蛛网膜下腔出血（SAH）被送入重症监护病房（ICU）。他的血清钠为115 mEq/L，24小时尿钠收集为350 mmol，中心静脉压（CVP）为1 mm Hg。最可能导致这些发现的原因是", + "A": "急性肾小管坏死（ATN）", + "B": "尿崩症（DI）", + "C": "脑性盐耗综合征（CSWS）", + "D": "抗利尿激素分泌不当综合征（SIADH）" + } + }, + { + "id": "3a53419f-827d-5dc8-b284-6808d8e56985", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Intracranial hypertension is defined as a sustained increase in intracranial pressure (ICP) above", + "A": "5 to 10 mm Hg", + "B": "15 to 20 mm Hg", + "C": "25 to 30 mm Hg", + "D": "30 + mm Hg" + }, + "zh": { + "question": "颅内高压被定义为颅内压（ICP）持续升高超过", + "A": "5 到 10 mm Hg", + "B": "15 到 20 mm Hg", + "C": "25 到 30 mm Hg", + "D": "30 + mm Hg" + } + }, + { + "id": "49425ec5-fef5-5d77-b6e8-8b76ca50c8b8", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Calculate cerebral perfusion pressure (CPP) from the following data: blood pressure (BP) 100/70, heart rate (HR) 65 beats/min, cardiac output 5 L/min, CVP of 5 cm/H2O, and ICP 15 mm Hg", + "A": "60 mm Hg", + "B": "65 mm Hg", + "C": "70 mm Hg", + "D": "75 mm Hg" + }, + "zh": { + "question": "根据以下数据计算脑灌注压（CPP）：血压（BP）100/70，心率（HR）65次/分钟，心输出量5升/分钟，中心静脉压（CVP）5 cm/H2O，颅内压（ICP）15 mm Hg", + "A": "60 mm Hg", + "B": "65 mm Hg", + "C": "70 mm Hg", + "D": "75 mm Hg" + } + }, + { + "id": "7e1159be-4dba-53b4-bb81-6d9412291a78", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements about cerebrospinal fluid (CSF) in a healthy adult is FALSE?", + "A": "CSF volume is about 150 mL", + "B": "CSF pressure is about 10 mm Hg", + "C": "CSF volume turns over 4 times a day", + "D": "Specific gravity of CSF is higher than the specific gravity of plasma" + }, + "zh": { + "question": "以下关于健康成人脑脊液（CSF）的说法中哪一项是错误的？", + "A": "脑脊液的体积约为150毫升", + "B": "脑脊液的压力约为10毫米汞柱", + "C": "脑脊液的体积每天更新4次", + "D": "脑脊液的比重高于血浆的比重" + } + }, + { + "id": "18a85d3d-bf42-593f-8fee-ebd10593f1f2", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "By what percentage does cerebral blood flow (CBF) change for each mm Hg *decrease* in Paco2 in a previously normotensive patient with a severe brain injury?", + "A": "2% to 4% increase", + "B": "2% to 4% decrease", + "C": "7% to 10% decrease", + "D": "7% to 10% increase" + }, + "zh": { + "question": "在一名先前血压正常的严重脑损伤患者中，每降低1 mm Hg的Paco2，脑血流量（CBF）会发生多少百分比的变化？", + "A": "增加2%到4%", + "B": "减少2%到4%", + "C": "减少7%到10%", + "D": "增加7%到10%" + } + }, + { + "id": "5a2409aa-f8ad-5215-98b7-98603ba9eb7c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following intravenous (IV) anesthetic induction agents is relatively contraindicated in patients with intracranial hypertension?", + "A": "Propofol", + "B": "Etomidate", + "C": "Ketamine", + "D": "Thiopental" + }, + "zh": { + "question": "以下哪种静脉麻醉诱导剂在颅内高压患者中相对禁忌？", + "A": "丙泊酚", + "B": "依托咪酯", + "C": "氯胺酮", + "D": "硫喷妥钠" + } + }, + { + "id": "1e7a67ad-3c42-5f4f-ad44-ca38026f8b1c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The term *cerebral steal* refers to a situation that occurs in the brain when", + "A": "Blood flow has resumed after a period of ischemia", + "B": "Blood flow is directed from a normal region of the brain to an ischemic region", + "C": "Vasoparalysis exists with hypercarbia", + "D": "The Robin Hood phenomenon exists" + }, + "zh": { + "question": "术语*脑窃血*指的是大脑中发生的一种情况，当", + "A": "缺血期后血流恢复", + "B": "血流从大脑的正常区域流向缺血区域", + "C": "存在高碳酸血症的血管麻痹", + "D": "存在罗宾汉现象" + } + }, + { + "id": "345f3cbe-f838-5b98-89a9-c3dd4687c59d", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 62-year-old patient is scheduled to undergo resection of a large frontal lobe intracranial tumor under general anesthesia. Preoperatively, the patient is alert and oriented, and has no focal neurologic deficits. Within what range should Paco2 be maintained during surgery?", + "A": "15 and 20 mm Hg", + "B": "30 and 35 mm Hg", + "C": "40 and 45 mm Hg", + "D": "45 and 50 mm Hg" + }, + "zh": { + "question": "一名62岁的患者计划在全身麻醉下进行大型额叶颅内肿瘤切除术。术前，患者意识清醒，定向力正常，无局灶性神经功能缺损。在手术期间，Paco2应维持在什么范围内？", + "A": "15和20 mm Hg", + "B": "30和35 mm Hg", + "C": "40和45 mm Hg", + "D": "45和50 mm Hg" + } + }, + { + "id": "5af58de4-9645-5900-bfec-d20db20ab8ae", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 32-year-old patient is anesthetized for resection of a supratentorial tumor. Preoperatively, the patient is lethargic and disoriented. Which of the following is MOST likely to adversely alter ICP?", + "A": "5% Dextrose in water", + "B": "Normal saline", + "C": "Lactated Ringer solution", + "D": "5% Albumin" + }, + "zh": { + "question": "一名32岁的患者因切除幕上肿瘤而接受麻醉。术前，患者嗜睡且意识模糊。以下哪一项最有可能不利于改变颅内压？", + "A": "5% 葡萄糖水", + "B": "生理盐水", + "C": "乳酸林格氏液", + "D": "5% 白蛋白" + } + }, + { + "id": "c4229b2d-14ea-5cad-81fa-af0ba5de0a0c", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 22-year-old patient is anesthetized for resection of a temporal lobe tumor. Preoperatively, he is lethargic and confused. After induction of general anesthesia, which of the following would be the MOST appropriate drug to control systemic arterial BP (160/100) during direct laryngoscopy and tracheal intubation?", + "A": "Esmolol", + "B": "Nitroprusside", + "C": "Hydralazine", + "D": "Isoflurane" + }, + "zh": { + "question": "一名22岁的患者因颞叶肿瘤切除术接受麻醉。术前，他表现出嗜睡和意识混乱。在诱导全身麻醉后，以下哪种药物最适合在直接喉镜检查和气管插管期间控制全身动脉血压（160/100）？", + "A": "艾司洛尔", + "B": "硝普钠", + "C": "肼屈嗪", + "D": "异氟醚" + } + }, + { + "id": "522cde54-ff82-58f0-8279-59ba7e9c14be", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Normal global cerebral blood flow (CBF) is", + "A": "25 mL/100 g brain tissue/min", + "B": "50 mL/100 g brain tissue/min", + "C": "75 mL/100 g brain tissue/min", + "D": "100 mL/100 g brain tissue/min" + }, + "zh": { + "question": "正常的全脑血流量（CBF）是", + "A": "25 mL/100 g 脑组织/分钟", + "B": "50 mL/100 g 脑组织/分钟", + "C": "75 mL/100 g 脑组织/分钟", + "D": "100 mL/100 g 脑组织/分钟" + } + }, + { + "id": "560649bf-b954-5ac4-b6a9-a156af007871", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "CBF remains constant between cerebral perfusion pressure (CPP)s of", + "A": "25 and 125 mm Hg", + "B": "25 and 200 mm Hg", + "C": "40 and 250 mm Hg", + "D": "50 and 150 mm Hg" + }, + "zh": { + "question": "脑血流量（CBF）在脑灌注压（CPP）为以下范围时保持恒定", + "A": "25 到 125 mm Hg", + "B": "25 到 200 mm Hg", + "C": "40 到 250 mm Hg", + "D": "50 到 150 mm Hg" + } + }, + { + "id": "bcd14584-6c0e-5bd4-b0e1-4a42bcd3caa5", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "All of the following are true concerning vagal nerve stimulator (VNS) placement for the treatment of medically refractory seizures EXCEPT", + "A": "Patients should not take their anticonvulsant medications before the surgery", + "B": "Placement is usually performed under general anesthesia", + "C": "The electrode array is placed around the left vagus nerve", + "D": "Hoarseness occurs about 50% of the time" + }, + "zh": { + "question": "以下关于用于治疗药物难治性癫痫的迷走神经刺激器（VNS）植入的描述，除了哪一项外，其他都是正确的？", + "A": "患者在手术前不应服用抗癫痫药物", + "B": "植入通常在全身麻醉下进行", + "C": "电极阵列放置在左侧迷走神经周围", + "D": "约50%的情况下会出现声音嘶哑" + } + }, + { + "id": "c66528b5-086b-5d77-9d4e-d42a92162f06", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Select the FALSE statement concerning autonomic hyperreflexia.", + "A": "Distention of a hollow viscus below the level of the spinal cord transection can elicit autonomic hyperreflexia", + "B": "Up to 85% of patients with a spinal cord transection above the T5 dermatome will exhibit autonomic hyperreflexia", + "C": "Propranolol alone is especially effective in treating hypertension associated with autonomic hyperreflexia", + "D": "Spinal anesthesia can be effective in preventing autonomic hyperreflexia" + }, + "zh": { + "question": "选择关于自主神经反射亢进的错误陈述。", + "A": "脊髓横断面以下的空腔脏器扩张可引发自主神经反射亢进。", + "B": "高达85%的脊髓横断面在T5皮节以上的患者会出现自主神经反射亢进。", + "C": "单独使用普萘洛尔在治疗与自主神经反射亢进相关的高血压方面特别有效。", + "D": "脊髓麻醉可以有效预防自主神经反射亢进。" + } + }, + { + "id": "e734e378-4194-554a-ac19-0f33d92b4758", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the normal cerebral metabolic rate for oxygen (CMRO2 ) per minute?", + "A": "0.5 mL of oxygen/100 g brain tissue/min", + "B": "2.0 mL of oxygen/100 g brain tissue/min", + "C": "3.5 mL of oxygen/100 g brain tissue/min", + "D": "7.5 mL of oxygen/100 g brain tissue/min" + }, + "zh": { + "question": "正常的大脑氧代谢率（CMRO2）每分钟是多少？", + "A": "0.5 mL 氧气/100 g 脑组织/分钟", + "B": "2.0 mL 氧气/100 g 脑组织/分钟", + "C": "3.5 mL 氧气/100 g 脑组织/分钟", + "D": "7.5 mL 氧气/100 g 脑组织/分钟" + } + }, + { + "id": "bf7297ba-3544-5c5e-b16d-d76542df198c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 14-year-old girl with severe scoliosis is to undergo spine surgery. Anesthesia is maintained with propofol, remifentanil, and N2O 50% in", + "A": "Increased amplitude and increased latency", + "B": "Decreased amplitude and increased latency", + "C": "Decreased amplitude and decreased latency", + "D": "Increased amplitude and decreased latency" + }, + "zh": { + "question": "一名14岁的女孩患有严重的脊柱侧弯，需进行脊柱手术。麻醉维持使用丙泊酚、瑞芬太尼和50%的N2O", + "A": "振幅增加，潜伏期增加", + "B": "振幅减少，潜伏期增加", + "C": "振幅减少，潜伏期减少", + "D": "振幅增加，潜伏期减少" + } + }, + { + "id": "d3121a9a-773a-5efc-9f9c-a7355d150662", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "For each 1° C decrease in body temperature, how much will cerebral metabolic rate (CMRO2 ) be diminished?", + "A": "2%", + "B": "4%", + "C": "6%", + "D": "10%" + }, + "zh": { + "question": "体温每下降1°C，脑代谢率（CMRO2）会降低多少？", + "A": "2%", + "B": "4%", + "C": "6%", + "D": "10%" + } + }, + { + "id": "b7a17dcb-613c-58c9-99c9-7355f8230a79", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 24-year-old carpenter is treated for a closed head injury sustained 3 days earlier after falling from a roof. He has been hemodynamically stable. Despite aggressive efforts to pharmacologically reduce ICP, he is now unconscious and unresponsive to painful stimuli. All of the following are clinical criteria consistent with a diagnosis of brain death in this patient EXCEPT", + "A": "Persistent apnea for 10 minutes", + "B": "Absence of pupillary light reflex", + "C": "Persistent spinal reflexes", + "D": "Decorticate posturing" + }, + "zh": { + "question": "一名24岁的木匠在从屋顶摔下后3天前遭受闭合性头部损伤，目前正在接受治疗。他的血流动力学一直稳定。尽管进行了积极的药物治疗以降低颅内压，但他现在已失去意识，对疼痛刺激无反应。以下所有临床标准均与该患者脑死亡的诊断一致，除了", + "A": "持续性呼吸暂停10分钟", + "B": "瞳孔对光反射消失", + "C": "持续性脊髓反射", + "D": "去皮质强直姿势" + } + }, + { + "id": "7388c7ce-3b45-5a51-8f1e-d61c6aaa9dc3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 60-year-old man is to undergo posterior fossa surgery in the sitting position. Which of the following is the MOST sensitive means of detecting venous air embolism (VAE)?", + "A": "Esophageal stethoscope", + "B": "End-tidal CO2", + "C": "Transesophageal echocardiography (TEE)", + "D": "Precordial Doppler" + }, + "zh": { + "question": "一名60岁的男性将接受坐位后颅窝手术。以下哪种方法是检测静脉空气栓塞（VAE）最敏感的手段？", + "A": "食管听诊器", + "B": "呼气末二氧化碳", + "C": "经食管超声心动图（TEE）", + "D": "心前区多普勒" + } + }, + { + "id": "0a4102cb-09f9-58ec-aa71-d327ae99598b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "When intracranial hypertension exists, the main initial compensatory mechanism from the body is", + "A": "Decreased production of CSF", + "B": "Increased absorption of CSF in the spinal arachnoid villi", + "C": "Shifting of CSF from intracranial to spinal subarachnoid space", + "D": "Reduction of cerebral blood volume (CBV) due to compression of intracranial arteries" + }, + "zh": { + "question": "当颅内高压存在时，身体的主要初始代偿机制是", + "A": "减少脑脊液的产生", + "B": "增加脊髓蛛网膜绒毛对脑脊液的吸收", + "C": "将脑脊液从颅内转移到脊髓蛛网膜下腔", + "D": "由于颅内动脉受压导致脑血容量（CBV）减少" + } + }, + { + "id": "84d0af63-0be8-5503-90c5-3e98d59a0084", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Administration of vecuronium during spinal surgery may interfere with monitoring of", + "A": "Dorsal columns", + "B": "Corticospinal tract", + "C": "ECoG (Electrocorticography)", + "D": "Bispectral index" + }, + "zh": { + "question": "在脊柱手术中使用维库溴铵可能会干扰对以下哪项的监测？", + "A": "背柱", + "B": "皮质脊髓束", + "C": "ECoG（皮层脑电图）", + "D": "双频指数" + } + }, + { + "id": "2c1d51ab-03d4-50b6-a5fa-2a3ff246a3c9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Patients can be safely imaged in the magnetic resonance imaging (MRI) scanner with conventional versions of which of the following monitors?", + "A": "Pulmonary artery catheter with cardiac output probe", + "B": "Foley catheter with temperature probe", + "C": "Electrocardiography (ECG) electrodes", + "D": "Arterial line" + }, + "zh": { + "question": "患者可以在磁共振成像（MRI）扫描仪中安全成像，使用以下哪种监测器的常规版本？", + "A": "带心输出量探头的肺动脉导管", + "B": "带温度探头的导尿管", + "C": "心电图（ECG）电极", + "D": "动脉导管" + } + }, + { + "id": "357078ae-0831-556f-81f9-f7072193facf", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the minimum quantity of intracardiac air that can be detected by a precordial Doppler?", + "A": "0.25 mL", + "B": "5.0 mL", + "C": "10 mL", + "D": "25 mL" + }, + "zh": { + "question": "经胸多普勒超声可以检测到的最小心内空气量是多少？", + "A": "0.25 mL", + "B": "5.0 mL", + "C": "10 mL", + "D": "25 mL" + } + }, + { + "id": "a636dbaf-4855-56cc-ac8e-c0ecc30ace76", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following drugs at high doses CANNOT produce an isoelectric electroencephalogram (EEG)?", + "A": "Etomidate", + "B": "Isoflurane", + "C": "Midazolam", + "D": "Propofol" + }, + "zh": { + "question": "下列哪种药物在高剂量下不能产生等电位脑电图（EEG）？", + "A": "依托咪酯", + "B": "异氟醚", + "C": "咪达唑仑", + "D": "丙泊酚" + } + }, + { + "id": "c8881f15-0856-5dbf-b84d-44621e582677", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements is FALSE concerning cerebral blood flow (CBF)?", + "A": "CBF is coupled with metabolic demand", + "B": "CBF is 10% to 20% of the cardiac output during the first 6 months of life", + "C": "CBF peaks at 55% of the cardiac output between 2 and 4 years of age", + "D": "CBF decreases to 35% of the cardiac output at 10 years of age" + }, + "zh": { + "question": "以下关于脑血流量 (CBF) 的说法中哪一项是错误的？", + "A": "CBF 与代谢需求相耦合", + "B": "在生命的前6个月，CBF 占心输出量的10%到20%", + "C": "在2到4岁之间，CBF 达到心输出量的55%", + "D": "在10岁时，CBF 降至心输出量的35%" + } + }, + { + "id": "1e0c2835-f7ed-51a8-86dc-efc7274c47db", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "At what level of cerebral blood flow (CBF) does the EEG start to show signs of cerebral ischemia?", + "A": "5 mL/100 g brain tissue/min", + "B": "10 mL/100 g brain tissue/min", + "C": "20 mL/100 g brain tissue/min", + "D": "25 mL/100 g brain tissue/min" + }, + "zh": { + "question": "在什么水平的脑血流量（CBF）时，脑电图（EEG）开始显示脑缺血的迹象？", + "A": "5 mL/100 g 脑组织/分钟", + "B": "10 mL/100 g 脑组织/分钟", + "C": "20 mL/100 g 脑组织/分钟", + "D": "25 mL/100 g 脑组织/分钟" + } + }, + { + "id": "a99210c2-02c1-560a-8e38-30045eb1fdf9", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What effect does cerebral ischemia have on CBF autoregulation?", + "A": "CBF autoregulation is abolished and becomes passively dependent on CPP", + "B": "CBF autoregulation is ablated at low CPPs but remains intact at high CPPs", + "C": "CBF autoregulation is ablated at high CPPs but remains intact at low CPPs", + "D": "The CBF autoregulatory curve is shifted to the right" + }, + "zh": { + "question": "脑缺血对脑血流自动调节有什么影响？", + "A": "脑血流自动调节被废除，变为被动依赖于脑灌注压", + "B": "在低脑灌注压时，脑血流自动调节被消除，但在高脑灌注压时保持完整", + "C": "在高脑灌注压时，脑血流自动调节被消除，但在低脑灌注压时保持完整", + "D": "脑血流自动调节曲线向右移动" + } + }, + { + "id": "33ab8c64-c22f-5a15-a908-b5d6316bc625", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the MOST rapid maneuver available for lowering ICP in a patient with a large intracranial mass?", + "A": "Mannitol, 1 g/kg IV", + "B": "Methylprednisolone, 30 mg/kg IV", + "C": "Hyperventilation to 25 mm Hg Paco2", + "D": "Furosemide, 1 mg/kg IV" + }, + "zh": { + "question": "以下哪种方法是降低具有大颅内肿块患者颅内压最快的方法？", + "A": "甘露醇，1 g/kg 静脉注射", + "B": "甲泼尼龙，30 mg/kg 静脉注射", + "C": "过度通气至 25 mm Hg 动脉二氧化碳分压", + "D": "呋塞米，1 mg/kg 静脉注射" + } + }, + { + "id": "ee3e8c13-3f49-569b-8004-31022c35b976", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What effect does propofol have on the CO2 responsiveness of the cerebral vasculature?", + "A": "Propofol attenuates the effect of hypocarbia on CBF", + "B": "Propofol attenuates the effect of hypercarbia on CBF", + "C": "Propofol augments the effect of hypocarbia on CBF", + "D": "Propofol does not affect CO2 reactivity at a dose used clinically" + }, + "zh": { + "question": "丙泊酚对脑血管对二氧化碳反应性的影响是什么？", + "A": "丙泊酚减弱低碳酸血症对脑血流量的影响", + "B": "丙泊酚减弱高碳酸血症对脑血流量的影响", + "C": "丙泊酚增强低碳酸血症对脑血流量的影响", + "D": "丙泊酚在临床使用剂量下不影响二氧化碳反应性" + } + }, + { + "id": "0757a989-358a-5448-9c04-115925710c19", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Cerebral autoregulation is MOST likely to remain intact", + "A": "Immediately after cerebral aneurysm rupture", + "B": "In a patient with traumatic brain injury (TBI) and a- Glasgow Coma Scale (GCS) score of 3", + "C": "With total IV anesthesia (TIVA) anesthetic using propofol", + "D": "With 2.5% end-tidal sevoflurane anesthesia" + }, + "zh": { + "question": "脑自我调节最有可能保持完整", + "A": "在脑动脉瘤破裂后立即", + "B": "在创伤性脑损伤（TBI）且格拉斯哥昏迷评分（GCS）为3的患者中", + "C": "使用丙泊酚进行全静脉麻醉（TIVA）", + "D": "使用2.5%呼气末七氟醚麻醉" + } + }, + { + "id": "8c566ad9-ff5e-5e3d-a93e-caa5410f7118", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 72-year-old patient undergoing resection of an astrocytoma in the sitting position suddenly develops hypotension. Air is heard on the precordial Doppler ultrasound. Each of the following therapeutic maneuvers to treat VAE is appropriate EXCEPT", + "A": "Discontinue N2O", + "B": "Apply jugular venous pressure", + "C": "Implement positive end-expiratory pressure (PEEP)", + "D": "Administer epinephrine to treat hypotension" + }, + "zh": { + "question": "一名72岁的患者在坐位下进行星形细胞瘤切除术时突然出现低血压。在心前区多普勒超声上听到空气。以下每种治疗VAE的操作都是合适的，除了", + "A": "停止使用N2O", + "B": "施加颈静脉压力", + "C": "实施呼气末正压通气（PEEP）", + "D": "给予肾上腺素治疗低血压" + } + }, + { + "id": "f429c75d-0599-564d-9837-156d6763fa82", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following is the LEAST likely sequela of venous air embolism (VAE) during posterior fossa surgery in the upright position?", + "A": "Increase in pulmonary dead space", + "B": "Bronchoconstriction", + "C": "Stroke", + "D": "Pulmonary hypotension" + }, + "zh": { + "question": "在坐位下进行后颅窝手术时，以下哪项最不可能是静脉空气栓塞（VAE）的后遗症？", + "A": "肺无效腔增加", + "B": "支气管收缩", + "C": "中风", + "D": "肺低血压" + } + }, + { + "id": "0e5c50c0-edaa-5d16-80d6-904500e3aa38", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 30-year-old anxious patient is to undergo Electrocorticography (ECoGH) monitoring to identify epileptogenic foci during seizure surgery. All of the following drugs may make it easier to identify the epileptogenic foci EXCEPT?", + "A": "Alfentanil (20 mcg/kg)", + "B": "Dexmedetomidine (1 mcg/kg over 10 minutes)", + "C": "Etomidate (0.2 mg/kg)", + "D": "Methohexital (20-50 mg)" + }, + "zh": { + "question": "一名30岁的焦虑患者将接受皮层脑电图（ECoGH）监测，以识别癫痫手术期间的致痫灶。以下所有药物都可能使识别致痫灶更容易，除了？", + "A": "阿芬太尼（20 mcg/kg）", + "B": "右美托咪定（1 mcg/kg，10分钟内）", + "C": "依托咪酯（0.2 mg/kg）", + "D": "甲氧己妥（20-50 mg）" + } + }, + { + "id": "01cd32d0-d4a1-5e58-8682-551e89b217d4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How long after a stroke should surgery be deferred for an elective surgical procedure?", + "A": "1 week", + "B": "6 weeks", + "C": "6 months", + "D": "1 year" + }, + "zh": { + "question": "中风后多久应推迟择期手术？", + "A": "1周", + "B": "6周", + "C": "6个月", + "D": "1年" + } + }, + { + "id": "56884fce-6d2d-5c5d-887c-605bd128a4ab", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 13-year-old boy is anesthetized with a propofol infusion and remifentanil infusion for scoliosis repair. SSEP monitoring is conducted during the procedure. Which of the following structures is NOT", + "A": "Corticospinal tract", + "B": "Medial lemniscus", + "C": "Ipsilateral dorsal column of the spinal cord", + "D": "Thalamus" + }, + "zh": { + "question": "一名13岁男孩接受异丙酚和瑞芬太尼输注麻醉以进行脊柱侧弯修复手术。在手术过程中进行SSEP监测。以下哪一结构不属于", + "A": "皮质脊髓束", + "B": "内侧丘系", + "C": "脊髓同侧背柱", + "D": "丘脑" + } + }, + { + "id": "b1eb7973-ccc2-5ad0-9e38-9223f88eda7c", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "A 19-year-old woman with scoliosis is undergoing surgery with Harrington rod placement under general anesthesia with SSEP monitoring. General anesthesia is administered with desflurane, nitrous oxide, and fentanyl. After completion of spinal instrumentation, the SSEP monitoring is equivocal and a wake-up test is undertaken. Four thumb twitches are present with a train-of-four ratio (TOF) of 0.9 when the nerve stimulator attached to the ulnar nerve is activated. The volatile anesthetic and nitrous oxide have been discontinued for 15 minutes, and the patient is asked to move her hands and feet. After repeated commands, the patient still does not move her hands or feet. The most appropriate intervention at this time would be", + "A": "3 mg neostigmine plus 0.6 mg glycopyrrolate IV", + "B": "0.04 mg naloxone IV", + "C": "0.1 mg flumazenil IV", + "D": "Reduce the distraction on the rods" + }, + "zh": { + "question": "一名19岁患有脊柱侧弯的女性正在接受全身麻醉下的Harrington棒置入手术，并进行SSEP监测。全身麻醉使用地氟醚、氧化亚氮和芬太尼。在脊柱器械安装完成后，SSEP监测结果不明确，因此进行唤醒试验。当连接到尺神经的神经刺激器被激活时，出现四次拇指抽搐，四次抽搐比率（TOF）为0.9。挥发性麻醉剂和氧化亚氮已停止使用15分钟，并要求患者移动她的手和脚。在重复命令后，患者仍然没有移动她的手或脚。此时最合适的干预措施是", + "A": "3 mg新斯的明加0.6 mg氢溴酸东莨菪碱静脉注射", + "B": "0.04 mg纳洛酮静脉注射", + "C": "0.1 mg氟马西尼静脉注射", + "D": "减少棒的牵引力" + } + }, + { + "id": "22d2ff40-3320-5bea-aeb0-bea35b79e10f", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 75-year-old patient is undergoing craniotomy for resection of a large astrocytoma. During administration of isoflurane anesthesia, the BP is 110/80 and the arterial blood gas sampling reveals a Paco2 of 30 mm Hg.", + "A": "15 mL/100 g brain tissue/min", + "B": "25 mL/100 g brain tissue/min", + "C": "35 mL/100 g brain tissue/min", + "D": "45 mL/100 g brain tissue/min" + }, + "zh": { + "question": "一名75岁的患者正在接受开颅手术以切除一个大的星形细胞瘤。在异氟醚麻醉期间，血压为110/80，动脉血气分析显示Paco2为30 mm Hg。", + "A": "15 mL/100 g 脑组织/分钟", + "B": "25 mL/100 g 脑组织/分钟", + "C": "35 mL/100 g 脑组织/分钟", + "D": "45 mL/100 g 脑组织/分钟" + } + }, + { + "id": "e08b0c19-3a90-5dd7-8806-028e6dac5b27", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 24-year-old patient is brought to the ICU after sustaining a closed head injury in a motor vehicle accident. Each of the following would be useful in managing intracranial hypertension in this patient EXCEPT", + "A": "Corticosteroids", + "B": "Propofol", + "C": "Hyperventilation to a Paco2 of 35 mm Hg", + "D": "Osmotic diuretics" + }, + "zh": { + "question": "一名24岁的患者在发生机动车事故后因闭合性头部损伤被送入ICU。以下每项措施中，除了哪一项对管理该患者的颅内高压无用？", + "A": "糖皮质激素", + "B": "丙泊酚", + "C": "过度通气至Paco2为35 mm Hg", + "D": "渗透性利尿剂" + } + }, + { + "id": "2ff6d71d-11ba-5665-9c11-5cccf689a39c", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 30-year-old patient with a spontaneous SAH from a ruptured", + "A": "Induced hypertension (to 20% above baseline)", + "B": "Sedation", + "C": "Administration of antiepileptic drugs", + "D": "Administration of nimodipine" + }, + "zh": { + "question": "一名30岁的患者因破裂的自发性蛛网膜下腔出血", + "A": "诱导性高血压（比基线高20%）", + "B": "镇静", + "C": "抗癫痫药物的使用", + "D": "尼莫地平的使用" + } + }, + { + "id": "9ee244e3-4066-599f-a98a-4e137756f14b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following frequency ranges is seen on the EEG in the normal awake patient?", + "A": "Delta (< 4 Hz)", + "B": "Theta (4-7 Hz)", + "C": "Alpha (8-13 Hz)", + "D": "Beta (> 13 Hz)" + }, + "zh": { + "question": "在正常清醒患者的脑电图中可以看到以下哪个频率范围？", + "A": "Delta (< 4 Hz)", + "B": "Theta (4-7 Hz)", + "C": "Alpha (8-13 Hz)", + "D": "Beta (> 13 Hz)" + } + }, + { + "id": "17e0839a-991f-5e99-89f7-32f60f068415", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 75-year-old patient with signs and symptoms of an SAH is brought to the emergency room for evaluation. T-wave inversion, a prolongation of the QT interval, and U waves are noted on the preoperative ECG. Appropriate action at this point would be to", + "A": "Begin infusion of nitroglycerin", + "B": "Check serum calcium and potassium", + "C": "Administer esmolol", + "D": "Place a pulmonary artery catheter" + }, + "zh": { + "question": "一名75岁的患者出现蛛网膜下腔出血的体征和症状，被送到急诊室进行评估。术前心电图显示T波倒置、QT间期延长和U波。此时适当的措施是", + "A": "开始输注硝酸甘油", + "B": "检查血清钙和钾", + "C": "给予艾司洛尔", + "D": "放置肺动脉导管" + } + }, + { + "id": "39d91b14-c0e2-511c-94af-b706df26fe25", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following pharmacologic agents would have the LEAST effect on transcranial motor evoked potentials (MEPs)?", + "A": "Isoflurane", + "B": "Nitrous oxide", + "C": "Etomidate", + "D": "Fentanyl" + }, + "zh": { + "question": "下列哪种药理剂对经颅运动诱发电位（MEPs）的影响最小？", + "A": "异氟醚", + "B": "一氧化二氮", + "C": "依托咪酯", + "D": "芬太尼" + } + }, + { + "id": "70728108-dffb-5aef-ba40-8e4c7d56aa11", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 75-year-old man with medically refractory Parkinson disease is to undergo deep brain stimulation (DBS). Each of the following statements about DBS is true EXCEPT", + "A": "DBS device can be placed with patients awake, slightly sedated, or with general anesthesia", + "B": "Dexmedetomidine is most often used for sedation and analgesia", + "C": "Midazolam is contraindicated for sedation", + "D": "Patients will need anticonvulsants for the associated seizures in over 50% of patients" + }, + "zh": { + "question": "一名75岁的男性患有药物难治性帕金森病，计划进行脑深部电刺激（DBS）。关于DBS，以下每个陈述都正确，除了", + "A": "DBS设备可以在患者清醒、轻度镇静或全身麻醉下放置", + "B": "右美托咪定最常用于镇静和镇痛", + "C": "咪达唑仑禁用于镇静", + "D": "超过50%的患者需要抗惊厥药物来治疗相关的癫痫发作" + } + }, + { + "id": "014aee6c-5a25-56a8-94f5-a92fc61e0959", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "CMR and CBF are decreased by", + "A": "Dexmedetomidine", + "B": "Seizure", + "C": "Hyperthermia", + "D": "Ketamine" + }, + "zh": { + "question": "CMR和CBF减少是由于", + "A": "右美托咪定", + "B": "癫痫发作", + "C": "高热", + "D": "氯胺酮" + } + }, + { + "id": "8e042ad3-72c7-5e72-b1b5-0e739f916dae", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements is FALSE concerning the blood supply to the central nervous system?", + "A": "70% of the brain's blood supply comes from the right and left internal carotid arteries; the remaining 30% comes from the two vertebral arteries", + "B": "Each internal carotid artery divides into three branches: the anterior cerebral artery, the posterior communicating artery, and the middle cerebral artery", + "C": "The vertebral arteries connect directly to the posterior communicating arteries, forming the circle of Willis", + "D": "The spinal cord gets its blood supply from one anterior spinal artery and two posterior spinal arteries" + }, + "zh": { + "question": "以下关于中枢神经系统血液供应的说法中哪一项是错误的？", + "A": "大脑70%的血液供应来自左右颈内动脉，其余30%来自两条椎动脉", + "B": "每条颈内动脉分为三个分支：大脑前动脉、后交通动脉和大脑中动脉", + "C": "椎动脉直接连接到后交通动脉，形成Willis环", + "D": "脊髓的血液供应来自一条前脊髓动脉和两条后脊髓动脉" + } + }, + { + "id": "b63fa2fb-e045-5d35-9214-ff1ee0da2546", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 65-year-old patient is brought to the ICU after sustaining a cervical spine injury with quadriplegia during a motor vehicle accident. In the first 24 hours after the injury, the patient is at risk for", + "A": "Hypothermia, hypotension", + "B": "Tachycardia", + "C": "Stress response with hypertension and hyperventilation", + "D": "Autonomic hyperreflexia" + }, + "zh": { + "question": "一名65岁的患者在机动车事故中因颈椎损伤伴四肢瘫痪被送入ICU。在受伤后的前24小时内，该患者面临的风险是", + "A": "体温过低、低血压", + "B": "心动过速", + "C": "伴有高血压和过度通气的应激反应", + "D": "自主神经反射亢进" + } + }, + { + "id": "c9e565e5-83dd-546c-b446-818236276289", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Signs and symptoms of intracranial hypertension include", + "A": "Papilledema", + "B": "Headache", + "C": "Nausea and vomiting", + "D": "All of the above" + }, + "zh": { + "question": "颅内高压的体征和症状包括", + "A": "视乳头水肿", + "B": "头痛", + "C": "恶心和呕吐", + "D": "以上所有" + } + }, + { + "id": "dc32c71f-71d9-5f4f-aad7-a593e27db47e", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 79-year-old man with a history of transient ischemic attacks is scheduled to undergo a carotid endarterectomy under general anesthesia with EEG monitoring. Which of the following would be appropriate in the anesthetic management of this patient?", + "A": "Initiation of deliberate hypotension (after induction of anesthesia) to reduce bleeding", + "B": "Hyperventilation of the lungs to a Paco2 of 30 mm Hg to reduce ICP", + "C": "Injection of local anesthetic around the carotid body to prevent bradycardia", + "D": "Induction of anesthesia with propofol" + }, + "zh": { + "question": "一名79岁有短暂性脑缺血发作病史的男性计划在全身麻醉下进行颈动脉内膜切除术，并进行脑电图监测。在该患者的麻醉管理中，以下哪项是合适的？", + "A": "在麻醉诱导后开始故意低血压以减少出血", + "B": "将肺部过度通气至Paco2为30 mm Hg以降低颅内压", + "C": "在颈动脉体周围注射局部麻醉剂以防止心动过缓", + "D": "使用丙泊酚进行麻醉诱导" + } + }, + { + "id": "8e84558d-6b5c-59ba-98ae-ac21268d4832", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Anesthetics that decrease ICP include", + "A": "Fentanyl", + "B": "Nitrous oxide", + "C": "Propofol", + "D": "All of the above" + }, + "zh": { + "question": "降低颅内压的麻醉剂包括", + "A": "芬太尼", + "B": "一氧化二氮", + "C": "丙泊酚", + "D": "以上全部" + } + }, + { + "id": "727f6763-69bc-5787-a971-e6ffb998788d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Therapy that is useful in the treatment of cerebral vasospasm after an SAH includes all of the following EXCEPT", + "A": "BP elevation", + "B": "Hemodilution", + "C": "Diuretics (e.g., furosemide)", + "D": "Calcium channel blockers (e.g., nimodipine)" + }, + "zh": { + "question": "在SAH后治疗脑血管痉挛的疗法包括以下所有选项，除了", + "A": "升高血压", + "B": "血液稀释", + "C": "利尿剂（例如呋塞米）", + "D": "钙通道阻滞剂（例如尼莫地平）" + } + }, + { + "id": "c3b7b4ff-f274-5b5f-8e65-1185b43bbd88", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are associated with acromegalic patients undergoing transsphenoidal hypophysectomy EXCEPT", + "A": "Enlargement of the tongue and epiglottis", + "B": "Narrowing of the glottic opening", + "C": "Difficulty in placing nasal airways", + "D": "Increased postoperative use of continuous positive airway pressure (CPAP) because obstructive sleep apnea (OSA) is more common" + }, + "zh": { + "question": "以下哪项与进行经蝶窦垂体切除术的肢端肥大症患者无关", + "A": "舌头和会厌增大", + "B": "声门开口变窄", + "C": "放置鼻气道困难", + "D": "术后使用持续气道正压通气（CPAP）增加，因为阻塞性睡眠呼吸暂停（OSA）更常见" + } + }, + { + "id": "e7a8a902-e6a2-5782-af98-b0e820e7a17f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The CBF autoregulatory curve is shifted to the right by", + "A": "Hypoxia (Pao2 < 50 mm Hg)", + "B": "Volatile anesthetics", + "C": "Hypercarbia", + "D": "Chronic hypertension" + }, + "zh": { + "question": "CBF自我调节曲线向右移动的原因是", + "A": "低氧（Pao2 < 50 mm Hg）", + "B": "挥发性麻醉剂", + "C": "高碳酸血症", + "D": "慢性高血压" + } + }, + { + "id": "c9ab9a97-41ca-57e6-b316-446c178daabc", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Cerebral autoregulation is abolished by", + "A": "Hyperbaric pressure of 4 atmospheres (breathing room air)", + "B": "Cardiopulmonary bypass with a core temperature of 27° C", + "C": "Chronic hypertension", + "D": "3% Isoflurane" + }, + "zh": { + "question": "脑自动调节被以下哪种情况废除", + "A": "4个大气压的高压（呼吸室内空气）", + "B": "核心温度为27°C的体外循环", + "C": "慢性高血压", + "D": "3% 异氟醚" + } + }, + { + "id": "7610e32a-dc1a-5468-9066-02cfb4e6aee0", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Etomidate does all of the following EXCEPT", + "A": "Abolishes CO2 reactivity of cerebral blood vessel tone", + "B": "Reduces CMR", + "C": "Increases both SSEP amplitude and latency", + "D": "Reduces CBF" + }, + "zh": { + "question": "依托咪酯具有以下所有作用，除了", + "A": "消除脑血管对二氧化碳的反应性", + "B": "降低脑代谢率（CMR）", + "C": "增加体感诱发电位（SSEP）的幅度和潜伏期", + "D": "降低脑血流量（CBF）" + } + }, + { + "id": "e9491f1e-56a4-5e0a-b31d-38ddba49e86a", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "Following a motor vehicle accident, a 25-year-old man with head trauma is brought to the operating room for repair of facial lacerations and fractures. The patient is cooperative but extremely micrognathic and weighs 150 kg (330 lb). Acceptable techniques for securing the airway include", + "A": "Blind nasal intubation", + "B": "Direct laryngoscopy after rapid-sequence induction", + "C": "Awake fiberoptic intubation", + "D": "Laryngeal mask airway" + }, + "zh": { + "question": "在一次机动车事故后，一名25岁的男性因头部外伤被送到手术室进行面部裂伤和骨折修复。患者合作但极度小颌，体重150公斤（330磅）。可接受的气道管理技术包括", + "A": "盲插鼻气管插管", + "B": "快速序贯诱导后的直接喉镜检查", + "C": "清醒纤维支气管镜插管", + "D": "喉罩气道" + } + }, + { + "id": "6e4562e1-75e9-5047-971f-d2baef262042", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "After resection of a grade II astrocytoma in a 60-year-old patient, the serum sodium is 127 mEq/L, urine sodium is 25 mEq/L, and the BP is 120/80. Therapy could include which of the following?", + "A": "Intranasal or IV vasopressin (DDAVP)", + "B": "500 mL 3% saline over 30 minutes", + "C": "Chlorpropamide", + "D": "Demeclocycline" + }, + "zh": { + "question": "在一名60岁患者切除II级星形细胞瘤后，血清钠为127 mEq/L，尿钠为25 mEq/L，血压为120/80。治疗可以包括以下哪项？", + "A": "鼻用或静脉注射加压素（DDAVP）", + "B": "30分钟内输注500毫升3%盐水", + "C": "氯磺丙脲", + "D": "去甲环素" + } + }, + { + "id": "f6773a59-36aa-5a15-9233-0a99cfbbefcd", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 48-year-old, 110-kg man with a supratentorial astrocytoma is scheduled for a craniotomy for tumor debulking. His wife states he has been somnolent and confused. On examination he is noted to be hyperventilating and sleepy, but arousable, and hypertensive. Useful measures for his anesthetic include", + "A": "Morphine to decrease his tachypnea", + "B": "Esmolol to reduce a hypertensive response to intubation", + "C": "Hyperventilation to 20 mm Hg", + "D": "10 cm H2O PEEP to reduce atelectasis" + }, + "zh": { + "question": "一名48岁、体重110公斤的男性患有幕上星形细胞瘤，计划进行开颅手术以减少肿瘤体积。他的妻子表示他一直嗜睡和困惑。检查发现他过度换气且昏昏欲睡，但可以唤醒，并且高血压。对他的麻醉有用的措施包括", + "A": "使用吗啡减少他的呼吸急促", + "B": "使用艾司洛尔减少插管时的高血压反应", + "C": "过度换气至20 mm Hg", + "D": "使用10 cm H2O的PEEP减少肺不张" + } + }, + { + "id": "5ba0cb41-c234-5845-8b6e-6c319ba5ec89", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "If, during an MRI scan, a patient were to become trapped in the scanner by a large (50 kg) metallic object, the appropriate course of action would be to", + "A": "Stop the scan immediately to release the magnet", + "B": "Summon enough people to pull the object away", + "C": "Interrupt electrical power for 60 seconds to release the magnetic force", + "D": "Quench the magnet" + }, + "zh": { + "question": "如果在 MRI 扫描过程中，患者被一个大型（50 公斤）金属物体困在扫描仪中，适当的行动方案是", + "A": "立即停止扫描以释放磁铁", + "B": "召集足够的人手将物体拉开", + "C": "中断电源 60 秒以释放磁力", + "D": "熄灭磁铁" + } + }, + { + "id": "73baa536-953a-5594-841c-82b4b70b5f3c", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 45-year-old man is undergoing a posterior cervical decompression in the sitting position. Induction of anesthesia and tracheal intubation are uneventful. Anesthesia is maintained with N2O 50% in O2 , and sevoflurane. Suddenly, air is heard on the precordial Doppler ultrasound.", + "A": "Decreased Paco2", + "B": "Decreased CVP", + "C": "Decreased pulmonary arterial pressure (PAP)", + "D": "Decreased end-tidal CO2" + }, + "zh": { + "question": "一名45岁的男性正在坐位接受后颈椎减压手术。麻醉诱导和气管插管顺利进行。麻醉维持使用50%的N2O和O2，以及七氟醚。突然，在前胸多普勒超声上听到了空气声。", + "A": "Paco2降低", + "B": "中心静脉压（CVP）降低", + "C": "肺动脉压（PAP）降低", + "D": "呼气末二氧化碳降低" + } + }, + { + "id": "040010c9-c20c-53ce-a2dc-c32be92f1b21", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "In patients with head injuries and increased ICP, hyperventilation is typically limited to a Paco2 of 25 to 30 mm Hg because additional hyperventilation", + "A": "Is virtually impossible", + "B": "Causes brain ischemia due to a rightward shifting of the oxyhemoglobin dissociation curve", + "C": "May be associated with a worsening of neurologic outcome", + "D": "Could result in paradoxical cerebral vasodilation" + }, + "zh": { + "question": "在头部损伤和颅内压增高的患者中，通常将过度通气限制在Paco2为25到30 mm Hg，因为额外的过度通气", + "A": "几乎不可能", + "B": "由于氧合血红蛋白解离曲线的右移导致脑缺血", + "C": "可能与神经系统结果的恶化有关", + "D": "可能导致矛盾的脑血管扩张" + } + }, + { + "id": "6ab47fca-fa6c-5721-b764-eac5315e6b52", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 28-year-old man arrives in the emergency department by ambulance after being hit by a car while riding his motorcycle. He was not wearing a helmet and sustained a head injury. His oxygen saturation is 99% breathing spontaneously, with a nasal airway in his right nostril and a face mask applied and 5 liters/min of oxygen flowing. Blood pressure is 130/85, and heart rate is 100. He is unresponsive to speech and makes only incomprehensible sounds. When a painful stimulus is applied to his sternum, he opens his eye to the pain and flexes his elbows, wrists, and fingers and extends his legs. What is his GCS score?", + "A": "11", + "B": "9", + "C": "7", + "D": "5# Neurologic Physiology and Anesthesia" + }, + "zh": { + "question": "一名28岁的男子在骑摩托车时被汽车撞到后由救护车送到急诊室。他没有戴头盔，头部受伤。自发呼吸时氧饱和度为99%，右鼻孔插入鼻导管，面罩供氧，氧流量为5升/分钟。血压为130/85，心率为100。他对语言无反应，只发出无法理解的声音。当对他的胸骨施加疼痛刺激时，他对疼痛睁开眼睛，屈曲肘部、手腕和手指，并伸展双腿。他的GCS评分是多少？", + "A": "11", + "B": "9", + "C": "7", + "D": "5# 神经生理学与麻醉" + } + }, + { + "id": "a33a2218-b6ca-5023-9d3a-8b7ae1079696", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the best example of neuropathic pain?", + "A": "Postherpetic neuralgia (PHN)", + "B": "Fibromyalgia", + "C": "Chronic hip pain", + "D": "Lumbar facet joint pain" + }, + "zh": { + "question": "以下哪一项是神经性疼痛的最佳例子？", + "A": "带状疱疹后神经痛 (PHN)", + "B": "纤维肌痛", + "C": "慢性髋关节疼痛", + "D": "腰椎小关节疼痛" + } + }, + { + "id": "50f6f4f7-5095-5084-a1bb-6efc4599ad61", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following techniques is LEAST effective in the treatment of pruritus from administration of neuraxial opiates?", + "A": "Nalbuphine 5 mg intravenous (IV)", + "B": "Dexmedetomidine 30 μg IV", + "C": "Diphenhydramine 50 mg IV", + "D": "Propofol 10 mg IV" + }, + "zh": { + "question": "以下哪种技术在治疗神经轴镇痛药引起的瘙痒方面效果最差？", + "A": "纳布啡 5 mg 静脉注射 (IV)", + "B": "右美托咪定 30 μg 静脉注射 (IV)", + "C": "苯海拉明 50 mg 静脉注射 (IV)", + "D": "丙泊酚 10 mg 静脉注射 (IV)" + } + }, + { + "id": "0ad47d38-92c5-575c-8e1e-af29b7c796b6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The MAXIMUM dose of lidocaine containing 1:200,000 epinephrine that can be administered to a 70-kg patient for most major regional anesthetic techniques (and excluding spinal and IV regional) is", + "A": "100 mg", + "B": "200 mg", + "C": "500 mg", + "D": "1000 mg" + }, + "zh": { + "question": "对于大多数主要区域麻醉技术（不包括脊髓和静脉区域麻醉），70公斤患者可接受的含1:200,000肾上腺素的利多卡因的最大剂量是", + "A": "100 毫克", + "B": "200 毫克", + "C": "500 毫克", + "D": "1000 毫克" + } + }, + { + "id": "5f9b9412-a260-5ace-8e7d-bdc1313fcb76", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following concentrations of epinephrine corresponds to a 1:200,000 mixture?", + "A": "0.5 μg/mL", + "B": "5 μg/mL", + "C": "50 μg/mL", + "D": "0.5 mg/mL" + }, + "zh": { + "question": "以下哪种肾上腺素浓度对应于1:200,000的混合物？", + "A": "0.5 μg/mL", + "B": "5 μg/mL", + "C": "50 μg/mL", + "D": "0.5 mg/mL" + } + }, + { + "id": "42654d1b-0de9-5566-86cb-6a6d92d576c9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 62-year-old fit patient with no comorbidities other than osteoarthrosis receives a spinal anesthetic for hip replacement. He takes nonsteroidal anti-inflammatory drugs (NSAIDs) and consumes coffee daily. The operation takes less than 1 hour and is uneventful. In the postanesthesia care unit (PACU) the patient complains of thirst and receives a caffeinated sugar-rich beverage and is discharged to floor. In his room he eats lunch and visits with family. After the spinal wears off, 3 hours after arrival to floor, the most likely observation will be", + "A": "Blood sugar greater than 200 mg/dL", + "B": "Nausea and vomiting", + "C": "Severe headache", + "D": "Urinary retention" + }, + "zh": { + "question": "一名62岁身体健康的患者，除了骨关节炎外没有其他合并症，接受了髋关节置换的脊髓麻醉。他服用非甾体抗炎药（NSAIDs）并每天饮用咖啡。手术不到1小时且顺利完成。在术后恢复室（PACU），患者抱怨口渴，喝了一种含咖啡因的高糖饮料后被送回病房。在病房里，他吃了午餐并与家人会面。脊髓麻醉消退后，抵达病房3小时后，最可能的观察结果是", + "A": "血糖大于200 mg/dL", + "B": "恶心和呕吐", + "C": "严重头痛", + "D": "尿潴留" + } + }, + { + "id": "d90430db-4c1d-55c8-9d66-194857d89b9c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the EARLIEST sign of lidocaine toxicity from a high blood level?", + "A": "Shivering", + "B": "Nystagmus", + "C": "Light-headedness and dizziness", + "D": "Tonic-clonic seizures" + }, + "zh": { + "question": "以下哪项是高血液浓度利多卡因毒性的最早期症状？", + "A": "发抖", + "B": "眼球震颤", + "C": "头晕和眩晕", + "D": "强直-阵挛性癫痫发作" + } + }, + { + "id": "1eaa9c87-fef7-5879-b567-22bdbca4188b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "An analgesic effect similar to the epidural administration of 2.5 mg of morphine could be achieved by which dose of intrathecal morphine?", + "A": "0.05 mg", + "B": "0.1 mg", + "C": "1 mg", + "D": "Morphine should not be injected into the intrathecal space" + }, + "zh": { + "question": "与硬膜外注射2.5毫克吗啡产生类似镇痛效果的鞘内吗啡剂量是多少？", + "A": "0.05毫克", + "B": "0.1毫克", + "C": "1毫克", + "D": "不应将吗啡注入鞘内空间" + } + }, + { + "id": "21dfaa91-a032-5790-8c55-2c93f9f7da2c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following peripheral nerves is MOST likely to become injured in patients who are under general anesthesia?", + "A": "Ulnar nerve", + "B": "Median nerve", + "C": "Radial nerve", + "D": "Common peroneal nerve" + }, + "zh": { + "question": "在全身麻醉的患者中，以下哪一条周围神经最有可能受损？", + "A": "尺神经", + "B": "正中神经", + "C": "桡神经", + "D": "腓总神经" + } + }, + { + "id": "8a645b2d-ea83-5f52-ad8c-910041b5b246", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the MOST important disadvantage of interscalene brachial plexus block compared with other approaches?", + "A": "Large volumes of local anesthetics required", + "B": "Frequent sparing of the ulnar nerve", + "C": "Frequent sparing of the musculocutaneous nerve", + "D": "High incidence of pneumothorax" + }, + "zh": { + "question": "以下哪项是与其他方法相比，斜角肌间臂丛阻滞最重要的缺点？", + "A": "需要大量局部麻醉药", + "B": "尺神经经常未被阻滞", + "C": "肌皮神经经常未被阻滞", + "D": "气胸发生率高" + } + }, + { + "id": "cb2e5c23-596f-54a9-8119-04f1925b949d", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 68-year-old woman is to undergo lower-extremity surgery under spinal anesthesia. Which of the following statements concerning the immediate physiologic response to the surgical incision is TRUE?", + "A": "The cardiovascular (CV) response to stress will be blocked, but the adrenergic response will not", + "B": "The adrenergic response to stress will be blocked, but the CV response will not", + "C": "Both the adrenergic and CV responses will be blocked", + "D": "Neither the adrenergic nor the CV response will be blocked" + }, + "zh": { + "question": "一名68岁的女性将在脊椎麻醉下接受下肢手术。关于手术切口的即时生理反应，下列哪项陈述是正确的？", + "A": "心血管（CV）对压力的反应将被阻断，但肾上腺素能反应不会", + "B": "肾上腺素能对压力的反应将被阻断，但心血管反应不会", + "C": "肾上腺素能和心血管反应都将被阻断", + "D": "肾上腺素能和心血管反应都不会被阻断" + } + }, + { + "id": "1330bac7-3ac9-5387-b694-5ae511c55511", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The \"snap\" felt just before entering the epidural space represents passage through which ligament?", + "A": "Posterior longitudinal ligament", + "B": "Ligamentum flavum", + "C": "Supraspinous ligament", + "D": "Interspinous ligament" + }, + "zh": { + "question": "在进入硬膜外腔之前感受到的“弹响”代表穿过了哪个韧带？", + "A": "后纵韧带", + "B": "黄韧带", + "C": "棘上韧带", + "D": "棘间韧带" + } + }, + { + "id": "91361c28-6002-535f-93af-1a0ff574dc0f", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "The common element thought to be present in cases of cauda equina syndrome after continuous spinal anesthesia is", + "A": "Use of microcatheter", + "B": "Maldistribution of local anesthetic", + "C": "Administration of lidocaine", + "D": "Addition of epinephrine" + }, + "zh": { + "question": "在持续性脊髓麻醉后被认为存在于马尾综合征病例中的常见因素是", + "A": "使用微导管", + "B": "局部麻醉药的分布不均", + "C": "使用利多卡因", + "D": "加入肾上腺素" + } + }, + { + "id": "ceba8cf4-8715-5c52-9ecb-e53ef7e02cb9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When performing a single-shot spinal anesthetic, the level of block for motor, sensory, and sympathetic blocks differs often by at least two dermatomes. Which of the following sequences is correct from the highest to the lowest level of block?", + "A": "Sensory, sympathetic, motor", + "B": "Sympathetic, sensory, motor", + "C": "Sympathetic, motor, sensory", + "D": "Sensory, motor, sympathetic" + }, + "zh": { + "question": "在进行单次脊髓麻醉时，运动、感觉和交感神经阻滞的水平通常至少相差两个皮节。以下哪种顺序从最高到最低的阻滞水平是正确的？", + "A": "感觉、交感神经、运动", + "B": "交感神经、感觉、运动", + "C": "交感神经、运动、感觉", + "D": "感觉、运动、交感神经" + } + }, + { + "id": "78d1dfe6-6549-52d7-8c49-31ea52d118e8", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 95-year-old woman has persistent and prolonged thoracic pain after a herpes zoster infection. Which of the treatments below would be the LEAST efficacious in the treatment of her pain?", + "A": "Oral amitriptyline", + "B": "Oral clonidine", + "C": "Topical capsaicin ointment", + "D": "Topical lidocaine patch" + }, + "zh": { + "question": "一位95岁的女性在带状疱疹感染后持续和长期的胸痛。以下哪种治疗方法对她的疼痛治疗效果最差？", + "A": "口服阿米替林", + "B": "口服可乐定", + "C": "局部辣椒素软膏", + "D": "局部利多卡因贴片" + } + }, + { + "id": "e06d8cd2-39a7-53b0-9c65-063deb476ac8", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The deep peroneal nerve innervates the", + "A": "Lateral aspect of the dorsum of the foot", + "B": "Entire dorsum of the foot", + "C": "Web space between the great toe and the second toe", + "D": "Medial aspect of the dorsum of the foot" + }, + "zh": { + "question": "深腓神经支配的是", + "A": "足背的外侧部分", + "B": "整个足背", + "C": "大脚趾和第二脚趾之间的蹼间隙", + "D": "足背的内侧部分" + } + }, + { + "id": "a19be952-1df6-58f7-b11e-ef0c3e2272be", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The correct arrangement of local anesthetics in order of their ability to produce cardiotoxicity from most to least is", + "A": "Bupivacaine, lidocaine, ropivacaine", + "B": "Bupivacaine, ropivacaine, lidocaine", + "C": "Ropivacaine, bupivacaine, lidocaine", + "D": "Lidocaine, ropivacaine, bupivacaine" + }, + "zh": { + "question": "局部麻醉药按其产生心脏毒性的能力从强到弱的正确排列是", + "A": "布比卡因、利多卡因、罗哌卡因", + "B": "布比卡因、罗哌卡因、利多卡因", + "C": "罗哌卡因、布比卡因、利多卡因", + "D": "利多卡因、罗哌卡因、布比卡因" + } + }, + { + "id": "e5c54631-e4e9-5d04-afa5-12c20d6584d0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Allodynia is defined as", + "A": "Spontaneous pain in an area or region that is anesthetic", + "B": "Pain initiated or caused by a primary lesion or dysfunction in the nervous system", + "C": "An increased response to a stimulus that is normally painful", + "D": "Pain caused by a stimulus that does not normally provoke pain" + }, + "zh": { + "question": "痛觉异常的定义是", + "A": "在麻醉的区域或部位出现自发性疼痛", + "B": "由神经系统的原发性病变或功能障碍引起或导致的疼痛", + "C": "对通常会引起疼痛的刺激反应增强", + "D": "由通常不会引起疼痛的刺激引起的疼痛" + } + }, + { + "id": "948fbb6f-5e33-5e65-aa92-df138715f239", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The primary mechanism by which the action of tetracaine is terminated when used for spinal anesthesia is", + "A": "Systemic absorption", + "B": "Uptake into neurons", + "C": "Hydrolysis by pseudocholinesterase", + "D": "Hydrolysis by nonspecific esterases" + }, + "zh": { + "question": "当使用丁卡因进行脊髓麻醉时，其作用终止的主要机制是", + "A": "全身吸收", + "B": "被神经元摄取", + "C": "被假性胆碱酯酶水解", + "D": "被非特异性酯酶水解" + } + }, + { + "id": "07d30928-7a87-5d5d-8132-f219027fd5ed", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Complex regional pain syndrome (CRPS) type I (reflex sympathetic dystrophy [RSD]) is differentiated from CRPS type II (causalgia) by knowledge of its", + "A": "Etiology", + "B": "Chronicity", + "C": "Type of symptoms", + "D": "Rapidity of onset" + }, + "zh": { + "question": "复杂区域疼痛综合征（CRPS）I型（反射性交感神经营养不良[RSD]）与CRPS II型（灼性神经痛）的区别在于其", + "A": "病因", + "B": "慢性程度", + "C": "症状类型", + "D": "发作速度" + } + }, + { + "id": "1ca32a72-b9dc-56a3-b362-0b030892344d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The primary determinant of local anesthetic potency is", + "A": "pKa", + "B": "Molecular weight", + "C": "Lipid solubility", + "D": "Protein binding" + }, + "zh": { + "question": "局部麻醉药效力的主要决定因素是", + "A": "pKa", + "B": "分子量", + "C": "脂溶性", + "D": "蛋白结合" + } + }, + { + "id": "4a9471ee-fb51-55dd-afaa-7d9744f7b5b7", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Which of the following would have the GREATEST effect on the level of sensory blockade after a subarachnoid injection of hyperbaric 0.75% bupivacaine?", + "A": "Patient age", + "B": "Addition of epinephrine to the local anesthetic solution", + "C": "Patient weight", + "D": "Patient position" + }, + "zh": { + "question": "以下哪项对蛛网膜下腔注射高比重0.75%布比卡因后的感觉阻滞水平影响最大？", + "A": "患者年龄", + "B": "在局麻药溶液中加入肾上腺素", + "C": "患者体重", + "D": "患者体位" + } + }, + { + "id": "690433ef-34f5-5ac4-a3a0-de7569886f6e", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following local anesthetics would produce the LOWEST concentration in the fetus relative to the maternal serum concentration during a continuous lumbar epidural?", + "A": "Ropivacaine", + "B": "Bupivacaine", + "C": "Lidocaine", + "D": "Chloroprocaine" + }, + "zh": { + "question": "在持续腰椎硬膜外麻醉期间，下列哪种局部麻醉药在胎儿中的浓度相对于母体血清浓度最低？", + "A": "罗哌卡因", + "B": "布比卡因", + "C": "利多卡因", + "D": "氯普鲁卡因" + } + }, + { + "id": "81b2a96f-158a-57b7-8fee-114b9031c9c8", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Severe hypotension associated with high spinal anesthesia is caused primarily by", + "A": "Decreased cardiac output secondary to decreased preload", + "B": "Decreased systemic vascular resistance", + "C": "Decreased cardiac output secondary to bradycardia", + "D": "Decreased cardiac output secondary to decreased myocardial contractility" + }, + "zh": { + "question": "与高位脊髓麻醉相关的严重低血压主要是由以下原因引起的", + "A": "继发于前负荷减少的心输出量减少", + "B": "全身血管阻力降低", + "C": "继发于心动过缓的心输出量减少", + "D": "继发于心肌收缩力下降的心输出量减少" + } + }, + { + "id": "cdae2fcd-cd95-561b-916f-b1f9e9eb8c54", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Select the one TRUE statement concerning phantom limb pain.", + "A": "The incidence of phantom limb pain increases with more distal amputations", + "B": "Most amputees do not experience phantom limb pain", + "C": "Nerve blocks may be used to decrease the incidence of phantom limb pain", + "D": "Traumatic amputees have a much higher incidence of phantom limb pain than nontraumatic amputees" + }, + "zh": { + "question": "选择一个关于幻肢痛的正确陈述。", + "A": "幻肢痛的发生率随着截肢部位越远端而增加", + "B": "大多数截肢者不会经历幻肢痛", + "C": "神经阻滞可用于减少幻肢痛的发生率", + "D": "创伤性截肢者的幻肢痛发生率远高于非创伤性截肢者" + } + }, + { + "id": "09e741d8-0144-547c-82ab-381a47d0ab28", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is TRUE regarding IV regional anesthesia (Bier block)?", + "A": "Useful for postoperative pain in extremity surgery", + "B": "Can be used for extremity surgeries lasting 2 to 3 hours", + "C": "Bupivacaine is the drug of choice for prolonged blocks", + "D": "Lidocaine is most commonly used" + }, + "zh": { + "question": "关于静脉区域麻醉（Bier block），以下哪项是正确的？", + "A": "对四肢手术后的疼痛有用", + "B": "可用于持续2到3小时的四肢手术", + "C": "布比卡因是长时间阻滞的首选药物", + "D": "利多卡因是最常用的药物" + } + }, + { + "id": "86df54bb-2883-56a5-ba89-e242bfce0164", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Select the FALSE statement regarding spinal anatomy and spinal anesthesia.", + "A": "The addition of phenylephrine to lidocaine will prolong spinal anesthesia", + "B": "A high thoracic sensory block will result in total sympathetic blockade", + "C": "The largest vertebral interspace is L5-S1", + "D": "The dural sac extends to the S4-S5 interspace" + }, + "zh": { + "question": "选择关于脊柱解剖和脊髓麻醉的错误陈述。", + "A": "将去氧肾上腺素加入利多卡因会延长脊髓麻醉时间", + "B": "高位胸段感觉阻滞会导致完全的交感神经阻滞", + "C": "最大的椎间隙是L5-S1", + "D": "硬膜囊延伸至S4-S5椎间隙" + } + }, + { + "id": "12a66e40-f503-5f32-bc04-fc879cb5d57c", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Four days after a left total hip arthroplasty, an obese 62-year-old woman complains of severe back pain in the region where the epidural was placed. Over the ensuing 72 hours, the back pain gradually worsens and a severe aching pain that radiates down the left leg to the knee develops. The MOST likely diagnosis is", + "A": "Epidural abscess", + "B": "Epidural hematoma", + "C": "Anterior spinal artery syndrome", + "D": "Meralgia paresthetica" + }, + "zh": { + "question": "左侧全髋关节置换术后四天，一名62岁的肥胖女性抱怨硬膜外麻醉部位的严重背痛。在接下来的72小时内，背痛逐渐加重，并出现严重的酸痛，疼痛向左腿放射至膝盖。最可能的诊断是", + "A": "硬膜外脓肿", + "B": "硬膜外血肿", + "C": "前脊髓动脉综合征", + "D": "股外侧皮神经炎" + } + }, + { + "id": "4b236f6d-5c44-584b-a22c-533f2fae2b4e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following choices is NOT consistent with a limb affected by complex regional pain syndrome (CRPS)", + "A": "Allodynia", + "B": "Dermatomal distribution of pain", + "C": "Atrophy of the involved extremity", + "D": "Hyperesthesia" + }, + "zh": { + "question": "以下哪一项与复杂性区域疼痛综合征（CRPS）影响的肢体不一致？", + "A": "痛觉过敏", + "B": "疼痛的皮节分布", + "C": "受累肢体萎缩", + "D": "感觉过敏" + } + }, + { + "id": "29097120-8805-5a92-980e-e70f2b591871", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The MAIN advantage of neurolytic nerve blockade with phenol versus alcohol is", + "A": "Denser blockade", + "B": "Blockade is permanent", + "C": "The effects of the block can be evaluated immediately", + "D": "The block is less painful" + }, + "zh": { + "question": "与酒精相比，使用苯酚进行神经溶解性神经阻滞的主要优点是", + "A": "阻滞更密集", + "B": "阻滞是永久性的", + "C": "阻滞效果可以立即评估", + "D": "阻滞较不痛苦" + } + }, + { + "id": "450c87c1-e266-560b-9782-e63c7b1035b6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 75-year-old man is scheduled to undergo elective orchiectomy for prostate cancer. The patient has selected spinal anesthesia. What is the minimum dermatomal level that must be achieved to carry out this operation?", + "A": "T4", + "B": "T10", + "C": "L3", + "D": "S1" + }, + "zh": { + "question": "一名75岁的男性计划进行前列腺癌的选择性睾丸切除术。患者选择了脊椎麻醉。为了进行这项手术，必须达到的最低皮节水平是什么？", + "A": "T4", + "B": "T10", + "C": "L3", + "D": "S1" + } + }, + { + "id": "9227f771-556d-517e-9fe9-3a8341b511eb", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The artery of Adamkiewicz MOST frequently arises from the aorta at which spinal level?", + "A": "T1-T4", + "B": "T5-T8", + "C": "T9-T12", + "D": "L1-L4" + }, + "zh": { + "question": "Adamkiewicz动脉最常从主动脉的哪个脊柱水平发出？", + "A": "T1-T4", + "B": "T5-T8", + "C": "T9-T12", + "D": "L1-L4" + } + }, + { + "id": "01753f53-f3cb-5732-a738-63961c3862dc", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which local anesthetic has the longest elimination half-time (T½)?", + "A": "Bupivacaine", + "B": "Lidocaine", + "C": "Mepivacaine", + "D": "Ropivacaine" + }, + "zh": { + "question": "哪种局部麻醉药的消除半衰期（T½）最长？", + "A": "布比卡因", + "B": "利多卡因", + "C": "甲哌卡因", + "D": "罗哌卡因" + } + }, + { + "id": "b386d201-d819-5355-851c-8207f5d0d1c9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Important landmarks for performing a sciatic nerve block (classic approach of Labat) include", + "A": "Iliac crest, sacral hiatus, and greater trochanter", + "B": "Iliac crest, coccyx, and greater trochanter", + "C": "Posterior superior iliac spine, coccyx, and greater trochanter", + "D": "Posterior superior iliac spine, greater trochanter, and sacral hiatus" + }, + "zh": { + "question": "进行坐骨神经阻滞（Labat经典方法）的重要标志包括", + "A": "髂嵴、骶裂孔和大转子", + "B": "髂嵴、尾骨和大转子", + "C": "后上髂棘、尾骨和大转子", + "D": "后上髂棘、大转子和骶裂孔" + } + }, + { + "id": "ec0a2475-bb0f-5ae4-897e-febe21a8cc54", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 76-year-old female patient is undergoing a carotid endarterectomy under a deep cervical plexus nerve block. Which of the following complications would be LEAST likely with this unilateral block?", + "A": "Unilateral phrenic nerve paralysis", + "B": "Subarachnoid injection", + "C": "Blockade of the spinal accessory nerve", + "D": "Vertebral artery injection" + }, + "zh": { + "question": "一名76岁的女性患者正在接受深颈丛神经阻滞下的颈动脉内膜切除术。以下哪种并发症最不可能发生在这种单侧阻滞中？", + "A": "单侧膈神经麻痹", + "B": "蛛网膜下腔注射", + "C": "副神经阻滞", + "D": "椎动脉注射" + } + }, + { + "id": "cad261c1-0278-59b2-abe9-09257dd3e2f6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A retrobulbar block anesthetizes each of the following nerves EXCEPT", + "A": "Ciliary nerves", + "B": "Cranial nerve III (oculomotor nerve)", + "C": "Cranial nerve VII (facial nerve)", + "D": "Cranial nerve VI (abducens nerve)" + }, + "zh": { + "question": "后球后阻滞麻醉以下每一条神经，除了", + "A": "睫状神经", + "B": "颅神经III（动眼神经）", + "C": "颅神经VII（面神经）", + "D": "颅神经VI（外展神经）" + } + }, + { + "id": "0a4b1b04-1811-5bd2-8f02-4245ca238810", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following muscles of the larynx is innervated by the external branch of the superior laryngeal nerve?", + "A": "Vocalis muscle", + "B": "Thyroarytenoid muscles", + "C": "Posterior cricoarytenoid muscle", + "D": "Cricothyroid muscle" + }, + "zh": { + "question": "以下哪一块喉肌由喉上神经的外支支配？", + "A": "声带肌", + "B": "甲杓肌", + "C": "后环杓肌", + "D": "环甲肌" + } + }, + { + "id": "d3cb77cb-94e3-5f66-87f7-3ef83c2421b3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "All of the following agents are acceptable for use in a Bier block EXCEPT", + "A": "0.5% Lidocaine", + "B": "0.5% Mepivacaine", + "C": "0.25% Bupivacaine", + "D": "0.5% Prilocaine" + }, + "zh": { + "question": "以下所有药物均可用于Bier阻滞，除了", + "A": "0.5% 利多卡因", + "B": "0.5% 甲哌卡因", + "C": "0.25% 布比卡因", + "D": "0.5% 丙胺卡因" + } + }, + { + "id": "30e5eb55-a46e-5133-8a7d-c45741c48530", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The stellate ganglion lies in closest proximity to which of the following vascular structures?", + "A": "Common carotid artery", + "B": "Internal carotid artery", + "C": "Vertebral artery", + "D": "Aorta" + }, + "zh": { + "question": "星状神经节最接近以下哪种血管结构？", + "A": "颈总动脉", + "B": "颈内动脉", + "C": "椎动脉", + "D": "主动脉" + } + }, + { + "id": "65c35646-40f0-59a8-8af3-9d8ff8ad3a9b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following structures in the antecubital fossa is the MOST medial?", + "A": "Brachial artery", + "B": "Radial nerve", + "C": "Tendon of the biceps", + "D": "Median nerve" + }, + "zh": { + "question": "在肘窝中，以下哪个结构是最内侧的？", + "A": "肱动脉", + "B": "桡神经", + "C": "肱二头肌腱", + "D": "正中神经" + } + }, + { + "id": "7a31da43-6229-545f-a669-65cf8235d07e", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "During placement of an epidural in a 78-year-old patient scheduled for a total knee arthroplasty, the patient complains of a sharp, sustained pain radiating down his left leg as the catheter is inserted to 2 cm. The MOST appropriate action at this time would be to", + "A": "Leave the catheter at 2 cm, and give a test dose", + "B": "Give a small dose to relieve pain, then advance 1 cm", + "C": "Withdraw the catheter 1 cm, then give a test dose", + "D": "Withdraw the needle and catheter, then reinsert in a new position" + }, + "zh": { + "question": "在为一名计划进行全膝关节置换术的78岁患者进行硬膜外麻醉置管时，患者在导管插入至2厘米时抱怨左腿有尖锐且持续的放射性疼痛。此时最合适的处理措施是", + "A": "将导管留在2厘米处，并给予试验剂量", + "B": "给予小剂量药物以缓解疼痛，然后推进1厘米", + "C": "将导管回撤1厘米，然后给予试验剂量", + "D": "拔出针头和导管，然后在新位置重新插入" + } + }, + { + "id": "09f83da6-af03-5437-97a2-ea39d76db88d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Cutaneous innervation of the plantar surface of the foot is provided by the", + "A": "Sural nerve", + "B": "Posterior tibial nerve", + "C": "Saphenous nerve", + "D": "Deep peroneal nerve" + }, + "zh": { + "question": "足底表面的皮肤感觉由以下哪一条神经提供？", + "A": "腓肠神经", + "B": "胫后神经", + "C": "隐神经", + "D": "腓深神经" + } + }, + { + "id": "66f7f21a-cacc-5cac-849b-c8047b6eeca9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 32-year-old army officer is unable to oppose the left thumb and left", + "A": "Radial", + "B": "Ulnar", + "C": "Median", + "D": "Musculocutaneous" + }, + "zh": { + "question": "一名32岁的军官无法对抗左拇指和左手", + "A": "桡神经", + "B": "尺神经", + "C": "正中神经", + "D": "肌皮神经" + } + }, + { + "id": "c3551e59-462b-5ebb-99d3-a9ca150d715c", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 57-year-old patient is scheduled for hemorrhoidectomy. The patient has a history of mild chronic obstructive pulmonary disease, hypertension, and traumatic foot amputation from a tractor accident. His only hospitalizations were for two suicide attempts related to phantom limb sensations 10 years ago. He takes phenelzine (Nardil), thiazide, and potassium. Which of the following anesthetic techniques would be MOST appropriate for this patient?", + "A": "Spinal anesthetic with 0.5% hyperbaric bupivacaine", + "B": "Epidural anesthetic with 0.5% bupivacaine", + "C": "Local infiltration with lidocaine and epinephrine, sedation with propofol and meperidine", + "D": "General anesthesia with propofol, succinylcholine, nitrous oxide, and fentanyl" + }, + "zh": { + "question": "一名57岁的患者计划进行痔疮切除术。该患者有轻度慢性阻塞性肺病、高血压和因拖拉机事故导致的足部创伤性截肢史。他唯一的住院经历是10年前因幻肢感觉导致的两次自杀未遂。他服用苯乙肼（Nardil）、噻嗪类药物和钾。以下哪种麻醉技术最适合该患者？", + "A": "使用0.5%高比重布比卡因的脊髓麻醉", + "B": "使用0.5%布比卡因的硬膜外麻醉", + "C": "使用利多卡因和肾上腺素的局部浸润麻醉，辅以丙泊酚和哌替啶镇静", + "D": "使用丙泊酚、琥珀胆碱、氧化亚氮和芬太尼的全身麻醉" + } + }, + { + "id": "77c58700-3d3b-50e5-8442-35a510357ebd", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "If the recurrent laryngeal nerve were transected bilaterally, the vocal cords would", + "A": "Be in the open position", + "B": "Be in the closed position", + "C": "Be in the intermediate position (i.e., 2-3 mm apart)", + "D": "Not be affected unless the superior laryngeal nerve were also injured" + }, + "zh": { + "question": "如果双侧喉返神经被切断，声带将会", + "A": "处于开放状态", + "B": "处于闭合状态", + "C": "处于中间位置（即相距2-3毫米）", + "D": "不会受到影响，除非上喉神经也受损" + } + }, + { + "id": "bc4fae47-f0a4-526b-b180-7eb48cda57e9", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 63-year-old woman undergoes total knee arthroplasty under spinal anesthesia. Two days later she complains of a severe headache. Pain intensity is not related to posture. The LEAST likely cause of this headache is", + "A": "Caffeine withdrawal", + "B": "Viral illness", + "C": "Migraine", + "D": "Postdural puncture headache (PDPH)" + }, + "zh": { + "question": "一名63岁的女性在脊椎麻醉下接受全膝关节置换术。两天后，她抱怨严重的头痛。疼痛强度与姿势无关。此头痛最不可能的原因是", + "A": "咖啡因戒断", + "B": "病毒感染", + "C": "偏头痛", + "D": "硬膜穿刺后头痛（PDPH）" + } + }, + { + "id": "11e4ddc1-0a65-5c77-a058-9f3d75cd10ce", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the CORRECT order of structures (from cephalad to caudad) in the intercostal space?", + "A": "Nerve, artery, vein", + "B": "Vein, nerve, artery", + "C": "Vein, artery, nerve", + "D": "Artery, nerve, vein" + }, + "zh": { + "question": "在肋间隙中，从头侧到尾侧的结构顺序是正确的？", + "A": "神经、动脉、静脉", + "B": "静脉、神经、动脉", + "C": "静脉、动脉、神经", + "D": "动脉、神经、静脉" + } + }, + { + "id": "07dff91f-68fe-5dc1-9fb8-21a2d01c79d1", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following types of regional anesthesia is associated with the GREATEST serum concentration of lidocaine?", + "A": "Intercostal", + "B": "Epidural", + "C": "Brachial plexus", + "D": "Femoral nerve block" + }, + "zh": { + "question": "以下哪种区域麻醉类型与利多卡因的血清浓度最高相关？", + "A": "肋间神经阻滞", + "B": "硬膜外麻醉", + "C": "臂丛神经阻滞", + "D": "股神经阻滞" + } + }, + { + "id": "58b8dc3a-83ea-5c3d-848b-6331385419dd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Differences in which of the following local anesthetic properties account for the fact that the onset of an epidural block with 3% 2-chloroprocaine is more rapid than 2% lidocaine?", + "A": "Protein binding", + "B": "pKa", + "C": "Lipid solubility", + "D": "Concentration" + }, + "zh": { + "question": "以下哪种局部麻醉药的特性差异解释了为什么3% 2-氯普鲁卡因的硬膜外阻滞起效比2%利多卡因更快？", + "A": "蛋白结合", + "B": "pKa", + "C": "脂溶性", + "D": "浓度" + } + }, + { + "id": "ed27c84f-51c9-5fbe-bf50-62e53084579e", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 69-year-old man with a history of diabetes mellitus and chronic renal failure is to undergo placement of a dialysis fistula under regional anesthesia. During needle manipulation for a supraclavicular brachial plexus block, the patient begins to cough and complain of chest pain and shortness of breath. The MOST likely diagnosis is", + "A": "Angina", + "B": "Pneumothorax", + "C": "Phrenic nerve irritation", + "D": "Intravascular injection of local anesthetic" + }, + "zh": { + "question": "一名69岁有糖尿病和慢性肾衰竭病史的男性计划在区域麻醉下进行透析瘘管置入术。在进行锁骨上臂丛神经阻滞的针刺操作时，患者开始咳嗽并抱怨胸痛和呼吸急促。最可能的诊断是", + "A": "心绞痛", + "B": "气胸", + "C": "膈神经刺激", + "D": "局部麻醉药物的血管内注射" + } + }, + { + "id": "91cdfa22-3e6e-5339-a5e7-c6b3e1861b2d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Each of the following statements is true concerning a femoral nerve block EXCEPT", + "A": "The femoral nerve primarily arises from the second to the fourth lumbar nerve roots", + "B": "The femoral nerve provides sensation to the anterior and medial aspect of the thigh", + "C": "The femoral nerve lies lateral to the femoral artery and femoral vein", + "D": "Proper needle placement produces sartorius musclecontraction without patellar movement when electrically stimulated" + }, + "zh": { + "question": "以下关于股神���阻滞的陈述中，除了哪一项外，其他都是正确的", + "A": "股神经主要起源于第二至第四腰神经根", + "B": "股神经为大腿的前部和内侧提供感觉", + "C": "股神经位于股动脉和股静脉的外侧", + "D": "正确的针头放置在电刺激时会引起缝匠肌收缩而不引起髌骨运动" + } + }, + { + "id": "ff8b7284-bb33-5287-928f-1e3ebea144f8", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "If a needle is introduced 1.5 cm inferior and 1.5 cm lateral to the pubic tubercle, to which nerve will it lie in close proximity?", + "A": "Obturator nerve", + "B": "Femoral nerve", + "C": "Lateral femoral cutaneous nerve", + "D": "Ilioinguinal nerve" + }, + "zh": { + "question": "如果针头插入耻骨结节下方1.5厘米和外侧1.5厘米的位置，它将靠近哪个神经？", + "A": "闭孔神经", + "B": "股神经", + "C": "股外侧皮神经", + "D": "髂腹股沟神经" + } + }, + { + "id": "9fa172f1-278f-5136-9022-6bd25659e784", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The MOST common complication associated with a supraclavicular brachial plexus block is", + "A": "Blockade of the phrenic nerve", + "B": "Intravascular injection into the vertebral artery", + "C": "Blockade of the recurrent laryngeal nerve", + "D": "Pneumothorax" + }, + "zh": { + "question": "与锁骨上臂丛神经阻滞相关的最常见并发症是", + "A": "膈神经阻滞", + "B": "椎动脉内注射", + "C": "喉返神经阻滞", + "D": "气胸" + } + }, + { + "id": "0093335f-1d6b-5ba6-81e1-68cc2b63fcac", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which portion of the upper extremity is NOT innervated by the brachial plexus?", + "A": "Posterior medial portion of the arm", + "B": "Elbow", + "C": "Lateral portion of the forearm", + "D": "Medial portion of the forearm" + }, + "zh": { + "question": "上肢的哪个部分不受臂丛神经支配？", + "A": "手臂的后内侧部分", + "B": "肘部", + "C": "前臂的外侧部分", + "D": "前臂的内侧部分" + } + }, + { + "id": "b8e49093-72fa-5f92-b6f5-cbb02e47ffdb", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which section of the brachial plexus is blocked with a supraclavicular block?", + "A": "Roots/trunks", + "B": "Trunks/divisions", + "C": "Cords", + "D": "Branches" + }, + "zh": { + "question": "锁骨上阻滞阻断臂丛神经的哪个部分？", + "A": "神经根/干", + "B": "干/分支", + "C": "束", + "D": "分支" + } + }, + { + "id": "9ab34869-997b-5804-8435-217abc31d79e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A celiac plexus block would NOT effectively treat pain resulting from a malignancy involving which of the following organs?", + "A": "Uterus", + "B": "Stomach", + "C": "Pancreas", + "D": "Gallbladder" + }, + "zh": { + "question": "腹腔神经丛阻滞不能有效治疗以下哪个器官的恶性肿瘤引起的疼痛？", + "A": "子宫", + "B": "胃", + "C": "胰腺", + "D": "胆囊" + } + }, + { + "id": "b82286e1-7146-51ea-ad63-65927013b19c", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A healthy 27-year-old woman stepped on a nail and is to undergo débridement of a wound on her right great toe. She is anxious about general anesthesia but agrees to an ankle block with mild sedation. Which nerves must be adequately blocked in order to perform the surgery?", + "A": "Deep peroneal, posterior tibial, saphenous, sural", + "B": "Deep peroneal, saphenous, superficial peroneal, sural", + "C": "Deep peroneal, posterior tibial, superficial peroneal, sural", + "D": "Deep peroneal, superficial peroneal, posterior tibial, saphenous" + }, + "zh": { + "question": "一名健康的27岁女性踩到钉子，需对右脚大脚趾的伤口进行清创。她对全身麻醉感到焦虑，但同意进行踝部阻滞和轻度镇静。为了进行手术，必须充分阻滞哪些神经？", + "A": "腓深神经、胫后神经、隐神经、���肠神经", + "B": "腓深神经、隐神经、腓浅神经、腓肠神经", + "C": "腓深神经、胫后神经、腓浅神经、腓肠神经", + "D": "腓深神经、腓浅神经、胫后神经、隐神经" + } + }, + { + "id": "cebf278b-9146-5136-8475-766f5f88860d", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 54-year-old man is administered morphine via patient-controlled analgesia (PCA) pump after a left total hip arthroplasty. The pump is programmed to deliver a maximum dose of 2 mg every 15 minutes (lockout time) as needed for patient comfort. The total maximum dose that can be delivered in 4 hours is 30 mg. On the first day the patient receives 15 doses every 4 hours by pressing the delivery button every 15 to 18 minutes. How should his pain control be further managed?", + "A": "Discontinue the PCA pump and administer intramuscular morphine", + "B": "Increase the lockout time from 15 to 25 minutes", + "C": "Change the analgesic from morphine to meperidine", + "D": "Increase the dose to 3 mg every 15 minutes as needed up to a total maximum dose of 40 mg every 4 hours" + }, + "zh": { + "question": "一名54岁的男性在左侧全髋关节置换术后通过患者自控镇痛（PCA）泵接受吗啡。泵被设定为每15分钟（锁定时间）最多输送2毫克，以满足患者的舒适需求。4小时内可输送的最大剂量为30毫克。第一天，患者每4小时按下输送按钮15次，每次间隔15到18分钟。他的疼痛控制应如何进一步管理？", + "A": "停止使用PCA泵，改为肌肉注射吗啡", + "B": "将锁定时间从15分钟增加到25分钟", + "C": "将镇痛药从吗啡换为哌替啶", + "D": "将剂量增加到每15分钟3毫克，每4小时最多40毫克" + } + }, + { + "id": "a0d93a6a-4d69-51b5-af6a-ff32eedcccb6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The mechanism of low-frequency transcutaneous electrical nerve stimulation (TENS) units in relieving pain is", + "A": "Direct electrical inhibition of type A-δ and C fibers", + "B": "Depletion of neurotransmitter in nociceptors", + "C": "Hyperpolarization of spinothalamic tract neurons", + "D": "Activation of inhibitory neurons" + }, + "zh": { + "question": "低频经皮神经电刺激（TENS）装置缓解疼痛的机制是", + "A": "直接电抑制A-δ和C纤维", + "B": "消耗伤害感受器中的神经递质", + "C": "丘脑脊髓束神经元的超极化", + "D": "激活抑制性神经元" + } + }, + { + "id": "ac7c59b3-02cb-5cba-b70b-17cc768ab419", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Epidural use of which of the following opioids would result in the GREATEST incidence of delayed respiratory depression?", + "A": "Sufentanil", + "B": "Fentanyl", + "C": "Morphine sulfate", + "D": "Hydromorphone" + }, + "zh": { + "question": "以下哪种阿片类药物的硬膜外使用会导致最大发生率的延迟性呼吸抑制？", + "A": "舒芬太尼", + "B": "芬太尼", + "C": "硫酸吗啡", + "D": "氢吗啡酮" + } + }, + { + "id": "d1e22ead-c03e-53b4-813b-6eb0509e7bff", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 21-year-old patient reports tingling in her thumb during her cesarean section under epidural anesthesia. To which dermatomal level would this correspond?", + "A": "C5", + "B": "C6", + "C": "C7", + "D": "C8" + }, + "zh": { + "question": "一名21岁的患者在硬膜外麻醉下进行剖宫产时报告拇指有刺痛感。这对应于哪个皮节水平？", + "A": "C5", + "B": "C6", + "C": "C7", + "D": "C8" + } + }, + { + "id": "79b7d5cd-da8d-5711-85a1-b0e93c03c99c", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "Which of the following would hasten the onset and increase the clinical duration of action of a local anesthetic, and provide the GREATEST depth of motor and sensory blockade when used for epidural anesthesia?", + "A": "Increasing the volume of local anesthetic", + "B": "Increasing the concentration of local anesthetic", + "C": "Increasing the dose", + "D": "Placing the patient in the head-down position" + }, + "zh": { + "question": "以下哪项会加速局部麻醉药的起效时间并延长其临床作用��间，并在用于硬膜外麻醉时提供最深的运动和感觉阻滞？", + "A": "增加局部麻醉药的体积", + "B": "增加局部麻醉药的浓度", + "C": "增加剂量", + "D": "将患者置于头低位" + } + }, + { + "id": "54b9cb73-c5fd-5022-8b47-0ca69f4a406c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Select the FALSE statement concerning neurolytic nerve blocks.", + "A": "Destruction of peripheral nerves can be followed by a denervation hypersensitivity that is worse than the original pain", + "B": "Neurolytic blocks should be reserved for patients with short life expectancies", + "C": "Neurolytic blockade with phenol is permanent", + "D": "Intrathecal neurolysis may be an effective management for certain pain conditions" + }, + "zh": { + "question": "选择关于神经溶解性神经阻滞的错误陈述。", + "A": "外周神经的破坏可能会导致去神经支配的敏感性增加，比原来的疼痛更严重", + "B": "神经溶解性阻滞应保留给预期寿命较短的患者", + "C": "使用苯酚进行的神经溶解性阻滞是永久性的", + "D": "鞘内神经溶解可能是某些疼痛状况的有效管理方法" + } + }, + { + "id": "e64d5879-46c0-5f0d-a011-c28a5158661f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Transient neurologic symptoms (TNS) after spinal anesthesia are associated with each of the following EXCEPT", + "A": "Lidocaine", + "B": "Lithotomy position", + "C": "Ambulatory anesthesia", + "D": "Concentration of local anesthetic injected" + }, + "zh": { + "question": "脊髓麻醉后短暂性神经症状（TNS）与以下各项有关，除了", + "A": "利多卡因", + "B": "截石位", + "C": "门诊麻醉", + "D": "注射局部麻醉药的浓度" + } + }, + { + "id": "83735247-6432-598a-a324-7abbc562e420", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "After you select the appropriate ultrasound transducer, you can adjust several factors to optimize the image for regional anesthesia. Which of the following descriptions is FALSE?", + "A": "Frequency—higher-frequency ultrasound use is better for viewing deep structures", + "B": "Depth—adjusted to limit the centimeters of viewing area on the monitor", + "C": "Gain—increased gain produces increased brightness", + "D": "Frequency—higher-frequency ultrasound use produces better image resolution" + }, + "zh": { + "question": "在选择合适的超声探头后，您可以调整几个因素以优化区域麻醉的图像。以下哪种描述是错误的？", + "A": "频率——使用高频超声更适合查看深部结构", + "B": "深度——调整以限制监视器上的查看区域的厘米数", + "C": "增益——增加增益会增加亮度", + "D": "频率——使用高频超声会产生更好的图像分辨率" + } + }, + { + "id": "2cdd217b-d692-5327-ad8b-4bf733eb365a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following is associated with an increased incidence of PDPHs EXCEPT", + "A": "Younger adults", + "B": "Early ambulation", + "C": "Pregnancy", + "D": "Large needle size" + }, + "zh": { + "question": "以下每项都与PDPH发生率增加有关，除了", + "A": "年轻的成年人", + "B": "早期下床活动", + "C": "怀孕", + "D": "较大的针头尺寸" + } + }, + { + "id": "cca9e816-74b4-590f-8e67-f76bf311c053", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following items describes pain in the abdominal viscera EXCEPT", + "A": "Pain is transmitted via the vagus nerve", + "B": "The nerve fibers are type C", + "C": "Pain is characterized by a dull aching or burning sensation", + "D": "Distention of the transverse colon causes more pain than surgical transection" + }, + "zh": { + "question": "以下各项中描述腹内脏器疼痛的是，除了", + "A": "疼痛通过迷走神经传递", + "B": "神经纤维是C型", + "C": "疼痛的特征是钝痛或烧灼感", + "D": "横结肠的扩张比手术切断引起更多疼痛" + } + }, + { + "id": "b3cb1e5e-b9c4-5089-89d2-9e9ae09875bb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following blocks has the LONGEST duration of action when bupivacaine with epinephrine is administered?", + "A": "Axillary", + "B": "Epidural", + "C": "Infiltration", + "D": "Spinal" + }, + "zh": { + "question": "使用含肾上腺素的布比卡因时，以下哪种阻滞的作用持续时间最长？", + "A": "腋窝阻滞", + "B": "硬膜外阻滞", + "C": "浸润麻醉", + "D": "脊髓麻醉" + } + }, + { + "id": "1ebc8389-aa7c-54cf-a79e-502131771b37", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following statements concerning a psoas compartment block are true EXCEPT", + "A": "Compartment block is used to provide unilateral anesthesia to the proximal aspect of the thigh and hip", + "B": "Stimulation of the quadriceps muscle demonstrates good needle placement", + "C": "Complete leg anesthesia can be obtained when combined with a sciatic nerve block", + "D": "Continuous catheters are not used because the amount of drug infused would lead to toxicity" + }, + "zh": { + "question": "以下关于腰大肌间隙阻滞的陈述中，除了哪一项外，其他都是正确的？", + "A": "间隙阻滞用于为大腿和髋部的近端提供单侧麻醉", + "B": "股四头肌的刺激表明针头位置良好", + "C": "结合坐骨神经阻滞可以获得完整的腿部麻醉", + "D": "不使用连续导管，因为输注的药物量会导致毒性" + } + }, + { + "id": "3da23039-ea9f-5ed3-9ba9-65e9fd6b638b", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 35-year-old woman receives a popliteal block for ankle and foot surgery. Which other nerve must be blocked in order to have complete anesthesia of the foot?", + "A": "Superficial peroneal nerve", + "B": "Sural nerve", + "C": "Saphenous nerve", + "D": "Posterior tibial nerve" + }, + "zh": { + "question": "一名35岁的女性接受腘窝神经阻滞以进行踝关节和足部手术。为了实现足部的完全麻醉，还需要阻滞哪个神经？", + "A": "浅腓神经", + "B": "腓肠神经", + "C": "隐神经", + "D": "胫后神经" + } + }, + { + "id": "11787521-a3cb-5720-8c69-b90f17195eeb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The most common complication of a celiac plexus block is", + "A": "Hypotension", + "B": "Seizure", + "C": "Retroperitoneal hematoma", + "D": "Constipation" + }, + "zh": { + "question": "腹腔神经丛阻滞最常见的并发症是", + "A": "低血压", + "B": "癫痫发作", + "C": "腹膜后血肿", + "D": "便秘" + } + }, + { + "id": "9ee2e1e9-ba28-51f8-a675-4af849bcd65b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The occipital portion of the skull receives sensory innervation from", + "A": "Spinal accessory nerve (nerve XI)", + "B": "Facial nerve (nerve VII)", + "C": "Ophthalmic branch of trigeminal nerve (nerve V)", + "D": "Cervical plexus" + }, + "zh": { + "question": "颅骨的枕部接受来自以下哪一项的感觉神经支配", + "A": "副神经（第XI对神经）", + "B": "面神经（第VII对神经）", + "C": "三叉神经的眼支（第V对神经）", + "D": "颈丛" + } + }, + { + "id": "f4cdb28a-c288-5c0b-bb13-a792a3cc5cd4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Each of the following is a potential complication of thoracic paravertebral blocks EXCEPT", + "A": "Pneumothorax", + "B": "Epidural spread of local anesthetic", + "C": "Hypertension", + "D": "Total spinal" + }, + "zh": { + "question": "以下每项都是胸椎旁神经阻滞的潜在并发症，除了", + "A": "气胸", + "B": "局麻药的硬膜外扩散", + "C": "高血压", + "D": "全脊髓麻醉" + } + }, + { + "id": "7ee1b9a2-a6b2-5618-853b-b1cc8a2d60ed", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "After placement of an epidural catheter in a 55-year-old patient for total hip arthroplasty, an entire epidural dose is administered into the subarachnoid space. Physiologic effects consistent with subarachnoid injection of large volumes of local anesthetic include all of the following EXCEPT", + "A": "Hypotension and bradycardia", + "B": "Respiratory depression", + "C": "Constricted pupils", + "D": "Possible cauda equina syndrome" + }, + "zh": { + "question": "在一名55岁患者进行全髋关节置换术时放置硬膜外导管后，将整个硬膜外剂量注入蛛网膜下腔。与大剂量局部麻醉药蛛网膜下腔注射一致的生理效应包括以下所有情况，除了", + "A": "低血压和心动过缓", + "B": "呼吸抑制", + "C": "瞳孔缩小", + "D": "可能的马尾综合征" + } + }, + { + "id": "ca300b9f-c9f6-560c-badd-bedc9f7f72bd", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "A 49-year-old type 1 diabetic patient with a long history of burning pain in the right lower extremity receives a spinal anesthetic with 100 mg of procaine with 5% dextrose. The patient reports no relief in symptoms but has complete bilateral motor blockade. What diagnosis is consistent with this differential blockade examination?", + "A": "Diabetic neuropathy", + "B": "Central pain", + "C": "Myofascial pain", + "D": "Complex regional pain syndrome (CRPS) I (RSD)" + }, + "zh": { + "question": "一名49岁的1型糖尿病患者有长期右下肢烧灼痛史，接受了100毫克普鲁卡因和5%葡萄糖的脊髓麻醉。患者报告症状没有缓解，但出现了完全的双侧运动阻滞。哪种诊断与这种差异性阻滞检查一致？", + "A": "糖尿病性神经病变", + "B": "中枢性疼痛", + "C": "筋膜疼痛", + "D": "复杂区域疼痛综合征（CRPS）I（反射性交感神经营养不良）" + } + }, + { + "id": "5d8cc638-1cb2-512d-8c61-65b7f00e3a87", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "An 18-year-old man has a seizure during placement of an interscalene brachial plexus block with 0.5% bupivacaine. The anesthesiologist begins to hyperventilate the patient's lungs with 100% O2 using an anesthesia bag and mask. The rationale for this therapy includes all of the following EXCEPT", + "A": "The therapy helps to prevent and treat hypoxia", + "B": "Hyperventilation decreases blood flow and delivery of local anesthetic to the brain", + "C": "Hyperventilation elevates the seizure threshold", + "D": "Hyperventilation induces alkalosis and converts local anesthetics to the protonated (ionized) form, which is less likely to cross the cell membranes" + }, + "zh": { + "question": "一名18岁的男性在进行0.5%布比卡因的斜角肌间臂丛神经阻滞时发生癫痫发作。麻醉师开始使用麻醉袋和面罩用100%氧气对患者进行过度通气。此疗法的理由包括以下所有内容，除了", + "A": "该疗法有助于预防和治疗缺氧", + "B": "过度通气减少了血流和局部麻醉剂向大脑的输送", + "C": "过度通气提高了癫痫发作的阈值", + "D": "过度通气引起碱中毒并将局部麻醉剂转化为质子化（离子化）形式，这种形式不易穿过细胞膜" + } + }, + { + "id": "18cde671-87f5-5c02-951e-a5dc689dc2c0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Para-aminobenzoic acid is a metabolite of", + "A": "Mepivacaine", + "B": "Ropivacaine", + "C": "Bupivacaine", + "D": "Procaine" + }, + "zh": { + "question": "对氨基苯甲酸是以下哪种药物的代谢产物", + "A": "甲哌卡因", + "B": "罗哌卡因", + "C": "布比卡因", + "D": "普鲁卡因" + } + }, + { + "id": "7d8444f6-5b88-5201-8c86-f531b2a89230", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which statement concerning peripheral nerve structure and function is FALSE?", + "A": "Both nonmyelinated and myelinated nerves are surrounded by Schwann cells", + "B": "The speed of propagation of an action potential along a nerve axon is greatly enhanced by myelin", + "C": "Generation of an action potential is an \"all-or-nothing\" phenomenon", + "D": "Myelination renders nerves less sensitive to local anesthetic blockade" + }, + "zh": { + "question": "关于周围神经的结构和功能，哪个陈述是错误的？", + "A": "无髓鞘和有髓鞘的神经都被施旺细胞包围", + "B": "髓鞘极大地提高了动作电位沿神经轴突的传播速度", + "C": "动作电位的产生是一个“全或无”的现象", + "D": "髓鞘化使神经对局部麻醉阻滞的敏感性降低" + } + }, + { + "id": "ba9d60fb-0551-5050-88d9-e52bb27f826c", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 42-year-old woman with a morbid fear of general anesthesia receives an interscalene block for shoulder arthroscopy consisting of 20 mL 0.5% ropivacaine. Much of her arm, shoulder, and hand are numb, but the patient complains of pain as the incision is made at the upper portion of the shoulder. The most appropriate next step is to", + "A": "Repeat block", + "B": "Perform intercostobrachial block", + "C": "Perform superficial cervical plexus block", + "D": "Perform a deep cervical plexus block" + }, + "zh": { + "question": "一名42岁的女性对全身麻醉有严重恐惧，为肩关节镜检查接受了20毫升0.5%罗哌卡因的斜角肌间隙阻滞。她的手臂、肩膀和手大部分都麻木了，但在肩膀上部切口时，患者抱怨疼痛。最合适的下一步是", + "A": "重复阻滞", + "B": "进行肋间臂神经阻滞", + "C": "进行浅颈丛阻滞", + "D": "进行深颈丛阻滞" + } + }, + { + "id": "ea33e006-9658-52d6-bcb4-d1a3f7147ac9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "According to the 2016 American Society of Regional Anesthesia and Pain Medicine (ASRA) practice advisory on infectious complications of regional anesthesia and pain medicine, the MOST important action to maintain aseptic technique and prevent cross-contamination during regional anesthesia techniques is", + "A": "Wearing a surgical gown", + "B": "Hand washing", + "C": "Using soap and water instead of alcohol-based antiseptics", + "D": "Using povidone-iodine (e.g., Betadine) instead of alcoholbased chlorhexidine to scrub" + }, + "zh": { + "question": "根据2016年美国区域麻醉与疼痛医学学会（ASRA）关于区域麻醉和疼痛医学感染并发症的实践建议，保持无菌技术和防止区域麻醉技术中交叉污染的最重要措施是", + "A": "穿手术衣", + "B": "洗手", + "C": "使用肥皂和水而不是酒精基防腐剂", + "D": "使用聚维酮碘（例如，Betadine）而不是酒精基氯己定进行擦洗" + } + }, + { + "id": "f76625c2-918d-588c-bec2-826dcc4c1ffa", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 75-year-old woman with a history of pulmonary embolism is scheduled for a right lower lobectomy for lung cancer. She is receiving dalteparin (Fragmin) for deep vein thrombosis (DVT) prophylaxis. How long after her last dose should one wait before placement of a thoracic epidural?", + "A": "12 hours", + "B": "24 hours", + "C": "72 hours", + "D": "No waiting is necessary since the dose for prophylaxis is low" + }, + "zh": { + "question": "一名75岁的女性有肺栓塞病史，计划进行右下肺叶切除术以治疗肺癌。她正在接受达肝素（Fragmin）用于深静脉血栓（DVT）预防。在她最后一次用药后，应等待多长时间才能放置胸椎硬膜外麻醉？", + "A": "12小时", + "B": "24小时", + "C": "72小时", + "D": "不需要等待，因为预防剂量较低" + } + }, + { + "id": "6e852d7c-3502-50d8-82d9-f01433be1a5c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How long should a patient be off clopidogrel (Plavix) before a central neuraxial block is performed?", + "A": "24 hours", + "B": "7 days", + "C": "14 days", + "D": "No waiting necessary" + }, + "zh": { + "question": "在进行中央神经轴阻滞前，患者应停用氯吡格雷（Plavix）多长时间？", + "A": "24小时", + "B": "7天", + "C": "14天", + "D": "无需等待" + } + }, + { + "id": "262cce88-50e0-542b-ac0e-fa14bfbcf0ed", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Addition of bicarbonate to local anesthetics results in", + "A": "Delayed onset of action", + "B": "Reduced toxicity", + "C": "Increased duration of action", + "D": "Reduced pain with skin infiltration" + }, + "zh": { + "question": "在局部麻醉剂中加入碳酸氢盐会导致", + "A": "起效延迟", + "B": "降低毒性", + "C": "延长作用时间", + "D": "减��皮肤浸润时的疼痛" + } + }, + { + "id": "34f41584-c7ec-532c-af7f-da6976f8ded5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Through which of the following would a spinal needle NOT pass during a midline placement of a subarachnoid block in the L3-L4 lumbar space?", + "A": "Supraspinous ligament", + "B": "Interspinous ligament", + "C": "Posterior longitudinal ligament", + "D": "Dura mater" + }, + "zh": { + "question": "在L3-L4腰椎间隙进行正中置入蛛网膜下腔阻滞时，脊椎针不会穿过以下哪一项？", + "A": "棘上韧带", + "B": "棘间韧带", + "C": "后纵韧带", + "D": "硬脊膜" + } + }, + { + "id": "b7041366-e924-5e8d-8e3c-00507c876eea", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "What epidural dose of bupivacaine will give sensory analgesia similar to 10 mL of 2% lidocaine?", + "A": "5 mL of 0.25%", + "B": "10 mL of 0.25%", + "C": "5 mL of 0.5%", + "D": "10 mL of 0.5%" + }, + "zh": { + "question": "哪种硬膜外布比卡因剂量能提供与10 mL 2%利多卡因相似的感觉镇痛？", + "A": "5 mL 0.25%", + "B": "10 mL 0.25%", + "C": "5 mL 0.5%", + "D": "10 mL 0.5%" + } + }, + { + "id": "297aace8-fa27-5d6a-a3ec-f4ba84d72886", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Each of the following additives to a spinal anesthetic possesses", + "A": "Clonidine", + "B": "Hydromorphone", + "C": "Epinephrine", + "D": "All of the above have analgesic properties" + }, + "zh": { + "question": "以下每种添加剂用于脊髓麻醉时都具有", + "A": "可乐定", + "B": "氢吗啡酮", + "C": "肾上腺素", + "D": "以上所有都有镇痛特性" + } + }, + { + "id": "80b3b6a0-1eea-5663-9699-3b2cbacbe300", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following local anesthetics is inappropriately paired with a clinical application because of its properties or toxicity?", + "A": "Tetracaine, topical anesthesia", + "B": "Bupivacaine, IV anesthesia", + "C": "Prilocaine, infiltrative anesthesia", + "D": "Chloroprocaine, epidural anesthesia" + }, + "zh": { + "question": "以下哪种局部麻醉药因其特性或毒性而与临床应用不当配对？", + "A": "丁卡因，表面麻醉", + "B": "布比卡因，静脉麻醉", + "C": "丙胺卡因，浸润麻醉", + "D": "氯普鲁卡因，硬膜外麻醉" + } + }, + { + "id": "a332c376-74b8-5b69-b86f-bc9962569258", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Discharge criteria from the PACU would be reached FASTEST after a 20- to 30-mL volume of which of the following epidurally administered local anesthetics?", + "A": "3% 2-Chloroprocaine", + "B": "2% Lidocaine", + "C": "0.75% Ropivacaine", + "D": "0.5% Levobupivacaine" + }, + "zh": { + "question": "在以下哪种硬膜外给药的局部麻醉药后，最快达到从PACU出院的标准？", + "A": "3% 2-氯普鲁卡因", + "B": "2% 利多卡因", + "C": "0.75% 罗哌卡因", + "D": "0.5% 左布比卡因" + } + }, + { + "id": "7ce6f370-b201-599c-92b7-5970d5e3ee33", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A caudal block (performed under sevoflurane general anesthesia) with 0.25% bupivacaine and 1:200,000 epinephrine is planned for postoperative analgesia after bilateral inguinal hernia repair in a 5 month-old patient. Each of the following would be consistent with an intravascular injection EXCEPT", + "A": "Systolic blood pressure increase by greater than 15 mm Hg", + "B": "Heart rate decrease by greater than 10 beats/min", + "C": "Ventricular extrasystoles", + "D": "Increase in T-wave amplitude > 25% over baseline" + }, + "zh": { + "question": "在5个月大的患者进行双侧腹股沟疝修补术后，计划在七氟醚全身麻醉下进行尾部阻滞，使用0.25%布比卡因和1:200,000肾上腺素。以下每一项都与血管内注射一致，除了", + "A": "收缩压增加超过15 mm Hg", + "B": "心率下降超过10次/分钟", + "C": "心室期外收缩", + "D": "T波幅度增加超过基线的25%" + } + }, + { + "id": "fae67c31-9027-52c5-a4b8-15b30c353867", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which is NOT a potential complication of a stellate ganglion block?", + "A": "Recurrent laryngeal nerve paralysis", + "B": "Subarachnoid block", + "C": "Brachial plexus block", + "D": "Increased heart rate" + }, + "zh": { + "question": "以下哪项不是星状神经节阻滞的潜在并发症？", + "A": "喉返神经麻痹", + "B": "蛛网膜下腔阻滞", + "C": "臂丛神经阻滞", + "D": "心率增加" + } + }, + { + "id": "16d2cf77-986b-5759-8603-96fa5aede5e9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Discontinuation of which of the following antiplatelet medications, for 14 days, would be necessary before a spinal could be safely administered?", + "A": "Aspirin", + "B": "Clopidogrel", + "C": "Ticlopidine", + "D": "Abciximab (GPIIb/IIIa)" + }, + "zh": { + "question": "在进行椎管内麻醉前，以下哪种抗血小板药物需要停用14天才能安全进行？", + "A": "阿司匹林", + "B": "氯吡格雷", + "C": "噻氯匹定", + "D": "阿昔单抗（GPIIb/IIIa）" + } + }, + { + "id": "3ad2f94d-f230-5ae9-8733-0ea6563317dc", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Three days after knee arthroscopy under spinal anesthesia, a 55-year-old patient complains of double vision and difficulty hearing. The other likely finding would be", + "A": "Headache", + "B": "Fever", + "C": "Weakness in legs", + "D": "Mental status changes" + }, + "zh": { + "question": "在脊椎麻醉下进行膝关节镜手术三天后，一名55岁的患者抱怨复视和听力困难。其他可能的发现是", + "A": "头痛", + "B": "发热", + "C": "腿部无力", + "D": "精神状态改变" + } + }, + { + "id": "20027f43-4b3d-586f-942f-cde048395e9e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following statements is TRUE concerning transversus abdominis plane (TAP) block?", + "A": "Ultrasound is useful in finding the intercostal nerves", + "B": "The local anesthetic is injected directly into the transversus abdominis muscle", + "C": "The subcostal, ilioinguinal, and iliohypogastric nerves are blocked", + "D": "10 mL of local anesthetic is all that is needed for good spread" + }, + "zh": { + "question": "关于腹横肌平面（TAP）阻滞，下列哪项陈述是正确的？", + "A": "超声在寻找肋间神经时很有用", + "B": "局部麻醉药直接注射到腹横肌中", + "C": "肋下神经、髂腹股沟神经和髂腹下神经被阻滞", + "D": "10毫升的局部麻醉药足以达到良好的扩散效果" + } + }, + { + "id": "0565684c-40df-5f41-a151-81e3741f6dcd", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following nerves can be electrically stimulated at the ankle to produce flexion of the toes?", + "A": "Posterior tibial nerve", + "B": "Saphenous nerve", + "C": "Deep peroneal nerve", + "D": "Superficial peroneal nerve" + }, + "zh": { + "question": "以下哪一条神经可以在踝部进行电刺激以引起脚趾屈曲？", + "A": "胫后神经", + "B": "隐神经", + "C": "腓深神经", + "D": "腓浅神经" + } + }, + { + "id": "9a98d381-84fb-5b8e-be46-a0fd8847585b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which motor response from peripheral nerve stimulation is", + "A": "Musculocutaneous nerve—flexion of the forearm at the elbow", + "B": "Radial nerve—extension of all digits as well as the wrist and forearm", + "C": "Ulnar nerve—abduction of the thumb", + "D": "Median nerve—flexion of the wrist, pronation of the forearm" + }, + "zh": { + "question": "周围神经刺激引起的哪种运动反应是", + "A": "肌皮神经——前臂在肘部的屈曲", + "B": "桡神经——所有手指、手腕和前臂的伸展", + "C": "尺神经——拇指的外展", + "D": "正中神经——手腕的屈曲，前臂的旋前" + } + }, + { + "id": "b6d114ae-5480-5151-9083-a1e1d908dd6f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "During an airway examination, a 53-year-old patient mentions that his right thumb tingles and then becomes numb if he extends his head for more than a few seconds. This symptom MOST likely represents a(n)", + "A": "Unstable C-spine", + "B": "Lhermitte's phenomenon", + "C": "C6 nerve root irritation", + "D": "C8 radiculopathy" + }, + "zh": { + "question": "在气道检查期间，一名53岁的患者提到，如果他将头部后仰超过几秒钟，他的右拇指会感到刺痛然后变得麻木。这个症状最可能代表的是", + "A": "不稳定的颈椎", + "B": "Lhermitte现象", + "C": "C6神经根刺激", + "D": "C8神经根病" + } + }, + { + "id": "782b5422-a832-58dd-b443-4b346b40670c", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "When performing an interscalene block with a peripheral nerve stimulator, you note diaphragmatic movement. You should now", + "A": "Inject the local anesthetic, as the needle is in an appropriate location", + "B": "Redirect the needle in an anterior direction", + "C": "Redirect the needle in a posterior direction", + "D": "Advance the needle about 0.5 cm more and inject" + }, + "zh": { + "question": "在使用周围神经刺激器进行斜角肌间隙阻滞时，您注意到膈肌运动。您现在应该", + "A": "注射局部麻醉剂，因为针头在适当的位置", + "B": "将针头向前方重新定向", + "C": "将针头向后方重新定向", + "D": "将针头再推进约0.5厘米并注射" + } + }, + { + "id": "9672624b-f8c4-5cde-8421-d3e11d1062fa", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "During placement of an interscalene block, the patient becomes hypotensive, bradycardic, apneic, and cyanotic. The MOST likely cause is", + "A": "Vertebral artery injection", + "B": "Phrenic nerve blockade", + "C": "Total spinal", + "D": "Stellate ganglion block" + }, + "zh": { + "question": "在进行斜角肌间隙阻滞时，患者出现低血压、心动过缓、呼吸暂停和发绀。最可能的原因是", + "A": "椎动脉注射", + "B": "膈神经阻滞", + "C": "全脊髓麻醉", + "D": "星状神经节阻滞" + } + }, + { + "id": "6ac14128-d988-5a03-a590-6f744c0bd41f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The reason that ropivacaine is marketed as pure S enantiomers is because the S form is associated with", + "A": "Increased potency", + "B": "Longer duration", + "C": "Reduced cardiac toxicity", + "D": "Reduced incidence of anaphylaxis" + }, + "zh": { + "question": "罗哌卡因以纯S对映体形式上市的原因是因为S形式与以下哪项有关", + "A": "增加效力", + "B": "延长持续时间", + "C": "降低心脏毒性", + "D": "减少过敏反应的发生率" + } + }, + { + "id": "f3fe3219-8873-5ea9-a65f-906bd5c12373", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Nerves that originate from the sacral plexus include each of the following EXCEPT", + "A": "Femoral nerve", + "B": "Tibial nerve", + "C": "Sciatic nerve", + "D": "Common peroneal nerve" + }, + "zh": { + "question": "起源于骶丛的神经包括以下各项，除了", + "A": "股神经", + "B": "胫神经", + "C": "坐骨神经", + "D": "腓总神经" + } + }, + { + "id": "bdcbd666-0cf9-5a3e-a103-d57e204874f6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The only technique shown to prevent anesthetic-related nerve injury during placement of peripheral nerve blocks is", + "A": "Ultrasound-guided regional technique", + "B": "Transarterial technique", + "C": "Nerve stimulator", + "D": "None of the above" + }, + "zh": { + "question": "唯一被证明能在外周神经阻滞置入过程中预防麻醉相关神经损伤的技术是", + "A": "超声引导的区域技术", + "B": "经动脉技术", + "C": "神经刺激器", + "D": "以上皆不是" + } + }, + { + "id": "4d55519c-50e2-5672-83ad-eaf6a66a12aa", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "An axillary block is performed on a healthy 19-year-old athlete. A 30 mL quantity of 0.75% bupivacaine is injected incrementally. Five minutes after the bupivacaine injection, the patient has a seizure and experiences CV collapse. Which of the measures below is NOT", + "A": "Begin chest compressions at 100 per minute", + "B": "Ventilate with 100% oxygen", + "C": "Bolus propofol to bind local anesthetic", + "D": "Infuse 20% lipid emulsion" + }, + "zh": { + "question": "对一名健康的19岁运动员进行腋神经阻滞。逐步注射30毫升0.75%的布比卡因。注射布比卡因五分钟后，患者出现癫痫发作和心血管崩溃。以下哪项措施是不正确的？", + "A": "以每分钟100次的速度开始胸外按压", + "B": "使用100%氧气进行通气", + "C": "推注丙泊酚以结合局部麻醉剂", + "D": "输注20%脂肪乳剂" + } + }, + { + "id": "5c50641d-900e-5f8f-b514-1c181694031e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The structure MOST likely to be blocked during placement of an interscalene block in addition to the brachial plexus is the", + "A": "Phrenic nerve", + "B": "Vertebral artery", + "C": "Recurrent laryngeal nerve", + "D": "Vagus nerve" + }, + "zh": { + "question": "在进行斜角肌间隙阻滞时，除了臂丛神经外，最有可能被阻滞的结构是", + "A": "膈神经", + "B": "椎动脉", + "C": "喉返神经", + "D": "迷走神经" + } + }, + { + "id": "806b3086-0666-5bc6-a11c-e468d762058e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are symptoms of a developing epidural hematoma EXCEPT", + "A": "Radicular back pain", + "B": "Bowel and bladder dysfunction", + "C": "Motor deficits", + "D": "Fever" + }, + "zh": { + "question": "以下哪项不是硬膜外血肿发展的症状？", + "A": "根性背痛", + "B": "肠道和膀胱功能障碍", + "C": "运动障碍", + "D": "发热" + } + }, + { + "id": "b8be242c-6807-5962-82d3-9156c07f419e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "In addition to C nerve fibers, which nerve fibers carry pain impulses?", + "A": "A-alpha (Aα)", + "B": "A-beta (Aβ)", + "C": "A-delta (Aδ)", + "D": "B" + }, + "zh": { + "question": "除了C神经纤维外，哪些神经纤维传递疼痛冲动？", + "A": "A-α (Aα)", + "B": "A-β (Aβ)", + "C": "A-δ (Aδ)", + "D": "B" + } + }, + { + "id": "39200c0a-e743-5601-97c3-7c27c7e97b08", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "An intradural mass lesion at the tip of a drug infusion catheter is LEAST likely to present as", + "A": "Increasing pain", + "B": "Development of numbness in T8 dermatomal pattern", + "C": "Hypopnea", + "D": "Perianal numbness" + }, + "zh": { + "question": "药物输注导管尖端的硬膜内肿块病变最不可能表现为", + "A": "疼痛加剧", + "B": "T8皮节模式的麻木发展", + "C": "呼吸减慢", + "D": "肛周麻木" + } + }, + { + "id": "e057fc22-3cab-5d78-97c9-a68d450f96e3", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A healthy 25-year-old man is anesthetized for a sagittal split osteotomy. Anesthesia is induced with propofol, hydromorphone, and vecuronium and maintained with 2.1% sevoflurane and 50% N2O. After induction, the nose is prepped with 4% lidocaine and 1% phenylephrine, and the patient is intubated through the right naris. Before emergence, the surgeon performs a bilateral inferior alveolar nerve block. The patient is reversed with neostigmine and glycopyrrolate. When the patient awakens, he is noted to have an 8-mm pupil on the right and a 3-mm pupil on the left. Results of physical examination are otherwise", + "A": "Right stellate ganglion block", + "B": "Accidental introduction of lidocaine into right eye", + "C": "Accidental introduction of phenylephrine into right eye", + "D": "Glycopyrrolate" + }, + "zh": { + "question": "一名健康的25岁男性接受矢状劈开截骨术的麻醉。麻醉诱导使用丙泊酚、氢吗啡酮和维库溴铵，并维��在2.1%七氟醚和50% N2O。诱导后，鼻子用4%利多卡因和1%去氧肾上腺素准备，患者通过右鼻孔插管。在苏醒前，外科医生进行双侧下牙槽神经阻滞。患者用新斯的明和格隆溴铵逆转。当患者醒来时，发现右侧瞳孔为8毫米，左侧为3毫米。体格检查结果其他方面正常", + "A": "右侧星状神经节阻滞", + "B": "利多卡因意外进入右眼", + "C": "去氧肾上腺素意外进入右眼", + "D": "格隆溴铵" + } + }, + { + "id": "02276081-79ed-5dc0-be1a-61fcd840cc97", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which statement concerning local anesthetics is CORRECT?", + "A": "The un-ionized form of a local anesthetic binds to the nerve membrane to actually block conduction", + "B": "If one node of Ranvier is blocked, conduction will be reliably interrupted", + "C": "The presence of myelin enhances the ability of a local anesthetic to block nerve conduction", + "D": "Local anesthetics block transmission by inhibiting the voltage-gated potassium ion channels" + }, + "zh": { + "question": "关于局部麻醉药的说法哪一项是正确的？", + "A": "局部麻醉药的非离子化形式结合到神经膜上以实际阻断传导", + "B": "如果一个郎飞结被阻断，传导将被可靠地中断", + "C": "髓鞘的存在增强了局部麻醉药阻断神经传导的能力", + "D": "局部麻醉药通过抑制电压门控钾离子通道来阻断传导" + } + }, + { + "id": "2646a111-995f-5250-8ebe-c67b3920e743", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Postdural puncture headaches (PDPHs)", + "A": "Usually occur immediately following dural puncture", + "B": "Are relieved 8 to 12 hours after an epidural blood patch is performed", + "C": "Occur more frequently in nonpregnant patients compared with pregnant patients", + "D": "Can be associated with neurologic deficits" + }, + "zh": { + "question": "硬膜穿刺后头痛（PDPH）", + "A": "通常在硬膜穿刺后立即发生", + "B": "在进行硬膜外血补片后8到12小时内缓解", + "C": "在非孕患者中比孕患者更常见", + "D": "可能与神经功能缺损有关" + } + }, + { + "id": "5864dc25-a579-509e-acc4-c171dfde8f1c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following procedures for treatment of chronic pain requires localization of the epidural space with an epidural needle as part of technique?", + "A": "Radio-frequency ablation of a lumbar facet joint", + "B": "Spinal cord stimulation", + "C": "Percutaneous disk decompression", + "D": "Vertebroplasty" + }, + "zh": { + "question": "以下哪种慢性疼痛治疗程序需要使用硬膜外针定位硬膜外腔作为技术的一部分？", + "A": "腰椎小关节的射频消融", + "B": "脊髓刺激", + "C": "经皮椎间盘减压", + "D": "椎体成形术" + } + }, + { + "id": "1154f109-f750-564a-bbff-ff68c9d85834", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Each of the following drugs has been used to treat neuropathic pain. Selective inhibition of serotonin and norepinephrine reuptake is the mechanism of which drug?", + "A": "Duloxetine", + "B": "Mexiletine", + "C": "Gabapentin", + "D": "Carbamazepine# Anatomy, Regional Anesthesia, and Pain Management#" + }, + "zh": { + "question": "以下每种药物都曾用于治疗神经性疼痛。选择性抑制5-羟色胺和去甲肾上腺素再摄取是哪个药物的机制？", + "A": "度洛西汀", + "B": "美西律", + "C": "加巴喷丁", + "D": "卡马西平# 解剖学、区域麻醉和疼痛管理#" + } + }, + { + "id": "014573aa-00c5-5303-9843-e25417e6a7b4", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "An oximetric pulmonary artery (PA) catheter is placed in a 69-year-old man who is undergoing surgical repair of an abdominal aortic aneurysm under general anesthesia. Before the aortic cross-clamp is placed, the mixed venous O2 saturation decreases from 75% to 60%. Each of the following could account for the decrease in mixed venous O2 saturation EXCEPT", + "A": "Hypovolemia", + "B": "Bleeding", + "C": "Congestive heart failure (CHF)", + "D": "Sepsis" + }, + "zh": { + "question": "在一名69岁男性患者中放置了一个血氧测定肺动脉（PA）导管，该患者正在全身麻醉下进行腹主动脉瘤的外科修复。在放置主动脉交叉夹之前，混合静脉氧饱和度从75%下降到60%。以下每种情况都可能导致混合静脉氧饱和度下降，除了", + "A": "低血容量", + "B": "出血", + "C": "充血性心力衰竭（CHF）", + "D": "败血症" + } + }, + { + "id": "b4dc711b-eab4-57b0-af28-641340f6a4c7", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Postoperatively a 64-year-old man develops heparin-induced thrombocytopenia (HIT), type II (antibody proven), after anticoagulation for aortic valve replacement with 25,000 units of heparin. The same patient requires an elective tricuspid valve replacement soon thereafter because of trauma from a transvenous pacemaker. The best option for cardiopulmonary bypass anticoagulation for this patient with the second operation would be", + "A": "Defer until disappearance of antibodies; use heparin", + "B": "Cardiopulmonary bypass with lepirudin in place of heparin", + "C": "Cardiopulmonary bypass with tirofiban in place of heparin", + "D": "Anticoagulation with fondaparinux" + }, + "zh": { + "question": "术后，一名64岁男性在接受25,000单位肝素的抗凝治疗后，因主动脉瓣置换术而出现肝素诱导的血小板减少症（HIT），II型（抗体证实）。由于经静脉心脏起搏器的创伤，该患者不久后需要进行选择性三尖瓣置换术。对于该患者第二次手术的体外循环抗凝的最佳选择是", + "A": "推迟至抗体消失后使用肝素", + "B": "用来匹鲁定代替肝素进行体外循环", + "C": "用替罗非班代替肝素进行体外循环", + "D": "用磺达肝癸钠进行抗凝" + } + }, + { + "id": "ccf8f252-e774-5362-9775-07905fe5c32d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the MOST sensitive indicator of left", + "A": "Wall-motion abnormalities on the echocardiogram", + "B": "ST segment changes in lead V5 of the electrocardiogram (ECG)", + "C": "Appearance of V waves on the pulmonary capillary wedge pressure tracing", + "D": "Decrease in cardiac output as measured by the thermodilution technique" + }, + "zh": { + "question": "以下哪项是最敏感的左心指示器？", + "A": "超声心动图上的壁运动异常", + "B": "心电图（ECG）V5导联的ST段变化", + "C": "肺毛细血管楔压描记图上出现V波", + "D": "通过热稀释技术测量的心输出量减少" + } + }, + { + "id": "8c33b732-514b-5fb4-8e00-7167707cadc4", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Oxygen consumption (Vo2 ) is measured in a 70-kg subject on a", + "A": "1 metabolic equivalent (MET)", + "B": "5 METs", + "C": "10 METs", + "D": "15 METs" + }, + "zh": { + "question": "在一个70公斤的受试者中测量氧气消耗量（Vo2）", + "A": "1 代谢当量（MET）", + "B": "5 代谢当量（MET）", + "C": "10 代谢当量（MET）", + "D": "15 代谢当量（MET）" + } + }, + { + "id": "82bcbca5-b628-5cb0-9022-38a242b15d4e", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Accidental injection of air into a peripheral vein would be LEAST likely to result in arterial air embolism in a patient with which of the following anatomic cardiac defects?", + "A": "Patent ductus arteriosus", + "B": "Eisenmenger syndrome", + "C": "Tetralogy of Fallot", + "D": "Tricuspid atresia" + }, + "zh": { + "question": "在以下哪种解剖性心脏缺陷的患者中，意外将空气注入外周静脉最不可能导致动脉空气栓塞？", + "A": "动脉导管未闭", + "B": "艾森曼格综合征", + "C": "法洛四联症", + "D": "三尖瓣闭锁" + } + }, + { + "id": "0c863a33-6719-5413-921c-d950b9a44e9b", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 71-year-old man is undergoing revascularization of three coronary vessels on cardiopulmonary bypass at 28° C. After the last graft is sewn into the aorta, the arterial pressure measured from a left radial artery is 47 mm Hg and the PA pressure is 6 mm Hg. Thirty minutes later, the arterial pressure is 52 mm Hg and PA pressure is 31 mm Hg. The MOST likely explanation for this is", + "A": "Malposition of the aortic cannula", + "B": "Malposition of the venous cannula", + "C": "Faulty ventricular venting", + "D": "PA catheter migration" + }, + "zh": { + "question": "一名71岁的男性正在进行28°C体外循环下的三支冠状动脉血管重建手术。在最后一个移植物缝合到主动脉后，从左桡动脉测得的动脉压为47 mm Hg，肺动脉压为6 mm Hg。三十分钟后，动脉压为52 mm Hg，肺动脉压为31 mm Hg。最可能的解释是", + "A": "主动脉插管位置不当", + "B": "静脉插管位置不当", + "C": "心室排气故障", + "D": "肺动脉导管移位" + } + }, + { + "id": "71e358ac-66da-56ce-80cc-dc5a32d20d6c", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "While on cardiopulmonary bypass during elective coronary artery revascularization, the patient is noted to have bulging sclerae. Mean arterial pressure (MAP) is 50 mm Hg, temperature is 28° C, and there is no ECG activity. The MOST appropriate action to take at this time is to", + "A": "Administer mannitol, 50 g IV", + "B": "Decrease the cardiac index", + "C": "Check the position of the aortic cannula", + "D": "Check the position of the venous return cannula" + }, + "zh": { + "question": "在进行选择性冠状动脉血运重建的体外循环期间，患者被发现巩膜隆起。平均动脉压（MAP）为50 mm Hg，温度为28°C，并且没有心电图活动。此时最合适的措施是", + "A": "静脉注射50克甘露醇", + "B": "降低心脏指数", + "C": "检查主动脉插管的位置", + "D": "检查静脉回流插管的位置" + } + }, + { + "id": "2283e4d1-c169-58da-a872-b9450690f1f0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Anastomosis of the right atrium to the PA (Fontan procedure) is a useful surgical treatment for each of the following congenital cardiac defects EXCEPT", + "A": "Tricuspid atresia", + "B": "Hypoplastic left heart syndrome", + "C": "Pulmonary valve stenosis", + "D": "Truncus arteriosus" + }, + "zh": { + "question": "右心房与肺动脉吻合术（Fontan手术）是以下先天性心脏缺陷的有效外科治疗方法，除了", + "A": "三尖瓣闭锁", + "B": "左心发育不良综合征", + "C": "肺动脉瓣狭窄", + "D": "共同动脉干" + } + }, + { + "id": "473f09f8-aed1-52d5-81b0-c05f72be97de", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "By what percentage is tissue metabolic rate reduced during cardiopulmonary bypass at 30° C?", + "A": "10%", + "B": "25%", + "C": "50%", + "D": "75%" + }, + "zh": { + "question": "在30°C的体外循环中，组织代谢率降低了多少百分比？", + "A": "10%", + "B": "25%", + "C": "50%", + "D": "75%" + } + }, + { + "id": "e4424267-31d2-5b45-8f66-5a64423b477c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Effective inflation of an intra-aortic balloon catheter should occur at which of the following times?", + "A": "Immediately after P wave on ECG", + "B": "Immediately after closure of aortic valve", + "C": "During opening of the aortic valve", + "D": "During systolic upstroke on arterial tracing" + }, + "zh": { + "question": "主动脉内球囊导管的有效充气应发生在以下哪个时间？", + "A": "在心电图的P波之后立即", + "B": "在主动脉瓣关闭后立即", + "C": "在主动脉瓣打开期间", + "D": "在动脉波形的收缩上升期期间" + } + }, + { + "id": "b812b8df-6ef8-5f6f-bf16-169b399184eb", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "Afterload reduction is beneficial during anesthesia for noncardiac surgery in patients with each of the following conditions EXCEPT", + "A": "Aortic insufficiency", + "B": "Patent ductus arteriosus", + "C": "Tetralogy of Fallot", + "D": "CHF" + }, + "zh": { + "question": "在非心脏手术的麻醉过程中，减轻后负荷对以下哪种情况的患者有益，除了", + "A": "主动脉瓣关闭不全", + "B": "动脉导管未闭", + "C": "法洛四联症", + "D": "充血性心力衰竭" + } + }, + { + "id": "c56d4a29-9e38-5302-860d-15a0135f9f00", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Administration of protamine to a patient who has not received heparin can result in", + "A": "Anticoagulation", + "B": "Hypercoagulation", + "C": "Profound bradycardia", + "D": "Hypertension" + }, + "zh": { + "question": "给未接受肝素的患者使用鱼精蛋白可能导致", + "A": "抗凝", + "B": "高凝", + "C": "严重心动过缓", + "D": "高血压" + } + }, + { + "id": "08fdcdfb-212e-5b5f-ae2a-0efd3c5af379", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The primary determinants of myocardial O2 consumption, from most to", + "A": "Preload > afterload > heart rate", + "B": "Heart rate > preload > afterload", + "C": "Afterload > preload > heart rate", + "D": "Heart rate > afterload > preload" + }, + "zh": { + "question": "心肌氧耗的主要决定因素，从最重要到最不重要的顺序是：", + "A": "前负荷 > 后负荷 > 心率", + "B": "心率 > 前负荷 > 后负荷", + "C": "后负荷 > 前负荷 > 心率", + "D": "心率 > 后负荷 > 前负荷" + } + }, + { + "id": "66cfe50a-da68-5b78-aa68-5fe5a53481e0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Cardiac tamponade is associated with", + "A": "Pulsus alternans", + "B": "Pulsus tardus", + "C": "Pulsus parvus", + "D": "Pulsus paradoxus" + }, + "zh": { + "question": "心脏压塞与以下哪项相关", + "A": "交替脉", + "B": "迟脉", + "C": "小脉", + "D": "奇脉" + } + }, + { + "id": "5552d041-85d5-5c13-a4a4-fd99a00b153e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following drugs should NOT be administered via an endotracheal tube?", + "A": "Lidocaine", + "B": "NaHCO3", + "C": "Atropine", + "D": "Naloxone" + }, + "zh": { + "question": "以下哪种药物不应通过气管插管给药？", + "A": "利多卡因", + "B": "碳酸氢钠", + "C": "阿托品", + "D": "纳洛酮" + } + }, + { + "id": "bec76444-d72c-5214-8c79-9a105a42f709", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "The MAP in a patient with a blood pressure of 180/60 mm Hg is", + "A": "90 mm Hg", + "B": "100 mm Hg", + "C": "110 mm Hg", + "D": "120 mm Hg" + }, + "zh": { + "question": "血压为180/60 mm Hg的患者的平均动脉压（MAP）是", + "A": "90 mm Hg", + "B": "100 mm Hg", + "C": "110 mm Hg", + "D": "120 mm Hg" + } + }, + { + "id": "f66b8323-3b03-5019-8d20-8523c7b256d5", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Hypothyroidism and hyperthyroidism could develop in patients receiving which of the following antidysrhythmic drugs?", + "A": "Amiodarone", + "B": "Verapamil", + "C": "Procainamide", + "D": "Lidocaine" + }, + "zh": { + "question": "接受以下哪种抗心律失常药物的患者可能会出现甲状腺功能减退和甲状腺功能亢进？", + "A": "胺碘酮", + "B": "维拉帕米", + "C": "普鲁卡因胺", + "D": "利多卡因" + } + }, + { + "id": "9479d7ae-4419-505b-8554-1e14a494b692", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Calculate the systemic vascular resistance (SVR; in dyne-sec/cm5 ) from the following data: cardiac output 5.0 L/min, central venous pressure (CVP) 8 mm Hg, mean arterial blood pressure 86 mm Hg, mean pulmonary arterial blood pressure 20 mm Hg, pulmonary capillary wedge pressure 9 mm Hg, heart rate 85 beats/min, patient weight 100 kg.", + "A": "750", + "B": "1000", + "C": "1250", + "D": "1500" + }, + "zh": { + "question": "根据以下数据计算全身血管阻力（SVR；单位：dyne-sec/cm5）：心输出量5.0 L/min，中心静脉压（CVP）8 mm Hg，平均动脉压86 mm Hg，平均肺动脉压20 mm Hg，肺毛细血管楔压9 mm Hg，心率85次/分钟，患者体重100 kg。", + "A": "750", + "B": "1000", + "C": "1250", + "D": "1500" + } + }, + { + "id": "aa5baf8d-d1bb-5944-b611-491c9b5b12d9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A 57-year-old man with a history of Brugada syndrome is scheduled for appendectomy. The greatest anesthetic concern for this patient would be", + "A": "Airway", + "B": "Response to nondepolarizing muscle relaxants", + "C": "Risk of malignant hyperthermia", + "D": "Dysrhythmias" + }, + "zh": { + "question": "一名57岁的男性有Brugada综合征病史，计划进行阑尾切除术。对该患者最大的麻醉关注是", + "A": "气道", + "B": "对非去极化肌松药的反应", + "C": "恶性高热的风险", + "D": "心律失常" + } + }, + { + "id": "2ae2ac76-9570-53a9-811e-ceecec10cbc9", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 65-year-old female patient with sepsis is undergoing an emergency exploratory laparotomy. After induction of anesthesia and tracheal intubation, the patient's blood pressure is noted to be 65 systolic with a heart rate of 120 beats/min. Cardiac output determined by a", + "A": "Dobutamine", + "B": "Vasopressin", + "C": "Norepinephrine", + "D": "Phenylephrine" + }, + "zh": { + "question": "一名65岁的女性患者因败血症正在接受紧急探查性剖腹手术。麻醉诱导和气管插管后，患者的血压为65收缩压，心率为120次/分钟。心输出量由以下哪种药物决定？", + "A": "多巴酚丁胺", + "B": "加压素", + "C": "去甲肾上腺素", + "D": "苯肾上腺素" + } + }, + { + "id": "7bda800f-22ea-5d02-a902-2f446d0a4ee8", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The MOST important pathophysiologic difference between pericardial effusion and cardiac tamponade is", + "A": "Type of fluid (e.g., transudate, exudate, blood)", + "B": "Quantity of fluid", + "C": "Pressure", + "D": "Inflammation" + }, + "zh": { + "question": "心包积液和心脏压塞之间最重要的病理生理学差异是", + "A": "液体类型（例如，漏出液、渗出液、血液）", + "B": "液体数量", + "C": "压力", + "D": "炎症" + } + }, + { + "id": "ad7b2ccc-5817-5cd3-8538-c89904cd1508", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A healthy 59-year-old, 60-kg woman with a normal preoperative ECG develops wide complex tachycardia under general anesthesia for breast biopsy. Blood pressure is 81/47 mm Hg, and heart rate is 220 beats/min and regular. The MOST appropriate therapy would be", + "A": "Electrical cardioversion", + "B": "Administration of lidocaine, 60 mg IV", + "C": "Administration of procainamide, 20 mg/min IV", + "D": "Administration of amiodarone, 300 mg IV" + }, + "zh": { + "question": "一名健康的59岁、60公斤女性，术前心电图正常，在进行乳房活检的全身麻醉下出现宽QRS波心动过速。血压为81/47 mm Hg，心率为220次/分钟且规则。最合适的治疗是", + "A": "电复律", + "B": "静脉注射利多卡因，60 mg", + "C": "静脉注射普鲁卡因胺，20 mg/分钟", + "D": "静脉注射胺碘酮，300 mg" + } + }, + { + "id": "972f42c5-ba16-5d4f-ba6b-3e65376c8e80", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Although β-adrenergic receptor blockade is the best treatment for", + "A": "Lidocaine", + "B": "Procainamide", + "C": "Left stellate ganglion blockade", + "D": "Right stellate ganglion blockade" + }, + "zh": { + "question": "尽管β-肾上腺素能受体阻滞是最佳治疗方法", + "A": "利多卡因", + "B": "普鲁卡因酰胺", + "C": "左侧星状神经节阻滞", + "D": "右侧星状神经节阻滞" + } + }, + { + "id": "4e737ec6-703e-53b5-9188-52293fe74e39", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 64-year-old patient with an axial flow left ventricular assist device (VAD; e.g., HeartWare) is scheduled for laparoscopic cholecystectomy under general anesthesia. Monitoring which of the following parameters is likely to be difficult in this patient?", + "A": "Blood pressure with blood pressure cuff", + "B": "Blood pressure with arterial line", + "C": "PA pressure with PA catheter", + "D": "Temperature with esophageal temperature probe" + }, + "zh": { + "question": "一名64岁的患者安装了轴流左心室辅助装置（VAD，例如HeartWare），计划在全身麻醉下进行腹腔镜胆囊切除术。监测以下哪个参数在该患者中可能会很困难？", + "A": "使用血压袖带测量血压", + "B": "使用动脉导管测量血压", + "C": "使用肺动脉导管测量肺动脉压力", + "D": "使用食管温度探头测量温度" + } + }, + { + "id": "e3de9d51-4267-596c-b7c2-facb5cd09f5e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In a normal person, what percentage of the cardiac output is dependent on the \"atrial kick\"?", + "A": "25%", + "B": "35%", + "C": "45%", + "D": "55%" + }, + "zh": { + "question": "在正常人中，心输出量中有多少百分比依赖于“心房收缩”?", + "A": "25%", + "B": "35%", + "C": "45%", + "D": "55%" + } + }, + { + "id": "72cd138a-6db3-59e3-a3c4-1be446162073", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Using transesophageal echocardiography (TEE), the midesophageal short axis view at 45 degrees shows a valve shaped like the \"Mercedes Benz\" sign. Which valve is examined in this view?", + "A": "Tricuspid valve", + "B": "Pulmonic valve", + "C": "Mitral valve", + "D": "Aortic valve" + }, + "zh": { + "question": "使用经食道超声心动图（TEE），在45度的中食道短轴视图中显示一个形状像“奔驰”标志的瓣膜。在此视图中检查的是哪个瓣膜？", + "A": "三尖瓣", + "B": "肺动脉瓣", + "C": "二尖瓣", + "D": "主动脉瓣" + } + }, + { + "id": "eba31f37-d3d6-58e3-863f-4755ec182eaf", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 54-year-old patient is undergoing a three-vessel coronary artery bypass graft (CABG) under general anesthesia. After induction, the pulmonary capillary wedge pressure is 15 mm Hg and PA pressures are", + "A": "Nitroglycerin", + "B": "Nitroprusside", + "C": "Esmolol", + "D": "Dobutamine" + }, + "zh": { + "question": "一名54岁的患者在全身麻醉下接受三支冠状动脉搭桥术（CABG）。诱导后，肺毛细血管楔压为15 mm Hg，PA压力为", + "A": "硝酸甘油", + "B": "硝普钠", + "C": "艾司洛尔", + "D": "多巴酚丁胺" + } + }, + { + "id": "3d4e0d28-11b4-56be-8250-a1322ba3feb5", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "A 62-year-old patient scheduled for elective repair of an abdominal aortic aneurysm develops a wide complex regular tachycardia (heart rate 150 beats/min) during induction of anesthesia. Blood pressure is 110/78 mm Hg. Which of the following drugs would be MOST useful in the management of this dysrhythmia?", + "A": "Esmolol, 35 mg IV", + "B": "Amiodarone, 150 mg IV over 10 minutes", + "C": "Adenosine, 6 mg rapidly over 3 seconds", + "D": "Verapamil, 5 to 10 mg IV" + }, + "zh": { + "question": "一名62岁的患者计划进行腹主动脉瘤的择期修复手术，在麻醉诱导期间出现宽QRS波群规则性心动过速（心率150次/分钟）。血压为110/78 mm Hg。以下哪种药物在管理这种心律失常时最有用？", + "A": "艾司洛尔，35 mg 静脉注射", + "B": "胺碘酮，150 mg 静脉注射，持续10分钟", + "C": "腺苷，6 mg 快速静脉注射，持续3秒", + "D": "维拉帕米，5到10 mg 静脉注射" + } + }, + { + "id": "293083cf-28c1-552d-9ed1-46a853f3b4d7", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A 47-year-old patient with known hypertrophic obstructive cardiomyopathy (HOCM) is anesthetized with propofol and nasally intubated. After induction, his blood pressure rises to 180/120 mm Hg and heart rate rises to 110. One millimeter ST depression is noted on leads I, II, and AVF. Which of the following interventions would be most appropriate at this time?", + "A": "Esmolol 30 mg IV", + "B": "Start sodium nitroprusside infusion", + "C": "Start nitroglycerin infusion", + "D": "Deepen the volatile anesthetic with desflurane" + }, + "zh": { + "question": "一名47岁的患者已知患有肥厚性梗阻性心肌病（HOCM），在使用丙泊酚麻醉后经鼻插管。诱导后，他的血压升至180/120 mm Hg，心率升至110。在导联I、II和AVF上注意到1毫米的ST段压低。此时以下哪种干预措施最为合适？", + "A": "静脉注射艾司洛尔30 mg", + "B": "开始输注硝普钠", + "C": "开始输注硝酸甘油", + "D": "使用地氟烷加深挥发性麻醉" + } + }, + { + "id": "a9844ec7-08cb-5ed8-a068-d5abe12476d8", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "With pacemakers, the concept of upper tracking rate (UTR) is relevant with which type(s) of device?", + "A": "VDD", + "B": "DDI", + "C": "AAI", + "D": "All of the above" + }, + "zh": { + "question": "对于起搏器，上限跟踪率（UTR）的概念与哪种类型的设备相关？", + "A": "VDD", + "B": "DDI", + "C": "AAI", + "D": "以上所有" + } + }, + { + "id": "79812b0b-cddc-560e-9534-655352a162c3", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Calculate the cardiac output from the following data: patient weight 70 kg, hemoglobin concentration 10 mg/dL, arterial blood gases on 100% O2 : Pao2 450 mm Hg, Paco2 32 mm Hg, pH 7.46, Sao2 99%. Mixed venous blood gases are: Pvo2 30 mm Hg, Paco2 45 mm Hg, pH 7.32, Svo2 60%.", + "A": "1.5 L/min", + "B": "2.5 L/min", + "C": "3.5 L/min", + "D": "4.5 L/min" + }, + "zh": { + "question": "根据以下数据计算心输出量：患者体重70公斤，血红蛋白浓度10 mg/dL，100%氧气下的动脉血气：Pao2 450 mm Hg，Paco2 32 mm Hg，pH 7.46，Sao2 99%。混合静脉血气为：Pvo2 30 mm Hg，Paco2 45 mm Hg，pH 7.32，Svo2 60%。", + "A": "1.5 L/min", + "B": "2.5 L/min", + "C": "3.5 L/min", + "D": "4.5 L/min" + } + }, + { + "id": "352e00f0-58fb-5bea-bce1-2e2d804c06d9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Normal resting myocardial O2 consumption is", + "A": "2.0 mL/100 g/min", + "B": "3.5 mL/100 g/min", + "C": "8 mL/100 g/min", + "D": "15 mL/100 g/min" + }, + "zh": { + "question": "正常静息状态下心肌的氧耗量是", + "A": "2.0 mL/100 g/min", + "B": "3.5 mL/100 g/min", + "C": "8 mL/100 g/min", + "D": "15 mL/100 g/min" + } + }, + { + "id": "bdbde68c-4e6c-5e22-b09a-68d642c73d6e", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 22-year-old man with HOCM is undergoing an elective", + "A": "Ephedrine", + "B": "Epinephrine", + "C": "Isoproterenol", + "D": "Phenylephrine" + }, + "zh": { + "question": "一名22岁的男性患有肥厚型梗阻性心肌病（HOCM），正在接受择期手术", + "A": "麻黄碱", + "B": "肾上腺素", + "C": "异丙肾上腺素", + "D": "去氧肾上腺素" + } + }, + { + "id": "3dc8aa0b-80e9-544a-8c33-4d904fb86ec2", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A 65-year-old patient with moderate aortic stenosis develops a sudden increase in heart rate during an appendectomy under general anesthesia. The ventricular rate is 190 beats/min and is irregularly irregular, arterial blood pressure is 70/45 mm Hg, and there is 2-mm ST segment depression in lead V5 of the ECG. Which of the following would be the", + "A": "Electrical cardioversion", + "B": "Esmolol", + "C": "Phenylephrine", + "D": "Verapamil" + }, + "zh": { + "question": "一名65岁的中度主动脉瓣狭窄患者在全身麻醉下进行阑尾切除术时，心率突然增加。心室率为190次/分钟，呈不规则不齐，动脉血压为70/45 mm Hg，心电图V5导联显示2毫米ST段压低。以下哪项是", + "A": "电复律", + "B": "艾司洛尔", + "C": "去氧肾上腺素", + "D": "维拉帕米" + } + }, + { + "id": "d4e734d9-7b5b-5064-9357-0e5df17c21a7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "All of the following are TRUE concerning purely vasospastic angina EXCEPT", + "A": "Chest discomfort occurs most often at rest", + "B": "Pain may awaken the patient in the morning", + "C": "β-blockers suppress episodes", + "D": "Transient ST segment elevation occurs with the discomfort" + }, + "zh": { + "question": "以下关于纯粹血管痉挛性心绞痛的描��，除了哪一项外，其他都正确？", + "A": "胸部不适最常在休息时发生", + "B": "疼痛可能在早晨唤醒患者", + "C": "β-受体阻滞剂抑制发作", + "D": "不适时出现短暂的ST段抬高" + } + }, + { + "id": "d086452b-8b25-532c-814f-a5510a33b853", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Normal resting coronary artery blood flow is", + "A": "10 mL/100 g/min", + "B": "40 mL/100 g/min", + "C": "75 mL/100 g/min", + "D": "120 mL/100 g/min" + }, + "zh": { + "question": "正常静息状态下冠状动脉的血流量是", + "A": "10 mL/100 g/min", + "B": "40 mL/100 g/min", + "C": "75 mL/100 g/min", + "D": "120 mL/100 g/min" + } + }, + { + "id": "f4dcf969-daac-5bf9-b002-792fe28060fa", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Each of the following is associated with an increased incidence of PA rupture in patients with PA catheters EXCEPT", + "A": "Pulmonary hypertension", + "B": "Presence of PA atheromas", + "C": "Old age", + "D": "Anticoagulation" + }, + "zh": { + "question": "以下每种情况均与使用PA导管的患者中PA破裂的发生率增加有关，除了", + "A": "肺动脉高压", + "B": "存在肺动脉粥样硬化斑", + "C": "高龄", + "D": "抗凝" + } + }, + { + "id": "c97c43b4-3451-5a0f-9577-995fd4ee60c9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Allergic reactions to protamine can occur with each of the following EXCEPT", + "A": "Diabetes treated with NPH insulin", + "B": "Diabetes treated with regular insulin", + "C": "Diabetes treated with PZI insulin", + "D": "Previous vasectomy" + }, + "zh": { + "question": "以下哪种情况不会引起鱼精蛋白过敏反应？", + "A": "使用NPH胰岛素治疗的糖尿病", + "B": "使用常规胰岛素治疗的糖尿病", + "C": "使用PZI胰岛素治疗的糖尿病", + "D": "曾经做过输精管切除术" + } + }, + { + "id": "e93c35c6-bb50-50c2-a14f-8d0d28531ef3", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 66-year-old patient is undergoing a three-vessel coronary artery bypass operation. Anticoagulation is achieved with 20,000 units of heparin. How much protamine should be administered to this patient to completely reverse the heparin after cardiopulmonary bypass?", + "A": "100 mg", + "B": "200 mg", + "C": "300 mg", + "D": "400 mg" + }, + "zh": { + "question": "一名66岁的患者正在接受三支血管冠状动脉搭桥手术。通过使用20,000单位的肝素实现抗凝。在体外循环后，应给该患者注射多少鱼精蛋白以完全逆转肝素的作用？", + "A": "100毫克", + "B": "200毫克", + "C": "300毫克", + "D": "400毫克" + } + }, + { + "id": "358a528d-920e-5baa-a34c-898ac4e494eb", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "A 69-year-old man with an axial flow left VAD is anesthetized for kidney stone removal from the left ureter. The patient is \"dry,\" and blood pressure falls precipitously to a mean pressure of 51 mm Hg with no pulsatility on the arterial tracing. In addition to a fluid bolus, each of the other interventions would be useful EXCEPT", + "A": "Increase pump speed from 7800 to 8500 rpm", + "B": "Ephedrine", + "C": "Phenylephrine", + "D": "Trendelenburg position" + }, + "zh": { + "question": "一名69岁的男性患者，左侧装有轴流式心室辅助装置（VAD），正在接受左侧输尿管结石移除手术的麻醉。患者“干燥”，血压急剧下降至平均51 mm Hg，动脉波形上无搏动性。除了液体推注外，以下每种干预措施都将有用，除了", + "A": "将泵速从7800提高到8500转/分钟", + "B": "麻黄碱", + "C": "去氧肾上腺素", + "D": "特伦德伦堡体位" + } + }, + { + "id": "69976497-cfd3-5dfc-99e1-911527c2dc83", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The dose of adenosine necessary to convert paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm should be initially reduced", + "A": "In patients receiving theophylline for chronic asthma", + "B": "In patients with a history of arterial thrombotic disease taking dipyridamole", + "C": "In patients with a history of chronic renal failure", + "D": "In chronic alcoholics" + }, + "zh": { + "question": "将阵发性室上性心动过速（PSVT）转为正常窦性心律所需的腺苷剂量应初步减少", + "A": "在接受茶碱治疗慢性哮喘的患者中", + "B": "在有动脉血栓病史并服用双嘧达莫的患者中", + "C": "在有慢性肾功能衰竭病史的患者中", + "D": "在慢性酗酒者中" + } + }, + { + "id": "0dd46625-3c4d-5697-bbf1-4872c68f4b7a", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 56-year-old male patient is anesthetized for elective coronary revascularization. A urinary catheter is placed after induction and coupled to a temperature transducer. A PA catheter is inserted, and the temperature probe on the distal portion of the catheter is also connected to a transducer. The reason for measuring the temperature of both the bladder and the blood in the pulmonary vasculature is", + "A": "Both are necessary for determining cardiac output by the thermodilution technique", + "B": "Bladder temperature is more accurate prebypass; PA catheter temperature is more accurate postbypass", + "C": "PA catheter temperature is more accurate prebypass; bladder temperature is more accurate postbypass", + "D": "It is helpful in determining the likelihood of temperature \"after-drop\" following discontinuation of cardiopulmonary bypass" + }, + "zh": { + "question": "一名56岁的男性患者接受选择性冠状动脉血运重建术的麻醉。在诱导后放置了导尿管并连接到温度传感器。插入了PA导管，并将导管远端的温度探头也连接到传感器。测量膀胱和肺血管中血液温度的原因是", + "A": "两者都是通过热稀释技术确定心输出量所必需的", + "B": "膀胱温度在旁路前更准确；PA导管温度在旁路后更准确", + "C": "PA导管温度在旁路前更准确；膀胱温度在旁路后更准确", + "D": "这有助于确定停用体外循环后温度“下降”的可能性" + } + }, + { + "id": "c42e30da-e4a5-505f-9fc2-82f61d13b6e6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following would be the best intraoperative TEE view to monitor for myocardial ischemia?", + "A": "Midesophageal four-chamber view", + "B": "Transgastric midpapillary left ventricular short axis view", + "C": "Midesophageal long axis view", + "D": "Midesophageal two-chamber view" + }, + "zh": { + "question": "以下哪种术中经食管超声心动图（TEE）视图最适合监测心肌缺血？", + "A": "中食管四腔心视图", + "B": "经胃中乳头肌左心室短轴视图", + "C": "中食管长轴视图", + "D": "中食管二腔心视图" + } + }, + { + "id": "0a3d0efd-c98a-58b2-b169-3d122826b423", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Select the TRUE statement regarding cardiopulmonary resuscitation (CPR) and defibrillation by a health care provider in patients experiencing sudden cardiac arrest.", + "A": "Defibrillation times one should always precede CPR", + "B": "CPR should always be carried out for 2 minutes before defibrillation", + "C": "Two minutes of chest compressions alone (no ventilation) should be carried out before first shock", + "D": "If arrest less than 1 minute (witnessed), deliver one biphasic shock, then five cycles of CPR" + }, + "zh": { + "question": "选择关于心肺复苏术（CPR）和医疗保健提供者在患者发生心脏骤停时进行除颤的正确陈述。", + "A": "除颤一次应始终在CPR之前进行", + "B": "CPR应始终在除颤前进行2分钟", + "C": "在第一次电击前应进行两分钟的单独胸部按压（无通气）", + "D": "如果心脏骤停少于1分钟（目击），则进行一次双相电击，然后进行五个循环的CPR" + } + }, + { + "id": "97867ec3-5e01-573a-80d9-d476b5ce5ead", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following medications blocks angiotensin at the receptor?", + "A": "Losartan (Cozaar)", + "B": "Terazosin (Hytrin)", + "C": "Lisinopril (Prinivil, Zestril)", + "D": "Spironolactone (Aldactone)" + }, + "zh": { + "question": "以下哪种药物在受体处阻断血管紧张素？", + "A": "���沙坦（可zaar）", + "B": "特拉唑嗪（海特林）", + "C": "赖诺普利（普利尼维尔，泽斯特里尔）", + "D": "螺内酯（安体舒通）" + } + }, + { + "id": "9baa5134-43a6-5e87-8ba3-30a1ae5eb44f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Untoward effects associated with administration of sodium bicarbonate during massive blood transfusion include each of the following", + "A": "Hyperkalemia", + "B": "Paradoxical cerebrospinal fluid acidosis", + "C": "Hypercarbia", + "D": "Hypernatremia" + }, + "zh": { + "question": "在大量输血过程中使用碳酸氢钠可能导致的不良反应包括以下哪项", + "A": "高钾血症", + "B": "矛盾性脑脊液酸中毒", + "C": "高碳酸血症", + "D": "高钠血症" + } + }, + { + "id": "b5b31c0d-d26b-5037-92e1-714e6ec99597", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Useful therapy for hypercyanotic \"tet spells\" in patients with tetralogy of Fallot might include any of the following EXCEPT", + "A": "Esmolol", + "B": "Morphine", + "C": "Phenylephrine", + "D": "Isoproterenol" + }, + "zh": { + "question": "对患有法洛四联症的患者，治疗高紫绀性“发作”的有效疗法可能包括以下任何一种，除了", + "A": "艾司洛尔", + "B": "吗啡", + "C": "苯肾上腺素", + "D": "异丙肾上腺素" + } + }, + { + "id": "952c06cc-c4e1-5d9e-9ee3-5f3c56b21cf1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Sildenafil (Viagra) belongs to the same class of drugs as which of the following?", + "A": "Yohimbine", + "B": "Hydralazine", + "C": "Enalapril", + "D": "Milrinone" + }, + "zh": { + "question": "西地那非（伟哥）与以下哪种药物属于同一类药物？", + "A": "育亨宾", + "B": "肼屈嗪", + "C": "依那普利", + "D": "米力农" + } + }, + { + "id": "c93d01e2-ff62-5787-a9b8-5dfa3c19df76", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the minimal time after angioplasty and placement of a drugeluting stent (DES) that dual antiplatelet therapy (DAPT) should be continued before considering stopping it for elective surgery?", + "A": "3 months", + "B": "6 months", + "C": "1 year", + "D": "18 months" + }, + "zh": { + "question": "在血管成形术和放置药物洗脱支架（DES）后，双重抗血小板治疗（DAPT）应持续多长时间，才可以考虑在择期手术前停止？", + "A": "3个月", + "B": "6个月", + "C": "1年", + "D": "18个月" + } + }, + { + "id": "3efdbacd-3ab5-5c3b-a51c-726e5357a4cc", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Bivalirudin is used as an anticoagulant for cardiopulmonary bypass primarily in patients with", + "A": "Heparin resistance", + "B": "Protamine allergy", + "C": "HIT type I", + "D": "HIT type II" + }, + "zh": { + "question": "比伐卢定主要用于心肺转流的抗凝治疗，适用于以下哪类患者", + "A": "肝素抵抗", + "B": "鱼精蛋白过敏", + "C": "HIT I型", + "D": "HIT II型" + } + }, + { + "id": "b65f34fc-d655-5149-b60b-9e9e2adb7262", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following anatomic sites is associated with the LEAST incidence of central line infection?", + "A": "Internal jugular vein", + "B": "External jugular vein", + "C": "Subclavian vein", + "D": "Femoral vein" + }, + "zh": { + "question": "以下哪个解剖部位与中心静脉导管感染的发生率最低相关？", + "A": "颈内静脉", + "B": "颈外静脉", + "C": "锁骨下静脉", + "D": "股静脉" + } + }, + { + "id": "facebd43-f7b7-5411-9b2b-2c852e6b1f04", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The effects of clopidogrel (Plavix) can be reversed with", + "A": "Fresh frozen plasma", + "B": "Factor VIII concentrate", + "C": "Aprotinin", + "D": "None of the above" + }, + "zh": { + "question": "氯吡格雷（Plavix）的作用可以通过以下哪种方式逆转", + "A": "新鲜冰冻血浆", + "B": "凝血因子VIII浓缩物", + "C": "抑肽酶", + "D": "以上都不是" + } + }, + { + "id": "2880a14c-f7a6-5ef5-a4c3-bfcb518ba201", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A disadvantage of port access coronary artery bypass surgery utilizing", + "A": "Need for hypothermic cardiac arrest", + "B": "Greater incidence of intraoperative hypoxia", + "C": "Greater incidence of trauma to sternum", + "D": "Increased transfusion requirements" + }, + "zh": { + "question": "使用端口通路冠状动脉旁路手术的一个缺点是", + "A": "需要低温心脏停搏", + "B": "术中低氧的发生率更高", + "C": "胸骨创伤的发生率更高", + "D": "输血需求增加" + } + }, + { + "id": "09b0a824-d5f2-5193-b54c-1bab096fec00", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "Which of the following maneuvers (after assuring proper tube placement) is LEAST likely to raise the Pao2 during one-lung ventilation with a double-lumen endotracheal tube?", + "A": "Continuous positive airway pressure (CPAP) to the nondependent lung", + "B": "Positive end-expiratory pressure (PEEP) to the dependentlung", + "C": "Continuous infusion of epoprostenol (Flolan) via central line", + "D": "Raising MAP from 60 to 85 mm Hg" + }, + "zh": { + "question": "在使用双腔气管导管进行单肺通气时，以下哪种操作（在确保导管正确放置后）最不可能提高Pao2？", + "A": "对非依赖肺进行持续气道正压通气（CPAP）", + "B": "对依赖肺进行呼气末正压通气（PEEP）", + "C": "通过中心静脉持续输注前列环素（Flolan）", + "D": "将平均动脉压从60 mm Hg提高到85 mm Hg" + } + }, + { + "id": "46dc959b-6fbf-546d-9e57-8d3767666c7f", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following drugs or interventions will cause the LEAST increase in heart rate in the transplanted denervated heart?", + "A": "Glucagon", + "B": "Atropine", + "C": "Isoproterenol", + "D": "Norepinephrine" + }, + "zh": { + "question": "以下哪种药物或干预措施对移植的去神经心脏的心率增加最小？", + "A": "胰高血糖素", + "B": "阿托品", + "C": "异丙肾上腺素", + "D": "去甲肾上腺素" + } + }, + { + "id": "2dfa8d77-bf57-5dc0-ac06-fa5542bd58cf", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A patient with known Wolff-Parkinson-White (WPW) syndrome develops a wide complex tachycardia during a hernia operation under general anesthesia. Vital signs are stable, and pharmacologic treatment is desired. Which of the following drugs is MOST likely to be successful in controlling heart rate in this patient?", + "A": "Verapamil", + "B": "Esmolol", + "C": "Adenosine", + "D": "Procainamide" + }, + "zh": { + "question": "一名已知患有沃尔夫-帕金森-怀特（WPW）综合征的患者在全身麻醉下进行疝气手术时出现宽QRS波心动过速。生命体征稳定，需要药物治疗。以下哪种药物最有可能成功控制该患者的心率？", + "A": "维拉帕米", + "B": "艾司洛尔", + "C": "腺苷", + "D": "普鲁卡因酰胺" + } + }, + { + "id": "a3831dd6-d4db-5634-8a2b-d251f3656e8d", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 63-year-old patient with a DDD-R pacemaker is scheduled for right hemicolectomy. The indication for pacemaker implantation was sick sinus syndrome, and the pacemaker has been reprogrammed to the asynchronous (DOO) mode at a rate of 70 for surgery. After induction, the patient's native heart rate rises to 85 beats/min with blood pressure 130/90 mm Hg. Which of the following actions would be MOST appropriate?", + "A": "Turn off pacemaker for duration of case", + "B": "Administer lidocaine", + "C": "Administer esmolol", + "D": "Observe" + }, + "zh": { + "question": "一名63岁的患者安装了DDD-R起搏器，计划进行右半结肠切除术。起搏器植入的指征是病态窦房结综合征，起搏器已重新编程为异步（DOO）模式，手术时速率为70。诱导后，患者的自主心��上升到85次/分钟，血压为130/90 mm Hg。以下哪项措施最为合适？", + "A": "在手术期间关闭起搏器", + "B": "给予利多卡因", + "C": "给予艾司洛尔", + "D": "观察" + } + }, + { + "id": "4985ba37-f3d7-5435-85ed-c6cff8d950b0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The main advantage of milrinone is that it lacks which side effect, compared with amrinone, for long-term use?", + "A": "Tachycardia", + "B": "Hypothyroidism", + "C": "Thrombocytopenia", + "D": "Hyperglycemia" + }, + "zh": { + "question": "与氨力农相比，米力农的主要优点是长期使用时缺乏哪种副作用？", + "A": "心动过速", + "B": "甲状腺功能减退", + "C": "血小板减少", + "D": "高血糖" + } + }, + { + "id": "33e9e604-0d3f-5433-9fa7-aa5bb1591ae4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Systemic inflammatory response syndrome (SIRS) differs from sepsis in", + "A": "A normal temperature", + "B": "A heart rate less than 90 beats/min", + "C": "A normal white blood cell count", + "D": "No documented infection" + }, + "zh": { + "question": "全身炎症反应综合征（SIRS）与脓毒症的区别在于", + "A": "正常体温", + "B": "心率小于90次/分钟", + "C": "正常白细胞计数", + "D": "无记录的感染" + } + }, + { + "id": "d11558f4-e381-53c5-b4f1-82580c8f1519", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Arrange the percutaneous insertion sites from nearest to farthest for placement of a PA catheter.", + "A": "Left internal jugular, right internal jugular, antecubital, femoral", + "B": "Right internal jugular, left internal jugular, antecubital, femoral", + "C": "Right internal jugular, left internal jugular, femoral, antecubital", + "D": "Left internal jugular, right internal jugular, femoral, antecubital" + }, + "zh": { + "question": "将经皮插入部位从最近到最远排列，以放置PA导管。", + "A": "左侧颈内静脉、右侧颈内静脉、肘前、股静脉", + "B": "右侧颈内静脉、左侧颈内静脉、肘前、股静脉", + "C": "右侧颈内静脉、左侧颈内静脉、股静脉、肘前", + "D": "左侧颈内静脉、右侧颈内静脉、股静脉、肘前" + } + }, + { + "id": "c7c50d0e-5214-5e5e-9270-48d0e33b9e3a", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A PA catheter capable of continuously monitoring is placed in a patient for coronary artery bypass surgery. Just before instituting cardiopulmonary bypass, the falls from 85% to 71%. Which of the following could account for this change in ?", + "A": "Cooling the patient to 27° C", + "B": "Transfusion of two units of packed red blood cells", + "C": "Epinephrine, 25 μg IV", + "D": "Myocardial ischemia" + }, + "zh": { + "question": "一名患者在进行冠状动脉搭桥手术时置入了一根能够连续监测的PA导管。在开始体外循环之前， 从85%下降到71%。以下哪项可以解释这种变化？", + "A": "将患者冷却至27°C", + "B": "输注两单位浓缩红细胞", + "C": "静脉注射25微克肾上腺素", + "D": "心肌缺血" + } + }, + { + "id": "d420f6cc-8c04-5853-8f56-7a0d321843cc", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following terms refers to myocardial relaxation or diastole?", + "A": "Inotropy", + "B": "Chronotropy", + "C": "Dromotropy", + "D": "Lusitropy" + }, + "zh": { + "question": "以下哪个术语指的是心肌松弛或舒张？", + "A": "肌力", + "B": "心率", + "C": "传导性", + "D": "舒张性" + } + }, + { + "id": "6274295f-8d06-5bdd-878a-dbd507a043b2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 31-year-old female with primary pulmonary hypertension is scheduled for a mastectomy. Pharmacologic agents that might be useful in reducing pulmonary vascular resistance (PVR) include each of the following EXCEPT", + "A": "Prostaglandin I2 (epoprostenol)", + "B": "Oxygen", + "C": "Nitrous oxide", + "D": "Milrinone" + }, + "zh": { + "question": "一名31岁的女性患有原发性肺动脉高压，计划进行乳房切除术。可能有助于降低肺血管阻力（PVR）的药理制剂包括以下各项，除了", + "A": "前列环素I2（依前列醇）", + "B": "氧气", + "C": "一氧化二氮", + "D": "米力农" + } + }, + { + "id": "aafb5a86-5ebe-51e0-8407-f0d5518716b9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "PVR as a function of lung volume is the LEAST at which volume?", + "A": "Total lung volume", + "B": "Residual volume", + "C": "Functional residual capacity (FRC)", + "D": "Expiratory reserve volume" + }, + "zh": { + "question": "肺血管阻力（PVR）作为肺容量的函数在哪个容量时最小？", + "A": "总肺容量", + "B": "残气量", + "C": "功能残气量（FRC）", + "D": "呼气储备容量" + } + }, + { + "id": "e02b5000-ab03-5991-a079-c5e6516eb3bf", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A 45-year-old patient with hypertrophic cardiomyopathy is anesthetized for skin grafting after suffering third-degree burns on his legs. As skin is harvested from his back, his heart rate rises and his systolic blood pressure falls to 85 mm Hg. Which of the following interventions is LEAST likely to improve this patient's hemodynamics?", + "A": "Administration of esmolol", + "B": "Fluid bolus", + "C": "Dobutamine infusion", + "D": "Administration of sufentanil" + }, + "zh": { + "question": "一名45岁的肥厚型心肌病患者在腿部遭受三度烧伤后接受皮肤移植麻醉。当从他的背部取皮时，他的心率上升，收缩压降至85 mm Hg。以下哪种干预措施最不可能改善该患者的血流动力学？", + "A": "给予艾司洛尔", + "B": "液体推注", + "C": "多巴酚丁胺输注", + "D": "给予舒芬太尼" + } + }, + { + "id": "a7234dab-9479-5930-9ae2-8dc9a3bbd3a5", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 59-year-old patient is scheduled for right knee replacement. The patient has a long history of CHF with 87% oxygen saturation while breathing room air in the holding area. Rales are audible throughout both lung fields with the patient upright. The MOST appropriate plan would be", + "A": "Arterial line and spinal with isobaric bupivacaine", + "B": "Arterial line, etomidate induction, sevoflurane, intraoperative TEE", + "C": "Arterial line, CVP line, ketamine induction, N2O narcotic anesthetic, furosemide, milrinone", + "D": "Cancel the case" + }, + "zh": { + "question": "一名59岁的患者计划进行右膝置换手术。患者有长期的充血性心力衰竭病史，在准备区呼吸室内空气时氧饱和度为87%。患者直立时在两侧肺野均可听到湿啰音。最合适的计划是", + "A": "动脉导管和等比重布比卡因脊髓麻醉", + "B": "动脉导管、依托咪酯诱导、七氟醚、术中经食道超声", + "C": "动脉导管、中心静脉压导管、氯胺酮诱导、笑气麻醉、呋塞米、米力农", + "D": "取消手术" + } + }, + { + "id": "85c49f73-1671-5d13-9bdd-467cc2aeb75d", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "You are called to the postanesthesia care unit to see a patient who had undergone a general anesthetic for a debridement of an infected sternum after aortic valve surgery 3 weeks earlier. The patient has a heart rate of 110 and a respiratory rate of 24 and is confused. The blood pressure is 85/40 mm Hg.", + "A": "Septic shock", + "B": "SIRS syndrome", + "C": "Sepsis", + "D": "Severe septic shock" + }, + "zh": { + "question": "你被叫到麻醉后护理单元去看一位在3周前进行过主动脉瓣手术后因感染的胸骨清创而接受全身麻醉的病人。该病人的心率为110，呼吸频率为24，并且意识模糊。血压为85/40 mm Hg。", + "A": "感染性休克", + "B": "全身炎症反应综合征", + "C": "脓毒症", + "D": "严重感染性休克" + } + }, + { + "id": "06a06159-8849-5bfb-9abc-e5d44ee396a3", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "You made an infusion of dopamine by mixing 200 mg of dopamine in 250 mL of sodium chloride (NS) or 5% dextrose injection (D5W). What is the infusion pump rate when infusing dopamine at a rate of 5 μg/kg/min for this 70-kg patient?", + "A": "10 mL/hr", + "B": "16 mL/hr", + "C": "20 mL/hr", + "D": "26 mL/hr" + }, + "zh": { + "question": "你通过将200毫克多巴胺混合在250毫升氯化钠（NS）或5%葡萄糖注射液（D5W）中制成多巴胺输液。对于这位70公斤的患者，以5微克/公斤/分钟的速度输注多巴胺时，输液泵的速度是多少？", + "A": "10毫升/小时", + "B": "16毫升/小时", + "C": "20毫升/小时", + "D": "26毫升/小时" + } + }, + { + "id": "ef304489-c4cc-509f-b590-60e6f28248c8", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A 79-year-old patient returns to the operating room with cardiac tamponade after three-vessel coronary artery grafting. In addition to gentle positive-pressure ventilation, which of the following permutations in hemodynamics would be MOST beneficial in this scenario?", + "A": "Increased preload, slow heart rate, increased afterload", + "B": "Normal preload, slow heart rate, decreased afterload", + "C": "Normal preload, fast heart rate, decreased afterload", + "D": "Increased preload, fast heart rate, increased afterload" + }, + "zh": { + "question": "一名79岁的患者在进行三支冠状动脉搭桥术后因心脏压塞返回手术室。除了轻柔的正压通气外，以下哪种血流动力学变化在这种情况下最有利？", + "A": "增加前负荷，心率慢，增加后负荷", + "B": "正常前负荷，心率慢，减少后负荷", + "C": "正常前负荷，心率快，减少后负荷", + "D": "增加前负荷，心率快，增加后负荷" + } + }, + { + "id": "c4479f03-9d3e-5db0-8052-42efadc0bc6f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Normal or increased PR interval, short QT interval", + "A": "Hypokalemia", + "B": "Hyperkalemia", + "C": "Hyponatremia", + "D": "Hypercalcemia# Cardiovascular Physiology and Anesthesia#" + }, + "zh": { + "question": "正常或延长的PR间期，缩短的QT间期", + "A": "低钾血症", + "B": "高钾血症", + "C": "低钠血症", + "D": "高钙血症# 心血管生理学与麻醉#" + } + }, + { + "id": "a0a9fd63-3ae6-5f51-83b5-01417e61c4fa", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What mixture of gases are used in anesthesia?", + "A": "O2 and N2O", + "B": "O2 and CO2", + "C": "CO2 and N2O", + "D": "O2 , CO2 and N2O" + }, + "zh": { + "question": "麻醉中使用哪种气体混合物？", + "A": "O2 和 N2O", + "B": "O2 和 CO2", + "C": "CO2 和 N2O", + "D": "O2、CO2 和 N2O" + } + }, + { + "id": "3ae425ee-8e9f-52bd-8fe6-4a786086a62d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The oxygen flush system provides a higher flow of oxygen of ________ L/min when the patient’s need for oxygen is greater than the amount the breathing circuit can provide.", + "A": "25-50", + "B": "35-75", + "C": "55-95", + "D": "65-105" + }, + "zh": { + "question": "当患者对氧气的需求大于呼吸回路所能提供的量时，氧气冲洗系统提供的氧气流量为 ________ L/min。", + "A": "25-50", + "B": "35-75", + "C": "55-95", + "D": "65-105" + } + }, + { + "id": "75af16ed-912d-5483-af01-6e5da1651001", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "One of the methods to measure changes in the levels of consciousness during anesthesia is ________", + "A": "Auditory Evoked Potential", + "B": "Visual Evoked Potential", + "C": "Tactile Evoked Potential", + "D": "Speech Evoked Potential" + }, + "zh": { + "question": "在麻醉期间测量意识水平变化的方法之一是 ________", + "A": "听觉诱发电位", + "B": "视觉诱发电位", + "C": "触觉诱发电位", + "D": "言语诱发电位" + } + }, + { + "id": "4812962e-ef27-531f-928f-e18da2c9aa33", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "AEP stands for ________", + "A": "Auditory Evoked Potential", + "B": "Auxiliary Evoked Potential", + "C": "Audiovisual Evoked Potential", + "D": "Ambulatory Evoked Potential" + }, + "zh": { + "question": "AEP 代表 ________", + "A": "听觉诱发电位", + "B": "辅助诱发电位", + "C": "视听诱发电位", + "D": "动态诱发电位" + } + }, + { + "id": "91762ee4-a09e-5058-a6cb-b6d3484347c4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What causes the pre-selected volume of air to flow into the patient by communicating directly with a breathing circuit?", + "A": "Nebulizer", + "B": "Microcontroller", + "C": "Bellows", + "D": "Humidifier" + }, + "zh": { + "question": "是什么通过直接与呼吸回路通信使预选的空气量流入患者？", + "A": "雾化器", + "B": "微控制器", + "C": "风箱", + "D": "加湿器" + } + }, + { + "id": "5c2f943d-54a3-511d-ad9b-8ede1e668607", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the function of a nebulizer?", + "A": "To supply moisture in the form of droplets", + "B": "To maintain temperature", + "C": "To maintain the gas levels of individual gases", + "D": "To check the safety of valves" + }, + "zh": { + "question": "雾化器的功能是什么？", + "A": "提供以液滴形式存在的湿气", + "B": "保持温度", + "C": "维持各个气体的气体水平", + "D": "检查阀门的安全性" + } + }, + { + "id": "9f64aace-7bd4-5add-b64a-c839c0f48731", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is one of the crucial reasons for lung compliance to fall?", + "A": "Wet gases", + "B": "Dry gases", + "C": "High temperature gases", + "D": "Low temperature gases" + }, + "zh": { + "question": "导致肺顺应性下降的一个关键原因是什么？", + "A": "湿气体", + "B": "干气体", + "C": "高温气体", + "D": "低温气体" + } + }, + { + "id": "cafb9618-d650-58e3-b740-e4cbd6072736", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "_______ is the most commonly used material for vapourizer.", + "A": "Steel", + "B": "Cast iron", + "C": "copper", + "D": "Brass" + }, + "zh": { + "question": "_______ 是蒸发器最常用的材料。", + "A": "钢", + "B": "铸铁", + "C": "铜", + "D": "黄铜" + } + }, + { + "id": "4ce54ba9-c3b0-5096-aa45-d9df0bdc36ad", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The gas pressure supplied by the hospital is maintained at the wall outlet at______ kPa.", + "A": "275-345", + "B": "245-325", + "C": "266-376", + "D": "225-315" + }, + "zh": { + "question": "医院提供的气体压力在墙壁出口处维持在______ kPa。", + "A": "275-345", + "B": "245-325", + "C": "266-376", + "D": "225-315" + } + }, + { + "id": "0af44b30-18db-5883-bb0d-019c12e6255b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": " Which of the following is known as laughing gas?", + "A": "CO2", + "B": "N2O", + "C": "NO2", + "D": "B2O" + }, + "zh": { + "question": "以下哪种被称为笑气？", + "A": "CO2", + "B": "N2O", + "C": "NO2", + "D": "B2O" + } + }, + { + "id": "d29d2510-1e5c-5b28-acc0-7876ee63d2c9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "After oxygenation of blood, what is the percentage of oxygen carried by hemoglobin?", + "A": "70 %", + "B": "75 %", + "C": "87 %", + "D": "97 %" + }, + "zh": { + "question": "血液氧合后，血红蛋白携带的氧气百分比是多少？", + "A": "70 %", + "B": "75 %", + "C": "87 %", + "D": "97 %" + } + }, + { + "id": "f80f52dc-a985-5a1b-9359-4345659cbb1e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the pressure of gases maintained in medical air supply?", + "A": "300 – 345 kPa", + "B": "345 – 380 kPa", + "C": "380 – 400 kPa", + "D": "400 – 425 kPa" + }, + "zh": { + "question": "医疗空气供应中气体的压力是多少？", + "A": "300 – 345 kPa", + "B": "345 – 380 kPa", + "C": "380 – 400 kPa", + "D": "400 – 425 kPa" + } + }, + { + "id": "351b7f71-e596-55e2-955a-6b643b5d8118", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the residual capacity of the lungs?", + "A": "2000 ml", + "B": "2300 ml", + "C": "2500 ml", + "D": "2700 ml" + }, + "zh": { + "question": "肺的残余容量是多少？", + "A": "2000 毫升", + "B": "2300 毫升", + "C": "2500 毫升", + "D": "2700 毫升" + } + }, + { + "id": "c6b0ef30-64f6-567b-9c22-260c56897987", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What all modes exist in ventilator?", + "A": "Neonatal mode, normal mode", + "B": "Normal mode, geriatric mode", + "C": "Neonatal mode, normal mode, geriatric mode", + "D": "Neonatal mode, pediatric mode, normal mode, geriatric mode" + }, + "zh": { + "question": "呼吸机有哪些模式？", + "A": "新生儿模式，普通模式", + "B": "普通模式，老年模式", + "C": "新生儿模式，普通模式，老年模式", + "D": "新生儿模式，儿童模式，普通模式，老年模式" + } + }, + { + "id": "8ffe6603-669e-5f19-b7d9-f776334b8f2e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The operation which allows air to be given directly in the trachea is called ________", + "A": "Tracheotomy", + "B": "Vasectomy", + "C": "Disc Prolapse", + "D": "Clog Removing" + }, + "zh": { + "question": "允许空气直接进入气管的手术称为 ________", + "A": "气管切开术", + "B": "输精管切除术", + "C": "椎间盘突出", + "D": "堵塞清除" + } + }, + { + "id": "a133206e-5f1a-561f-ba0a-48b98164b991", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The pump used to pump air mechanically into the respiratory tract __________", + "A": "Mechanical Pump", + "B": "Ventilator", + "C": "Ambulatory Bag", + "D": "CPR" + }, + "zh": { + "question": "用于机械地将空气泵入呼吸道的泵是 __________", + "A": "机械泵", + "B": "呼吸机", + "C": "便携式呼吸袋", + "D": "心肺复苏" + } + }, + { + "id": "e1423f23-8e0b-5e72-8ee1-a8d38c85d3c2", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "A ventilator can sometimes cause a disruption in the normal breathing pattern.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "呼吸机有时会导致正常呼吸模式的中断。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "e2b5a093-3d79-53cf-82ee-b0cd1829de21", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Prolonged bed rest can lead to which problem?", + "A": "Tuberculosis", + "B": "Diarrhea", + "C": "Cholera", + "D": "Hyper Tension" + }, + "zh": { + "question": "长期卧床休息可能导致哪个问题？", + "A": "结核病", + "B": "腹泻", + "C": "霍乱", + "D": "高血压" + } + }, + { + "id": "9db9aa09-b961-5ef8-9e2c-d3f24978af21", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The first anesthesia used was ___________", + "A": "polyvinyl chloride", + "B": "trichloro methane", + "C": "chlorofluorocarbon", + "D": "tetra fluorocarbon" + }, + "zh": { + "question": "最早使用的麻醉剂是 ___________", + "A": "聚氯乙烯", + "B": "三氯甲烷", + "C": "氯氟烃", + "D": "四氟碳" + } + }, + { + "id": "0e2dc92f-3a6f-57ea-85cf-f92711605c50", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following parameters does not affect anesthesia?", + "A": "Blood pressure", + "B": "Blood sugar", + "C": "Temperature", + "D": "Moisture content of the exhaled air" + }, + "zh": { + "question": "下列哪个参数不影响麻醉？", + "A": "血压", + "B": "血糖", + "C": "体温", + "D": "呼出气体的湿度" + } + }, + { + "id": "ae35245e-ce21-56a9-99ee-6f09ce356846", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Obesity can pose a risk of anesthesia.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "肥胖可能会增加麻醉的风险。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "041b62a8-1bdc-5c5e-b759-cd6e9ebe3988", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is epidural?", + "A": "A type of anesthesia used during childbirth", + "B": "A type of anesthesia used for implants", + "C": "A type of anesthesia used for rheumatic surgery", + "D": "A type of anesthesia used for renal transplant" + }, + "zh": { + "question": "什么是硬膜外麻醉？", + "A": "一种用于分娩的麻醉类型", + "B": "一种用于植入手术的麻醉类型", + "C": "一种用于风湿手术的麻醉类型", + "D": "一种用于肾移植的麻醉类型" + } + }, + { + "id": "95e63edc-10ab-53fb-be6d-2c2e859bdb4c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The anesthesia applied directly to the skin is ___________", + "A": "Topical Anesthesia", + "B": "Caudal Anesthesia", + "C": "Local Blocks", + "D": "General Anesthesia" + }, + "zh": { + "question": "直接应用于皮肤的麻醉是 ___________", + "A": "表面麻醉", + "B": "尾部麻醉", + "C": "局部阻滞", + "D": "全身麻醉" + } + }, + { + "id": "e943ec63-6841-5bcc-baad-557c813300e7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "In a caudal block, where is the anesthesia injected?", + "A": "Thoracic Canal", + "B": "Lumbar Canal", + "C": "Sacral Canal", + "D": "Coccyx Canal" + }, + "zh": { + "question": "在尾部阻滞中，麻醉药注射到哪里？", + "A": "胸椎管", + "B": "腰椎管", + "C": "骶管", + "D": "尾椎管" + } + }, + { + "id": "edcbc842-e02a-5ab3-b552-20418c361ff6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In this type of anesthesia, all the impulses from a nerve are blocked.", + "A": "Nerve Blocks", + "B": "Spinal Anesthesia", + "C": "Topical Anesthesia", + "D": "Epidural Blocks" + }, + "zh": { + "question": "在这种类型的麻醉中，来自神经的所有冲动都被阻断。", + "A": "神经阻滞", + "B": "脊髓麻醉", + "C": "表面麻醉", + "D": "硬膜外阻滞" + } + }, + { + "id": "72332500-b186-5bbb-816e-714c6f280b82", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "In a spinal anesthesia, where all is the anesthetic injected?", + "A": "1st and 2nd thoracic space, 11th and 12th thoracic space", + "B": "3rd and 4th Lumbar space, 5th lumbar and 1st sacral space", + "C": "7th cervical and 1st thoracic space, 12th thoracic and 1st lumbar space", + "D": "1st and 2nd lumbar space, 4th and 5th lumbar space" + }, + "zh": { + "question": "在脊髓麻醉中，麻醉剂注射在哪里？", + "A": "第1和第2胸椎间隙，第11和第12胸椎间隙", + "B": "第3和第4腰椎间隙，第5腰椎和第1骶椎间隙", + "C": "第7颈椎和第1胸椎间隙，第12胸椎和第1腰椎间隙", + "D": "第1和第2腰椎间隙，第4和第5腰椎间隙" + } + }, + { + "id": "79f2a579-271a-5e73-8856-6f653893b81d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": " In which of these sub cutaneous infiltration with a desensitizing agent is done?", + "A": "Saddle Blocks", + "B": "Epidural Blocks", + "C": "Local Blocks", + "D": "General Anesthesia" + }, + "zh": { + "question": "在以下哪种情况下进行皮下浸润以使用脱敏剂？", + "A": "鞍麻", + "B": "硬膜外麻醉", + "C": "局部麻醉", + "D": "全身麻醉" + } + }, + { + "id": "0194ea2d-4282-5225-99f6-f498d1907770", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Immediately after the surgery, the patient is usually shifted to _____________", + "A": "ICU", + "B": "PACU", + "C": "CCU", + "D": "Recovery room" + }, + "zh": { + "question": "手术后立即将患者转移到_____________", + "A": "ICU", + "B": "PACU", + "C": "CCU", + "D": "恢复室" + } + }, + { + "id": "ad1d73e6-3bb7-5002-af7a-a1d32779b34f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In the usual preparation for general surgery, the client may be __________", + "A": "Given specifically ordered oral medications with small amounts of water", + "B": "Given ice chips", + "C": "NPO for 12 to 14 hours before", + "D": "Allowed regular diet" + }, + "zh": { + "question": "在通常的全身手术准备中，患者可能会被__________", + "A": "给予特定口服药物并用少量水送服", + "B": "给予冰块", + "C": "术前禁食12到14小时", + "D": "允许正常饮食" + } + }, + { + "id": "4e229734-b8ec-5d01-8e75-6558d33da16d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "If a nurse finds that a patient’s abdominal wound has eviscerated, she should ________", + "A": "Administer antibiotics", + "B": "Position the patient sideways and call for help", + "C": "Attempt to drain the site", + "D": "Cover the site with saline-soaked sterile gauze" + }, + "zh": { + "question": "如果护士发现病人的腹部伤口已外翻，她应该________", + "A": "使用抗生素", + "B": "将病人侧卧并呼救", + "C": "尝试引流伤口", + "D": "用生理盐水浸湿的无菌纱布覆盖伤口" + } + }, + { + "id": "62ec8d85-c9e1-563f-8b18-03824ac11913", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "After surgery, an incentive spirometer is used to prevent _________", + "A": "Lung collapse", + "B": "Gastric and intestinal problems", + "C": "Elevated blood pressure", + "D": "Blood Clotting" + }, + "zh": { + "question": "手术后，使用激励性肺量计来预防_________", + "A": "肺塌陷", + "B": "胃肠问题", + "C": "血压升高", + "D": "血液凝固" + } + }, + { + "id": "63ddeb4c-4188-51e0-9de3-105d543a6d25", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the ideal time interval for patient monitoring in the Postanesthesia care unit?", + "A": "Every hour", + "B": "Every 15 mins", + "C": "Every 30 mins", + "D": "Every 10 mins" + }, + "zh": { + "question": "在麻醉后护理单元中，理想的患者监测时间间隔是多少？", + "A": "每小时", + "B": "每15分钟", + "C": "每30分钟", + "D": "每10分钟" + } + }, + { + "id": "5bf6e3d4-93a3-5e9e-bd64-8dcd509d1690", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Spinal Anaesthesia used on a patient needs monitoring for ________", + "A": "Oxygen levels", + "B": "Hyper tension", + "C": "Renal Function", + "D": "Brain activity" + }, + "zh": { + "question": "对接受脊髓麻醉的患者需要监测________", + "A": "氧气水平", + "B": "高血压", + "C": "肾功能", + "D": "脑活动" + } + }, + { + "id": "4572d0e6-71b6-53b0-acbe-a5cb9ca356a1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "To be approved for discharge from PACU, the patient should exhibit:", + "A": "Normal breathing", + "B": "No bleeding and swelling", + "C": "Oxygen saturation of min 90", + "D": "emperature greater than 96.8" + }, + "zh": { + "question": "要获得从麻醉恢复室出院的批准，患者应表现出：", + "A": "正常呼吸", + "B": "无出血和肿胀", + "C": "氧饱和度至少90", + "D": "体温高于96.8" + } + }, + { + "id": "caa22c74-e36e-572b-bb81-0165c9dc5aa5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A preoperative assessment should include all of the following except:", + "A": "Current medication and drugs", + "B": "Psychological aspects", + "C": "Patient knowledge of rehabilitation", + "D": "Age, Weight, Height" + }, + "zh": { + "question": "术前评估应包括以下所有内容，除了：", + "A": "当前的药物和药品", + "B": "心理方面", + "C": "患者对康复的了解", + "D": "年龄、体重、身高" + } + }, + { + "id": "a6de3e4c-69b2-5f03-96a4-a5459837d5de", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "A patient with a history of heart disease can be put on a prophylactic antibiotic.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "有心脏病史的患者可以使用预防性抗生素。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "883fa2d3-ea23-54e1-bf2b-95c87045e71e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": " Paralytic ileus is a possible postoperative complication. To check for it, which of the following should be done?", + "A": "Monitor renal function", + "B": "Auscultate for bowel sounds every 4 hours", + "C": "Administer antibiotics", + "D": "Observe and monitor patient heart rate" + }, + "zh": { + "question": "麻痹性肠梗阻是术后可能出现的并发症。为了检查它，应该进行以下哪项操作？", + "A": "监测肾功能", + "B": "每4小时听诊肠鸣音", + "C": "给予抗生素", + "D": "观察并监测患者心率" + } + }, + { + "id": "5148e746-d06f-5429-b8fa-01debcbdf5f7", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Before reaching the operation theater, how many zones exist?", + "A": "1", + "B": "3", + "C": "5", + "D": "7" + }, + "zh": { + "question": "在到达手术室之前，有多少个区域？", + "A": "1", + "B": "3", + "C": "5", + "D": "7" + } + }, + { + "id": "f25d8867-c5a5-55c3-ad1e-a7c889e28289", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How many sections are there in the operation table?", + "A": "1 – 3", + "B": "4 – 5", + "C": "6 – 7", + "D": "7 – 8" + }, + "zh": { + "question": "手术台有多少个部分？", + "A": "1 – 3", + "B": "4 – 5", + "C": "6 – 7", + "D": "7 – 8" + } + }, + { + "id": "3f2641f0-5b0d-5c44-a7d4-9a6a18b38e6b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What kind of lights exists in the OT?", + "A": "Fluorescent Lamps", + "B": "LED lights", + "C": "Tungsten Light", + "D": "LCD" + }, + "zh": { + "question": "手术室中存在哪种灯光？", + "A": "荧光灯", + "B": "LED灯", + "C": "钨丝灯", + "D": "液晶显示器" + } + }, + { + "id": "584cf399-c45c-5680-88a3-d0c126aadfdc", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When a baby is born, why are they placed under UV lamps?", + "A": "To reduce the possibility of skin disease", + "B": "To reduce the possibility of jaundice", + "C": "To ensure proper blood flow", + "D": "To allow the bones to absorb nutrients" + }, + "zh": { + "question": "婴儿出生时，为什么要将他们放在紫外线灯下？", + "A": "减少皮肤病的可能性", + "B": "减少黄疸的可能性", + "C": "确保血液流动正常", + "D": "让骨骼吸收营养" + } + }, + { + "id": "979081e6-f878-52f6-b1d5-4df1ee8c4d76", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is all usually present in an OT trolley?", + "A": "i, ii, iii, iv", + "B": "i, ii, iii, iv, v, vi, vii", + "C": "ii, iii, iv", + "D": "iii, iv, vi" + }, + "zh": { + "question": "手术室推车上通常有哪些物品？", + "A": "i, ii, iii, iv", + "B": "i, ii, iii, iv, v, vi, vii", + "C": "ii, iii, iv", + "D": "iii, iv, vi" + } + }, + { + "id": "a9557eb7-c44d-5c2a-879f-9418ab16cfd6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the ratio of the gases in medical air?", + "A": "78% Nitrogen, 21 % oxygen", + "B": "75 % Oxygen, 25 % Carbon dioxide", + "C": "60% Nitrogen, 20% Oxygen, 20% Carbon Di oxide", + "D": "50% Nitrogen, 50% Oxygen" + }, + "zh": { + "question": "医用空气中气体的比例是多少？", + "A": "78% 氮气, 21% 氧气", + "B": "75% 氧气, 25% 二氧化碳", + "C": "60% 氮气, 20% 氧气, 20% 二氧化碳", + "D": "50% 氮气, 50% 氧气" + } + }, + { + "id": "07473cbd-44ee-52c8-bb4e-5201735432cb", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How are the OT ventilated?", + "A": "Air is blown in from the lower part of the wall", + "B": "Air is sucked out from the upper region of the wall", + "C": "Air is blown in from the lower part and sucked out from the upper part", + "D": "Air is blown in from the upper part and sucked out from the lower part" + }, + "zh": { + "question": "手术室如何通风？", + "A": "空气从墙壁的下部吹入", + "B": "空气从墙壁的上部抽出", + "C": "空气从下部吹入并从上部抽出", + "D": "空气从上部吹入并从下部抽出" + } + }, + { + "id": "9ee451bc-155e-51d2-804b-823fa09fb05a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the general equipment found in OT?", + "A": "i, iii, iv, vi, vii", + "B": "i, ii, iii, iv, v, vi, vii, viii", + "C": "ii, iii, vi, vii", + "D": "i, iii, iv, vii, viii" + }, + "zh": { + "question": "在手术室中通常可以找到哪些设备？", + "A": "i, iii, iv, vi, vii", + "B": "i, ii, iii, iv, v, vi, vii, viii", + "C": "ii, iii, vi, vii", + "D": "i, iii, iv, vii, viii" + } + }, + { + "id": "01eb0e7b-a743-5510-8fda-279ccf49b0ad", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the resolution of the microscopes used in neurosurgery?", + "A": "1 μm", + "B": "1 nm", + "C": "1 Åm", + "D": "1 pm" + }, + "zh": { + "question": "神经外科使用的显微镜的分辨率是多少？", + "A": "1 μm", + "B": "1 nm", + "C": "1 Åm", + "D": "1 pm" + } + }, + { + "id": "e9534603-25f9-529c-a6b9-e050c4c1cdd0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": " For how long can a heart lung machine be used?", + "A": "4 hours", + "B": "6 hours", + "C": "8 hours", + "D": "10 hours" + }, + "zh": { + "question": "心肺机可以使用多长时间？", + "A": "4小时", + "B": "6小时", + "C": "8小时", + "D": "10小时" + } + }, + { + "id": "c66b6279-2ba0-5524-b1c1-6e085a2fd71c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": " In which of the following is not used for suturing?", + "A": "Silk", + "B": "Nylon", + "C": "Polyester", + "D": "Bakelite" + }, + "zh": { + "question": "以下哪种材料不用于缝合？", + "A": "丝线", + "B": "尼龙", + "C": "聚酯纤维", + "D": "酚醛塑料" + } + }, + { + "id": "73646513-ff56-5821-bb08-a7e6403de682", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": " What are all precautions taken for a patient directly out of surgery?", + "A": "The injury should not be infected", + "B": "The person must take a bath", + "C": "The blood pressure should go down", + "D": "The blood sugar should go up" + }, + "zh": { + "question": "手术后直接出院的患者需要采取哪些预防措施？", + "A": "伤口不应感染", + "B": "患者必须洗澡", + "C": "血压应下降", + "D": "血糖应上升" + } + }, + { + "id": "be97358d-6e54-5259-a998-1c6c0a56d46e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": " The following steps are for _______", + "A": "sterilization", + "B": "disinfection", + "C": "antiseptic", + "D": "hand washing" + }, + "zh": { + "question": "以下步骤是用于_______", + "A": "灭菌", + "B": "消毒", + "C": "防腐", + "D": "洗手" + } + }, + { + "id": "7606e062-c138-524d-8151-a5bcebcea7fe", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": " What are the temperature and humidity maintained in an OT?", + "A": "T = 20 – 26 ℃, H = 20% – 30% air exchanges = 7 – 8 per hour", + "B": "T = 18 – 22 ℃, H = 40% – 50% air exchanges = 10 – 12 per hour", + "C": "T = 10 – 12 ℃, H = 10% – 30% air exchanges = 9 – 10 per hour", + "D": "T = 30 – 35 ℃, H = 50% – 60% air exchanges = 15 – 20 per hour" + }, + "zh": { + "question": "手术室内维持的温度和湿度是多少？", + "A": "T = 20 – 26 ℃, H = 20% – 30% 换气次数 = 每小时 7 – 8 次", + "B": "T = 18 – 22 ℃, H = 40% – 50% 换气次数 = 每小时 10 – 12 次", + "C": "T = 10 – 12 ℃, H = 10% – 30% 换气次数 = 每小时 9 – 10 次", + "D": "T = 30 – 35 ℃, H = 50% – 60% 换气次数 = 每小时 15 – 20 次" + } + }, + { + "id": "35885303-7421-5569-9195-2ed9a0251a2c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the purpose of CSSD?", + "A": "storage of clean equipment", + "B": "providing sterile equipment to the operation theater", + "C": "storing sterile equipment", + "D": "pharmacy of the operation theater" + }, + "zh": { + "question": "CSSD的目的是什么？", + "A": "存放清洁设备", + "B": "为手术室提供无菌设备", + "C": "存放无菌设备", + "D": "手术室的药房" + } + }, + { + "id": "f10f3b53-96ef-59e9-9b5c-d69a98b424ca", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which machine uses the temperature and pressure of the steam for disinfection?", + "A": "Laminar Airflow", + "B": "Autoclave", + "C": "Oven", + "D": "Water Jet" + }, + "zh": { + "question": "哪种机器利用蒸汽的温度和压力进行消毒？", + "A": "层流空气流", + "B": "高压灭菌器", + "C": "烤箱", + "D": "水射流" + } + }, + { + "id": "cc0c9988-f73c-5464-a85a-3f45e3f87006", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following cannot be autoclaved?", + "A": "catheter", + "B": "mes", + "C": "scalpel", + "D": "scissors" + }, + "zh": { + "question": "以下哪一项不能进行高压灭菌？", + "A": "导管", + "B": "手术刀片", + "C": "手术刀", + "D": "剪刀" + } + }, + { + "id": "4220a0d9-172c-5745-810a-afab146721ee", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following chemicals are used to treat the instruments made out of polymers?", + "A": "i, ii, iii, iv, v, vi", + "B": "ii, iv, vi, viii, x, xii", + "C": "i, iv, v, viii, ix, x, xii, xiii", + "D": "iii, iv, ix, xii, xv" + }, + "zh": { + "question": "以下哪种化学品用于处理由聚合物制成的仪器？", + "A": "i, ii, iii, iv, v, vi", + "B": "ii, iv, vi, viii, x, xii", + "C": "i, iv, v, viii, ix, x, xii, xiii", + "D": "iii, iv, ix, xii, xv" + } + }, + { + "id": "24873320-ad4c-5c38-a77f-2921833f1086", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": " How are the gauze and cotton sterilized?", + "A": "Hot air sterilization", + "B": "Wet Heat Sterilization", + "C": "Sterilization Under High Pressure", + "D": "Chemical Sterilization" + }, + "zh": { + "question": "纱布和棉花是如何消毒的？", + "A": "热空气消毒", + "B": "湿热消毒", + "C": "高压消毒", + "D": "化学消毒" + } + }, + { + "id": "d2951556-ddf5-5cb2-bba1-88edcb441c13", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What machine is used to package the cotton and gauze?", + "A": "Heat Sealing Machine", + "B": "UV sealing Machine", + "C": "Zip Lock Machine", + "D": "Needle and Thread Sealing" + }, + "zh": { + "question": "哪种机器用于包装棉花和纱布？", + "A": "热封机", + "B": "紫外线封口机", + "C": "拉链���机", + "D": "针线封口" + } + }, + { + "id": "740b658d-5984-5ae1-8c9d-63c265b894ce", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": " What is sterilized in dry conditions?", + "A": "Implant", + "B": "Gauze", + "C": "Scalpel", + "D": "Cannula" + }, + "zh": { + "question": "在干燥条件下可以进行灭菌的是？", + "A": "植入物", + "B": "纱布", + "C": "手术刀", + "D": "套管" + } + }, + { + "id": "94258dfa-3c87-56ba-b235-3af0ed50b857", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How is dry sterilization done?", + "A": "In autoclave", + "B": "In oven", + "C": "In Magnetic Vibrator", + "D": "In Hot Plate" + }, + "zh": { + "question": "如何进行干燥灭菌？", + "A": "在高压灭菌器中", + "B": "在烤箱中", + "C": "在磁力振动器中", + "D": "在加热板上" + } + }, + { + "id": "2ffa576b-7fdc-5485-8921-5d409350b3ff", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What are opioid analgesics?", + "A": "Render a specific portion of the body insensitive to pain", + "B": "Render the full body of the patient insensitive to pain", + "C": "Render insensitive to pain by binding to opioid receptors", + "D": "Render a specific CNS of the body insensitive to pain" + }, + "zh": { + "question": "什么是阿片类镇痛药？", + "A": "使身体的特定部位对疼痛不敏感", + "B": "使患者的全身对疼痛不敏感", + "C": "通过结合阿片受体使对疼痛不敏感", + "D": "使身体的特定中枢神经系统对疼痛不敏感" + } + }, + { + "id": "022c67ab-aaf2-5612-882a-e41755b852a1", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following are natural opiates?", + "A": "Codeine", + "B": "Oxycodone", + "C": "Fentanyl", + "D": "Endomorphins" + }, + "zh": { + "question": "以下哪项是天然阿片类药物？", + "A": "可待因", + "B": "羟考酮", + "C": "芬太尼", + "D": "内啡肽" + } + }, + { + "id": "8a6b165b-2ebe-5f07-84ca-74013f399c52", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following are semi-synthetic opiates?", + "A": "Codeine", + "B": "Oxycodone", + "C": "Fentanyl", + "D": "Endomorphins" + }, + "zh": { + "question": "以下哪项是半合成阿片类药物？", + "A": "可待因", + "B": "羟考酮", + "C": "芬太尼", + "D": "内啡肽" + } + }, + { + "id": "8796fd62-9a77-54d8-9d28-ed9844587848", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following are fully synthetic opioids?", + "A": "Codeine", + "B": "Oxycodone", + "C": "Fentanyl", + "D": "Endomorphins" + }, + "zh": { + "question": "以下哪项是全合成阿片类药物？", + "A": "可待因", + "B": "羟考酮", + "C": "芬太尼", + "D": "内啡肽" + } + }, + { + "id": "3d83b583-0b40-5bee-8f3d-9baeab2100ab", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following are endogenous opioid peptides?", + "A": "Codeine", + "B": "Oxycodone", + "C": "Fentanyl", + "D": "Endomorphins" + }, + "zh": { + "question": "以下哪项是内源性阿片肽？", + "A": "可待因", + "B": "羟考酮", + "C": "芬太尼", + "D": "内啡肽" + } + }, + { + "id": "70cddefe-6614-5439-a282-37113dedce37", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How does the general opioids function?", + "A": "Render a specific portion of the body insensitive to pain", + "B": "Render the full body of the patient insensitive to pain", + "C": "Render insensitive to pain by decreasing the pain threshold", + "D": "Render a specific CNS of the body insensitive to pain" + }, + "zh": { + "question": "阿片类药物一般如何发挥作用？", + "A": "使身体的特定部位对疼痛不敏感", + "B": "使患者的全身对疼痛不敏感", + "C": "通过降低疼痛阈值使对疼痛不敏感", + "D": "使身体的特定中枢神经系统对疼痛不敏感" + } + }, + { + "id": "9465037a-551f-58ad-9f97-b63282a8cd04", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following side effects of morphine is the most dangerous?", + "A": "Excitation", + "B": "Nausea", + "C": "Constipation", + "D": "Tolerance and dependence" + }, + "zh": { + "question": "以下哪种吗啡的副作用是最危险的？", + "A": "兴奋", + "B": "恶心", + "C": "便秘", + "D": "耐受性和依赖性" + } + }, + { + "id": "b671687e-da9a-5cdf-9052-7e0640e1e430", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is opiophobia?", + "A": "Fear of opioid plant", + "B": "Fear of drugs", + "C": "Fear of prescribing opioid drugs", + "D": "Fear of anesthesia" + }, + "zh": { + "question": "什么是阿片恐惧症？", + "A": "对阿片植物的恐惧", + "B": "对药物的恐惧", + "C": "对开具阿片类药物的恐惧", + "D": "对麻醉的恐惧" + } + }, + { + "id": "fef2ff6d-fca6-5d2a-bfb2-ff9a6af61ffe", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the short-term effect of heroin?", + "A": "Euphoria", + "B": "Infection of the heart lining", + "C": "Addiction", + "D": "Decreased function of the liver" + }, + "zh": { + "question": "以下哪项是海洛因的短期效应？", + "A": "欣快感", + "B": "心内膜感染", + "C": "成瘾", + "D": "肝功能下降" + } + }, + { + "id": "03138edf-7755-5e6d-ac29-3d6599ba3570", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": " Which of the following is the long term effect of heroine?", + "A": "Dryness of mouth", + "B": "Collapsed veins", + "C": "Muscle weakness", + "D": "Euphoria" + }, + "zh": { + "question": "以下哪项是海洛因的长期影响？", + "A": "口干", + "B": "静脉塌陷", + "C": "肌肉无力", + "D": "欣快感" + } + }, + { + "id": "f9468a53-6066-5fbd-a53d-0d5f3f2fe237", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": " What is the antagonist for heroin?", + "A": "Naloxone", + "B": "Oxycodone", + "C": "Fentanyl", + "D": "Endomorphins" + }, + "zh": { + "question": "海洛因的拮抗剂是什么？", + "A": "纳洛酮", + "B": "羟考酮", + "C": "芬太尼", + "D": "内啡肽" + } + }, + { + "id": "f2af5c6d-47ab-55ac-96ff-10f2d52be6d7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": " Which of the following Fentanyl analogues is ultra-short acting analgesic?", + "A": "Alfentanyl", + "B": "Sufentanil", + "C": "Remifentanil", + "D": "Carfentanil" + }, + "zh": { + "question": "以下哪种芬太尼类似物是超短效镇痛药？", + "A": "阿芬太尼", + "B": "舒芬太尼", + "C": "瑞芬太尼", + "D": "卡芬太尼" + } + }, + { + "id": "edf65a4f-ac3e-5795-a3fe-d1f0f9230c3f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": " Which of the following fentanyl analogue is used in heart surgery?", + "A": "Alfentanyl", + "B": "Sufentanil", + "C": "Remifentanil", + "D": "Carfentanil" + }, + "zh": { + "question": "以下哪种芬太尼类似物用于心脏手术？", + "A": "阿芬太尼", + "B": "舒芬太尼", + "C": "瑞芬太尼", + "D": "卡芬太尼" + } + }, + { + "id": "c9873431-dcc9-57aa-abde-1c7ba8abaff1", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": " Which of the following is the shortest acting fentanyl analogue?", + "A": "Alfentanyl", + "B": "Sufentanil", + "C": "Remifentanil", + "D": "Carfentanil" + }, + "zh": { + "question": "以下哪种是作用时间最短的芬太尼类似物？", + "A": "阿芬太尼", + "B": "舒芬太尼", + "C": "瑞芬太尼", + "D": "卡芬太尼" + } + }, + { + "id": "737a23f7-bd4c-521c-9386-aa0e863467c3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": " Which of the following fentanyl analogue is being used in veterinary practice?", + "A": "Alfentanyl", + "B": "Sufentanil", + "C": "Remifentanil", + "D": "Carfentanil" + }, + "zh": { + "question": "以下哪种芬太尼类似物用于兽医实践？", + "A": "阿芬太尼", + "B": "舒芬太尼", + "C": "瑞芬太尼", + "D": "卡芬太尼" + } + }, + { + "id": "f45f3c35-3076-58aa-a08f-e6df017e45cd", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the function of local anesthetics?", + "A": "Suppress the activity of the brain", + "B": "Render a specific portion insensitive to pain", + "C": "Suppress the function of a whole organ", + "D": "Make the patient’s full body insensitive to pain" + }, + "zh": { + "question": "局部麻醉药的功能是什么？", + "A": "抑制大脑活动", + "B": "使特定部位对疼痛不敏感", + "C": "抑制整个器官的功能", + "D": "使患者全身对疼痛不敏感" + } + }, + { + "id": "216044d9-4979-5f6d-add4-4b1fd61ba6d9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the parenteral application of local anesthetics?", + "A": "When applied to the mucous membrane", + "B": "When applied to the skin", + "C": "When injected to CNS through spinal injection techniques", + "D": "Using ophthalmic drops" + }, + "zh": { + "question": "以下哪项是局部麻醉药的肠外应用？", + "A": "应用于粘膜时", + "B": "应用于皮肤时", + "C": "通过脊髓注射技术注入中枢神经系统时", + "D": "使用眼科滴剂时" + } + }, + { + "id": "f952996f-b526-5744-96cf-0b84a4f861ae", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following are natural local anesthetics?", + "A": "Cocaine", + "B": "Benzocaine", + "C": "Benzyl alcohol", + "D": "Clove oil" + }, + "zh": { + "question": "以下哪项是天然局部麻醉剂？", + "A": "可卡因", + "B": "苯佐卡因", + "C": "苄醇", + "D": "丁香油" + } + }, + { + "id": "343b20c8-bc20-5d2a-a8fd-faa9beeb2720", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is synthetic nitrogenous local anesthetic?", + "A": "Cocaine", + "B": "Benzocaine", + "C": "Benzyl alcohol", + "D": "Clove oil" + }, + "zh": { + "question": "以下哪一项是合成的含氮局部麻醉剂？", + "A": "可卡因", + "B": "苯佐卡因", + "C": "苯甲醇", + "D": "丁香油" + } + }, + { + "id": "1703d589-6d4d-59f5-9caa-cfe102eaf6e7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is synthetic non-nitrogenous anesthetic?", + "A": "Cocaine", + "B": "Benzocaine", + "C": "Benzyl alcohol", + "D": "Clove oil" + }, + "zh": { + "question": "以下哪一种是合成的非含氮麻醉剂？", + "A": "可卡因", + "B": "苯佐卡因", + "C": "苯甲醇", + "D": "丁香油" + } + }, + { + "id": "cd6eb515-3261-51ea-b9e4-08716801b43e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Apart from natural, synthetic, synthetic non-nitrogenous, which of the following is also a local anesthetic?", + "A": "Cocaine", + "B": "Benzocaine", + "C": "Benzyl alcohol", + "D": "Clove oil" + }, + "zh": { + "question": "除了天然、合成、合成非氮化合物，以下哪一项也是局部麻醉剂？", + "A": "可卡因", + "B": "苯佐卡因", + "C": "苯甲醇", + "D": "丁香油" + } + }, + { + "id": "4f1c198a-86dc-56c0-be92-c27965957627", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is the pharmacological action of local anesthetics?", + "A": "Reversible block of conduction in nerve", + "B": "Class II antidysrhythmic like action", + "C": "Contraction of smooth muscle", + "D": "Excitation of neuro-muscular transmission in skeletal muscle" + }, + "zh": { + "question": "以下哪项是局部麻醉药的药理作用？", + "A": "可逆性阻断神经传导", + "B": "类似II类抗心律失常药的作用", + "C": "平滑肌收缩", + "D": "兴奋骨骼肌的神经肌肉传导" + } + }, + { + "id": "dcac3575-0df1-5f1d-a8dc-a37a0de03ea8", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What does membrane expansion theory states?", + "A": "The mechanism is not similar to the general anesthetics", + "B": "Does not rely upon the lipophilic moiety of drugs", + "C": "The molecules of the agent get incorporated into the lipid membrane", + "D": "Causes nerve polarization" + }, + "zh": { + "question": "膜扩张理论说明了什么？", + "A": "其机制与全身麻醉剂不同", + "B": "不依赖于药物的亲脂性部分", + "C": "药剂分子被掺入脂质膜中", + "D": "导致神经极化" + } + }, + { + "id": "5ef4af04-e046-56ba-8d69-e7b95bfc9f32", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What does the specific receptor theory state?", + "A": "Local anesthetics bind to various receptors", + "B": "Produces chemical changes to the receptors", + "C": "Tries to open all the closed sodium gates", + "D": "Binding produces conformational changes" + }, + "zh": { + "question": "特定受体理论说明了什么？", + "A": "局部麻醉药与各种受体结合", + "B": "对受体产生化学变化", + "C": "试图打开所有关闭的钠通道", + "D": "结合产生构象变化" + } + }, + { + "id": "27592b3a-22c6-5dd7-9d68-e5252c13c0c4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": " Which of the following factor do not affect the absorption of local anesthetics?", + "A": "Vasodilating ability of drug", + "B": "Volume and concentration", + "C": "Vascularity of the tissue", + "D": "Presence of vasodilator" + }, + "zh": { + "question": "下列哪项因素不影响局部麻醉药的吸收？", + "A": "药物的血管扩张能力", + "B": "体积和浓度", + "C": "组织的血管化程度", + "D": "血管扩张剂的存在" + } + }, + { + "id": "9c5e6db6-ff53-522a-b6b8-6b468fc3117a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": " Which is the first local anesthetic?", + "A": "Cocaine", + "B": "Benzocaine", + "C": "Benzyl alcohol", + "D": "Clove oil" + }, + "zh": { + "question": "哪一种是第一种局部麻醉剂？", + "A": "可卡因", + "B": "苯佐卡因", + "C": "苄醇", + "D": "丁香油" + } + }, + { + "id": "5d06e321-15ac-5954-aa98-703ca92005b7", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": " Which of the following is being used in dentistry when patients have an allergy from procaine?", + "A": "Cocaine", + "B": "Benzocaine", + "C": "Benzyl alcohol", + "D": "Procaine" + }, + "zh": { + "question": "当患者对普鲁卡因过敏时，牙科中使用以下哪种药物？", + "A": "可卡因", + "B": "苯佐卡因", + "C": "苄醇", + "D": "普鲁卡因" + } + }, + { + "id": "a0f33277-47c0-5bd5-877c-4d2051654535", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": " Which of the following is amide type drug?", + "A": "Lignocaine", + "B": "Cocaine", + "C": "Procaine", + "D": "Benzocaine" + }, + "zh": { + "question": "以下哪种是酰胺类药物？", + "A": "利多卡因", + "B": "可卡因", + "C": "普鲁卡因", + "D": "苯佐卡因" + } + }, + { + "id": "3fa6e2fe-317b-57c1-b7c0-7e065410bada", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": " Which of the following is topical with high concentration?", + "A": "Lignocaine", + "B": "Cocaine", + "C": "Procaine", + "D": "Benzocaine" + }, + "zh": { + "question": "以下哪一种是高浓度的局部用药？", + "A": "利多卡因", + "B": "可卡因", + "C": "普鲁卡因", + "D": "苯佐卡因" + } + }, + { + "id": "7dcd0dce-3a84-5232-a23b-342e5dc30136", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": " Cocaine, when used for local anesthetics, has a half-life of 30 minutes.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "可卡因作为局部麻醉剂使用时，其半衰期为30分钟。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "93ca7391-a135-5348-add2-838ba1835416", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following will work as an anesthetic?", + "A": "Pantoprazole", + "B": "Amlodipine", + "C": "Cocaine", + "D": "Mannitol" + }, + "zh": { + "question": "以下哪种物质可以作为麻醉剂？", + "A": "泮托拉唑", + "B": "氨氯地平", + "C": "可卡因", + "D": "甘露醇" + } + }, + { + "id": "1c29cc91-d980-5a9c-854c-a1e9b5557240", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In which of the stage of general anesthesia the movement of the diaphragm is the highest?", + "A": "Plane 1 of stage III", + "B": "Plane 2 of stage III", + "C": "Plane 3 of stage III", + "D": "Plane 4 of stage III" + }, + "zh": { + "question": "在全身麻醉的哪个阶段，膈肌的活动最强？", + "A": "第三阶段平面1", + "B": "第三阶段平面2", + "C": "第三阶段平面3", + "D": "第三阶段平面4" + } + }, + { + "id": "994607fa-e66a-5c2a-82b0-f9d2a6ff83ca", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "In which stage of general anesthesia the patient starts vomiting?", + "A": "Stage I ending", + "B": "Stage II ending", + "C": "Stage III ending", + "D": "Stage IV ending" + }, + "zh": { + "question": "在全身麻醉的哪个阶段患者开始呕吐？", + "A": "第一阶段结束", + "B": "第二阶段结束", + "C": "第三阶段结束", + "D": "第四阶段结束" + } + }, + { + "id": "e9323b2b-46c8-5010-9dc8-038f010e5e80", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the function of general anesthetics?", + "A": "Render a specific portion of the body insensitive to pain", + "B": "Render a full body of the patient insensitive to pain", + "C": "Render a specific organ of the body insensitive to pain", + "D": "Render a specific CNS of the body insensitive to pain" + }, + "zh": { + "question": "全身麻醉药的功能是什么？", + "A": "使身体的特定部位对疼痛不敏感", + "B": "使患者的全身对疼痛不敏感", + "C": "使身体的特定器官对疼痛不敏感", + "D": "使身体的特定中枢神经系统对疼痛不敏感" + } + }, + { + "id": "c721a35e-0e93-5582-8d10-9ccfc0323016", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": " Which of the following is not an inhaled anesthetics?", + "A": "Haloethane", + "B": "Enflurane", + "C": "Isoflurane", + "D": "Diflurane" + }, + "zh": { + "question": "以下哪一项不是吸入性麻醉剂？", + "A": "氟烷", + "B": "恩氟烷", + "C": "异氟烷", + "D": "二氟烷" + } + }, + { + "id": "a0c92f1a-6dbf-5337-b445-c23c55039930", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following order of inducing cardiac arrhythmias of inhaled anesthetics is correct?", + "A": "F < Br < I < Cl", + "B": "F < Cl < Br < I", + "C": "F > Cl > Br > I", + "D": "Br < I < F < Cl" + }, + "zh": { + "question": "以下哪种吸入麻醉剂诱发心律失常的顺序是正确的？", + "A": "F < Br < I < Cl", + "B": "F < Cl < Br < I", + "C": "F > Cl > Br > I", + "D": "Br < I < F < Cl" + } + }, + { + "id": "5c1fe3bc-17d8-5b6d-a7ed-ee7d602e3183", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is incorrect if we are talking about the essential components of general anesthesia?", + "A": "Analgesia", + "B": "Hypnosis", + "C": "Depression of spinal motor reflexes", + "D": "Muscle contraction" + }, + "zh": { + "question": "以下哪项不是全身麻醉的基本成分？", + "A": "镇痛", + "B": "催眠", + "C": "抑制脊髓运动反射", + "D": "肌肉收缩" + } + }, + { + "id": "8fe9687e-c9df-55e1-b716-04bc99602cc4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What does the lipid theory tell?", + "A": "Lower the solubility of the anesthetic in water higher potency it has", + "B": "Higher the solubility of the anesthetic in water higher potency it has", + "C": "Higher the solubility of the anesthetic in oil higher potency it has", + "D": "Lower the solubility of the anesthetic in oil higher potency it has" + }, + "zh": { + "question": "脂质理论说明了什么？", + "A": "麻醉剂在水中的溶解度越低，其效力越高", + "B": "麻醉剂在水中的溶解度越高，其效力越高", + "C": "麻醉剂在油中的溶解度越高，其效力越高", + "D": "麻醉剂在油中的溶解度越低，其效力越高" + } + }, + { + "id": "47190b99-b96d-5c2b-b11a-3fa4306a1413", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What does the protein (receptor) theory tells us?", + "A": "Anesthetic potency is related to the ability of anesthetic to inhibit enzyme activity", + "B": "Higher the solubility of the anesthetic in water higher potency it has", + "C": "Higher the solubility of the anesthetic in oil higher potency it has", + "D": "Lower the solubility of the anesthetic in oil higher potency it has" + }, + "zh": { + "question": "蛋白质（受体）理论告诉我们什么？", + "A": "麻醉药效力与麻醉药抑制酶活性的能力有关", + "B": "麻醉药在水中的溶解度越高，其效力越高", + "C": "麻醉药在油中的溶解度越高，其效力越高", + "D": "麻醉药在油中的溶解度越低，其效力越高" + } + }, + { + "id": "843391b9-0b1e-548e-bd85-feb912145bd1", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": " Administration of general anesthetics decreases the presynaptic Ca2+ entry.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "全身麻醉药的使用会减少突触前Ca2+的进入。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "757abf0c-02fb-5c34-8200-82e52a67eda4", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": " Local anesthetics increase the axonal Na+ entry.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "局部麻醉剂增加轴突的Na+进入。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "a658460c-5b0f-5087-b44f-a6d4075740b9", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": " The lower the blood: gas ratio, the more anesthetics will arrive at the brain.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "血液:气体比率越低，越多的麻醉剂会到达大脑。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "d50c6e15-a4d5-5812-94ea-5d81ce8dee71", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": " Which option will be correct for the market place in the diagram shown below?", + "A": "Alveoli", + "B": "Arterial blood", + "C": "Venous blood", + "D": "Brain" + }, + "zh": { + "question": "在下图所示的市场中，哪个选项是正确的？", + "A": "肺泡", + "B": "动脉血", + "C": "静脉血", + "D": "大脑" + } + }, + { + "id": "ee133db3-c6e2-53b1-b601-846c1680ba63", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": " Which option will be correct for the marked place in the diagram shown below?", + "A": "Alveoli", + "B": "Arterial blood", + "C": "Venous blood", + "D": "Brain" + }, + "zh": { + "question": "下图中标记位置的正确选项是什么？", + "A": "肺泡", + "B": "动脉血", + "C": "静脉血", + "D": "大脑" + } + }, + { + "id": "e53dc56e-55a6-577e-9657-efe14b79e24a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which hormone is a major contributor to the symptoms of inflammation?", + "A": "Histamine", + "B": "Serotonin", + "C": "Bradykinin", + "D": "Leukotrienes" + }, + "zh": { + "question": "哪种激素是炎症症状的主要贡献者？", + "A": "组胺", + "B": "血清素", + "C": "缓激肽", + "D": "白三烯" + } + }, + { + "id": "eb7e20f8-2242-543b-bd2c-19033bb37ab8", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following promotes edema?", + "A": "Histamine", + "B": "Serotonin", + "C": "Bradykinin", + "D": "Prostaglandins" + }, + "zh": { + "question": "下列哪一项促进水肿？", + "A": "组胺", + "B": "血清素", + "C": "缓激肽", + "D": "前列腺素" + } + }, + { + "id": "7d52c27f-0eca-55bd-a422-aba1ff0ef367", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which hormone is a major contributor for pain during inflammation reaction?", + "A": "Histamine", + "B": "Serotonin", + "C": "Bradykinin", + "D": "Leukotrienes" + }, + "zh": { + "question": "哪种激素是炎症反应中疼痛的主要原因？", + "A": "组胺", + "B": "血清素", + "C": "缓激肽", + "D": "白三烯" + } + }, + { + "id": "f9e96e02-eaa9-5102-8144-6a35951b24c6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which hormone is a major contributor to chemotaxis while inflammation reaction?", + "A": "Histamine", + "B": "Serotonin", + "C": "Prostaglandins", + "D": "Leukotrienes" + }, + "zh": { + "question": "哪种激素在炎症反应中是趋化作用的主要贡献者？", + "A": "组胺", + "B": "血清素", + "C": "前列腺素", + "D": "白三烯" + } + }, + { + "id": "1083988b-5178-579b-a3a1-9bb8014abc84", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which hormone is a major contributor for increasing vascular permeability during inflammation?", + "A": "Histamine", + "B": "Serotonin", + "C": "Bradykinin", + "D": "Leukotrienes" + }, + "zh": { + "question": "哪种激素是炎症过程中增加血管通透性的主要因素？", + "A": "组胺", + "B": "血清素", + "C": "缓激肽", + "D": "白三烯" + } + }, + { + "id": "6c55e33b-a526-56a3-b3ac-ba41005464fd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which hormone is a major contributor to vasodilation during inflammation reaction?", + "A": "Histamine", + "B": "Serotonin", + "C": "Bradykinin", + "D": "Leukotrienes" + }, + "zh": { + "question": "哪种激素是炎症反应中血管扩张的主要贡献者？", + "A": "组胺", + "B": "血清素", + "C": "缓激肽", + "D": "白三烯" + } + }, + { + "id": "9ff5a8ad-857d-5e67-b097-8975d5e91c32", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Why the redness can be seen during inflammation?", + "A": "Local blood vessel dilation", + "B": "Influx of plasma proteins, phagocytic cells into the tissue spaces", + "C": "Release of enzymes", + "D": "Increased of tissue pressure" + }, + "zh": { + "question": "为什么在炎症期间会出现发红？", + "A": "局部血管扩张", + "B": "血浆蛋白和吞噬细胞进入组织间隙", + "C": "酶的释放", + "D": "组织压力增加" + } + }, + { + "id": "0cb46e52-74a7-5916-8462-642aa4cc545d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Why the Heat can be seen during inflammation?", + "A": "Local blood vessel dilation", + "B": "Influx of plasma proteins, phagocytic cells into the tissue spaces", + "C": "Release of enzymes", + "D": "Increased of tissue pressure" + }, + "zh": { + "question": "为什么在炎症期间会看到热感？", + "A": "局部血管扩张", + "B": "血浆蛋白和吞噬细胞进入组织间隙", + "C": "酶的释放", + "D": "组织压力增加" + } + }, + { + "id": "caba7840-5bd5-51f7-9950-560d5ef89975", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Why the swelling can be seen during inflammation?", + "A": "Local blood vessel dilation", + "B": "Influx of plasma proteins, phagocytic cells into the tissue spaces", + "C": "Release of enzymes", + "D": "Increased of tissue pressure" + }, + "zh": { + "question": "为什么在炎症期间会出现肿胀？", + "A": "局部血管扩张", + "B": "血浆蛋白和吞噬细胞进入组织间隙", + "C": "酶的释放", + "D": "组织压力增加" + } + }, + { + "id": "74b4dddf-a665-50eb-841d-9f42ed390bac", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": " Why the pain can be felt during inflammation?", + "A": "Local blood vessel dilation", + "B": "Influx of plasma proteins", + "C": "Release of enzymes and increased of tissue pressure", + "D": "Influx of phagocytic cells" + }, + "zh": { + "question": "为什么在炎症期间会感到疼痛？", + "A": "局部血管扩张", + "B": "血浆蛋白的流入", + "C": "酶的释放和组织压力的增加", + "D": "吞噬细胞的流入" + } + }, + { + "id": "ec1fe441-3e32-5f0c-b7bc-f78c0600f5a8", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": " Which of the following drug is an indole derivative?", + "A": "ASA", + "B": "Ibuprofen", + "C": "Phenylbutazone", + "D": "Indomethacin" + }, + "zh": { + "question": "以下哪种药物是吲哚衍生物？", + "A": "阿司匹林", + "B": "布洛芬", + "C": "保泰松", + "D": "吲哚美辛" + } + }, + { + "id": "aab212cf-43d0-5af0-853d-6a54e05ad5a7", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": " Which of the following drug is a Phenylpropionic acid derivative?", + "A": "ASA", + "B": "Ibuprofen", + "C": "Phenylbutazone", + "D": "Indomethacin" + }, + "zh": { + "question": "以下哪种药物是苯丙酸衍生物？", + "A": "ASA", + "B": "布洛芬", + "C": "保泰松", + "D": "吲哚美辛" + } + }, + { + "id": "65e14b67-5527-59e7-8fbf-3fe9ef27e4b2", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": " Which of the following is an example of salicylates?", + "A": "ASA", + "B": "Ibuprofen", + "C": "Phenylbutazone", + "D": "Indomethacin" + }, + "zh": { + "question": "以下哪一项是水杨酸盐的例子？", + "A": "阿司匹林 (ASA)", + "B": "布洛芬", + "C": "苯丁酸", + "D": "吲哚美辛" + } + }, + { + "id": "221fdfd6-db9c-5517-9ce8-87e4fba0dea4", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": " Inflammatory response is an abnormal defense mechanism.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "炎症反应是一种异常的防御机制。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "77910d39-7b05-5374-bd8d-3128048b14b1", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": " Inflammatory switch does not have an off switch.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "炎症开关没有关闭开关。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "42186061-541c-5a7d-837c-6bec6e6965f6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which is the predominant form of cyclooxygenase enzyme?", + "A": "COX 1", + "B": "COX 2", + "C": "COX 3", + "D": "COX 4" + }, + "zh": { + "question": "哪种是环氧合酶酶的主要形式？", + "A": "COX 1", + "B": "COX 2", + "C": "COX 3", + "D": "COX 4" + } + }, + { + "id": "a5601215-3657-58c8-83df-121e76890dc5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How does NSAIDs work?", + "A": "Inhibit arachidonic acid", + "B": "Inhibit Endoperoxide intermediate", + "C": "Inhibit Prostaglandin and thromboxane synthesis", + "D": "Inhibit cyclooxygenase" + }, + "zh": { + "question": "NSAIDs 如何起作用？", + "A": "抑制花生四烯酸", + "B": "抑制内过氧化物中间体", + "C": "抑制前列腺素和血栓素的合成", + "D": "抑制环氧合酶" + } + }, + { + "id": "0da92388-08e5-5511-904a-1bb4629e3b91", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following has a half-life of 45 Hrs?", + "A": "Piroxicam", + "B": "Phenylbutazone", + "C": "Ibuprofen", + "D": "Indomethacin" + }, + "zh": { + "question": "以下哪种药物的半衰期为45小时？", + "A": "吡罗昔康", + "B": "苯丁酮", + "C": "布洛芬", + "D": "吲哚美辛" + } + }, + { + "id": "8eeac021-dd3d-5693-9f1f-03873b2a870a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following has the same potency as ASA and better tolerated by patients?", + "A": "Piroxicam", + "B": "Phenylbutazone", + "C": "Ibuprofen", + "D": "Indomethacin" + }, + "zh": { + "question": "以下哪种药物与阿司匹林（ASA）具有相同的效力且患者耐受性更好？", + "A": "吡罗昔康", + "B": "保泰松", + "C": "布洛芬", + "D": "吲哚美辛" + } + }, + { + "id": "fcea5cb1-a323-59a5-8496-d9abefe0e1d5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following cannot be tolerated, rheumatoid arthritis patient?", + "A": "Piroxicam", + "B": "Phenylbutazone", + "C": "Ibuprofen", + "D": "Indomethacin" + }, + "zh": { + "question": "以下哪种药物是类风湿性关节炎患者不能耐受的？", + "A": "吡罗昔康", + "B": "保泰松", + "C": "布洛芬", + "D": "吲哚美辛" + } + }, + { + "id": "f5812299-3140-5a9d-883c-9b657f619c79", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following pyrazolone derivative’s has toxic side effects?", + "A": "Piroxicam", + "B": "Phenylbutazone", + "C": "Ibuprofen", + "D": "Indomethacin" + }, + "zh": { + "question": "以下哪种吡唑酮衍生物具有毒性副作用？", + "A": "吡罗昔康", + "B": "保泰松", + "C": "布洛芬", + "D": "吲哚美辛" + } + }, + { + "id": "3bae23a2-0c48-5779-ad0e-b9728e81ce5b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is a pro-drug and related to indomethacin?", + "A": "Piroxicam", + "B": "Phenylbutazone", + "C": "Sulindac", + "D": "Indomethacin" + }, + "zh": { + "question": "以下哪种药物是前药并与吲哚美辛相关？", + "A": "吡罗昔康", + "B": "保泰松", + "C": "舒林酸", + "D": "吲哚美辛" + } + }, + { + "id": "257706f0-1659-5282-8742-ab93d615365a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is also known as “housekeeping enzyme”?", + "A": "COX 1", + "B": "COX 2", + "C": "COX 3", + "D": "COX 4" + }, + "zh": { + "question": "以下哪一种也被称为“管家酶”？", + "A": "COX 1", + "B": "COX 2", + "C": "COX 3", + "D": "COX 4" + } + }, + { + "id": "ea2bee76-f95e-54ae-be3c-5069a0704a5d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following responsible for inflammatory response mainly?", + "A": "COX 1", + "B": "COX 2", + "C": "COX 3", + "D": "COX 4" + }, + "zh": { + "question": "以下哪一项主要负责炎症反应？", + "A": "COX 1", + "B": "COX 2", + "C": "COX 3", + "D": "COX 4" + } + }, + { + "id": "3fdb5100-6d96-5ebe-a700-296aa22bd6cd", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": " Why there are side effects of NSAIDs?", + "A": "Inhibition of COX 1", + "B": "Inhibition of COX 2", + "C": "Inhibition of COX 3", + "D": "Inhibition of COX 4" + }, + "zh": { + "question": "为什么NSAIDs会有副作用？", + "A": "抑制COX 1", + "B": "抑制COX 2", + "C": "抑制COX 3", + "D": "抑制COX 4" + } + }, + { + "id": "5c6e6039-4df1-5400-8db6-6ed55fea71b3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": " Which of the following has the least GI effect and derived from parent NSAIDs?", + "A": "Piroxicam", + "B": "Phenylbutazone", + "C": "NO-NSAIDs", + "D": "Indomethacin" + }, + "zh": { + "question": "以下哪种药物对胃肠道的影响最小，并且来源于母体NSAIDs？", + "A": "吡罗昔康", + "B": "苯丁酮", + "C": "NO-NSAIDs", + "D": "吲哚美辛" + } + }, + { + "id": "d7d42a0d-f12d-5153-8d3f-197028565d56", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": " How does Eicosapentaenoic acid functions to decrease the inflammation rate?", + "A": "Decrease Prostaglandin production", + "B": "Don’t form prostaglandin", + "C": "Induce the formation of prostaglandins at certain times", + "D": "The prostaglandins, thromboxane produced from EPA are less active" + }, + "zh": { + "question": "二十碳五烯酸如何发挥作用以降低炎症率？", + "A": "减少前列腺素的产生", + "B": "不形成前列腺素", + "C": "在特定时间诱导前列腺素的形成", + "D": "由EPA产生的前列腺素和血栓素活性较低" + } + }, + { + "id": "f254e7cd-71c3-5ef1-a85f-69ea57a3ecfd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": " Which of the following option will correct for the marked place?", + "A": "Urate crystal", + "B": "Interleukin-1", + "C": "Mononuclear phagocytes", + "D": "Prostaglandins" + }, + "zh": { + "question": "以下哪个选项将纠正标记的地方？", + "A": "尿酸盐晶体", + "B": "白细胞介素-1", + "C": "单核吞噬细胞", + "D": "前列腺素" + } + }, + { + "id": "c8fd4703-0571-5529-b7c4-81562eed528a", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": " Macrophages with a high content of EPA produce less TNF and IL-l.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "含有高含量EPA的巨噬细胞产生较少的TNF和IL-1。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "0f517e47-ab7c-5278-b154-28b6d4c35436", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following comprises the low-pressure system?", + "A": "Flowmeter tubes", + "B": "Vaporizers", + "C": "Check valves", + "D": "Common gas outlet", + "E": "All of the above" + }, + "zh": { + "question": "以下哪项组成了低压系统？", + "A": "流量计管", + "B": "挥发器", + "C": "止回阀", + "D": "公共气体出口", + "E": "以上所有" + } + }, + { + "id": "8b589961-aa9c-57f1-b3b5-97d1e854ff0e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the last safeguard before the gases reach the patient?", + "A": "ETT", + "B": "Thorpe tube", + "C": "Oxygen analyzer", + "D": "Capnograph" + }, + "zh": { + "question": "在气体到达患者之前的最后一道防线是什么？", + "A": "气管导管（ETT）", + "B": "Thorpe 管", + "C": "氧气分析仪", + "D": "二氧化碳图（Capnograph）" + } + }, + { + "id": "26bbd9cb-6ab3-54af-bcf9-1579d99a405e", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "When is an O2 analyzer reading erroneous?", + "A": "When an LMA is used", + "B": "A deflated ETT cuff", + "C": "When used with nasal cannula", + "D": "When it is used higher than sea level" + }, + "zh": { + "question": "何时O2分析仪的读数是错误的？", + "A": "使用喉罩时", + "B": "气管导管套囊放气时", + "C": "与鼻导管一起使用时", + "D": "在高于海平面时使用" + } + }, + { + "id": "cb5a056d-78b1-5f2c-9a75-7d66ca60f4f0", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "There are ____ sprockets on an oxygen flowmeter.", + "A": "10", + "B": "2", + "C": "14", + "D": "23", + "E": "I don't know I was never good at math" + }, + "zh": { + "question": "氧气流量计上有多少个链轮。", + "A": "10", + "B": "2", + "C": "14", + "D": "23", + "E": "我不知道，我数学一直不好" + } + }, + { + "id": "eb9baa68-5450-5d6c-9015-2473e04d0a19", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the minimum o2: N2O ration?", + "A": "1:1", + "B": "1:2", + "C": "1:3", + "D": "1:4" + }, + "zh": { + "question": "氧气与氧化亚氮的最小比例是多少？", + "A": "1:1", + "B": "1:2", + "C": "1:3", + "D": "1:4" + } + }, + { + "id": "1246d9a5-ca82-536d-8330-e8b4f173fb09", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The purpose of the safety devices in the low flow system is:", + "A": "Increase the saturated vapor pressure", + "B": "Minimize the density of the gas", + "C": "Minimize turbulence throughout the system", + "D": "Decrease the risk of a hypoxic mixture" + }, + "zh": { + "question": "低流量系统中安全装置的目的是：", + "A": "增加饱和蒸气压", + "B": "减少气体的密度", + "C": "减少系统内的湍流", + "D": "降低低氧混合物的风险" + } + }, + { + "id": "f6315bc8-063c-5d24-b625-114121ccbdba", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Name the gas that we use as a carrier gas for agents.", + "A": "Air", + "B": "N2O", + "C": "Oxygen", + "D": "CO", + "E": "CO2" + }, + "zh": { + "question": "我们用作药物载体气体的气体是什么？", + "A": "空气", + "B": "N2O", + "C": "氧气", + "D": "CO", + "E": "CO2" + } + }, + { + "id": "6cac436b-2357-5403-a2bf-c7ba9caca6c0", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Modern vaporizers are within the breathing circuit. True or false?", + "A": "True", + "B": "False" + }, + "zh": { + "question": "现代挥发器在呼吸回路内。对还是错？", + "A": "对", + "B": "错" + } + }, + { + "id": "c6bc635d-57cc-5885-a387-19af08784ea0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is a vaporizer interlock mechanism?", + "A": "Prevents the vaporizer from falling to floor and releasing its contents", + "B": "Prevents the wrong agent from being placed into the vaporizer", + "C": "Allows specific flowover to the breathing circuit", + "D": "Prevents more than 1 vaporizer to be turned on at one time" + }, + "zh": { + "question": "什么是蒸发器联锁机制？", + "A": "防止蒸发器掉落到地板上并释放其内容物", + "B": "防止错误的药剂被放入蒸发器", + "C": "允许特定的流量进入呼吸回路", + "D": "防止同时开启多个蒸发器" + } + }, + { + "id": "fb472fdb-82e4-5145-b511-5208f9266143", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The main purpose of the circle system is:", + "A": "To allow rapid transition to ambu bag", + "B": "To prevent rebreathing of CO2", + "C": "To help the scavenger system", + "D": "All of the above" + }, + "zh": { + "question": "环路系统的主要目的是：", + "A": "允许快速切换到人工呼吸袋", + "B": "防止二氧化碳再呼吸", + "C": "帮助废气排放系统", + "D": "以��所有" + } + }, + { + "id": "e6917021-7157-5047-8cff-f1f971a195cb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "If the APL valve is open and the ventilation bag squeezed where will all of it contents go", + "A": "Scavenger system", + "B": "The patient", + "C": "The circle system", + "D": "To the hospital gas supply" + }, + "zh": { + "question": "如果APL阀门打开并挤压通气袋，所有内容物将去往哪里", + "A": "废气处理系统", + "B": "患者", + "C": "循环系统", + "D": "医院气体供应" + } + }, + { + "id": "ddfe62ba-9dc3-5be7-95c2-48eb9ed94ed4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The approximate water content of Soda Lime is", + "A": "10-12%", + "B": "12-14%", + "C": "14-19%", + "D": "23-37%" + }, + "zh": { + "question": "苏打石灰的水含量大约是", + "A": "10-12%", + "B": "12-14%", + "C": "14-19%", + "D": "23-37%" + } + }, + { + "id": "6f38b5d9-1af7-5c73-b672-904cd4760b30", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following are ventilator components?", + "A": "Safety release valve", + "B": "Driving gas supply", + "C": "Injector", + "D": "Bellows assembly", + "E": "All of the above" + }, + "zh": { + "question": "以下哪些是呼吸机的组成部分？", + "A": "安全释放阀", + "B": "驱动气体供应", + "C": "喷射器", + "D": "风箱组件", + "E": "以上所有" + } + }, + { + "id": "4d36dea3-6084-5da7-a913-9db72cc08416", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The standard size in the U.S. for a scavenger system hose is ________.", + "A": "19mm", + "B": "20mm", + "C": "30mm", + "D": "33mm" + }, + "zh": { + "question": "美国标准的废气收集系统软管尺寸是 ________。", + "A": "19mm", + "B": "20mm", + "C": "30mm", + "D": "33mm" + } + }, + { + "id": "f33dc343-acd0-5736-9119-cdadb2e75818", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Define regulations", + "A": "Accepted methods of practice", + "B": "Legal mandate", + "C": "Micro-adjustments to the vaporizer", + "D": "Who cares I am just a SRNA" + }, + "zh": { + "question": "定义法规", + "A": "公认的实践方法", + "B": "法律授权", + "C": "对蒸发器的微调", + "D": "谁在乎，我只是个麻醉护理研究生" + } + }, + { + "id": "64f5eaf8-9759-58d6-beae-9cdc2c5d8cbf", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What are standards?", + "A": "Accepted methods of practice", + "B": "Legal mandates", + "C": "Based upon the MAC of a volatile agent", + "D": "FIU let Chris into the CRNA program, they obviously have no standards, then why should I!" + }, + "zh": { + "question": "什么是标准？", + "A": "公认的实践方法", + "B": "法律规定", + "C": "基于挥发性药物的MAC", + "D": "FIU让Chris进入CRNA项目，他们显然没有标准，那我为什么要有！" + } + }, + { + "id": "cf7ea8e9-eccb-5a61-a55c-2c190b01fa92", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following regulate gas cylinders?", + "A": "FDA", + "B": "NIOSH", + "C": "OSHA", + "D": "DOT", + "E": "MLBPA" + }, + "zh": { + "question": "以下哪项负责监管气瓶？", + "A": "FDA", + "B": "NIOSH", + "C": "OSHA", + "D": "DOT", + "E": "MLBPA" + } + }, + { + "id": "5ebad4f8-2bd9-5505-840a-220122e7e752", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which agency enforces a safe working environment?", + "A": "FDA", + "B": "NIOSH", + "C": "OSHA", + "D": "DOT", + "E": "MLBPA" + }, + "zh": { + "question": "哪个机构负责执行安全的工作环境？", + "A": "FDA", + "B": "NIOSH", + "C": "OSHA", + "D": "DOT", + "E": "MLBPA" + } + }, + { + "id": "62f8aaf3-2296-5585-9144-e866fdd78aa3", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Name the agency that writes criteria for OSHA to enforce.", + "A": "FDA", + "B": "MLBPA", + "C": "NIOSH", + "D": "DOT", + "E": "NFPA" + }, + "zh": { + "question": "请列出为OSHA执行标准制定标准的机构。", + "A": "FDA", + "B": "MLBPA", + "C": "NIOSH", + "D": "DOT", + "E": "NFPA" + } + }, + { + "id": "9c25e6b4-307f-5fa9-afc8-69a6c226d08a", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of these agencies writes standards for the prevention of fires?", + "A": "DOT", + "B": "FDA", + "C": "NIOSH", + "D": "NFPA", + "E": "OSHA" + }, + "zh": { + "question": "以下哪个机构制定防火标准？", + "A": "DOT", + "B": "FDA", + "C": "NIOSH", + "D": "NFPA", + "E": "OSHA" + } + }, + { + "id": "d0c81236-d669-5243-b4f1-d0ed406dfcb5", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Who handles most standards affecting anesthesia?", + "A": "FDA", + "B": "NIOSH", + "C": "ASTM", + "D": "CGA", + "E": "NFPA" + }, + "zh": { + "question": "谁负责处理影响麻醉的大多数标准？", + "A": "FDA", + "B": "NIOSH", + "C": "ASTM", + "D": "CGA", + "E": "NFPA" + } + }, + { + "id": "cfe568bb-8ed5-50bd-8535-554d0304a5fe", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of these are thw parts of the medical gas cylinder?", + "A": "Cylinder", + "B": "Valve", + "C": "Pressure Relief Device", + "D": "Conical Depression", + "E": "All of the above" + }, + "zh": { + "question": "以下哪些是医用气瓶的组成部分？", + "A": "气瓶", + "B": "阀门", + "C": "压力释放装置", + "D": "锥形凹陷", + "E": "以上所有" + } + }, + { + "id": "5e5765e7-87ec-5d4e-b9c8-c8e3b350e13c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the danger with Adiabatic compression?", + "A": "Icing of cylinder", + "B": "Rapid vaporization", + "C": "Fire hazard with recompression", + "D": "Fire hazard with decompression" + }, + "zh": { + "question": "绝热压缩的危险是什么？", + "A": "气缸结冰", + "B": "快速汽化", + "C": "再压缩时的火灾危险", + "D": "减压时的火灾危险" + } + }, + { + "id": "9f6c71b6-c2c1-532c-ae43-692a5b34e00f", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What is the danger with Adiabatic expansion?", + "A": "Rapid vaporization", + "B": "Icing of cylinder", + "C": "Fire hazard with recompression", + "D": "An increase in volatile anesthetic delivery" + }, + "zh": { + "question": "绝热膨胀的危险是什么？", + "A": "快速汽化", + "B": "气瓶结冰", + "C": "再压缩时的火灾危险", + "D": "挥发性麻醉剂输送增加" + } + }, + { + "id": "1c486560-2bed-533d-be4e-7508b3b124ad", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is PISS?", + "A": "Diameter index safety system", + "B": "Premature induction sevoflurane system", + "C": "Pin index safety system", + "D": "How most Irishmen feel at the end of a week of CRNA school without drinking beer" + }, + "zh": { + "question": "PISS是什么？", + "A": "直径索引安全系统", + "B": "早期诱导七氟醚系统", + "C": "销钉索引安全系统", + "D": "在没有喝啤酒的情况下度过了一周CRNA学校后，大多数爱尔兰人的感受" + } + }, + { + "id": "dd4fa6fb-98bb-5a64-852b-db427e7bf470", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the PISS of O2?", + "A": "1,5", + "B": "2,5", + "C": "3,5", + "D": "4,5" + }, + "zh": { + "question": "O2的PISS是什么？", + "A": "1,5", + "B": "2,5", + "C": "3,5", + "D": "4,5" + } + }, + { + "id": "621c5635-b26d-506b-9e97-b911cced0efd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the PISS of N2O?", + "A": "1,5", + "B": "2,5", + "C": "3,5", + "D": "4,5" + }, + "zh": { + "question": "N2O的PISS是什么？", + "A": "1,5", + "B": "2,5", + "C": "3,5", + "D": "4,5" + } + }, + { + "id": "50146695-499b-51de-8b0a-a3b2b0e85689", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the PISS of Air?", + "A": "1,5", + "B": "2,5", + "C": "3,5", + "D": "4,5" + }, + "zh": { + "question": "空气的PISS是什么？", + "A": "1,5", + "B": "2,5", + "C": "3,5", + "D": "4,5" + } + }, + { + "id": "0ba07e26-6552-54fb-8819-5b455bc0547c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is DISS?", + "A": "Diameter index safety system", + "B": "Pin index safety system", + "C": "Desflurane induction safety standards", + "D": "What a Super senior will do to you at the hospital after asking them a stupid question" + }, + "zh": { + "question": "什么是DISS？", + "A": "直径索引安全系统", + "B": "销钉索引安全系统", + "C": "地氟烷诱导安全标准", + "D": "在医院问了一个愚蠢的问题后，超级前辈会对你做什么" + } + }, + { + "id": "9252232a-b940-5982-a63b-77ba86a615f3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is NOT a component of the anesthesia machine?", + "A": "Vaporizer", + "B": "Ventilator", + "C": "Defibrillator", + "D": "Scavenging system" + }, + "zh": { + "question": "以下哪项不是麻醉机的组成部分？", + "A": "挥发器", + "B": "呼吸机", + "C": "除颤器", + "D": "废气排放系统" + } + }, + { + "id": "83e7377a-e24a-5e15-beff-633311149ea3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How many liter of O2 are in a G cylinder?", + "A": "660", + "B": "1500", + "C": "1200", + "D": "5300" + }, + "zh": { + "question": "G型氧气瓶中有多少升氧气？", + "A": "660", + "B": "1500", + "C": "1200", + "D": "5300" + } + }, + { + "id": "68853dff-594a-551d-9972-692e9929b563", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Define Vapor.", + "A": "The amount of pressure in a cylinder", + "B": "Conversion of a liquid to a gas", + "C": "Gas phase of a substance that is liquid at room temperature and atmospheric pressure", + "D": "All of the above" + }, + "zh": { + "question": "定义蒸气。", + "A": "气缸中的压力量", + "B": "液体转化为气体", + "C": "在室温和大气压下为液体的物质的气态", + "D": "以上所有" + } + }, + { + "id": "cb3c7d93-0193-5cc8-8ffe-3337933e7dfc", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is vaporization?", + "A": "The amount of pressure in a cylinder", + "B": "Conversion of a liquid to a gas", + "C": "Gas phase of a substance that is liquid at room temperature and atmospheric pressure", + "D": "All of the above" + }, + "zh": { + "question": "什么是汽化？", + "A": "气缸中的压力量", + "B": "液体转化为气体", + "C": "在室温和大气压下为液体的物质的气态", + "D": "以上所有" + } + }, + { + "id": "10a71806-b51d-5ac2-a08e-03e4ed40fb56", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Vaporization depends on what?", + "A": "Vapor pressure of the agent", + "B": "Temperature of the environment", + "C": "Amount of carrier gas used", + "D": "All of the above" + }, + "zh": { + "question": "蒸发取决于什么���", + "A": "药剂的蒸气压", + "B": "环境的温度", + "C": "使用的载气量", + "D": "以上所有" + } + }, + { + "id": "9034f925-c2a9-57af-9087-0f65bb85aab5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Define volatile anesthetic agent.", + "A": "Molecules of a liquid that break away and enter the space at the top of the vaporizer", + "B": "Pressure created when the molecules bombard the walls of the containe", + "C": "Molecules entering the liquid phase", + "D": "Liquid that has a tendency to change to a vapor at standard temperature and pressure" + }, + "zh": { + "question": "定义挥发性麻醉剂。", + "A": "液体的分子脱离并进入蒸发器顶部的空间", + "B": "分子撞击容器壁时产生的压力", + "C": "进入液相的分子", + "D": "在标准温度和压力下有转变为蒸气倾向的液体" + } + }, + { + "id": "0c4c58a0-aba4-5f64-8cac-54fd1589530b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the SVP of Sevo?", + "A": "175", + "B": "238", + "C": "160", + "D": "243" + }, + "zh": { + "question": "Sevo的SVP是多少？", + "A": "175", + "B": "238", + "C": "160", + "D": "243" + } + }, + { + "id": "9d0a0aee-515d-558c-91d6-8f8e424539f1", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "What is the SVP of Isoflurane?", + "A": "238", + "B": "175", + "C": "160", + "D": "243", + "E": "660" + }, + "zh": { + "question": "异氟醚的饱和蒸气压是多少？", + "A": "238", + "B": "175", + "C": "160", + "D": "243", + "E": "660" + } + }, + { + "id": "0d879309-a6bb-594a-910d-9972246e24b7", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "What is the SVP of Des?", + "A": "23", + "B": "669", + "C": "238", + "D": "243", + "E": "175" + }, + "zh": { + "question": "Des的SVP是多少？", + "A": "23", + "B": "669", + "C": "238", + "D": "243", + "E": "175" + } + }, + { + "id": "cccb0a33-be29-5118-8be7-c9b1c7acf7a9", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "What is the SVP of Enflurane", + "A": "23", + "B": "175", + "C": "243", + "D": "248", + "E": "660" + }, + "zh": { + "question": "恩氟烷的饱和蒸气压是多少", + "A": "23", + "B": "175", + "C": "243", + "D": "248", + "E": "660" + } + }, + { + "id": "63a70074-7e27-5f40-a5c5-49d57242dd0d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What increases SVP?", + "A": "Cooling", + "B": "Heating", + "C": "Passing gas over the liquid", + "D": "All of the above" + }, + "zh": { + "question": "什么会增加饱和蒸气压？", + "A": "冷却", + "B": "加热", + "C": "将气体通过液体", + "D": "以上所有" + } + }, + { + "id": "0c8a41f1-76ea-5a6d-8253-70ea46bc3c64", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What does a wick do in a vaporizer?", + "A": "Changes FGF", + "B": "A safeguard for system pressure failure", + "C": "Increases surface area", + "D": "Play backup QB for the Philadelphia Eagles" + }, + "zh": { + "question": "蒸发器中的灯芯有什么作用？", + "A": "改变新鲜气体流量", + "B": "系统压力故障的安全保障", + "C": "增加表面积", + "D": "为费城老鹰队担任替补四分卫" + } + }, + { + "id": "679216bd-bfcf-5201-9c16-72a80ffe6ab4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "With what method is all of the gas vaporized into the gas flow?", + "A": "Bubble through", + "B": "Flow over", + "C": "Injection", + "D": "All of the above" + }, + "zh": { + "question": "使用哪种方法将所有气体蒸发到气流中？", + "A": "气泡通过", + "B": "流过", + "C": "注射", + "D": "以上所有" + } + }, + { + "id": "2e6d2444-cb42-5137-bba3-3555c8cf5367", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which anesthetic agent requires supplied heat.", + "A": "Sevo", + "B": "Iso", + "C": "Des", + "D": "Halothane" + }, + "zh": { + "question": "哪种麻醉剂需要提供热量。", + "A": "七氟醚", + "B": "异氟醚", + "C": "地氟醚", + "D": "氟烷" + } + }, + { + "id": "b00a05c3-10e1-592f-a388-b81c2159247b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is vapor pressure?", + "A": "The temperature at which Vapor pressure is equal to barometric pressure", + "B": "Pressure exerted on the walls of a container by molecules that have broken away from the liquid surface", + "C": "The number of calories needed to convert one gram of liquid into vapor", + "D": "The pressure prior to solidifying of the liquid" + }, + "zh": { + "question": "什么是蒸气压？", + "A": "蒸气压等于大气压时的温度", + "B": "由从液体表面逸出的分子对容器壁施加的压力", + "C": "将一克液体转化为蒸气所需的卡路里数", + "D": "液体固化前的压力" + } + }, + { + "id": "83e740f3-f07d-5ffb-96a5-52e1e186a49d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is boling point?", + "A": "The temperature at which Vapor pressure is equal to barometric pressure", + "B": "Pressure exerted on the walls of a container by molecules that have broken away from the liquid surface", + "C": "The number of calories needed to convert one gram of liquid into vapor", + "D": "The pressure prior to solidifying of the liquid" + }, + "zh": { + "question": "什么是沸点？", + "A": "蒸汽压等于大气压时的温度", + "B": "从液体表面逸出的分子对容器壁施加的压力", + "C": "将一克液体转化为蒸汽所需的卡路里数", + "D": "液体固化前的压力" + } + }, + { + "id": "bab5ce2c-27d6-5817-b418-3e6a3300f7c4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Define heat of vaporization", + "A": "Pressure exerted on the walls of a container by molecules that have broken away from the liquid surface", + "B": "The number of calories needed to convert one kilogram of liquid into vapor", + "C": "The temperature at which Vapor pressure is equal to barometric pressure", + "D": "The number of calories needed to convert one gram of liquid into vapor" + }, + "zh": { + "question": "定义汽化热", + "A": "由从液体表面逸出的分子对容器壁施加的压力", + "B": "将一公斤液体转化为蒸汽所需的卡路里数", + "C": "蒸汽压等于大气压的温度", + "D": "将一克液体转化为蒸汽所需的卡路里数" + } + }, + { + "id": "7154ad82-2a8d-5cf3-bdfe-1c250fe2079d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the heat of vaporization of Desflurane?", + "A": "20C", + "B": "39C", + "C": "25C", + "D": "10C" + }, + "zh": { + "question": "Desflurane的汽化热是多少？", + "A": "20C", + "B": "39C", + "C": "25C", + "D": "10C" + } + }, + { + "id": "f7ae2296-8111-5ac8-b7f2-441307336beb", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the heat of vaporization of Halothane?", + "A": "20", + "B": "39", + "C": "15", + "D": "10" + }, + "zh": { + "question": "氟烷的汽化热是多少？", + "A": "20", + "B": "39", + "C": "15", + "D": "10" + } + }, + { + "id": "2a1e440c-d049-59b6-8859-d11da0b33a5c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the heat of vaporization of Isoflurane?", + "A": "25", + "B": "20", + "C": "39", + "D": "10" + }, + "zh": { + "question": "异氟醚的汽化热是多少？", + "A": "25", + "B": "20", + "C": "39", + "D": "10" + } + }, + { + "id": "2fcbf0f5-9d03-5b05-938e-545671ee5f9d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the boiling point in celsius of Des?", + "A": "50", + "B": "23", + "C": "48", + "D": "58" + }, + "zh": { + "question": "Des 的沸点是多少摄氏度？", + "A": "50", + "B": "23", + "C": "48", + "D": "58" + } + }, + { + "id": "40938008-30c3-5ba9-bc76-f43c7a520bc7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the boiling point in celsius of Halothane?", + "A": "23", + "B": "48", + "C": "50", + "D": "58" + }, + "zh": { + "question": "氟烷的沸点是多少摄氏度？", + "A": "23", + "B": "48", + "C": "50", + "D": "58" + } + }, + { + "id": "fe937557-1120-531f-bfb3-cabc357a64b4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the boiling point in celsius of Sevo?", + "A": "23", + "B": "48", + "C": "50", + "D": "58" + }, + "zh": { + "question": "Sevo的沸点是多少摄氏度？", + "A": "23", + "B": "48", + "C": "50", + "D": "58" + } + }, + { + "id": "b6ea6193-2a5d-5c68-8ebe-299c9f230de5", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the boiling point in celsius of Iso?", + "A": "23", + "B": "48", + "C": "50", + "D": "58" + }, + "zh": { + "question": "Iso的沸点是多少摄氏度？", + "A": "23", + "B": "48", + "C": "50", + "D": "58" + } + }, + { + "id": "021bcda2-4a74-5e39-8f99-4d9146768b44", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The most volatile agents have.....", + "A": "Low boiling point", + "B": "High heat of vaporization", + "C": "High specific heats", + "D": "All of the above" + }, + "zh": { + "question": "最易挥发的药剂具有.....", + "A": "低沸点", + "B": "高汽化热", + "C": "高比热", + "D": "以上所有" + } + }, + { + "id": "514ae68f-07f0-5ed5-918b-3775f8fa5d46", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the SVP of Halothane?", + "A": "23", + "B": "175", + "C": "239", + "D": "243" + }, + "zh": { + "question": "Halothane的饱和蒸气压是多少？", + "A": "23", + "B": "175", + "C": "239", + "D": "243" + } + }, + { + "id": "4b324753-9f15-538a-83b0-ababfd6ec028", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the SVP of Enflurane?", + "A": "243", + "B": "239", + "C": "175", + "D": "23" + }, + "zh": { + "question": "恩氟烷的饱和蒸气压是多少？", + "A": "243", + "B": "239", + "C": "175", + "D": "23" + } + }, + { + "id": "6b16bf8d-c602-51e9-aa64-38e4f5139c1c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "When is usually seen with the pumping effect and overdosing?", + "A": "Low levels of anesthetic agent in chamber", + "B": "Low flows", + "C": "Low dial settings", + "D": "All of the above" + }, + "zh": { + "question": "什么时候通常会看到泵效应和过量给药？", + "A": "麻醉剂在室内的低水平", + "B": "低流量", + "C": "低刻度设置", + "D": "以上所有" + } + }, + { + "id": "3b4f964d-3026-56ab-b9b1-1dbed59a5981", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "When is usually seen with the pumping effect and inadequate dose", + "A": "High flows", + "B": "Oxygen flush", + "C": "Manual ventilation", + "D": "All of the above" + }, + "zh": { + "question": "通常在何时会看到泵效应和剂量不足", + "A": "高流量", + "B": "氧气冲洗", + "C": "手动通气", + "D": "以上所有" + } + }, + { + "id": "bc810c7e-c648-5b9f-ba3e-d42090ed070b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the meaning of double-circuit in reference to a ventilator?", + "A": "Pneumatic force that compresses the bellows which empties its contents to the patient", + "B": "A split circuit to regulate gas flow", + "C": "A means of ventilation with use of an LMA", + "D": "All of the above" + }, + "zh": { + "question": "在呼吸机中，双回路的含义是什么？", + "A": "压缩气囊的气动力将其内容物排空至患者", + "B": "用于调节气体流量的分流电路", + "C": "使用喉罩通气的方法", + "D": "以上所有" + } + }, + { + "id": "598f9eea-2a06-5fe5-9746-119ad53e47e4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Why would set TV differ from delivered TV", + "A": "Compliance", + "B": "Losses", + "C": "Leaks", + "D": "All of the above" + }, + "zh": { + "question": "为什么设定的潮气量（TV）与实际输送的潮气量不同", + "A": "顺应性", + "B": "损失", + "C": "泄漏", + "D": "以上所有原因" + } + }, + { + "id": "9da2a4a0-252c-5e1f-b78d-abaee7e61ba7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the pressure limit on most ventilators", + "A": "200", + "B": "100", + "C": "40", + "D": "20" + }, + "zh": { + "question": "大多数呼吸机的压力限制是多少", + "A": "200", + "B": "100", + "C": "40", + "D": "20" + } + }, + { + "id": "5de9d65c-191f-5e92-9cf6-ee66d4f74d53", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Why is a patient taken of the ventilator if there is a failure from the central supply.", + "A": "Most patients can survive on a hypoxic mix for short period", + "B": "We do not want a backflow of gas into central supply", + "C": "You will waste oxygen driving the bellows", + "D": "All of the above" + }, + "zh": { + "question": "如果中央供气系统出现故障，为什么要将病人从呼吸机上撤下？", + "A": "大多数患者可以在短时间内在低氧混合气体中生存", + "B": "我们不希望气体回流到中央供气系统", + "C": "使用风箱会浪费氧气", + "D": "以上全部" + } + }, + { + "id": "4dc2d235-4afd-54fc-8f96-379492d568ae", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Be familiar with the process of the bellows and ventilator slides 17-22 of week 4 lecture.  Trivia time! In 1947 Ted Williams won the triple crown, in an absolute disgrace to mankind as we now know it, he did not win the MVP.  Who did", + "A": "Mickey Mantle", + "B": "Roger Maris", + "C": "Joe Dimaggio", + "D": "Roger Hornsby", + "E": "J.P. Mato" + }, + "zh": { + "question": "熟悉第4周讲座第17-22页幻灯片中的风箱和呼吸机过程。冷知识时间！1947年，泰德·威廉姆斯赢得了三冠王，但令人遗憾的是，他没有赢得MVP。那么，谁赢得了呢？", + "A": "米奇·曼托", + "B": "罗杰·马里斯", + "C": "乔·迪马乔", + "D": "罗杰·霍恩斯比", + "E": "J.P. 马托" + } + }, + { + "id": "4b93561f-c2f3-590d-b2e2-eda07c02e8d2", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "TV is given at 10-15ml/kg can you clarify?", + "A": "Based on a patients TBW", + "B": "Based on a patients ideal body weight", + "C": "Based on the patients surface area", + "D": "All of the above" + }, + "zh": { + "question": "TV 给定为 10-15ml/kg，你能澄清一下吗？", + "A": "基于患者的总身体重量", + "B": "基于患者的理想体重", + "C": "基于患者的体表面积", + "D": "以上所有" + } + }, + { + "id": "6fd7523f-ea17-548c-aaee-95d74bacce71", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which patient would benefit from a prolonged expiratory time?", + "A": "CHF", + "B": "COPD", + "C": "CAD", + "D": "Anterior cruciate ligament tear" + }, + "zh": { + "question": "哪位��者会从延长呼气时间中受益？", + "A": "充血性心力衰竭（CHF）", + "B": "慢性阻塞性肺病（COPD）", + "C": "冠状动脉疾病（CAD）", + "D": "前交叉韧带撕裂" + } + }, + { + "id": "adfaa99f-ddfd-5ee7-b419-1df93529aceb", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is part of the high pressure cylinder?", + "A": "Pipeline inlet", + "B": "Flowmeter", + "C": "O2 flush", + "D": "Hanger yoke" + }, + "zh": { + "question": "以下哪项是高压气瓶的一部分？", + "A": "管道入口", + "B": "流量计", + "C": "氧气冲洗", + "D": "吊架支架" + } + }, + { + "id": "725769e7-e483-507d-b2d8-c4bc42225393", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is included in the high pressure system?", + "A": "BVM", + "B": "Pipeline pressure gauge & O2 flush", + "C": "Flowmeter", + "D": "Vaporizers", + "E": "Hanger Yoke" + }, + "zh": { + "question": "以下哪项属于高压系统？", + "A": "BVM", + "B": "管道压力表和氧气冲洗", + "C": "流量计", + "D": "挥发器", + "E": "挂钩支架" + } + }, + { + "id": "b09f59a9-ec28-5270-9e57-d45925daa476", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How does the O2 fail safe work?", + "A": "Prevents dialing of a hypoxic mixture", + "B": "Cuts off N2O if O2 supply fails", + "C": "Prevents hypoxic mixture", + "D": "Cuts off O2 when N2O supply falls" + }, + "zh": { + "question": "氧气失效保护装置如何工作？", + "A": "防止拨入低氧混合气", + "B": "如果氧气供应失败则切断一氧化二氮", + "C": "防止低氧混合气", + "D": "当一氧化二氮供应减少时切断氧气" + } + }, + { + "id": "8c3568d8-d087-5b2a-b180-0d2399c940d9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The O2 flush valve", + "A": "Delivers O2 between 50-75 L /min", + "B": "Can be locked in the ON position", + "C": "Only pushed during expiration", + "D": "Is easy to activate" + }, + "zh": { + "question": "氧气冲洗阀", + "A": "提供50-75升/分钟的氧气", + "B": "可以锁定在开启位置", + "C": "仅在呼气时按下", + "D": "易于激活" + } + }, + { + "id": "3351ee7c-3312-58a8-83c2-a7b5ec9b2ffb", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the function of the fail safe valve used with oxygen?", + "A": "Prevents hypoxic mix", + "B": "Prevents failure of gas supply from central hospital supply", + "C": "The set oxygen concentration shall not be decrease at the CGO", + "D": "Will rupture allowing safe passage of the contained gas without rupture" + }, + "zh": { + "question": "氧气使用的安全阀的功能是什么？", + "A": "防止低氧混合", + "B": "防止中央医院供气系统的气体供应故障", + "C": "设定的氧气浓度在CGO处不应降低", + "D": "会破裂，允许安全通过所含气体而不破裂" + } + }, + { + "id": "955033a5-0034-5179-bd74-cf1dc3b3ee86", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is your last safeguard in preventing a hypoxic mix?", + "A": "PSIG of the N2O cylinder", + "B": "Hypoxic guard system", + "C": "PSIG of the oxygen cylinder", + "D": "Fail safe valve" + }, + "zh": { + "question": "防止低氧混合的最后一道防线是什么？", + "A": "N2O气瓶的PSIG", + "B": "低氧防护系统", + "C": "氧气瓶的PSIG", + "D": "失效保护阀" + } + }, + { + "id": "c4051960-78dd-5e6c-aec1-9c5f98fee57f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the most accurate way of identifying cylinders?", + "A": "Weight", + "B": "PSIG", + "C": "Label", + "D": "Olfactory thrshold" + }, + "zh": { + "question": "识别气瓶的最准确方法是什么？", + "A": "重量", + "B": "PSIG", + "C": "标签", + "D": "嗅觉阈值" + } + }, + { + "id": "1c8927be-d0c8-5f76-9026-129412f4a3ff", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which VAA is used in the TEC-6 vaporizer?", + "A": "ISO", + "B": "DES", + "C": "SEVO", + "D": "Halothane" + }, + "zh": { + "question": "哪种挥发性麻醉剂用于TEC-6蒸发器？", + "A": "异氟醚", + "B": "地氟醚", + "C": "七氟醚", + "D": "氟烷" + } + }, + { + "id": "cd9c57f7-f882-576b-a40d-db203d543a7c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which VAA is used in the TEC-5 Vaporizer?", + "A": "ISO", + "B": "DES", + "C": "SEVO", + "D": "Halothane" + }, + "zh": { + "question": "哪种挥发性麻醉剂用于TEC-5蒸发器？", + "A": "异氟醚", + "B": "地氟醚", + "C": "七氟醚", + "D": "氟烷" + } + }, + { + "id": "b22e439c-afd1-5ca4-bc39-89b3d51e76ab", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Where is the best place to have the oxygen flowmeter?", + "A": "Furthest to left", + "B": "In the middle", + "C": "Furthest to right", + "D": "Just outside the OR" + }, + "zh": { + "question": "氧气流量计放置在什么位置最好？", + "A": "最左边", + "B": "中间", + "C": "最右边", + "D": "手术室外面" + } + }, + { + "id": "97699204-eba5-5ff7-9af4-9c27d14deea3", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "Which type of scavenger system requires relief valves", + "A": "Open scavenger system", + "B": "Closed scavenger system", + "C": "A Yankee fan! Not only are they scavengers they are part of the \"Evil Empire\"" + }, + "zh": { + "question": "哪种类型的废气收集系统需要安全阀", + "A": "开放式废气收集系统", + "B": "封闭式废气收集系统", + "C": "一个洋基队的粉丝！他们不仅是拾荒者，还是“邪恶帝国”的一部分" + } + }, + { + "id": "12024ba1-4793-512a-8243-ecc76d3ce3dd", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What are the hazards with aluminum cylinders", + "A": "Adiabatic expansion", + "B": "Fire", + "C": "Can not be used with MRI Patients", + "D": "Very heavy injury concern" + }, + "zh": { + "question": "铝制气瓶的危害是什么", + "A": "绝热膨胀", + "B": "火灾", + "C": "不能用于MRI患者", + "D": "非常重的伤害隐患" + } + }, + { + "id": "6642887b-0b16-5f95-a6cd-ba7a5f62113a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How often must cylinders be inspected?", + "A": "2 years", + "B": "3 years", + "C": "5 years", + "D": "15 years" + }, + "zh": { + "question": "气瓶必须多久检查一次？", + "A": "2年", + "B": "3年", + "C": "5年", + "D": "15年" + } + }, + { + "id": "95f59471-42e0-539e-8afd-ec9ccc1208cd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How many liters of gas is in a H tank of o2?", + "A": "330", + "B": "660", + "C": "6,600", + "D": "13,800" + }, + "zh": { + "question": "一个H型氧气罐中有多少升气体？", + "A": "330", + "B": "660", + "C": "6,600", + "D": "13,800" + } + }, + { + "id": "af9e231e-12f1-5f13-a0df-019a3274591b", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "How many liters of gas is in a N2O H tank?", + "A": "330", + "B": "660", + "C": "745", + "D": "1590", + "E": "13800" + }, + "zh": { + "question": "N2O H罐中有多少升气体？", + "A": "330", + "B": "660", + "C": "745", + "D": "1590", + "E": "13800" + } + }, + { + "id": "02ed51a0-dec3-5aa8-b371-b5e4597a3e20", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is a hazard of a pipeline system?", + "A": "Foreign material", + "B": "Gaseous", + "C": "Water", + "D": "Bacterial", + "E": "All of the above" + }, + "zh": { + "question": "管道系统的危害是什么？", + "A": "异物", + "B": "气体", + "C": "水", + "D": "细菌", + "E": "以上所有" + } + }, + { + "id": "6e529438-9ff6-599a-b959-e576fb6cf968", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the normal tidal volume for a patient?", + "A": "700cc", + "B": "600cc", + "C": "10-15cc/kg", + "D": "10-15cc/kg of ideal body weight" + }, + "zh": { + "question": "患者的正常潮气量是多少？", + "A": "700cc", + "B": "600cc", + "C": "10-15cc/kg", + "D": "理想体重的10-15cc/kg" + } + }, + { + "id": "75ae1877-2884-5498-8b8c-cd50babe044b", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "What does the tidal volume sensor tell you?", + "A": "How much volume remaining in circuit", + "B": "How much volume being delivered", + "C": "How much volume being returned", + "D": "All of the above", + "E": "None of the above" + }, + "zh": { + "question": "潮气量传感器告诉你什么？", + "A": "回路中剩余的体积", + "B": "正在输送的体积", + "C": "正在返回的体积", + "D": "以上全部", + "E": "以上都不是" + } + }, + { + "id": "fc34fc88-68f4-5849-a61b-ca1f522ddf64", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "WHat is the biggest hazard with ventilators?", + "A": "Barotrauma", + "B": "Low PEEP", + "C": "Failure to resume ventilation after turning off", + "D": "All of the above" + }, + "zh": { + "question": "呼吸机最大的危害是什么？", + "A": "压力伤", + "B": "低PEEP", + "C": "关闭后未能恢复通气", + "D": "以上所有" + } + }, + { + "id": "8d3b4e17-82c7-5478-8710-6fabffbbf91e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which monitoring device can not be deactivated?", + "A": "Precordial monitor", + "B": "Capnometer", + "C": "Spirometer", + "D": "Pulse oximetry", + "E": "EKG" + }, + "zh": { + "question": "哪种监测设备不能被停用？", + "A": "胸骨前监测器", + "B": "二氧化碳监测仪", + "C": "肺活量计", + "D": "脉搏血氧仪", + "E": "心电图" + } + }, + { + "id": "006e1854-248b-5867-8e64-211778c8d674", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Though rare, what will be seen in the presence of the pumping effect?", + "A": "Wrong agent being dispensed", + "B": "Underdosing", + "C": "Overdosing", + "D": "All of the above" + }, + "zh": { + "question": "虽然罕见，但在泵效应存在的情况下会看到什么？", + "A": "错误的药剂被分配", + "B": "剂量不足", + "C": "剂量过多", + "D": "以上所有" + } + }, + { + "id": "1627b564-7808-568a-b1c7-c730795ce81e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Though rare, what will be seen in the presence of the pressurizing effect?", + "A": "Wrong agent being dispensed", + "B": "Underdosing", + "C": "Overdosing", + "D": "None of the above" + }, + "zh": { + "question": "虽然罕见，但在加压效应的情况下会看到什么？", + "A": "分发错误的药剂", + "B": "剂量不足", + "C": "剂量过多", + "D": "以上都不是" + } + }, + { + "id": "2837f887-71b3-5d4e-9fb3-e6bea11c0b3a", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 74 yo male with hypertension is undergoing a knee replacement under GA. At some point intraoperatively, the BP and O2 saturation both unexpectedly drop significantly. Which of the following is a likely cause?", + "A": "History of alcoholism", + "B": "The use of femoral and sciatic nerve blocks", + "C": "Bone cement implantation syndrome/fat embolism", + "D": "Long-term use of convective warmers intraoperatively" + }, + "zh": { + "question": "一名74岁患有高血压的男性正在全身麻醉下进行膝关节置换手术。在手术过程中，血压和氧饱和度都意外显著下降。以下哪项是可能的原因？", + "A": "酗酒史", + "B": "使用股神经和坐骨神经阻滞", + "C": "骨水泥植入综合征/脂肪栓塞", + "D": "术中长期使用对流加温器" + } + }, + { + "id": "7180f21e-d371-5b74-be77-e47b994e9755", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The Diameter Index Safety System (DISS) is designed to:", + "A": "Ensure that a vaporizer isn't filled with the wrong volatile anesthetic", + "B": "Prevent connection of the wrong gas at the wall", + "C": "Ensure that tubing designed for IV infusions can't be connected to an epidural catheter", + "D": "Allow both ET tubes and LMA's to connect to the same-sized circuit" + }, + "zh": { + "question": "直径索引安全系统 (DISS) 的设计目的是：", + "A": "确保挥发性麻醉剂蒸发器不会被错误的麻醉剂填充", + "B": "防止错误的气体连接到墙上", + "C": "确保用于静脉输液的管道不能连接到硬膜外导管", + "D": "允许气管插管和喉罩连接到相同尺寸的回路" + } + }, + { + "id": "f8de02ab-29d5-5330-b092-4ead7376246d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The nitrous oxide tank can't have both liquid and gas phases present if:", + "A": "The temperature in the tank is greater than the critical temperature", + "B": "The pressure is too high", + "C": "The tank is stationary", + "D": "The temperature in the tank is less than the critical temperature" + }, + "zh": { + "question": "如果出现以下情况，氧化亚氮罐中不能同时存在液相和气相：", + "A": "罐内温度高于临界温度", + "B": "压力过高", + "C": "罐是静止的", + "D": "罐内温度低于临界温度" + } + }, + { + "id": "b19bfdbd-2324-54b1-825c-c44f9675dbad", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In the shown lung volume tracing, letter \"A\" corresponds to which volume/capacity?", + "A": "Tidal Volume (TV)", + "B": "Functional Residual Capacity (FRC)", + "C": "Reserve Volume (RV)", + "D": "Vital Capacity (RV)" + }, + "zh": { + "question": "在所示的肺容量曲线中，字母“A”对应于哪个容量/容积？", + "A": "潮气量 (TV)", + "B": "功能残气量 (FRC)", + "C": "储备容量 (RV)", + "D": "肺活量 (RV)" + } + }, + { + "id": "60999cd7-0c34-5afa-96f8-c2f4de77a80e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The curve that relates the SV to preload is called:", + "A": "The pulsatility index", + "B": "The Giddings Curve", + "C": "The heart performance index (HPI)", + "D": "The Starling Curve" + }, + "zh": { + "question": "将SV与前负荷相关联的曲线称为：", + "A": "搏动指数", + "B": "吉丁斯曲线", + "C": "心脏性能指数 (HPI)", + "D": "斯塔林曲线" + } + }, + { + "id": "2ffd5db7-febb-5244-8427-17a79313a583", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A patient is on warfarin and requires emergent abdominal surgery. There is considerable bleeding during the procedure. What would be an appropriate way to counteract this patient's anticoagulation?", + "A": "Vitamin C", + "B": "Hypothermia", + "C": "Protamine", + "D": "FFP" + }, + "zh": { + "question": "一名患者正在服用华法林，需要进行紧急腹部手术。手术过程中出血严重。哪种方法适合抵消该患者的抗凝作用？", + "A": "维生素C", + "B": "低温", + "C": "鱼精蛋白", + "D": "新鲜冰冻血浆（FFP）" + } + }, + { + "id": "2493be9f-4aad-55f1-977a-02db5ca24dff", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A gremlin enters the OR during surgery and moves the art-line transducer (pressure sensor) to the floor, which places it well below the height of the patient. Which of the following is correct about the indicated arterial line blood pressure?", + "A": "The arterial line MAP will be accurate, but not the systolic or diastolic pressures", + "B": "The arterial line blood pressure will be accurate", + "C": "The arterial line blood pressure will read lower than the patient's actual blood pressure", + "D": "The arterial line blood pressure will read higher than the patient's actual blood pressure" + }, + "zh": { + "question": "在手术过程中，一个小精灵进入手术室并将动脉线传感器（压力传感器）移到地板上，这使得它远低于患者的高度。以下关于动脉线血压的说法哪项是正确的？", + "A": "动脉线的平均动脉压（MAP）将是准确的，但收缩压或舒张压不准确", + "B": "动脉线的血压将是准确的", + "C": "动脉线的血压读数将低于患者的实际血压", + "D": "动脉线的血压读数将高于患者的实际血压" + } + }, + { + "id": "1c22fd44-23ca-5f6a-87b1-60bb2f999c84", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A clinician is placing an epidural and notices an (unintentional) dural puncture. What issue is this patient most likely to subsequently experience?", + "A": "Hypotension", + "B": "Headache", + "C": "Death", + "D": "Lower extremity weakness that lasts for several days" + }, + "zh": { + "question": "一名临床医生正在进行硬膜外麻醉时注意到（非故意的）硬膜穿刺。该患者最有可能随后出现什么问题？", + "A": "低血压", + "B": "头痛", + "C": "死亡", + "D": "持续数天的下肢无力" + } + }, + { + "id": "367e1d2f-a966-58b5-848f-716fa002f71d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A postop patient is found to have a new-onset adrenal insufficiency, diagnosed with a low plasma cortisol concentration. Which medication did the patient likely receive to cause this?", + "A": "Ketamine", + "B": "Etomidate", + "C": "Sugammadex", + "D": "Propofol" + }, + "zh": { + "question": "一名术后患者被发现有新发的肾上腺功能不全，诊断为血浆皮质醇浓度低。患者可能接受了哪种药物导致这种情况？", + "A": "氯胺酮", + "B": "依托咪酯", + "C": "舒更葡糖", + "D": "丙泊酚" + } + }, + { + "id": "d7928443-cb38-51a2-a5b2-a41f7bb37077", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 54 yo Male with vocal cord lesions is having a suspension micro laryngoscopy with laser treatment of the vocal cord lesions. Which of the following ET tubes might be used for this procedure?", + "A": "A metal-reinforced laser tube", + "B": "A NIMS tube with electrodes for monitoring the vocal cords", + "C": "Bronchial blocker", + "D": "Double-lumen" + }, + "zh": { + "question": "一名54岁男性患有声带病变，正在进行悬吊显微喉镜检查，并用激光治疗声带病变。以下哪种气管导管可能用于此手术？", + "A": "金属加强激光管", + "B": "带有电极用于监测声带的NIMS管", + "C": "支气管封堵器", + "D": "双腔管" + } + }, + { + "id": "cdb9fc7b-e86b-5eb6-baaa-3e7a7de23a2b", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "For the laminar flow of a fluid through a tube, which of the following would not be expected to increase the flow?", + "A": "Decreased viscosity of the fluid", + "B": "Increased pressure applied", + "C": "Increased length of the tube", + "D": "Increased diameter of the tube" + }, + "zh": { + "question": "对于流体通过管道的层流，以下哪项不会增加流量？", + "A": "降低流体的粘度", + "B": "增加施加的压力", + "C": "增加管道的长度", + "D": "增加管道的直径" + } + }, + { + "id": "0af54671-3dd7-5e71-b479-fee4cc172062", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Posterior fossa sciatic nerve blocks and ankle blocks would be most useful for which kinds of surgeries?", + "A": "Knee surgeries", + "B": "Surgeries involving the distal femur", + "C": "Foot surgeries", + "D": "Hip fracture surgeries" + }, + "zh": { + "question": "后颅窝坐骨神经阻滞和踝关节阻滞最适用于哪种手术？", + "A": "膝关节手术", + "B": "涉及股骨远端的手术", + "C": "足部手术", + "D": "髋部骨折手术" + } + }, + { + "id": "0be87e07-594c-5999-87c8-ecb91d9c9272", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A trauma patient comes to the OR. He has a small pneumothorax (punctured lung) on CT scan in the ER. Which inhaled anesthetic would be the least desirable to use in this context?", + "A": "Desflurane", + "B": "Nitrous Oxide", + "C": "Sevoflurane", + "D": "Isoflurane" + }, + "zh": { + "question": "一名创伤患者来到手术室。他在急诊室的CT扫描中显示有小的气胸（肺部穿孔）。在这种情况下，哪种吸入麻醉剂是最不理想的选择？", + "A": "地氟醚", + "B": "一氧化二氮", + "C": "七氟醚", + "D": "异氟醚" + } + }, + { + "id": "31afb88f-6c92-5d74-b369-706dd8595ad9", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Per ASA guidelines, patients on mechanical ventilation require all of the following EXCEPT:", + "A": "Spontaneous breathing attempt alarm", + "B": "Audible breathing circuit disconnect alarm", + "C": "Qualified volume of air movement with each breath (tidal volume)", + "D": "Inspired oxygen concentration monitor" + }, + "zh": { + "question": "根据ASA指南，机械通气的患者需要以下所有条件，除了：", + "A": "自发呼吸尝试报警", + "B": "可听见的呼吸回路断开报警", + "C": "每次呼吸的合格气体流量（潮气量）", + "D": "吸入氧浓度监测器" + } + }, + { + "id": "24869527-201a-51bf-bf95-08b887c113a3", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 26 yo male patient is stabbed in the chest several times and comes to the OR for emergency surgery. An ultrasound in the ER shows cardiac tamponade. The hemodynamic objective for this anesthetic would be:", + "A": "Maintain a very low BP", + "B": "Keep the HR high", + "C": "Keep the HR low", + "D": "Minimize IV fluids" + }, + "zh": { + "question": "一名26岁男性患者被刺伤胸部多次，需进行紧急手术。急诊室的超声显示心脏压塞。该麻醉的血流动力学目标是：", + "A": "维持非常低的血压", + "B": "保持心率高", + "C": "保持心率低", + "D": "尽量减少静脉输液" + } + }, + { + "id": "38c09c9b-81f5-5516-b102-c04e3627d6cc", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient in the PACU becomes unresponsive and is found to be pulseless. The EKG shows sinus tachycardia with an HR of 115. Which of the following should be done first?", + "A": "Synchronized cardioversion", + "B": "Administration of IV magnesium sulfate", + "C": "CPR", + "D": "Administration of adenosine 6mg IV" + }, + "zh": { + "question": "一名患者在术后恢复室变得无反应，并被发现无脉搏。心电图显示窦性心动过速，心率为115。以下哪项应首先进行？", + "A": "同步电复律", + "B": "静脉注射硫酸镁", + "C": "心肺复苏", + "D": "静脉注射6mg腺苷" + } + }, + { + "id": "1f5ad08d-8166-573f-80ba-01ea8aeb981c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following would be expected to increase contractility?", + "A": "Increased PEEP", + "B": "Administration of Calcium", + "C": "Adenosine", + "D": "Amiodarone" + }, + "zh": { + "question": "下列哪项预期会增加心肌收缩力？", + "A": "增加PEEP", + "B": "钙的给药", + "C": "腺苷", + "D": "胺碘酮" + } + }, + { + "id": "90c4db10-c5e9-541c-9856-d9e7bdabf484", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "All of the following contribute to increased ICP in robotic surgeries EXCEPT:", + "A": "Profound muscle relaxation", + "B": "Elevated intra-abdominal pressure from the pneumoperitoneum", + "C": "Trendelenberg position", + "D": "Hypercarbia from insufflation of CO2" + }, + "zh": { + "question": "在机器人手术中，以下所有因素都会导致颅内压（ICP）增加，除了：", + "A": "深度肌肉松弛", + "B": "气腹导致的腹腔内压升高", + "C": "特伦德伦堡体位", + "D": "二氧化碳充气导致的高碳酸血症" + } + }, + { + "id": "4a056ed2-95b0-54c5-babf-85383b3bcd2b", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient in the PACU requires a significant amount of hydromorphone for pain, and is later observed to desaturate (SpO2 approx 70%) and isn't breathing. Which medication would be appropriate to use to fix the problem?", + "A": "Steroids", + "B": "Naloxone (Narcan)", + "C": "Methylene Blue", + "D": "Epinephrine" + }, + "zh": { + "question": "一名患者在术后恢复室需要大量使用氢吗啡酮来缓解疼痛，随后被观察到血氧饱和度下降（SpO2约为70%）且没有呼吸。使用哪种药物可以解决这个问题？", + "A": "类固醇", + "B": "纳洛酮（Narcan）", + "C": "亚甲蓝", + "D": "肾上腺素" + } + }, + { + "id": "0db6ab6f-511a-5c85-87d5-71e016833b20", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The most common nerve injury for patients in lithotomy position is:", + "A": "Spinal injury", + "B": "Gluteal nerve injury", + "C": "Sciatic nerve injury", + "D": "Common peroneal nerve injury" + }, + "zh": { + "question": "患者处于截石位时最常见的神经损伤是：", + "A": "脊髓损伤", + "B": "臀神经损伤", + "C": "坐骨神经损伤", + "D": "腓总神经损伤" + } + }, + { + "id": "c9de55f3-61fb-57f2-a4bf-58907ff0b0d4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The appropriate initial dose of dantrolene is:", + "A": "0.25 mg/kg", + "B": "10 mg/kg", + "C": "1 mg/kg", + "D": "2.5 mg/kg" + }, + "zh": { + "question": "丹曲林的适当初始剂量是：", + "A": "0.25 mg/kg", + "B": "10 mg/kg", + "C": "1 mg/kg", + "D": "2.5 mg/kg" + } + }, + { + "id": "2f147b65-7d58-5573-8f0e-05ba595efd91", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "All of the following can increase the MAC of a volatile anesthetic EXCEPT:", + "A": "Recent use of a stimulant, such as cocaine", + "B": "Young age", + "C": "Female patient", + "D": "Natural redhead patient" + }, + "zh": { + "question": "以下哪项不会增加挥发性麻醉药的最低肺泡浓度（MAC）？", + "A": "最近使用兴奋剂，如可卡因", + "B": "年轻年龄", + "C": "女性患者", + "D": "自然红发患者" + } + }, + { + "id": "87eeff07-5771-57b2-b5e3-c1159d71323e", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 28 yo female patient is involved in a car accident and brought emergently to the OR. She receives emergency release blood. What is the most appropriate blood type for transfusion of PRBC's in this context?", + "A": "AB -", + "B": "O -", + "C": "O +", + "D": "AB +" + }, + "zh": { + "question": "一名28岁女性患者卷入车祸，被紧急送至手术室。她接受了紧急放行的血液。在这种情况下，输注红细胞悬液最合适的血型是什么？", + "A": "AB -", + "B": "O -", + "C": "O +", + "D": "AB +" + } + }, + { + "id": "f653fa9a-dba7-53b4-9694-ac4dc55708a2", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "An 80 kg, 180 cm patient has the following intraoperative ABG: pH 7.29 / pCO2 55 / PO2 265 / HCO3 25. How should the ventilator settings be adjusted?", + "A": "Decrease the tidal volume from 500 mL to 250 mL", + "B": "Remove PEEP", + "C": "Increase FiO2", + "D": "Increase the respiratory rate" + }, + "zh": { + "question": "一名80公斤，180厘米的患者术中动脉血气分析结果如下：pH 7.29 / pCO2 55 / PO2 265 / HCO3 25。应如何调整呼吸机设置？", + "A": "将潮气量从500 mL减少到250 mL", + "B": "去除PEEP", + "C": "增加FiO2", + "D": "增加呼吸频率" + } + }, + { + "id": "c86d53be-a137-5c3f-9ca1-e60cf920fb3c", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A patient receives Drug X, which increases contractility while maintaining the same preload and afterload. What would be the expected result to this drug?", + "A": "Increased SV", + "B": "Unchanged SV", + "C": "Decreased HR", + "D": "Decreased SV" + }, + "zh": { + "question": "一名患者接受药物X，该药物在维持相同的前负荷和后负荷的同时增加收缩力。对此药物的预期结果是什么？", + "A": "增加的SV", + "B": "不变的SV", + "C": "降低的HR", + "D": "降低的SV" + } + }, + { + "id": "90fa1cab-e4aa-5565-a80a-361df728f64d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "An inspector from the Joint Commission comes and asks you what prevents someone from connecting a nitrous oxide tank where an oxygen tank should be. How do you answer?", + "A": "Left-handed threads on oxygen tanks", + "B": "The Pin Index Safety System (PISS)", + "C": "The Diameter Index Safety System (DISS)", + "D": "Automated barcode analysis" + }, + "zh": { + "question": "一位来自联合委员会的检查员来问你，是什么防止有人将一氧化二氮罐连接到氧气罐的位置。你如何回答？", + "A": "氧气罐上的左旋螺纹", + "B": "针式索引安全系统（PISS）", + "C": "直径索引安全系统（DISS）", + "D": "自动条码分析" + } + }, + { + "id": "f4fb291c-491c-5c72-a1b6-643c13ad0733", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Hospital-grade electrical outlets are identified by:", + "A": "A green circle", + "B": "The entire outlet is red-colored", + "C": "A red triangle", + "D": "A green square" + }, + "zh": { + "question": "医院级电源插座的标识是：", + "A": "绿色圆圈", + "B": "整个插座是红色的", + "C": "红色三角形", + "D": "绿色方形" + } + }, + { + "id": "e56c909a-8ea3-5bad-ae6a-bbfe126bd5f5", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A patient comes to the ER and has an EKG that shows \"prominent U waves\". Which of the following would be the most likely result of their plasma potassium level?", + "A": "7.9 mEq/L", + "B": "3.6 mEq/L", + "C": "5.2 mEq/L", + "D": "1.8 mEq/L" + }, + "zh": { + "question": "一名患者来到急诊室，心电图显示“明显的U波”。以下哪项最可能是他们的血浆钾水平结果？", + "A": "7.9 mEq/L", + "B": "3.6 mEq/L", + "C": "5.2 mEq/L", + "D": "1.8 mEq/L" + } + }, + { + "id": "939fff3b-9930-5779-99bd-fcd3d2cff373", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following has the most effect on the preload?", + "A": "Blood volume status", + "B": "Arterial dilation", + "C": "Systemic vascular resistance", + "D": "Compression of the aorta" + }, + "zh": { + "question": "以下哪项对前负荷影响最大？", + "A": "血容量状态", + "B": "动脉扩张", + "C": "全身血管阻力", + "D": "主动脉压迫" + } + }, + { + "id": "a66e7300-031f-5024-91b3-bca91eef7019", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "EKG electrodes work by using a combination of:", + "A": "Silver chloride and conducting gel", + "B": "Petroleum jelly layer for improved conductance with skin", + "C": "Copper rings for decreased electrical resistance", + "D": "Calcium chloride solution" + }, + "zh": { + "question": "心电图电极通过以下组合工作：", + "A": "氯化银和导电凝胶", + "B": "石油膏层以改善与皮肤的导电性", + "C": "铜环以降低电阻", + "D": "氯化钙溶液" + } + }, + { + "id": "a0e17c69-2bb0-5795-81b3-06c966e93ca0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The most common causes of death from administration of blood products in the US are:", + "A": "Administration of Rh-negative blood to an Rh-positive patient", + "B": "Zika Virus", + "C": "Citrate intoxication resulting in hypocalcemia and death", + "D": "Transfusion Related Acute Lung Injury (TRALI) and Tranfusion Related Cardiac Overload (TACO)" + }, + "zh": { + "question": "在美国，输注血液制品导致死亡的最常见原因是：", + "A": "将Rh阴性血液输给Rh阳性患者", + "B": "寨卡病毒", + "C": "柠檬酸中毒导致低钙血症和死亡", + "D": "输血相关急性肺损伤（TRALI）和输血相关心脏超负荷（TACO）" + } + }, + { + "id": "a20dae6b-3b38-57cd-b29b-3f3390c7eecf", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A patient is undergoing a neurosurgical procedure for removal of a brain tumor. The surgeon requests acute lowering of the ICP. Which of the following can facilitate that?", + "A": "Mannitol", + "B": "Esmolol", + "C": "Use of LR's solution as the IV fluid", + "D": "Hypoventilation (to PaCO2 50-60 mm Hg)" + }, + "zh": { + "question": "一名患者正在接受神经外科手术以切除脑肿瘤。外科医生要求急性降低颅内压。以下哪项可以促进这一点？", + "A": "甘露醇", + "B": "艾司洛尔", + "C": "使用乳酸林格氏液作为静脉输液", + "D": "低通气（使PaCO2达到50-60 mm Hg）" + } + }, + { + "id": "5652663e-f2cd-5679-b070-b08d6646d551", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the design that modern vaporizers use?", + "A": "Wet wick", + "B": "Electromagnetic Induction", + "C": "Variable bypass", + "D": "Copper Kettle" + }, + "zh": { + "question": "现代蒸发器使用的设计是什么？", + "A": "湿芯", + "B": "电磁感应", + "C": "可变旁路", + "D": "铜壶" + } + }, + { + "id": "d42576f1-6d73-56df-84e3-b903b316f20f", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Interpret the following ABG:\n\npH 7.24 / pCO2 60 / PO2 96 / HCO3 23", + "A": "Metabolic alkalosis", + "B": "Respiratory alkalosis", + "C": "Respiratory acidosis", + "D": "Metabolic acidosis" + }, + "zh": { + "question": "解释以下动脉血气分析结果：\n\npH 7.24 / pCO2 60 / PO2 96 / HCO3 23", + "A": "代谢性碱中毒", + "B": "呼吸性碱中毒", + "C": "呼吸性酸中毒", + "D": "代谢性酸中毒" + } + }, + { + "id": "7b91bba0-e0e7-558b-8bec-f851cc00392a", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient is referred to medication allergy testing at Bayview and is found to have a true allergy to bupivacaine. Which local anesthetic could the patient safely receive?", + "A": "This patient cannot safely receive ANY local anesthetics", + "B": "Lidocaine", + "C": "Chloroprocaine", + "D": "Ropivacaine" + }, + "zh": { + "question": "一名患者被转诊至Bayview进行药物过敏测试，结果发现对布比卡因有真正的过敏反应。该患者可以安全使用哪种局部麻醉药？", + "A": "该患者不能安全使用任何局部麻醉药", + "B": "利多卡因", + "C": "氯普鲁卡因", + "D": "罗哌卡因" + } + }, + { + "id": "56253714-ea69-566c-ab53-541ace4ca224", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is bone cement implantation syndrome?", + "A": "Bone cement inappropriately sticking to RBC's, resulting in low SpO2", + "B": "Thrombocytopenia (low platelet count) caused by methyl methacrylate", + "C": "A poorly defined syndrome of hypoxemia, hypotension, and/or altered mental status in patients with cementation", + "D": "Excessive adherence of bone to a newly placed joint hardware" + }, + "zh": { + "question": "什么是骨水泥植入综合征？", + "A": "骨水泥不适当地粘附在红细胞上，导致低血氧饱和度", + "B": "由甲基丙烯酸甲酯引起的血小板减少症（低血小板计数）", + "C": "在使用骨水泥的患者中出现低氧血症、低血压和/或精神状态改变的定义不明确的综合征", + "D": "骨头过度粘附在新置入的关节硬件上" + } + }, + { + "id": "cbd004e9-78ae-561e-8272-00f57f70c600", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following ventilation strategies would be most likely to reduce the ICP?", + "A": "Increase PEEP to 15 cm H2O", + "B": "Keep ETCO2 20-30 mm Hg", + "C": "Keep ETCO2 50-60 mm Hg", + "D": "Keep FiO2 > 0.60 (60%)" + }, + "zh": { + "question": "以下哪种���气策略最有可能降低颅内压（ICP）？", + "A": "将PEEP增加到15 cm H2O", + "B": "保持ETCO2在20-30 mm Hg", + "C": "保持ETCO2在50-60 mm Hg", + "D": "保持FiO2 > 0.60（60%）" + } + }, + { + "id": "8a0222da-f583-5804-a550-bb1fc48b10eb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Dantrolene should be reconstituted using:", + "A": "Sterile Water", + "B": "5% Dextrose in Water", + "C": "Albumin", + "D": "Normal Saline" + }, + "zh": { + "question": "丹曲林应使用以下哪种溶液重构：", + "A": "无菌水", + "B": "5% 葡萄糖水", + "C": "白蛋白", + "D": "生理盐水" + } + }, + { + "id": "230c8348-07eb-5647-b540-546ca80b8f95", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Anectine is the trade name for which medication?", + "A": "Remifentanil", + "B": "Cefazolin", + "C": "Succinylcholine", + "D": "Rocuronium" + }, + "zh": { + "question": "Anectine 是哪种药物的商品名？", + "A": "瑞芬太尼", + "B": "头孢唑林", + "C": "琥珀胆碱", + "D": "罗库溴铵" + } + }, + { + "id": "d1e2da3b-488a-5c46-9d3f-cc68708e73d5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A patient is on a dexmedetomidine infusion for an awake fiberoptic intubation. What would be the most likely side effect of this infusion?", + "A": "Acute agitation", + "B": "Apnea", + "C": "Tachycardia and hypertension", + "D": "Bradycardia and hypotension" + }, + "zh": { + "question": "一名患者正在接受右美托咪定输注以进行清醒纤维支气管镜插管。该输注最可能的副作用是什么？", + "A": "急性躁动", + "B": "呼吸暂停", + "C": "心动过速和高血压", + "D": "心动过缓和低血压" + } + }, + { + "id": "48167a3f-5c49-527a-8f40-f0700e551976", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is the most favorable airway exam for intubation and ventilation?", + "A": "Oral excursion 2 FB, Mallampati 3, Thyromental distance 3 FB, Limited neck range of motion", + "B": "Oral excursion 4 FB, Mallampati 1, Thyromental distance 4 FB, Full neck range of motion", + "C": "Oral excursion 1 fingerbreadth (1 FB), Mallampati 1, Thyromental distance 1 FB, Full neck range of motion", + "D": "Oral excursion 4 FB, Mallampati 4, Thyromental distance 2 FB, Full neck range of motion" + }, + "zh": { + "question": "以下哪项是对插管和通气最有利的气道检查？", + "A": "口腔张开度 2 指宽，Mallampati 3，甲颏距离 3 指宽，颈部活动范围受限", + "B": "口腔张开度 4 指宽，Mallampati 1，甲颏距离 4 指宽，颈部活动范围正常", + "C": "口腔张开度 1 指宽，Mallampati 1，甲颏距离 1 指宽，颈部活动范围正常", + "D": "口腔张开度 4 指宽，Mallampati 4，甲颏距离 2 指宽，颈部活动范围正常" + } + }, + { + "id": "8cb60f8a-e53d-59fc-903d-a2bd1667d2a6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A patient comes to the OR from the ICU. He is on a heparin infusion. Which of the following tests would be most appropriate to determine the degree of anticoagulation from the heparin?", + "A": "Bleeding time", + "B": "PT (INR)", + "C": "Blood smear", + "D": "PTT" + }, + "zh": { + "question": "一名患者从ICU来到手术室。他正在接受肝素输注。以下哪项测试最适合确定肝素的抗凝程度？", + "A": "出血时间", + "B": "PT（INR）", + "C": "血涂片", + "D": "PTT" + } + }, + { + "id": "b6176c49-13f2-5221-a5f4-87daf4f35e53", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A patient had an accidental dural puncture on an epidural placement the day before. What would be the most effective treatment for her symptoms (headache, etc...)?", + "A": "Atropine", + "B": "Dexmedetomidine infusion", + "C": "Epidural blood patch", + "D": "Avoidance of lying flat" + }, + "zh": { + "question": "一名患者在前一天进行硬膜外麻醉时意外刺破硬脑膜。对于她的症状（头痛等），最有效���治疗方法是什么？", + "A": "阿托品", + "B": "右美托咪定输注", + "C": "硬膜外血补片", + "D": "避免平躺" + } + }, + { + "id": "74f48442-2ae4-5453-a14a-2740ce1e1901", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A patient is suspected to have MH intraoperatively. Early signs of MH include all of the following EXCEPT:", + "A": "Increased temperature", + "B": "Mixed metabolic and respiratory acidosis", + "C": "Bradycardia", + "D": "Dramatic increase in ETCO2" + }, + "zh": { + "question": "一名患者在术中被怀疑患有恶性高热。恶性高热的早期症状包括以下所有症状，除了：", + "A": "体温升高", + "B": "混合代谢性和呼吸性酸中毒", + "C": "心动过缓", + "D": "呼气末二氧化碳显著增加" + } + }, + { + "id": "6a74b111-9cda-522c-94dd-9e1d45539293", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "As patients get more acidotic, the plasma potassium concentration trends:", + "A": "Higher", + "B": "Acidosis has no impact on the potassium concentration", + "C": "Lower", + "D": "Initially no difference, then lower" + }, + "zh": { + "question": "当患者酸中毒加重时，血浆钾浓度的趋势是：", + "A": "更高", + "B": "酸中毒对钾浓度没有影响", + "C": "更低", + "D": "最初没有变化，然后降低" + } + }, + { + "id": "d8a7c8e9-ca72-58ea-a06a-19fb51d621eb", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient receives a nerve block with ropivacaine and IV lidocaine and subsequently starts having a seizure. What is the most likely cause of the seizure?", + "A": "Increased PaO2", + "B": "Carbon monoxide poisoning", + "C": "Local Anesthetic Systemic Toxicity (LAST)", + "D": "Propofol infusion syndrome" + }, + "zh": { + "question": "一名患者接受了罗哌卡因神经阻滞和静脉注射利多卡因，随后开始出现癫痫发作。癫痫发作最可能的原因是什么？", + "A": "PaO2增加", + "B": "一氧化碳中毒", + "C": "局部麻醉药全身毒性（LAST）", + "D": "丙泊酚输注综合征" + } + }, + { + "id": "dd266f88-a119-55c0-b77b-e4acda1d6f9f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The failsafe in an anesthesia machine is designed to:", + "A": "Prevent the accidental delivery of 100% oxygen", + "B": "Avoid hypoxic mixtures if the pipeline oxygen pressure drops", + "C": "Avoid rebreathing of carbon dioxide", + "D": "Prevent excessive pressures in the breathing circuit" + }, + "zh": { + "question": "麻醉机的安全装置旨在：", + "A": "防止意外输送100%氧气", + "B": "在管道氧气压力下降时避免低氧混合物", + "C": "避免二氧化碳的再呼吸", + "D": "防止呼吸回路中过高的压力" + } + }, + { + "id": "01edc7bd-f458-5599-b05b-4c3f961ef584", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the trade name for oxytocin?", + "A": "Gynastrict", + "B": "Pregozam", + "C": "Pitocin", + "D": "Uteropres" + }, + "zh": { + "question": "催产素的商品名是什么？", + "A": "Gynastrict", + "B": "Pregozam", + "C": "Pitocin", + "D": "Uteropres" + } + }, + { + "id": "d2f85beb-2c69-523a-adb5-b1166e386b77", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A patient is having laparoscopic surgery. The abdomen is insufflated to a certain pressure. At what insufflation pressure does the preload generally start to decrease?", + "A": "15 mm Hg", + "B": "5 mm Hg", + "C": "25 mm Hg", + "D": "10 mm Hg" + }, + "zh": { + "question": "一名患者正在进行腹腔镜手术。腹腔被充气到一定压力。一般在什么充气压力下，前负荷开始减少？", + "A": "15 mm Hg", + "B": "5 mm Hg", + "C": "25 mm Hg", + "D": "10 mm Hg" + } + }, + { + "id": "2c4fdf4a-f997-59cd-8c24-73ff4f18be17", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "An ICU patient is coming to the OR for an urgent procedure. This patient has the hepatorenal syndrome, meaning that both the liver and kidneys are failing. Which medication would most likely have its metabolism affected (and hence last longer than expected) in this patient?", + "A": "Vecuronium", + "B": "Esmolol", + "C": "Cisatracurium", + "D": "Succinylcholine" + }, + "zh": { + "question": "一名ICU患者因紧急手术被送往手术室。该患者患有肝肾综合征，这意味着肝脏和肾脏都出现衰竭。在这种情况下，哪种药物的代谢最有可能受到影响（因此持续时间比预期更长）？", + "A": "维库溴铵", + "B": "艾司洛尔", + "C": "西酞铵", + "D": "琥珀胆碱" + } + }, + { + "id": "eb1f8a39-3dd0-5310-8276-a634ff340357", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "Which patient as at highest risk for ischemic optic neuropathy (ION)?", + "A": "Slender female patient with 100 mL blood loss", + "B": "Obese female patient for 1 hour L4-5 discectomy surgery with minimal blood loss", + "C": "Obese make patient with 5 L blood loss using the Wilson Frame", + "D": "Slender male patient with 500 mL blood loss and lowest hemoglobin concentration of 12 g/dL" + }, + "zh": { + "question": "哪位患者患缺血性视神经病变（ION）的风险最高？", + "A": "瘦弱的女性患者，失血量为100毫升", + "B": "肥胖的女性患者，进行1小时的L4-5椎间盘切除术，失血量很少", + "C": "肥胖的男性患者，使用Wilson架，失血量为5升", + "D": "瘦弱的男性患者，失血量为500毫升，最低血红蛋白浓度为12克/分升" + } + }, + { + "id": "5f9f16a6-5f9c-59b4-b664-948da0910d79", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Malignant hyperthermia is:", + "A": "Hyperthyroidism (high thyroid hormone production)", + "B": "A disorder of calcium regulation in cells (specifically muscle cells)", + "C": "A sudden release of epinephrine and norepinephrine from the adrenal glands", + "D": "The consequence of giving anesthesia to a patient when they have a fever" + }, + "zh": { + "question": "恶性高热是：", + "A": "甲状腺功能亢进（甲状腺激素分泌过高）", + "B": "细胞内钙调节障碍（特别是肌肉细胞）", + "C": "肾上腺突然释放肾上腺素和去甲肾上腺素", + "D": "在患者发烧时给予麻醉的后果" + } + }, + { + "id": "7b10ffe1-f18e-501c-8931-43ec495b663e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Resistance represents:", + "A": "A way of measuring the HR", + "B": "The oxygen-carrying capacity", + "C": "The opposition to fluid flow", + "D": "Venous blood clots" + }, + "zh": { + "question": "阻力代表：", + "A": "一种测量心率的方法", + "B": "携氧能力", + "C": "对流体流动的阻力", + "D": "静脉血栓" + } + }, + { + "id": "9040e7a9-320f-5e42-aac2-34b7734f6249", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Shortly after induction of GA with propofol, a patient is found to be difficult to mask ventilate and the clinician is unable to intubate the patient with direct laryngoscopy. The patient was well-pre oxygenated and the SpO2 is 98%. The next step should be:", + "A": "Use a retrograde intubation", + "B": "Avoid any muscle relaxation", + "C": "Attempt to place an LMA", + "D": "Continue to attempt direct laryngoscopy until a total of 5 have been attempted" + }, + "zh": { + "question": "在用丙泊酚诱导全身麻醉后不久，发现患者难以面罩通气，临床医生无法通过直接喉镜插管。患者预先氧合良好，SpO2为98%。下一步应该是：", + "A": "使用逆行插管", + "B": "避免任何肌肉松弛", + "C": "尝试放置喉罩", + "D": "继续尝试直接喉镜插管，直到尝试总数达到5次" + } + }, + { + "id": "65f265c3-9ac9-5572-9550-8899a5f75907", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "1% propofol is being infused through an IV pump. The pump indicates that it is running at 5- mL/hr. How many milligrams per hour (mg/hr) of the propofol is the patient currently receiving?", + "A": "50 mg/hr", + "B": "100 mg/hr", + "C": "1000 mg/hr", + "D": "500 mg/hr" + }, + "zh": { + "question": "1%丙泊酚通过静脉输液泵输注。泵显示其运行速度为5毫升/小时。患者目前每小时接收多少毫克的丙泊酚？", + "A": "50毫克/小时", + "B": "100毫克/小时", + "C": "1000毫克/小时", + "D": "500毫克/小时" + } + }, + { + "id": "09f076b4-39e2-5dd7-9a7c-e4fd7e73525f", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Identify the EKG rhythm shown:", + "A": "2nd Degree AV Block, Mobitz type II", + "B": "Sinus rhythm with PVC's", + "C": "2nd Degree AV Block, Mobitz type I (Wenkebach)", + "D": "1st Degree AV Block" + }, + "zh": { + "question": "识别所示的心电图节律：", + "A": "二度房室传导阻滞，Mobitz II型", + "B": "窦性心律伴室性早搏", + "C": "二度房室传导阻滞，Mobitz I型（文氏阻滞）", + "D": "一度房室传导阻滞" + } + }, + { + "id": "28cef2e1-9513-56e3-be96-5978f2ce9372", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the trade name for propofol?", + "A": "Sedapro", + "B": "Versed", + "C": "Amidate", + "D": "Diprivan" + }, + "zh": { + "question": "丙泊酚的商品名是什么？", + "A": "Sedapro", + "B": "Versed", + "C": "Amidate", + "D": "Diprivan" + } + }, + { + "id": "882bcdfd-6c28-5218-9815-aec1bad4e039", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "You don't like your neighbor, so you get a voodoo doll of him and use it to constrict his aorta. This will be expected to acutely cause an increase in:", + "A": "Afterload", + "B": "Contractility", + "C": "Preload", + "D": "Tidal Volume" + }, + "zh": { + "question": "你不喜欢你的邻居，所以你做了一个他的巫毒娃娃，并用它来收缩他的主动脉。这预计会急性导致增加：", + "A": "后负荷", + "B": "收缩力", + "C": "前负荷", + "D": "潮气量" + } + }, + { + "id": "85d97a01-68ef-56c5-b2f2-4a56241a00a0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A patient is undergoing a TURP procedure for an enlarged prostate and at some point intraoperatively the clinician feels that he may have TURP syndrome. This would be due to which of the following causes?", + "A": "Hypernatremia from excessive sodium load", + "B": "Fat Embolism", + "C": "Carbon dioxide embolism", + "D": "Extensive absorption of the irrigation fluid" + }, + "zh": { + "question": "一名患者正在接受经尿道前列腺切除术（TURP）以治疗前列腺增生，术中某个时刻，临床医生认为他可能患有TURP综合征。这可能是由于以下哪种原因？", + "A": "过量钠负荷导致的高钠血症", + "B": "脂肪栓塞", + "C": "二氧化碳栓塞", + "D": "灌洗液的广泛吸收" + } + }, + { + "id": "b17e926e-d37b-5fb8-9de2-be4e44f6d90a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following actions would be undertaken first in an airway fire?", + "A": "Irrigate the airway with saline", + "B": "Remove the ET tube", + "C": "Send someone to get the fire extinguisher", + "D": "Mask ventilate with air" + }, + "zh": { + "question": "在气道火灾中首先应采取以下哪项措施？", + "A": "用生理盐水冲洗气道", + "B": "移除气管插管", + "C": "派人去拿灭火器", + "D": "用空气进行面罩通气" + } + }, + { + "id": "f1959c04-8f17-5c74-b4f1-2a20cb6502ea", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A patient receives a nerve block with ropivacaine and IV lidocaine, and subsequently starts having a seizure. Local Anesthetic Systemic Toxicity (LAST) is suspected. What is the appropriate treatment?", + "A": "Methylene Blue", + "B": "Flumanzenil", + "C": "Naloxone", + "D": "Intralipid" + }, + "zh": { + "question": "一名患者接受了罗哌卡因神经阻滞和静脉注射利多卡因，随后开始出现癫痫发作。怀疑是局部麻醉药全身毒性（LAST）。适当的治疗是什么？", + "A": "亚甲蓝", + "B": "氟马西尼", + "C": "纳洛酮", + "D": "脂肪乳" + } + }, + { + "id": "1d4fcd36-d6af-59f7-a065-afaf221ed596", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A patient has the heart rhythm shown. What is the appropriate treatment?", + "A": "Magnesium", + "B": "Calcium-channel blockers", + "C": "Beta-blockers", + "D": "Adenosine" + }, + "zh": { + "question": "患者出现如图所示的心律。适当的治疗是什么？", + "A": "镁", + "B": "钙通道阻滞剂", + "C": "β受体阻滞剂", + "D": "腺苷" + } + }, + { + "id": "96b467fc-38df-52d7-90b7-96135a3c228f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "An epidural test dose is used to determine which of the following?", + "A": "The epidural catheter is not intravascular or intrathecal", + "B": "That the epidural is in the lumbar region", + "C": "The epidural isn't one-sided", + "D": "That the epidural will function for surgical anesthesia" + }, + "zh": { + "question": "硬膜外试验剂量用于确定以下哪项？", + "A": "硬膜外导管不在血管内或蛛网膜下腔内", + "B": "硬膜外麻醉在腰椎区域", + "C": "硬膜外麻醉不是单侧的", + "D": "硬膜外麻醉可用于手术麻醉" + } + }, + { + "id": "6407ee8a-c3ed-58b8-a3ee-39357c858444", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A normal ICP is typically:", + "A": "20-40 mm Hg", + "B": "50-70 mm Hg", + "C": "100-140 mm Hg", + "D": "5-15 mm Hg" + }, + "zh": { + "question": "正常的颅内压通常是：", + "A": "20-40 mm Hg", + "B": "50-70 mm Hg", + "C": "100-140 mm Hg", + "D": "5-15 mm Hg" + } + }, + { + "id": "81ab6fed-e97a-53b5-bad3-7d63b2f35e40", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "An ICU patient has been on propofol, dexmedetomidine, and LR's infusions for the past 3 days. He develops a severe, unexplained metabolic acidosis. What is a potential cause of this condition?", + "A": "Oxygen toxicity from being on FiO2 > 0.60", + "B": "Decmedetomidine infusion syndrom (DIS)", + "C": "Propofol-related infusion syndrome (PRIS)", + "D": "Sodium toxicity from the LR's" + }, + "zh": { + "question": "一名ICU患者在过去3天中一直接受丙泊酚、右美托咪定和乳酸林格氏液的输注。他出现了严重的、无法解释的代谢性酸中毒。此情况的潜在原因是什么？", + "A": "吸入氧浓度大于0.60导致的氧中毒", + "B": "右美托咪定输注综合征（DIS）", + "C": "丙泊酚相关输注综合征（PRIS）", + "D": "乳酸林格氏液导致的钠中毒" + } + }, + { + "id": "4da61bb6-e647-5041-ac18-7030db1ee8e9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the trade name for remifentanil?", + "A": "Sublimaze", + "B": "Remizist", + "C": "Remazicon", + "D": "Ultiva" + }, + "zh": { + "question": "瑞芬太尼的商品名是什么？", + "A": "舒芬太尼", + "B": "瑞米齐斯特", + "C": "瑞马齐康", + "D": "优力凡" + } + }, + { + "id": "78fce303-f800-51e2-866e-26f2a39f96af", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "An 82-year-old female patient has a past medical history that includes aortic stenosis. Her anesthetic strategy includes which of the following:", + "A": "Low HR", + "B": "Maintain a very low BP", + "C": "Only use Ketamine", + "D": "High HR" + }, + "zh": { + "question": "一位82岁的女性患者有主动脉瓣狭窄的病史。她的麻醉策略包括以下哪项：", + "A": "低心率", + "B": "维持非常低的血压", + "C": "仅使用氯胺酮", + "D": "高心率" + } + }, + { + "id": "25a93924-1608-56f7-adcd-9e63e0aa011e", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "A patient is emergently brought from the ICU to the OR for sepsis and dead bowel. The patient is hypotensive and on a norepinephrine infusion. The ABG is: pH 7.02 / PCO2 36 / PO2 108 / HCO3 12. Which medication might be considered to help with the BP in this context?", + "A": "Phenylephrine", + "B": "Intralipid", + "C": "Vasopressin", + "D": "Dobutamine" + }, + "zh": { + "question": "一名患者因败血症和肠坏死从ICU紧急送至手术室。患者血压低，正在输注去甲肾上腺素。动脉血气分析结果为：pH 7.02 / PCO2 36 / PO2 108 / HCO3 12。在这种情况下，哪种药物可能有助于改善血压？", + "A": "去氧肾上腺素", + "B": "脂肪乳", + "C": "加压素", + "D": "多巴酚丁胺" + } + }, + { + "id": "20a02ee6-987c-5009-ac6b-2b5f45aef1c3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A patient is to undergo a thyroidectomy due to thyroid cancer. The surgeon requests a special type of endotracheal tube for nerve monitoring during the procedure. Which nerve is monitored due to concerns about injury during thyroid surgeries?", + "A": "Lateral pharyngeal nerve", + "B": "Long thoracic nerve", + "C": "Glossopharyngeal nerve", + "D": "Recurrent laryngeal nerve" + }, + "zh": { + "question": "一名患者因甲状腺癌需进行甲状腺切除术。外科医生要求使用一种特殊的气管插管以便在手术过程中进行神经监测。由于担心在甲状腺手术中受伤，监测的是哪一条神经？", + "A": "咽侧神经", + "B": "长胸神经", + "C": "舌咽神经", + "D": "喉返神经" + } + }, + { + "id": "5d53c78e-469c-5c1a-a656-1e0aad5f081c", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient is in the recovery room after having a laparoscopic cholecystectomy. Suddenly he develops a narrow-complex tachyarrhythmia with an HR of 180. BP is 60/40. What is the appropriate treatment?", + "A": "Magnesium", + "B": "Diltiazem", + "C": "Synchronized cardioversion", + "D": "Esmolol" + }, + "zh": { + "question": "一名患者在接受腹腔镜胆囊切除术后处于恢复室。突然，他出现了心率为180的窄复合波心动过速。血压为60/40。适当的治疗是什么？", + "A": "镁", + "B": "地尔硫卓", + "C": "同步电复律", + "D": "艾司洛尔" + } + }, + { + "id": "d4124be8-5267-5229-9830-61d75ae88420", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which IV fluid is considered physiologically hypotonic?", + "A": "3% sodium chloride", + "B": "Normal Saline (0.9% sodium chloride)", + "C": "Plasma-Lyte", + "D": "Lactated Ringer's" + }, + "zh": { + "question": "哪种静脉输液被认为是生理性低渗的？", + "A": "3% 氯化钠", + "B": "生理盐水 (0.9% 氯化钠)", + "C": "Plasma-Lyte", + "D": "乳酸林格氏液" + } + }, + { + "id": "f35cb49b-97bf-557f-b0f9-3c4e09090aba", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Lactated Ringer's, although compatible with PRBC administration under certain circumstances, is often avoided when transfusing PRBC's because:", + "A": "The red blood cells in the PRBC's shrink because LR is hypertonic", + "B": "It results in hyperkalemia", + "C": "The lactate in LR builds up because of the PRBC's", + "D": "The calcium in the LR can antagonize the citrate anticoagulant in the PRBC's and potentially result in clotting" + }, + "zh": { + "question": "尽管在某些情况下乳酸林格氏液与红细胞悬液的输注是兼容的，但在输注红细胞悬液时通常避免使用乳酸林格氏液，因为：", + "A": "红细胞悬液中的红细胞会收缩，因为乳酸林格氏液是高渗的", + "B": "会导致高钾血症", + "C": "乳酸林格氏液中的乳酸会因为红细胞悬液而积累", + "D": "乳酸林格氏液中的钙可能会拮抗红细胞悬液中的枸橼酸抗凝剂，可能导致凝血" + } + }, + { + "id": "0f0d80e4-c073-5b21-b0d9-6c4d83afaed8", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which type of blood product has the highest risk of bacterial contamination?", + "A": "Cryoprecipitate", + "B": "PRBC's", + "C": "FFP", + "D": "Platelets" + }, + "zh": { + "question": "哪种类型的血液制品具有最高的细菌污染风险？", + "A": "冷沉淀", + "B": "红细胞悬液", + "C": "新鲜冰冻血浆", + "D": "血小板" + } + }, + { + "id": "9b0d74c0-255e-5573-91a4-763da7fd31c6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The MAC of a volatile anesthetic is defined as:", + "A": "The alveolar concentration where 95% of patients don't move to surgical stimulation", + "B": "The minimum concentration the vaporizer can be set to", + "C": "The alveolar concentration where 50% of patients don't move to surgical stimulation", + "D": "The point at which toxicity develops" + }, + "zh": { + "question": "挥发性麻醉药的MAC定义为：", + "A": "95%的患者对手术刺激无反应的肺泡浓度", + "B": "蒸发器可以设置的最低浓度", + "C": "50%的患者对手术刺激无反应的肺泡浓度", + "D": "出现毒性反应的浓度点" + } + }, + { + "id": "d0b5c1c5-e7e3-5fbb-97a6-c7527e80f46e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "According to Bernoulli's Principle, a fast-flowing fluid has _________ pressure compared to a slower-flowing fluid.", + "A": "Can be either higher or lower", + "B": "Lower", + "C": "The same", + "D": "Higher" + }, + "zh": { + "question": "根据伯努利原理，快速流动的流体与较慢流动的流体相比具有_________压力。", + "A": "可以是更高或更低", + "B": "更低", + "C": "相同", + "D": "更高" + } + }, + { + "id": "d75da3ee-fe5a-537b-9a11-dffcb0136ed9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "OR's have isolated electrical supplies due to:", + "A": "Isolation capacitors", + "B": "Double circuit breakers", + "C": "Faraday cage", + "D": "Isolation transformers" + }, + "zh": { + "question": "手术室具有隔离电源是因为：", + "A": "隔离电容器", + "B": "双断路器", + "C": "法拉第笼", + "D": "隔离变压器" + } + }, + { + "id": "b065a392-eb84-519a-9f0a-384b76c232d2", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient has high acute blood loss in the OR and receives 7 PRBC's. What electrolyte abnormalities might be expected as a result of the multiple PRBC transfusions?", + "A": "Low potassium and high calcium", + "B": "High potassium and high calcium", + "C": "High potassium and low calcium", + "D": "Low potassium and low calcium" + }, + "zh": { + "question": "一名患者在手术室中出现急性大量失血，并接受了7个单位的红细胞悬液。由于多次输注红细胞悬液，可能会出现哪些电解质异常？", + "A": "低钾和高钙", + "B": "高钾和高钙", + "C": "高钾和低钙", + "D": "低钾和低钙" + } + }, + { + "id": "cc7d3af7-6aed-52f8-b931-f8fb8780b900", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The clinical indication for administration of FFP is:", + "A": "Reduced platelet function due to renal failure", + "B": "Need for increased oxygen-carrying capacity", + "C": "High plasma osmolarity", + "D": "Treatment of coagulopathy/administration of clotting factors" + }, + "zh": { + "question": "FFP的临床适应症是：", + "A": "因肾功能衰竭导致的血小板功能降低", + "B": "需要增加携氧能力", + "C": "高血浆渗透压", + "D": "治疗凝血功能障碍/给予凝血因子" + } + }, + { + "id": "3dd0d48a-84db-5b93-b2ab-bd0c604fe794", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The high pressure system in an anesthesia machine consists of:", + "A": "The APL valve", + "B": "The flowmeters", + "C": "The wall gas connectors", + "D": "The tanks mounted to the back of the anesthesia machine" + }, + "zh": { + "question": "麻醉机中的高压系统包括：", + "A": "APL阀", + "B": "流量计", + "C": "墙壁气体连接器", + "D": "安装在麻醉机后部的气罐" + } + }, + { + "id": "650a4436-4ec5-5a83-bfb3-b83477540bc9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "EKG lead II uses which electrodes?", + "A": "Left Arm (LA) and Left Leg (LL)", + "B": "Left Arm (LA) and Right Arm (RA)", + "C": "Left Arm (LA) and Right Leg (RL)", + "D": "Right Arm (RA) and Left Leg (LL)" + }, + "zh": { + "question": "心电图导联II使用哪些电极？", + "A": "左臂 (LA) 和左腿 (LL)", + "B": "左臂 (LA) 和右臂 (RA)", + "C": "左臂 (LA) 和右腿 (RL)", + "D": "右臂 (RA) 和左腿 (LL)" + } + }, + { + "id": "c04714de-c46b-5eac-b350-e3f4ce308658", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A patient is going to have a large spine surgery with both MEP and SSEP monitoring. What is true about an appropriate anesthetic for this case?", + "A": "TIVA with an infusion of neuromuscular blocker to maintain about 2/4 twitches is a good choice of anesthetic", + "B": "Ketamine is contraindicated", + "C": "High-dose volatile anesthetic will improve the signals", + "D": "Avoidance of any NMBD's" + }, + "zh": { + "question": "一名患者将进行大型脊柱手术，并使用MEP和SSEP监测。关于此病例的合适麻醉，以下哪项是正确的？", + "A": "使用静脉全麻并输注神经肌肉阻滞剂以维持约2/4的抽搐是一个不错的麻醉选择", + "B": "氯胺酮是禁忌的", + "C": "高剂量挥发性麻醉剂将改善信号", + "D": "避免使用任何神经肌肉阻滞剂" + } + }, + { + "id": "a5db76d6-64e6-59bb-b179-95006e2157cf", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "All of the following are risk factors for carbon monoxide formation in the anesthesia breathing system EXCEPT:", + "A": "Moist absorbent", + "B": "Low fresh gas flowrates", + "C": "The use of desflurane (vs sevoflurane)", + "D": "Non-use of the absorber for 2 or more days" + }, + "zh": { + "question": "以下哪项不是麻醉呼吸系统中一氧化碳形成的风险因素：", + "A": "潮湿的吸收剂", + "B": "低新鲜气体流量", + "C": "使用地氟醚（与七氟醚相比）", + "D": "吸收剂未使用2天或更长时间" + } + }, + { + "id": "9bfe383f-1134-56fd-8e72-d67506415086", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "The line isolation monitor outside of an OR shows a leakage current of 8 mA. This most likely indicates:", + "A": "There is no problem; this is a normal leakage current for an OR", + "B": "An automatic oxygen turnoff valve will stop the flow of oxygen to that room", + "C": "There is likely a device with a wiring fault", + "D": "If 100% of this leakage current was directed through the patient's packing wires, it would be below the threshold of injury for microshock and therefore harmless" + }, + "zh": { + "question": "手术室外的线路隔离监测器显示漏电流为8 mA。这最有可能表明：", + "A": "没有问题；这是手术室的正常漏电流", + "B": "自动氧气关闭阀将停止向该房间输送氧气", + "C": "可能有设备存在线路故障", + "D": "如果100%的漏电流通过患者的导线传导，将低于微电击的损伤阈值，因此是无害的" + } + }, + { + "id": "b9af78ef-a266-581b-b76f-c4c95ef43d09", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the trade name for fentanyl?", + "A": "Sublimaze", + "B": "Sufenta", + "C": "Versed", + "D": "Norcuron" + }, + "zh": { + "question": "芬太尼的商品名是什么？", + "A": "舒芬太尼", + "B": "舒芬", + "C": "咪达唑仑", + "D": "诺库隆" + } + }, + { + "id": "e074b60e-8139-541e-9c69-6e8534432155", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "All of the following are requirements for an OR fire EXCEPT:", + "A": "A source of ignition (electrocautery, lasers, etc...)", + "B": "Oxygen", + "C": "Line isolation monitor failure", + "D": "Fuel (such as surgical drapes, etc...)" + }, + "zh": { + "question": "以下所有都是手术室火灾的必要条件，除了：", + "A": "点火源（电刀、激光等）", + "B": "氧气", + "C": "线路隔离监测器故障", + "D": "燃料（如手术布等）" + } + }, + { + "id": "fe5652f7-d0a0-5b4a-81af-e89e405223c4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which is correct regarding proper patient arm positioning to reduce the risk of a nerve injury?", + "A": "The arms should be extended at least 90 degrees", + "B": "There can never be any straps holding the arm to the armboard", + "C": "The area under the elbow should be padded", + "D": "The palm should be facing downward" + }, + "zh": { + "question": "关于正确的患者手臂定位以减少神经损伤风险，哪项是正确的？", + "A": "手臂应至少伸展90度", + "B": "手臂上永远不能有任何绑带固定在手臂板上", + "C": "肘部下方的区域应有衬垫", + "D": "手掌应朝下" + } + }, + { + "id": "e3c75038-5340-5af8-9d7a-e9b72fd25eb9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A patient with a known pseudocholinesterase deficiency comes to the OR for elective surgery. Which medication's effects would be expected to be significantly prolonged in this patient?", + "A": "Remifentanil", + "B": "Midazolam", + "C": "Cisatracurium", + "D": "Succinylcholine" + }, + "zh": { + "question": "一名已知有假性胆碱酯酶缺乏症的患者来到手术室进行择期手术。在该患者中，哪种药物的作用预计会显著延长？", + "A": "瑞芬太尼", + "B": "咪达唑仑", + "C": "西酞普兰", + "D": "琥珀胆碱" + } + }, + { + "id": "4c977b27-e6b5-5dd4-92da-e95ac9cfc91d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which medication is a pure alpha-1 agonist?", + "A": "Phenylephrine", + "B": "Dopamine", + "C": "Norepinephrine", + "D": "Ephedrine" + }, + "zh": { + "question": "哪种药物是纯α-1激动剂？", + "A": "去氧肾上腺素", + "B": "多巴胺", + "C": "去甲肾上腺素", + "D": "麻黄碱" + } + }, + { + "id": "c403e2e3-4973-5052-9888-0ce111c526f6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the trade name for cefazolin?", + "A": "Unasyn", + "B": "Moxasyn", + "C": "Zosyn", + "D": "Ancef" + }, + "zh": { + "question": "头孢唑林的商品名是什么？", + "A": "优耐信", + "B": "莫西信", + "C": "佐信", + "D": "安塞夫" + } + }, + { + "id": "6b95b47a-c74e-5cbe-bb2f-70e9812aa940", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following patients in most at risk for microshock?", + "A": "A patient with a central line", + "B": "A patient with a BIS monitor attached", + "C": "A patient on the Wilson Frame", + "D": "Intraoperative radiation therapy" + }, + "zh": { + "question": "以下哪位患者最有可能发生微电击？", + "A": "有中心静脉导管的患者", + "B": "连接了BIS监测仪的患者", + "C": "在Wilson架上的患者", + "D": "术中放射治疗" + } + }, + { + "id": "b890a3b8-036a-50f1-bef2-34938bbc5bad", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following medical gasses is matched incorrectly with the standard color of its holding canister?", + "A": "Air : Yellow", + "B": "Oxygen : Green", + "C": "Carbon Dioxide : Orange", + "D": "Nitrous Oxide : Blue", + "E": "Nitrogen : Black" + }, + "zh": { + "question": "以下哪种医用气体与其储存罐的标准颜色匹配不正确？", + "A": "空气：黄色", + "B": "氧气：绿色", + "C": "二氧化碳：橙色", + "D": "一氧化二氮：蓝色", + "E": "氮气：黑色" + } + }, + { + "id": "6656b43a-ef07-51ff-b04d-570a149e7a7d", + "choice_num": 8, + "answer": "F", + "level": 3, + "en": { + "question": "Which of the following explains the monitor reading seen here?", + "A": "Incompetent inspiratory valve", + "B": "Incompetent expiratory valve", + "C": "Incompetent pop off valve", + "D": "Breathing circuit air leak", + "E": "Exhausted CO2 absorbent", + "F": "More than one of the above", + "G": "More than two of the above", + "H": "None of the above" + }, + "zh": { + "question": "以下哪项解释了此处监测器读数？", + "A": "吸气阀失效", + "B": "呼气阀失效", + "C": "排气阀失效", + "D": "呼吸回路漏气", + "E": "CO2 吸收剂耗尽", + "F": "以上多项", + "G": "以上多于两项", + "H": "以上皆非" + } + }, + { + "id": "4d5db762-f64f-5df4-8e54-eff5f3191ff6", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "An incompetent pressure relief valve will result in which of the following?", + "A": "Hypoxia", + "B": "Barotrauma", + "C": "Hypoventilation", + "D": "Hyperventilation", + "E": "A low-circuit pressure signal" + }, + "zh": { + "question": "不合格的压力释放阀将导致以下哪种情况？", + "A": "缺氧", + "B": "气压伤", + "C": "通气不足", + "D": "通气过度", + "E": "低回路压力信号" + } + }, + { + "id": "54d70b8e-825a-56cf-b4e4-bf848d85253b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following values (in PSI) corresponds with the pressure inside a standard Oxygen canister at 100%, 50%, and 25% volume respectively?", + "A": "4000, 4000, 4000", + "B": "4000, 2000, 1000", + "C": "2200, 2200, 2200", + "D": "2200, 1100, 550" + }, + "zh": { + "question": "以下哪个值（以PSI为单位）分别对应于标准氧气罐在100%、50%和25%体积时的压力？", + "A": "4000, 4000, 4000", + "B": "4000, 2000, 1000", + "C": "2200, 2200, 2200", + "D": "2200, 1100, 550" + } + }, + { + "id": "a0b63624-47d3-5cac-b9bd-99ea00242064", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "According to the ASA 2008 Recommendations, which of the following machine checks should be completed before each case?", + "A": "Test scavenging system function", + "B": "Verify that there are no leaks in the gas supply lines between the flowmeters and the common gas outlet", + "C": "Verify that patient suction is adequate to clear the airway", + "D": "Calibrate the oxygen monitor and check the low oxygen alarm" + }, + "zh": { + "question": "根据ASA 2008年建议，以下哪项机器检查应在每次手术前完成？", + "A": "测试废气排放系统功能", + "B": "确认从流量计到公共气体出口的气体供应管线无泄漏", + "C": "确认患者吸引装置足以清除气道", + "D": "校准氧气监测器并检查低氧报警" + } + }, + { + "id": "9f6bdacd-1b20-5ecd-b3cc-920d44223d83", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following values (in PSI) corresponds with the pressure inside a standard nitrous oxide canister at 100%, 50%, and 25% volume respectively?", + "A": "2200, 2200, 2200", + "B": "2200, 1100, 550", + "C": "745, 745, 745", + "D": "745, 373, 187" + }, + "zh": { + "question": "以下哪个值（以PSI为单位）分别对应标准一氧化二氮罐在100%、50%和25%体积时的压力？", + "A": "2200, 2200, 2200", + "B": "2200, 1100, 550", + "C": "745, 745, 745", + "D": "745, 373, 187" + } + }, + { + "id": "96c5545f-cb00-5505-9602-04cc8b6aee67", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The presence of a bubble in the tubing between the transducer and catheter of an arterial line is which of the following:", + "A": "Not significant", + "B": "Leads to an artificially high reading", + "C": "Leads to a damping of the tracing", + "D": "Has the greatest effect on the mean blood pressure", + "E": "Has a greater effect on the mean blood pressure" + }, + "zh": { + "question": "在动脉导管的传感器和导管之间的管路中存在气泡会导致以下哪种情况：", + "A": "无显著影响", + "B": "导致读数人为偏高", + "C": "导致波形阻尼", + "D": "对平均血压影响最大", + "E": "对平均血压影响更大" + } + }, + { + "id": "eb6f9cf6-0436-57a1-9bed-956cf1b1b49a", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The device on anesthesia machines that most reliably detects delivery of hypoxic gas mixtures is which of the following?", + "A": "Fail-safe valve", + "B": "O2 analyzer", + "C": "Gas rotamers", + "D": "Disconnection alarm", + "E": "Diameter index safety system" + }, + "zh": { + "question": "麻醉机上最可靠地检测低氧气体混合物输送的装置是以下哪一项？", + "A": "失效保护阀", + "B": "氧气分析仪", + "C": "气体流量计", + "D": "断开报警", + "E": "直径指数安全系统" + } + }, + { + "id": "a230617d-93ec-55f5-a4ff-90f8eaaa2778", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "As the surgeon is closing from a laparotomy for small bowel obstruction, the hospital central oxygen line stops working, and the size E oxygen cylinder comes on automatically.  The pressure gauge says 550 psi.  If the patient requires 4L by nasal cannula, how long will the canister last?", + "A": "36 minutes", + "B": "42 minutes", + "C": "58 minutes", + "D": "67 minutes", + "E": "> 75 minutes" + }, + "zh": { + "question": "当外科医生正在为小肠梗阻进行剖腹手术缝合时，医院的中央氧气管线停止工作，E型氧气瓶自动启动。压力表显示为550 psi。如果患者需要通过鼻导管吸入4升氧气，氧气瓶能持续多长时间？", + "A": "36分钟", + "B": "42分钟", + "C": "58分钟", + "D": "67分钟", + "E": "> 75分钟" + } + }, + { + "id": "31b56f82-2211-58d5-a858-89e8e3eb5fe3", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 26 yo F with no PMHx is getting a rhinoplasty.  As the surgeon is using the bovie, flames start shooting out of the ET tube.  Which of the following is the best next step?", + "A": "Disconnect the ET tube", + "B": "Extubate the patient", + "C": "Cover the area with water", + "D": "Use the fire extinguisher" + }, + "zh": { + "question": "一名26岁女性，无既往病史，正在接受鼻整形手术。当外科医生使用电刀时，火焰从气管插管中喷出。以下哪项是最佳的下一步措施？", + "A": "断开气管插管", + "B": "拔除气管插管", + "C": "用水覆盖该区域", + "D": "使用灭火器" + } + }, + { + "id": "09d6773f-7f9a-5bed-941a-ff49a3086bf6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the end product of the reaction of soda-lime with CO2?", + "A": "CaCO3 + H2O", + "B": "NaHCO3 + H2O", + "C": "NaCO3 + H2O", + "D": "None of the above" + }, + "zh": { + "question": "碱石灰与CO2反应的最终产物是什么？", + "A": "CaCO3 + H2O", + "B": "NaHCO3 + H2O", + "C": "NaCO3 + H2O", + "D": "以上都不是" + } + }, + { + "id": "23f77be9-9bb0-57aa-935f-d954effdbbe0", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The most frequent cause of mechanical failure to deliver adequate FiO2 is which of the following?", + "A": "Attachment of the wrong compression gas cylinder to the O2 yoke", + "B": "Crossing the pipelines during daily set-up", + "C": "Malfunctioning rotamer", + "D": "Fresh gas line disconnection from the machine to the hospital supply", + "E": "Disconnection of the O2 supply system from the patient" + }, + "zh": { + "question": "以下哪项是导致无法提供足够FiO2的机械故障的最常见原因？", + "A": "将错误的压缩气体钢瓶连接到氧气接口", + "B": "在日常设置中交叉连接管道", + "C": "流量计故障", + "D": "从机器到医院供给的新鲜气体管线断开", + "E": "氧气供给系统与患者的连接断开" + } + }, + { + "id": "2893d11e-0cb6-5d81-a137-84f5f5e3706a", + "choice_num": 6, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following breathing systems is most efficient for a patient with controlled ventilation?", + "A": "Mapleson A", + "B": "Mapleson B", + "C": "Mapleson C", + "D": "Mapleson D", + "E": "Mapleson E", + "F": "Bain Modification" + }, + "zh": { + "question": "以下哪种呼吸系统对控制通气的患者最有效？", + "A": "Mapleson A", + "B": "Mapleson B", + "C": "Mapleson C", + "D": "Mapleson D", + "E": "Mapleson E", + "F": "Bain 改良型" + } + }, + { + "id": "3cfbf8b3-52ad-58ac-a75f-01d572804446", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A radial arterial line is zeroed with the transducer level to a position 12 cm posterior to the patient's sternal border.  While positioning the patient, the arm with the arterial line is elevated, and the catheter rests 10 cm above the transducer.  The blood pressure currently is measured as 130 / 72.  Which of the following is the actual blood pressure?", + "A": "118 / 60", + "B": "130 / 72", + "C": "142 / 84", + "D": "142 / 72", + "E": "130 / 84" + }, + "zh": { + "question": "桡动脉导管的换能器水平与患者胸骨边缘后方12厘米处校零。在调整患者体位时，带有动脉导管的手臂被抬高，导管位于换能器上方10厘米处。当前测得的血压为130 / 72。以下哪项是实际血压？", + "A": "118 / 60", + "B": "130 / 72", + "C": "142 / 84", + "D": "142 / 72", + "E": "130 / 84" + } + }, + { + "id": "5a8ae324-bd8f-5400-9d2f-fd125cce89c0", + "choice_num": 6, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following breathing systems is most efficient for a patient with spontaneous ventilation?", + "A": "Mapleson A", + "B": "Mapleson B", + "C": "Mapleson C", + "D": "Mapleson D", + "E": "Mapleson E", + "F": "Bain Circuit" + }, + "zh": { + "question": "以下哪种呼吸系统对自发呼吸的患者最有效？", + "A": "Mapleson A", + "B": "Mapleson B", + "C": "Mapleson C", + "D": "Mapleson D", + "E": "Mapleson E", + "F": "Bain 回路" + } + }, + { + "id": "ad135d32-5a52-545e-b365-e2f825917e92", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A healthy 25 yo M is in sitting position for an open craniotomy under general anesthesia when his ETCO2 and HR suddenly drop significantly. Rank the following from most sensitive to least in diagnosing this patient's most likely problem:\r\n\r\n1. Increased HR\r\n2. Decreased CVP\r\n3. Transesophageal Echo\r\n4. Pre-cordial doppler\r\n5. Decreased ET-CO2", + "A": "3, 4, 2, 1, 5", + "B": "4, 3, 5, 2, 1", + "C": "4, 3, 5, 2, 1", + "D": "3, 4, 5, 2, 1" + }, + "zh": { + "question": "一名健康的25岁男性在全身麻醉下坐位进行开颅手术时，其ETCO2和心率突然显著下降。请按以下顺序从最敏感到最不敏感来诊断该患者最可能的问题：\n\n1. 心率增加\n2. 中心静脉压下降\n3. 经食道超声\n4. 胸前多普勒\n5. ET-CO2下降", + "A": "3, 4, 2, 1, 5", + "B": "4, 3, 5, 2, 1", + "C": "4, 3, 5, 2, 1", + "D": "3, 4, 5, 2, 1" + } + }, + { + "id": "2dcafa72-9c85-56ab-85b0-e77f17dbdc2f", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A patient in Denver is going to have an exploratory laparotomy with sevoflurane.  When compared to a patient at sea level with the same setting on the vaporizer, what are the changes in the percentage of sevoflurane delivered as well as the sevoflurane partial pressure in the gas mixture?", + "A": "None of the above", + "B": "Percent sevoflurane delivered will increase, partial pressure of sevoflurane will also increase", + "C": "Percent sevoflurane delivered will increase, partial pressure of sevoflurane will remain the same", + "D": "Percent sevoflurane delivered will remain the same, partial pressure of sevoflurane will also remain the same", + "E": "Percent sevoflurane delivered will decrease, and partial pressure of sevoflurane will also decrease" + }, + "zh": { + "question": "一名在丹佛的患者将接受七氟醚探查性剖腹手术。与海平面上使用相同蒸发器设置的患者相比，七氟醚的输送百分比以及气体混合物中七氟醚的分压有什么变化？", + "A": "以上都不是", + "B": "七氟醚的输送百分比会增加，七氟醚的分压也会增加", + "C": "七氟醚的输送百分比会增加，七氟醚的分压保持不变", + "D": "七氟醚的输送百分比保持不变，七氟醚的分压也保持不变", + "E": "七氟醚的输送百分比会减少，七氟醚的分压也会减少" + } + }, + { + "id": "81de2840-892f-5e21-8d33-2596ba430eb9", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following will increase the damping of an arterial line?", + "A": "Air bubbles between the catheter and transducer", + "B": "A kink in the tubing between the catheter and the transducer", + "C": "A blood clot within the catheter", + "D": "Using soft tubing", + "E": "All of the above" + }, + "zh": { + "question": "以下哪项会增加动脉导管的阻尼？", + "A": "导管和传感器之间的气泡", + "B": "导管和传感器之间的管路打折", + "C": "导管内的血凝块", + "D": "使用软管", + "E": "以上所有" + } + }, + { + "id": "644fb857-8a79-51a9-96a1-645aef1ee02a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Nerve impulses travel in myelinated nerves by a process called what?", + "A": "Domino effect", + "B": "Saltatory conducation", + "C": "Relative refractory", + "D": "Nodes of Ranvier" + }, + "zh": { + "question": "神经冲动在髓鞘化神经中通过什么过程传播？", + "A": "多米诺效应", + "B": "跳跃式传导", + "C": "相对不应期", + "D": "郎飞结" + } + }, + { + "id": "f5b7a500-ece3-5275-a2d4-5897ac1ef1ce", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which portion of the nerve do local anesthetics work on?", + "A": "Neuron", + "B": "Dendrites", + "C": "Nerve membrane", + "D": "Myelinated sheath", + "E": "Schwann cells" + }, + "zh": { + "question": "局部麻醉药作用于神经的哪个部分？", + "A": "神经元", + "B": "树突", + "C": "神经膜", + "D": "髓鞘", + "E": "施旺细胞" + } + }, + { + "id": "5c24f55b-47c1-55c3-815f-d3341299be2c", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "What is one important way that local anesthetic drugs differ from all other drugs used in dentistry?", + "A": "High potential of overdose", + "B": "Route of administration", + "C": "Rate of uptake into bloodstream", + "D": "Action ceased when absorbed into bloodstream", + "E": "Blood levels must be sufficient to exert effect" + }, + "zh": { + "question": "局部麻醉药物与牙科中使用的其他药物有何重要区别？", + "A": "高过量风险", + "B": "给药途径", + "C": "进入血流的速度", + "D": "被吸收到血流中时作用停止", + "E": "血液浓度必须足够以发挥作用" + } + }, + { + "id": "073a849b-578f-5de0-be4d-2ff235e9f580", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "When procaine undergoes metabolic breakdown, the major metabolic product (metabolite) is what?", + "A": "Pseudocholinesterase", + "B": "Chloroprocaine", + "C": "PAMA", + "D": "Succinylcholine", + "E": "Para-aminobenzoic acid" + }, + "zh": { + "question": "普鲁卡因在代谢分解时，主要的代谢产物是什么？", + "A": "假性胆碱酯酶", + "B": "氯普鲁卡因", + "C": "PAMA", + "D": "琥珀胆碱", + "E": "对氨基苯甲酸" + } + }, + { + "id": "03de0b5d-0408-5e8a-aeff-df1b705da8fd", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Biotransformation of amides takes place where?", + "A": "Liver", + "B": "Kidneys", + "C": "Blood plasma", + "D": "Spleen", + "E": "Bloodstream" + }, + "zh": { + "question": "酰胺的生物转化发生在哪里？", + "A": "肝脏", + "B": "肾脏", + "C": "血浆", + "D": "脾脏", + "E": "血流" + } + }, + { + "id": "74500cbc-edd4-5ccc-b7bd-eea4d3dc6e03", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The concentration of epinephrine that is optimal for hemostasis is what?", + "A": "1:5000", + "B": "1:50,000", + "C": "1:150,000", + "D": "1:100,000", + "E": "1:200,000" + }, + "zh": { + "question": "肾上腺素的最佳止血浓度是多少？", + "A": "1:5000", + "B": "1:50,000", + "C": "1:150,000", + "D": "1:100,000", + "E": "1:200,000" + } + }, + { + "id": "399ce52a-316a-5175-b3f9-702da1853f8b", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "All of the following are reasons to include a vasoconstrictor, EXCEPT one.  Which one is the EXCEPTION?", + "A": "Lower blood flow to injection site", + "B": "Increase anesthetic blood levels", + "C": "Increase duration of local anesthetic", + "D": "Lower anesthetic toxicity", + "E": "Improve field of vision for treatment" + }, + "zh": { + "question": "以下所有原因都是为了加入血管收缩剂，除了一个。哪一个是例外？", + "A": "降低注射部位的血流量", + "B": "增加麻醉剂的血液浓度", + "C": "延长局部麻醉的持续时间", + "D": "降低麻醉毒性", + "E": "改善治疗的视野" + } + }, + { + "id": "2853400a-5e15-5998-8ca4-f3e0c3ac1941", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "When it is necessary to administer more than one anesthetic drug, a safe total dose should be determined by not exceeding what?", + "A": "The lower of the two maximum doses for the individual agents", + "B": "The maximum dose of each drug being administered", + "C": "25% of the maximum dose of each drug being administered", + "D": "35% of the maximum dose of each drug being administered", + "E": "Dental work being done in many more than on quadrant" + }, + "zh": { + "question": "当需要施用多种麻醉药物时，安全的总剂量应通过不超过什么来确定？", + "A": "两种药物中较低的最大剂量", + "B": "每种药物的最大剂量", + "C": "每种药物最大剂量的25%", + "D": "每种药物最大剂量的35%", + "E": "在多个象限进行的牙科工作" + } + }, + { + "id": "fbe25aed-0266-5649-afb0-7a021ed9afed", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "One of the many proprietary names for lidocaine is what?", + "A": "Xylocaine HCL", + "B": "3% Polocaine", + "C": "Sandonest HCL", + "D": "Mepivicaine", + "E": "Candicaine HCL" + }, + "zh": { + "question": "利多卡因的众多专有名称之一是什么？", + "A": "盐酸赛罗卡因", + "B": "3% 波罗卡因", + "C": "盐酸桑多内斯特", + "D": "甲哌卡因", + "E": "盐酸坎地卡因" + } + }, + { + "id": "74dec2c7-429f-5136-a620-dae66e2e03ef", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A healthy patient weighing 155 lbs has been given 2 cartridges of 2% lidocaine with epinephrine 1:100,000.  How many MORE cartridges of 3% Arestocaine can they have?", + "A": "4.0", + "B": "4.2", + "C": "4.4", + "D": "4.6", + "E": "None" + }, + "zh": { + "question": "一名体重155磅的健康患者已接受2支2%利多卡因与1:100,000肾上腺素。 他们还可以再使用多少支3% Arestocaine？", + "A": "4.0", + "B": "4.2", + "C": "4.4", + "D": "4.6", + "E": "无" + } + }, + { + "id": "c20f1873-7d1f-51dd-ac2b-9c2042d39d0b", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "All of the following are ways of caring for a syringe EXCEPT one.  Which one is the EXCEPTION?", + "A": "Place in an ultrasonic bath", + "B": "Dismantle and lubricate every 5 uses", + "C": "Sharpen or replace harpoon as needed", + "D": "Rinse syringe of saliva and foreign matter", + "E": "Clean with an ultrasonic instrument" + }, + "zh": { + "question": "以下所有选项都是注射器护理的方法，除了一个。哪个是例外？", + "A": "放入超声波清洗槽", + "B": "每使用5次拆卸并润滑", + "C": "根据需要磨尖或更换鱼叉", + "D": "冲洗注射器上的唾液和异物", + "E": "用超声波仪器清洗" + } + }, + { + "id": "580b967c-eba7-5eb9-9b10-03cea6f35536", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "In the dental office, the MOST important consideration when selecting a syringe-type is the ability of the syringe to:", + "A": "Deliver anesthetic solution to a patient", + "B": "Aspirate", + "C": "Accept a 30 guage needle", + "D": "Not frighten patients", + "E": "Be cost effective" + }, + "zh": { + "question": "在牙科诊所中，选择注射器类型时最重要的考虑因素是注射器的能力：", + "A": "向患者输送麻醉溶液", + "B": "抽吸", + "C": "接受30号针头", + "D": "不吓到患者", + "E": "具有成本效益" + } + }, + { + "id": "462729fd-0b69-5b49-b0f9-1af179b990c5", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "In local anesthetic dissociation, tissues with a low pH would have what effect on base (RN) and cations (RNH+) in the solution?", + "A": "A lower protion of RN and a higher portion of RNH+", + "B": "A loswer protion of RNH+ and a higher portion of RN", + "C": "Rapid onset of local anesthetic", + "D": "Increase duration of local anesthetic", + "E": "Decrease potency of local anesthetic" + }, + "zh": { + "question": "在局部麻醉药的解离中，低pH值的组织对溶液中的碱（RN）和阳离子（RNH+）有什么影响？", + "A": "RN的比例降低，RNH+的比例升高", + "B": "RNH+的比例降低，RN的比例升高", + "C": "局部麻醉药起效迅速", + "D": "延长局部麻醉药的作用时间", + "E": "降低局部麻醉药的效力" + } + }, + { + "id": "6b881f2a-7f9e-5bb5-9731-c35f0583da8f", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "After properly loading the cartridge into the syringe, a few drops of local anesthetic should be expelled. Why?", + "A": "The ensure proper placement of the harpoon", + "B": "To ensure free flow of the solution", + "C": "The ensure the correct anesthetic has been used", + "D": "To ensure the needle has not been barbed", + "E": "To ensure the ability to aspirate" + }, + "zh": { + "question": "在正确将药筒装入注射器后，应排出几滴局部麻醉剂。为什么？", + "A": "确保鱼叉的正确放置", + "B": "确保溶液的自由流动", + "C": "确保使用了正确的麻醉剂", + "D": "确保针头没有倒钩", + "E": "确保能够抽吸" + } + }, + { + "id": "fec26951-3d42-54ed-aca6-94cc113a4ba4", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The major factor influencing the ability to aspirate is what?", + "A": "Gauge of the needle", + "B": "Size of clinician's hands", + "C": "Site of injection", + "D": "Size of thumb ring", + "E": "Harpoon being sterile" + }, + "zh": { + "question": "影响抽吸能力的主要因素是什么？", + "A": "针头的规格", + "B": "临床医生手的大小", + "C": "注射部位", + "D": "拇指环的大小", + "E": "鱼叉的无菌状态" + } + }, + { + "id": "c7c25b45-fee0-5991-8600-f99f8f528178", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "All of the following methods will REDUCE the chance of needle breakage, EXCEPT one - which one is the exception?", + "A": "Establishing a firm hand rest", + "B": "Using a larger gauge needle", + "C": "Burying the needle to the hub", + "D": "Minimizing the need for redirection in tissue", + "E": "Not beding the needle excessively" + }, + "zh": { + "question": "以下所有方法都可以减少针断裂的机会，除了一个 - 哪一个是例外？", + "A": "建立一个稳固的手部支撑", + "B": "使用较大规格的针头", + "C": "将针头埋入至针座", + "D": "尽量减少在组织中的重新定向", + "E": "不过度弯曲针头" + } + }, + { + "id": "7f873bb2-97de-58c2-be93-8a745199ae4a", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The antioxidant used to preserve epinephrine in a local anesthetic solution is:", + "A": "Sodium bisulfate", + "B": "Sodium bicarbonate", + "C": "Sodium chloride", + "D": "Sodium pentathol", + "E": "Sodium hydrochloride" + }, + "zh": { + "question": "用于在局部麻醉溶液中保存肾上腺素的抗氧化剂是：", + "A": "亚硫酸氢钠", + "B": "碳酸氢钠", + "C": "氯化钠", + "D": "戊硫醇钠", + "E": "盐酸钠" + } + }, + { + "id": "a7fc1256-da39-5ef4-a656-f32e98535d0e", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A small bubble of approximately 1 to 2 mm diameter will frequently be found in the local anesthetic cartridge. These bubbles are caused by?", + "A": "The anesthetic solution being frozen", + "B": "The cartridge was stored in a chemical disinfectant", + "C": "Nitrogen gas being pumped in during manufacturing", + "D": "Oxygen being trapped in the cartridge", + "E": "Shaking the cartridge vigorously" + }, + "zh": { + "question": "在局部麻醉药筒中经常会发现直径约为1到2毫米的小气泡。这些气泡是由什么引起的？", + "A": "麻醉溶液被冷冻", + "B": "药筒存放在化学消毒剂中", + "C": "制造过程中注入的氮气", + "D": "氧气被困在药筒中", + "E": "剧烈摇晃药筒" + } + }, + { + "id": "df516ab4-bbc9-5164-8531-d1152c203680", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Distilled water is added to the cartridge for what purpose?", + "A": "To make the solution isotonic with the tissues of the body", + "B": "To increase the safely and the duration of the anesthetic", + "C": "To prevent the biodegradation of the vasopressor", + "D": "To provide the volume of the solution", + "E": "To prevent the propagation of nerve impulses" + }, + "zh": { + "question": "在药筒中加入蒸馏水的目的是什么？", + "A": "使溶液与身体组织等渗", + "B": "增加麻醉的安全性和持续时间", + "C": "防止血管加压药的生物降解", + "D": "提供溶液的体积", + "E": "防止神经冲动的传播" + } + }, + { + "id": "9ca13342-9b7b-5670-8f17-67b1e35bbe88", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Topical antiseptic does which of the following?", + "A": "Numbs 2-3 mm of tissue prior to injection", + "B": "Makes patient more comfortable during initial penetration", + "C": "Lessens the chance of inflammation or infection", + "D": "Allows the clinician to practice their site of penetration", + "E": "Reduces the risk of a local anesthetic overdose" + }, + "zh": { + "question": "局部抗菌剂具有以下哪种作用？", + "A": "在注射前使2-3毫米的组织麻木", + "B": "使患者在初次穿刺时更舒适", + "C": "减少炎症或感染的机会", + "D": "允许临床医生练习穿刺部位", + "E": "降低局部麻醉药物过量的风险" + } + }, + { + "id": "b7ae8d87-12c3-51e1-93ba-b0bae7d68ab1", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "What is the MOST important reason hemostats/cotton roll pliers are part of the armamentarium?", + "A": "They are used to remove the Dentipatch", + "B": "They are used to place a cotton roll on the needle", + "C": "They are used for the retrieval of a broken needle", + "D": "They are used to place the plastic cap on the needle", + "E": "They are used to unscrew the needle from the syringe" + }, + "zh": { + "question": "止血钳/棉卷钳是器械装备中最重要的原因是什么？", + "A": "用于去除Dentipatch", + "B": "用于将棉卷放在针头上", + "C": "用于取出断针", + "D": "用于将塑料帽放在针头上", + "E": "用于将针头从注射器上拧下" + } + }, + { + "id": "b14bae2f-9342-5196-96d6-75dded0d3b3b", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "At what time are professionals MOST at risk for a needle stick?", + "A": "Disassembly of syringe", + "B": "Recapping", + "C": "Assembling the syringe", + "D": "Giving the injection", + "E": "Unsheathing the needle" + }, + "zh": { + "question": "专业人员在什么时候最容易发生针刺伤？", + "A": "拆卸注射器", + "B": "重新盖上针帽", + "C": "组装注射器", + "D": "进行注射", + "E": "拔出针头" + } + }, + { + "id": "3ffdd2a2-0ed3-542d-8d3d-4e1441d899a6", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "All of the following are acceptable ways of recapping a needle EXCEPT:", + "A": "Carefully directing the cap over needle with fingers", + "B": "Utilizing \"card\" or other holding device", + "C": "Performing the one handed scoop technique", + "D": "Implementing cotton roll pliers or a hemostat", + "E": "Securing cap with fingers on vertical syringe" + }, + "zh": { + "question": "以下所有方法均为可接受的针头回套方式，除了：", + "A": "用手指小心地将针帽套在针头上", + "B": "使用“卡片”或其他固定装置", + "C": "进行单手回套技术", + "D": "使用棉卷钳或止血钳", + "E": "用手指固定垂直注射器上的针帽" + } + }, + { + "id": "b8e774aa-0895-5461-a3a2-596e6fca4b5d", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Stacey, an 18-year-old soccer player, arrives for the extraction of teeth #4, 12, 20, and 28.  She is given 5 cartridges of 4% Articaine with epi 1:100,000.  Her mother calls 3 hours following the appointment stating that Stacey appears cyanotic and sluggish. Her nail beds look dark blue and the blood in the extraction sites is chocolate brown.  What is MOST likely the condition presented?", + "A": "Aytpical plasma cholinesterase", + "B": "Methemoglobinemia", + "C": "Malignant hyperthermia", + "D": "Local anesthetic overdose", + "E": "Local anesthetic allergy" + }, + "zh": { + "question": "18岁的足球运动员Stacey前来拔除4号、12号、20号和28号牙齿。她被给予5支4% Articaine与1:100,000肾上腺素。她的母亲在预约后3小时打电话说Stacey看起来发绀和迟钝。她的指甲床呈深蓝色，拔牙部位的血液呈巧克力棕色。最可能出现的情况是什么？", + "A": "非典型血浆胆碱酯酶", + "B": "高铁血红蛋白血症", + "C": "恶性高热", + "D": "局部麻醉药过量", + "E": "局部麻醉药过敏" + } + }, + { + "id": "1d716087-03c3-5280-8a03-cd4aa95af3c9", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "A patient with epilepsy is scheduled for root planing and scaling with local anesthetic today. What should the dental hygienist know about this condition?", + "A": "Epilepsy is a realtive contraindication to ester type anesthtetics", + "B": "In low doses local anesthetic is an anti-convulsant", + "C": "The patient should be pre-medicated prior to treatment", + "D": "Epilepsy is an absolute contraindication to amide type anesthetics", + "E": "Oxygen should be available to deliver in an emergency" + }, + "zh": { + "question": "一名患有癫痫的患者今天计划进行局部麻醉的根面平整和刮治。牙科保健员应该了解这种情况的哪些方面？", + "A": "癫痫是酯类麻醉剂的相对禁忌症", + "B": "在低剂量下，局部麻醉剂具有抗惊厥作用", + "C": "患者在治疗前应进行预先用药", + "D": "癫痫是酰胺类麻醉剂的绝对禁忌症", + "E": "应准备好氧气以备紧急情况下使用" + } + }, + { + "id": "65dd5019-1ee4-5d0e-9fd9-30839a441bf2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following anesthetic agents is a potent intravenous analgesic with minimal cardiovascular effects but can cause chest wall rigidity?", + "A": "Propofol", + "B": "Ketamine", + "C": "Fentanyl", + "D": "Midazolam" + }, + "zh": { + "question": "以下哪种麻醉药是一种强效的静脉镇痛药，具有最小的心血管影响，但可能导致胸壁僵硬？", + "A": "丙泊酚", + "B": "氯胺酮", + "C": "芬太尼", + "D": "咪达唑仑" + } + }, + { + "id": "7e761ef1-3189-5445-9b2c-4822f9ae8eb9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Define Pharmacodynamics.", + "A": "The time necessary for plasma drug concentration to fall by 50% or other % after a continuous infusion or specific duration.", + "B": "Is the relationship between the dose of the drug given and its observed plasma concentration and/or tissue concentration", + "C": "What the body does to the drug", + "D": "Describes the relationship between the drug concentration and the response." + }, + "zh": { + "question": "定义药效学。", + "A": "药物浓度在连续输注或特定时间后下降50%或其他百分比所需的时间。", + "B": "药物给药剂量与其观察到的血浆浓度和/或组织浓度之间的关系。", + "C": "身体对药物的作用。", + "D": "描述药物浓度与反应之间的关系。" + } + }, + { + "id": "76eb9b68-e748-5dee-b3d1-7fc15cacd601", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "PK and PD can vary between patients.  Which of the following would be a reason for variation?", + "A": "AGE", + "B": "Concominant Medications", + "C": "Concurrent Illness", + "D": "All of the Above" + }, + "zh": { + "question": "PK和PD在患者之间可能会有所不同。以下哪项会导致这种差异？", + "A": "年龄", + "B": "伴随用药", + "C": "并发疾病", + "D": "以上所有" + } + }, + { + "id": "b75f65fa-b22d-580a-8d08-02b4e978376d", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What is assumed if the oral dose of a drug is the same as the IV dose of the same drug?", + "A": "The drug is liquid in oral form.", + "B": "The drug is bound to protein.", + "C": "There is little first dose metabolism", + "D": "The patient has a big mouth" + }, + "zh": { + "question": "如果一种药物的口服剂量与相同药物的静脉注射剂量相同，假设是什么？", + "A": "该药物以液体形式口服。", + "B": "该药物与蛋白质结合。", + "C": "首次代谢作用很小。", + "D": "患者嘴巴很大。" + } + }, + { + "id": "fe1cf33e-b52d-5b16-8306-b8a00bf19270", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The transfer of drug across a membrane is based on what?", + "A": "Molecular size", + "B": "Degree of ionization", + "C": "Lipid solublity", + "D": "Protein binding", + "E": "All of the above" + }, + "zh": { + "question": "药物通过膜的转运基于什么？", + "A": "分子大小", + "B": "电离程度", + "C": "脂溶性", + "D": "蛋白结合", + "E": "以上所有" + } + }, + { + "id": "c228e1fe-b2cb-5dd0-a5d2-6a356a5dbab6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the pKa of a drug?", + "A": "An estimate of the osmotic gradient of the drug", + "B": "Is the ph at which ionized vs nonionized form of the drug are the same.", + "C": "The kick after a touchdown worth one point.", + "D": "The amount of drug bound to protein." + }, + "zh": { + "question": "药物的pKa是什么？", + "A": "药物渗透梯度的估计值", + "B": "药物的离子化形式与非离子化形式相同的pH值。", + "C": "达阵后的踢球得一分。", + "D": "与蛋白质结合的药物量。" + } + }, + { + "id": "de9d4eab-fe85-5bfd-8fac-ce81138144ab", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Define pH.", + "A": "An estimate of the osmotic gradient of the drug", + "B": "The natural log [H+]", + "C": "The negative log [H+].", + "D": "A new application for the Iphone" + }, + "zh": { + "question": "定义pH值。", + "A": "药物渗透梯度的估计值", + "B": "氢离子浓度的自然对数", + "C": "氢离子浓度的负对数。", + "D": "Iphone的新应用程序" + } + }, + { + "id": "fe70d657-e746-5396-850d-bed72642d868", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which anesthetic agent has analgesic effects?", + "A": "Desflurane", + "B": "Sevoflurane", + "C": "Isoflurane", + "D": "Nitrous oxide" + }, + "zh": { + "question": "哪种麻醉剂具有镇痛作用？", + "A": "地氟醚", + "B": "七氟醚", + "C": "异氟醚", + "D": "一氧化二氮" + } + }, + { + "id": "02af059f-3f41-55ed-a7da-77bde29e8f7c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What was the main problem with early anesthetic agents?", + "A": "Early agents needed CO2 to vaporize", + "B": "They caused coronay steal", + "C": "Early agents were toxic", + "D": "All of the above" + }, + "zh": { + "question": "早期麻醉剂的主要问题是什么？", + "A": "早期的麻醉剂需要二氧化碳才能挥发", + "B": "它们导致冠状动脉盗血", + "C": "早期的麻醉剂有毒性", + "D": "以上所有问题" + } + }, + { + "id": "917294bb-4f47-59a3-bbdf-91b6255635d9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When is a basic drug ionized.", + "A": "When it is eliminated by the body.", + "B": "When the pH is less than the pKa", + "C": "When the pH is more than the pKa", + "D": "When the pH is equal to the pKa" + }, + "zh": { + "question": "碱性药物何时电离。", + "A": "当它被身体排除时。", + "B": "当pH值小于pKa时。", + "C": "当pH值大于pKa时。", + "D": "当pH值等于pKa时。" + } + }, + { + "id": "04502ff0-1950-5be4-964f-27ae4f06d907", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What helped decreased flammability of the anesthetic agents", + "A": "Elimintating the use of oxygen in the ventilator", + "B": "Combining carbon with fluorine", + "C": "The use of industrial gas cylinders", + "D": "The use of the positive pressure scavenging system" + }, + "zh": { + "question": "什么有助于降低麻醉剂的可燃性", + "A": "消除在呼吸机中使用氧气", + "B": "将碳与氟结合", + "C": "使用工业气瓶", + "D": "使用正压排气系统" + } + }, + { + "id": "52ba718d-3367-5a57-8014-8339812efdca", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which drug has the tendency to potentiate cardiac arrythmias when halothane is used?", + "A": "Lidocaine", + "B": "Atropine", + "C": "Epinepherine", + "D": "Adenosine" + }, + "zh": { + "question": "在使用氟烷时，哪种药物有增强心律失常的倾向？", + "A": "利多卡因", + "B": "阿托品", + "C": "肾上腺素", + "D": "腺苷" + } + }, + { + "id": "5fce192e-1316-5423-b3ae-df97a6830846", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which inhaled agent can cause renal failure?", + "A": "Methoxyflurane", + "B": "Enflurane", + "C": "Isoflurane", + "D": "Desflurane" + }, + "zh": { + "question": "哪种吸入性药物可能导致肾衰竭？", + "A": "甲氧氟烷", + "B": "恩氟烷", + "C": "异氟烷", + "D": "地氟烷" + } + }, + { + "id": "5653f786-74d9-54a0-aabc-b97dafc6d0b2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The less soluble the agent....", + "A": "The slower the patient falls to sleep", + "B": "The more nephrotoxic the drug is", + "C": "The faster the drug goes to the brian", + "D": "The slower the drug goes to the brain" + }, + "zh": { + "question": "麻醉剂的溶解度越低……", + "A": "患者入睡得越慢", + "B": "药物的肾毒性越大", + "C": "药物进入大脑的速度越快", + "D": "药物进入大脑的速度越慢" + } + }, + { + "id": "00cfd55d-6017-5b60-af8d-ff03d5323fce", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Why do babies and infants require more anesthetic agent?", + "A": "They have large heads compared to their chest", + "B": "Because they have less surface area than adults", + "C": "They have higher metabolic rates", + "D": "They don't, they require less" + }, + "zh": { + "question": "为什么婴儿和幼儿需要更多的麻醉剂？", + "A": "与胸部相比，他们的头部较大", + "B": "因为他们的表面积比成年人小", + "C": "他们的新陈代谢率较高", + "D": "不，他们需要更少" + } + }, + { + "id": "3f0f80d5-8a44-523b-81d8-1e3a157a4381", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which patient will require the least anesthetic", + "A": "A chronic alcoholic", + "B": "A heavily intoxicated high school student", + "C": "An infant", + "D": "An chronic heroin user" + }, + "zh": { + "question": "哪个病人需要最少的麻醉剂", + "A": "慢性酗酒者", + "B": "严重醉酒的高中生", + "C": "婴儿", + "D": "慢性海洛因使用者" + } + }, + { + "id": "e308f3c7-5a6a-5bc3-a01c-b179b66926f0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Why is isoflurane not the best choice for inhalation induction in children", + "A": "Agent is too powerful for a child", + "B": "Agent has pungent odor", + "C": "Isoflurane is the best choice for inhalation induction", + "D": "It requires higher peak pressures to deliver the agent to the patient" + }, + "zh": { + "question": "为什么异氟醚不是儿童吸入诱导的最佳选择", + "A": "药物对儿童来说过于强效", + "B": "药物有刺激性气味", + "C": "异氟醚是吸入诱导的最佳选择", + "D": "需要更高的峰值压力将药物输送给患者" + } + }, + { + "id": "656913b2-32da-558a-b1a7-d581bddf46af", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which agent is least likely to form carbon monxide when introduced to co2 absorbers?", + "A": "N20", + "B": "Halothan", + "C": "Sevoflurane", + "D": "Desflurane" + }, + "zh": { + "question": "哪种药剂在引入二氧化碳吸收剂时最不可能形成一氧化碳？", + "A": "N20", + "B": "氟烷", + "C": "七氟醚", + "D": "地氟醚" + } + }, + { + "id": "75b724ca-407a-5464-b003-ba3aafb800ed", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the blood-gas solubility coefficient an indicator of?", + "A": "Which fluid compartment the anesthetic will occupy", + "B": "Speed of uptake and elimination", + "C": "If the anesthetic is a gas or liquid at room temperature", + "D": "The relative toxicity of the drug" + }, + "zh": { + "question": "血气溶解度系数是哪个指标的指示？", + "A": "麻醉剂将占据哪个液体隔室", + "B": "吸收和消除的速度", + "C": "麻醉剂在室温下是气体还是液体", + "D": "药物的相对毒性" + } + }, + { + "id": "4583e888-83a3-5234-bc0d-4e8d1f5c5122", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What does the Oil-gas coefficient represent?", + "A": "The lower the coefficient the more potent the gas", + "B": "The higer the coefficient the more potent the gas", + "C": "The proper placement of a hanger yoke", + "D": "The acceptable trace levels of oils in the vaporizers" + }, + "zh": { + "question": "油气系数代表什么？", + "A": "系数越低，气体越有效", + "B": "系数越高，气体越有效", + "C": "挂钩支架的正确放置", + "D": "蒸发器中可接受的油的痕量水平" + } + }, + { + "id": "101e2a8c-fd2f-53bc-a3d1-a42e7f561143", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Define general anesthesia.", + "A": "An altered physiologic state characterized by loss of consciousness analgesia of the entire body, amnesia, and to some degree muscle relaxation", + "B": "When 50 percent of the population between 33 and 55 years old has complete muscle relaxation", + "C": "When a patient is able to respond to commands during anesthesia however is able to make their own adjustments in regards to airway management", + "D": "Minimum alveolar concentration" + }, + "zh": { + "question": "定义全身麻醉。", + "A": "一种改变的生理状态，其特征是意识丧失、全身镇痛、遗忘以及一定程度的肌肉松弛", + "B": "当33至55岁之间的人群中有50%完全肌肉松弛时", + "C": "当患者在麻醉期间能够响应指令，但能够自行调整气道管理时", + "D": "最低肺泡浓度" + } + }, + { + "id": "f412cfb4-48bc-5417-8859-4135f400f5e4", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Factors that influence the magnitude of\r\ncarbon monoxide production from volatile anesthetics include:", + "A": "Dryness of the carbon dioxide absorbent with hydration preventing formation", + "B": "High temperatures of carbon dioxide absorbent as during low fresh gas flows and/or increased metabolic production of carbon dioxide.", + "C": "Prolonged high fresh gas flows that cause dryness.", + "D": "Type of carbon dioxide absorbent.", + "E": "All of the above" + }, + "zh": { + "question": "影响挥发性麻醉剂产生一氧化碳量的因素包括：", + "A": "二氧化碳吸收剂的干燥程度，水合作用可防止形成", + "B": "二氧化碳吸收剂的高温，如在低新鲜气体流量和/或二氧化碳代谢产量增加时。", + "C": "长时间的高新鲜气体流量导致干燥。", + "D": "二氧化碳吸收剂的类型。", + "E": "以上所有" + } + }, + { + "id": "ad080796-4548-5bfb-aacb-acc94087a2e1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is Monday morning phenomena.", + "A": "When Co2 absorbers have been left out of the anesthesia machine", + "B": "When CO2 absorbers have been exhausted over the weekend from lack of use and are no longer effective", + "C": "The phenomena of more accidents occuring on Mondays in the OR", + "D": "The phenomena of Miami Dolphins fans questioning the effectiveness of the \"wildcat\" offense" + }, + "zh": { + "question": "什么是星期一早晨现象。", + "A": "麻醉机的二氧化碳吸收剂被遗忘在外面", + "B": "由于周末未使用，二氧化碳吸收剂已耗尽且不再有效", + "C": "手术室里星期一发生更多事故的现象", + "D": "迈阿密海豚队的球迷质疑“野猫”进攻战术有效性的现象" + } + }, + { + "id": "202e0a65-d39d-5d2d-bb73-5b7a32c4c184", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which inhaled agent causes the largest increase in heart rate", + "A": "Desflurane", + "B": "Isoflurane", + "C": "N2O", + "D": "Halothane" + }, + "zh": { + "question": "哪种吸入性麻醉剂导致心率增加最大", + "A": "地氟醚", + "B": "异氟醚", + "C": "氧化亚氮", + "D": "氟烷" + } + }, + { + "id": "a6481447-4216-5f97-b7d9-d91f7a2c46ee", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which inhalation agent has the least amount of effects on BP?", + "A": "N2O", + "B": "Isoflurane", + "C": "Desflurane", + "D": "Sevoflurane" + }, + "zh": { + "question": "哪种吸入性麻醉剂对血压的影响最小？", + "A": "N2O", + "B": "异氟醚", + "C": "地氟醚", + "D": "七氟醚" + } + }, + { + "id": "feaaa9dc-3b99-51b5-8528-9496bd3ef75c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which agent's use has the highest incident of coronary steal?", + "A": "Isoflurane", + "B": "N2O", + "C": "Desflurane", + "D": "Sevoflurane" + }, + "zh": { + "question": "哪种药物的使用具有最高的冠状动脉盗血事件发生率？", + "A": "异氟醚", + "B": "一氧化二氮", + "C": "地氟醚", + "D": "七氟醚" + } + }, + { + "id": "52775ee5-c806-5353-9e8f-ec3ec0d08665", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which inhaled agent would be best for a patient with an ischemic CVA", + "A": "Sevoflurane", + "B": "Desflurane", + "C": "Isoflurane", + "D": "N2O" + }, + "zh": { + "question": "哪种吸入性麻醉剂最适合缺血性脑卒中患者", + "A": "七氟醚", + "B": "地氟醚", + "C": "异氟醚", + "D": "笑气" + } + }, + { + "id": "60b7d47e-75f9-5248-9023-339b8239ab29", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "What is the meyer-overton theory?", + "A": "Explains the increasing oil-gas partition pressure coefficient that is correlated with anesthetic potency", + "B": "Explains the increasing blood-gas partition pressure coefficient that is correlated with anesthetic potency" + }, + "zh": { + "question": "什么是迈耶-奥弗顿理论？", + "A": "解释与麻醉效力相关的油-气分配压系数的增加", + "B": "解释与麻醉效力相关的血-气分配压系数的增加" + } + }, + { + "id": "c7e4cdc1-90a2-533c-82ee-02a415ba15b9", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following agents does not have any muscle relaxing properties?", + "A": "Isoflurane", + "B": "Sevoflurane", + "C": "N2O", + "D": "Desflurane", + "E": "Halothane" + }, + "zh": { + "question": "以下哪种药物没有任何肌肉松弛特性？", + "A": "异氟醚", + "B": "七氟醚", + "C": "N2O", + "D": "地氟醚", + "E": "氟烷" + } + }, + { + "id": "0eb3f572-c952-5f63-bca4-c6d2574f8a36", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Describe how MAC changes with age", + "A": "It increase 6% for every decade of life", + "B": "It increase 10% for every decade of life", + "C": "It decrease 6% for every decade of life", + "D": "It decrease 10% for every decade of life" + }, + "zh": { + "question": "描述MAC如何随年龄变化", + "A": "每增加十年，MAC增加6%", + "B": "每增加十年，MAC增加10%", + "C": "每增加十年，MAC减少6%", + "D": "每增加十年，MAC减少10%" + } + }, + { + "id": "b24bac8c-13f3-5b11-a22d-15ea4231a4a4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "At what age is a patients highest MAC levels?", + "A": "1 year", + "B": "21 years", + "C": "6 months", + "D": "1 month" + }, + "zh": { + "question": "患者在什么年龄时MAC值最高？", + "A": "1岁", + "B": "21岁", + "C": "6个月", + "D": "1个月" + } + }, + { + "id": "4b010377-c785-5d9b-9e5b-e8725d4cc137", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the only inorganic agent used", + "A": "N2O", + "B": "Sevoflurane", + "C": "Isoflurane", + "D": "Desflurane" + }, + "zh": { + "question": "唯一使用的无机麻醉剂是什么", + "A": "N2O", + "B": "七氟醚", + "C": "异氟醚", + "D": "地氟醚" + } + }, + { + "id": "59ccdc80-8a05-5f6f-9010-0e117d229cb0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What are the cardiac effects of N20?", + "A": "Prolonger PR interval", + "B": "Peaked T waves", + "C": "Torsades de pointe", + "D": "Can cause myocardial ischemia in hypovolemic patients and in patients with CAD." + }, + "zh": { + "question": "N20对心脏的影响是什么？", + "A": "延长PR间期", + "B": "T波高尖", + "C": "尖端扭转型室速", + "D": "可导致低血容量患者和冠心病患者的心肌缺血。" + } + }, + { + "id": "5f101bb6-5cc3-5615-823c-0bf2e13dabdd", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is NOT a respiratory effect of N2O?", + "A": "Tachypnea", + "B": "Reddish skin discoloration", + "C": "Response to CO2 is depressed", + "D": "Increases the apneic threshold" + }, + "zh": { + "question": "下列哪项不是N2O的呼吸效应？", + "A": "呼吸急促", + "B": "皮肤发红", + "C": "对CO2的反应减弱", + "D": "增加呼吸暂停阈值" + } + }, + { + "id": "89a0627b-0b67-5e99-a92d-1cd8548350ed", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "All of these factors affect pharmacokinetics of a drug except?", + "A": "Extremes of age", + "B": "Hydration", + "C": "Renal or hepatic disease", + "D": "Skeletal muscle mass", + "E": "Skin pigmentation" + }, + "zh": { + "question": "以下哪些因素不影响药物的药代动力学？", + "A": "极端年龄", + "B": "水合状态", + "C": "肾脏或肝脏疾病", + "D": "骨骼肌质量", + "E": "皮肤色素沉着" + } + }, + { + "id": "46287bf2-4840-5ef3-bd31-99d707856e3d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The Pka of the drug delineates what % of a drug is in an ionized form?", + "A": "25%", + "B": "35%", + "C": "50%", + "D": "75%" + }, + "zh": { + "question": "药物的Pka值表示多少百分比的药物处于离子化形式？", + "A": "25%", + "B": "35%", + "C": "50%", + "D": "75%" + } + }, + { + "id": "78efb2de-2a21-5e03-a952-b48242f1e71f", + "choice_num": 2, + "answer": "B", + "level": 2, + "en": { + "question": "Does a weak acid inserted into an alkaline medium manifest its desired effects faster?", + "A": "True", + "B": "False" + }, + "zh": { + "question": "弱酸插入碱性介质中是否更快表现出其预期效果？", + "A": "正确", + "B": "错误" + } + }, + { + "id": "63f7a794-c949-53a8-9617-2cbe94f719a6", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A weak acid inserted into an acidic environment will be absorbed how?", + "A": "Faster", + "B": "Slower", + "C": "The same", + "D": "None of the above" + }, + "zh": { + "question": "弱酸在酸性环境中将如何被吸收？", + "A": "更快", + "B": "更慢", + "C": "相同", + "D": "以上都不是" + } + }, + { + "id": "61bb1057-69c7-502b-b55c-1d69c640d3cb", + "choice_num": 3, + "answer": "A", + "level": 2, + "en": { + "question": "A weak acid inserted into an alkaline medium will manifest its desired effect how?", + "A": "Faster", + "B": "Slower", + "C": "No change" + }, + "zh": { + "question": "将弱酸插入碱性介质中将如何表现其预期效果？", + "A": "更快", + "B": "更慢", + "C": "没有变化" + } + }, + { + "id": "06b21fe8-f3db-5db4-ba05-f3f1fa932b5e", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "An ionized medication will be metabolized by the liver.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "离子化药物会被肝脏代谢。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "ae2958c6-3ba2-5841-bd40-d40bd559efa6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What happens to a drug when the Pka and the pH are the same?", + "A": "30% inoized & 70% unionized", + "B": "60% inoized & 40% unionized", + "C": "50% inoized & 50% unionized", + "D": "75% inoized & 25% unionized" + }, + "zh": { + "question": "当药物的Pka和pH相同时，会发生什么？", + "A": "30%电离 & 70%未电离", + "B": "60%电离 & 40%未电离", + "C": "50%电离 & 50%未电离", + "D": "75%电离 & 25%未电离" + } + }, + { + "id": "25c5514f-e46e-5ba1-90e9-7d51d7c8a1c4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "When the pH and the Pka are equal how does a small change in pH effect the ionization", + "A": "Little difference", + "B": "Small changes in degree of ionization", + "C": "No notable therapeutic effect", + "D": "Large changes is degree of ionization" + }, + "zh": { + "question": "当pH值和pKa值相等时，pH值的微小变化如何影响电离程度", + "A": "差别不大", + "B": "电离程度有小变化", + "C": "没有显著的治疗效果", + "D": "电离程度有大变化" + } + }, + { + "id": "7ed612a8-ebce-5655-b436-4c7e9a0f5f80", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Propofol, a weak acid, has a Pka of 11, how will propofol behave in a body with a pH of 7.4", + "A": "More ionized", + "B": "Less Ionized", + "C": "No Change", + "D": "Less ionized" + }, + "zh": { + "question": "丙泊酚是一种弱酸，其pKa为11，在pH为7.4的体内，丙泊酚将如何表现？", + "A": "更多电离", + "B": "更少电离", + "C": "无变化", + "D": "更少电离" + } + }, + { + "id": "147adc8e-c5e0-5f6e-a000-a10147bc950c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Isoflurane is a methyl esther what is halothane.", + "A": "Alkyne derivative", + "B": "Alkene derivative", + "C": "Alkane derivative", + "D": "Ethyl methyl terrible" + }, + "zh": { + "question": "异氟醚是一种甲基酯，那么氟烷是什么。", + "A": "炔烃衍生物", + "B": "烯烃衍生物", + "C": "烷烃衍生物", + "D": "乙基甲基可怕" + } + }, + { + "id": "63e3c68c-801b-59d7-861a-74022a3e5d28", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "What is the MAC of sevoflurane?", + "A": "1.7", + "B": "1.15", + "C": "6", + "D": "104", + "E": "0.77" + }, + "zh": { + "question": "七氟醚的最低肺泡浓度（MAC）是多少？", + "A": "1.7", + "B": "1.15", + "C": "6", + "D": "104", + "E": "0.77" + } + }, + { + "id": "f408d804-445e-57ac-965c-0ee6442e97e0", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "What is the MAC of Isoflurane", + "A": "1.7", + "B": "1.15", + "C": "6", + "D": "105", + "E": "0.77" + }, + "zh": { + "question": "Isoflurane的最低肺泡浓度（MAC）是多少", + "A": "1.7", + "B": "1.15", + "C": "6", + "D": "105", + "E": "0.77" + } + }, + { + "id": "aa0edf36-7e19-5587-9695-bb7c7845be14", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is the MAC of Halothane", + "A": "1.7", + "B": "1.15", + "C": "6", + "D": "104", + "E": "0.77" + }, + "zh": { + "question": "Halothane的MAC是多少", + "A": "1.7", + "B": "1.15", + "C": "6", + "D": "104", + "E": "0.77" + } + }, + { + "id": "a214c296-4485-5bfc-abd6-d6bb04d6f206", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "What is the MAC of desflurane", + "A": "1.7", + "B": "1.15", + "C": "6", + "D": "105", + "E": "0.77" + }, + "zh": { + "question": "地氟醚的最低肺泡浓度（MAC）是多少", + "A": "1.7", + "B": "1.15", + "C": "6", + "D": "105", + "E": "0.77" + } + }, + { + "id": "a6688358-94ee-5b05-95be-4f921127f8fe", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "How does age effect MAC?", + "A": "Older patient less MAC, younger patient more MAC", + "B": "Older patients More MAC, younger patients less MAC", + "C": "Older women less MAC older men more MAC", + "D": "Teenagers usually need th most MAC" + }, + "zh": { + "question": "年龄如何影响MAC？", + "A": "年长患者需要更少的MAC，年轻患者需要更多的MAC", + "B": "年长患者需要更多的MAC，年轻患者需要更少的MAC", + "C": "年长女性需要更少的MAC，年长男性需要更多的MAC", + "D": "青少年通常需要最多的MAC" + } + }, + { + "id": "af14ec82-6ccc-51ce-825e-a4cdb3338b48", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which gas causes the most coronary steal?", + "A": "Desflurane", + "B": "Isoflurane", + "C": "Sevoflurane", + "D": "N2O" + }, + "zh": { + "question": "哪种气体导致最明显的冠状动脉盗血？", + "A": "地氟醚", + "B": "异氟醚", + "C": "七氟醚", + "D": "一氧化二氮" + } + }, + { + "id": "ba4b4ad1-dfef-561e-9021-03f56290fb71", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is coronary steal.", + "A": "When the heart become less compliant and there is an inotropic decrease", + "B": "When the heart slows down decreasing CO", + "C": "When O2 is stolen from ischemic areas of the heart and brought to non ischemic areas.", + "D": "Occurs in lateral decubiti position and placement of the kidney rest." + }, + "zh": { + "question": "什么是冠状动脉盗血。", + "A": "当心脏变得不那么顺应性并且有正性肌力下降时", + "B": "当心脏减慢导致心输出量减少时", + "C": "当氧气从心脏缺血区域被盗走并带到非缺血区域时。", + "D": "发生在侧卧位和肾托的放置时。" + } + }, + { + "id": "5b535ca8-7ad7-55be-bff7-eb45528d6286", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is Compound A?", + "A": "A medicine that allows all CRNA student to get A's", + "B": "CO2 absorbents containing Na/K OH react with Sevo and form a by-product that may cause Nephrotoxicity", + "C": "A compound associated with increased MAC levels", + "D": "Only found with the use of epinepherine" + }, + "zh": { + "question": "什么是化合物A？", + "A": "一种让所有CRNA学生都能得A的药物", + "B": "含有Na/K OH的CO2吸收剂与Sevo反应形成的副产物，可能导致肾毒性", + "C": "一种与MAC水平增加相关的化合物", + "D": "仅在使用肾上腺素时发现" + } + }, + { + "id": "f97ffe0c-df40-5526-adf2-205c668a99be", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What happens when you give an anesthetic agent and BP decreases what are your compensatory mechanisms?", + "A": "Bradycardia and chemoreceptors", + "B": "Bradycardia and baroreceptors", + "C": "Tachycardia and chemoreceptors", + "D": "Tachycardia and baroreceptors" + }, + "zh": { + "question": "当你给予麻醉剂并且血压下降时，你的代偿机制是什么？", + "A": "心动过缓和化学感受器", + "B": "心动过缓和压力感受器", + "C": "心动过速和化学感受器", + "D": "心动过速和压力感受器" + } + }, + { + "id": "3c6ba08c-3280-5496-8269-e1ee8029e73e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is a potential side effect of Halothane", + "A": "Halothane induced neuropathy", + "B": "Halothane induced hepatitis", + "C": "Halothane induced ESRD", + "D": "Halothane induced myopathy" + }, + "zh": { + "question": "Halothane 的潜在副作用是什么", + "A": "Halothane 诱导的神经病变", + "B": "Halothane 诱导的肝炎", + "C": "Halothane 诱导的终末期肾病", + "D": "Halothane 诱导的肌病" + } + }, + { + "id": "f2325c77-8d2b-5e8c-ab95-d9c5a3ad75e2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Where do inhaled anesthetics go first?", + "A": "Adipose tissue", + "B": "Bone", + "C": "The blood vessel rich group such as the lungs heart liver brain", + "D": "Scavenger system" + }, + "zh": { + "question": "吸入性麻醉剂首先到达哪里？", + "A": "脂肪组织", + "B": "骨骼", + "C": "血管丰富的组织，如肺、心脏、肝脏、大脑", + "D": "清除系统" + } + }, + { + "id": "404ac037-5430-5e73-8b76-ae8c89b0ec06", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is First Order Kinetics?", + "A": "Drug is eliminated at a constant rate regardless of amount", + "B": "The amount of time to eliminate half the drug concentration", + "C": "When the first reaction with the body/drug takes place", + "D": "A constant fraction is eliminated per unit time" + }, + "zh": { + "question": "什么是一级动力学？", + "A": "药物以恒定速率消除，无论数量多少", + "B": "消除一半药物浓度所需的时间", + "C": "当身体/药物发生第一次反应时", + "D": "每单位时间消除恒定比例" + } + }, + { + "id": "18026cfb-0c66-515c-8368-93a584f3e0c6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How is emergence determined?", + "A": "Brain elimination of the agent", + "B": "Cardiac elimination of the agent", + "C": "Pulmonary elimination of the agent", + "D": "Kidney elimination of the agent" + }, + "zh": { + "question": "如何确定苏醒？", + "A": "药物在大脑中的消除", + "B": "药物在心脏中的消除", + "C": "药物在肺部中的消除", + "D": "药物在肾脏中的消除" + } + }, + { + "id": "39a49a68-fefd-5325-9991-75eef66ec21d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which inhalation agent is good for pediatric induction?", + "A": "Isoflurane", + "B": "Sevoflurane", + "C": "Desflurane", + "D": "Halothane" + }, + "zh": { + "question": "哪种吸入性麻醉剂适合用于儿童诱导？", + "A": "异氟醚", + "B": "七氟醚", + "C": "地氟醚", + "D": "氟烷" + } + }, + { + "id": "e2beb05f-93d9-5ee6-8831-53f77c796d94", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How is elimination of an agent accomplished", + "A": "Exhalation", + "B": "Bio-transformation", + "C": "Transcutaneous loss", + "D": "All of the above" + }, + "zh": { + "question": "如何实现药物的清除", + "A": "呼气", + "B": "生物转化", + "C": "经皮损失", + "D": "以上所有" + } + }, + { + "id": "6f9d4cf7-0ded-5577-a0eb-b33ddba687bc", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the most important route of elimination for an anesthetic agent?", + "A": "Urine", + "B": "Insensible loss through the skin", + "C": "Bronchi", + "D": "Alveoli" + }, + "zh": { + "question": "麻醉剂最重要的消除途径是什么？", + "A": "尿液", + "B": "通过皮肤的无感蒸发", + "C": "支气管", + "D": "肺泡" + } + }, + { + "id": "1c4ba5c2-8a46-50fc-9423-5437d4dafd98", + "choice_num": 2, + "answer": "B", + "level": 2, + "en": { + "question": "True or false hyperventilation will decrease the rate of alveolar concentration?", + "A": "True", + "B": "False" + }, + "zh": { + "question": "过度通气会降低肺泡浓度的速率，对吗？", + "A": "对", + "B": "错" + } + }, + { + "id": "626b0c65-fcb1-52aa-a8a0-5eff35e86954", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "True or false hypoventilation will decrease the rate of alveolar concentration?", + "A": "True", + "B": "False" + }, + "zh": { + "question": "低通气会降低肺泡浓度的速率，对还是错？", + "A": "对", + "B": "错" + } + }, + { + "id": "b60c3673-586d-5321-9701-7740b44ba974", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Complete the following: \"The higher the flow delivered.....\"", + "A": "The higher the inspiratory concentration", + "B": "The lower the inspiratory concentration", + "C": "The higher the solubility", + "D": "The lower the solubility" + }, + "zh": { + "question": "完成以下内容：“流量越高……”", + "A": "吸入浓度越高", + "B": "吸入浓度越低", + "C": "溶解度越高", + "D": "溶解度越低" + } + }, + { + "id": "6c4bd9ca-07db-57ed-96e9-8b91450623e9", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What is the first thing a CRNA can do with a patient who has mild inspiratory wheezes?", + "A": "Give subcutaneous epi", + "B": "Give Brethine SQ", + "C": "Increase rate of agent", + "D": "Hang 1-2 gram Magnesium IV" + }, + "zh": { + "question": "CRNA对有轻度吸气性哮鸣音的患者可以首先采取什么措施？", + "A": "给予皮下注射肾上腺素", + "B": "给予皮下注射Brethine", + "C": "增加麻醉剂的速率", + "D": "静脉滴注1-2克镁" + } + }, + { + "id": "60df7196-9dd2-54b6-bb66-23638b18ac81", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "Both hypothermia and hyperthermia require decreases in MAC True or False", + "A": "True", + "B": "False", + "C": "True unless the Patient temperature is greater than 42 degrees celcius then more MAC is required" + }, + "zh": { + "question": "低体温和高体温都需要降低MAC，对还是错", + "A": "对", + "B": "错", + "C": "对，除非患者体温高于42摄氏度，则需要更多的MAC" + } + }, + { + "id": "8bc0a12d-bfc1-588d-b12a-e732856ca10e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What decrease in Hct would constitute less MAC?", + "A": "A 5% decrease", + "B": "A 10% decrease", + "C": "A 15% decrease", + "D": "A 20% decrease" + }, + "zh": { + "question": "Hct减少多少会导致MAC减少？", + "A": "减少5%", + "B": "减少10%", + "C": "减少15%", + "D": "减少20%" + } + }, + { + "id": "e5d75da0-17a3-5307-8532-234c18e30d67", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "At what PaO2 level is a decrease in MAC required?", + "A": "80", + "B": "60", + "C": "40", + "D": "30" + }, + "zh": { + "question": "在什么PaO2水平需要减少MAC？", + "A": "80", + "B": "60", + "C": "40", + "D": "30" + } + }, + { + "id": "a739305c-78f8-5a38-a387-77dd4739b29c", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "If a patient has hypocalcemia what change is MAC would be required", + "A": "A decrease in MAC", + "B": "An increase in MAC", + "C": "No change in MAC" + }, + "zh": { + "question": "如果患者有低钙血症，MAC 需要做出什么改变", + "A": "MAC 减少", + "B": "MAC 增加", + "C": "MAC 不变" + } + }, + { + "id": "602faec1-807a-5935-8352-37f1fb3d3a1c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How many days postpartum must a patient be prior to returning to normal MAC level needs?", + "A": "1 day", + "B": "2 days", + "C": "3 days", + "D": "1 week" + }, + "zh": { + "question": "产妇在产后多少天后才能恢复到正常的MAC水平需求？", + "A": "1天", + "B": "2天", + "C": "3天", + "D": "1周" + } + }, + { + "id": "3fa570cd-9ae8-52f9-b580-2def9daaed9d", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is the CRNA's concerns with a patient who takes St. John's Wart", + "A": "Increased cytochrome p-450 activity", + "B": "Digoxin interference", + "C": "Fatigue", + "D": "Dizziness", + "E": "All of the above" + }, + "zh": { + "question": "CRNA 对服用圣约翰草的患者有哪些担忧？", + "A": "增加细胞色素 p-450 活性", + "B": "地高辛干扰", + "C": "疲劳", + "D": "头晕", + "E": "以上所有" + } + }, + { + "id": "fbe7eff9-2ca5-5e99-9849-8adcbe375ed4", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "What is the usual effects of sevoflurane on BP", + "A": "Increase", + "B": "Decrease", + "C": "No change" + }, + "zh": { + "question": "七氟醚对血压的常见影响是什么", + "A": "升高", + "B": "降低", + "C": "无变化" + } + }, + { + "id": "cb25b986-dd87-5786-9e5a-bf5cda5fa424", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Isoflurane and Sevoflurane will have what type of effect on respiratory rate?", + "A": "Increase", + "B": "Decrease", + "C": "No change" + }, + "zh": { + "question": "异氟醚和七氟醚对呼吸频率有什么影响？", + "A": "增加", + "B": "减少", + "C": "无变化" + } + }, + { + "id": "628183d6-9020-5cbd-81df-6e8371a9165f", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "Isoflurane and Sevoflurane will have what type of effect on tidal volume?", + "A": "Increase", + "B": "Decrease", + "C": "No change" + }, + "zh": { + "question": "异氟醚和七氟醚对潮气量会有什么影响？", + "A": "增加", + "B": "减少", + "C": "无变化" + } + }, + { + "id": "93c801d4-2de1-50c3-9424-cc75f6cf9793", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which agent is best for a patient with cerebral ischemia?", + "A": "Desflurane", + "B": "Sevoflurane", + "C": "Isoflurane", + "D": "N2O" + }, + "zh": { + "question": "哪种药物最适合脑缺血患者？", + "A": "地氟醚", + "B": "七氟醚", + "C": "异氟醚", + "D": "氧化亚氮" + } + }, + { + "id": "da491b6c-7d84-5884-934a-ca4fb2bc9283", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "FOr cerebral blood flow what range are you trying to keep", + "A": "20-120", + "B": "60-160", + "C": "90-140", + "D": "75-135" + }, + "zh": { + "question": "对于脑血流量，你希望保持在哪个范围内？", + "A": "20-120", + "B": "60-160", + "C": "90-140", + "D": "75-135" + } + }, + { + "id": "c26437db-3310-5de1-aea0-61bf9c3d6eac", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What are the factors that influence the magnitude of carbon monoxide production from volatile anesthetics?", + "A": "Dryness of the carbon dioxide absorbent with hydration preventing formation", + "B": "High temperatures of carbon dioxide absorbent as during fresh gas flow and/or increased metabolic production of carbon dioxide", + "C": "Prolonged high fresh gas flow that causes dryness", + "D": "Type of carbon dioxide absorbent", + "E": "All of the above" + }, + "zh": { + "question": "哪些因素会影响挥发性麻醉剂产生一氧化碳的量？", + "A": "二氧化碳吸收剂的干燥程度，水合作用可防止形成", + "B": "二氧化碳吸收剂的高温，如在新鲜气体流动和/或二氧化碳代谢产量增加时", + "C": "长时间高流量的新鲜气体导致的干燥", + "D": "二氧化碳吸收剂的类型", + "E": "以上所有因素" + } + }, + { + "id": "cb8dcf8c-0564-5e27-b2f9-330fa91dbf9c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What does clinical pharmacokinetics describe?", + "A": "Absorption", + "B": "Distribution", + "C": "Metabolism", + "D": "Elimination", + "E": "All of the above" + }, + "zh": { + "question": "临床药代动力学描述了什么？", + "A": "吸收", + "B": "分布", + "C": "代谢", + "D": "消除", + "E": "以上所有" + } + }, + { + "id": "10168666-784f-5020-b0a9-5dfb831e7d33", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What does information about pharmacokinetis help us as CRNA's with", + "A": "It describes ADME of a drug within the body", + "B": "Describes the effects of the drug upon the body", + "C": "It allows the prediction of plasma concentration following different dosing regimens", + "D": "All of the above" + }, + "zh": { + "question": "药代动力学信息如何帮助我们作为CRNA", + "A": "它描述了药物在体内的ADME", + "B": "描述药物对身体的影响", + "C": "它允许预测不同给药方案后的血浆浓度", + "D": "以上所有" + } + }, + { + "id": "04e1ab44-b34d-5fd0-ab7b-819b7d9092b7", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is ultimately responsible for undesired effects of a drug", + "A": "Pharmacokinetics", + "B": "Pharmacodynamics", + "C": "Plasma levels", + "D": "Metabolism" + }, + "zh": { + "question": "什么最终导致药物的不良反应", + "A": "药代动力学", + "B": "药效学", + "C": "血浆水平", + "D": "代谢" + } + }, + { + "id": "22f43679-a60a-5e39-8112-f2542ad933f2", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What factors are responsible for variability in both PK&PD of drugs among patients?", + "A": "Age", + "B": "Concurrent illnesses", + "C": "Concomitant medications", + "D": "All of the above" + }, + "zh": { + "question": "哪些因素导致患者之间药物的药代动力学和药效动力学的差异？", + "A": "年龄", + "B": "并发疾病", + "C": "伴随用药", + "D": "以上所有因素" + } + }, + { + "id": "295625dd-a514-5801-9295-c69aa9a891fa", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Transfer of drugs across membranes are dependent upon what?", + "A": "Molecular size", + "B": "Degree of ionization", + "C": "Lipid solubility", + "D": "Protein binding", + "E": "All of the above" + }, + "zh": { + "question": "药物跨膜转运依赖于什么？", + "A": "分子大小", + "B": "电离程度", + "C": "脂溶性", + "D": "蛋白结合", + "E": "以上所有因素" + } + }, + { + "id": "2dc04f4e-8f9d-59b0-b968-87e42b88f8d8", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "True or false most electrolyte actions do not require energy", + "A": "True", + "B": "False" + }, + "zh": { + "question": "大多数电解质作用不需要能量，对还是错？", + "A": "对", + "B": "错" + } + }, + { + "id": "ea1801b1-e9ab-5565-820a-2028bfd7b3e9", + "choice_num": 2, + "answer": "B", + "level": 2, + "en": { + "question": "Where is a drug concentration greater?", + "A": "On the side of the membrane where the drug is more ionized", + "B": "On the side of the membrane where the drug is less ionized" + }, + "zh": { + "question": "药物浓度在哪一侧更高？", + "A": "在药物电离更多的膜的一侧", + "B": "在药物电离较少的膜的一侧" + } + }, + { + "id": "33fd240c-e832-5efd-b862-ce809767d81c", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "True or false.  For a drug to be transported it must be ionized?", + "A": "True", + "B": "False" + }, + "zh": { + "question": "对或错。药物必须电离才能被运输？", + "A": "对", + "B": "错" + } + }, + { + "id": "5aebf7c7-a549-59a1-b3ae-e3f3e8cdd886", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "I could not figure a good question for this...I am not the smartest guy, but review slide 10 on the PK-PD power point slide.  Trivia question.  Who is the only defenseman in NHL history who did not have to wait the normal 5 year waiting period for induction to the hall of fame?", + "A": "Wayne Gretzky", + "B": "Phil Esposito", + "C": "Bobby Orr", + "D": "Ray Bourque" + }, + "zh": { + "question": "我无法想出一个好的问题……我不是最聪明的人，但请查看PK-PD幻灯片的第10页。小测验问题。谁是NHL历史上唯一一位不必等待正常5年等待期即可入选名人堂的防守队员？", + "A": "韦恩·格雷茨基", + "B": "菲尔·埃斯波西托", + "C": "鲍比·奥尔", + "D": "雷·布尔克" + } + }, + { + "id": "619785a1-37bb-551f-af08-6b6a2810aecc", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "If a drug binds to a nonspecific sight what occurs?", + "A": "Pharmacologic response", + "B": "Toxic Response", + "C": "No response", + "D": "All of the above" + }, + "zh": { + "question": "如果一种药物与非特异性位点结合，会发生什么？", + "A": "药理反应", + "B": "毒性反应", + "C": "无反应", + "D": "以上皆是" + } + }, + { + "id": "38a8d2d9-cc08-5a01-aa2c-d2bb9c7b4fbe", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which organs have enzymes that can metabolize drugs resulting in metabolites that may be active or inactive?", + "A": "Liver", + "B": "GI tract", + "C": "Lungs", + "D": "All of the above" + }, + "zh": { + "question": "哪些器官具有能够代谢药物的酶，从而产生可能活性或非活性的代谢产物？", + "A": "肝脏", + "B": "胃肠道", + "C": "肺", + "D": "以上所有" + } + }, + { + "id": "b4b58c95-7912-56a5-abfa-cb84537f8d8c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What part of the body has esterases (esterases are enzymes that cleave ester bonds and make the drug inactive)", + "A": "Neuro tissue", + "B": "Integumentary tissue", + "C": "Blood", + "D": "Catabolized muscle cells" + }, + "zh": { + "question": "身体的哪个部位含有酯酶（酯酶是切割酯键并使药物失活的酶）", + "A": "神经组织", + "B": "皮肤组织", + "C": "血液", + "D": "分解代谢的肌肉细胞" + } + }, + { + "id": "f80bf2b6-2240-5ee4-8828-d9018a8f8912", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What are pro-drugs?", + "A": "Drugs with a very short half life for example adenosine", + "B": "Drugs that are not active until the body itself activates them", + "C": "Drugs that can only be given by MD anesthesiologist because of their toxic effect", + "D": "I have no idea, but if I ask Barry Bonds, Roger Clemens, Sammy Sosa, A-Rod, or Manny Ramirez they would know." + }, + "zh": { + "question": "什么是前药？", + "A": "半衰期非常短的药物，例如腺苷", + "B": "在体内被激活后才具有活性的药物", + "C": "由于其毒性作用只能由麻醉科医生给予的药物", + "D": "我不知道，但如果我问巴里·邦兹、罗杰·克莱门斯、萨米·索萨、A-Rod或曼尼·拉米雷斯，他们会知道。" + } + }, + { + "id": "51896065-7470-57d8-897e-c3f885da6284", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is a phase I reaction?", + "A": "The initial reaction to a drug prior to anaphylaxis", + "B": "When the drug is made more polar and water soluble", + "C": "Inactivation of the pharmacologic activity of the drug", + "D": "All of the above" + }, + "zh": { + "question": "什么是第一相反应？", + "A": "药物在发生过敏反应前的初始反应", + "B": "药物变得更极性和水溶性", + "C": "药物药理活性的失活", + "D": "以上所有" + } + }, + { + "id": "3cf81a92-de98-566b-b5c5-2a4e2847085f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is a phase II reaction", + "A": "The initial reaction to a drug prior to anaphylaxis", + "B": "When the drug is made more polar and water soluble", + "C": "Inactivation of the pharmacologic activity of the drug", + "D": "All of the above" + }, + "zh": { + "question": "什么是II期反应", + "A": "药物在发生过敏反应前的初始反应", + "B": "药物变得更极性和水溶性", + "C": "药物药理活性的失活", + "D": "以上所有" + } + }, + { + "id": "8a34e0c5-f338-5cd1-b118-4cc62eaeec29", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements best describes linear PK", + "A": "It is the pharmacokinetics in which most drugs follow", + "B": "Serum drug concentrations change proportionally to dosing", + "C": "It is a steady state, when given IV, between dosage rate and elimination", + "D": "All of the above" + }, + "zh": { + "question": "以下哪项陈述最能描述线性药代动力学", + "A": "大多数药物遵循的药代动力学", + "B": "血清药物浓度与剂量成比例变化", + "C": "在静脉给药时，剂量速率与消除之间达到稳态", + "D": "以上全部" + } + }, + { + "id": "976c3f3e-4275-5e7e-bcf0-3f1178374fdd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is compartmental PK?", + "A": "Inactivation of the pharmacologic activity of the drug", + "B": "When the drug is made more polar and water soluble", + "C": "Describes the body as hypothetical compartments linked by transfer rate processes", + "D": "All of the above" + }, + "zh": { + "question": "什么是分室药代动力学？", + "A": "药物药理活性的失活", + "B": "药物变得更极性和水溶性", + "C": "将身体描述为通过转移速率过程连接的假想隔室", + "D": "以上所有" + } + }, + { + "id": "42b1033a-bb89-5de6-8258-3e8805b0475a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which compartment can a drug sample not be taken from", + "A": "Central Compartment", + "B": "Peripheral compartment", + "C": "One-compartment", + "D": "All of the above" + }, + "zh": { + "question": "不能从哪个隔室取药样？", + "A": "中央隔室", + "B": "外周隔室", + "C": "单隔室", + "D": "以上所有" + } + }, + { + "id": "5e259bef-6962-5b43-a529-2f51ae18966d", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What makes up the hypothetical central compartment", + "A": "Brain", + "B": "Lungs", + "C": "Liver", + "D": "Heart", + "E": "All of the above" + }, + "zh": { + "question": "假设的中央室由什么组成", + "A": "大脑", + "B": "肺", + "C": "肝脏", + "D": "心脏", + "E": "以上所有" + } + }, + { + "id": "240ab438-da34-54d1-bc66-1e2ae016f4f5", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What makes up the peripheral compartment", + "A": "Muscle", + "B": "Skin", + "C": "Fat", + "D": "Bone", + "E": "All of the above" + }, + "zh": { + "question": "外周室由什么组成", + "A": "肌肉", + "B": "皮肤", + "C": "脂肪", + "D": "骨骼", + "E": "以上全部" + } + }, + { + "id": "dcaade16-629f-5d7e-80d1-0dd446eff187", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "How is the volume of distribution of a drug calculated?", + "A": "Total dose of the drug divided by the plasma concentrationat time=0", + "B": "Theoretical volume of plasma that is completely cleared of a drug at a given tim", + "C": "TIme it takes the drug concentration to fall 1/2", + "D": "The time it takes for the total amount of drug to decrease by 1/2" + }, + "zh": { + "question": "如何计算药物的分布容积？", + "A": "药物总剂量除以时间=0时的血浆浓度", + "B": "在给定时间内完全清除药物的理论血浆体积", + "C": "药物浓度下降到1/2所需的时间", + "D": "药物总量减少到1/2所需的时间" + } + }, + { + "id": "72e3b631-3c83-5f17-bfcc-5fb5884f7398", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is clearance", + "A": "Total dose of the drug divided by the plasma concentrationat time=0", + "B": "Theoretical volume of plasma that is completely cleared of a drug at a given time", + "C": "TIme it takes the drug concentration to fall 1/2", + "D": "The time it takes for the total amount of drug to decrease by 1/2" + }, + "zh": { + "question": "什么是清除率", + "A": "药物总剂量除以时间=0时的血浆浓度", + "B": "在给定时间内完全清除药物的理论血浆体积", + "C": "药物浓度下降一半所需的时间", + "D": "药物总量减少一半所需的时间" + } + }, + { + "id": "24ba83c7-0d3f-5a0d-922d-b76902904052", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is elimination half time?", + "A": "The time it takes for the total amount of drug to decrease by 1/2", + "B": "Total dose of the drug divided by the plasma concentrationat time=0", + "C": "TIme it takes the drug concentration to fall 1/2", + "D": "Theoretical volume of plasma that is completely cleared of a drug at a given time" + }, + "zh": { + "question": "什么是消除半衰期？", + "A": "药物总量减少一半所需的时间", + "B": "药物的总剂量除以时间=0时的血浆浓度", + "C": "药物浓度下降一半所需的时间", + "D": "在给定时间内完全清除药物的理论血浆体积" + } + }, + { + "id": "2d10cc26-465e-5c49-b4f1-2dccbeb0e46b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is elimination half life?", + "A": "The time it takes for the total amount of drug to decrease by 1/2", + "B": "Total dose of the drug divided by the plasma concentrationat time=0", + "C": "TIme it takes the drug concentration to fall 1/2", + "D": "Theoretical volume of plasma that is completely cleared of a drug at a given time" + }, + "zh": { + "question": "什么是消除半衰期？", + "A": "药物总量减少一半所需的时间", + "B": "药物的总剂量除以时间=0时的血浆浓度", + "C": "药物浓度下降一半所需的时间", + "D": "在给定时间内完全清除药物的理论血浆体积" + } + }, + { + "id": "6743a746-0753-50ff-8827-3ae32b6bcfaf", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is context sensitive half time?", + "A": "Theoretical volume of plasma that is completely cleared of a drug at a given time", + "B": "The time necessary for plasma drug concentration to fall by 50% or other % after continuous infusion of specific duration", + "C": "TIme it takes the drug concentration to fall 1/2", + "D": "All of the above" + }, + "zh": { + "question": "什么是上下文敏感半衰期？", + "A": "在特定时间内完全清除药物的理论血浆体积", + "B": "在特定持续时间的连续输注后，血浆药物浓度下降50%或其他百分比所需的时间", + "C": "药物浓度下降一半所需的时间", + "D": "以上全部" + } + }, + { + "id": "5ac3537d-4f3e-5703-ac94-6bd8ae5f586b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Why are diuretic usually held prior to surgery?", + "A": "Volume depletion", + "B": "Rebound hypertension", + "C": "Intraoperative hypertension", + "D": "Intraoperative hyperglycemia" + }, + "zh": { + "question": "为什么在手术前通常停用利尿剂？", + "A": "容量不足", + "B": "反弹性高血压", + "C": "术中高血压", + "D": "术中高血糖" + } + }, + { + "id": "9f78fe29-aff0-53d5-a9ec-ceecc106827c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "At what diastolic BP will surgery usually be held?", + "A": "80", + "B": "90", + "C": "100", + "D": "110" + }, + "zh": { + "question": "在什么舒张压下通常会暂停手术？", + "A": "80", + "B": "90", + "C": "100", + "D": "110" + } + }, + { + "id": "7102a8ff-ba56-53d2-bae8-c0653bdb9779", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the ASA recommendation in regards to herbal supplements?", + "A": "Stop taking 3 days prior to surgery", + "B": "Stop taking 1 week prior to surgery", + "C": "Stop 2 weeks prior to surgery", + "D": "Stop taking 3 weeks prior to surgery" + }, + "zh": { + "question": "ASA 对草药补充剂的建议是什么？", + "A": "在手术前3天停止服用", + "B": "在手术前1周停止服用", + "C": "在手术前2周停止服用", + "D": "在手术前3周停止服用" + } + }, + { + "id": "1c98eb16-075f-5424-b8cf-f53b8d0252b5", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is the CRNA's concerns with a patient who takes echinacea (used to treat viral bacterial and fungal infections)", + "A": "Tachyphylaxis", + "B": "Barbituate toxicity", + "C": "Hepatotoxicity", + "D": "Activation of macrophages and killer T-Cells", + "E": "All of the above" + }, + "zh": { + "question": "CRNA 对服用紫锥菊（用于治疗病毒、细菌和真菌感染）的患者有哪些担忧？", + "A": "快速耐药性", + "B": "巴比妥类毒性", + "C": "肝毒性", + "D": "巨噬细胞和杀伤性T细胞的激活", + "E": "以上所有" + } + }, + { + "id": "83f4f220-60e9-5e28-a4f2-9738bbc9618c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is the CRNA's concerns with a patient who takes Ephedra or Ma Huang (used for increased energy and appetite supression", + "A": "Acts on Alpha and Beta cells like ephedrine", + "B": "Increased HR", + "C": "Increased BP", + "D": "Relaxation of smooth muscles", + "E": "All of the above" + }, + "zh": { + "question": "CRNA 对服用麻黄或麻黄（用于增加能量和抑制食欲）的患者有哪些担忧？", + "A": "像麻黄碱一样作用于α和β细胞", + "B": "心率增加", + "C": "血压升高", + "D": "平滑肌松弛", + "E": "以上所有" + } + }, + { + "id": "665dbeae-0078-591d-8f8c-47cde773a31d", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "What drug should be used for a patient who is currently taking ephedra and become hypotensive during surgery", + "A": "Dopamine", + "B": "Neosynephrine", + "C": "Dobutamine", + "D": "Calcium" + }, + "zh": { + "question": "对于一名正在服用麻黄的患者，在手术中出现低血压时应使用哪种药物？", + "A": "多巴胺", + "B": "新福林", + "C": "多巴酚丁胺", + "D": "钙" + } + }, + { + "id": "df71562b-df62-585e-a23d-3b239a338965", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is the CRNA's concerns with a patient who takes Garlic", + "A": "Hypotension", + "B": "Increased bleeding times", + "C": "Increased risk for hypotension", + "D": "Impaired platelet aggregation", + "E": "All of the above" + }, + "zh": { + "question": "CRNA 对服用大蒜的患者有哪些担忧", + "A": "低血压", + "B": "出血时间延长", + "C": "增加低血压风险", + "D": "血小板聚集受损", + "E": "以上所有" + } + }, + { + "id": "757eb328-06e4-599e-a6e6-bd4e051813c4", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is the CRNA's concerns with a patient who takes Ginseng", + "A": "Hypertension", + "B": "Insomnia", + "C": "Hemodynamic instability", + "D": "Prolonged bleeding time", + "E": "All of the above" + }, + "zh": { + "question": "CRNA 对服用人参的患者有哪些担忧", + "A": "高血压", + "B": "失眠", + "C": "血流动力学不稳定", + "D": "出血时间延长", + "E": "以上所有" + } + }, + { + "id": "6f2d511c-ca3a-54f5-bb89-d5e0c2f496c6", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is the CRNA's concerns with a patient who takes Kava-Kava", + "A": "Interaction with levodopa", + "B": "Potentiation of barbituates", + "C": "Potentiation of benzodiazepines", + "D": "Decrease in MAC", + "E": "All of the above" + }, + "zh": { + "question": "CRNA 对服用卡瓦卡瓦的患者有哪些担忧", + "A": "与左旋多巴的相互作用", + "B": "巴比妥类药物的增强作用", + "C": "苯二氮䓬类药物的增强作用", + "D": "MAC 的降低", + "E": "以上所有" + } + }, + { + "id": "3780afbf-9f27-50cf-b625-7a3d6b004bde", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is the CRNA's concerns with a patient who takes Valerian", + "A": "Tremors", + "B": "Headache", + "C": "Dysrythmias", + "D": "Liver dysfunction", + "E": "All of the above" + }, + "zh": { + "question": "CRNA 对服用缬草的患者有哪些担忧", + "A": "震颤", + "B": "头痛", + "C": "心律失常", + "D": "肝功能障碍", + "E": "以上所有" + } + }, + { + "id": "f4e0b2a3-9743-50ec-9b1a-021ea13ff44a", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Higher Vd relates to elimination how?", + "A": "Longer elimination", + "B": "Shorter elimination", + "C": "No change in elimination time" + }, + "zh": { + "question": "较高的分布容积与消除有何关系？", + "A": "消除时间更长", + "B": "消除时间更短", + "C": "消除时间不变" + } + }, + { + "id": "18b55fa9-223b-5745-8433-47bde3ba0217", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Define zero order kinetics", + "A": "A constant fraction is eliminated per unit time", + "B": "A constant amount of drug is eliminated per unit time", + "C": "The time necessary for plasma drug concentration to fall by 50% or other % after a continuous infusion or specific duration.", + "D": "All of the above" + }, + "zh": { + "question": "定义零级动力学", + "A": "每单位时间消除恒定比例", + "B": "每单位时间消除恒定量的药物", + "C": "在连续输注或特定持续时间后，血浆药物浓度下降50%或其他百分比所需的时间。", + "D": "以上全部" + } + }, + { + "id": "dd893617-3648-5fa9-ac42-6074886988ef", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Where can elimination of a drug from the body occur", + "A": "Central compartment", + "B": "Peripheral compartment", + "C": "All of the above" + }, + "zh": { + "question": "药物从体内的消除可以发生在哪里", + "A": "中央室", + "B": "外周室", + "C": "以上所有" + } + }, + { + "id": "3b6200f0-1747-5b82-92cd-67ea1148357e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Once again not sure how to write the question but refer to slide 11 in the Pk-Pd pt 2 lecture.  Be able to set up the chart for calculation of half life.  Trivia (yeah!)  Who was the last MLB pitcher to win the Cy Young and MVP awards in the same year.", + "A": "Roger Clemens", + "B": "CC Sabathia", + "C": "Dennis Eckersley", + "D": "Catfish Hunter" + }, + "zh": { + "question": "再次不确定如何写这个问题，但请参考Pk-Pd pt 2讲座的第11张幻灯片。能够设置计算半衰期的图表。小知识（是的！）谁是最后一位在同一年赢得赛扬奖和MVP奖的MLB投手。", + "A": "罗杰·克莱门斯", + "B": "CC·萨巴西亚", + "C": "丹尼斯·艾克斯利", + "D": "鲶鱼·亨特" + } + }, + { + "id": "38245fcf-dc44-5e94-ba05-a61a32996cf5", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Emergence is mainly dependent on what?", + "A": "Fresh gas flow", + "B": "Pulmonary elimination", + "C": "Kidney elimination", + "D": "Nephrotoxicity" + }, + "zh": { + "question": "苏醒��要依赖于什么？", + "A": "新鲜气体流量", + "B": "肺部排除", + "C": "肾脏排除", + "D": "肾毒性" + } + }, + { + "id": "8b7d1035-ca3c-53e3-a62c-60dc24f34c5f", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Which type of agent is taken up by the blood more readily soluble or insoluble?", + "A": "Soluble", + "B": "Insoluble" + }, + "zh": { + "question": "哪种类型的药物更容易被血液吸收，易溶性还是不溶性？", + "A": "易溶性", + "B": "不溶性" + } + }, + { + "id": "70a837f2-e9ee-53b6-ad9b-28d606f2170c", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "How is the blood gas coefficient related to solubilty?", + "A": "The lower the coefficient the more soluble the agent", + "B": "The lower the coefficient the less soluble the agent", + "C": "The higher the concentration the less soluble the agent" + }, + "zh": { + "question": "血气分配系数与溶解度的关系是什么？", + "A": "系数越低，药剂越易溶解", + "B": "系数越低，药剂越不易溶解", + "C": "浓度越高，药剂越不易溶解" + } + }, + { + "id": "236e363d-bea8-59c8-b60f-0953b866efaa", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is dead space?", + "A": "Perfusion no ventilation", + "B": "Perfusion with ventilation", + "C": "Ventilation with perfusion", + "D": "Ventilation but no perfusion" + }, + "zh": { + "question": "什么是死腔？", + "A": "有灌注无通气", + "B": "有灌注有通气", + "C": "有通气有灌注", + "D": "有通气无灌注" + } + }, + { + "id": "474a3094-ec0b-5777-a19d-d392a49a4dda", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is shunting", + "A": "Perfusion no ventilation", + "B": "Perfusion with ventilation", + "C": "Ventilation with perfusion", + "D": "Ventilation but no perfusion" + }, + "zh": { + "question": "什么是分流", + "A": "灌注无通气", + "B": "灌注伴通气", + "C": "通气伴灌注", + "D": "通气无灌注" + } + }, + { + "id": "a67f0c92-2f0c-5e97-9d49-ea9ff16928cd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How is elimination accomplishes?", + "A": "Exhalation", + "B": "Biotransformation", + "C": "Transcutaneous loss", + "D": "All of the above" + }, + "zh": { + "question": "如何实现消除？", + "A": "呼气", + "B": "生物转化", + "C": "经皮损失", + "D": "以上所有" + } + }, + { + "id": "a1c1ead2-6ced-5b1e-8fc0-9c8fa3ba82e3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is MAC-BAR", + "A": "When there is a bromide attachment to the agent", + "B": "When there is a barium attachment to the agent", + "C": "Block adrenergic response", + "D": "Where all Irish guys go after class" + }, + "zh": { + "question": "什么是MAC-BAR", + "A": "当药剂附有溴化物时", + "B": "当药剂附有钡时", + "C": "阻断肾上腺素反应", + "D": "所有爱尔兰人在下课后去的地方" + } + }, + { + "id": "be24961b-d395-5b56-9af9-75f20b53b170", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is MAC- awake?", + "A": "This is the MAC at time=0", + "B": "50% of patients will be able to follow a a simple command at this level", + "C": "This is MAC when patient arrises from anesthesia", + "D": "All of the above" + }, + "zh": { + "question": "什么是MAC-苏醒？", + "A": "这是时间=0时的MAC", + "B": "50%的患者在此水平能够执行简单指令", + "C": "这是患者从麻醉中苏醒时的MAC", + "D": "以上全部" + } + }, + { + "id": "8f08cfe1-c738-549d-84f6-dbf46a32491b", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What do you have to be concerned with when a patient is hypovolemic and receive N20", + "A": "Pulmonary vascular resistance", + "B": "Myocardium depression", + "C": "Myocardium ischemia", + "D": "Catecholamine release", + "E": "All of the above" + }, + "zh": { + "question": "当患者低血容量并接受N2O时，你需要关注什么？", + "A": "肺血管阻力", + "B": "心肌抑制", + "C": "心肌缺血", + "D": "儿茶酚胺释放", + "E": "以上所有" + } + }, + { + "id": "efe52753-5842-54e7-9373-b6e3d432169f", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "When giving N2O what respiratory concerns will you have as a CRNA?", + "A": "Increased Apneic threshold", + "B": "Tachypnea", + "C": "Increased respiratory rate", + "D": "Decreased tidal volume", + "E": "All of the above" + }, + "zh": { + "question": "作为麻醉护士，使用N2O时您会有哪些呼吸方面的顾虑？", + "A": "呼吸暂停阈值增加", + "B": "呼吸急促", + "C": "呼吸频率增加", + "D": "潮气量减少", + "E": "以上所有" + } + }, + { + "id": "ff486530-b895-5b7c-9c4d-56a2b2afed67", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "In which of the following surgeries will N2O be contraindicated?", + "A": "Craniotomy", + "B": "Eye globe", + "C": "Pneumothorax", + "D": "All of the above" + }, + "zh": { + "question": "在以下哪种手术中，N2O是禁忌的？", + "A": "开颅手术", + "B": "眼球手术", + "C": "气胸", + "D": "以上所有" + } + }, + { + "id": "5f8e0bce-df39-5905-b52b-4792315b4f46", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "What is the MAC of desflurane?", + "A": "1", + "B": "2", + "C": "4", + "D": "6", + "E": "7" + }, + "zh": { + "question": "地氟醚的最低肺泡浓度（MAC）是多少？", + "A": "1", + "B": "2", + "C": "4", + "D": "6", + "E": "7" + } + }, + { + "id": "748b7d13-d207-5816-bbca-f1f7db1e2793", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following vaporizers is heated?", + "A": "Isoflurane", + "B": "Halothane", + "C": "Sevoflurane", + "D": "Desflurane" + }, + "zh": { + "question": "以下哪种挥发器是加热的？", + "A": "异氟醚", + "B": "氟烷", + "C": "七氟醚", + "D": "地氟醚" + } + }, + { + "id": "8213067a-01f2-5d9d-b9d6-90ca169e6bfb", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "True or false minute volume is (RR*V)/minutes", + "A": "True", + "B": "False" + }, + "zh": { + "question": "分钟通气量是 (RR*V)/分钟 对吗？", + "A": "对", + "B": "错" + } + }, + { + "id": "b15e994c-fe6c-5970-a1c6-f501af900006", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which gas is the most irritating to the airway?", + "A": "Sevoflurane", + "B": "Isoflurane", + "C": "Desflurane", + "D": "Halothane" + }, + "zh": { + "question": "哪种气体对气道的刺激性最大？", + "A": "七氟醚", + "B": "异氟醚", + "C": "地氟醚", + "D": "氟烷" + } + }, + { + "id": "532d2b64-4836-53d3-a5be-73bdb8e9b8f7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which gas is the Least irritating to the airway", + "A": "Sevoflurane", + "B": "Desflurane", + "C": "Isoflurane", + "D": "Halothane" + }, + "zh": { + "question": "哪种气体对气道的刺激性最小", + "A": "七氟醚", + "B": "地氟醚", + "C": "异氟醚", + "D": "氟烷" + } + }, + { + "id": "839acc1f-2559-5feb-a2f2-3f9924fdb32a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What factors affect flow inspired", + "A": "FGF rate", + "B": "Absorption in circuit", + "C": "Volume in circuit", + "D": "All of the above" + }, + "zh": { + "question": "哪些因素影响吸入流量", + "A": "新鲜气流速率", + "B": "回路中的吸收", + "C": "回路中的体积", + "D": "以上所有因素" + } + }, + { + "id": "8716519e-749d-51fc-960a-995aec5d6411", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What factors affect flow alveolar", + "A": "Concentration", + "B": "Uptake", + "C": "Ventilation", + "D": "All of the above" + }, + "zh": { + "question": "哪些因素影响肺泡流量", + "A": "浓度", + "B": "摄取", + "C": "通气", + "D": "以上所有因素" + } + }, + { + "id": "0df8fb98-691d-59d3-a780-393afed2c90f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What factors affect uptake", + "A": "Solubility", + "B": "Partial pressure difference", + "C": "Flow", + "D": "All of the above" + }, + "zh": { + "question": "哪些因素影响吸收", + "A": "溶解度", + "B": "分压差", + "C": "流量", + "D": "以上所有因素" + } + }, + { + "id": "1a490eca-ba43-58b9-a459-b554fec1cd32", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the blood:gas coefficient of Isoflurane?", + "A": "0.47", + "B": "0.69", + "C": "0.42", + "D": "1.43" + }, + "zh": { + "question": "异氟醚的血气分配系数是多少？", + "A": "0.47", + "B": "0.69", + "C": "0.42", + "D": "1.43" + } + }, + { + "id": "69492f91-6d59-5c3b-91ff-5da9a6422970", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the blood:gas coefficient of sevoflurane?", + "A": "0.47", + "B": "0.69", + "C": "0.42", + "D": "1.43" + }, + "zh": { + "question": "七氟醚的血气分配系数是多少？", + "A": "0.47", + "B": "0.69", + "C": "0.42", + "D": "1.43" + } + }, + { + "id": "200a1948-3570-5cf0-984d-5db5797fe8fd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the gas coefficient of desflurane?", + "A": "1.43", + "B": "0.69", + "C": "0.47", + "D": "0.42" + }, + "zh": { + "question": "地氟醚的气体系数是多少？", + "A": "1.43", + "B": "0.69", + "C": "0.47", + "D": "0.42" + } + }, + { + "id": "ecd5df2b-b560-579a-a2bd-a2d62df47ff3", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the blood:gas coefficient of N2O", + "A": "0.42", + "B": "0.69", + "C": "0.47", + "D": "1.43" + }, + "zh": { + "question": "N2O的血气分配系数是多少", + "A": "0.42", + "B": "0.69", + "C": "0.47", + "D": "1.43" + } + }, + { + "id": "34d55533-b160-54e3-8ab5-c2cba4041ddb", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the MAC of N2O", + "A": "1.15", + "B": "2", + "C": "6", + "D": "104" + }, + "zh": { + "question": "N2O的MAC是多少", + "A": "1.15", + "B": "2", + "C": "6", + "D": "104" + } + }, + { + "id": "eb19c978-7404-53bd-9fac-416e89a1a289", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the MAC of Desflurane?", + "A": "1.15", + "B": "2", + "C": "6", + "D": "104" + }, + "zh": { + "question": "Desflurane的MAC是多少？", + "A": "1.15", + "B": "2", + "C": "6", + "D": "104" + } + }, + { + "id": "ee6dffaa-5007-5fde-b1cb-1f89f65b7afd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What factors increase the production of CO", + "A": "High temperatures", + "B": "Dryness", + "C": "Type of absorbent", + "D": "All of the above" + }, + "zh": { + "question": "哪些因素会增加一氧化碳的产生", + "A": "高温", + "B": "干燥", + "C": "吸收剂的类型", + "D": "以上所有因素" + } + }, + { + "id": "6f32034f-02d5-58d1-84c5-8cf0533fb412", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "OK I am very tired so that is it.  One last trivia question.  The ABA was actually the first professional basketball league to adopt the 3 point field goal (they also used a red, white, and blue ball like the Harlem globe trotters) who was the first player in NBA player in history to make a 3 point field goal in a regular season NBA game?", + "A": "Larry \"Joe\" Bird", + "B": "Chris Ford", + "C": "Pistol pete Maravich", + "D": "Michael Jordan", + "E": "Bob Cousy" + }, + "zh": { + "question": "好吧，我很累了，这就是最后一个小问题。ABA实际上是第一个采用三分球的职业篮球联赛（他们还使用了像哈林环球旅行者队那样的红、白、蓝三色球），谁是NBA历史上第一个在常规赛中投进三分球的球员？", + "A": "拉里 “乔” 伯德", + "B": "克里斯·福特", + "C": "“手枪” 皮特·马拉维奇", + "D": "迈克尔·乔丹", + "E": "鲍勃·库西" + } + }, + { + "id": "b79815ac-ea70-5e35-89c6-e01f4ffe5b5d", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "The minimum fasting period before anesthesia after consuming breast milk is 4 hours.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "在麻醉前，摄入母乳后的最短禁食时间是4小时。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "ad37aee6-465c-5efa-b556-11dbdc967b2b", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "The minimum time before anesthesia after a heavy meal is 6 hours.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "在一次丰盛的餐后，麻醉前的最短时间是6小时。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "bf97ba20-d802-5bfa-8ff6-478e8bf597e1", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Minimal sedation impeds a patient's ability to independently maintain an airway.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "轻度镇静会妨碍患者独立保持气道的能力。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "ec7068e5-4be5-50e5-8dec-5df4042ba62e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is an ASA level VI patient, according to American Society of Anesthesiologists patient physical status classification?", + "A": "Normal health patient", + "B": "Patient with severe systemic disease", + "C": "Moribund patient not expected to survive without operation", + "D": "Brain-dead patient who's organs are being removed for donor purposes" + }, + "zh": { + "question": "根据美国麻醉医师协会的患者身体状况分类，ASA VI 级患者是什么？", + "A": "健康正常的患者", + "B": "患有严重全身性疾病的患者", + "C": "濒死患者，若不手术预计无法存活", + "D": "脑死亡患者，其器官正在被移除用于捐赠目的" + } + }, + { + "id": "8d2931aa-90ba-5769-b32b-0f55fdd53e4e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Under which of these states is the patient least responsive?", + "A": "General anisthesia", + "B": "Minimal sedation", + "C": "Moderate sedation", + "D": "Deep sedation" + }, + "zh": { + "question": "在以下哪种状态下，患者的反应最不敏感？", + "A": "全身麻醉", + "B": "轻度镇静", + "C": "中度镇静", + "D": "深度镇静" + } + }, + { + "id": "98631d02-3b41-5591-aa18-183d536d4aa4", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Maximum recommended dose of a drug is printed on the FDA-approved label for unmonitored home use.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "药物的最大推荐剂量印在FDA批准的标签上用于无监测的家庭使用。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "c77e1d75-4a2d-5af7-a444-4211495150d3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "There have always been some legal/ethical issues with sedation. How many states do not have a sedation policy for non-anesthesia nurses?", + "A": "5", + "B": "8", + "C": "10", + "D": "14" + }, + "zh": { + "question": "关于镇静一直存在一些法律/伦理问题。有多少个州没有针对非麻醉护士的镇静政策？", + "A": "5", + "B": "8", + "C": "10", + "D": "14" + } + }, + { + "id": "6fd7dbfb-cc91-5369-976e-578c2b416c64", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 40 lb dog weighs how many kgs?", + "A": "18.18 kgs", + "B": "88 kgs", + "C": "44 kgs", + "D": "13.7 kgs" + }, + "zh": { + "question": "一只40磅的狗重多少千克？", + "A": "18.18千克", + "B": "88千克", + "C": "44千克", + "D": "13.7千克" + } + }, + { + "id": "9452f54a-b7cd-5b83-98ec-fcdb031e31da", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Anticholinergics reduce or eliminate some of the undesirable effects of anesthesia.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "抗胆碱药可以减少或消除一些麻醉的不良反应。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "422e81fc-a330-5cb0-81de-13a99fcbac23", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Compressed gas sources should be changed when they contain", + "A": "0-10 psi", + "B": "25-50 psi", + "C": "90 psi", + "D": "100-200 psi" + }, + "zh": { + "question": "压缩气体源应在其含有多少时更换", + "A": "0-10 psi", + "B": "25-50 psi", + "C": "90 psi", + "D": "100-200 psi" + } + }, + { + "id": "d2d68c71-0c87-55d1-ab9e-ec1eb57af9e9", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Glycopyrrolate decreases GI motility.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "格隆溴铵减少胃肠蠕动。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "981e7a9f-89a1-5a4a-b03c-39ba87168cfd", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Laryngoscopes are not used in what animals?", + "A": "Cattle and horses", + "B": "Sheep and goats", + "C": "Cats and dogs", + "D": "Pigs" + }, + "zh": { + "question": "喉镜不用于哪些动物？", + "A": "牛和马", + "B": "羊和山羊", + "C": "猫和狗", + "D": "猪" + } + }, + { + "id": "1a11c404-8d11-54cb-87a6-a6c7445763cb", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Long and intermediate acting barbituates are generally used for anticonvulsant therapy", + "A": "True", + "B": "False" + }, + "zh": { + "question": "长效和中效巴比妥类药物通常用于抗惊厥治疗", + "A": "正确", + "B": "错误" + } + }, + { + "id": "504d86d1-60a2-5130-8e11-66f75341a14e", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Neuroleptoanalgesia is a state of profound sedation and analgesia produced by giving simultaneous administration of an opioid and tranquilizer.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "神经安定镇痛是一种通过同时给予阿片类药物和镇静剂产生的深度镇静和镇痛状态。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "66a13213-20b4-5fb5-bfd5-7e4f9806028e", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Nitrous oxide tanks are blue.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "一氧化二氮气罐是蓝色的。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "63a9d124-88dc-57c9-869d-78b5f88899a9", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Valium lowers the seizure threshold.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "安定降低癫��发作阈值。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "cd2db8d0-e3c4-5cf9-a56b-5ddca53053f8", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What rebreathing bag would you select for a 57 lb dog?", + "A": ".5 liter bag", + "B": "1 liter bag", + "C": "1.5 liter bag", + "D": "2 liter bag" + }, + "zh": { + "question": "您会为一只57磅的狗选择哪种呼吸囊？", + "A": "0.5升呼吸囊", + "B": "1升呼吸囊", + "C": "1.5升呼吸囊", + "D": "2升呼吸囊" + } + }, + { + "id": "119aa208-dea6-5a9e-9232-de691f66a66a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What rebreathing bag would you select for an 8 kg cat?", + "A": ".5 liter bag", + "B": "1 liter bag", + "C": "1.5 liter bag", + "D": "2 liter bag" + }, + "zh": { + "question": "你会为一只8公斤的猫选择哪个呼吸囊？", + "A": "0.5升呼吸囊", + "B": "1升呼吸囊", + "C": "1.5升呼吸囊", + "D": "2升呼吸囊" + } + }, + { + "id": "533dd6be-6d79-5241-882d-a7e0a7ae0b76", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "___________ allow us to deliver oxygen and anesthetic gas to the patient which maintains them at a surgical plane of anesthesia", + "A": "Vaporizers", + "B": "Rebreathing bags", + "C": "Endotracheal tubes", + "D": "Scavenger units" + }, + "zh": { + "question": "___________ 允许我们向患者输送氧气和麻醉气体，从而使他们保持在手术麻醉平面上", + "A": "挥发器", + "B": "呼吸囊", + "C": "气管插管", + "D": "废气排放装置" + } + }, + { + "id": "55e92859-1b49-5fe5-b613-2c5c132cd307", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When do we give preanesthetic drugs to an animal?", + "A": "At least 5 minutes before the patient is induced", + "B": "At least 15 minutes before the patient is induced", + "C": "At least 30 minutes before the patient is induced", + "D": "At least 1 hour before the patient is induced" + }, + "zh": { + "question": "我们什么时候给动物使用术前药物？", + "A": "至少在诱导患者前5分钟", + "B": "至少在诱导患者前15分钟", + "C": "至少在诱导患者前30分钟", + "D": "至少在诱导患者前1小时" + } + }, + { + "id": "049d98aa-8282-51b1-b30e-bd38f5910904", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements regarding opioids is false?", + "A": "Analgesics often used in preanesthesia and post-op pain", + "B": "Examples include Morphine, Diazepam, Butorphanol, and Fentanyl", + "C": "Potent respiratory depressants", + "D": "Can have bradycardic effects", + "E": "All of the above are true" + }, + "zh": { + "question": "以下关于阿片类药物的说法哪一项是错误的？", + "A": "常用于术前和术后镇痛", + "B": "例子包括吗啡、地西泮、布托啡诺和芬太尼", + "C": "强效呼吸抑制剂", + "D": "可能有心动过缓的作用", + "E": "以上所有说法都正确" + } + }, + { + "id": "312555d6-0c8a-5bda-b508-34f572dccd6d", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following statements regarding tranquilizers and sedatives is true?", + "A": "Aid in restraint", + "B": "Decrease anxiety", + "C": "Decrease amount of anesthetic needed", + "D": "Aid in smoother recovery", + "E": "All of the above are true" + }, + "zh": { + "question": "以下关于镇静剂和安定剂的说法哪一项是正确的？", + "A": "有助于约束", + "B": "减少焦虑", + "C": "减少所需麻醉剂量", + "D": "有助于更平稳的恢复", + "E": "以上所有说法都正确" + } + }, + { + "id": "bd4af48d-e00b-5d56-8ce0-94f4ebe1974c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which preanesthetic drug is used more commonly in equine anesthesia?", + "A": "Atropine", + "B": "Glycopyrolate", + "C": "Acepromazine", + "D": "Butorphanol" + }, + "zh": { + "question": "哪种术前麻醉药在马科动物麻醉中更常用？", + "A": "阿托品", + "B": "格隆溴铵", + "C": "乙酰丙嗪", + "D": "布托啡诺" + } + }, + { + "id": "3572e183-9684-5fdf-878a-d122dc1b90ed", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Dr. Monday provided a comprehensive clinical pathology consultation at the request of Dr. Adams. This request was regarding a patient with various infections, drug allergies, skin rash, and Down's syndrome. This patient is in the hospital intensive care unit being treated with intravenous antibiotics. Dr. Monday did not see the patient but he reviewed the patient's history, complex medical records, and provided a written report back to Dr. Adams regarding his findings and recommendations for further treatment. How would Dr. Monday report his services?", + "A": "80502", + "B": "99244-25, 80502", + "C": "99244", + "D": "99255-25, 80500" + }, + "zh": { + "question": "周一医生应亚当斯医生的要求提供了一次全面的临床病理咨询。该请求涉及一名患有多种感染、药物过敏、皮疹和唐氏综合症的患者。该患者在医院的重症监护室接受静脉注射抗生素治疗。周一医生没有见到患者，但他审阅了患者的病史、复杂的医疗记录，并向亚当斯医生提供了一份书面报告，说明他的发现和进一步治疗的建议。周一医生将如何报告他的服务？", + "A": "80502", + "B": "99244-25, 80502", + "C": "99244", + "D": "99255-25, 80500" + } + }, + { + "id": "a62bfabd-62a0-5685-b5d8-1fde6c79404d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A patient had a semi-quantitative urinalysis for infectious agent detection. How should you report this test?", + "A": "81050", + "B": "81007", + "C": "81005", + "D": "81005, 83518" + }, + "zh": { + "question": "一名患者进行了半定量尿液分析以检测感染因子。你应该如何报告此测试？", + "A": "81050", + "B": "81007", + "C": "81005", + "D": "81005, 83518" + } + }, + { + "id": "51ce56aa-8841-5d6a-9004-527572d620d4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Code 3011F describes which diagnostic or screening process?", + "A": "Lipid panel results including total cholesterol", + "B": "Lipid panel results including cholesterol, triglycerides, lipoprotein", + "C": "Lipid panel results including total cholesterol, HDL-C, triglycerides, calculated LDL-C", + "D": "Lipid panel results including cholesterol, triglycerides, carbon dioxide, glucose, potassium" + }, + "zh": { + "question": "代码3011F描述了哪种诊断或筛查过程？", + "A": "脂质面板结果包括总胆固醇", + "B": "脂质面板结果包括胆固醇、甘油三酯、脂蛋白", + "C": "脂质面板结果包括总胆固醇、HDL-C、甘油三酯、计算的LDL-C", + "D": "脂质面板结果包括胆固醇、甘油三酯、二氧化碳、葡萄糖、钾" + } + }, + { + "id": "70f4f235-f2fa-53c4-b425-c4d4bb1d90cf", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 58-year-old male patient with abdominal pain and episodes of bright red blood in his stool reports to his physician's office for a check-up. His physician performs a digital rectal exam and tests for occult blood. Dr. Smith documents this blood occult test was done for purposes other than colorectal cancer screening. How would you report the occult blood test?", + "A": "82274", + "B": "82271", + "C": "82270", + "D": "82272" + }, + "zh": { + "question": "一名58岁的男性患者因腹痛和大便中出现鲜红色血液而到医生办公室进行检查。他的医生进行了直肠指检并测试隐血。史密斯医生记录此隐血测试是出于结直肠癌筛查以外的目的进行的。你会如何报告隐血测试？", + "A": "82274", + "B": "82271", + "C": "82270", + "D": "82272" + } + }, + { + "id": "dbb42872-67b4-5723-b439-d6fe6b730e06", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Kathy has had intermittent abdominal pain, occasional diarrhea, stool frequency, and bloating. Her symptoms have worsened over the past two months. Her physician orders a fecal Calprotectin test to check for Crohn's disease. How should you report the lab test ?", + "A": "82270", + "B": "83993", + "C": "82272, 83993", + "D": "82271, 82272" + }, + "zh": { + "question": "凯西有间歇性腹痛、偶尔腹泻、排便频率增加和腹胀。她的症状在过去两个月中有所加重。她的医生要求进行粪便钙卫蛋白测试以检查克罗恩病。你应该如何报告实验室测试？", + "A": "82270", + "B": "83993", + "C": "82272, 83993", + "D": "82271, 82272" + } + }, + { + "id": "e55ee67d-e515-5713-99e1-5abad82d7075", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Colin had a comprehensive audiometry threshold evaluation and speech recognition testing to the left ear. What code(s) capture this procedure?", + "A": "92700-59", + "B": "92553, 92556", + "C": "92557", + "D": "92557-52" + }, + "zh": { + "question": "科林进行了左耳的全面听力阈值评估和言语识别测试。哪个代码捕捉到此程序？", + "A": "92700-59", + "B": "92553, 92556", + "C": "92557", + "D": "92557-52" + } + }, + { + "id": "304f3ba2-2fe3-5d73-913b-5824429799da", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "An adult patient had the following immunizations with administration: yellow fever vaccine, subcutaneous injection, Hepatitis B vaccine, IM injection,Plague vaccine, intramuscular injection. How would you report these services?", + "A": "90460, 90461 X 2, 90717-51, 90746-51, 90727-51", + "B": "90471, 90472 X 2, 90717, 90746, 90727", + "C": "90471, 90472 X 2, 90727-51, 90746-51, 90717-51", + "D": "90473, 90474 X 2, 90746, 90727,90717" + }, + "zh": { + "question": "一名成年患者接受了以下疫苗接种：黄热病疫苗，皮下注射；乙型肝炎疫苗，肌肉注射；鼠疫疫苗，肌肉注射。你将如何报告这些服务？", + "A": "90460, 90461 X 2, 90717-51, 90746-51, 90727-51", + "B": "90471, 90472 X 2, 90717, 90746, 90727", + "C": "90471, 90472 X 2, 90727-51, 90746-51, 90717-51", + "D": "90473, 90474 X 2, 90746, 90727,90717" + } + }, + { + "id": "234b081c-0919-5b95-ace6-4e5145727d23", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Sally suffered from dehydration after running from a marathon. She was taken into her primary care doctor's office. Dr. Small checked sally and ordered hydration therapy with normal saline. The hydration lasted 45 minutes.  How would you report this service?", + "A": "96369, 96370", + "B": "96360, 96361", + "C": "96365", + "D": "96360" + }, + "zh": { + "question": "萨莉在跑完马拉松后因脱水而受苦。她被送到她的初级保健医生办公室。小医生检查了萨莉，并下令用生理盐水进行补液治疗。补液持续了45分钟。你将如何报告这项服务？", + "A": "96369, 96370", + "B": "96360, 96361", + "C": "96365", + "D": "96360" + } + }, + { + "id": "ed7006bf-664b-533d-b902-e28aa32b8af3", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient had a bronchoscopy with destruction for relief of stenosis by laser therapy. During this procedure photodynamic therapy by endoscopic application of light was used to ablate abnormal tissue via activation of photosensitive drugs. The photodynamic therapy lasted 60 minutes. How would you report this procedure?", + "A": "96567 X 2", + "B": "31641, 96570, 96571 X 2", + "C": "31645, 96567", + "D": "31643, 96570-51, 96571-51" + }, + "zh": { + "question": "一名患者接受了支气管镜检查，通过激光治疗消除狭窄。在此过程中，通过内镜应用光的光动力疗法用于通过激活光敏药物消融异常组织。光动力疗法持续了60分钟。你会如何报告这个程序？", + "A": "96567 X 2", + "B": "31641, 96570, 96571 X 2", + "C": "31645, 96567", + "D": "31643, 96570-51, 96571-51" + } + }, + { + "id": "5bddf3b4-808c-5806-b441-5d33aae76c3f", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Dr. George asked the local pharmacist to review Ann's new medications with her when she picked them up. Ann is a new patient who just moved into the area and required several new medications. Ann is hard of hearing and had a difficult time understanding Dr. George when he called her. The pharmacist spent 35 minutes with Ann and documented a review of her history, recommendations for improving health outcomes, and treatment compliance. The pharmacist faxed this note back to Dr. George's office.  How would the pharmacist report his services?", + "A": "99213", + "B": "99607 X 3", + "C": "This service has no codes to report", + "D": "99605, 99606" + }, + "zh": { + "question": "乔治医生要求当地药剂师在安取药时与她一起查看她的新药。安是刚搬到该地区的新患者，需要几种新药。安听力不好，乔治医生打电话给她时，她很难理解。药剂师花了35分钟与安交流，并记录了她的病史、改善健康结果的建议和治疗依从性。药剂师将这份记录传真回乔治医生的办公室。药剂师如何报告他的服务？", + "A": "99213", + "B": "99607 X 3", + "C": "此服务没有可报告的代码", + "D": "99605, 99606" + } + }, + { + "id": "bde229b4-02db-56db-97ab-ddc59b12399a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What code would report an internet assessment and management services provided by a qualified non-physician healthcare professional to an established patient not originating from a related assessment and management service provided within the previous seven days?", + "A": "99444", + "B": "96150", + "C": "98969", + "D": "96151" + }, + "zh": { + "question": "哪个代码用于报告由合格的非医生医疗专业人员向既往患者提供的互联网评估和管理服务，而该服务并非源自前七天内提供的相关评估和管理服务？", + "A": "99444", + "B": "96150", + "C": "98969", + "D": "96151" + } + }, + { + "id": "b07cc1a3-be7b-5abf-9996-db982ffa9cd3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Code 95907 could describe studies to which of the following nerves?", + "A": "Lateral antebrachial cutaneous sensory nerve and posterior femoral cutaneous sensory nerve", + "B": "Medial calcaneal sensory nerve and radial sensory nerve to digit one", + "C": "Both A and B", + "D": "None of the above" + }, + "zh": { + "question": "代码95907可以描述对以下哪些神经的研究？", + "A": "外侧前臂皮神经和股后皮神经", + "B": "内侧跟骨皮神经和第一指桡侧皮神经", + "C": "A和B都包括", + "D": "以上都不是" + } + }, + { + "id": "1e6679b3-075d-5eb0-a01a-0040bc6960bf", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Jane has a family history of skin melanoma. Her primary care doctor asked for a consult with Dr. John. During Jane's first visit with her new dermatologist, Dr. John, he documented a comprehensive history, comprehensive examination, and medical-decision making of moderate complexity. Dr. John also performed a whole body integumentary photography for monitoring of Jane's skin. Dr. John sent a report back to her PCP and told Jane sheshould return in one year or before then if anything should change on her skin.  What Code(s) would you use to report Dr. John's services?", + "A": "99213", + "B": "96904", + "C": "99244-25, 96904", + "D": "99204, 96904" + }, + "zh": { + "question": "简有家族皮肤黑色素瘤病史。她的初级保健医生要求与约翰医生会诊。在简第一次拜访她的新皮肤科医生约翰医生时，他记录了全面的病史、全面的检查以及中等复杂度的医疗决策。约翰医生还进行了全身皮肤摄影以监测简的皮肤。约翰医生将报告发送回她的初级保健医生，并告诉简如果她的皮肤有任何变化，应在一年内或之前回来复诊。你会用什么代码来报告约翰医生的服务？", + "A": "99213", + "B": "96904", + "C": "99244-25, 96904", + "D": "99204, 96904" + } + }, + { + "id": "6594a6b4-a813-5180-8a3a-e80fe8c6ff14", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What services can you report in addition to the general ophthalmological services or evaluation and management services?", + "A": "Only new patient general ophthalmological services", + "B": "Only established patient general ophthalmological services", + "C": "Special ophthalmological services", + "D": "Intermediate ophthalmological services" + }, + "zh": { + "question": "除了普通眼科服务或评估和管理服务之外，您还可以报告哪些服��？", + "A": "仅限新患者普通眼科服务", + "B": "仅限已建立患者普通眼科服务", + "C": "特殊眼科服务", + "D": "中级眼科服务" + } + }, + { + "id": "2ac5d82a-e0af-5754-af46-43534f575f26", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Jim underwent a Code for a percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery, intracoronary stent, single vessel. What code(s) should you use to report these services?", + "A": "92943", + "B": "92944", + "C": "92941", + "D": "92973" + }, + "zh": { + "question": "吉姆在急性心肌梗死期间接受了急性完全/亚完全闭塞的经皮腔内血管重建术，冠状动脉，冠状动脉内支架，单一血管。您应该使用哪个代码来报告这些服务？", + "A": "92943", + "B": "92944", + "C": "92941", + "D": "92973" + } + }, + { + "id": "49e26699-581c-510b-93ba-d0fcf2a02da4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "MEDICAL CONCEPTS :   MEDICAL TERMINOLOGYWhat part of the neuron receives signals?", + "A": "Dendrites", + "B": "Cell body", + "C": "Myelin sheath", + "D": "Axon" + }, + "zh": { + "question": "医学概念：医学术语 神经元的哪个部分接收信号？", + "A": "树突", + "B": "细胞体", + "C": "髓鞘", + "D": "轴突" + } + }, + { + "id": "979ed8b2-24bd-53c0-b4c3-89cfa517061c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which type of atelectasis is the most common?", + "A": "Compression", + "B": "Chronic", + "C": "Inflammation", + "D": "Absorption" + }, + "zh": { + "question": "哪种类型的肺不张最常见？", + "A": "压缩性", + "B": "慢性", + "C": "炎症性", + "D": "吸收性" + } + }, + { + "id": "23dee272-8ad4-5913-bf22-b09192894fe3", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What condition is symptomatic of an enlargement of the alveoli and loss of elasticity?", + "A": "Emphysema", + "B": "Chronic bronchitis", + "C": "Empyema", + "D": "Asthma" + }, + "zh": { + "question": "哪种疾病的症状是肺泡扩大和弹性丧失？", + "A": "肺气肿", + "B": "慢性支气管炎", + "C": "脓胸", + "D": "哮喘" + } + }, + { + "id": "e9965f27-f7ef-5177-bdf7-c9e5ea1b1728", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A malignant bone tumor :", + "A": "Chondrosarcoma", + "B": "Multiple myeloma", + "C": "Rhabdomyosarcoma", + "D": "Osteosarcoma" + }, + "zh": { + "question": "恶性骨肿瘤：", + "A": "软骨肉瘤", + "B": "多发性骨髓瘤", + "C": "横纹肌肉瘤", + "D": "骨肉瘤" + } + }, + { + "id": "9c9949ab-3151-5a8f-9d64-ab732404c3c5", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Name a malignant cartilage-based tumor found in middle-aged and older people.", + "A": "Chondrosarcoma", + "B": "Osteosarcoma", + "C": "Rhabdomyosarcoma", + "D": "Chondroblastoma" + }, + "zh": { + "question": "请列举一种在中年和老年人中发现的恶性软骨肿瘤。", + "A": "软骨肉瘤", + "B": "骨肉瘤", + "C": "横纹肌肉瘤", + "D": "软骨母细胞瘤" + } + }, + { + "id": "ed2c52b8-17bb-5b7a-a46d-24d58c870450", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the condition called when one accumulates dust particles in the lungs?", + "A": "Tuberculosis", + "B": "Pleurisy", + "C": "Pneumoconiosis", + "D": "Chronic obstructive pulmonary disease" + }, + "zh": { + "question": "当一个人在肺中积累灰尘颗粒时，这种情况被称为什么？", + "A": "结核病", + "B": "胸膜炎", + "C": "尘肺病", + "D": "慢性阻塞性肺病" + } + }, + { + "id": "b1bea13e-0db6-5b90-9766-cab30459912d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the condition called where pus is in the pleural space and is sometimes a complication of pneumonia?", + "A": "Pneumothorax", + "B": "Cor pullmonale", + "C": "Atelectasis", + "D": "Empyema" + }, + "zh": { + "question": "在胸膜腔内有脓液且有时是肺炎并发症的情况称为什么？", + "A": "气胸", + "B": "肺心病", + "C": "肺不张", + "D": "脓胸" + } + }, + { + "id": "9cae646f-3f78-5a3d-a25c-2bc885b47245", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is another name for a compound fracture?", + "A": "Open", + "B": "Incomplete", + "C": "Complete", + "D": "Closed" + }, + "zh": { + "question": "复合性骨折的另一种名称是什么？", + "A": "开放性", + "B": "不完全", + "C": "完全", + "D": "闭合性" + } + }, + { + "id": "bcce054d-4f0b-5261-a3db-5f5c285bcd9e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not an ear bone?", + "A": "Malleus", + "B": "Stapes", + "C": "Incus", + "D": "Styloid" + }, + "zh": { + "question": "下列哪一项不是耳骨？", + "A": "锤骨", + "B": "镫骨", + "C": "砧骨", + "D": "茎突" + } + }, + { + "id": "1b6b40c4-1fb1-506e-b2b7-6c7d4252a601", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The term for a growth plate is?", + "A": "Periosteum", + "B": "Endosteum", + "C": "Metaphysic", + "D": "Epiphyseal" + }, + "zh": { + "question": "生长板的术语是？", + "A": "骨膜", + "B": "骨内膜", + "C": "干骺端", + "D": "骺板" + } + }, + { + "id": "d1834db5-73ca-5fd0-b8eb-8146ce80d4af", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "ANATOMY:Which septum divides the upper two chambers of the heart?", + "A": "Myocardium", + "B": "Interatrial", + "C": "Intraventricular", + "D": "Tricuspid" + }, + "zh": { + "question": "解剖学：哪个隔膜将心脏的上两个腔室分开？", + "A": "心肌", + "B": "房间隔", + "C": "室间隔", + "D": "三尖瓣" + } + }, + { + "id": "3c1c2038-f85b-5b14-bca1-2a8692fa35af", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What condition has predominant symptoms of rapid, involuntary eye movement?", + "A": "Nystagmus", + "B": "Astigmatism", + "C": "Hyperopia", + "D": "Diplopia" + }, + "zh": { + "question": "哪种情况的主要症状是快速、不自主的眼球运动？", + "A": "眼球震颤", + "B": "散光", + "C": "远视", + "D": "复视" + } + }, + { + "id": "f4843f62-1bbe-5d9b-be5c-3e6dbf7e3a30", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Bacterial cystitis is usually caused by?", + "A": "E. Coli", + "B": "Proteus", + "C": "Staphylococci", + "D": "Pseudomonas" + }, + "zh": { + "question": "细菌性膀胱炎通常由什么引起？", + "A": "大肠杆菌", + "B": "变形杆菌", + "C": "葡萄球菌", + "D": "假单胞菌" + } + }, + { + "id": "ade5dcc8-c29d-56f7-a48b-ba5f7fcfdb05", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which below is located in a depression in the skull at the base of the brain :", + "A": "Adrenal", + "B": "Pituitary", + "C": "Thymus", + "D": "Pineal" + }, + "zh": { + "question": "以下哪个位于大脑底部的颅骨凹陷中：", + "A": "肾上腺", + "B": "垂体", + "C": "胸腺", + "D": "松果体" + } + }, + { + "id": "7b32fefa-6cf2-58b5-a430-e0db070fa682", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What term could describe an inflammation of the plantar, causing foot or heel pain when walking or running?", + "A": "Plantar fasciitis", + "B": "Tendon fasciitis", + "C": "Tenodesis", + "D": "Tenolysis" + }, + "zh": { + "question": "什么术语可以描述足底的炎症，导致行走或跑步时的足部或脚跟疼痛？", + "A": "足底筋膜炎", + "B": "肌腱筋膜炎", + "C": "肌腱固定术", + "D": "肌腱松解术" + } + }, + { + "id": "85b54c8a-6f96-5483-9488-ff877cffd447", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Blepharoplasty describes what type of procedure?", + "A": "Surgical reduction of the upper/lower eyelids to remove excess fat, skin, and muscle", + "B": "Treatment for spider veins with injections of sclerosing solution", + "C": "Replacement of damaged skin with healthy tissue taken from a donor", + "D": "Destruction of tissue by burning or freezing." + }, + "zh": { + "question": "眼睑成形术描述的是哪种类型的手术？", + "A": "通过手术减少上/下眼睑的脂肪、皮肤和肌肉", + "B": "通过注射硬化剂溶液治疗蜘蛛静脉", + "C": "用来自供体的健康组织替换受损皮肤", + "D": "通过烧灼或冷冻破坏组织。" + } + }, + { + "id": "bdb22c1c-d66c-5b42-b5e0-a52c4fe6edb1", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which autoimmune disorder will eventually destroy the thyroid gland?", + "A": "Hayem-Farber disease", + "B": "Lou Gehrig's disease", + "C": "Hashimoto's thyroiditis", + "D": "Alzheimer's thyroiditis" + }, + "zh": { + "question": "哪种自身免疫性疾病最终会破坏甲状腺？", + "A": "Hayem-Farber病", + "B": "Lou Gehrig病", + "C": "桥本氏甲状腺炎", + "D": "阿尔茨海默氏甲状腺炎" + } + }, + { + "id": "f2ce739a-ec90-5bda-8a71-5365a31ad1ba", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements best describes a rheumatologist?", + "A": "A specialist who provides medical care and drug treatments focused on mental and cognitive disorders.", + "B": "A specialist who provides treatment to women during pregnancy, childbirth, and their aftercare.", + "C": "A specialist who provides the diagnosis and surgical treatment of bone disorders", + "D": "A specialist who provides the diagnosis and treatment of disease characterized by inflammation of the connective tissues." + }, + "zh": { + "question": "以下哪项陈述最能描述风湿病学家？", + "A": "专门提供针对精神和认知障碍的医疗护理和药物治疗的专家。", + "B": "专门为女性在怀孕、分娩及产后提供治疗的专家。", + "C": "专门提供骨骼疾病的诊断和外科治疗的专家。", + "D": "专门提供以结缔组织炎症为特征的疾病的诊断和治疗的专家。" + } + }, + { + "id": "677f0281-6204-5faa-a5e1-1bcb069531f9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A patient suffered a burn that involved the epidermis, dermis, and subcutaneous layers with some muscle involvement. What degree of burn would describe this injury?", + "A": "First-degree, superficial with blisters", + "B": "Second-degree, partial thickness with muscle", + "C": "Third-degree, full thickness", + "D": "None of the above" + }, + "zh": { + "question": "一名患者遭受了涉及表皮、真皮和皮下层以及部分肌肉的烧伤。该损伤属于哪种程度的烧伤？", + "A": "一度烧伤，表浅伴有水疱", + "B": "二度烧伤，部分厚度伴有肌肉", + "C": "三度烧伤，全层", + "D": "以上都不是" + } + }, + { + "id": "0fb213ec-d62c-55d4-ade5-990ed3707a34", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which combining form refers to the small intestine?", + "A": "Enter/o", + "B": "Celi/o", + "C": "Col/o", + "D": "Gastr/o" + }, + "zh": { + "question": "哪个词根指的是小肠？", + "A": "Enter/o", + "B": "Celi/o", + "C": "Col/o", + "D": "Gastr/o" + } + }, + { + "id": "bd363ef5-8853-5b74-956e-c3f86b2b5d55", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "In which part of the body would you find the choroid?", + "A": "Muscles of the hand", + "B": "Brain", + "C": "Eyeball", + "D": "Spinal column" + }, + "zh": { + "question": "脉络膜位于身体的哪个部位？", + "A": "手部肌肉", + "B": "大脑", + "C": "眼球", + "D": "脊柱" + } + }, + { + "id": "5445b591-f1a6-56d5-ad96-1cf2837c2229", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "An ERG is what type of a procedure?", + "A": "Electrorhidogram", + "B": "Electroretinograph", + "C": "Electroretinography", + "D": "Electrorenalography" + }, + "zh": { + "question": "ERG 是哪种类型的程序？", + "A": "电眼球图", + "B": "电视网膜图", + "C": "视网膜电图", + "D": "电肾图" + } + }, + { + "id": "76cd2446-eb17-558b-a8ce-1fc30d83d40a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which term refers to the anus, rectum, and the cecum?", + "A": "Anorectal", + "B": "Rectal", + "C": "Ilium", + "D": "Esophageal" + }, + "zh": { + "question": "哪个术语指的是肛门、直肠和盲肠？", + "A": "肛直肠的", + "B": "直肠的", + "C": "髂骨", + "D": "食管的" + } + }, + { + "id": "fc3ad174-f34b-5159-a3ea-44418942fe74", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which term does not refer to a level of consciousness?", + "A": "Syncope", + "B": "Sciatica", + "C": "Coma", + "D": "Stupor" + }, + "zh": { + "question": "哪个术语不指意识水平？", + "A": "晕厥", + "B": "坐骨神经痛", + "C": "昏迷", + "D": "昏睡" + } + }, + { + "id": "87bbfd9f-445b-5a46-b288-2dc93aae734b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What type of condition describes a patient diagnosed with oligospermia?", + "A": "An abnormally low number of sperm in the semen.", + "B": "Knots is the varicose veins", + "C": "An inflammation of the prostate gland", + "D": "Failure to ovulate" + }, + "zh": { + "question": "诊断为少精症的患者属于哪种情况？", + "A": "精液中精子数量异常低。", + "B": "静脉曲张中的结节", + "C": "前列腺炎症", + "D": "排卵失败" + } + }, + { + "id": "43888bf8-c1c6-5248-8444-78a78d75cc78", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What does the term cystopexy mean?", + "A": "Surgical suture of the knee joints", + "B": "Crushing procedure to remove cysts", + "C": "Surgical fixation of the urinary bladder", + "D": "Inflammation of the spinal cord and brain" + }, + "zh": { + "question": "术语膀胱固定术是什么意思？", + "A": "膝关节的外科缝合", + "B": "粉碎手术以去除囊肿", + "C": "膀胱的外科固定", + "D": "脊髓和大脑的炎症" + } + }, + { + "id": "e458b22c-4f02-5eb9-b1af-c6e9275a7d9c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is an episiotomy and why would a patient need to have this procedure?", + "A": "Surgical puncture of the cervix to remove fluid", + "B": "Surgical incision of the vulva to facilitate delivery of a baby", + "C": "Surgical suturing of the rectum caused by extensive tissue damage following a bowel repair", + "D": "Surgical creation of an opening into the small intestine to provide relief of excessive gastritis." + }, + "zh": { + "question": "什么是会阴切开术，为什么患者需要进行这种手术？", + "A": "子宫颈的外科穿刺以去除液体", + "B": "外阴的外科切开以促进婴儿的分娩", + "C": "由于肠道修复后广泛的组织损伤而进行的直肠外科缝合", + "D": "外科创建一个进入小肠的开口以缓解过度的胃炎。" + } + }, + { + "id": "0225964c-eda5-570f-98e5-8f20e9bc6a7f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What direction describes raising the foot, pulling the toes toward the shin?", + "A": "Pronation", + "B": "Plantar flexion", + "C": "Protraction", + "D": "Dorsiflexion" + }, + "zh": { + "question": "哪种方向��述了抬起脚，将脚趾拉向小腿？", + "A": "旋前", + "B": "跖屈", + "C": "前伸", + "D": "背屈" + } + }, + { + "id": "ad45bcdb-ecf6-51e0-a102-8a3bdc37b99e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which artery opens to allow oxygen-rich blood to pass from the left ventricle into the aorta where the blood is delivered to the rest of the body?", + "A": "Renal", + "B": "Aortic", + "C": "Superior vena cava", + "D": "Inferior vena cava" + }, + "zh": { + "question": "哪条动脉开放以允许富含氧气的血液从左心室流入主动脉，从而将血液输送到身体的其他部分？", + "A": "肾动脉", + "B": "主动脉", + "C": "上腔静脉", + "D": "下腔静脉" + } + }, + { + "id": "91cbd707-3e07-5cc8-8047-f40bf5ea782b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What syndrome is a condition caused by abnormal production of the hormone gastrin?", + "A": "Vogt-Koyanagi", + "B": "Silverstroni-Bianco", + "C": "Sudeck-Leriche", + "D": "Zollinger-Ellison" + }, + "zh": { + "question": "哪种综合征是由胃泌素激素异常产生引起的？", + "A": "Vogt-Koyanagi", + "B": "Silverstroni-Bianco", + "C": "Sudeck-Leriche", + "D": "Zollinger-Ellison" + } + }, + { + "id": "d609d71f-314e-5c77-92ba-f9c3747775eb", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How can air pass through the upper respiratory tract?", + "A": "Via nose, larynx, bronchus, and trachea", + "B": "Via the nose, larynx, and bronchus", + "C": "Via nose, larynx, bronchus, trachea, and pleura", + "D": "Via the nose, nasal cavity, nasopharynx, oropharynx, laryngopharynx, and larynx into the lower respiratory system" + }, + "zh": { + "question": "空气如何通过上呼吸道？", + "A": "通过鼻子、喉、支气管和气管", + "B": "通过鼻子、喉和支气管", + "C": "通过鼻子、喉、支气管、气管和胸膜", + "D": "通过鼻子、鼻腔、鼻咽、口咽、喉咽和喉进入下呼吸系统" + } + }, + { + "id": "0340387a-9826-5d03-96f3-b3caabd0d4ed", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the uvula?", + "A": "A female organ used to contain and nourish the embryo and fetus from the time the fertilized egg is implanted to the time of birth of the fetus.", + "B": "A small soft structure hanging from the free edge of the soft palate in midline above the root of the tongue. It is composed of muscle, connective tissue, and mucous membrane.", + "C": "A canal, used for the discharge of urine that extends from the bladder to the outside of the body.", + "D": "A receptacle for urine before it is voided." + }, + "zh": { + "question": "什么是悬雍垂？", + "A": "一种女性器官，用于容纳和滋养从受精卵植入到胎儿出生期间的胚胎和胎儿。", + "B": "一个小而柔软的结构，悬挂在软腭的自由边缘中线，位于舌根上方。它由肌肉、结缔组织和粘膜组成。", + "C": "一个用于排尿的管道，从膀胱延伸到身体外部。", + "D": "尿液在排出前的储存器。" + } + }, + { + "id": "f047a225-80a7-5380-8795-a9b72b3bb4c7", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What term refers to white blood cells?", + "A": "Monocytes", + "B": "Lymphocytes", + "C": "Erythrocytes", + "D": "Leukocytes" + }, + "zh": { + "question": "哪个术语指的是白细胞？", + "A": "单核细胞", + "B": "淋巴细胞", + "C": "红细胞", + "D": "白细胞" + } + }, + { + "id": "0c5d1ed0-37c1-5032-a828-af1d435bdd82", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which statement(s) describe a passive natural acquired immunity process?", + "A": "Both A and C", + "B": "The passage of antibodies through the placenta or breast milk.", + "C": "Immunization that uses a greatly weakened form of the antigen, thus enabling the body to develop antibodies in response to this intentional exposure.", + "D": "Use of immunoglobulin harvested from a donor who developed resistance against specific antigens." + }, + "zh": { + "question": "哪种陈述描述了被动自然获得免疫过程？", + "A": "A和C都对", + "B": "通过胎盘或母乳传递抗体。", + "C": "使用极大减弱形式的抗原进行免疫接种，从而使身体能够对这种有意暴露产生抗体。", + "D": "使用从对特定抗原产生抵抗力的供体中提取的免疫球蛋白。" + } + }, + { + "id": "3d924d94-86d1-5d02-8de0-cf179b27372b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What does the olecranon process refer to?", + "A": "Plasma membranes", + "B": "Excision of a tumor in the large intestine", + "C": "The elbow", + "D": "Use of a surgical endoscope in the knee" + }, + "zh": { + "question": "鹰嘴突指的是哪个部位？", + "A": "质膜", + "B": "大肠肿瘤切除术", + "C": "肘部", + "D": "膝关节镜手术" + } + }, + { + "id": "62f9f401-7912-5ba3-884e-113fc04d93fb", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "ICD-9-CM CODING :The patient, a four-year old child, complained of pain from inside her ear. The doctor found a retained glass fragment in the child's ear.", + "A": "388.70; 385.83; V90.80", + "B": "388.71; 385.83; V90.81", + "C": "388.71; 381.82; V90.81", + "D": "388.70; 385.82; V90.81" + }, + "zh": { + "question": "ICD-9-CM 编码：患者是一名四岁的儿童，抱怨耳朵内部疼痛。医生发现孩子耳朵里有一块残留的玻璃碎片。", + "A": "388.70; 385.83; V90.80", + "B": "388.71; 385.83; V90.81", + "C": "388.71; 381.82; V90.81", + "D": "388.70; 385.82; V90.81" + } + }, + { + "id": "b1d67e9d-aab6-52ba-a394-f89973d59315", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Acute bacterial endocarditis due to AIDS.", + "A": "421.1, 042", + "B": "421.0, 042", + "C": "042, 421.0", + "D": "042, 421.1" + }, + "zh": { + "question": "由艾滋病引起的急性细菌性心内膜炎。", + "A": "421.1, 042", + "B": "421.0, 042", + "C": "042, 421.0", + "D": "042, 421.1" + } + }, + { + "id": "148ef8e8-fc4f-5968-8a27-db6d9a830fd3", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Asymptomatic, non-sustained, ventricular tachycardia, there are no prolonged pauses; predominant rhythm is atrial fibrillation with well-controlled ventricular rate.", + "A": "427.31, 425.4", + "B": "427.32, 425.4", + "C": "427.41, 425.4", + "D": "425.4, 427.31" + }, + "zh": { + "question": "无症状的、非持续性的室性心动过速，没有长时间的停顿；主要节律是房颤，心室率控制良好。", + "A": "427.31, 425.4", + "B": "427.32, 425.4", + "C": "427.41, 425.4", + "D": "425.4, 427.31" + } + }, + { + "id": "81435694-a27c-5076-9638-bc8a33a67ef8", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 50-year-old female patient had two separate carbuncles removed from the left axilla. Pathology report indicated staphylococcal infection.", + "A": "680.3, 041.10", + "B": "680.9, 041.0", + "C": "680.9,041.09", + "D": "680.3, 041.19" + }, + "zh": { + "question": "一名50岁的女性患者在左腋窝处切除了两个不同的痈。病理报告显示葡萄球菌感染。", + "A": "680.3, 041.10", + "B": "680.9, 041.0", + "C": "680.9,041.09", + "D": "680.3, 041.19" + } + }, + { + "id": "b75d3081-2894-53a4-89f1-d38c71e6cd7a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 55-year-old female with spinal stenosis of the cervical disk C4-5 and C5-6 with inter-vertebral disk displacement had a cervical discectomy, corpectomy, allograft from C4 to C6 and placement of arthrodesis( a 34 mm plate from C4 to C6)", + "A": "723.0, 722.10", + "B": "723.01, 722.51", + "C": "723.0, 722.0", + "D": "722.91" + }, + "zh": { + "question": "一名55岁的女性患有颈椎间盘C4-5和C5-6的椎管狭窄，并伴有椎间盘移位，进行了颈椎间盘切除术、椎体切除术、C4到C6的同种异体移植和关节融合术（从C4到C6的34毫米板）", + "A": "723.0, 722.10", + "B": "723.01, 722.51", + "C": "723.0, 722.0", + "D": "722.91" + } + }, + { + "id": "c65856a2-e9e1-5f45-84f3-334a8e16fcb7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 50-year-old male has staphylococcal septicemia with systemic inflammatory response syndrome and respiratory and hepatic failure.", + "A": "038.10, 995.92, 518.81, 570", + "B": "518.81, 570, 038, 995.92", + "C": "038.10, 518.81, 995.92", + "D": "995.92, 038.10, 518.81, 570" + }, + "zh": { + "question": "一名50岁的男性患有葡萄球菌败血症，伴有全身炎症反应综合征以及呼吸和肝功能衰竭。", + "A": "038.10, 995.92, 518.81, 570", + "B": "518.81, 570, 038, 995.92", + "C": "038.10, 518.81, 995.92", + "D": "995.92, 038.10, 518.81, 570" + } + }, + { + "id": "ed7380af-834a-59ef-beda-2f2deac345a4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The patient, a 21-year-old female, has acute laryngitis, chronic fatigue syndrome and presents for both the FLU and pneumococcal vaccine.", + "A": "V04.2, V03.89; 464.0; 780.71", + "B": "V04.81, V03.82; 464.0; 780.71", + "C": "V04.7, V03.82; 476.0; 780.79", + "D": "V04.81, V03.89; 476.0; 780.79" + }, + "zh": { + "question": "患者是一名21岁的女性，患有急性喉炎、慢性疲劳综合症，并前来接种流感和肺炎球菌疫苗。", + "A": "V04.2, V03.89; 464.0; 780.71", + "B": "V04.81, V03.82; 464.0; 780.71", + "C": "V04.7, V03.82; 476.0; 780.79", + "D": "V04.81, V03.89; 476.0; 780.79" + } + }, + { + "id": "6c792dcf-735d-5f0c-a27e-4fab23f2e07a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 5-year-old patient is seen by a physician in an outpatient clinic for chronic lymphoid leukemia in remission and Shiga toxin-producing Escherichia coli.", + "A": "203.21, 038.42", + "B": "204.11, 041.41", + "C": "204.81, 041.49", + "D": "204.21, 008.00" + }, + "zh": { + "question": "一名5岁患者在门诊被医生诊断为缓解期慢性淋巴性白血病和产生志贺毒素的大肠杆菌。", + "A": "203.21, 038.42", + "B": "204.11, 041.41", + "C": "204.81, 041.49", + "D": "204.21, 008.00" + } + }, + { + "id": "69c04eb1-aed1-528e-b422-efa24931ffae", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Discharged with Pneumonia, Klebsiella pneumoniae, COPD with emphysema, multifocal atrial tachycardia, middle dementia", + "A": "486, 492.8, 427.89, 294.8", + "B": "482; 492.8, 427.89, 294.8", + "C": "486, 492.0, 427.89, 294.11", + "D": "482.0, 492.8, 427.89, 294.8" + }, + "zh": { + "question": "出院诊断：肺炎，克雷伯氏肺炎杆菌，慢性阻塞性肺病伴肺气肿，多灶性房性心动过速，中度痴呆", + "A": "486, 492.8, 427.89, 294.8", + "B": "482; 492.8, 427.89, 294.8", + "C": "486, 492.0, 427.89, 294.11", + "D": "482.0, 492.8, 427.89, 294.8" + } + }, + { + "id": "8d1e1e6d-f77a-51e4-b4a5-b2d0efa5bb7b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A patient with a history of myocardial infarction is admitted for cardiac catheterization. It is also noted the patient has unstable angina, hypertension, and diabetes with hypoglycemia.", + "A": "411.1, 410.90, 250.80, 412", + "B": "411.1, 401.00, 250.80, 412", + "C": "411.1, 401.90, 250.00, 210.9", + "D": "413.9, 401.90, 250.80, 412" + }, + "zh": { + "question": "一名有心肌梗死病史的患者因心脏导管插入术入院。还注意到患者有不稳定型心绞痛、高血压和伴有低血糖的糖尿病。", + "A": "411.1, 410.90, 250.80, 412", + "B": "411.1, 401.00, 250.80, 412", + "C": "411.1, 401.90, 250.00, 210.9", + "D": "413.9, 401.90, 250.80, 412" + } + }, + { + "id": "6e4ba9f3-76b5-5c71-bd3b-457ba42ad956", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Lucy, a 69-year-old patient, was admitted to a nursing home with cellulitis of the right foot, excluding the toes. She was placed on IV therapy for the cellulitis and is now recovering nicely. She plans to return to her home upon discharge. She has a history of Type I diabetes with no complications. She is being treated for both the cellulitis and the diabetic condition. How would you report these diagnoses?", + "A": "682.7, 250.71", + "B": "250.03, 682.7", + "C": "682.7, 250.01", + "D": "681.9, 250.00" + }, + "zh": { + "question": "69岁的患者露西因右脚蜂窝织炎（不包括脚趾）被送入疗养院。她接受了静脉治疗，目前恢复良好，计划出院后回家。她有1型糖尿病病史，但无并发症。她正在接受蜂窝织炎和糖尿病的治疗。你会如何报告这些诊断？", + "A": "682.7, 250.71", + "B": "250.03, 682.7", + "C": "682.7, 250.01", + "D": "681.9, 250.00" + } + }, + { + "id": "c56f23e4-6fab-5916-8210-d9a226bfcf75", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "If the type of diabetes mellitus is not documented in the medical record what is the default type you should assign?", + "A": "Type I and Type II", + "B": "Type II", + "C": "Type I", + "D": "There are no guidelines to determine the type assignment" + }, + "zh": { + "question": "如果病历中没有记录糖尿病的类型，您应该分配的默认类型是什么？", + "A": "I型和II型", + "B": "II型", + "C": "I型", + "D": "没有指导方针来确定类型分配" + } + }, + { + "id": "1bf8a598-6105-5366-8c5f-353992529254", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A patient is suffering with acute respiratory failure, viral pneumonia, atrial fibrillation, and alcoholic liver cirrhosis. What codes describe these conditions?", + "A": "518.81, 480.9, 427.31, 571.2", + "B": "571.3, 491.0, 571.2, 480.1", + "C": "414.0, 518.81, 572.2, 427.32, 571.8", + "D": "518.83, 482.40, 491.0, 571.2" + }, + "zh": { + "question": "一名患者患有急性呼吸衰竭、病毒性肺炎、心房颤动和酒精性肝硬化。哪些代码描述了这些情况？", + "A": "518.81, 480.9, 427.31, 571.2", + "B": "571.3, 491.0, 571.2, 480.1", + "C": "414.0, 518.81, 572.2, 427.32, 571.8", + "D": "518.83, 482.40, 491.0, 571.2" + } + }, + { + "id": "20b558eb-14b5-5a41-95ed-ced7d7476d59", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 44-year-old male was spraying weeds in his backyard.  He accidentally got some of the weed killer in his ice tea. After drinking the ice tea and working for several hours, he told his wife he felt \"funny\" and started to vomit. She drove him to the emergency room for treatment. How would you report this scenario?", + "A": "787.03, 989.4, E863.5", + "B": "989.4, 787.03, E863.5", + "C": "989.4, 787.03", + "D": "787.01, E950.6, E980.7" + }, + "zh": { + "question": "一名44岁的男性在自家后院喷洒除草剂。他不小心将一些除草剂弄进了他的冰茶中。喝了冰茶并工作了几个小时后，他告诉妻子他感觉“奇怪”，然后开始呕吐。她开车送他去急诊室接受治疗。你会如何报告这种情况？", + "A": "787.03, 989.4, E863.5", + "B": "989.4, 787.03, E863.5", + "C": "989.4, 787.03", + "D": "787.01, E950.6, E980.7" + } + }, + { + "id": "baea3529-9ede-5fb4-a683-01008935b031", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The patient has dementia with a behavior disturbance, unspecified depression, NOS and insomnia with sleep apnea.", + "A": "294.21; 311; 780.51", + "B": "294.21; 311; 780.51; 780.57", + "C": "294.21; 311; 780.52", + "D": "294.21; 311.0; 780.51" + }, + "zh": { + "question": "患者患有伴有行为障碍的痴呆、未特指的抑郁症、NOS和伴有睡眠呼吸暂停的失眠。", + "A": "294.21; 311; 780.51", + "B": "294.21; 311; 780.51; 780.57", + "C": "294.21; 311; 780.52", + "D": "294.21; 311.0; 780.51" + } + }, + { + "id": "bacd2256-01d7-5d3e-bf21-b7c0f5244042", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Jim lost control of his car while driving on an icy highway and hit a parked car. He was transported to a local emergency room for treatment. He suffered a greenstick fracture of six ribs and atelectasis. How would you report this?", + "A": "E849.5, 807.05, 518.0, E812.0", + "B": "807.06, 418.0, E812.0, E849.5", + "C": "E812.0, E849.5, 807.00, 518.0", + "D": "E812.0, 518.2, 624.01, 807.03, 518.0" + }, + "zh": { + "question": "吉姆在冰雪覆盖的高速公路上驾驶时失去控制，撞上了一辆停着的车。他被送往当地急诊室接受治疗。他遭受了六根肋骨的青枝骨折和肺不张。你会如何报告这一情况？", + "A": "E849.5, 807.05, 518.0, E812.0", + "B": "807.06, 418.0, E812.0, E849.5", + "C": "E812.0, E849.5, 807.00, 518.0", + "D": "E812.0, 518.2, 624.01, 807.03, 518.0" + } + }, + { + "id": "1a390b27-c864-56a9-8dc0-0e6ea13261dc", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Laurie has a malignant secondary tumor of the Bartholin's gland.Her doctors do not know where this cancer started in Laurie's system. She is coming in today for radiation of the secondary site. How would you report her diagnoses for today's treatment?", + "A": "198.82, V58.0", + "B": "V58.0, 198.82, 199.1", + "C": "239.5, 198.82, V58.0, 199.1", + "D": "184.1, 198.82" + }, + "zh": { + "question": "Laurie有巴氏腺的恶性继发性肿瘤。她的医生不知道这种癌症在Laurie的系统中是从哪里开始的。她今天要来进行继发部位的放射治疗。你会如何报告她今天治疗的诊断？", + "A": "198.82, V58.0", + "B": "V58.0, 198.82, 199.1", + "C": "239.5, 198.82, V58.0, 199.1", + "D": "184.1, 198.82" + } + }, + { + "id": "e7a9b4a5-3f3b-5b1f-a689-24da302a5001", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the correct external cause code for the therapeutic use of wintergreen oil?", + "A": "E946.3", + "B": "E980.4, 976.3", + "C": "E858.7, E962.0", + "D": "976.3" + }, + "zh": { + "question": "冬青油治疗用途的正确外因代码是什么？", + "A": "E946.3", + "B": "E980.4, 976.3", + "C": "E858.7, E962.0", + "D": "976.3" + } + }, + { + "id": "31db31a3-26f2-5e3a-bb71-e8e8d67c490e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Nancy has been suffering with abdominal cramping pain in the belly area, persistent watery diarrhea, fever, and fatigue. She underwent a colonoscopy and was diagnosed with Crohn's disease of the large bowel and colon. How would you report the diagnosis from the colonoscopy?", + "A": "789.00,787.91, 780.79, 780.6", + "B": "789.00, 555.9", + "C": "555.1", + "D": "556.9, 787.91, 780.79, 780.6, 789.00" + }, + "zh": { + "question": "南希一直遭受腹部绞痛、持续性水样腹泻、发烧和疲劳的困扰。她接受了结肠镜检查，并被诊断为大肠和结肠的克罗恩病。你会如何报告结肠镜检查的诊断？", + "A": "789.00,787.91, 780.79, 780.6", + "B": "789.00, 555.9", + "C": "555.1", + "D": "556.9, 787.91, 780.79, 780.6, 789.00" + } + }, + { + "id": "fea9b053-7e0a-593e-a06f-39c357fa6be6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What bones make up the axial skeleton?", + "A": "Coccyx, ulna, femur, and tibia.", + "B": "Spine, collar bones, and arms", + "C": "Shoulder bones, pelvic bones, arms, and legs", + "D": "Skull, rib cage, and spine" + }, + "zh": { + "question": "哪些骨骼构成了中轴骨骼？", + "A": "尾骨、尺骨、股骨和胫骨。", + "B": "脊柱、锁骨和手臂", + "C": "肩骨、骨盆骨、手臂和腿", + "D": "头骨、肋骨和脊柱" + } + }, + { + "id": "fcefcce5-80d0-50b9-8bc3-68e9d64bdee3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "HCPCS CODING:Level II HCPCS codes for drugs are administered :", + "A": "Intravenously", + "B": "Intramuscularly", + "C": "Subcutaneously", + "D": "All of the above" + }, + "zh": { + "question": "HCPCS 编码：II 级 HCPCS 药物代码的给药方式是：", + "A": "静脉注射", + "B": "肌肉注射", + "C": "皮下注射", + "D": "以上所有方式" + } + }, + { + "id": "7be97777-260b-513a-814c-740d93097b77", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A male 62-year-old presents for a digital rectal exam and total prostate-specific antigen test  (PSA), which code would be used?", + "A": "G0102, G0107", + "B": "G0102, G0103", + "C": "G0103", + "D": "G0102" + }, + "zh": { + "question": "一名62岁的男性前来进行直肠指检和总前列腺特异性抗原测试（PSA），应使用哪个代码？", + "A": "G0102, G0107", + "B": "G0102, G0103", + "C": "G0103", + "D": "G0102" + } + }, + { + "id": "1f1443a1-10c1-5458-bf75-4a5c44e39a4c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A Medicare patient, 82-year-old female has an energy x-ray absorptiometry (SEXA) bone density study of two sites of the wrists.", + "A": "76071", + "B": "76070", + "C": "G0130", + "D": "76075" + }, + "zh": { + "question": "一位82岁的女性Medicare患者进行了两个手腕部位的能量X射线吸收测定（SEXA）骨密度检查。", + "A": "76071", + "B": "76070", + "C": "G0130", + "D": "76075" + } + }, + { + "id": "2c525e6f-de88-582d-b20a-549821fe34d3", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A 63-year-old male, Medicare recipient receives 30 minutes of individual diabetes outpatiself-management training :", + "A": "G0108", + "B": "99213", + "C": "G0176", + "D": "G0109" + }, + "zh": { + "question": "一名63岁的男性，Medicare受益人，接受30分钟的个人糖尿病自我管理培训：", + "A": "G0108", + "B": "99213", + "C": "G0176", + "D": "G0109" + } + }, + { + "id": "5aaf2061-caaa-593e-80d1-e85786da9a25", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A Medicare recipient presents for an influenza and pneumococcal vaccination.", + "A": "G0008", + "B": "G0010, G0008", + "C": "G0009", + "D": "G0008, G0009" + }, + "zh": { + "question": "一位 Medicare 受益人前来接种流感和肺炎球菌疫苗。", + "A": "G0008", + "B": "G0010, G0008", + "C": "G0009", + "D": "G0008, G0009" + } + }, + { + "id": "3d21f24c-5bdb-50b4-89a9-5a0a6f16cc91", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "General guidelines for HCPCS Level II Coding includes :", + "A": "Code directly from the index", + "B": "Note the reference codes as given in the index", + "C": "Search for main terms and any applicable sub-terms", + "D": "All of the above" + }, + "zh": { + "question": "HCPCS 二级编码的一般指南包括：", + "A": "直接从索引中编码", + "B": "注意索引中给出的参考代码", + "C": "搜索主要术语和任何适用的子术语", + "D": "以上所有" + } + }, + { + "id": "0fbcccd0-acb6-519d-814a-526b049e0bee", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A patient received a 12 sq. cm. dermal tissue substitute of human origin, without other bioengineered elements, without metabolically active elements. This treatment was completed due to a burn on the abdomen. How would you report the supply?", + "A": "J7342", + "B": "C1762", + "C": "C1763", + "D": "J7344" + }, + "zh": { + "question": "一名患者接受了12平方厘米的人源性皮肤组织替代物治疗，该替代物不含其他生物工程元素，也不含代谢活性元素。此治疗是由于腹部烧伤完成的。你会如何报告供应？", + "A": "J7342", + "B": "C1762", + "C": "C1763", + "D": "J7344" + } + }, + { + "id": "e0ccc1cc-7b78-5e00-9212-6398b3a19fa4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "During an emergency room visit, Sally was diagnosed with pneumonia. She was admitted to the hospital observation unit and treated with 500 mg of Zithromax through an IV route. How would you report the supply of this drug?", + "A": "J1190 X 2", + "B": "J 0456", + "C": "Q0144", + "D": "J2020 X 2" + }, + "zh": { + "question": "在急诊室就诊期间，萨莉被诊断出患有肺炎。她被送入医院观察病房，并通过静脉注射途径接受了500毫克的Zithromax治疗。你将如何报告这种药物的供应？", + "A": "J1190 X 2", + "B": "J 0456", + "C": "Q0144", + "D": "J2020 X 2" + } + }, + { + "id": "aa20db85-2781-587e-8f2f-181874be724f", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Report an initial Medicare Annual Wellness Exam  (AWV) with a Established E & M visit , EPF Hx and Exam and LOW MDM (the CC was GERD and HTN)", + "A": "G0438 only", + "B": "99213, G0438-33", + "C": "This is a sick visit so only report 99213.", + "D": "99213, G0438" + }, + "zh": { + "question": "报告初次 Medicare 年度健康检查 (AWV) 与已建立的 E & M 访问，EPF 病史和检查以及低 MDM（主诉为 GERD 和 HTN）", + "A": "仅 G0438", + "B": "99213, G0438-33", + "C": "这是一次生病的访问，所以只报告 99213。", + "D": "99213, G0438" + } + }, + { + "id": "85351a52-0107-5a87-9217-cab5a1b03cad", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which code describes an addition to the lower extremity, knee disarticulation, and leather socket?", + "A": "L5105", + "B": "L5640", + "C": "L5850", + "D": "L5624" + }, + "zh": { + "question": "哪个代码描述了下肢、膝关节离断和皮革插座的附加物？", + "A": "L5105", + "B": "L5640", + "C": "L5850", + "D": "L5624" + } + }, + { + "id": "8addb405-3623-5c78-afdc-d5a98cee138a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A nursing home's x-ray machine was not working. A portable x-ray machine and personnel was transported to the nursing home to test nine patients. How would you report the transportation of equipment?", + "A": "R0075", + "B": "76499", + "C": "S9999", + "D": "R0070 X 9" + }, + "zh": { + "question": "一家疗养院的X光机无法工作。一台便携式X光机和工作人员被运送到疗养院以测试九名患者。你会如何报告设备的运输？", + "A": "R0075", + "B": "76499", + "C": "S9999", + "D": "R0070 X 9" + } + }, + { + "id": "e7e3fd0c-cab1-5870-9035-79130256c5fe", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "CODING GUIDELINES A separate procedure is coded per CPT guidelines :", + "A": "Is never coded under any circumstances", + "B": "Both a and b above", + "C": "Is considered to be an integral part of a larger service", + "D": "Is coded when it is performed as a part of another, larger procedure" + }, + "zh": { + "question": "编码指南 根据CPT指南，单独的程序编码为：", + "A": "在任何情况下都不会编码", + "B": "以上a和b都正确", + "C": "被视为较大服务的组成部分", + "D": "当作为另一较大程序的一部分执行时进行编码" + } + }, + { + "id": "11503019-e0da-5a6c-90ba-d8325e360613", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The symbol TRIANGLE before a code in the CPT manuals means?", + "A": "The code is exempt from bundling requirements", + "B": "The code is exempt from unbundling requirements", + "C": "The code can be used as an add-on code , never reported alone or first.", + "D": "The code has been revised in some way this year" + }, + "zh": { + "question": "CPT 手册中代码前的符号 TRIANGLE 表示什么？", + "A": "该代码不受捆绑要求的限制", + "B": "该代码不受解捆绑要求的限制", + "C": "该代码可以用作附加代码，不能单独或首先报告。", + "D": "该代码在今年以某种方式进行了修订" + } + }, + { + "id": "525ed140-6f88-5a38-94e9-8c9092b0889f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which is true of the CPT code(s) :", + "A": "They are numeric.", + "B": "They describe non-physician services.", + "C": "All of the above are correct", + "D": "Only physicians can report them." + }, + "zh": { + "question": "以下哪项是关于CPT代码的正确描述：", + "A": "它们是数字形式。", + "B": "它们描述非医师服务。", + "C": "以上所有都是正确的。", + "D": "只有医生可以报告它们。" + } + }, + { + "id": "13800c9f-ccfa-527e-b9b2-d114b3af18f5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "CPT has been developed and maintained by", + "A": "The cooperating parties", + "B": "WHO", + "C": "CMS", + "D": "AMA" + }, + "zh": { + "question": "CPT 是由谁开发和维护的", + "A": "合作方", + "B": "世界卫生组织", + "C": "美国医疗保险和医疗补助服务中心", + "D": "美国医学会" + } + }, + { + "id": "1e5ceb71-6b81-52cc-87e4-9ce2d272a76e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "This group performs the daily operations for CMS.", + "A": "FI (and carriers)", + "B": "OIG", + "C": "WHO", + "D": "PRO" + }, + "zh": { + "question": "这个小组负责执行CMS的日常运作。", + "A": "FI（和承运人）", + "B": "OIG", + "C": "WHO", + "D": "PRO" + } + }, + { + "id": "9b6171aa-b8bc-5c75-aa7c-35780786e64f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "When using the ICD-9-CM", + "A": "Always use the index only when coding", + "B": "B and c are correct", + "C": "Check the tabular before assigning a code", + "D": "It is perfectly appropriate to memorize codes" + }, + "zh": { + "question": "使用ICD-9-CM时", + "A": "编码时始终只使用索引", + "B": "B和C是正确的", + "C": "在分配代码之前检查分类表", + "D": "记忆代码是完全合适的" + } + }, + { + "id": "22c5c09d-ee38-5cf7-b272-afcc9871e1bf", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "ICD-9-CM codes are composed of  3, 4 and 5 digit codes, when using them :", + "A": "B and c is correct", + "B": "Code to the 4th digit when you don't have the information in your note.", + "C": "Code to the greatest detail", + "D": "It is appropriate to code the 3 digit code when the category is further defined" + }, + "zh": { + "question": "ICD-9-CM 代码由 3、4 和 5 位数字组成，使用时：", + "A": "B 和 C 是正确的", + "B": "当笔记中没有信息时，编码到第 4 位。", + "C": "编码到最详细的程度", + "D": "当类别有进一步定义时，使用 3 位代码是合适的" + } + }, + { + "id": "cd0c3ede-e76f-5374-bf0a-2ef2aebd263b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "When Acute and Chronic conditions are noted :", + "A": "B and c are correct", + "B": "Always code the Acute Condition first", + "C": "Code both and sequence the acute (sub-acute) code first", + "D": "Always code the Chronic condition first" + }, + "zh": { + "question": "当急性和慢性病情被记录时：", + "A": "B和C是正确的", + "B": "总是先编码急性病情", + "C": "编码两者并将急性（亚急性）编码排在前面", + "D": "总是先编码慢性病情" + } + }, + { + "id": "c3ef3d9a-4e9a-53f4-9425-21c869f18083", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which is not true of V-Codes?", + "A": "Are used for other reasons for the encounter", + "B": "Describe signs & symptoms", + "C": "Can always be used at primary diagnosis", + "D": "Used to classify diseases and injuries" + }, + "zh": { + "question": "以下哪项不是关于V代码的正确描述？", + "A": "用于其他原因的就诊", + "B": "描述症状和体征", + "C": "总是可以用作主要诊断", + "D": "用于分类疾病和损伤" + } + }, + { + "id": "9561fa4d-bf5c-5aca-bfe5-0ec2d7b7106c", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "When using the CPT index to locate procedures, which of the following are considered primary classes for main entries?", + "A": "Abbreviations; signs and symptoms, anatomic site; and code assignment", + "B": "Procedure or service; modifiers; clinical examples; and definitions", + "C": "Procedure or service; organ or other anatomic site; condition.", + "D": "Synonyms, eponyms, and abbreviations", + "E": "Conventions; code ranges; modifying terms" + }, + "zh": { + "question": "使用CPT索引查找程序时，以下哪些被视为主要条目类别？", + "A": "缩写；症状和体征，解剖部位；和代码分配", + "B": "程序或服务；修饰语；临床示例；和定义", + "C": "程序或服务；器官或其他解剖部位；病情", + "D": "同义词，专有名词和缩写", + "E": "惯例；代码范围；修饰术语" + } + }, + { + "id": "c14c959b-bba5-5f0e-9577-5c0af22bbd55", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How are the diagnoses sequenced when coding for multiple fractures?", + "A": "Multiple fractures are sequenced according to anatomic location.", + "B": "Multiple fractures are sequenced in accordance with the severity of the fracture.", + "C": "Multiple fractures are always sequenced with pathologic fractures.", + "D": "Multiple fractures are sequenced in accordance with the longest bone first." + }, + "zh": { + "question": "在对多处骨折进行编码时，诊断是如何排序的？", + "A": "多处骨折根据解剖位置排序。", + "B": "多处骨折根据骨折的严重程度排序。", + "C": "多处骨折总是与病理性骨折一起排序。", + "D": "多处骨折根据最长的骨头优先排序。" + } + }, + { + "id": "4497e067-0c62-5a77-a415-3eb6e03f11a1", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "When coding for a liver transplantation, what are the three distinct components of the physician's work?", + "A": "Cadaver biopsy, cholecystectomy, reconstruction of the liver graft", + "B": "Preparations of the common bile duct, trisegment split, management of liver hemorrhage with re-exploration of post operative abscess", + "C": "Cadaver/living donor hepatectomy, backbench work, recipient liver allotransplantation", + "D": "Hemorrhoidopexy, ligation and hepatectomy, cholecystectomy" + }, + "zh": { + "question": "在为肝移植编码时，医生工作的三个不同组成部分是什么？", + "A": "尸体活检、胆囊切除术、肝移植物重建", + "B": "胆总管准备、三段分割、术后脓肿再探查管理肝出血", + "C": "尸体/活体供体肝切除术、后台工作、受体肝异体移植", + "D": "痔疮固定术、结扎和肝切除术、胆囊切除术" + } + }, + { + "id": "9955adfb-4c90-522b-9b52-3351050fcdab", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "BILLINGWhat tool is in place that manages multiple third-party payments to ensure that over-payment does not happen?", + "A": "DME", + "B": "PRO", + "C": "FUD", + "D": "COB" + }, + "zh": { + "question": "BILLING哪种工具用于管理多个第三方付款以确保不会发生超额付款？", + "A": "DME", + "B": "PRO", + "C": "FUD", + "D": "COB" + } + }, + { + "id": "28afe8ef-f188-54bf-8b51-77914c00a426", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A PAR provider :", + "A": "Signs an agreement with the Fiscal Intermediary", + "B": "Submits charges directly to CMS", + "C": "Receives 5% less than some other providers", + "D": "Can bill the patient after payment from Medicare" + }, + "zh": { + "question": "PAR 提供者：", + "A": "与财政中介签署协议", + "B": "直接向 CMS 提交费用", + "C": "比其他一些提供者少收 5%", + "D": "在收到 Medicare 付款后可以向患者收费" + } + }, + { + "id": "6641c7d2-a6af-593e-826e-b3611d46ae58", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What part of Medicare covers the inpatient costs after the deductible is paid?", + "A": "Part C", + "B": "Part A", + "C": "Part B", + "D": "Part D" + }, + "zh": { + "question": "在支付免赔额后，Medicare 的哪个部分涵盖住院费用？", + "A": "C 部分", + "B": "A 部分", + "C": "B 部分", + "D": "D 部分" + } + }, + { + "id": "6b31b4e7-44e7-56da-bbcf-5e39e9d36e20", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Excision of the gallbladder is commonly referred to as a :", + "A": "Cholecystectomy", + "B": "Corpectomy", + "C": "Choledochectomy", + "D": "Colectomy" + }, + "zh": { + "question": "胆囊切除术通常被称为：", + "A": "胆囊切除术", + "B": "椎体切除术", + "C": "胆总管切除术", + "D": "结肠切除术" + } + }, + { + "id": "476166a5-8c95-547f-9221-6de69c7c4cec", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What code best describes an ablation of a polyp in the colon?", + "A": "Hot biopsy Forceps", + "B": "Snare", + "C": "Bipolar cautery removal", + "D": "Cryosurgery" + }, + "zh": { + "question": "哪个代码最能描述结肠息肉的消融？", + "A": "热活检钳", + "B": "圈套器", + "C": "双极电凝切除", + "D": "冷冻手术" + } + }, + { + "id": "43308b56-0027-50fa-9647-9630a979271a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Peritonitis is a condition that occurs in which system?", + "A": "Integumentary", + "B": "Genitourinary", + "C": "Cardiovascular", + "D": "Digestive" + }, + "zh": { + "question": "腹膜炎是发生在哪个系统的疾病？", + "A": "皮肤系统", + "B": "泌尿生殖系统", + "C": "心血管系统", + "D": "消化系统" + } + }, + { + "id": "f3ac551d-3fe6-5df6-bcc7-01735d3edb5d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What type of infection is Helicobactor pylorus?", + "A": "Staphyloccus", + "B": "Streptococcus", + "C": "Viral", + "D": "Bacterial" + }, + "zh": { + "question": "幽门螺杆菌是什么类型的感染？", + "A": "葡萄球菌", + "B": "链球菌", + "C": "病毒", + "D": "细菌" + } + }, + { + "id": "9d5f41af-993b-5d21-b995-a5fd9bd664b9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which following term describes a congenital absence of a limb?", + "A": "Amputation", + "B": "Hallux varus", + "C": "Genu vagum", + "D": "Ectromelia" + }, + "zh": { + "question": "下列哪个术语描述了先天性肢体缺失？", + "A": "截肢", + "B": "拇趾内翻", + "C": "膝外翻", + "D": "肢体缺如" + } + }, + { + "id": "a7b56e24-a79c-51d5-abf6-3c76caf451cf", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The patient presents with a laceration on the auricle pinna that needs a wound repair. What part of the body will the physician repair?", + "A": "Ear", + "B": "Nasal", + "C": "Vermilion", + "D": "Eyelid" + }, + "zh": { + "question": "患者耳廓有撕裂伤需要伤口修复。医生将修复身体的哪个部位？", + "A": "耳朵", + "B": "鼻部", + "C": "唇红缘", + "D": "眼睑" + } + }, + { + "id": "f52be708-ab28-5e2a-8dd5-1a2726983d49", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The kidneys, bladder, and urethra make up what system?", + "A": "Urinary", + "B": "Digestive", + "C": "Endocrine", + "D": "Nervous" + }, + "zh": { + "question": "肾脏、膀胱和尿道组成了哪个系统？", + "A": "泌尿系统", + "B": "消化系统", + "C": "内分泌系统", + "D": "神经系统" + } + }, + { + "id": "8a5f26ff-3015-573b-80bb-6bb2ffe604fd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Complete the series : Frontal, Ethmoid, Maxillary, -------------------------------", + "A": "Turbinates", + "B": "Inferior", + "C": "Sphenoid", + "D": "Nasopharynx" + }, + "zh": { + "question": "完成系列：额骨，筛骨，上颌骨，-------------------------------", + "A": "鼻甲", + "B": "下鼻甲", + "C": "蝶骨", + "D": "鼻咽" + } + }, + { + "id": "4deb68d5-b6ec-5e4f-8b08-dd01e111eff7", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A physician anesthetizes the brachial plexus nerves with an injection to provide pain control. These nerves are located :", + "A": "From the hip joint to the thigh.", + "B": "From the neck to the subclavicular.", + "C": "From the shoulder to the wrist.", + "D": "From the thigh to the foot." + }, + "zh": { + "question": "医生通过注射麻醉臂丛神经以提供疼痛控制。这些神经位于：", + "A": "从髋关节到大腿。", + "B": "从颈部到锁骨下。", + "C": "从肩部到手腕。", + "D": "从大腿到脚。" + } + }, + { + "id": "d2a6c273-8667-5175-bc20-ce01716ae9e6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Adrenal glands are part of which anatomical system?", + "A": "Digestive", + "B": "Genitourinary", + "C": "Circulatory", + "D": "Endocrine" + }, + "zh": { + "question": "肾上腺是哪个解剖系统的一部分？", + "A": "消化系统", + "B": "泌尿生殖系统", + "C": "循环系统", + "D": "内分泌系统" + } + }, + { + "id": "30102d02-d72b-5974-b85d-ba155974bdda", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The basilic vein is located in the :", + "A": "Arm", + "B": "Leg", + "C": "Head", + "D": "Foot" + }, + "zh": { + "question": "贵要静脉位于：", + "A": "手臂", + "B": "腿", + "C": "头部", + "D": "脚" + } + }, + { + "id": "44cb41ad-be6e-5677-860c-a118a7116130", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The small intestine is divided into what parts :", + "A": "Pylorus, Jejunum, Cecum", + "B": "Stomach, Descending Colon, Rectum", + "C": "Duodenum, Jejunum, Ileum", + "D": "Esophagus, Stomach, Duodenum" + }, + "zh": { + "question": "小肠分为哪些部分：", + "A": "幽门、空肠、盲肠", + "B": "胃、降结肠、直肠", + "C": "十二指肠、空肠、回肠", + "D": "食管、胃、十二指肠" + } + }, + { + "id": "36f6111b-469e-50c9-98dd-84b0f7c06ce0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The right upper quadrant of the abdominal area contains which of the following?", + "A": "Pancreas", + "B": "Stomach", + "C": "Gallbladder", + "D": "Appendix" + }, + "zh": { + "question": "腹部右上象限包含以下哪一项？", + "A": "胰腺", + "B": "胃", + "C": "胆囊", + "D": "阑尾" + } + }, + { + "id": "07b83a65-12cc-5495-9472-402415f0938b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How would you characterize oligomenorrhea?", + "A": "Irregular menstrual cycle", + "B": "Absence of a menstruation", + "C": "Bleeding unrelated to the menstrual cycle.", + "D": "Infrequent menstruation" + }, + "zh": { + "question": "你如何描述稀发月经？", + "A": "月经周期不规律", + "B": "没有月经", + "C": "与月经周期无关的出血", + "D": "月经稀少" + } + }, + { + "id": "4f48cacb-e989-5b2f-afa5-c70b85812da9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A Cochlear implant is placed in the  :", + "A": "Spine", + "B": "Cornea", + "C": "Heart", + "D": "Inner Ear" + }, + "zh": { + "question": "人工耳蜗植入于：", + "A": "脊柱", + "B": "角膜", + "C": "心脏", + "D": "内耳" + } + }, + { + "id": "1176c8a2-bca9-547f-b5f1-80979c0bc136", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is Sialadenitis?", + "A": "An inflammation of a salivary gland", + "B": "An inflammation of a tear duct gland", + "C": "An inflammation of a pituitary gland", + "D": "An inflammation of an adrenal gland" + }, + "zh": { + "question": "什么是唾液腺炎？", + "A": "唾液腺的炎症", + "B": "泪腺的炎症", + "C": "垂体的炎症", + "D": "肾上腺的炎症" + } + }, + { + "id": "fd68a541-5a2d-531c-9c1a-cc53168737d7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the meaning of the root word  \"myelo-\"?", + "A": "Spinal Cord", + "B": "Blood", + "C": "Muscle", + "D": "Bone" + }, + "zh": { + "question": "词根“myelo-”的含义是什么？", + "A": "脊髓", + "B": "血液", + "C": "肌肉", + "D": "骨头" + } + }, + { + "id": "5227fa61-8235-5689-925d-7c8719aa4d48", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Surgical repair on the levator muscle of the eyelid to correct drooping is called :", + "A": "Conjunctivoplasty", + "B": "Blepharoplasty", + "C": "Blepharoptosis Repair.", + "D": "Canthotomy" + }, + "zh": { + "question": "对眼睑提肌进行手术修复以矫正下垂称为：", + "A": "结膜成形术", + "B": "眼睑成形术", + "C": "眼睑下垂修复术", + "D": "眦切开术" + } + }, + { + "id": "398f6de3-e0d9-5058-8540-38674df0ee04", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Dislocation of the scaphoid bone is located in the :", + "A": "Elbow", + "B": "Shoulder", + "C": "Foot", + "D": "Knee" + }, + "zh": { + "question": "舟骨脱位位于：", + "A": "肘部", + "B": "肩部", + "C": "足部", + "D": "膝部" + } + }, + { + "id": "04b120c7-977c-5bdd-ad19-a7e3f07fa388", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A patient who has been severely burned will be undergoing a skin xenograft for temporary wound closure. The xenograft harvests the skin from where?", + "A": "From synthetic material.", + "B": "From a donor of the same species.", + "C": "From the body of the patient.", + "D": "From a donor that is non-human." + }, + "zh": { + "question": "一名严重烧伤的患者将接受皮肤异种移植以暂时闭合伤口。异种移植的皮肤来源于哪里？", + "A": "来自合成材料。", + "B": "来自同种供体。", + "C": "来自患者自身。", + "D": "来自非人类供体。" + } + }, + { + "id": "745492fc-8225-5a3d-abc7-289882494950", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the code book volumes are used in a physician's office?", + "A": "Volume 1", + "B": "Volume 3", + "C": "Only A and B are used.", + "D": "Volume 2" + }, + "zh": { + "question": "在医生办公室中使用哪一卷代码书？", + "A": "第一卷", + "B": "第三卷", + "C": "仅使用A和B。", + "D": "第二卷" + } + }, + { + "id": "d576ba99-c78e-5363-88a0-c1b329cc9c81", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "\" ------------------------------- \" is a reference that instructs coder to look up another term to locate a code for a particular condition.", + "A": "See category", + "B": "Eponym", + "C": "See condition", + "D": "And" + }, + "zh": { + "question": "“ ------------------------------- ” 是一个参考，指示编码员查找另一个术语以找到特定情况的代码。", + "A": "参见类别", + "B": "专有名词", + "C": "参见情况", + "D": "和" + } + }, + { + "id": "6259c9cb-a6a2-5152-87d0-a86c5557b3bf", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "--------------------------------------- is (are) used in both the index and Tabular List to enclose supplementary words that may be present or absent in the statement of a disease or procedure, without affecting the code assignment.", + "A": "Brackets", + "B": "Parentheses", + "C": "\"Excludes\"", + "D": "Includes" + }, + "zh": { + "question": "--------------------------------------- 用于索引和分类表中，以括住在疾病或手术陈述中可能出现或缺失的补充词，而不影响代码分配。", + "A": "方括号", + "B": "圆括号", + "C": "“排除”", + "D": "“包括”" + } + }, + { + "id": "d0ae988b-b917-5d4c-a690-26d5d8e01e80", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which statement is NOT true of inclusion terms?", + "A": "The terms may be included under certain four-and five-digit codes.", + "B": "The inclusion terms are not necessarily exhaustive.", + "C": "These terms are the conditions for which that code number is to be used.", + "D": "An \"Inclusion note\" under a code indicates that the terms excluded from the code are to be coded elsewhere." + }, + "zh": { + "question": "以下哪项陈述不符合包含术语的定义？", + "A": "术语可能包含在某些四位和五位代码下。", + "B": "包含术语不一定是详尽无遗的。", + "C": "这些术语是该代码编号所适用的条件。", + "D": "代码下的“包含说明”表示从代码中排除的术语应在其他地方编码。" + } + }, + { + "id": "83ea2c15-97c8-59e0-8755-1efc19043c39", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The word(s) \" ----------- \" should be interpreted to mean either \"and\" or \"or\" when it appears in the title.", + "A": "Omit code", + "B": "And", + "C": "With", + "D": "See" + }, + "zh": { + "question": "标题中出现的词语“ ----------- ”应被解释为“和”或“或”。", + "A": "省略代码", + "B": "和", + "C": "与", + "D": "参见" + } + }, + { + "id": "f90fd62c-4d28-5e9e-9c54-1863e168363e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The most commonly used etiology/manifestation combinations are the codes for --------------------------, category 250.", + "A": "Heart disease.", + "B": "Tachycardia.", + "C": "Hypertension.", + "D": "Diabetes mellitus." + }, + "zh": { + "question": "最常用的病因/表现组合是--------------------------的代码，类别250。", + "A": "心脏病。", + "B": "心动过速。", + "C": "高血压。", + "D": "糖尿病。" + } + }, + { + "id": "21d7bcf6-6982-54aa-9e40-c8cf404ae402", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "\" -------------------------- \" is used in the Alphabetic Index to provide guidance when two conditions are related or have a casual relationship.", + "A": "See category", + "B": "Due to", + "C": "See condition", + "D": "And" + }, + "zh": { + "question": "在字母索引中使用 \"--------------------------\" 来提供指导，当两个条件相关或具有因果关系时。", + "A": "参见类别", + "B": "由于", + "C": "参见条件", + "D": "和" + } + }, + { + "id": "2e5f5356-930b-5f01-92f2-1c4711e1cc29", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "When coding neoplasm (cancer) , \"metastatic from\" means?", + "A": "Primary or secondary site.", + "B": "Unspecified site.", + "C": "Secondary site.", + "D": "Primary site." + }, + "zh": { + "question": "在编码肿瘤（癌症）时，“转移自”是什么意思？", + "A": "原发或继发部位。", + "B": "未指定部位。", + "C": "继发部位。", + "D": "原发部位。" + } + }, + { + "id": "dbeb6760-6864-5c33-864d-17d7599c4979", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "INTEGUMENTARY SYSTEM SECTION OF SURGERY SECTION :A new patient presents to the urgent care center with a laceration to the left elbow that happened 10 days ago and was not treated. An infected gaping wound was found, with resulting cellulitis to the forearm and upper left arm. Extensive irrigation and debridement using sterile water were performed but closure was not attempted pending resolution of the infection. Culture of the wound revealed streptococcus. The patient received 1, 200, 000 units of Bicillin CR IM and is to return in 3 days for follow up. The history and physical examination were problem focused.", + "A": "884.0, 041.00, 99201", + "B": "881.11, 682.3, 041.00, 99201, 96372, J0540", + "C": "881.01, 99281, 96372, J0540", + "D": "881.11, 682.3, 041.00, 96372-LT, J0540" + }, + "zh": { + "question": "手术部分的皮肤系统：一名新患者来到急诊中心，左肘部有一个10天前发生且未处理的裂伤。发现一个感染的裂开的伤口，导致前臂和左上臂的蜂窝织炎。使用无菌水进行了广泛的冲洗和清创，但未尝试闭合，等待感染消退。伤口培养显示链球菌。患者接受了1,200,000单位的Bicillin CR肌肉注射，并将在3天后返回复查。病史和体格检查以问题为重点。", + "A": "884.0, 041.00, 99201", + "B": "881.11, 682.3, 041.00, 99201, 96372, J0540", + "C": "881.01, 99281, 96372, J0540", + "D": "881.11, 682.3, 041.00, 96372-LT, J0540" + } + }, + { + "id": "b1106d1d-bece-5422-bc16-b5f0390690b0", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "12-year-old female was chasing her friend when she fell through a sliding glass door sustaining three lacerations. Left knee 5.5 cm laceration, involving deep subcutaneous tissue and fascia, was repaired with layered closure using 1% lidocaine anesthetic. Right knee: 7.2 cm laceration was repaired under local anesthetic with a single-layer closure. Right hand: 2.5 cm laceration of the dermis was repaired with simple closure using Dermabond tissue adhesive.What are the correct ICD-9-CM and CPT procedure codes? Do not code anesthesia administration.", + "A": "891.0, 882.0, E920.8, E849.0, 12032-LT, 12004-51-RT", + "B": "894.0, 12032, 12002-LT, E/M code for Dermabond adhesive", + "C": "891.1, 882.0, 12002-RT, 12032-51-LT, 17999-51-LT", + "D": "891.0, 882.0, E920.8, E849.0, 12005" + }, + "zh": { + "question": "12岁女性在追赶朋友时跌入滑动玻璃门，造成三处撕裂伤。左膝5.5厘米撕裂伤，涉及深层皮下组织和筋膜，使用1%利多卡因麻醉进行分层缝合修复。右膝：7.2厘米撕裂伤在局部麻醉下进行单层缝合修复。右手：2.5厘米真皮撕裂伤使用Dermabond组织粘合剂进行简单缝合修复。正确的ICD-9-CM和CPT手术代码是什么？不要编码麻醉管理。", + "A": "891.0, 882.0, E920.8, E849.0, 12032-LT, 12004-51-RT", + "B": "894.0, 12032, 12002-LT, E/M code for Dermabond adhesive", + "C": "891.1, 882.0, 12002-RT, 12032-51-LT, 17999-51-LT", + "D": "891.0, 882.0, E920.8, E849.0, 12005" + } + }, + { + "id": "ae5fd5e6-337c-58b1-800c-240821520a50", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Excision lesion on left shoulder, 2.5 X 1.0 X .5 cm, including circumferential margins. Excision lesion, skin of right cheek, 1.0 X 1.0 X .5 cm, including margins. Pathology report states that the skin lesion on the left shoulder is a lipoma and the lesion on the right cheek is a squamous cell carcinoma. The physician progress note states that the left shoulder was sutured with a layered closure, and the cheek was repaired with a simple repair. What are the correct code sets?", + "A": "173.3, 214.8, 11641-RT, 12031-51-LT", + "B": "173.3, 214.1, 11641-RT, 12031-51-LT", + "C": "173.3, 11643-RT, 12031-51-LT", + "D": "173.3, 214.8, 11641-RT, 11403-51-LT, 12031-51-LT" + }, + "zh": { + "question": "左肩病变切除，2.5 X 1.0 X 0.5 厘米，包括周围边缘。右脸颊皮肤病变切除，1.0 X 1.0 X 0.5 厘米，包括边缘。病理报告指出左肩的皮肤病变是脂肪瘤，右脸颊的病变是鳞状细胞癌。医生的进展记录指出左肩进行了分层缝合，脸颊进行了简单修复。正确的编码集是什么？", + "A": "173.3, 214.8, 11641-RT, 12031-51-LT", + "B": "173.3, 214.1, 11641-RT, 12031-51-LT", + "C": "173.3, 11643-RT, 12031-51-LT", + "D": "173.3, 214.8, 11641-RT, 11403-51-LT, 12031-51-LT" + } + }, + { + "id": "a67e66b8-f5c8-5f05-abaa-5bb5c2666725", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "OPERATIVE REPORT :Postoperative Diagnosis : Full thickness burn wound to anterior left lower leg. Operation: Split-thickness graft, approximately 35 centimeters; preparation of the wound. Procedure: Left lower leg was prepped and draped in the usual sterile fashion. The ulcer, which measured approximately  8 X 4 to 4.5 cm, was debrided sharply with Goulian knife until healthy bleeding was seen. Split-thickness skin graft was harvested from the left lateral buttock area approximately 4.5 to 5 cm X 8 cm at the depth of 14/1000 of an inch.What are the correct procedure codes reported by the physician for this procedure performned in the hospital outpatient surgical suite?", + "A": "15100-LT", + "B": "15220-LT, 15221-51-LT, 15002-51-LT", + "C": "14021-LT, 15002-51-LT", + "D": "15100-LT, 15002-51-LT" + }, + "zh": { + "question": "手术报告：术后诊断：左下腿前部全层烧伤创面。手术：约35厘米的分层植皮；创面准备。程序：左下腿按常规无菌方式准备并覆盖。用Goulian刀锐利清创溃疡，溃疡约为8 X 4至4.5厘米，直至见到健康出血。从左侧臀部区域采集分层皮肤移植，约4.5至5厘米X 8厘米，深度为14/1000英寸。医生在医院门诊手术室进行的此手术的正确程序代码是什么？", + "A": "15100-LT", + "B": "15220-LT, 15221-51-LT, 15002-51-LT", + "C": "14021-LT, 15002-51-LT", + "D": "15100-LT, 15002-51-LT" + } + }, + { + "id": "c0b8e7fd-2b03-5dc1-8e2e-1a074c61a5fe", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Postoperative Diagnosis : Basal Cell Carcinoma of the forehead.Procedure: Excision of basal cell carcinoma with split-thickness skin graft.The area of the excision measured 5 X 4 cm in total.Attention was then turned to the skin graft. A pattern of the defect was transferred to the left anterior thigh using a new needle. A local infiltration was performed on the thigh. Using a free-hand knife, a split-thickness skin graft was harvested.", + "A": "195.0, 15120", + "B": "195.0, 15002, 15120", + "C": "173.3, 15120, 11646", + "D": "173.3, 15120" + }, + "zh": { + "question": "术后诊断：额头基底细胞癌。手术：切除基底细胞癌并进行分层皮肤移植。切除区域总计测量为5 X 4厘米。然后注意力转向皮肤移植。缺损的图案被转移到左前大腿，使用新的针头。对大腿进行了局部浸润。使用自由手刀，收获了分层皮肤移植。", + "A": "195.0, 15120", + "B": "195.0, 15002, 15120", + "C": "173.3, 15120, 11646", + "D": "173.3, 15120" + } + }, + { + "id": "849c3f6e-879f-51ec-8b56-36153923289e", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A skilled nursing home patient with an indwelling Foley catheter is diagnosed with a serious urinary tract infection due to E. coli caused by the catheter.  The catheter is removed,m and a urine culture and sensitivity is performed. A temporary catheter is placed through the urethra, and aggressive antibiotic therapy is begun in the emergency room of the hospital. Which of the following code sets will be reported by the ER physician? No medical evaluation was performed because the patient was evaluated by her primary care physician via telephone with the nursing home staff, and orders were called into the hospital.", + "A": "599.0, 041.4, 51701", + "B": "996.64, E879.6, 51703, 99281", + "C": "996.64, 599.0, 041.4, E879.6, 51702", + "D": "599.0, 996.64, E878.8, 51020" + }, + "zh": { + "question": "一名住在专业护理院的病人因导尿管引起的严重大肠杆菌尿路感染被诊断出来。导尿管被移除，进行了尿液培养和药敏试验。通过尿道放置了一个临时导尿管，并在医院急诊室开始了积极的抗生素治疗。急诊室医生将报告以下哪个代码集？没有进行医学评估，因为病人的初级保健医生通过电话与护理院工作人员进行了评估，并将医嘱传达给了医院。", + "A": "599.0, 041.4, 51701", + "B": "996.64, E879.6, 51703, 99281", + "C": "996.64, 599.0, 041.4, E879.6, 51702", + "D": "599.0, 996.64, E878.8, 51020" + } + }, + { + "id": "5c4be428-e47e-5b8e-b2aa-0e913f6dadb8", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A five-year-old boy was brought to the ER by a social worker who discovered him alone in spasms, and seizures. The Social Worker relates that the child's older sister told her the boy was bitten on the hand by a raccoon he played with 11 days ago. No treatment was sought for the injury at the time, but the area was inflamed and hot. According to the Social Worker, the mother is a drug addict and often leaves the children unattended, illness actually began 2 days ago with a headache and restlessness and inflammation at the wound site.The child expired due to cardiorespiratory failure before any effectivetreatment could be administered. CPR was performed but was not successful. The physician's diagnosis was listed as Rhabdovirus from infected raccoon bite, not treated due to child's neglect. Critical care was provided for 60 minutes. Which of the following code sets will be provided?", + "A": "799.1, 780.39, 780.6, 882.1, E906.3, E968.4, E967.2, 92950", + "B": "071, 882.1, E906.3, E968.4, E967.2, 99291, 92950", + "C": "071,780.39, 780.6, 92950", + "D": "079.89, 99285" + }, + "zh": { + "question": "一名五岁男孩被一名社工带到急诊室，社工发现他独自在抽搐和癫痫发作。社工表示，孩子的姐姐告诉她，男孩在11天前被他玩耍的一只浣熊咬伤了手。当时没有对伤口进行治疗，但该区域发炎且发热。根据社工的说法，孩子的母亲是吸毒者，经常让孩子无人看管，疾病实际上在2天前开始，伴有头痛、烦躁不安和伤口部位的炎症。在任何有效治疗实施之前，孩子因心肺衰竭去世。进行了心肺复苏术，但未成功。医生的诊断是感染浣熊咬伤导致的狂犬病毒，由于孩子被忽视未得到治疗。提供了60分钟的重症监护。以下哪组代码将被提供？", + "A": "799.1, 780.39, 780.6, 882.1, E906.3, E968.4, E967.2, 92950", + "B": "071, 882.1, E906.3, E968.4, E967.2, 99291, 92950", + "C": "071,780.39, 780.6, 92950", + "D": "079.89, 99285" + } + }, + { + "id": "fc337d8c-68a4-54e4-9f05-9c9b551997d5", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 49-year-old female sustained injuries to the forehead, 1.5 cm. And a 1 cm wound to the eyebrow when she hit her steering wheel with her head. The closure was layered. Code the service only.", + "A": "12051", + "B": "12011", + "C": "12001", + "D": "13131" + }, + "zh": { + "question": "一名49岁的女性在用头撞到方向盘时，前额受伤1.5厘米，眉毛处有1厘米的伤口。伤口缝合是分层的。仅对服务进行编码。", + "A": "12051", + "B": "12011", + "C": "12001", + "D": "13131" + } + }, + { + "id": "85669fba-c307-554a-92b6-b09aa4d93070", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "The burn patient had a 20 sq cm Biobrane skin graft  the upper right leg and a 30 sq cm Biobrane skin graft of the lower left leg.", + "A": "15271-RT; 15271-LT, 15272-LT", + "B": "15271-RT", + "C": "15271", + "D": "15271-RT; 15271-LT X 2" + }, + "zh": { + "question": "烧伤患者在右上腿进行了20平方厘米的Biobrane皮肤移植，在左下腿进行了30平方厘米的Biobrane皮肤移植。", + "A": "15271-RT; 15271-LT, 15272-LT", + "B": "15271-RT", + "C": "15271", + "D": "15271-RT; 15271-LT X 2" + } + }, + { + "id": "a47ca0ba-933a-5bf3-a8e2-b69ad5366288", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Tracy a 5-year-old female fell down stairs at a daycare. She hit her coccygeal bone and fractured it. The doctor manually manipulated the bone into the proper alignment and told Tracy's mom to have her sit on a rubber ring to alleviate pain.", + "A": "27200", + "B": "28445", + "C": "27202", + "D": "27510" + }, + "zh": { + "question": "Tracy，一个5岁的女孩，在托儿所摔下楼梯。她撞到了尾骨并骨折。医生手动将骨头调整到正确的位置，并告诉Tracy的妈妈让她坐在橡胶圈上以减轻疼痛。", + "A": "27200", + "B": "28445", + "C": "27202", + "D": "27510" + } + }, + { + "id": "f34f248e-3dd3-5fac-bf1c-577eb046ff65", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Fred, a 40-year old carpenter at a local college. While working on a window frame from a ladder, the weld on the rung of the metal ladder loosened and he fell backward  8 ft. He landed on his left hip, dislocating it. Under general anesthesia, the Allis maneuver is used to repair the anterior dislocation of the right hip. The pelvis is stabilized and pressure applied to the thigh to reduce the hip and bring it into proper alignment.", + "A": "27253-LT", + "B": "27252", + "C": "27250-LT", + "D": "27252-LT" + }, + "zh": { + "question": "Fred 是一名 40 岁的木匠，在当地一所大学工作。在从梯子上修理窗框时，金属梯子的横档焊接松动，他向后摔下 8 英尺。他落在左髋上，导致髋关节脱位。在全身麻醉下，使用 Allis 手法修复右髋前脱位。骨盆被固定，并对大腿施加压力以复位髋关节并使其对齐。", + "A": "27253-LT", + "B": "27252", + "C": "27250-LT", + "D": "27252-LT" + } + }, + { + "id": "f2200cee-c6bd-516b-b402-c3683948c054", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A 12-year-old female sustained multiple tibial tuberosity fractures of the left knee while playing soccer at her local track meet. The physician extended the left leg and manipulated several fragments back into place. The knee was then aspirated. A long-leg knee brace was then placed on the knee.", + "A": "27538-LT", + "B": "27550-LT", + "C": "27330-LT", + "D": "27334-LT" + }, + "zh": { + "question": "一名12岁女性在当地田径比赛中踢足球时，左膝多处胫骨结节骨折。医生伸直左腿并将几块碎片复位。随后对膝盖进行了抽吸。然后在膝盖上放置了长腿膝支架。", + "A": "27538-LT", + "B": "27550-LT", + "C": "27330-LT", + "D": "27334-LT" + } + }, + { + "id": "be51f6a5-1992-50f9-9780-80f1552c8b54", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "By manipulation, under general anesthesia a 6-year-old left tarsal's dislocation was reduced. Correct alignment was confirmed by a two-view intraoperative x-rays. A short leg cast was then applied to the left leg. Code only the reduction service.", + "A": "28545-LT, 29405-LT-51", + "B": "28545-LT", + "C": "28540-LT, 73620", + "D": "28545-LT, 29405-LT, 73620" + }, + "zh": { + "question": "在全身麻醉下，通过手法复位，一名6岁儿童的左跗骨脱位得以复位。通过两视图术中X光确认了正确的对齐。然后在左腿上应用了短腿石膏。仅编码复位服务。", + "A": "28545-LT, 29405-LT-51", + "B": "28545-LT", + "C": "28540-LT, 73620", + "D": "28545-LT, 29405-LT, 73620" + } + }, + { + "id": "a11dec1f-b265-53f2-b435-7f3b2e4c9570", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Dr. Devine applied a cranial halo to Gary to stabilize the cervical spine in preparation for x-rays and subsequent surgery.  The scalp was sterilized and local anesthesia injected over the pin insertion sites. Posterior and anterior cranial pins are inserted and the halo device attached.", + "A": "20664, 96372", + "B": "20661, 96372", + "C": "20661", + "D": "20664" + }, + "zh": { + "question": "德文医生为加里应用了颅骨环，以稳定颈椎，为X光检查和后续手术做准备。头皮被消毒，并在针插入点注射了局部麻醉。后部和前部颅骨针被插入，并连接了环装置。", + "A": "20664, 96372", + "B": "20661, 96372", + "C": "20661", + "D": "20664" + } + }, + { + "id": "8b7865f0-c31b-55b3-850c-f282386b50e6", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Charley was playing in the backyard when his sister fired a pellet gun at his left leg and hit him from close range. The pellet penetrated the skin and lodged in the muscle underlying the area. The doctor removed the pellet without complication or incident. Code the procedure only.", + "A": "20525-LT", + "B": "20520-LT", + "C": "10121-LT", + "D": "10120-LT" + }, + "zh": { + "question": "查理在后院玩耍时，他的妹妹用气枪射击他的左腿，并在近距离击中他。弹丸穿透皮肤并嵌入该区域下方的肌肉中。医生在没有并发症或事故的情况下取出了弹丸。仅对手术进行编码。", + "A": "20525-LT", + "B": "20520-LT", + "C": "10121-LT", + "D": "10120-LT" + } + }, + { + "id": "089db057-5981-574f-ae61-2cebe8e66843", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Steve presents with a deep, old hematoma on his right shoulder. After examination of the shoulder area, the doctor decides that the hematoma needs to be incised and drained.", + "A": "23030-RT", + "B": "10140-RT", + "C": "10060-RT", + "D": "10160-RT" + }, + "zh": { + "question": "Steve的右肩部有一个深且陈旧的血肿。经过对肩部区域的检查，医生决定需要切开并引流该血肿。", + "A": "23030-RT", + "B": "10140-RT", + "C": "10060-RT", + "D": "10160-RT" + } + }, + { + "id": "d8571555-1dc0-5655-915e-fd33bf6ec385", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "The surgeon performed an arthrodesis, including a laminectomy of the L1 and L2 segments. Approach was posterior with a posterior interbody technique.", + "A": "22634 X 2", + "B": "22633; 22634", + "C": "22630; 22632", + "D": "22633 X 2" + }, + "zh": { + "question": "外科医生进行了关节融合术，包括L1和L2节段的椎板切除术。采用后路入路和后路椎间技术。", + "A": "22634 X 2", + "B": "22633; 22634", + "C": "22630; 22632", + "D": "22633 X 2" + } + }, + { + "id": "dd944d2e-f078-5403-b271-30080aed4d17", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "A child is seen in the office for a superficial laceration of the right knee. The physician repairs the  3.0 cm. laceration with simple suturing.", + "A": "12002-RT", + "B": "12031-RT", + "C": "12007-50", + "D": "13120-RT" + }, + "zh": { + "question": "一名儿童因右膝表浅裂伤在诊所就诊。医生用简单缝合修复了3.0厘米的裂伤。", + "A": "12002-RT", + "B": "12031-RT", + "C": "12007-50", + "D": "13120-RT" + } + }, + { + "id": "694448a3-2724-55a9-88fa-8fc05975cd72", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A woman presents to the Emergency Department for a deep 3.5 cm wound of the right arm. A routine cleansing and layer closure was required.", + "A": "12032-RT", + "B": "10061-RT", + "C": "10121-RT", + "D": "12031-RT" + }, + "zh": { + "question": "一名女性因右臂3.5厘米的深伤口来到急诊科。需要常规清洗和分层缝合。", + "A": "12032-RT", + "B": "10061-RT", + "C": "10121-RT", + "D": "12031-RT" + } + }, + { + "id": "5e994310-3fce-5fe6-9e51-03fd41f52e83", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Sam is treated for multiple wounds of the right forearm, hand and knee. The physician sutured the following : simple repair, 2.5 cm forearm; intermediate repair, 1.5 cm. hand;  2.0 cm.  simple repair, right knee.", + "A": "11600-RT, 11420-RT", + "B": "12041-RT, 12002-RT", + "C": "12041-RT, 12002-RT-51", + "D": "11400-RT, 11420-51-RT" + }, + "zh": { + "question": "Sam接受了右前臂、手和膝盖的多处伤口治疗。医生缝合了以下伤口：简单修复，2.5厘米前臂；中等修复，1.5厘米手；2.0厘米简单修复，右膝盖。", + "A": "11600-RT, 11420-RT", + "B": "12041-RT, 12002-RT", + "C": "12041-RT, 12002-RT-51", + "D": "11400-RT, 11420-51-RT" + } + }, + { + "id": "0cec0b87-0e3a-5929-886c-2a79cad4e234", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "CARDIOVASCULAR SYSTEM : 30000 SeriesA 69-year-old male is admitted for coronary ASHD. A prior cardiac catheterization showed numerous native vessels to be 70% to 100% blocked. The patient was then taken to the operating room. After opening the chest and separating the rib cage, a coronary artery bypass was performed using five venous grafts and four coronary arterial grafts. Code the graft procedure(s) and the diagnosis :", + "A": "33536, 33517-51, 414.9", + "B": "33536, 33522, 414.01", + "C": "33514, 414", + "D": "33533, 33522, 414.05" + }, + "zh": { + "question": "心血管系统：30000系列 一名69岁的男性因冠状动脉粥样硬化性心脏病入院。先前的心脏导管检查显示多条原生血管阻塞70%至100%。随后将患者送入手术室。打开胸腔并分离肋骨后，使用五条静脉移植物和四条冠状动脉移植物进行了冠状动脉搭桥术。为移植手术和诊断编码：", + "A": "33536, 33517-51, 414.9", + "B": "33536, 33522, 414.01", + "C": "33514, 414", + "D": "33533, 33522, 414.05" + } + }, + { + "id": "471c0873-99e7-5aa5-b4bc-c39ddc2fa253", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "An arterial catheterization is coded how?", + "A": "36620", + "B": "36600", + "C": "36640", + "D": "36620, 36625" + }, + "zh": { + "question": "动脉导管插入术如何编码？", + "A": "36620", + "B": "36600", + "C": "36640", + "D": "36620, 36625" + } + }, + { + "id": "8632bece-adac-5ca6-8869-73260c91cafd", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A patient is taken to the operating room for a ruptured spleen. A partial splenectomy and repair of a rupture was done.", + "A": "38120, 865.04", + "B": "38115, 289.59", + "C": "38101-58, 38115-51, 289.59", + "D": "38101, 865.14" + }, + "zh": { + "question": "一名患者因脾破裂被送入手术室。进行了部分脾切除术和破裂修复。", + "A": "38120, 865.04", + "B": "38115, 289.59", + "C": "38101-58, 38115-51, 289.59", + "D": "38101, 865.14" + } + }, + { + "id": "52a260c1-2b73-5899-86fe-34b7f034c7b7", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 50-year-old patient has a PICC line with a port placed for chemotherapy infusion. Fluoroscopic guidance was used to gain access to check placement.", + "A": "36571, 76937", + "B": "36571, 77001", + "C": "36568, 76937", + "D": "35651, 77001" + }, + "zh": { + "question": "一名50岁的患者安装了一个用于化疗输注的PICC线和端口。使用透视引导来获得进入并检查位置。", + "A": "36571, 76937", + "B": "36571, 77001", + "C": "36568, 76937", + "D": "35651, 77001" + } + }, + { + "id": "98123be7-c437-5a5b-a059-ac0e3d14c099", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The 55-year-old female was seen previously for a laparoscopic biopsy of her cervical lymph nodes. The biopsy came back showing abnormal cells. The decision was made to do a lymphadenectomy. The patient was brought to the operating room and put under general anesthesia.  When the radical neck dissection was complete, the lymph nodes were excised. The patient was returned to recovery in satisfactory condition. Code the lymphadenectomy only.", + "A": "38571", + "B": "38720, 38570-51", + "C": "38724", + "D": "38720, 38500-51" + }, + "zh": { + "question": "55岁女性之前因宫颈淋巴结的腹腔镜活检就诊。活检结果显示异常细胞。决定进行淋巴结清扫术。患者被送入手术室并接受全身麻醉。当根治性颈部清扫术完成后，淋巴结被切除。患者以满意的状态返回恢复室。仅对淋巴结清扫术进行编码。", + "A": "38571", + "B": "38720, 38570-51", + "C": "38724", + "D": "38720, 38500-51" + } + }, + { + "id": "cfc0f258-5d42-5f18-bc27-555c50f7d7b9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "For revascularization therapy of the femoral/popliteal territory, how many codes should be used for a combination angioplasty, stent and angioplasty?", + "A": "One but use an Add-on code for any additional Vessels", + "B": "One ----- 37230", + "C": "None of the Answers are Correct", + "D": "Three" + }, + "zh": { + "question": "对于股动脉/腘动脉区域的血运重建治疗，组合使用血管成形术、支架和血管成形术应使用多少个代码？", + "A": "一个，但对于任何额外的血管使用附加代码", + "B": "一个 ----- 37230", + "C": "没有一个答案是正确的", + "D": "三个" + } + }, + { + "id": "a01788f2-8d68-5e5f-a5d9-57a6fe9edc2c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "RESPIRATORY SYSTEMPREOPERATIVE DIAGNOSIS :  Deviated septum.PROCEDURE PERFORMED : Septoplasty; Resection of inferior turbinatesThe patient was taken to the operating room and placed under general anesthesia. The fracture of the inferior turbinates was first performed to do the septoplasty.  Once this was done, the septoplasty was completed and the turbinates were placed back in their original position. The patient was taken to recovery in satisfactory condition.  Code the procedure(s) and the diagnosis :", + "A": "30520, 30140-51, 802.0", + "B": "30520, 30140-51, 470", + "C": "30520, 30130-51, 470", + "D": "30520, 30130, 470" + }, + "zh": { + "question": "呼吸系统术前诊断：鼻中隔偏曲。实施的手术：鼻中隔成形术；下鼻甲切除术患者被送入手术室并置于全身麻醉下。首先进行下鼻甲骨折以进行鼻中隔成形术。完成后，鼻中隔成形术完成，下鼻甲被放回原位。患者以满意的状态被送入恢复室。编码手术和诊断：", + "A": "30520, 30140-51, 802.0", + "B": "30520, 30140-51, 470", + "C": "30520, 30130-51, 470", + "D": "30520, 30130, 470" + } + }, + { + "id": "62507255-1350-515d-b190-9fff93463baa", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "RESPIRATORY SYSTEMThe patient is seen at the clinic for chronic sinusitis. It is determined that an endoscopic sinus surgery is scheduledd for the next day. The patient arrives for same-day surgery, and the physician performs an endoscopic total ethmoidectomy with an endoscopic maxillary antrostomy with removal of maxillary tissue. Code the procedure(s) and diagnosis.", + "A": "31254, 31256-51, 473.9", + "B": "31255, 31267-51, 461.9", + "C": "31255, 31267-51, 473.9", + "D": "31200, 31225-51, 473.9" + }, + "zh": { + "question": "呼吸系统患者因慢性鼻窦炎在诊所就诊。确定安排次日进行内窥镜鼻窦手术。患者当天到达进行手术，医生进行内窥镜全筛窦切除术和内窥镜上颌窦开窗术并去除上颌窦组织。为手术和诊断编码。", + "A": "31254, 31256-51, 473.9", + "B": "31255, 31267-51, 461.9", + "C": "31255, 31267-51, 473.9", + "D": "31200, 31225-51, 473.9" + } + }, + { + "id": "58e57d16-d6ab-5475-9a55-ffca87392e3b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "DIGESTIVE SYSTEM : 40000 seriesGary is admitted to same-day surgery for a laparoscopic cholecystectomy.", + "A": "47562, 47550", + "B": "47562", + "C": "47560", + "D": "47600" + }, + "zh": { + "question": "消化系统：40000系列Gary因腹腔镜胆囊切除术入院进行同日手术。", + "A": "47562, 47550", + "B": "47562", + "C": "47560", + "D": "47600" + } + }, + { + "id": "bf4e9e6f-73a8-5350-bdf1-757f0fc651de", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Code an excision of a ruptured appendix with generalized peritonitis.", + "A": "44960", + "B": "49021", + "C": "49020", + "D": "44960-22" + }, + "zh": { + "question": "为伴有全身性腹膜炎的破裂阑尾切除术编码。", + "A": "44960", + "B": "49021", + "C": "49020", + "D": "44960-22" + } + }, + { + "id": "5081fd1f-0570-5bdf-88de-87bb7806a571", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Code an ERCP with sphincterotomy", + "A": "43262", + "B": "43264", + "C": "43260", + "D": "43262, 43273" + }, + "zh": { + "question": "为ERCP编码并进行括约肌切开术", + "A": "43262", + "B": "43264", + "C": "43260", + "D": "43262, 43273" + } + }, + { + "id": "62ecfacb-e8d1-56d6-bf18-99e27f9a81ce", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "When the physician does not specify the method used to remove a lesion during an endoscopy, what is the appropriate procedure?", + "A": "Assign the ablation code", + "B": "Query the physician as to the method used.", + "C": "Assign the removal by hot biopsy forceps code", + "D": "Assign the removal by snare technique code as a default." + }, + "zh": { + "question": "当医生未指明在内镜检查中去除病变的方法时，适当的程序是什么？", + "A": "分配消融代码", + "B": "询问医生所用的方法。", + "C": "分配热活检钳去除代码", + "D": "默认分配圈套技术去除代码。" + } + }, + { + "id": "f1fcd41a-a2c5-512b-bda1-887b44f0f630", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Excision of parotid tumor or gland or both. Once the patient was under general anesthesia, successfully, Dr. White assisted by Dr. Green, opened the area in which the parotid gland is located. After inspecting the gland, the decision was made to excise the total gland because of the size of the tumor  (5 cm.). With careful dissection and preservation of the facial nerve, the parotid gland was removed. The wound was cleaned and closed,  and the patient was brought to recovery in satisfactory condition.  Report one Dr. Green's service.", + "A": "42410-80, 97597, 142.0", + "B": "11426. 239.8", + "C": "42420-80, 239.8", + "D": "42426-62, 210.2" + }, + "zh": { + "question": "切除腮腺肿瘤或腺体或两者兼有。在患者成功接受全身麻醉后，White医生在Green医生的协助下，打开了腮腺所在的区域。检查腺体后，由于肿瘤的大小（5厘米），决定切除整个腺体。在仔细解剖并保护面神经后，腮腺被切除。伤口被清理并缝合，患者在满意的状态下被送到恢复室。报告Green医生的一项服务。", + "A": "42410-80, 97597, 142.0", + "B": "11426. 239.8", + "C": "42420-80, 239.8", + "D": "42426-62, 210.2" + } + }, + { + "id": "7673672a-0032-5d07-a387-5a50c6d7a3f9", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "This 10-year-old girl presents for a tonsillectomy because of chronic tonsillitis and possible adenoidectomy. On inspection the adenoids were found not to be inflamed. Only the tonsillectomy was done. Code the tonsillectomy only.", + "A": "42826, 42835-51, 474.02", + "B": "42825, 474.00", + "C": "42830, 42825-51, 474.1", + "D": "42820, 474.10" + }, + "zh": { + "question": "这名10岁女孩因慢性扁桃体炎和可能的腺样体切除术而接受扁桃体切除术。检查发现腺样体没有发炎。仅进行了扁桃体切除术。仅对扁桃体切除术进行编码。", + "A": "42826, 42835-51, 474.02", + "B": "42825, 474.00", + "C": "42830, 42825-51, 474.1", + "D": "42820, 474.10" + } + }, + { + "id": "ddb02085-c58b-5188-8f62-067d75035e0d", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A 63-year-old male present to Acute Surgical Care for a sigmoidoscopy.  The physician inserts a flexible scope into the patient's rectum and determines the rectum is clear of polyps. The scope is advanced to the sigmoid colon, and a total of three polyps are found. Using the snare technique, the polyps are removed.  The remainder of the colon is free of polyps. The flexible scope is withdrawn.", + "A": "44111, 153.3", + "B": "45383, 211.3", + "C": "45338, 211.3", + "D": "44110, 153.9" + }, + "zh": { + "question": "一名63岁的男性来到急诊外科进行乙状结肠镜检查。医生将一根柔性镜插入患者的直肠，确定直肠没有息肉。镜子推进到乙状结肠，发现总共有三个息肉。使用圈套技术，息肉被切除。结肠的其余部分没有息肉。柔性镜被撤回。", + "A": "44111, 153.3", + "B": "45383, 211.3", + "C": "45338, 211.3", + "D": "44110, 153.9" + } + }, + { + "id": "f04c6452-9245-59b9-92e8-8c66a7547838", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "This woman is in for multiple external hemorrhoids. After inspection of the hemorrhoids, the physician decides to excise all the hemorrhoids.", + "A": "46083, 455.5", + "B": "46255, 455.5", + "C": "46615, 455.0", + "D": "46250, 455.3" + }, + "zh": { + "question": "这名女性患有多发性外痔。检查痔疮后，医生决定切除所有痔疮。", + "A": "46083, 455.5", + "B": "46255, 455.5", + "C": "46615, 455.0", + "D": "46250, 455.3" + } + }, + { + "id": "daae82c3-2d3c-5d00-818b-2e82508097f3", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "URINARY SYSTEM : 50000 SeriesOPERATIVE REPORT DIAGNOSIS: Acute renal insufficiencyprocedure : Renal biopsyThe patient was taken to the operating room for percutaneous needle biopsy of the right and left kidneys.", + "A": "50542-LT, 50542-RT", + "B": "50555-50", + "C": "50200-50", + "D": "49000-50" + }, + "zh": { + "question": "泌尿系统：50000 系列手术报告诊断：急性肾功能不全手术：肾活检患者被送往手术室进行右肾和左肾的经皮针活检。", + "A": "50542-LT, 50542-RT", + "B": "50555-50", + "C": "50200-50", + "D": "49000-50" + } + }, + { + "id": "42a18142-f4fe-5629-ace0-2fbc4b356371", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "OPERATIVE REPORTDIAGNOSIS : Large bladder neck obstructionPROCEDURE PERFORMED : Cystoscopy and transurethral resection of the prostate.Code the procedure(s) performed and the diagnosis.", + "A": "52450, 52001-51, 596.0", + "B": "52450, 52001, 753.6", + "C": "52450, 52000-59, 596.0", + "D": "52450, 52000, 753.6" + }, + "zh": { + "question": "手术报告诊断：膀胱颈大面积梗阻手术操作：膀胱镜检查和经尿道前列腺切除术。为所执行的手术和诊断编码。", + "A": "52450, 52001-51, 596.0", + "B": "52450, 52001, 753.6", + "C": "52450, 52000-59, 596.0", + "D": "52450, 52000, 753.6" + } + }, + { + "id": "24097104-6ca2-5049-869e-d00f3c5b7163", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "MALE GENITAL SYSTEM : 50000 SeriesCode reconstruction of the penis for straightening of chordee :", + "A": "54328", + "B": "54435", + "C": "54360", + "D": "54300" + }, + "zh": { + "question": "男性生殖系统：50000系列代码用于阴茎重建以矫正阴茎弯曲：", + "A": "54328", + "B": "54435", + "C": "54360", + "D": "54300" + } + }, + { + "id": "720d1277-7e4b-57aa-91c0-00c55f0c5d99", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "New born clamp circumcision.", + "A": "54161", + "B": "54150", + "C": "54150-52", + "D": "54162" + }, + "zh": { + "question": "新生儿夹钳包皮环切术", + "A": "54161", + "B": "54150", + "C": "54150-52", + "D": "54162" + } + }, + { + "id": "86209fd6-c34c-595b-9ec1-42cf457d1118", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Sam is a 40-year-old male in for a bilateral vasectomy that will include three postoperative semen examinations.", + "A": "52648", + "B": "52402 X 3", + "C": "55250", + "D": "55250 X 3" + }, + "zh": { + "question": "Sam 是一名 40 岁的男性，计划进行双侧输精管切除术，并将进行三次术后精液检查。", + "A": "52648", + "B": "52402 X 3", + "C": "55250", + "D": "55250 X 3" + } + }, + { + "id": "7acbeae5-5709-5616-8bfa-5485a6d42ff4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "FEMALE GENITAL SYSTEM : 50000 SeriesPatient is seen for Bartholin's gland abscess. The abscess is incised and drained by the physician.", + "A": "50600", + "B": "53060", + "C": "56405", + "D": "56420" + }, + "zh": { + "question": "女性生殖系统：50000系列患者因巴氏腺脓肿就诊。医生切开并引流脓肿。", + "A": "50600", + "B": "53060", + "C": "56405", + "D": "56420" + } + }, + { + "id": "ab83edf3-d9c7-59d5-9e55-47091540b198", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A 22-year-old female is seen at the clinic today for a colposcopy. The physician will take multiple biopsies of the cervix uteri.", + "A": "57461", + "B": "56821", + "C": "57455", + "D": "57420" + }, + "zh": { + "question": "一名22岁的女性今天在诊所接受阴道镜检查。医生将对子宫颈进行多次活检。", + "A": "57461", + "B": "56821", + "C": "57455", + "D": "57420" + } + }, + { + "id": "dcdc72af-7d78-5148-92cc-734a5acb9171", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "EVALUATION AND MANAGEMENT :A 90-year-old patient asks for a second opinion when he was recently diagnosed with bilateral senile cataracts. His regular ophthalmologist has recommended implantation of lenses after surgical removal of the cataracts. The patient presents to the clinic stating that he is concerned about the necessity of the procedure. During the detailed history, the patient states that he has had decreasing vision over the last year or two but has always had excellent vision. He cannot recall a trauma to the eye in the past. The physician conducted a detailed visual examination and confirmed the diagnosis of the patient's ophthalmologist. The medical decision-making was of low complexity.", + "A": "99203", + "B": "92002", + "C": "99252", + "D": "99241" + }, + "zh": { + "question": "评估和管理：一位90岁的患者在最近被诊断为双侧老年性白内障后要求获得第二意见。他的常规眼科医生建议在手术移除白内障后植入晶状体。患者来到诊所表示他对手术的必要性感到担忧。在详细的病史中，患者表示他在过去一两年中视力下降，但一直以来视力很好。他回忆不起过去有眼部创伤。医生进行了详细的视力检查，并确认了患者眼科医生的诊断。医疗决策的复杂性较低。", + "A": "99203", + "B": "92002", + "C": "99252", + "D": "99241" + } + }, + { + "id": "f5fe9c08-3a08-598b-b2eb-3c9992c78b75", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "The attending physician requests a confirmatory consultation from an interventional radiologist for a second opinion about a 60-year-old male with abnormal areas within the liver. The recommendation for a CT guided biopsy is requested, which the attending has recommened be performed. During the comprehensive history, the patient reported right upper quadrant pain. His liver enzymes were elevated.  Previous CT study revealed multiple low attenuation areas within the liver (infection not tumor). The laboratory studies were creatinine, 0.9; hemoglobin, 9.5; PT and PTT, 13.0/31.5 with an INR of 1.2. The comprehensive physical examination showed that the lungs were clear to auscultation and the heart had regular rate and rhythm. The mental status was oriented times three. Temperature, intermittent low-grade fever, up to 101 deg. fahrenheit, usually occurs at night. The CT-guided biopsy was considered appropriate for this patient. The medical decision making was of high complexity.", + "A": "99255", + "B": "99221", + "C": "99245", + "D": "99223" + }, + "zh": { + "question": "主治医师要求介入放射科医生进行确认性会诊，以对一名60岁男性肝脏异常区域提供第二意见。请求进行CT引导下的活检，主治医师建议进行。在全面病史中，患者报告右上腹痛。他的肝酶升高。先前的CT研究显示肝脏内有多个低密度区域（感染而非肿瘤）。实验室研究结果为肌酐0.9；血红蛋白9.5；PT和PTT为13.0/31.5，INR为1.2。全面体格检查显示肺部听诊清晰，心脏节律规则。精神状态为定向三项。体温为间歇性低烧，最高达101华氏度，通常在夜间发生。CT引导下的活检被认为适合该患者。医疗决策的复杂性很高。", + "A": "99255", + "B": "99221", + "C": "99245", + "D": "99223" + } + }, + { + "id": "7443f8e6-e8b9-5077-b21d-2380e9d9cb6e", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A cardiology consultation is requested for a 69-year-old inpatient for recent onset of dyspnea on exertion and chest pain. The comprehensive history reveals that the patient cannot walk three blocks without exhibiting retrosternal squeezing sensation with shortness of breath. A comprehensive physical examination reveals pleasant, elderly female in no apparent distress. The medical decision making complexity is high based on the various diagnosis options.", + "A": "99223", + "B": "99254", + "C": "99245", + "D": "99255" + }, + "zh": { + "question": "一名69岁的住院患者因最近出现运动时呼吸困难和胸痛而请求心脏病学会诊。详尽的病史显示，患者无法在不出现胸骨后挤压感和呼吸急促的情况下步行三个街区。全面的体格检查显示，这是一位愉快的老年女性，没有明显的痛苦。基于各种诊断选项，医疗决策的复杂性很高。", + "A": "99223", + "B": "99254", + "C": "99245", + "D": "99255" + } + }, + { + "id": "2bc52ebd-56f7-5e52-926d-f98d1c7be503", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "FEMALE GENITAL SYSTEM : 50000 SeriesD & C performed for a woman with dysfunctional bleeding.", + "A": "58100", + "B": "58120", + "C": "59160", + "D": "57505" + }, + "zh": { + "question": "女性生殖系统：50000系列D&C为功能性出血的女性进行的手术。", + "A": "58100", + "B": "58120", + "C": "59160", + "D": "57505" + } + }, + { + "id": "ea684f5d-c9c9-51ff-a6ad-73b1dd390c12", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A new patient presents to the emergency department with an ankle sprain received when he fell while roller-blading. The physician completes an expanded problem focused history and examination. The medical decision making complexity is low.", + "A": "99284", + "B": "99282", + "C": "99202", + "D": "99232" + }, + "zh": { + "question": "一名新患者因在滑旱冰时摔倒导致脚踝扭伤而来到急诊科。医生完成了扩展问题为重点的病史和检查。医疗决策的复杂性较低。", + "A": "99284", + "B": "99282", + "C": "99202", + "D": "99232" + } + }, + { + "id": "4e79f4bf-cdad-5aad-8ab3-977121cc5afa", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "MALE GENITAL SYSTEM : 50000 SeriesIncision into abscess of scrotal wall to drain pus.", + "A": "55100", + "B": "11006", + "C": "11004", + "D": "54700" + }, + "zh": { + "question": "男性生殖系统：50000系列切开阴囊壁脓肿以引流脓液。", + "A": "55100", + "B": "11006", + "C": "11004", + "D": "54700" + } + }, + { + "id": "512f234b-cb17-5b78-9e99-d4a79b12d02f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A physician provides a service to a new patient in a custodial care center. The physician performed an expanded problem-focused history and examination. The medical decision making was of low complexity.", + "A": "99308", + "B": "99325", + "C": "99342", + "D": "99236" + }, + "zh": { + "question": "医生在一个护理中心为一名新患者提供服务。医生进行了扩展问题导向的病史和检查。医疗决策的复杂性较低。", + "A": "99308", + "B": "99325", + "C": "99342", + "D": "99236" + } + }, + { + "id": "cbea2fbc-6938-575a-baeb-894e143a1ce2", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "ENDOCRINE SYSTEM, NERVOUS SYSTEM, EYE AND OCULAR ADNEXA, AND AUDITORY SYSTEM  : 60000 SeriesOPERATIVE REPORT DIAGNOSIS : Malignant tumor, thyroidPROCEDURE : Thyroidectomy, totalThe patient was prepped and draped. The neck area was opened. With careful radical dissection of the neck completed, one could visualize the size of the tumor. The decision was made to do a total thyroidectomy.Note :  The pathology report later indicated that the tumor was malignant.", + "A": "60271, 193", + "B": "60220, 164.0", + "C": "60240, 193", + "D": "60254, 193" + }, + "zh": { + "question": "内分泌系统、神经系统、眼和眼附属器及听觉系统：60000系列手术报告诊断：恶性肿瘤，甲状腺手术：全甲状腺切除术患者已准备好并铺好无菌巾。颈部区域被打开。完成颈部的仔细根治性解剖后，可以看到肿瘤的大小。决定进行全甲状腺切除术。注意：病理报告后来表明肿瘤是恶性的。", + "A": "60271, 193", + "B": "60220, 164.0", + "C": "60240, 193", + "D": "60254, 193" + } + }, + { + "id": "62d05e87-ad22-57fd-8f62-e2cf4ee7660d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A new patient is admitted to the observation unit of the local hospital after a 10 foot fall from a ladder. The physician completed a comprehensive history and physical examination. The medical decision making is moderately complex. Also code for Code for a subsequent observation, one day, Expanded problem-focused history, Expanded problem-focused exam and Moderate Medical Decision Making. What is noteworthy about the subsequent day observation codes?", + "A": "99220; 99226; They Do Not Follow E & M Rules of the Three Key Components.", + "B": "99219; 99225; They are Out of Order Codes", + "C": "99235; 99224; They are Modifier 51 Exempt", + "D": "99222; 99223; They are Add-On Codes" + }, + "zh": { + "question": "一名新患者在从梯子上摔下10英尺后被送入当地医院的观察病房。医生完成了全面的病史和体格检查。医疗决策的复杂性为中等。还需为后续观察编码，一天，扩展问题导向的病史，扩展问题导向的检查和中等医疗决策。关于后续观察日的编码有什么值得注意的？", + "A": "99220; 99226; 它们不遵循三大关键要素的E & M规则。", + "B": "99219; 99225; 它们是无序编码", + "C": "99235; 99224; 它们免除修饰符51", + "D": "99222; 99223; 它们是附加编码" + } + }, + { + "id": "a753744f-d0a8-5a74-8e4c-baee66656128", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Report the codes you would use for burr hole(s) to drain an abscess of the brain?", + "A": "61156", + "B": "61150", + "C": "61151", + "D": "61253" + }, + "zh": { + "question": "报告用于钻孔引流脑脓肿的代码？", + "A": "61156", + "B": "61150", + "C": "61151", + "D": "61253" + } + }, + { + "id": "219e7c20-20db-5307-b08a-11c4ea9ec7bf", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "An established patient is admitted to the hospital by his attending physician after a car accident in which the patient hit the steering wheel of the automobile with significant enough force to fold the wheel backward. After a detailed history and physical examination, the physician believed the patient may have sustained a right rotator cuff injury. The medical decision was straightforward in complexity.", + "A": "99221", + "B": "99283", + "C": "99253", + "D": "99255" + }, + "zh": { + "question": "一位已建立病历的患者在车祸后被其主治医生收治入院，事故中患者以足够大的力量撞击汽车方向盘，导致方向盘向后弯曲。经过详细的病史和体格检查，医生认为患者可能遭受了右侧肩袖损伤。医疗决策的复杂性是简单的。", + "A": "99221", + "B": "99283", + "C": "99253", + "D": "99255" + } + }, + { + "id": "4d49328d-5da5-5bd2-a481-0001e2882063", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In the operating room the Dr. repaired an aneurysm of the intracranial artery by balloon catheter.", + "A": "61710", + "B": "61700", + "C": "61697", + "D": "61698" + }, + "zh": { + "question": "在手术室中，医生通过球囊导管修复了颅内动脉的动脉瘤。", + "A": "61710", + "B": "61700", + "C": "61697", + "D": "61698" + } + }, + { + "id": "545f65b4-b959-530f-af31-2f78d7e33b12", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "An established patient is seen in a nursing facility by the physician because the patient, who is a diabetic, has developed a stage II decubitus ulcer with cellulitis. The physician performs a detailed history and examination. The medical decision making complexity is moderate.", + "A": "99228", + "B": "99309", + "C": "99315", + "D": "99310" + }, + "zh": { + "question": "一位已建立病历的患者在护理机构由医生看诊，因为该患者是糖尿病患者，已发展为伴有蜂窝织炎的II期褥疮。医生进行了详细的病史和检查。医疗决策的复杂性为中等。", + "A": "99228", + "B": "99309", + "C": "99315", + "D": "99310" + } + }, + { + "id": "830da456-8dad-5754-ae17-2276fa112a92", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Removal of a foreign body embedded in the eyelid.", + "A": "67801", + "B": "67830", + "C": "67938", + "D": "67413" + }, + "zh": { + "question": "去除嵌入眼睑的异物。", + "A": "67801", + "B": "67830", + "C": "67938", + "D": "67413" + } + }, + { + "id": "37146bd4-c905-5bef-b3e8-13adbfe79e5a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Observation Codes 99218, 99219 and 99220 have estimated times of :", + "A": "30, 50 and 70 minutes, respectively", + "B": "These are observation codes and do not have estimated times.", + "C": "30, 45 and 60 minutes respectively", + "D": "20, 40 and 60 minutes, respectively" + }, + "zh": { + "question": "观察代码99218、99219和99220的预计时间是：", + "A": "分别为30、50和70分钟", + "B": "这些是观察代码，没有预计时间。", + "C": "分别为30、45和60分钟", + "D": "分别为20、40和60分钟" + } + }, + { + "id": "22be2755-5714-5075-85d7-e399aa4fa9a9", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Karen a 13-year-old with chronic otitis media. The patient was taken to same-day surgery andd placed under general anesthesia. Dr. White performed a bilateral tympanostomy with the insertion of ventilating tubes.  The patient tolerated the procedure well.", + "A": "69421-50, 69433-51, 382.1", + "B": "69420-50, 382.4", + "C": "69436-50, 382.02", + "D": "69436-50, 382.9" + }, + "zh": { + "question": "Karen 是一名13岁的慢性中耳炎患者。患者被送往日间手术并在全身麻醉下进行手术。White医生进行了双侧鼓膜切开术并插入通气管。患者耐受手术良好。", + "A": "69421-50, 69433-51, 382.1", + "B": "69420-50, 382.4", + "C": "69436-50, 382.02", + "D": "69436-50, 382.9" + } + }, + { + "id": "b8afb2d6-fbb7-50df-bb87-9139970eb3cd", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A 60-year-old male presents for a complete physical. There are no new complaints since my previous examination on June 9 of last year. On physical examination, the patient is a well-developed, well-nourished male.The physician continues and provides a complete examination of the patient lasting 45 minutes.", + "A": "99450", + "B": "99386", + "C": "99403", + "D": "99396" + }, + "zh": { + "question": "一名60岁的男性进行全面体检。自去年6月9日的上次检查以来，没有新的投诉。在体格检查中，患者是一个发育良好、营养良好的男性。医生继续进行完整的检查，持续45分钟。", + "A": "99450", + "B": "99386", + "C": "99403", + "D": "99396" + } + }, + { + "id": "2448298c-a89a-5312-9b23-651706ccf0f5", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Karen, a 14-year-old female, is seen today for removal of bilateral ventilating tubes that Dr. White inserted 1 year ago.  General anesthesia is used.", + "A": "69424-50", + "B": "69436", + "C": "69424-50-78", + "D": "69424" + }, + "zh": { + "question": "14岁的女性Karen今天来就诊，目的是移除Dr. White在1年前插入的双侧通气管。使用了全身麻醉。", + "A": "69424-50", + "B": "69436", + "C": "69424-50-78", + "D": "69424" + } + }, + { + "id": "6fbd025a-c35c-58ff-b621-90558f29f503", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "ANESTHESIA :The physical status for a patient who had a mild systemic disease would be?", + "A": "P4", + "B": "P2", + "C": "P1", + "D": "P3" + }, + "zh": { + "question": "麻醉：患有轻度全身性疾病的患者的身体状况是？", + "A": "P4", + "B": "P2", + "C": "P1", + "D": "P3" + } + }, + { + "id": "466fdf9d-efc0-512c-98c1-b074d8455046", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Biopsy of the upper left eyelid :", + "A": "67810, 69990", + "B": "67810-E1", + "C": "67801", + "D": "67700-E1" + }, + "zh": { + "question": "左上眼睑活检：", + "A": "67810, 69990", + "B": "67810-E1", + "C": "67801", + "D": "67700-E1" + } + }, + { + "id": "a3417a88-4e34-5905-981a-0d01f312d36f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "This type of sedation decreases the level of patient's alertness but allows the patient to cooperate during the procedure.", + "A": "Topical", + "B": "Conscious", + "C": "Local", + "D": "Regional" + }, + "zh": { + "question": "这种类型的镇静会降低患者的警觉性，但允许患者在手术过程中配合。", + "A": "表面", + "B": "清醒", + "C": "局部", + "D": "区域" + } + }, + { + "id": "ecdb2790-a7b1-5720-aa42-7a704718319c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What publication is the National Unit Values published?", + "A": "BVR by AS", + "B": "RVG by ASA", + "C": "ASA by RVG", + "D": "RVP by ASA" + }, + "zh": { + "question": "国家单位价值发布在哪种出版物中？", + "A": "BVR 由 AS", + "B": "RVG 由 ASA", + "C": "ASA 由 RVG", + "D": "RVP 由 ASA" + } + }, + { + "id": "8d0b7536-a5e4-5fd7-a0fd-5d05447ed245", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Excisional transverse blepharotomy with one-quarter lid margin rotation graft.", + "A": "67961", + "B": "67961, 15576", + "C": "67966", + "D": "67950" + }, + "zh": { + "question": "横向切除睑缘旋转移植术四分之一。", + "A": "67961", + "B": "67961, 15576", + "C": "67966", + "D": "67950" + } + }, + { + "id": "74cc12a5-2e41-5beb-814a-9ccb230f0250", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "To calculate the unit value of services for two procedures performed on the same patient during the same operative session you would do the following to report anesthesia services.", + "A": "Add the units of the two procedures together.", + "B": "Report only the units for the highest unit value procedure.", + "C": "Subtract the procedure with the lowest unit value from the procedure with the highest unit value.", + "D": "Report only the units for the lowest unit value procedure." + }, + "zh": { + "question": "要计算在同一手术期间对同一患者进行的两个手术的服务单位值，您将执行以下操作以报告麻醉服务。", + "A": "将两个手术的单位相加。", + "B": "仅报告单位值最高的手术的单位。", + "C": "从单位值最高的手术中减去单位值最低的手术。", + "D": "仅报告单位值最低的手术的单位。" + } + }, + { + "id": "064cdd2b-ce02-5dab-955b-7399702946f0", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Code anesthesia service provided for an anterior cervical discectomy with decompression of a single interspace of  the spinal cord and nerve roots and including osteophytectomy.", + "A": "00600", + "B": "00630", + "C": "00640", + "D": "00620" + }, + "zh": { + "question": "为前路颈椎间盘切除术提供的麻醉服务进行编码，包括脊髓和神经根的单个间隙减压术以及骨赘切除术。", + "A": "00600", + "B": "00630", + "C": "00640", + "D": "00620" + } + }, + { + "id": "790545fb-dfaf-59e4-8a3e-aaa5b9dba2f3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Per CPT guidelines, anesthesia time ends :", + "A": "When the patient leaves the post anesthesia care unit.", + "B": "When the patient leaves the operating room", + "C": "When the patient has fulfilled post anesthesia care unit criteria for recovery", + "D": "When the anesthesiologist is no longer in personal attendance on the patient." + }, + "zh": { + "question": "根据CPT指南，麻醉时间结束于：", + "A": "当患者离开麻醉后护理单元时。", + "B": "当患者离开手术室时。", + "C": "当患者满足麻醉后护理单元的恢复标准时。", + "D": "当麻醉师不再亲自照看患者时。" + } + }, + { + "id": "2a974108-939e-592d-b1ae-c4df0a5671b0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A physical status anesthesia modifier of P4 means that a patient has :", + "A": "Has a mild systemic disease", + "B": "Is moribound", + "C": "Has a severe systemic disease that is a constant threat to life.", + "D": "Has a severe systemic disease" + }, + "zh": { + "question": "麻醉身体状况修饰符P4表示患者：", + "A": "有轻度全身性疾病", + "B": "病危", + "C": "有严重的全身性疾病，持续威胁生命。", + "D": "有严重的全身性疾病" + } + }, + { + "id": "1b171826-1116-5124-af5f-615f05ef7122", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Qualifying circumstances anesthesia codes are used :", + "A": "To describe circumstances that impact the character of the anesthesia.", + "B": "In addition to the anesthesia.", + "C": "To describe provision of anesthesia under particularly difficult circumstances.", + "D": "All of the above." + }, + "zh": { + "question": "麻醉合格情况代码用于：", + "A": "描述影响麻醉特性的情况。", + "B": "作为麻醉的补充。", + "C": "描述在特别困难的情况下提供麻醉。", + "D": "以上所有。" + } + }, + { + "id": "dd4efdce-499b-5830-9560-258ff73756fd", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "Anesthesia time starts when :", + "A": "When the radiologist begins to administer drugs", + "B": "When the radiologist prepares the patient for induction ---- preoperative", + "C": "When the radiologist meets the family" + }, + "zh": { + "question": "麻醉时间开始于：", + "A": "放射科医生开始给药时", + "B": "放射科医生为患者进行诱导准备时 ---- 术前", + "C": "放射科医生与家属会面时" + } + }, + { + "id": "34a24b2f-b94c-5238-97b8-14432a8d570c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "RADIOLOGY :A 60-year-old female comes to the clinic with shortness of breath. The doctor orders a chest x-ray, frontal and lateral.", + "A": "71035 X 2, 786.9", + "B": "71020, 786.05", + "C": "71020 X 2, 786.07", + "D": "71015, 786.09" + }, + "zh": { + "question": "放射学：一名60岁的女性因呼吸急促来到诊所。医生要求进行胸部X光检查，包括正位和侧位。", + "A": "71035 X 2, 786.9", + "B": "71020, 786.05", + "C": "71020 X 2, 786.07", + "D": "71015, 786.09" + } + }, + { + "id": "f80953d1-6465-56c5-9887-a73b34f37010", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Code an endoscopic catheterization of the biliary ductal system for the professional radiology component only.", + "A": "74300-26", + "B": "43271, 74320", + "C": "74330-26", + "D": "74328-26" + }, + "zh": { + "question": "仅为专业放射学部分编码胆管系统的内窥镜导管插入术。", + "A": "74300-26", + "B": "43271, 74320", + "C": "74330-26", + "D": "74328-26" + } + }, + { + "id": "5b370628-f05c-533f-b2ec-91146f27f8c7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Marcy is a 29-year-old pregnant female in for a follow-up ultrasound with image documentation of the uterus.", + "A": "76816", + "B": "74710", + "C": "74740", + "D": "76856" + }, + "zh": { + "question": "Marcy 是一名 29 岁的孕妇，进行随访超声检查并记录子宫图像。", + "A": "76816", + "B": "74710", + "C": "74740", + "D": "76856" + } + }, + { + "id": "c2eac929-40bf-5414-b5d1-1f6b8190d410", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Code a complex brachytherapy isodose calculation for a patient with prostate cancer.", + "A": "77300, 184", + "B": "77327-22, 186", + "C": "77328, 185", + "D": "77776, 184" + }, + "zh": { + "question": "为一名前列腺癌患者编写复杂的近距离放射治疗等剂量计算代码。", + "A": "77300, 184", + "B": "77327-22, 186", + "C": "77328, 185", + "D": "77776, 184" + } + }, + { + "id": "edc47109-aff0-5b28-a332-dcf64c599811", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "This patient received a prescription for a therapeutic radiology for a cancerous neoplasm of the adrenal gland. What code would you use for complex treatment planing?", + "A": "77263", + "B": "77315", + "C": "77401", + "D": "60520" + }, + "zh": { + "question": "该患者收到了针对肾上腺癌性肿瘤的治疗性放射学处方。对于复杂的治疗计划，您会使用哪个代码？", + "A": "77263", + "B": "77315", + "C": "77401", + "D": "60520" + } + }, + { + "id": "e830ebb4-5d1f-52a8-a492-8560ae67b584", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Because of frequent headaches, this 50-year-old female's doctor ordered a CT scan of the head, without contrast materials.", + "A": "70460", + "B": "70450", + "C": "70496", + "D": "70470" + }, + "zh": { + "question": "由于频繁的头痛，这位50岁的女性的医生要求进行头部CT扫描，不使用对比材料。", + "A": "70460", + "B": "70450", + "C": "70496", + "D": "70470" + } + }, + { + "id": "0cbfcc71-a725-5fda-b252-c69049030b0f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "PATHOLOGY AND LABORATORY :A patient presents to the laboratory in the clinic for the following tests : TSH, comprehensive metabolic panel, and an automated hemogram with manual differential WBC count (CBC). How would you code this lab?", + "A": "84445, 80051, 85025", + "B": "80050", + "C": "84443, 80053, 85027, 85007", + "D": "84443" + }, + "zh": { + "question": "病理学和实验室：一名患者到诊所的实验室进行以下测试：TSH、综合代谢面板和带有手动白细胞分类计数的自动血常规（CBC）。你会如何为这个实验室编码？", + "A": "84445, 80051, 85025", + "B": "80050", + "C": "84443, 80053, 85027, 85007", + "D": "84443" + } + }, + { + "id": "cb83c27d-d392-5b1d-b26b-7f02f348fb1b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "An 81-year-old female patient presented to the laboratory for a lipid panel that includes measurement of total serum cholesterol, lipoprotein (direct measurement, HDL), and triglycerides.", + "A": "82465, 83718, 84478", + "B": "80061", + "C": "82465-52, 83718, 84478", + "D": "80061-52" + }, + "zh": { + "question": "一名81岁的女性患者来到实验室进行脂质面板检查，包括测量总血清胆固醇、脂蛋白（直接测量，HDL）和甘油三酯。", + "A": "82465, 83718, 84478", + "B": "80061", + "C": "82465-52, 83718, 84478", + "D": "80061-52" + } + }, + { + "id": "9b929498-7bd0-5cbd-8f31-51e4601a2f4f", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Thomas has end stage renal failure and comes to the clinic lab today for his monthly urinalysis (qualitative, microscopic only).", + "A": "81001, 584.9", + "B": "81003, 585.6", + "C": "81015, 585.6", + "D": "81015, 586" + }, + "zh": { + "question": "托马斯患有终末期肾衰竭，今天来到诊所实验室进行每月的尿液分析（定性，仅显微镜检查）。", + "A": "81001, 584.9", + "B": "81003, 585.6", + "C": "81015, 585.6", + "D": "81015, 586" + } + }, + { + "id": "4abbf096-3bdf-548a-bc1e-83f8b58fca9f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "This 34-year-old female had been suffering from chronic fatigue. Her physician has ordered a TSH test.", + "A": "80418, 780.71", + "B": "84443, 780.79", + "C": "80438, 780.71", + "D": "80440, 780.79" + }, + "zh": { + "question": "这位34岁的女性一直饱受慢性疲劳的困扰。她的医生已要求进行TSH测试。", + "A": "80418, 780.71", + "B": "84443, 780.79", + "C": "80438, 780.71", + "D": "80440, 780.79" + } + }, + { + "id": "93ea55d3-1a16-5c27-bad2-3468a677dff0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Surgical pathology, gross examination, or microscopic examination is most often required when a sample of an organ, tissue, or body fluid is taken from the body. What code(s) would you use to report biopsy of the colon, hematoma, pancreas, and a tumor of the testis ?", + "A": "88305, 88303, 88307, 88309", + "B": "88304, 88304, 88307, 88309", + "C": "88307, 88304, 88309", + "D": "88305, 88304, 88307, 88309" + }, + "zh": { + "question": "当从身体中取出器官、组织或体液样本时，通常需要进行外科病理学、大体检查或显微镜检查。您会使用哪个代码来报告结肠活检、血肿、胰腺和睾丸肿瘤的活检？", + "A": "88305, 88303, 88307, 88309", + "B": "88304, 88304, 88307, 88309", + "C": "88307, 88304, 88309", + "D": "88305, 88304, 88307, 88309" + } + }, + { + "id": "e54f9785-7970-5d63-b455-340b74c916c6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "This patient presents to the clinic lab for a prothrombin time measurement because of long-term use of Coumadin.", + "A": "85610, V58.61", + "B": "85230, V58", + "C": "85210, V58.61", + "D": "85210, V58.62" + }, + "zh": { + "question": "这位患者因长期使用库马丁而到诊所实验室进行凝血酶原时间测量。", + "A": "85610, V58.61", + "B": "85230, V58", + "C": "85210, V58.61", + "D": "85210, V58.62" + } + }, + { + "id": "f4e1d2e7-ee7d-57aa-9d92-ed63e7a6821c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The 67-year-old female suffers from Chronic liver disease and needs a hepatic function panel performed every six months. Tests include total bilirubin (82247), direct bilirubin (82248), total protein (84155), alanin aminotransferases (ALT and SGPT) (84460),  aspartate aminotransferases (AST and SGOT) (84450) and what other lab tests ?", + "A": "84295, 84450", + "B": "80061, 83718", + "C": "82040, 82247", + "D": "82040, 84075" + }, + "zh": { + "question": "67岁的女性患有慢性肝病，需要每六个月进行一次肝功能检查。测试包括总胆红素 (82247)、直接胆红素 (82248)、总蛋白 (84155)、丙氨酸氨基转移酶 (ALT 和 SGPT) (84460)、天冬氨酸氨基转移酶 (AST 和 SGOT) (84450) 以及哪些其他实验室测试？", + "A": "84295, 84450", + "B": "80061, 83718", + "C": "82040, 82247", + "D": "82040, 84075" + } + }, + { + "id": "072be14c-4413-570e-bdef-97f51e1dfb02", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The patient presented to the laboratory at the clinic for the following blood tests ordered by her physician : albumin (serum), bilirubin (total), and BUN (quantitative)", + "A": "82044, 82248, 84520", + "B": "82044, 82247, 84540", + "C": "82040, 82252, 84525", + "D": "82040, 82247, 84520" + }, + "zh": { + "question": "患者到诊所的实验室进行以下由她的医生开具的血液检查：白蛋白（血清）、胆红素（总量）和尿素氮（定量）", + "A": "82044, 82248, 84520", + "B": "82044, 82247, 84540", + "C": "82040, 82252, 84525", + "D": "82040, 82247, 84520" + } + }, + { + "id": "7535a202-7c5a-575a-a1fb-c5c236e566a3", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "This male is status post kidney transplant and comes into the clinic for a follow up creatinine clearance.", + "A": "82565, 586", + "B": "82540, V42.0", + "C": "82570, 585.6", + "D": "82575, V42.0" + }, + "zh": { + "question": "这名男性在肾移植后状态良好，来到诊所进行随访肌酐清除率检查。", + "A": "82565, 586", + "B": "82540, V42.0", + "C": "82570, 585.6", + "D": "82575, V42.0" + } + }, + { + "id": "0c91cd0a-9e82-52db-b777-6d9a19b52334", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "MEDICINE SECTION :An elderly man comes in for his flu (split virus, IM) and pneumonia (23-valent, IM) vaccines. Code only the immunization administration and diagnoses for the vaccines.", + "A": "90471 X 2, 90658, 90632, V04.81", + "B": "90471, 90472, V04.81, V03.82", + "C": "90658, 90632, V05.8, V04.81", + "D": "90471, 90658, 90472, 90732, V04.81, V03.82" + }, + "zh": { + "question": "医学部分：一位老年男性来接种流感疫苗（裂解病毒，肌肉注射）和肺炎疫苗（23价，肌肉注射）。仅对疫苗的免疫接种管理和诊断进行编码。", + "A": "90471 X 2, 90658, 90632, V04.81", + "B": "90471, 90472, V04.81, V03.82", + "C": "90658, 90632, V05.8, V04.81", + "D": "90471, 90658, 90472, 90732, V04.81, V03.82" + } + }, + { + "id": "9dd50ddf-9b72-581e-9005-f79b25c9278f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Code for an IM influenza vaccine, inactivated, subunit, adjuvanted.", + "A": "90655", + "B": "90654", + "C": "90656", + "D": "90653" + }, + "zh": { + "question": "肌内注射的灭活亚单位流感疫苗，含佐剂的编码。", + "A": "90655", + "B": "90654", + "C": "90656", + "D": "90653" + } + }, + { + "id": "969458c5-5165-55f1-ad0b-186ae85b8902", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "The established patient is seen for a comprehensive eye exam (not E & M), fundus photography and the application of corneal bandage lenses for keratoconus. Code for this encounter.", + "A": "92014, 92250, 92071", + "B": "99215, 92250, 92070", + "C": "92014, 92250, 92072", + "D": "92004, 92250, 92072" + }, + "zh": { + "question": "已建立的患者接受全面的眼科检查（不包括E & M）、眼底摄影和用于圆锥角膜的角膜绷带镜片的应用。为此次就诊编码。", + "A": "92014, 92250, 92071", + "B": "99215, 92250, 92070", + "C": "92014, 92250, 92072", + "D": "92004, 92250, 92072" + } + }, + { + "id": "1682d6b4-e568-5df6-afa4-3df3d4dbd341", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "The patient, a 55-year-old male, This was a follow up for POAG. The patient had IOP of 22 OD and 24 OS. The optometrist added Timolol Maleate to the patient's Xalatan prescription. The OD performed a Comprehensive Eye Exam, which included ExtraOcular Motility  (EOM) Confrontation Fields and Dilated Fundus Exam, No ROS was taken. The provider performed a refraction exam and GDX of the retina of both eyes.", + "A": "92004, 92250, 92105", + "B": "92014, 92134", + "C": "99215, 92132", + "D": "92014, 92134, 92105" + }, + "zh": { + "question": "患者是一名55岁的男性，这是对原发性开角型青光眼（POAG）的随访。患者的眼压为右眼22，左眼24。验光师在患者的Xalatan处方中添加了马来酸噻吗洛尔。眼科医生进行了全面的眼科检查，包括眼外肌运动（EOM）对抗视野和散瞳眼底检查，未进行系统回顾（ROS）。提供者进行了屈光检查和双眼视网膜的GDX检查。", + "A": "92004, 92250, 92105", + "B": "92014, 92134", + "C": "99215, 92132", + "D": "92014, 92134, 92105" + } + }, + { + "id": "a2a2cb34-6f8c-52ce-b2b5-7e26831ebaad", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "This 70-year-old male is taken to the emergency room with severe chest pain. The physician provided an expanded problem-focused history and examination. While the physician is examining the patient, his pressures drop and he goes into cardiac arrest. Cardiopulmonary resuscitation is given to the patient, and his pressure returns to normal; he is transferred to the intensive care unit in critical condition. Code the cardiopulmonary resuscitation and the diagnosis. The medical decision making was of low complexity.", + "A": "99282, 92950, 427.5", + "B": "92960, 427.5", + "C": "99283, 92970, 427.5", + "D": "92950, 427.5" + }, + "zh": { + "question": "这名70岁的男性因严重胸痛被送往急诊室。医生提供了扩展问题为重点的病史和检查。在医生检查病人时，他的血压下���并发生心脏骤停。病人接受了心肺复苏术，血压恢复正常；他被转移到重症监护室，病情危急。为心肺复苏术和诊断编码。医疗决策的复杂性较低。", + "A": "99282, 92950, 427.5", + "B": "92960, 427.5", + "C": "99283, 92970, 427.5", + "D": "92950, 427.5" + } + }, + { + "id": "37d6ea4b-af6f-5329-bf77-3c7b1e27f7e6", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A patient is taken to the OR for insertion of a Swan-Ganz catheter. The physician inserts the catheter for monitoring cardiac output measurements and blood gases.", + "A": "93508", + "B": "36013, 93503", + "C": "93503", + "D": "36013" + }, + "zh": { + "question": "一名患者被送到手术室进行 Swan-Ganz 导管的插入。医生插入导管以监测心输出量测量和血气。", + "A": "93508", + "B": "36013, 93503", + "C": "93503", + "D": "36013" + } + }, + { + "id": "c098bab6-f06b-5fd8-8b0e-ebfa7d0685a5", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Mary is a 50-year-old female with end-stage renal failure. She receives dialysis Tuesdays, Thursdays, and Saturdays each week. She sees the physician 4 times per month. Code a full month of dialysis for the month of December.", + "A": "90961, 586", + "B": "90960 X 4, 585", + "C": "90960, 585", + "D": "90960, 586" + }, + "zh": { + "question": "玛丽是一名50岁的女性，患有终末期肾衰竭。她每周在周二、周四和周六接受透析。她每月看医生4次。为12月份的整个透析月编码。", + "A": "90961, 586", + "B": "90960 X 4, 585", + "C": "90960, 585", + "D": "90960, 586" + } + }, + { + "id": "80718453-dd32-56a1-87e8-dc0972657a6f", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "OPERATIVE REPORT :PROCEDURE PERFORMED : Primary stenting of 70% proximal posterior descending  artery stenosis.INDICATIONS : Atherosclerotic heart diseaseDESCRIPTION OF PROCEDURE : Stents inserted via percutaneous transcatheter placement. A 2.5 X 13 mm pixel stent was deployed.", + "A": "92933-RC, 414.01", + "B": "92920-RC, 414.9", + "C": "92920-RC, 92928, 414.01", + "D": "92928-RC, 414.01" + }, + "zh": { + "question": "手术报告：执行的手术：70%近端后降支动脉狭窄的初级支架置入术。适应症：动脉粥样硬化性心脏病。手术描述：通过经皮导管插入术放置支架。部署了一个2.5 X 13毫米的像素支架。", + "A": "92933-RC, 414.01", + "B": "92920-RC, 414.9", + "C": "92920-RC, 92928, 414.01", + "D": "92928-RC, 414.01" + } + }, + { + "id": "b112a205-8cfe-5028-ad34-e303c1df861d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Dr. Green is a neuroradiologist who has taken Barry, a 42-year-old male, with a diagnosis of carotid stenosis, to the operating room to perform a thrombo-endarterectomy, unilateral. During the surgery, the patient is monitored by electroencephalogram (EEG). Code the monitoring only.", + "A": "95816", + "B": "95817", + "C": "95955", + "D": "95957" + }, + "zh": { + "question": "格林医生是一位神经放射科医生，他带着42岁的男性患者巴里，诊断为颈动脉狭窄，进入手术室进行单侧血栓内膜切除术。在手术过程中，患者通过脑电图（EEG）进行监测。仅对监测进行编码。", + "A": "95816", + "B": "95817", + "C": "95955", + "D": "95957" + } + }, + { + "id": "2b55be43-5c88-55ce-b861-818b851a86dd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How does the CPT Professional Edition define a new patient?", + "A": "A new patient is one who has received hospital services but has never been seen in the clinic by the reporting physician.", + "B": "A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past two years.", + "C": "A new patient is one who has received professional services from the physician or another physician of the same specialty within the last two years for the same problem.", + "D": "A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years." + }, + "zh": { + "question": "CPT专业版如何定义新患者？", + "A": "新患者是指接受过医院服务但从未在诊所由报告医生看诊的患者。", + "B": "新患者是指在过去两年内未接受过该医生或属于同一团体执业的同一专业的其他医生的任何专业服务的患者。", + "C": "新患者是指在过去两年内因同一问题接受过该医生或同一专业的其他医生的专业服务的患者。", + "D": "新患者是指在过去三年内未接受过该医生或属于同一团体执业的同一专业的其他医生的任何专业服务的患者。" + } + }, + { + "id": "33d7d5c7-09d0-5fa4-adf5-edaf38dc63a1", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "James, a 35-year-old new patient, received 45 minutes of counseling and risk factor reduction intervention services from Dr. Kelly. Dr. Kelly talked to James about how to avoid sports injuries. Currently, James does not have any symptoms  or injuries and wants to maintain this status. This was the only service rendered. How would you report this service?", + "A": "99403", + "B": "99203", + "C": "99213", + "D": "99385" + }, + "zh": { + "question": "詹姆斯，一位35岁的新患者，接受了凯利医生45分钟的咨询和风险因素减少干预服务。凯利医生与詹姆斯讨论了如何避免运动损伤。目前，詹姆斯没有任何症状或损伤，并希望保持这种状态。这是提供的唯一服务。你将如何报告这项服务？", + "A": "99403", + "B": "99203", + "C": "99213", + "D": "99385" + } + }, + { + "id": "9e03223e-8a50-5929-955d-7e6e796da450", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Andrea, a 52-year-old patient, had a hysterectomy on Monday morning. That afternoon, after returning to her hospital room, she suffered a cardiac arrest.  A cardiologist responded to the call and delivered one hour and 35 minutes of critical care. During this time the cardiologist ordered a single view chest x-ray and provided ventilation management. How should you report the cardiologist's services?", + "A": "99291, 99292", + "B": "71010, 94002, 99231", + "C": "99291, 99292, 99292-52", + "D": "99291, 99292, 71010, 94002" + }, + "zh": { + "question": "52岁的患者Andrea在周一上午进行了子宫切除术。那天下午，返回病房后，她发生了心脏骤停。一位心脏病专家响应了呼叫并提供了一小时35分钟的重症监护。在此期间，心脏病专家下令进行单视图胸部X光检查并提供通气管理。你应该如何报告心脏病专家的服务？", + "A": "99291, 99292", + "B": "71010, 94002, 99231", + "C": "99291, 99292, 99292-52", + "D": "99291, 99292, 71010, 94002" + } + }, + { + "id": "7addaaae-f236-5e11-b2f0-880067e25b2c", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Brandon was seen in Dr. Shaw's office after falling off his bunk bed. Brandon's mother reported that Brandon and his  sister were jumping on the beds when she heard  a \"thud\".  Brandon complained of knee pain and had trouble walking. Dr. Shaw ordered a knee x-ray that was done at the imaging center across the street. The x-ray showed no fracture or dislocations. Dr. Shaw had seen Brandon for his school physical six months ago. Today, Dr. Shaw documented a detailed examination and decision-making of moderate complexity.  He also instructed Brandon's mother that if Brandon had any additional pain or trouble walking he should see an orthopedic specialist. How should Dr. Shaw report her services from today's visit?", + "A": "99204", + "B": "99394, 99214", + "C": "99214", + "D": "99203" + }, + "zh": { + "question": "布兰登从他的双层床上摔下来后，在肖医生的办公室就诊。布兰登的母亲报告说，当她听到“砰”的一声时，布兰登和他的妹妹正在床上跳。布兰登抱怨膝盖疼痛并且行走困难。肖医生要求在街对面的影像中心进行膝盖X光检查。X光显示没有骨折或脱位。六个月前，肖医生为布兰登进行了学校体检。今天，肖医生记录了详细的检查和中等复杂度的决策。他还指示布兰登的母亲，如果布兰登有任何额外的疼痛或行走困难，应去看骨科专家。肖医生应该如何报告今天的就诊服务？", + "A": "99204", + "B": "99394, 99214", + "C": "99214", + "D": "99203" + } + }, + { + "id": "b2e4db4d-0297-5e55-9688-55b8a40a8ded", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Adam, a 48-year-old patient, presented to Dr. Crampon's office with complaints of fever, malaise, chills, chest pain, and a severe cough. Dr. Crampon took a history, did an exam, and ordered a chest x-ray. After reviewing the x-ray, Dr. Crampon admitted Adam to the hospital for treatment of pneumonia. After his regular office hours, Dr. Crampon visited Adam in the hospital where he dictated a comprehensive history, comprehensive examination, and decision-making of moderate complexity. How would you report Dr. Crampon's services?", + "A": "99223, 99214-21", + "B": "99222", + "C": "99204, 99222-51", + "D": "99214" + }, + "zh": { + "question": "48岁的患者亚当因发烧、全身不适、寒战、胸痛和严重咳嗽到克兰彭医生的诊所就诊。克兰彭医生进行了病史采集、体检，并要求进行胸部X光检查。在查看X光片后，克兰彭医生将亚当收治入院以治疗肺炎。在正常办公时间结束后，克兰彭医生到医院探望亚当，并记录了详细的病史、全面的体检和中等复杂度的决策。你会如何报告克兰彭医生的服务？", + "A": "99223, 99214-21", + "B": "99222", + "C": "99204, 99222-51", + "D": "99214" + } + }, + { + "id": "dc694814-0559-5181-9ace-43833a2fe82a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Larry is being managed for his warfarin therapy on an outpatient basis.  Dr. Nancy continues to review Larry's INR tests, gives patient instructions, dosage adjustment as needed, and ordered additional tests. How would you report the initial 90 days of therapy including 8 INR measurements?", + "A": "99363, 99471", + "B": "99214", + "C": "99363", + "D": "This services is bundled with evaluation and management services." + }, + "zh": { + "question": "拉里正在门诊管理他的华法林治疗。南希医生继续查看拉里的INR测试，给予患者指导，根据需要调整剂量，并下达了额外的测试。你将如何报告包括8次INR测量在内的最初90天的治疗？", + "A": "99363, 99471", + "B": "99214", + "C": "99363", + "D": "此服务与评估和管理服务捆绑在一起。" + } + }, + { + "id": "6cf46f34-4c87-5716-8c2b-735bab351c35", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Dr. Jane admitted a 67-year-old woman to the coronary care unit for an acute myocardial infarction. The admission included a comprehensive history, comprehensive examination, and high complexity decision-making. Dr. Jane visited the patient on days two and three and documented (each day) an expanded problem-focused examination and decision-making of moderate complexity. On day four, Dr. Jane moved the patient to the medical floor and documented a problem focused examination and straightforward decision-making. Day five, Dr. Jane discharged the patient to home. The discharge took over an hour. How would you report the services from day one to day five?", + "A": "99221, 99222, 99223, 99238", + "B": "99223, 99232, 99232, 99231, 99239", + "C": "99213, 99232, 99231, 99239 X 2", + "D": "99231, 99232, 99355, 99217" + }, + "zh": { + "question": "简医生将一名67岁的女性因急性心肌梗死收入冠心病监护病房。入院包括全面的病史、全面的检查和高复杂性决策。简医生在第二天和第三天探视了病人，并记录了（每天）扩展的问题导向检查和中等复杂性的决策。第四天，简医生将病人转移到普通病房，并记录了问题导向检查和简单的决策。第五天，简医生将病人出院回家。出院过程花费了一个多小时。你会如何报告从第一天到第五天的服务？", + "A": "99221, 99222, 99223, 99238", + "B": "99223, 99232, 99232, 99231, 99239", + "C": "99213, 99232, 99231, 99239 X 2", + "D": "99231, 99232, 99355, 99217" + } + }, + { + "id": "3ce89564-265e-5a15-ba21-40a0416c9a89", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which code range would describe services for a critically ill patient who is 23 days old?", + "A": "99238-99239", + "B": "99477-99480", + "C": "99291-99292", + "D": "None of the above" + }, + "zh": { + "question": "哪个代码范围描述的是23天大的危重病人的服务？", + "A": "99238-99239", + "B": "99477-99480", + "C": "99291-99292", + "D": "以上都不是" + } + }, + { + "id": "ce613532-ee23-55c5-936e-586742d79910", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Mr. Johnson, a 38-year-old established patient is being seen for management of his hypertension, diabetes, and weight control. On his last visit, he was told he had a diabetic foot ulcer and needed to be hospitalized for this condition. He decided to get a second opinion and went to see Dr. Myers. This was the first time Dr. Myers had seen Mr. Johnson. Dr. Myers documented a comprehensive history, comprehensive examination, and decision-making of high complexity. He concurred with hospitalization for the foot ulcer and sent a report back to Mr. Johnson's primary care doctor. How would you report Dr. Myers visit?", + "A": "99255", + "B": "99215", + "C": "99205", + "D": "99245" + }, + "zh": { + "question": "38岁的老病人约翰逊先生因高血压、糖尿病和体重控制问题就诊。在上次就诊时，他被告知患有糖尿病足溃疡，需要住院治疗。他决定寻求第二意见，去看了迈尔斯医生。这是迈尔斯医生第一次见到约翰逊先生。迈尔斯医生记录了全面的病史、全面的检查和高复杂性的决策。他同意因足溃疡住院，并将报告发送回约翰逊先生的初级保健医生。你会如何报告迈尔斯医生的就诊？", + "A": "99255", + "B": "99215", + "C": "99205", + "D": "99245" + } + }, + { + "id": "6b8f3f3a-1eb7-5c20-9fdc-b9515dd6c07e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Code for the supervision by a control physician of interfacility transport care of the critically ill or critically injured pediatric patient, 24 months of age or younger, includes two-way communication with transport team before transport, at the referring facility and during the transport, including data interpretation and report; first 30 minutes.", + "A": "99486", + "B": "99487", + "C": "99485", + "D": "99488" + }, + "zh": { + "question": "对24个月或以下的危重病或重伤儿科患者进行院际运输护理的控制医生监督的代码，包括在运输前、转诊机构和运输期间与运输团队的双向沟通，包括数据解释和报告；前30分钟。", + "A": "99486", + "B": "99487", + "C": "99485", + "D": "99488" + } + }, + { + "id": "35a47a19-4281-51c0-aed4-d11d727d3542", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Lucus, a three-year-old new patient is seen for a well-child examination. The doctor documents an age appropriate history, examination, anticipatory guidelines, risk factor reduction intervention, and indicates Lucus' immunizations are up to date. How  would you report this service?", + "A": "99392", + "B": "99213-25,99385", + "C": "99203", + "D": "99382" + }, + "zh": { + "question": "Lucus 是一名三岁的新患者，进行儿童健康检查。医生记录了符合年龄的病史、检查、预期指导、风险因素减少干预，并指出 Lucus 的免疫接种是最新的。你会如何报告这项服务？", + "A": "99392", + "B": "99213-25,99385", + "C": "99203", + "D": "99382" + } + }, + { + "id": "23bdf05d-fa18-57db-9fb8-d175067c17e8", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "An anesthesiologist provides general anesthesia for a 72-year-old patient with mild systemic disease who is undergoing a ventral hernia repair. How would you report the anesthesia service?", + "A": "00834-P2, 99100", + "B": "00832", + "C": "43560, 00834, 91000-P2", + "D": "00832-P2, 99100" + }, + "zh": { + "question": "一名麻醉医师为一位患有轻度全身性疾病的72岁患者提供全身麻醉，该患者正在接受腹壁疝修补手术。你会如何报告麻醉服务？", + "A": "00834-P2, 99100", + "B": "00832", + "C": "43560, 00834, 91000-P2", + "D": "00832-P2, 99100" + } + }, + { + "id": "8a1fba05-567f-5f37-85f7-3678f5ecac3a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Dr. Member performed a transesophageal echocardiography for a congenital cardiac condition on a 16-year-old patient. Prior to the probe placement, moderate conscious sedation was administered. The probe was placed, images acquired, interpretation and reports were completed in the provider's office. This procedure lasted 45 minutes. What code(s) capture the services performed by Dr. Member?", + "A": "93315-P1", + "B": "00320, 99144, 99145", + "C": "93315,99144, 99145", + "D": "93315" + }, + "zh": { + "question": "成员医生为一名16岁的患者进行了经食道超声心动图检查，以诊断先天性心脏病。在放置探头之前，进行了中度意识镇静。探头放置后，获取图像，完成解释和报告，整个过程在医生办公室进行。该程序持续了45分钟。哪个代码捕捉到了成员医生所执行的服务？", + "A": "93315-P1", + "B": "00320, 99144, 99145", + "C": "93315,99144, 99145", + "D": "93315" + } + }, + { + "id": "28e9ebed-1bbd-5242-a5ea-d708ed9ff6e2", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A surgeon performed a cervical approach esophagoplasty with repair of a tracheoesophageal fistula under general anesthesia. The surgeon performed both the procedure and the anesthesia. How would you report these service?", + "A": "00500, 43305", + "B": "00500-47", + "C": "Both A and C", + "D": "43305-47" + }, + "zh": { + "question": "一名外科医生在全身麻醉下进行了颈部入路食管成形术并修复了气管食管瘘。外科医生同时进行了手术和麻醉。你会如何报告这些服务？", + "A": "00500, 43305", + "B": "00500-47", + "C": "A和C都包括", + "D": "43305-47" + } + }, + { + "id": "c091b8d9-31e0-57d2-841a-06ac7d3d5afb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which service is not included with anesthesia services?", + "A": "Swan-Ganz monitoring.", + "B": "Blood pressure", + "C": "Mass spectrometry.", + "D": "Administration of blood" + }, + "zh": { + "question": "哪项服务不包括在麻醉服务中？", + "A": "Swan-Ganz 监测。", + "B": "血压", + "C": "质谱分析。", + "D": "输血" + } + }, + { + "id": "d896e799-6ddd-55b6-bba0-d2d4c80dbb4e", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A patient was placed under general anesthesia for a simple incision and removal of a foreign body from the subcutaneous tissue. This procedure usually required local anesthesia. Due to unusual circumstances, which required general anesthesia, what modifier would best describe this situation?", + "A": "22", + "B": "P6", + "C": "23", + "D": "47" + }, + "zh": { + "question": "一名患者在全身麻醉下进行简单的切开手术并从皮下组织中取出异物。该手术通常需要局部麻醉。由于特殊情况需要全身麻醉，哪个修饰符最能描述这种情况？", + "A": "22", + "B": "P6", + "C": "23", + "D": "47" + } + }, + { + "id": "65e7894e-7f70-5247-9cdc-b0ba0a51d07f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Erin, a 45-year-old, asymptomatic female comes in for her annual bilateral screening mammography. Her physician ordered a computer aided detection along with the mammography. The procedure was performed in a hospital. How would you report the professional services for this study?", + "A": "77057, 77052-51", + "B": "77057-26, 77052-26", + "C": "77059-26, 77057-51", + "D": "77056-26. 77051-26-59" + }, + "zh": { + "question": "45岁的Erin是一名无症状女性，前来进行年度双侧筛查性乳房X光检查。她的医生要求在乳房X光检查的同时进行计算机辅助检测。该程序是在医院进行的。您将如何报告此研究的专业服务？", + "A": "77057, 77052-51", + "B": "77057-26, 77052-26", + "C": "77059-26, 77057-51", + "D": "77056-26. 77051-26-59" + } + }, + { + "id": "99c29594-5626-5ebb-8f66-bd691a7b1060", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient presents to a freestanding radiology center and had ultrasonic guidance needle placement with imaging supervision and interpretation of two separate lesions in the left breast. The procedure required several passes to complete. How would you report the imaging procedure?", + "A": "76930 X 2", + "B": "76942 x 2-LT", + "C": "76941", + "D": "76942-LT" + }, + "zh": { + "question": "一名患者来到一个独立的放射中心，进行了超声引导下的针定位，并对左乳房的两个独立病灶进行了影像监督和解释。该程序需要多次穿刺才能完成。你将如何报告���像程序？", + "A": "76930 X 2", + "B": "76942 x 2-LT", + "C": "76941", + "D": "76942-LT" + } + }, + { + "id": "1e973c0b-265e-5d69-8b00-504d4493152b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Sally had a DXA bone density study for her hips, pelvis, and spine. The procedure was performed in a hospital. How would you report for the professional services of this study?", + "A": "77082-26", + "B": "77078-26, 77080-26", + "C": "77080-26", + "D": "77081-26, 77080-26" + }, + "zh": { + "question": "萨莉进行了髋部、骨盆和脊柱的DXA骨密度检查。该程序是在医院进行的。您将如何报告此研究的专业服务？", + "A": "77082-26", + "B": "77078-26, 77080-26", + "C": "77080-26", + "D": "77081-26, 77080-26" + } + }, + { + "id": "ffb8a398-359e-5e54-a100-ae3cbc9b87cb", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How is proton beam treatment delivery defined?", + "A": "Simple, Complex, and Compound", + "B": "Simple, Complicated, and Comprehensive", + "C": "Superficial, Deep Vein, and Distal.", + "D": "Simple, Complex, and Intermediate" + }, + "zh": { + "question": "质子束治疗的递送如何定义？", + "A": "简单、复杂和复合", + "B": "简单、复杂和全面", + "C": "浅表、深静脉和远端", + "D": "简单、复杂和中等" + } + }, + { + "id": "8de8e3c0-e2a5-5812-a7ef-caa8ffdc9cc4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How does cardiac magnetic imaging differ from a traditional MRI?", + "A": "In its ability to provide only a one dimensional view of the heart.", + "B": "In its ability to provide a physiologic evaluation of cardiac function.", + "C": "In its ability to provide a measurement of the cardiac output.", + "D": "In its ability to provide only mapping points for cardiac regurgitation." + }, + "zh": { + "question": "心脏磁共振成像与传统MRI有何不同？", + "A": "在其只能提供心脏的一维视图的能力上。", + "B": "在其能够提供心脏功能生理评估的能力上。", + "C": "在其能够提供心输出量测量的能力上。", + "D": "在其只能提供心脏返流映射点的能力上。" + } + }, + { + "id": "27f9f127-54a6-53d0-929a-e3d93eca44ab", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Jim has received brachytherapy, complex at a free-standing oncology center. What code(s) report this service?", + "A": "77778", + "B": "77761 X 2", + "C": "77799", + "D": "77776" + }, + "zh": { + "question": "吉姆在一个独立的肿瘤中心接受了复杂的近距离放射治疗。哪个代码报告了这项服务？", + "A": "77778", + "B": "77761 X 2", + "C": "77799", + "D": "77776" + } + }, + { + "id": "c0ba4a53-05e8-51ac-b39c-c81bd426a91f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the correct CPT description of code 78135?", + "A": "Differential organ/tissue kinetics (e.g., splentic and/or hepatic sequestration)", + "B": "Red cell survival study; Differential organ/tissue kinetic (e.g., splentic and/or hepatic sequestration)", + "C": "Bone marrow imaging; limited area", + "D": "None of the above" + }, + "zh": { + "question": "代码78135的正确CPT描述是什么？", + "A": "差异性器官/组织动力学（例如，脾脏和/或肝脏隔离）", + "B": "红细胞存活研究；差异性器官/组织动力学（例如，脾脏和/或肝脏隔离）", + "C": "骨髓成像；有限区域", + "D": "以上都不是" + } + }, + { + "id": "6833da00-a47f-5fbc-9a01-060120df465a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Code for oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm reported as a risk score.", + "A": "81506", + "B": "81500", + "C": "81503", + "D": "81508" + }, + "zh": { + "question": "肿瘤学（卵巢）的代码，利用血清进行两种蛋白质（CA-125和HE4）的生化测定，结合绝经状态，算法报告为风险评分。", + "A": "81506", + "B": "81500", + "C": "81503", + "D": "81508" + } + }, + { + "id": "7585db12-3dd0-5722-a0bb-7e50462a3a9c", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Dr. Lee performed an intra-operative consultation on a bile duct tumor requiring frozen section and cytological evaluation to a bladder tumor. How would you report his professional services?", + "A": "88331-26, 88334-26", + "B": "88331, 88332 X 2", + "C": "88329", + "D": "88331-26, 88333-26" + }, + "zh": { + "question": "李医生对胆管肿瘤进行了术中会诊，需要进行冰冻切片和膀胱肿瘤的细胞学评估。您将如何报告他的专业服务？", + "A": "88331-26, 88334-26", + "B": "88331, 88332 X 2", + "C": "88329", + "D": "88331-26, 88333-26" + } + }, + { + "id": "1a774616-de04-56a9-8277-3df14f8c2cc2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which modifier would you use to report with code 88239 if the test was looking for hereditary breast cancer?", + "A": "OA", + "B": "59", + "C": "OB", + "D": "91" + }, + "zh": { + "question": "如果测试是寻找遗传性乳腺癌，使用代码88239时应使用哪个修饰符？", + "A": "OA", + "B": "59", + "C": "OB", + "D": "91" + } + }, + { + "id": "af29141d-b029-50ef-b44c-1ec1f0d88cdd", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the MAIN component of Soda-lime?", + "A": "CaOH", + "B": "NaOH", + "C": "KOH", + "D": "H2O" + }, + "zh": { + "question": "苏打石灰的主要成分是什么？", + "A": "CaOH", + "B": "NaOH", + "C": "KOH", + "D": "H2O" + } + }, + { + "id": "aa49d116-0f71-59cb-a370-ed2a429c3cd3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the biggest concern when working in an operating room using lasers?", + "A": "Bathroom breaks because laser surgeries are very long", + "B": "Looking cool in whatever color glasses you are wearing", + "C": "What music the surgeon is playing", + "D": "Patient and Staff eye protection" + }, + "zh": { + "question": "在使用激光的手术室工作时，最大的关注是什么？", + "A": "上厕所，因为激光手术时间很长", + "B": "无论戴什么颜色的眼镜都很酷", + "C": "外科医生播放的音乐", + "D": "患者和工作人员的眼睛保护" + } + }, + { + "id": "a1621646-fd86-56a4-b99c-5d6ef1e31c58", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Flow through tubes is primarily dependent upon ___1____ , Flow through orifices is primarily dependent upon ____2____.", + "A": "Density, Viscosity", + "B": "Radius of tube, Radius of orifice", + "C": "Viscosity, Density", + "D": "Length of tube, length of orifice" + }, + "zh": { + "question": "管道内的流动主要取决于___1____，孔口的流动主要取决于____2____。", + "A": "密度，粘度", + "B": "管道半径，孔口半径", + "C": "粘度，密度", + "D": "管道长度，孔口长度" + } + }, + { + "id": "24cb7b8f-b9b7-5ab8-b901-55b235c8f0a0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What are the measurement units used to define Macroshock?", + "A": "Volts", + "B": "Ampere", + "C": "Milliampere (mA)", + "D": "Hertz" + }, + "zh": { + "question": "用于定义宏电击的测量单位是什么？", + "A": "伏特", + "B": "安培", + "C": "毫安 (mA)", + "D": "赫兹" + } + }, + { + "id": "7daac878-566e-5dd9-9c2c-a58b35458a35", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What does Boyle's law state?", + "A": "At a constant volume, the pressure of a gas is directly proportional to the temperature.", + "B": "The amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas over the liquid and indirectly proportional to temperature.", + "C": "At a constant temperature, the volume of a gas varies inversely with the pressure.", + "D": "The total pressure of a mixture of gases in a closed container at a given temperature is equal to the sum of the pressure that each gas exerts" + }, + "zh": { + "question": "波义耳定律的内容是什么？", + "A": "在恒定体积下，气体的压力与温度成正比。", + "B": "溶解在液体中的气体量与气体在液体上方的分压成正比，与温度成反比。", + "C": "在恒定温度下，气体的体积与压力成反比。", + "D": "在给定温度下，密闭容器中气体混合物的总压力等于每种气体所施加压力的总和。" + } + }, + { + "id": "760e3a32-b76d-5642-ba2f-53c9efe637e4", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "During your pre-op assessment, you find your pt has pulmonary edema. How will this affect the Diffusion of your gases?", + "A": "Increase Distance across membrane, and Increase diffusion", + "B": "Increase Distance across membrane and decrease diffusion", + "C": "Decrease distance across membrane and increase diffusion.", + "D": "Decrease distance across membrane and decrease diffusion." + }, + "zh": { + "question": "在术前评估中，你发现病人有肺水肿。这将如何影响气体的扩散？", + "A": "增加膜的距离，增加扩散", + "B": "增加膜的距离，减少扩散", + "C": "减少膜的距离，增加扩散", + "D": "减少膜的距离，减少扩散" + } + }, + { + "id": "e9316c71-17fe-5a12-962a-132514b3acf7", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "You are going to do a peripheral nerve block on a patient and are using Ultrasound to assist you. What would you want to use on your Ultrasound?", + "A": "Low Frequency to produce a high resolution", + "B": "High frequency to produce a high resolution", + "C": "Low frequency to penetrate deep into tissue", + "D": "High frequency to penetrate deep into tissue" + }, + "zh": { + "question": "您准备对一名患者进行外周神经阻滞，并使用超声波来辅助。您希望在超声波上使用什么？", + "A": "低频以产生高分辨率", + "B": "高频以产生高分辨率", + "C": "低频以深入穿透组织", + "D": "高频以深入穿透组织" + } + }, + { + "id": "3c4ac451-c3ad-50d7-aa96-e5d80b33a1d6", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "When in the middle of a case your CO2 absorbent turns purple. What would you do?", + "A": "Change the canister, to get rid of exhausted CO2 absorber", + "B": "Kiss their forehead and wish them the best of luck", + "C": "Increase Fresh Gas Flow, to compensate for exhausted CO2 absorbent", + "D": "Increase their Respiratory rate to blow off excess CO2" + }, + "zh": { + "question": "在手术过程中，如果你的CO2吸收剂变成紫色，你会怎么做？", + "A": "更换罐子，以去除耗尽的CO2吸收剂", + "B": "亲吻他们的额头并祝他们好运", + "C": "增加新鲜气体流量，以补偿耗尽的CO2吸收剂", + "D": "增加呼吸频率以排出多余的CO2" + } + }, + { + "id": "042e38c5-3ea7-523d-bd8b-06e743d850cc", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "Which statement best defines diffusion?", + "A": "When the numbers of molecules entering and exiting the liquid phase become equal.", + "B": "The movement of SOLVENT ONLY across a semipermeable membrane from an area of low concentration, to an area of high concentration", + "C": "The movement of SOLVENT & SOLUTE across a permeable membrane from an area of high concentration to an area of low concentration" + }, + "zh": { + "question": "哪种说法最好地定义了扩散？", + "A": "当进入和退出液相的分子数量相等时。", + "B": "溶剂仅通过半透膜从低浓度区域移动到高浓度区域", + "C": "溶剂和溶质通过可渗透膜从高浓度区域移动到低浓度区域" + } + }, + { + "id": "f27264c8-7fba-5965-bba2-1bcfd6fd8bae", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Give an Example of a colloid.", + "A": "0.9 NS", + "B": "Cough Syrup", + "C": "Hespan", + "D": "Lactated ringers" + }, + "zh": { + "question": "举例说明一种胶体。", + "A": "0.9% 生理盐水", + "B": "止咳糖浆", + "C": "Hespan", + "D": "乳酸林格氏液" + } + }, + { + "id": "774f6093-bacb-56d2-8d54-46e3cdb89c28", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the range of frequency we use for Ultrasound equipment?", + "A": "0 - 20 Hz", + "B": "20 Hz- 20 KHz", + "C": "20 - 200 Khz", + "D": "1- 15 MHz" + }, + "zh": { + "question": "我们使用的超声设备的频率范围是多少？", + "A": "0 - 20 Hz", + "B": "20 Hz- 20 KHz", + "C": "20 - 200 KHz", + "D": "1- 15 MHz" + } + }, + { + "id": "8336c504-51ad-5675-9646-59339bb89929", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "When would hypothermia be useful intra-operatively?", + "A": "During a debridement of a Burn patient", + "B": "To decrease morbidity by decreasing risk of developing coagulopathies", + "C": "During a major Neurologic surgery to reduce CBF & cerebral metabolic requirement", + "D": "To increase GFR and speed up recovery" + }, + "zh": { + "question": "什么时候在术中使用低温是有益的？", + "A": "在烧伤患者的清创过程中", + "B": "通过降低发生凝血功能障碍的风险来减少发病率", + "C": "在重大神经外科手术中以减少脑血流量和脑代谢需求", + "D": "增加肾小球滤过率并加快恢复速度" + } + }, + { + "id": "36399cd7-c583-5330-bd55-7df2e05bed39", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following facilitates the flow of electrons?", + "A": "Inductance", + "B": "Capacitance", + "C": "Insulators", + "D": "Reflection" + }, + "zh": { + "question": "下列哪项有助于电子流动？", + "A": "电感", + "B": "电容", + "C": "绝缘体", + "D": "反射" + } + }, + { + "id": "e6725f63-8cf6-51ff-a4f4-f52b8e85e301", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A Hypotonic solution may do what to the cells of the body?", + "A": "The cell to shrink", + "B": "Nothing, the osmolar pressures are equal", + "C": "The cell to become really muscular", + "D": "The cell swells, and burst" + }, + "zh": { + "question": "低渗溶液可能对身体的细胞产生什么影响？", + "A": "细胞收缩", + "B": "没有影响，渗透压相等", + "C": "细胞变得非常肌肉发达", + "D": "细胞膨胀并破裂" + } + }, + { + "id": "42af13a4-9d1e-53c7-9ad9-c9b5b08a2da9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which type of solution will precipitate upon cooling?", + "A": "Saturated", + "B": "Super Saturated", + "C": "Unsaturated", + "D": "Super Unsaturated" + }, + "zh": { + "question": "哪种类型的溶液在冷却时会沉淀？", + "A": "饱和", + "B": "过饱和", + "C": "不饱和", + "D": "超不饱和" + } + }, + { + "id": "7cedceba-ea9d-5158-8952-8a0494437398", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Define Acoustic Impedence:", + "A": "Loss of strength of sound waves as they ravel through a medium.", + "B": "Refers to mediums resistance to vibrate os the sound waves strike it. The higher this is, the more resistance to vibration.", + "C": "The rate in one second at which an AC current changed direction", + "D": "The quality of an ultrasound picture." + }, + "zh": { + "question": "定义声阻抗：", + "A": "声波在介质中传播时强度的损失。", + "B": "指介质对声波撞击时振动的阻力。阻力越大，振动的阻力越大。", + "C": "交流电流在一秒钟内改变方向的速率。", + "D": "超声波图像的质量。" + } + }, + { + "id": "56405859-a9ff-5be3-b6b8-ce8da8f14aca", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "When choosing an IV gauge, you want to choose a larger bore IV in order to increase the radius of the tube and thereby increase flow. This is an example of which law?", + "A": "Poiseuille’s Law", + "B": "Dalton’s Law", + "C": "Bernoulli’s Law", + "D": "Charles Law" + }, + "zh": { + "question": "在选择静脉注射针规时，您希望选择一个较大的针孔，以增加管子的半径，从而增加流量。这是哪个定律的例子？", + "A": "泊肃叶定律", + "B": "道尔顿定律", + "C": "伯努利定律", + "D": "查理定律" + } + }, + { + "id": "fbe03295-4ce7-5c42-a61a-0a0bfc281ed0", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "At sea level, the volume of a gas is 800ml. If you decrease the atmospheric pressure to 608 mm Hg what will the volume of gas be now?", + "A": "1200 ml", + "B": "1600 ml", + "C": "1000 ml", + "D": "640 ml" + }, + "zh": { + "question": "在海平面上，气体的体积是800毫升。如果将大气压降低到608毫米汞柱，现在气体的体积将是多少？", + "A": "1200 毫升", + "B": "1600 毫升", + "C": "1000 毫升", + "D": "640 毫升" + } + }, + { + "id": "0a7a2f0b-a9a6-5daa-9831-fd6487e5de6c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is NOT a method of heat transfer?", + "A": "Convection", + "B": "Condensation", + "C": "Radiation", + "D": "Conduction" + }, + "zh": { + "question": "以下哪一项不是热传递的方法？", + "A": "对流", + "B": "凝结", + "C": "辐射", + "D": "传导" + } + }, + { + "id": "009ec42e-7116-5758-b46c-d0fd218367fe", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "At 20 C the pressure inside your cylinder is 800 psi. If you increase your temp to 30 C what will your pressure be?", + "A": "400 psi", + "B": "1600 psi", + "C": "530 psi", + "D": "1200 psi" + }, + "zh": { + "question": "在20摄氏度时，气瓶内的压力是800 psi。如果温度升高到30摄氏度，压力会是多少？", + "A": "400 psi", + "B": "1600 psi", + "C": "530 psi", + "D": "1200 psi" + } + }, + { + "id": "b3b08ab9-ef49-5afe-9a16-f1628c940652", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The Sagittal plane divides the body into", + "A": "Left and Right", + "B": "Superior and Inferior", + "C": "Anterior and Posterior", + "D": "Right and Wrong" + }, + "zh": { + "question": "矢状面将身体分为", + "A": "左和右", + "B": "上和下", + "C": "前和后", + "D": "对和错" + } + }, + { + "id": "eead570f-c7b5-50c8-83f2-f1154c66bc28", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What harmful substance is Desflurane known to cause more than other anesthetic agents upon a breakdown in a CO2 absorber?", + "A": "Trifluoroacetylic acid", + "B": "Compound A", + "C": "Your gramma's perfume", + "D": "Carbon Monoxide" + }, + "zh": { + "question": "与其他麻醉剂相比，地氟烷在CO2吸收器中分解时更容易产生哪种有害物质？", + "A": "三氟乙酸", + "B": "化合物A", + "C": "你奶奶的香水", + "D": "一氧化碳" + } + }, + { + "id": "f3b791c0-dcc7-58c2-ba80-4c02d6822dfd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is a good example of Graham's Law in Anesthesia practice?", + "A": "The Venturi Mask effect where increasing velocity of flow decreases pressure exerted on walls of tube.", + "B": "Being aware of how air flows through larger (turbulent) and smaller (laminar) airways within lungs.", + "C": "Determining the partial pressure of O2 in a cylinder of air.", + "D": "Realizing that CO2 diffuses 20x faster than O2 due to increased solubility of CO2." + }, + "zh": { + "question": "在麻醉实践中，格雷厄姆定律的一个好例子是什么？", + "A": "Venturi 面罩效应，其中流速增加会降低对管壁的压力。", + "B": "了解空气如何通过肺内较大的（湍流）和较小的（层流）气道流动。", + "C": "确定气瓶中氧气的分压。", + "D": "意识到由于 CO2 的溶解度增加，CO2 的扩散速度比 O2 快 20 倍。" + } + }, + { + "id": "fb6f6254-dfba-5a59-8788-0a626fdd14a4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the simplest way to tell when your CO2 absorber is exhausted?", + "A": "Increasing ETCO2 in your patient", + "B": "During your AM machine check", + "C": "The absorbent will turn a deep purple color", + "D": "An alarm will sound to alert of absorbent exhaustion" + }, + "zh": { + "question": "判断CO2吸收剂耗尽的最简单方法是什么？", + "A": "患者的呼气末二氧化碳（ETCO2）增加", + "B": "在早晨机器检查时", + "C": "吸收剂会变成深紫色", + "D": "会有警报声提示吸收剂耗尽" + } + }, + { + "id": "a199e0a4-ba27-51e6-a4dc-a0a094ca19eb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is a Microshock?", + "A": "Occurs only in susceptible pateints where there is a direct connection between the heart and extrenal environment.", + "B": "An electrical shock that is very small, like static electricity.", + "C": "Gross current shock applied to surface of body.", + "D": "A Electrical shock that is mostly aborbed by tissues of body with minimal electrical shock going to the heart." + }, + "zh": { + "question": "什么是微电击？", + "A": "仅发生在易感患者中，心脏与外部环境之间有直接连接。", + "B": "非常小的电击，如静电。", + "C": "施加于身体表面的强电流电击。", + "D": "一种电击，大部分被身体组织吸收，只有极少量电流到达心脏。" + } + }, + { + "id": "75393ca0-82ae-50ce-bf2f-b2187e6cc404", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What does Gay-Lusaac's law state?", + "A": "At a constant volume, the pressure of a gas is directly proportional to the temperature.", + "B": "The amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas over the liquid and indirectly proportional to temperature.", + "C": "At a constant temperature, the volume of a gas varies inversely with the pressure.", + "D": "The total pressure of a mixture of gases in a closed container at a given temperature is equal to the sum of the pressure that each gas exerts." + }, + "zh": { + "question": "盖-吕萨克定律表述了什么？", + "A": "在恒定体积下，气体的压力与温度成正比。", + "B": "溶解在液体中的气体量与气体在液体上方的分压成正比，与温度成反比。", + "C": "在恒定温度下，气体的体积与压力成反比。", + "D": "在给定温度下，密闭容器中气体混合物的总压力等于每种气体所施加压力的总和。" + } + }, + { + "id": "01d660c0-0573-5056-bd44-adb1e499ed30", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "Which statement is NOT TRUE about water?", + "A": "It is considered to be the universal solvent", + "B": "Heat increases density", + "C": "Cooling increases density" + }, + "zh": { + "question": "关于水，哪个说法是不正确的？", + "A": "它被认为是通用溶剂", + "B": "加热会增加密度", + "C": "冷却会增加密度" + } + }, + { + "id": "991a5d64-62f3-5fcd-a152-ef48dfdf984f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following involves movement of a SOLVENT ONLY across a semi permeable membrane?", + "A": "Osmosis", + "B": "Diffusion", + "C": "Oncotic Pressure", + "D": "Hypnosis" + }, + "zh": { + "question": "以下哪项仅涉及溶剂通过半透膜的移动？", + "A": "渗透作用", + "B": "扩散", + "C": "胶体渗透压", + "D": "催眠" + } + }, + { + "id": "f7f5b5de-09ff-5611-8732-b113ef9c62bf", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "At room temp (20 C ) and at sea level the pressure reading on your O2 tank is 750 psi. There is a drastic change in temperature and now your tank reads 1275 psi. What temperature is it?", + "A": "30 C", + "B": "34 C", + "C": "12 C", + "D": "40 C" + }, + "zh": { + "question": "在室温（20°C）和海平面时，你的氧气罐的压力读数是750 psi。温度发生了剧烈变化，现在你的罐子读数是1275 psi。现在的温度是多少？", + "A": "30°C", + "B": "34°C", + "C": "12°C", + "D": "40°C" + } + }, + { + "id": "e2f6a333-a471-5838-aff0-59482d40ef79", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What agent revolutionized anesthesia in 1846?", + "A": "Cocaine", + "B": "Cannabis", + "C": "Diethyl Ether", + "D": "Propane" + }, + "zh": { + "question": "哪种药剂在1846年彻底改变了麻醉学？", + "A": "可卡因", + "B": "大麻", + "C": "乙醚", + "D": "丙烷" + } + }, + { + "id": "63da2bde-caaf-54f9-a033-9c410b615bc9", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The three basic phases of anesthesia.", + "A": "Pre medication, intubation, O2", + "B": "Induction,Emergence, Awakening", + "C": "IV, Intubation,Emergence", + "D": "Induction, Maintenace, Emergence" + }, + "zh": { + "question": "麻醉的三个基本阶段。", + "A": "术前用药、插管、氧气", + "B": "诱导、苏醒、觉醒", + "C": "静脉注射、插管、苏醒", + "D": "诱导、维持、苏醒" + } + }, + { + "id": "b24c1278-e3e9-5fea-a1f3-d94ba446ff8f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Name a neuromuscular blocking agent.", + "A": "Rocuranium", + "B": "Fentanyl", + "C": "Neostigmine", + "D": "Ketamine" + }, + "zh": { + "question": "请列举一种神经肌肉阻滞剂。", + "A": "罗库溴铵", + "B": "芬太尼", + "C": "新斯的明", + "D": "氯胺酮" + } + }, + { + "id": "111b8f51-28d0-59fc-901a-608a5e274f8b", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Muscle strength returns in reverse, smaller ones( eyelid muscles) regain strength last.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "肌肉力量的恢复是逆向的，较小的肌肉（如眼睑肌肉）最后恢复力量。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "63db2f1d-c965-5316-83c7-207165a773f4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Name two pharmaceutical methods that were somewhat effective for pain management before 1846.", + "A": "Alcohol & Tea", + "B": "Canabis & Coffee", + "C": "Alcohol & Cocaine", + "D": "Opium and Plums" + }, + "zh": { + "question": "在1846年之前，有哪两种药物方法对疼痛管理有一定效果？", + "A": "酒精和茶", + "B": "大麻和咖啡", + "C": "酒精和可卡因", + "D": "鸦片和李子" + } + }, + { + "id": "af42e013-658a-5fb5-b3cc-3ee6eabc4a97", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The Triad of Anesthesia include following, Except", + "A": "Analgesia", + "B": "Sleep / Hypnosis", + "C": "Muscle Relaxation", + "D": "Memory Loss", + "E": "Non of Above" + }, + "zh": { + "question": "麻醉三联征包括以下内容，除了", + "A": "镇痛", + "B": "睡眠/催眠", + "C": "肌肉松弛", + "D": "记忆丧失", + "E": "以上都不是" + } + }, + { + "id": "54f49e75-add5-5944-96d6-3041a7dc4bca", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "For Obese Patients,\nWhen used in overweight or obese patients (defined as patients with a body weight of 30% or more above ideal body weight) doses should be reduced taking into account ideal body weight.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "对于肥胖患者，使用在超重或肥胖患者（定义为体重超过理想体重30%或以上的患者）时，剂量应根据理想体重进行减少。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "b5d12a4a-91d6-5502-8c88-3b4e43218117", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Acetylcholine is one of the most important Neurotransmitters, made up of Acetyl Co-A and Choline Molecules.\nWhich of the following is it's the site of release, at Neuromuscular junction?", + "A": "Presynaptic Neuromuscular Vasicles", + "B": "Post-synaptic Nicotinic receptor sites", + "C": "Inter-synaptic Membrane", + "D": "I dont know", + "E": "All of Above" + }, + "zh": { + "question": "乙酰胆碱是最重要的神经递质之一，由乙酰辅酶A和胆碱分子组成。以下哪一项是它在神经肌肉接头处的释放部位？", + "A": "突触前神经肌肉小泡", + "B": "突触后烟碱受体位点", + "C": "突触间膜", + "D": "我不知道", + "E": "以上全部" + } + }, + { + "id": "595456eb-57f9-535c-8bea-1d5718b4f50a", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "For Maintenance dose of Rocuronium, \nThe recommended maintenance dose is 0.15 mg.kg-1 rocuronium bromide; in the case of long-term inhalational anesthesia, this should be reduced to 0.075-0.1 mg.kg-1 rocuronium bromide. The maintenance doses should best be given when twitch height has recovered to 25% of control twitch height, or when 2 to 3 responses to a train of four stimulation are present.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "关于罗库溴铵的维持剂量，推荐的维持剂量是0.15 mg.kg-1罗库溴铵；在长期吸入麻醉的情况下，应减少至0.075-0.1 mg.kg-1罗库溴铵。维持剂量最好在抽搐高度恢复到对照抽搐高度的25%时给药，或者在四连刺激有2到3次反应时给药。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "eef02949-1bf1-5d9f-b3c8-502117911010", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Following are the routes of Anesthesia, Except", + "A": "Intravenous Anesthesia", + "B": "Inhalation Anesthesia", + "C": "Oral Anesthesia", + "D": "Total Intravenous Anesthesia", + "E": "Non of Above" + }, + "zh": { + "question": "以下是麻醉的途径，除了", + "A": "静脉麻醉", + "B": "吸入麻醉", + "C": "口服麻醉", + "D": "全静脉麻醉", + "E": "以上都不是" + } + }, + { + "id": "13fdbe57-5b6d-5031-9563-d9bcb52b6b59", + "choice_num": 6, + "answer": "A", + "level": 1, + "en": { + "question": "Total clinical Duration...", + "A": "Time (min) from end of injection till recovery of neuromuscular transmission (twitch height) to a level of 90% of control", + "B": "Time between start of injection and the first moment at which endotracheal intubation can be performed", + "C": "Time between end of injection and first mooment at which endotracheal intubation can be preformed", + "D": "Time (min) from start of injection till recovery of neuromuscular transmission (twitch height) to a level of 90% of control", + "E": "I dont Know", + "F": "Non of above" + }, + "zh": { + "question": "总临床持续时间……", + "A": "从注射结束到神经肌肉传导（抽搐高度）恢复到控制水平的90%的时间（分钟）", + "B": "从注射开始到可以进行气管插管的第一个时刻之间的时间", + "C": "从注射结束到可以进行气管插管的第一个时刻之间的时间", + "D": "从注射开始到神经肌肉传导（抽搐高度）恢复到控制水平的90%的时间（分钟）", + "E": "我不知道", + "F": "以上都不是" + } + }, + { + "id": "98e307f3-11fe-5155-b918-d343086e5cd3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Succinylcholine belongs to which of the following groups of Neuromuscular Blocking Agent.", + "A": "Aminosteroid NMBA", + "B": "Benzyllisoquinolines NMBA", + "C": "Depolarizing NMBA", + "D": "Non-Depolarizing NMBA" + }, + "zh": { + "question": "琥珀胆碱属于以下哪一组神经肌肉阻滞剂。", + "A": "氨基类甾体 NMBA", + "B": "苄基异喹啉类 NMBA", + "C": "去极化 NMBA", + "D": "非去极化 NMBA" + } + }, + { + "id": "e097e217-f999-5dc4-9d62-b1ae09baeb24", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "For Continuous Infusion of Rocuronium, \nIf rocuronium bromide is administered by continuous infusion, it is recommended to give a loading dose of 0.6 mg.kg-1 rocuronium bromide and, when neuromuscular block starts to recover, to start administration by \n\ninfusion. The infusion rate should be adjusted to maintain twitch response at 10% of control twitch height or to maintain 1 to 2 responses to train of four stimulation. In adults under intravenous anesthesia, the infusion rate required to maintain neuromuscular block at this level ranges from 0.3-0.6 mg.kg-1.h-1, and under inhalational anesthesia the infusion rate ranges from 0.3-0.4 mg.kg-1.h-1. Continuous monitoring of neuromuscular block is recommended since infusion rate requirements vary from patient to patient and with the anesthetic method used.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "关于罗库溴铵的持续输注，如果通过持续输注给药，建议给予0.6 mg.kg-1的负荷剂量，当神经肌肉阻滞开始恢复时，开始输注。输注速率应调整以维持抽搐反应在对照抽搐高度的10%或维持四联刺激的1到2次反应。在静脉麻醉下，维持这种水平的神经肌肉阻滞所需的输注速率为0.3-0.6 mg.kg-1.h-1，而在吸入麻醉下，输注速率为0.3-0.4 mg.kg-1.h-1。建议持续监测神经肌肉阻滞，因为输注速率的需求因患者和所用麻醉方法而异。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "64907339-480b-508b-b1e6-556b93013d86", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "According to American Society of Anesthesiologists, ASA-3 assign for the physical status who are;", + "A": "Patients with Mild Systemic Disease", + "B": "Normal Healthy Person with no significant illness or disability", + "C": "Patients with Severe uncontrolled medical problems that are life threatening", + "D": "Patients with severe systemic disease that effect their daily life but not life threatening", + "E": "A brain dead person being taken for Organ donation surgery" + }, + "zh": { + "question": "根据美国麻醉医师协会，ASA-3分配给以下哪种身体状况的人；", + "A": "患有轻度全身性疾病的患者", + "B": "没有重大疾病或残疾的正常健康人", + "C": "患有严重失控且危及生命的医疗问题的患者", + "D": "患有严重全身性疾病影响日常生活但不危及生命的患者", + "E": "被带去进行器官捐献手术的脑死亡者" + } + }, + { + "id": "2bab52a9-6d4f-5d56-9131-133fd5eabf6a", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "Select the Single best for Rocuronium:", + "A": "Rocuronium launched in 1977", + "B": "The experience with rocuronium bromide in rapid sequence induction in\npediatric patients is limited. Rocuronium bromide is therefore not\nrecommended for facilitating tracheal intubation conditions during rapid\nsequence induction in pediatric patients", + "C": "In pediatric population, Rocuronium is the only option for Anesthetist" + }, + "zh": { + "question": "选择关于罗库溴铵的最佳选项：", + "A": "罗库溴铵于1977年推出", + "B": "在快速序贯诱导中，罗库溴铵在儿科患者中的经验有限。因此，不推荐在儿科患者中使用罗库溴铵来促进气管插管条件", + "C": "在儿科人群中，罗库溴铵是麻醉师的唯一选择" + } + }, + { + "id": "70ce7af5-8c2b-5875-ac07-06403c20e1b6", + "choice_num": 6, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following are the Strengths of Cis-atracurium, Except", + "A": "Organ-independent elimination (less prolonged recovery in elderly and renal/hepatic impaired)", + "B": "No significant histamine release", + "C": "Slow onset", + "D": "Suitable for CV-unstable and atopic patients", + "E": "Ready to Use", + "F": "Non of Above" + }, + "zh": { + "question": "以下哪项不是顺式阿曲库铵的优点", + "A": "器官非依赖性消除（在老年人和肾/肝功能受损者中恢复时间较短）", + "B": "无显著组胺释放", + "C": "起效慢", + "D": "适合心血管不稳定和特应性患者", + "E": "即用型", + "F": "以上皆非" + } + }, + { + "id": "556edc7d-5ad7-5058-9559-a8a5b28e1909", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Types of Anesthesia.", + "A": "General Anesthesia", + "B": "Local Anesthesia", + "C": "Regional Anestehsia", + "D": "Spinal or Epidural Anesthesia", + "E": "All of Above" + }, + "zh": { + "question": "麻醉的类型。", + "A": "全身麻醉", + "B": "局部麻醉", + "C": "区域麻醉", + "D": "脊髓或硬膜外麻醉", + "E": "以上所有" + } + }, + { + "id": "54601bdd-d081-5a3e-9012-0844b893dd39", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The best explanation for Anesthesia is...", + "A": "Irreversible Loss of Feeling or Sensation in all parts of body", + "B": "Reversible Loss of Feeling or Sensation in part of body", + "C": "Reversible Loss of Feeling or Sensation in All or Part of Body", + "D": "All or Above" + }, + "zh": { + "question": "对麻醉的最佳解释是……", + "A": "身体所有部位感觉或知觉的不可逆丧失", + "B": "身体部分部位感觉或知觉的可逆丧失", + "C": "身体全部或部分部位感觉或知觉的可逆丧失", + "D": "以上所有" + } + }, + { + "id": "29b6625f-1d04-54a5-8943-ee1705c21fee", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Following are true for Rocuronium Bromide, Except.", + "A": "Indicated as adjunct to general anesthesia to facilitate routine Endotracheal Intubation to provide skeletal muscle relaxation during surgery or mechanical ventilation", + "B": "Indicated as adjunct to general anesthesia to facilitate Rapid Sequence Intubation to provide skeletal muscle relaxation during surgery or mechanical ventilation", + "C": "Rocuronium bromide is a nondepolarizing neuromuscular blocking agent with rapid to intermediate onset and an intermediate duration of action, depending on dose used", + "D": "Rocuronium has its effect on Conciousness, pain threshold, thinking ability and memory.", + "E": "Route of administration is Intravenous." + }, + "zh": { + "question": "以下关于溴化罗库溴铵的描述是正确的，除了。", + "A": "作为全身麻醉的辅助药物，用于常规气管插管，以在手术或机械通气期间提供骨骼肌松弛", + "B": "作为全身麻醉的辅助药物，用于快速序列插管，以在手术或机械通气期间提供骨骼肌松弛", + "C": "溴化罗库溴铵是一种非去极化神经肌肉阻滞剂，具有快速至中等起效时间和中等作用持续时间，具体取决于使用剂量", + "D": "罗库溴铵对意识、痛阈、思维能力和记忆有影响。", + "E": "给药途径为静脉注射。" + } + }, + { + "id": "7822395a-4aea-5bef-a2c1-834fb4c72ed9", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Unconsciousness occurs before MAC is reached.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "在达到MAC之前会发生无意识。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "9fef8640-fa8d-539a-8190-862b5a0c9e11", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "When does MAC not change?", + "A": "Between 20-60 years of age", + "B": "Between 5-20 years of age", + "C": "Between 20-65 years of age", + "D": "Between 10-20 years of age" + }, + "zh": { + "question": "在什么时候MAC不会改变？", + "A": "20-60岁之间", + "B": "5-20岁之间", + "C": "20-65岁之间", + "D": "10-20岁之间" + } + }, + { + "id": "23340af4-8623-52c7-8cb9-aae08360076c", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "MAC BAR is...", + "A": "1.5 MAC and opioids will increase MAC BAR", + "B": "0.3-0.4 MAC and opioids will decrease MAC BAR", + "C": "0.3-0.4 MAC and opioids will increase MAC BAR", + "D": "1.5 MAC and opioids will decrease MAC BAR" + }, + "zh": { + "question": "MAC BAR 是...", + "A": "1.5 MAC 和阿片类药物会增加 MAC BAR", + "B": "0.3-0.4 MAC 和阿片类药物会减少 MAC BAR", + "C": "0.3-0.4 MAC 和阿片类药物会增加 MAC BAR", + "D": "1.5 MAC 和阿片类药物会减少 MAC BAR" + } + }, + { + "id": "3b413562-0015-5e5b-9fc4-e07ee263bf19", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of these is MAC a measure of?", + "A": "Homeostasis", + "B": "Movement", + "C": "Analgesia", + "D": "Amnesia" + }, + "zh": { + "question": "MAC 是以下哪项的衡量标准？", + "A": "体内平衡", + "B": "运动", + "C": "镇痛", + "D": "遗忘" + } + }, + { + "id": "c5b5d180-b7e6-5f75-9cfe-4624e8281b1c", + "choice_num": 8, + "answer": "C", + "level": 1, + "en": { + "question": "Which of these does CAN change MAC?", + "A": "PaO2 >38 mmHg", + "B": "Sex", + "C": "Sodium levels", + "D": "Duration of anesthesia", + "E": "K/Mg levels", + "F": "PaCO2 15-95 mmHg", + "G": "Anesthetic metabolism", + "H": "Thyroid function" + }, + "zh": { + "question": "以下哪些因素可以改变MAC？", + "A": "PaO2 >38 mmHg", + "B": "性别", + "C": "钠水平", + "D": "麻醉持续时间", + "E": "钾/镁水平", + "F": "PaCO2 15-95 mmHg", + "G": "麻醉代谢", + "H": "甲状腺功能" + } + }, + { + "id": "51a843a4-5929-53d0-9d83-7047a22a46c1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Where do we have to block to get the movement, reflex, or withdrawal to pain reflexes to stop?", + "A": "Peripheral sensory nerves", + "B": "Spinal cord", + "C": "Cerebral cortex", + "D": "Brain stem" + }, + "zh": { + "question": "我们需要在哪里阻断才能使运动、反射或对疼痛的撤退反射停止？", + "A": "外周感觉神经", + "B": "脊髓", + "C": "大脑皮层", + "D": "脑干" + } + }, + { + "id": "308c82e8-cb99-51fd-abc0-1a59562b1da0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Choose the correct statement.", + "A": "Inhaled anesthetics do NOT block SSEPs (stimulus in periphery still reaches cortex).", + "B": "All of these statements are correct.", + "C": "Inhaled aneshetics will not stop hyperalgesia, will not work for pre-emptive analgesia.", + "D": "Peripheral sensory receptors are NOT affected by inhalation agents." + }, + "zh": { + "question": "选择正确的陈述。", + "A": "吸入麻醉剂不会阻断SSEP（外周的刺激仍然到达大脑皮层）。", + "B": "所有这些陈述都是正确的。", + "C": "吸入麻醉剂不会停止痛觉过敏，也不适用于预防性镇痛。", + "D": "外周感觉受体不受吸入剂的影响。" + } + }, + { + "id": "fb08dcb2-d7e3-5f1a-9e33-21cf89bb0067", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Duration of anesthesia can change MAC.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "麻醉持续时间可以改变MAC。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "a35cf18d-8e92-56df-9b38-73f73b7be4fb", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of these is NOT a characteristic of MAC?", + "A": "\"Free drug\" is measured in plasma concentrations rather than partial pressure or %", + "B": "Monitored breath by breath, minute by minute", + "C": "Reproducible", + "D": "Value does not correlate with other anesthetic drugs" + }, + "zh": { + "question": "以下哪项不是MAC的特征？", + "A": "“游离药物”是通过血浆浓度而不是分压或%来测量的", + "B": "逐呼吸、逐分钟监测", + "C": "可重复的", + "D": "数值与其他麻醉药物不相关" + } + }, + { + "id": "94df844e-bc4e-5cb2-8a6e-a818f8525539", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "MAC is the level at which 50% of patients do not move on...", + "A": "Intubation", + "B": "Incision", + "C": "Extubation", + "D": "Excision" + }, + "zh": { + "question": "MAC是指50%的患者在以下情况下不动的水平...", + "A": "插管", + "B": "切口", + "C": "拔管", + "D": "切除" + } + }, + { + "id": "0695e63f-2aaf-56f1-bb06-16b466da487e", + "choice_num": 9, + "answer": "D", + "level": 2, + "en": { + "question": "If your patient is 90 years old, how much would you decrease/increase your MAC by?", + "A": "Decrease by 18%", + "B": "Decrease by 6%", + "C": "Increase by 24%", + "D": "Decrease by 30%", + "E": "Decrease by 36%", + "F": "Decrease by 24%", + "G": "Increase by 18%", + "H": "Increase by 30%", + "I": "Increase by 50%" + }, + "zh": { + "question": "如果您的患者是90岁，您会将MAC减少/增加多少？", + "A": "减少18%", + "B": "减少6%", + "C": "增加24%", + "D": "减少30%", + "E": "减少36%", + "F": "减少24%", + "G": "增加18%", + "H": "增加30%", + "I": "增加50%" + } + }, + { + "id": "9c86b50e-b76c-5631-b117-260fff890b6d", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The spinal cord is the site of action for ______, only with potent gases.", + "A": "Homeostasis", + "B": "Loss of recall", + "C": "Amnesia", + "D": "Analgesia", + "E": "Immobility" + }, + "zh": { + "question": "脊髓是______的作用部位，仅限于强效气体。", + "A": "体内平衡", + "B": "失去记忆", + "C": "失忆", + "D": "镇痛", + "E": "不动性" + } + }, + { + "id": "851ac931-252e-5a16-a68a-f20d508e5bed", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Anesthesia is the drug-induced reversible depression of the CNS resulting in the loss of response to external stimuli.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "麻醉是药物诱导的中枢神经系统可逆性抑制，导致对外部刺激的反应丧失。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "e4a49de8-7a50-5fe2-8b6f-be4c691cb2c0", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "With MAC, a patient will have all of the following, EXCEPT...", + "A": "No response to ETT placement", + "B": "No movement on incision", + "C": "All of these are correct.", + "D": "No response to verbal commands", + "E": "No recall" + }, + "zh": { + "question": "在 MAC 下，患者将具有以下所有特征，除了……", + "A": "对气管插管无反应", + "B": "切口时无动作", + "C": "以上皆是。", + "D": "对口头指令无反应", + "E": "无回忆" + } + }, + { + "id": "624c1d65-b12b-5d9f-995e-e2416ccbc8a8", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "MAC awake is the alveolar concentration of anesthetic at which patients...", + "A": "Opens eyes to commands", + "B": "Starts breathing on their one", + "C": "Won't move on incision", + "D": "Responds spiritually to commands" + }, + "zh": { + "question": "MAC awake 是指患者在以下哪种情况下的麻醉剂肺泡浓度...", + "A": "睁眼听从指令", + "B": "开始自主呼吸", + "C": "切口时不动", + "D": "精神上响应指令" + } + }, + { + "id": "09a30a3a-2a6d-5094-b52e-f6319c3947b3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "MAC BAR is the alveolar concentration of anesthetic at which the patient will", + "A": "Not move on surgical incision", + "B": "Open eyes to command", + "C": "Blunt adrenergic responses to noxious stimuli (incision)", + "D": "Start breathing on their own" + }, + "zh": { + "question": "MAC BAR 是指患者在以下情况下的麻醉剂肺泡浓度", + "A": "在手术切口时不动", + "B": "听从指令睁眼", + "C": "减弱对有害刺激（切口）的肾上腺素反应", + "D": "开始自主呼吸" + } + }, + { + "id": "fe271dc6-34f4-501f-990e-643791957d7b", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Peripheral sensory receptors are affected by inhalation anesthesia.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "吸入麻醉会影响外周感觉受体。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "db2cbb9a-836e-57e1-bfe5-38f1eca3aecc", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Studies have shown that inhaled anesthetics have some teratogenic/carcinogenic effects.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "研究表明，吸入性麻醉剂具有一定的致畸/致癌作用。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "968b3eab-4830-5a72-afd0-18507ee46785", + "choice_num": 6, + "answer": "F", + "level": 1, + "en": { + "question": "Which of the following is a potent gas?", + "A": "Nitrogen", + "B": "Room air", + "C": "Zabaflurane", + "D": "Nitrous oxide", + "E": "Oxygen", + "F": "None of these are correct." + }, + "zh": { + "question": "以下哪一种是强效气体？", + "A": "氮气", + "B": "室内空气", + "C": "Zabaflurane", + "D": "一氧化二氮", + "E": "氧气", + "F": "以上都不正确。" + } + }, + { + "id": "498d6fb9-748c-5090-b2cc-4750274461cb", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Inhalation agents inhibit the _____- receptor at the myoneural junction. This is important because there are times where you want muscle relaxation, but can't give any muscle relaxants. High levels of anesthetic can cause muscle relaxation.", + "A": "Mu", + "B": "Voltage-gated", + "C": "ACh", + "D": "GABA", + "E": "Beta" + }, + "zh": { + "question": "吸入性麻醉剂在肌神经接头处抑制_____受体。这很重要，因为有时你需要肌肉松弛，但不能给予任何肌肉松弛剂。高水平的麻醉剂可以导致肌肉松弛。", + "A": "Mu", + "B": "电压门控", + "C": "ACh", + "D": "GABA", + "E": "Beta" + } + }, + { + "id": "ee703227-4fdf-5cd8-ac8d-83eb0b2a7b53", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Loss of self-awareness/recall occurs at...", + "A": "0.3-0.4 MAC", + "B": "0.1-0.2 MAC", + "C": "1.0-1.5 MAC", + "D": "0.5-0.6 MAC" + }, + "zh": { + "question": "自我意识/回忆的丧失发生在...", + "A": "0.3-0.4 MAC", + "B": "0.1-0.2 MAC", + "C": "1.0-1.5 MAC", + "D": "0.5-0.6 MAC" + } + }, + { + "id": "ea924538-88fc-566a-98cf-062262cb7435", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Minimum anesthesia concentration of an anesthetic at one ATM that prevents movement in response to surgical incision.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "在一个大气压下，防止手术切口反应的最低麻醉浓度。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "f4767518-3a72-5a69-918a-74a3a0f84ddc", + "choice_num": 6, + "answer": "C", + "level": 1, + "en": { + "question": "MAC of isoflurane", + "A": "1.51", + "B": "2.5", + "C": "1.15", + "D": "2", + "E": "6", + "F": "105" + }, + "zh": { + "question": "异氟醚的最低肺泡浓度（MAC）", + "A": "1.51", + "B": "2.5", + "C": "1.15", + "D": "2", + "E": "6", + "F": "105" + } + }, + { + "id": "cd93d77e-9c52-5254-9f1c-475db2efd58f", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Large carbon chains are better at attenuating movement in the spinal cord than small carbon chains.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "大碳链比小碳链更能减弱脊髓中的运动。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "dfc9f5d5-ce26-5c8f-b26b-058a1e94f856", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Supraspinal action of inhaled anesthetics will sensitize the spinal cord to pain at lower doses.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "吸入性麻醉药的超脊髓作用会在较低剂量下使脊髓对疼痛敏感。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "2ecd870d-590f-592c-8ce3-4fddb7b9775f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "MAC changes how much per decade?", + "A": "16%", + "B": "8%", + "C": "3%", + "D": "6%" + }, + "zh": { + "question": "MAC每十年变化多少？", + "A": "16%", + "B": "8%", + "C": "3%", + "D": "6%" + } + }, + { + "id": "8b4b8076-662c-5510-b04f-69f01dc1f52d", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "Of the following which is the MOST important prior to performing dental treatment including giving local anesthesia?", + "A": "Vital signs to determine the baseline in the event of an emergency", + "B": "Visual inspection to determine the overall physical state of the patient", + "C": "Dialogue history, to ensure the patient has answered truthfully", + "D": "Medical history questionnaire, thoroughly reviewed and updated", + "E": "Treatment plan and patient consent forms completed" + }, + "zh": { + "question": "在进行包括局部麻醉在内的牙科治疗之前，以下哪项是最重要的？", + "A": "生命体征，以便在紧急情况下确定基线", + "B": "目视检查，以确定患者的整体身体状况", + "C": "对话历史，以确保患者如实回答", + "D": "病史问卷，彻底审查和更新", + "E": "治疗计划和患者同意书已完成" + } + }, + { + "id": "6a971000-a694-56dc-9f27-74fc01bd7fd3", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Why do we implement \"ideal patient positioning\"?", + "A": "To reduce the risk of syncope", + "B": "To speed the onset of anesthesia", + "C": "To keep the syringe out of a patient's sight", + "D": "To ensure clinician caan obtain a firm hand rest", + "E": "To slow the absorption of anesthetic into bloodstream" + }, + "zh": { + "question": "为什么我们要实施“理想的病人定位”？", + "A": "减少晕厥的风险", + "B": "加快麻醉的起效", + "C": "避免注射器被病人看到", + "D": "确保临床医生可以获得稳固的手部支撑", + "E": "减缓麻醉剂进入血流的吸收" + } + }, + { + "id": "57cd943e-4287-5915-bc31-3d11026dca06", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is the best patient positioning while delivering local anesthetic?", + "A": "Knees above sea level", + "B": "Heart and hands parallel to the floor", + "C": "Head and heart parallel to the floor", + "D": "Toes above the nose", + "E": "Hear and heart parallel, toes slightly elevated" + }, + "zh": { + "question": "以下哪种是施用局部麻醉时最佳的病人姿势？", + "A": "膝盖高于海平面", + "B": "心脏和手与地面平行", + "C": "头部和心脏与地面平行", + "D": "脚趾高于鼻子", + "E": "头部和心脏平行，脚趾略微抬高" + } + }, + { + "id": "e8f0f2f2-f176-5591-9dfa-13fde31ebe4e", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The main reason to inject slowly is to accomplish which of the following?", + "A": "Make the injection as comfortable as possible", + "B": "Not disturb the homeostasis of the tissues", + "C": "Lessen the chance of anesthetic overdose", + "D": "Ensure you are not in a blood vessel", + "E": "Lessen the chance of a hematoma developing" + }, + "zh": { + "question": "缓慢注射的主要原因是为了实现以下哪一项？", + "A": "使注射尽可能舒适", + "B": "不干扰组织的稳态", + "C": "减少麻醉药物过量的可能性", + "D": "确保没有进入血管", + "E": "减少血肿形成的可能性" + } + }, + { + "id": "de4c4897-3f2c-5ae7-9b65-bd8eaaad17c8", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The nerve that can be inadvertently anesthetized during an IA injection is what?", + "A": "Facial nerve", + "B": "Trigeminal nerve", + "C": "Zygomatic nerve", + "D": "Middle meningeal nerve", + "E": "Buccal nerve" + }, + "zh": { + "question": "在进行下牙槽神经注射时可能被意外麻醉的神经是什么？", + "A": "面神经", + "B": "三叉神经", + "C": "颧神经", + "D": "中脑膜神经", + "E": "颊神经" + } + }, + { + "id": "aec4c9f1-82d4-513c-bda8-803744977046", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following injection types will provide the longest duration?", + "A": "Nerve block", + "B": "Field block", + "C": "Supraperiosteal", + "D": "Infiltration", + "E": "Intrasseptal" + }, + "zh": { + "question": "以下哪种注射类型能提供最长的持续时间？", + "A": "神经阻滞", + "B": "区域阻滞", + "C": "骨膜上", + "D": "浸润", + "E": "间隔内" + } + }, + { + "id": "567c5a85-7dd6-51cf-bef6-d41be2bb9851", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The maxillary division of the Trigeminal nerve travels anteriorly and downward to exit the cranium through which foramen?", + "A": "Ovale", + "B": "Spinosum", + "C": "Magnum", + "D": "Rotundum", + "E": "Superior orbital" + }, + "zh": { + "question": "三叉神经的上颌分支向前和向下行走，通过哪个孔离开颅骨？", + "A": "卵圆孔", + "B": "棘孔", + "C": "枕骨大孔", + "D": "圆孔", + "E": "眶上裂" + } + }, + { + "id": "e8d3e9d9-00c5-5865-88b3-297d06f99e63", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Following the administration of a right PSA nerve block, the patient complains that tooth #3 is still sensitive.  What is most likely the cause of this?", + "A": "Deposition was too low", + "B": "Deposition was too anterior", + "C": "The mesiobuccal root of the 1st molar was not anesthetized with the PSA", + "D": "Local anesthetic solution has probably expired", + "E": "Insufficient amount of anesthetic deposited" + }, + "zh": { + "question": "在进行右侧后上牙槽神经阻滞后，患者抱怨牙齿#3仍然敏感。最可能的原因是什么？", + "A": "注射位置过低", + "B": "注射位置过于前方", + "C": "第一磨牙的近中颊根未被后上牙槽神经麻醉", + "D": "局部麻醉药可能已过期", + "E": "麻醉剂量不足" + } + }, + { + "id": "2cc6d58a-d15c-5c73-81c4-aaa308f3a84e", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "In order to have a proper duration of a PSA, how much total anesthetic will you give?", + "A": "0.6-0.9 ml", + "B": "0.9-1.8 ml", + "C": "1.5-1.8 ml", + "D": "0.9-1.2 ml", + "E": ".45-.9 ml" + }, + "zh": { + "question": "为了确保 PSA 的适当持续时间，你会给予多少总麻醉剂量？", + "A": "0.6-0.9 毫升", + "B": "0.9-1.8 毫升", + "C": "1.5-1.8 毫升", + "D": "0.9-1.2 毫升", + "E": "0.45-0.9 毫升" + } + }, + { + "id": "bfbe4a75-c27a-564c-aadf-d4001169a4cf", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The Vazirani-Akinosi mandibular technique is recommended for what type of patients?", + "A": "Children", + "B": "Large boned", + "C": "Reduced opening", + "D": "Enlarged tongue", + "E": "Autistic" + }, + "zh": { + "question": "Vazirani-Akinosi下颌技术推荐用于哪类患者？", + "A": "儿童", + "B": "骨骼较大", + "C": "开口受限", + "D": "舌头肥大", + "E": "自闭症患者" + } + }, + { + "id": "09c0565d-b726-53f0-98a2-7d68f84e4d35", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Pressure syringes are primarily designed to deliver what type of injection?", + "A": "Palatal", + "B": "Intraosseous", + "C": "Intraseptal", + "D": "Periodontal ligament", + "E": "Incisive/mental" + }, + "zh": { + "question": "压力注射器主要用于提供哪种类型的注射？", + "A": "腭部", + "B": "骨内", + "C": "间隔内", + "D": "牙周韧带", + "E": "切牙/颏神经" + } + }, + { + "id": "8190785d-27f4-5b09-84e5-67edd587edf9", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "If a right-handed clinician contacts bone too soon (one half penetration depth or less) on the left IA nerve block, what should be done?", + "A": "Withdraw and select a penetration site more posterior", + "B": "Immediately redirect needle/syringe more laterally", + "C": "Withdraw slightly, redirect needle/syringe more medially", + "D": "Withdraw and select a penetration site more medially", + "E": "Withdraw slightly, redirect needle/syringe more laterally" + }, + "zh": { + "question": "如果惯用右手的临床医生在左侧下牙槽神经阻滞时过早接触到骨头（穿透深度的一半或更少），应该怎么做？", + "A": "撤回并选择更靠后的穿刺点", + "B": "立即将针头/注射器更向外侧重定向", + "C": "稍微撤回，将针头/注射器更向内侧重定向", + "D": "撤回并选择更靠内���的穿刺点", + "E": "稍微撤回，将针头/注射器更向外侧重定向" + } + }, + { + "id": "ad383791-2ecf-50f0-b7cb-02558ef212d3", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "What is the recommended amount of anesthetic deposited for the Gow-Gates injection technique?", + "A": "1.5 ml", + "B": "1.8 ml", + "C": "1.2 ml", + "D": "1.3 ml", + "E": "1.0 ml" + }, + "zh": { + "question": "Gow-Gates注射技术推荐的麻醉剂注射量是多少？", + "A": "1.5 ml", + "B": "1.8 ml", + "C": "1.2 ml", + "D": "1.3 ml", + "E": "1.0 ml" + } + }, + { + "id": "3cc8304a-e96b-5b29-b025-b032c859ed5e", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "What type of injection is contraindicated in primary teeth?", + "A": "Intraosseous", + "B": "Infraorbital", + "C": "Periodontal ligament", + "D": "Posterior superior alveolar", + "E": "Inferior alveolar" + }, + "zh": { + "question": "哪种类型的注射在乳牙中是禁忌的？", + "A": "骨内", + "B": "眶下", + "C": "牙周膜", + "D": "上颌后牙槽", + "E": "下牙槽" + } + }, + { + "id": "cb367961-578d-5ae7-bd04-4548ef4d1fc4", + "choice_num": 6, + "answer": "A", + "level": 1, + "en": { + "question": "Applying topical for longer than indicated can result in sloughing of the tissues - this is officially called what?", + "A": "Epithelial desquamation", + "B": "Sterile abscess", + "C": "Cheek rot", + "D": "White lacy striations", + "E": "Epithelial dysplasia", + "F": "Epithelial dysplasia" + }, + "zh": { + "question": "局部应用时间超过指示时间可能导致组织脱落——这在官方上被称为什么？", + "A": "上皮脱屑", + "B": "无菌脓肿", + "C": "面颊腐烂", + "D": "白色蕾丝状条纹", + "E": "上皮发育不良", + "F": "上皮发育不良" + } + }, + { + "id": "f8c7925a-7c6f-5f25-9445-1ab60c56d3a6", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Persistent paresthesia following a local anesthetic injection.", + "A": "Is always preventable", + "B": "Is often caused by a needle penetrating the cheek", + "C": "Is always reversible", + "D": "Is desirable", + "E": "Is the most common on the tip/side of the tongue" + }, + "zh": { + "question": "局部麻醉注射后持续性感觉异常。", + "A": "总是可以预防的", + "B": "通常是由针头穿透脸颊引起的", + "C": "总是可逆的", + "D": "是可取的", + "E": "最常见于舌尖/舌侧" + } + }, + { + "id": "2c0d0406-087b-543b-8a67-b4ff4684150c", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Trismus is best defined as what?", + "A": "A low grade infection", + "B": "A holiday in December", + "C": "Anesthesia that doesn't \"wear off\"", + "D": "Trauma to muscles and/or blood vessels", + "E": "A flooding or pooling of blood" + }, + "zh": { + "question": "如何最好地定义牙关紧闭？", + "A": "低度感染", + "B": "十二月的假期", + "C": "麻醉没有“消退”", + "D": "肌肉和/或血管的创伤", + "E": "血液的泛滥或积聚" + } + }, + { + "id": "ef056820-cb57-5d5c-b781-aaeec877b44c", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "An epinephrine overdose reaction.", + "A": "Usually requires formal management", + "B": "Requires placing the patient in a supine position", + "C": "May manifest as anxiety or restlessness", + "D": "Minimally affects blood pressure and heart rate", + "E": "Indicates an epinephrine allergy" + }, + "zh": { + "question": "肾上腺素过量反应。", + "A": "通常需要正式管理", + "B": "需要将患者置于仰卧位", + "C": "可能表现为焦虑或不安", + "D": "对血压和心率的影响很小", + "E": "表明对肾上腺素过敏" + } + }, + { + "id": "911eca9b-bca9-54a7-8b42-e50ad038a6ec", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "A patient suffering from local anesthetic overdose induced seizures should be given what?", + "A": "Oxygen only", + "B": "Glucose", + "C": "Oxygen and diazepam", + "D": "Oxygen and epinephrine", + "E": "Oxygen and diphenhydramine" + }, + "zh": { + "question": "对于因局部麻醉药过量引起癫痫发作的患者，应给予什么？", + "A": "仅氧气", + "B": "葡萄糖", + "C": "氧气和地西泮", + "D": "氧气和肾上腺素", + "E": "氧气和苯海拉明" + } + }, + { + "id": "821b46b6-7fb9-5889-96aa-692ef6f50dfc", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "After administering topical Benzocaine 20% and 3% Mepivacaine with epinephrine 1:100,000, the patient complains of intense itching of the face and is feeling a tightening in the throat.  What is most likely the cause of this reaction?", + "A": "The patient is experiencing psychogenic anxiety", + "B": "The anesthetic was injected too rapidly", + "C": "The patient is having a reaction to the epinephrine", + "D": "The patient is allergic to the Benzocaine", + "E": "The patient is having an idiosyncratic reaction" + }, + "zh": { + "question": "在使用20%苯佐卡因和含有1:100,000肾上腺素的3%甲哌卡因后，患者抱怨面部剧烈瘙痒并感到喉咙紧缩。最可能导致这种反应的原因是什么？", + "A": "患者正在经历心理性焦虑", + "B": "麻醉剂注射得太快", + "C": "患者对肾上腺素有反应", + "D": "患者对苯佐卡因过敏", + "E": "患者正在经历特异性反应" + } + }, + { + "id": "1e2ae0e1-5275-5a2b-8de6-c797d89c9f33", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "All of the following are acceptable alternatives for an anesthetic-allergic patient except one, which is the exception?", + "A": "Hypnosis", + "B": "Electronic dental anesthesia", + "C": "Use limited amounts of esters", + "D": "Use general anesthesia", + "E": "Use limited amounts of sterile Benadryl" + }, + "zh": { + "question": "以下所有选项均为麻醉过敏患者的可接受替代方案，除了一个，哪个是例外？", + "A": "催眠", + "B": "电子牙科麻醉", + "C": "使用有限量的酯类", + "D": "使用全身麻醉", + "E": "使用有限量的无菌苯海拉明" + } + }, + { + "id": "b1ef77ff-f8b5-56b9-863d-6f1a2b477cf6", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "All of the following patients represent a potential for a local anesthetic overdose except one, which is the exception?", + "A": "Pregnant women", + "B": "Patients with hepatitis", + "C": "A marathon runner", + "D": "Highly anxious patients", + "E": "A sweet little child" + }, + "zh": { + "question": "以下所有患者都有可能发生局部麻醉药过量，除了一个，哪个是例外？", + "A": "孕妇", + "B": "患有肝炎的患者", + "C": "马拉松跑者", + "D": "高度焦虑的患者", + "E": "一个可爱的小孩" + } + }, + { + "id": "4cfba8d7-97c7-5fc3-b3c6-49be956f61a8", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "If a patient has an allergy to esters, which of the following topical anesthetics should not be used?", + "A": "Lidocaine", + "B": "Denti-patch", + "C": "Benzocaine", + "D": "Pressure", + "E": "Betadine" + }, + "zh": { + "question": "如果患者对酯类过敏，以下哪种局部麻醉剂不应使用？", + "A": "利多卡因", + "B": "Denti-patch", + "C": "苯佐卡因", + "D": "压力", + "E": "碘伏" + } + }, + { + "id": "e9544558-0ac6-540f-9e33-ccca0b400e71", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "You administer 2% lidocaine with epinephrine 1:50,000 into the palate of your patient.  Three days later, they call complaining of a large sore on the roof of their mouth.  What is the sore MOST likely to be?", + "A": "Herpes simplex virus", + "B": "Aphthous ulcer", + "C": "Epithelial desquamation", + "D": "Sterile abscess", + "E": "Necrotizing sialiometaplasia" + }, + "zh": { + "question": "您在患者的上颚注射了2%利多卡因和1:50,000肾上腺素。三天后，他们打电话抱怨上颚有一个大溃疡。这个溃疡最有可能是什么？", + "A": "单纯疱疹病毒", + "B": "口腔溃疡", + "C": "上皮脱落", + "D": "无菌脓肿", + "E": "坏死性涎腺化生" + } + }, + { + "id": "67e70879-09b6-50b3-a91d-9a6a9781a034", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "Your patient is a 190 lb man.  He was scheduled with the dentist prior to seeing you today.  The dentist used 3 cartridges of 4% Articaine with epinephrine 1:100,000.  He is becoming sensitive during root planing and scaling.  How many additional cartridges of 2% lidocaine with epinephrine 1:100,000 can he have?", + "A": "2.3", + "B": "4.5", + "C": "7.3", + "D": "3.8", + "E": "1.9" + }, + "zh": { + "question": "您的病人是一名190磅的男性。他在今天见您之前已经预约了牙医。牙医使用了3支4%盐酸阿替卡因和1:100,000肾上腺素。他在进行根面平整和刮治时开始感到敏感。他还可以使用多少支2%利多卡因和1:100,000肾上腺素？", + "A": "2.3", + "B": "4.5", + "C": "7.3", + "D": "3.8", + "E": "1.9" + } + }, + { + "id": "f6a2d993-e74a-54e8-97e9-66122eeeb4a9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of these is the most potent?", + "A": "Remifentanil", + "B": "Meperidine", + "C": "Sufentanil", + "D": "Morphine" + }, + "zh": { + "question": "以下哪一种是最强效的？", + "A": "瑞芬太尼", + "B": "哌替啶", + "C": "舒芬太尼", + "D": "吗啡" + } + }, + { + "id": "451fe29d-4efc-5b17-b3da-72b2c612a4e7", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is the best agent to relieve post-op itching caused by Morphine?", + "A": "Naloxone 40-80 mcg IV", + "B": "Butorphanol", + "C": "Meperidine", + "D": "Flumazenil, titrate by doses of 0.2 mg", + "E": "Nalbuphine" + }, + "zh": { + "question": "哪种药物最适合缓解由吗啡引起的术后瘙痒？", + "A": "纳洛酮 40-80 微克 静脉注射", + "B": "布托啡诺", + "C": "哌替啶", + "D": "氟马西尼，按 0.2 毫克 剂量滴定", + "E": "纳布啡" + } + }, + { + "id": "697a2f5e-96cd-5e64-b0b1-73ae2ef1cb9d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The wooden chest is a result of", + "A": "A central delta effect", + "B": "A central mu effect", + "C": "A central kappa effect", + "D": "A central muscle contraction effect" + }, + "zh": { + "question": "木制箱子的结果是", + "A": "中枢δ效应", + "B": "中枢μ效应", + "C": "中枢κ效应", + "D": "中枢肌肉收缩效应" + } + }, + { + "id": "10a03488-49ce-5c51-ad78-7ba6b5854036", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "You are caring for Mrs. So & So who has a past history of A-fib, DM, pancreatitis, and asthma. Which drug would you choose to relieve her pain?", + "A": "Ketorolac", + "B": "Ethanol", + "C": "Fentanyl", + "D": "Morphine" + }, + "zh": { + "question": "您正在照顾有房颤、糖尿病、胰腺炎和哮喘病史的So & So女士。您会选择哪种药物来缓解她的疼痛？", + "A": "酮咯酸", + "B": "乙醇", + "C": "芬太尼", + "D": "吗啡" + } + }, + { + "id": "1a782497-75ba-5ec0-a4db-5bd1a68d4028", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which class of drugs would you NOT give to a patient undergoing a cholangiogram?", + "A": "Opioids", + "B": "Barbituates", + "C": "NSAIDs", + "D": "Benzo's" + }, + "zh": { + "question": "在进行胆管造影时，您不会给患者使用哪一类药物？", + "A": "阿片类药物", + "B": "巴比妥类药物", + "C": "非甾体抗炎药", + "D": "苯二氮䓬类药物" + } + }, + { + "id": "e550a43e-dd75-5c3d-9da9-f407b6eef351", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Enkephalin is responsible for stimulating which opioid receptors?", + "A": "Mu and delta", + "B": "Mu and kappa", + "C": "Delta and kappa" + }, + "zh": { + "question": "脑啡肽负责刺激哪种阿片受体？", + "A": "μ和δ", + "B": "μ和κ", + "C": "δ和κ" + } + }, + { + "id": "8b335410-4703-59aa-9ca1-e8e31e851f64", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "If your patient is currently receiving erythromycin to treat an infection, which of these is NOT ok to give for analgesia?", + "A": "Hydromorphone", + "B": "Alfentanil", + "C": "Remifentanil", + "D": "Morphine", + "E": "Sufentanil" + }, + "zh": { + "question": "如果您的患者目前正在接受红霉素治疗感染，以下哪种药物不适合用于镇痛？", + "A": "氢吗啡酮", + "B": "阿芬太尼", + "C": "瑞芬太尼", + "D": "吗啡", + "E": "舒芬太尼" + } + }, + { + "id": "f63d3b78-7bd5-5756-b40a-a17181930788", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Which drug when combined with benzodiazepine's causes the greatest drop in MAP?", + "A": "Alfentanil", + "B": "Fentanyl", + "C": "Sufentanil" + }, + "zh": { + "question": "哪种药物与苯二氮卓类药物联合使用时会导致平均动脉压（MAP）下降最大？", + "A": "阿芬太尼", + "B": "芬太尼", + "C": "舒芬太尼" + } + }, + { + "id": "125ae5d6-a7c5-5a84-81ca-124cf47b2c8e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of these is the greatest histamine releaser?", + "A": "Codeine", + "B": "Meperidine", + "C": "Fentanyl", + "D": "Morphine" + }, + "zh": { + "question": "以下哪种药物是最大的组胺释放剂？", + "A": "可待因", + "B": "哌替啶", + "C": "芬太尼", + "D": "吗啡" + } + }, + { + "id": "0f3add6c-64a2-5f45-8567-16a8ddbb9f16", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of these is a highly protein-bound drug?", + "A": "Sufentanil", + "B": "Fentanyl", + "C": "Remifentanil", + "D": "Morphine" + }, + "zh": { + "question": "以下哪种药物是高蛋白结合药物？", + "A": "舒芬太尼", + "B": "芬太尼", + "C": "瑞芬太尼", + "D": "吗啡" + } + }, + { + "id": "9fec687b-0efd-511e-9c2d-4997f0ff0492", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following statements are true?", + "A": "The less soluble an agent is, the slower it will reach equilibration.", + "B": "The less soluble an agent is, the faster it will reach equilibration.", + "C": "The more soluble an agent is, the faster it will reach equilibration." + }, + "zh": { + "question": "以下哪项陈述是正确的？", + "A": "一种药剂的溶解度越低，达到平衡的速度越慢。", + "B": "一种药剂的溶解度越低，达到平衡的速度越快。", + "C": "一种药剂的溶解度越高，达到平衡的速度越快。" + } + }, + { + "id": "98296461-8522-5680-8016-96be14aaae42", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Which medication would you give to reverse post-op ventilatory depression from Fentanyl, while maintaining analgesia?", + "A": "Nalbuphine", + "B": "Flumazenil", + "C": "Switch to meperidine", + "D": "Naloxone, carefully titrated" + }, + "zh": { + "question": "在维持镇痛的同时，您会给予哪种药物来逆转芬太尼引起的术后呼吸抑制？", + "A": "纳布啡", + "B": "氟马西尼", + "C": "改用哌替啶", + "D": "小心滴定纳洛酮" + } + }, + { + "id": "322ce98e-9647-5bb8-b675-3a69704c558a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of these is not a site of synthesis for Pro-opiomelanocortin?", + "A": "Pituitary", + "B": "Pancreas", + "C": "Placenta", + "D": "Adrenal medulla" + }, + "zh": { + "question": "以下哪一项不是促黑素原的合成部位？", + "A": "垂体", + "B": "胰腺", + "C": "胎盘", + "D": "肾上腺髓质" + } + }, + { + "id": "870e178a-f7c7-5422-928a-0a0d592f0198", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Dynorphin is responsible for stimulating which opioid receptor?", + "A": "Kappa", + "B": "Mu", + "C": "Delta" + }, + "zh": { + "question": "强啡肽负责刺激哪种阿片受体？", + "A": "κ受体", + "B": "μ受体", + "C": "δ受体" + } + }, + { + "id": "3d9c8750-44c5-560b-9026-9fb9ba30e9e2", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "At what age does a baby upregulate CYP450?", + "A": "0-6 months", + "B": "19-25 months", + "C": "6-12 months", + "D": "13-18 months" + }, + "zh": { + "question": "婴儿在多大年龄时上调CYP450？", + "A": "0-6个月", + "B": "19-25个月", + "C": "6-12个月", + "D": "13-18个月" + } + }, + { + "id": "c3d9b5ca-e47b-58a8-ac23-c5947f438a84", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of these is not an endogenous opioid peptide?", + "A": "Dynorphin", + "B": "Epinorphin", + "C": "Enkephalin", + "D": "Endorphin" + }, + "zh": { + "question": "以下哪一项不是内源性阿片肽？", + "A": "强啡肽", + "B": "表啡肽", + "C": "脑啡肽", + "D": "内啡肽" + } + }, + { + "id": "fcf0d933-9ff0-5bbb-ba2b-0b0425b7efdc", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "You are caring for Mr. So & So who is currently having a left BKA. You notice his HR increasing and his pupils are of normal size. His train of four is 0/4. What does this tell you?", + "A": "He needs a little more midazolam to calm him down.", + "B": "Maybe he could use some more opioids to relieve pain.", + "C": "Maybe he could use more paralytic.", + "D": "He is too light, increase the sevoflurane." + }, + "zh": { + "question": "您正在照顾目前正在进行左侧小腿截肢的So & So先生。您注意到他的心率增加，瞳孔大小正常。他的四个刺激反应为0/4。这告诉您什么？", + "A": "他需要多一点咪达唑仑来让他平静下来。", + "B": "也许他需要更多的阿片类药物来缓解疼痛。", + "C": "也许他需要更多的肌肉松弛剂。", + "D": "他太浅了，增加七氟醚。" + } + }, + { + "id": "6d5c540a-c163-52d1-bc0b-73c71d0a4c9b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "MAC represents that half of patients will not", + "A": "Breathe on incision", + "B": "Breathe spontaneously until emergence", + "C": "Move on incision", + "D": "Move on emergence" + }, + "zh": { + "question": "MAC 表示一半的患者将不会", + "A": "在切口时呼吸", + "B": "在苏醒前自发呼吸", + "C": "在切口时移动", + "D": "在苏醒时移动" + } + }, + { + "id": "c566cabe-96c0-5891-aedd-563be1e15810", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of these will not cause miosis?", + "A": "Sufentanil", + "B": "Morphine", + "C": "Meperidine", + "D": "Fentanyl" + }, + "zh": { + "question": "以下哪种不会引起瞳孔缩小？", + "A": "舒芬太尼", + "B": "吗啡", + "C": "哌替啶", + "D": "芬太尼" + } + }, + { + "id": "8e244b91-a4d9-528e-bf79-8a84e57e4b3e", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Morphine causes itching by releasing large amounts of histamine.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "吗啡通过释放大量组胺引起瘙痒。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "6a64bf30-c642-5713-9092-054e2f9c73c4", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of these is not a characteristic of vaporizers?", + "A": "Temperature compensated", + "B": "Inside of circuit", + "C": "Flow-Over", + "D": "Variable bypass", + "E": "Agent-specific" + }, + "zh": { + "question": "以下哪项不是蒸发器的特征？", + "A": "温度补偿", + "B": "电路内部", + "C": "流过式", + "D": "可变旁路", + "E": "特定于药剂" + } + }, + { + "id": "aa823a79-47a7-5c52-ba94-5eee53eb87f4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which opioid receptor causes diuresis?", + "A": "Mu2", + "B": "Kappa", + "C": "Mu1", + "D": "Delta" + }, + "zh": { + "question": "哪种阿片受体引起利尿？", + "A": "Mu2", + "B": "Kappa", + "C": "Mu1", + "D": "Delta" + } + }, + { + "id": "446c511f-e0a2-520e-b5c3-0b452b04da24", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Remifentanil needs pseudocholinesterase for metabolism.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "瑞芬太尼需要假胆碱酯酶进行代谢。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "4fee9263-48ab-5389-a961-39aa62c169e5", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The term Regional Anesthesia refers to:", + "A": "Loss of sensation in a limited area of the body produced by administration of a local anesthetic or other agent proximal to sensory nerves", + "B": "Loss of sensation in a small area of the body produced by administration of a local anesthetic agent in proximity to the area of interest", + "C": "Loss of sensation of a localized area produced by administration of a local anesthetic directly to a body surface or to a surgical or traumatic wound", + "D": "A drug-induced sleeplike state that impairs the ability of the patient to respond appropriately to stimuli" + }, + "zh": { + "question": "区域麻醉是指：", + "A": "通过在感觉神经附近施用局部麻醉剂或其他药物，使身体的局部区域失去感觉", + "B": "通过在感兴趣区域附近施用局部麻醉剂，使身体的小区域失去感觉", + "C": "通过直接在身体表面或手术或创伤伤口施用局部麻醉剂，使局部区域失去感觉", + "D": "一种药物诱导的类似睡眠的状态，削弱患者对刺激作出适当反应的能力" + } + }, + { + "id": "5039ca6f-66df-5ce7-9238-e236c0085e49", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The term Balanced Anesthesia refers to:", + "A": "The administration of two or more agents in equal volume", + "B": "Administration of multiple drugs concurrently in smaller quantities than would be required if each were given alone", + "C": "General anesthesia in which the patient's physiological status remains stable", + "D": "The administration of a local and general anesthetic concurrently" + }, + "zh": { + "question": "平衡麻醉是指：", + "A": "以相等的体积给予两种或多种药物", + "B": "同时给予多种药物，其用量小于单独使用时所需的量", + "C": "患者生理状态保持稳定的全身麻醉", + "D": "同时给予局部和全身麻醉" + } + }, + { + "id": "80694282-060e-5af9-8bbd-caba117b96d1", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "In gathering a patient history, which of the following would be the best way to frame a question about a patient's exercise level?", + "A": "\"Your dog does not exercise much, does he, Mrs. Jones?\"", + "B": "\"Does your dog exercise, Mrs. Jones?\"", + "C": "\"How many times a week does your pet go for a walk or exercise, Mrs. Jones?\"", + "D": "\"You don't give your dog as much exercise as you should, do you Mrs. Jones?\"" + }, + "zh": { + "question": "在收集病史时，以下哪种方式是询问患者运动水平的最佳方式？", + "A": "“您的狗不怎么运动，对吗，琼斯夫人？”", + "B": "“您的狗运动吗，琼斯夫人？”", + "C": "“您的宠物每周散步或运动多少次，琼斯夫人？”", + "D": "“您没有给您的狗足够的运动，对吗，琼斯夫人？”" + } + }, + { + "id": "af100187-ebbe-5fd2-99f8-5a459f484406", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following examples of species associations is not correct?", + "A": "Horses and cats are more sensitive to opioids than dogs and ruminants.", + "B": "The use of anticholinergics is recommended in ruminants to avoid airway occlusion", + "C": "Horses may fracture limbs during anesthetic recovery and thus require special attention during the recovery period", + "D": "Large animals are prone to respiratory depression and dependent atelectasis and thus often require ventilatory support" + }, + "zh": { + "question": "以下哪种物种关联的例子是不正确的？", + "A": "马和猫对阿片类药物比狗和反刍动物更敏感。", + "B": "建议在反刍动物中使用抗胆碱能药物以避免气道阻塞。", + "C": "马在麻醉恢复期间可能会骨折，因此在恢复期需要特别注意。", + "D": "大型动物容易出现呼吸抑制和依赖性肺不张，因此通常需要呼吸支持。" + } + }, + { + "id": "dca3e548-e305-5fe0-9b7b-5c9424bda0ef", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Dehydration increses the risk of hypotension.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "脱水增加低血压的风险。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "f4985a3b-509e-50e6-ab8e-f76033ad2ed3", + "choice_num": 2, + "answer": "B", + "level": 2, + "en": { + "question": "A dog with a body condition score of 8/9 will require more anesthetic per unit body weight than a dog of the same breed with a body condition score of 5/9.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "体况评分为8/9的狗比同品种体况评分为5/9的狗每单位体重需要更多的麻醉剂。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "fc5f1239-24c6-5443-9ba7-fd92e5b0a9ea", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Anemia predisposes the patient to hypoxemia.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "贫血使患者易患低氧血症。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "6597fbd6-98a4-5ead-a5ca-88cbfc684198", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Patients with bruising may be at higher risk for potentially life-threatening intraoperative and postoperative bleeding.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "有瘀伤的患者可能在术中和术后有更高的潜在致命出血风险。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "d38fb5ff-2e84-51cc-8965-285156860311", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "You are evaluating a patient's LOC (level of consciousness) and find the patient in a sleeplike state, nonresponsive to a verbal stimulus but arousable by a painful stimulus. This patient is:", + "A": "Lethargic", + "B": "Obtunded", + "C": "Stuporous", + "D": "Comatose" + }, + "zh": { + "question": "您正在评估患者的意识水平（LOC），发现患者处于类似睡眠的状态，对语言刺激无反应，但对疼痛刺激有反应。该患者是：", + "A": "嗜睡", + "B": "迟钝", + "C": "昏睡", + "D": "昏迷" + } + }, + { + "id": "0f5e639b-1057-5a9e-9abf-c3dff7b35283", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "You are evaluating a patient's hydration. The skin elasticity is somewhat slowed, the patient's mucous membranes are tacky, the CRT is 1.5 seconds, but the eye is in a normal position in the orbit. Your patient is:", + "A": "Approximately 5-6% dehydrated", + "B": "Approximately 6-8% dehydrated", + "C": "Approximately 8-10% dehydrated", + "D": "Approximately 12-15% dehydrated" + }, + "zh": { + "question": "您正在评估一位患者的水合状态。皮肤弹性稍有减慢，患者的粘膜有些粘稠，CRT为1.5秒，但眼睛在眼窝中的位置正常。您的患者是：", + "A": "大约5-6%脱水", + "B": "大约6-8%脱水", + "C": "大约8-10%脱水", + "D": "大约12-15%脱水" + } + }, + { + "id": "356df21b-08b2-5a8b-a0a0-217f47ca3408", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following fasting times is least advisable?", + "A": "Dogs: 8-12 hours", + "B": "Horse: 2-4 hours", + "C": "Cow: 24-48 hours", + "D": "Small ruminant: 12-18 hours" + }, + "zh": { + "question": "以下哪种禁食时间最不建议？", + "A": "狗：8-12小时", + "B": "马：2-4小时", + "C": "牛：24-48小时", + "D": "小反刍动物：12-18小时" + } + }, + { + "id": "a62a64a4-5127-5992-98f3-bd6f99e32da5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is not a Crystalloid solution?", + "A": "Lactated Ringer's solution", + "B": "Normal saline solution", + "C": "Dextran", + "D": "5% Dextrose" + }, + "zh": { + "question": "以下哪一项不是晶体溶液？", + "A": "乳酸林格氏液", + "B": "生理盐水", + "C": "右旋糖酐", + "D": "5% 葡萄糖溶液" + } + }, + { + "id": "895b0f46-1c18-5412-9bea-6b27ac34d6cc", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Which of the following signs of disease in a calm canine patient would be most significant in terms of the potential to increase the risk of anesthesia?", + "A": "Increase respiratory effort", + "B": "Lethargy", + "C": "A body temp of 103.4*F", + "D": "A sinus arrhythmia" + }, + "zh": { + "question": "在一只平静的犬类患者中，以下哪种疾病迹象在增加麻醉风险方面最为显著？", + "A": "呼吸努力增加", + "B": "嗜睡", + "C": "体温为103.4°F", + "D": "窦性心律不齐" + } + }, + { + "id": "9c2742d7-db37-5694-89dd-e936769a2b4d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following species or breeds must be watched especially close during any anesthetic procedure to ensure a patent airway?", + "A": "Brachiocephalic breeds", + "B": "Exotic breeds", + "C": "Sighthounds", + "D": "Cats and horses" + }, + "zh": { + "question": "在任何麻醉过程中，以下哪种物种或品种必须特别注意以确保呼吸道通畅？", + "A": "短头品种", + "B": "异国品种", + "C": "视猎犬", + "D": "猫和马" + } + }, + { + "id": "80d6a479-a28b-541a-8f4b-970457895c93", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The fluid type most appropriate to replace moderate losses from dehydration would be:", + "A": "Colloids", + "B": "Hypertonic saline", + "C": "Isotonic crystalloids", + "D": "50% Dextrose" + }, + "zh": { + "question": "最适合替代中度脱水损失的液体类型是：", + "A": "胶体", + "B": "高渗盐水", + "C": "等渗晶体液", + "D": "50% 葡萄糖" + } + }, + { + "id": "ee5eae0b-0b52-55a1-8f3c-06c0779e847d", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "About two-thirds of the total body water is inside the cells.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "大约三分之二的总身体水分在细胞内。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "ed7bdfdc-f13f-506e-bdf2-5f006e02d206", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Blood plasma makes up about 5% of the total body weight.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "血浆约占人体总重量的5%。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "41b7addc-7da0-59ab-9e36-c49223d4d511", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "The extracellular fluid contains more sodium than intracellular fluid.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "细胞外液含有比细胞内液更多的钠。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "139e6cbb-33f2-56a5-93e8-ae096cca6251", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following statements regarding IV catheter placement in surgery patients is incorrect?", + "A": "Choose and administration set with an injection port", + "B": "Give all IV drugs slowly unless told otherwise", + "C": "Always follow IV injections through a catheter with sterile saline flush", + "D": "Choose a catheter that is small in diameter to minimize the risk of bleeding" + }, + "zh": { + "question": "以下关于手术患者静脉导管置入的说法中哪一项是不正确的？", + "A": "选择带有注射口的输液装置", + "B": "除非另有说明，否则所有静脉注射药物都应缓慢给药", + "C": "通过导管进行静脉注射后应始终用无菌生理盐水冲洗", + "D": "选择直径较小的导管以尽量减少出血风险" + } + }, + { + "id": "9390c792-26f0-57c6-93fe-e7ec946dea67", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "The intracellular fluid contains more potassium than intravascular fluid.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "细胞内液含有比血管内液更多的钾。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "0deaaa03-c623-5779-85e6-0474199e53c3", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "The intravascular fluid has more negatively charged particles than positively charged particles.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "血管内液体中带负电的粒子比带正电的粒子多。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "3244cee4-f751-5a4c-b41c-529856a4f2c8", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "The osmolarity of intracellular fluid is similar to that of extracellular fluid.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "细胞内液的渗透压与细胞外液的渗透压相似。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "6b5a67c4-0dd4-59b9-8a47-4856de09e4f7", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following heart rhythms is not normal in a resting horse?", + "A": "NSR", + "B": "SA", + "C": "Second-degree AV block", + "D": "Third-degree AV block" + }, + "zh": { + "question": "以下哪种心律在静止的马中是不正常的？", + "A": "窦性心律（NSR）", + "B": "窦性心动过缓（SA）", + "C": "二度房室传导阻滞", + "D": "三度房室传导阻滞" + } + }, + { + "id": "31ffcec9-c373-5413-b269-68bcc9bdd3e9", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Regarding fluid infusion rates:", + "A": "Standard shock doses of fluids are about the same as doses used during routine surgery", + "B": "Surgery patients with blood loss may require colloids instead of crystalloids", + "C": "Crystalloids are generally given at lower administration rates than colloids", + "D": "Hypertonic saline is administered in large volumes to patients in shock" + }, + "zh": { + "question": "关于液体输注速度：", + "A": "标准休克剂量的液体与常规手术中使用的剂量大致相同", + "B": "失血的手术患者可能需要使用胶体而不是晶体", + "C": "晶体通常以比胶体更低的速度给药", + "D": "高渗盐水以大剂量给予休克患者" + } + }, + { + "id": "a1e5ecd8-176b-5a45-9e86-2f0e98a3627e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not a sign of fluid overload?", + "A": "Ocular and nasal discharge", + "B": "Hypotension", + "C": "Increased lung sounds and respiratory rate", + "D": "Dyspnea" + }, + "zh": { + "question": "以下哪项不是液体过载的表现？", + "A": "眼部和鼻部分泌物", + "B": "低血压", + "C": "肺音增加和呼吸频率增加", + "D": "呼吸困难" + } + }, + { + "id": "7656c56d-45ad-50dd-adea-305ae59fca7a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A neuroleptanalgesic is a combination of:", + "A": "An opioid and an anticholinergic", + "B": "An anticholinergic and a tranquilizer", + "C": "An opioid and a tranquilizer", + "D": "An anticholinergic and a benzodiazepine" + }, + "zh": { + "question": "神经安定镇痛剂是以下��种组合：", + "A": "阿片类药物和抗胆碱药", + "B": "抗胆碱药和镇静剂", + "C": "阿片类药物和镇静剂", + "D": "抗胆碱药和苯二氮䓬类药物" + } + }, + { + "id": "52bc7f7d-fde5-5a7b-9ba8-ea032eaeaa92", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Most pre-anesthetic will not cross the placental barrier.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "大多数术前麻醉药不会通过胎盘屏障。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "3721bdfc-31e0-5c9f-89fe-e3018a70b07f", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "It is recommended that atropine not be given to an animal that has tachycardia.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "建议不要给心动过速的动物使用阿托品。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "c15ffa03-9495-5a5f-b07b-37a2f42c4752", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Anticholinergic drugs, such as atropine, block the release of acetylcholine a the:", + "A": "Muscarinic receptors of the parasympathetic system", + "B": "Nicotinic receptors of the parasympathetic system", + "C": "Muscarinic receptors of the sympathetic system", + "D": "Nicotinic receptors of the sympathetic system" + }, + "zh": { + "question": "抗胆碱能药物，如阿托品，阻断乙酰胆碱在以下部位的释放：", + "A": "副交感神经系统的毒蕈碱受体", + "B": "副交感神经系统的烟碱受体", + "C": "交感神经系统的毒蕈碱受体", + "D": "交感神经系统的烟碱受体" + } + }, + { + "id": "40285c73-3c20-5bf5-9fd5-11a38774b071", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "High doses of opioids can cause bradycardia and respiratory depression.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "高剂量的阿片类药物会导致心动过缓和呼吸抑制。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "ce0d48e7-9cb5-543e-85e1-8e808830623e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Severe bradycardia caused by dexmedetomidine is best treated with the following drug:", + "A": "Atropine", + "B": "Naloxone", + "C": "Epinephrine", + "D": "Atipamezole" + }, + "zh": { + "question": "由右美托咪定引起的严重心动过缓最好用以下药物治疗：", + "A": "阿托品", + "B": "纳洛酮", + "C": "肾上腺素", + "D": "阿替平" + } + }, + { + "id": "5f05ce1b-86a8-5b52-8b1e-10a5412676f1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Opioids are reversed with:", + "A": "Atipamezole", + "B": "Naloxone", + "C": "Atropine", + "D": "Yohimbine" + }, + "zh": { + "question": "阿片类药物的拮抗剂是：", + "A": "阿替美唑", + "B": "纳洛酮", + "C": "阿托品", + "D": "育亨宾" + } + }, + { + "id": "09e0b575-0dbb-5cf4-a1cc-27d04b763dcb", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following drugs will precipitate out when mixed with other drugs or solutions?", + "A": "Atropine", + "B": "Acepromazine", + "C": "Diazepam", + "D": "Butorphanol" + }, + "zh": { + "question": "以下哪种药物在与其他药物或溶液混合时会沉淀出来？", + "A": "阿托品", + "B": "氨丙嗪", + "C": "地西泮", + "D": "布托啡诺" + } + }, + { + "id": "2eaacb8b-6303-5552-a7b6-bc16353b1339", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Etomidate is particularly well suited for the induction of dogs with which of the following problems?", + "A": "Severe cardiac disease", + "B": "Renal failure", + "C": "Orthopedic disease", + "D": "Pediatric(younger than 4 weeks)" + }, + "zh": { + "question": "依托咪酯特别适合用于诱导患有以下哪种问题的狗？", + "A": "严重的心脏病", + "B": "肾衰竭", + "C": "骨科疾病", + "D": "小儿（小于4周）" + } + }, + { + "id": "ccb4dd1e-4ae3-5b59-8bfd-529f83a498ef", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is an example of a dissociative anesthetic?", + "A": "Thiopental sodium", + "B": "Pentobarbital sodium", + "C": "Ketamine hydrochloride", + "D": "Propofol" + }, + "zh": { + "question": "以下哪一项是分离性麻醉剂的例子？", + "A": "硫喷妥钠", + "B": "戊巴比妥钠", + "C": "氯胺酮", + "D": "丙泊酚" + } + }, + { + "id": "775c5da1-2e8c-559b-9f3a-325172827c72", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "One of the disadvantages of the drug methohexital is that animals that are anesthetized with it may demonstrate excitement during recovery.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "使用甲己托合酯作为麻醉药的一个缺点是，动物在恢复过程中可能会表现出兴奋。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "534753e8-5f88-521a-b127-699800105145", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Compared with methoxyflurane, isoflurane is considered to have a:", + "A": "Higher vapor pressure", + "B": "Similar vapor pressure", + "C": "Lower vapor pressure" + }, + "zh": { + "question": "与甲氧氟烷相比，异氟醚被认为具有：", + "A": "更高的蒸气压", + "B": "相似的蒸气压", + "C": "更低的蒸气压" + } + }, + { + "id": "1341d7d1-14ef-579b-8b5f-38a95a96a9f5", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "An anesthetic agent that has a low blood-gas partition coefficient will result in ____ induction and recovery time.", + "A": "Slow", + "B": "Moderate", + "C": "Fast" + }, + "zh": { + "question": "血气分配系数低的麻醉剂将导致____的诱导和恢复时间。", + "A": "慢", + "B": "适中", + "C": "快" + } + }, + { + "id": "23e4e6d8-4242-5926-8c40-77e094a955a5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following has the lowest blood-gas partition coefficient?", + "A": "Halothane", + "B": "Isoflurane", + "C": "Methoxyflurane", + "D": "Sevoflurane" + }, + "zh": { + "question": "以下哪种药物的血气分配系数最低？", + "A": "氟烷", + "B": "异氟醚", + "C": "甲氧氟烷", + "D": "七氟醚" + } + }, + { + "id": "dc1e2a3d-e869-5148-ae9b-8f49f50ad6e7", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Propofol sometimes causes transient apnea. To avoid this, the anesthetist should:", + "A": "Give by infusion only", + "B": "Premedicate with opioids", + "C": "Administer intravenously only", + "D": "Titrate this drug in several boluses" + }, + "zh": { + "question": "丙泊酚有时会引起短暂的呼吸暂停。为了避免这种情况，麻醉师应该：", + "A": "仅通过输注给药", + "B": "用阿片类药物进行术前用药", + "C": "仅静脉注射给药", + "D": "将该药物分成几次推注给药" + } + }, + { + "id": "aa4b0ca2-50e2-54bb-87af-9740ee18c2e1", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Effects that are commonly seen after administration of a dissociative include:", + "A": "Increased blood pressure", + "B": "Increased heart rate", + "C": "Increased CSF pressure", + "D": "Increased intraocular pressure", + "E": "All the above" + }, + "zh": { + "question": "解离性麻醉药常见的作用包括：", + "A": "血压升高", + "B": "心率加快", + "C": "脑脊液压力升高", + "D": "眼内压升高", + "E": "以上全部" + } + }, + { + "id": "51b88ac6-75d6-5e6b-9c51-3c9b60090ce0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Adverse effects common with isoflurane include:", + "A": "Hepatic toxicity", + "B": "Accumulation in body fat stores", + "C": "Depression of respiration", + "D": "Seizures during recovery" + }, + "zh": { + "question": "异氟醚常见的不良反应包括：", + "A": "肝毒性", + "B": "在体脂储存中积累", + "C": "呼吸抑制", + "D": "恢复期间的癫痫发作" + } + }, + { + "id": "ec066ee2-066b-5878-8c0b-81536e6c4c57", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Appropriate drugs and doses for induction of general anesthesia for Cesarean delivery in a stable patient include all the following except:", + "A": "Propofol 2 mg/kg", + "B": "Sodium thiopental 4 mg/kg", + "C": "Propofol 3 mg/kg", + "D": "Ketamine 2 mg/kg" + }, + "zh": { + "question": "对于一名稳定患者进行剖宫产全身麻醉诱导的适当药物和剂量包括以下所有选项，除了：", + "A": "丙泊酚 2 mg/kg", + "B": "硫喷妥钠 4 mg/kg", + "C": "丙泊酚 3 mg/kg", + "D": "氯胺酮 2 mg/kg" + } + }, + { + "id": "80649589-9e17-5aeb-8127-fa8aaa05902e", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Pick the false statement: Cricoid pressure….", + "A": "…has been shown to be efficacious and should be used without release during the intubation of a pregnant patient.", + "B": "…is the standard of care and should be employed, but may be released to get a better view during intubation.", + "C": "…should not be initiated before induction.", + "D": "…should be released if the patient starts retching while obtunded." + }, + "zh": { + "question": "选择错误的陈述：环状软骨压迫……", + "A": "……已被证明是有效的，且在孕妇插管时应持续使用而不释放。", + "B": "……是护理标准，应使用，但在插管时可以释放以获得更好的视野。", + "C": "……不应在诱导前开始。", + "D": "……如果患者在意识模糊时开始干呕，应释放。" + } + }, + { + "id": "635dc608-ca30-54c8-afdc-538088249a2d", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Pick the false statement.", + "A": "The uterine vein:maternal vein ratio for succinylcholine is between 0.1 and 0.2.", + "B": "Magnesium potentiates non-depolarizing neuromuscular blockers.", + "C": "Succinylcholine is safe for the baby because of rapid metabolism.", + "D": "Succinylcholine is highly ionized.", + "E": "When using a succinylcholine infusion, doses up to 10 mg/kg are considered safe." + }, + "zh": { + "question": "选择错误的陈述。", + "A": "琥珀胆碱的子宫静脉:母体静脉比率在0.1到0.2之间。", + "B": "镁增强非去极化神经肌肉阻滞剂的作用。", + "C": "由于快速代谢，琥珀胆碱对婴儿是安全的。", + "D": "琥珀胆碱高度电离。", + "E": "使用琥珀胆碱输注时，剂量高达10 mg/kg被认为是安全的。" + } + }, + { + "id": "b6623745-5dea-58c1-bdee-52439c350278", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Pregnant patients desaturate faster than non-pregnant patients.   In this study from the BJA (1974:46:358) patients were pre-oxygenated and then a minute after apnea a blood gas was drawn and compared to a gas drawn just before induction.", + "A": "Pregnant women have a lower FRC", + "B": "Pregnant women have bronchial swelling", + "C": "Pregnant women have a faster metabolism", + "D": "Aortocaval compression" + }, + "zh": { + "question": "孕妇比非孕妇更快出现脱饱和。在这项来自BJA的研究中（1974:46:358），患者进行了预氧合，然后在呼吸暂停后一分钟抽取血气，并与诱导前抽取的气体进行比较。", + "A": "孕妇的功能残气量较低", + "B": "孕妇有支气管肿胀", + "C": "孕妇的新陈代谢更快", + "D": "主动脉腔静脉压迫" + } + }, + { + "id": "3179fe1b-1532-5747-8d8a-3595cfccdaf0", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Pick the false statement: With general anesthesia for cesarean delivery:", + "A": "The risk of awareness is about 2%", + "B": "About 50% of patients respond to verbal stimulation during a general anesthetic for cesarean delivery.", + "C": "A laryngeal mask airway has been shown to be very safe in healthy, fasted patients.", + "D": "Inhalational agents used at concentrations between 0.5 and 1.2 MAC increase the risk of bleeding significantly.", + "E": "Blood loss is greater with general anesthesia compared to regional techniques in healthy patients." + }, + "zh": { + "question": "选择错误的陈述：关于剖宫产的全身麻醉：", + "A": "意识清醒的风险约为2%", + "B": "约50%的患者在剖宫产全身麻醉期间对语言刺激有反应。", + "C": "在健康、禁食的患者中，喉罩气道被证明是非常安全的。", + "D": "在0.5到1.2 MAC浓度之间使用的吸入性麻醉剂显著增加出血风险。", + "E": "在健康患者中，全身麻醉的失血量比区域麻醉技术更大。" + } + }, + { + "id": "627ab5f9-f524-589a-9c1e-f8aa2b611382", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "For pre-oxygenation is it important for a pregnant patient to have 3 full minutes of breathing 100% oxygen or are 4 vital capacity breaths more appropriate?", + "A": "Use the 4-breath method even if it is not as effective, it is faster and there is not time to do the full 3 minutes.", + "B": "Use the 4 breath method it is much more efficacious.", + "C": "Use the 4 breath method, it is faster and equally efficacious.", + "D": "Use the full 3 minutes method that is significantly more efficacious." + }, + "zh": { + "question": "对于孕妇的预氧合，重要的是让她们呼吸100%氧气3分钟，还是采用4次肺活量呼吸更合适？", + "A": "即使效果不如3分钟法好，也要使用4次呼吸法，因为它更快，没有时间进行完整的3分钟。", + "B": "使用4次呼吸法，它更有效。", + "C": "使用4次呼吸法，它更快且同样有效。", + "D": "使用完整的3分钟法，它的效果显著更好。" + } + }, + { + "id": "2262695b-12b2-55d1-9182-f39d5c75b523", + "choice_num": 3, + "answer": "C", + "level": 2, + "en": { + "question": "For an elective Cesarean Delivery we give metaclopramide, ranitidine, and sodium bicitrate before induction.  Of these three drugs, which is the most important one to give bfore a general anesthetic for an emergent Cesarean Delivery?", + "A": "Metaclopramide", + "B": "Ranitidine", + "C": "Sodium bicitrate" + }, + "zh": { + "question": "对于择期剖宫产，我们在诱导前给予甲氧氯普胺、雷尼替丁和枸橼酸钠。在这三种药物中，哪一种在紧急剖宫产全身麻醉前最重要？", + "A": "甲氧氯普胺", + "B": "雷尼替丁", + "C": "枸橼酸钠" + } + }, + { + "id": "16ebb224-4614-5771-a3da-7e7eb94c499d", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The expression that for a fixed mass of gas at constant temperature, the product of pressure and volume is constant is known as:", + "A": "Graham's law", + "B": "Bernoulli's law", + "C": "Boyle's law", + "D": "Dalton's law", + "E": "Charles' law" + }, + "zh": { + "question": "对于固定质量的气体在恒定温度下，压力和体积的乘积是恒定的，这种表达被称为：", + "A": "格雷厄姆定律", + "B": "伯努利定律", + "C": "波义耳定律", + "D": "道尔顿定律", + "E": "查尔斯定律" + } + }, + { + "id": "65e29523-d294-59a1-9030-b1110702f85d", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "The pressure gauge on size \"E\" compressed-gas cylinder containing O2 reads 1,600 pounds per square inch absolute temperature (psia). How long could O2 be delivered from this cylinder at a rate of 2 L/min", + "A": "90 min", + "B": "140 min", + "C": "245 min", + "D": "320 min", + "E": "Cannot be calculated" + }, + "zh": { + "question": "E型压缩气瓶中含有O2的压力表读数为1,600磅每平方英寸绝对温度（psia）。以2 L/min的速率从该气瓶中输送O2可以持续多长时间？", + "A": "90分钟", + "B": "140分钟", + "C": "245分钟", + "D": "320分钟", + "E": "无法计算" + } + }, + { + "id": "6063b1d8-74b6-50f8-ba63-ab505e02dd81", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "An otherwise healthy 25-year-old patient is udergoing a femoral hernia repair. General anesthesia is induced with thiopental, 3,5 mg/kg, and after administration of succinylcholine, 1,5 mg/kg, tracheal intubation is performed under direct laryngoscopy without difficulty. Bilateral breath sounds are auscultated and end-expired CO2 is noted on mass spectrometer. Anesthesia is maintaned with isoflurane and N2O, 50% in O2, and the patient's lungs are mechanically vemtilated. Suddenly, the \"low-arterial-saturation\" warning signal on pulse oximeter alarms. After being disconnected from the anesthesia machine, the patient is ventilated with AMBU bag with 100% O2 without difficulty and arterial saturation quickly improves. During inspection of your anesthesia equipment, you notice that bobbin in O2 rotameter is not rotating. This most likely indicates:", + "A": "The flow of N2O through the O2 rotameter", + "B": "No flow of O2 through the O2 rotameter", + "C": "A flow of O2 through the O2 rotameter that is markedly lower than indicated", + "D": "A leak in the O2 rotameter above the bobbin", + "E": "A leak in the O2 rotameter below the bobbin" + }, + "zh": { + "question": "一名25岁健康患者正在接受股疝修补术。用3.5 mg/kg的硫喷妥钠诱导全身麻醉，并在给予1.5 mg/kg的琥珀胆碱后，通过直接喉镜检查顺利进行气管插管。听诊到双侧呼吸音，并在质谱仪上观察到呼气末二氧化碳。麻醉维持使用异氟醚和50%氧化亚氮在氧气中，患者的肺部进行机械通气。突然，脉搏血氧仪发出“低动脉饱和度”警报。与麻醉机断开后，患者用100%氧气的AMBU袋通气，动脉饱和度迅速改善。在检查麻醉设备时，您注意到氧气流量计中的浮子没有旋转。这最可能表明：", + "A": "氧化亚氮通过氧气流量计的流动", + "B": "氧气流量计中没有氧气流动", + "C": "氧气流量计中的氧气流量明显低于指示值", + "D": "氧气流量计中浮子上方的泄漏", + "E": "氧气流量计中浮子下方的泄漏" + } + }, + { + "id": "690d43dc-9ee8-580f-ab07-3f94126462b6", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The O2 pressure-sensor-shutoff valve requires what O2 pressure to remain open and allow N2O flow into the N2O rotameter?", + "A": "10 psia", + "B": "25 psia", + "C": "50 psia", + "D": "100 psia", + "E": "600 psia" + }, + "zh": { + "question": "氧气压力传感器关闭阀需要多少氧气压力才能保持打开状态并允许一氧化二氮流入一氧化二氮流量计？", + "A": "10 psia", + "B": "25 psia", + "C": "50 psia", + "D": "100 psia", + "E": "600 psia" + } + }, + { + "id": "c7e26ff7-4977-5702-8016-e1e6aa5f9ab4", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A copper kettle vaporizer is filled with a volitile anesthetic that is a saturated vapor pressure of 304 mm Hg at 20ºC. The carrier-gas flow through the vaporizing chamber is 90 ml/min. What diluent fresh-gas flow is required to deliver from the vaporizer a final concentration of the anesthetic of 1,5%?", + "A": "1,000 ml/min", + "B": "2,000 ml/min", + "C": "3,000 ml/min", + "D": "4,000 ml/min", + "E": "5,000 ml/min" + }, + "zh": { + "question": "一个铜壶蒸发器中装有一种挥发性麻醉剂，其在20ºC时的饱和蒸气压为304 mm Hg。载气流经蒸发室的流量为90 ml/min。为了从蒸发器中输送出麻醉剂的最终浓度为1.5%，需要多少稀释新鲜气体流量？", + "A": "1,000 ml/min", + "B": "2,000 ml/min", + "C": "3,000 ml/min", + "D": "4,000 ml/min", + "E": "5,000 ml/min" + } + }, + { + "id": "8be467f9-f6f1-56db-9b00-4aa403c9e071", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The second-stage O2 pressure regulator delivers a constant O2 pressure to the rotameters of:", + "A": "4 psia", + "B": "8 psia", + "C": "16 psia", + "D": "32 psia", + "E": "64 psia" + }, + "zh": { + "question": "第二级氧气压力调节器向流量计提供恒定的氧气压力：", + "A": "4 psia", + "B": "8 psia", + "C": "16 psia", + "D": "32 psia", + "E": "64 psia" + } + }, + { + "id": "b8c5c68e-1296-5a46-ad97-a5e8d4e87e06", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The highest trace concentration of N2O allowed in the operating room atmosphere by the National Institute for Occupational Safety and Health (NIOSH) is:", + "A": "1 ppm", + "B": "5 ppm", + "C": "25 ppm", + "D": "50 ppm", + "E": "100 ppm" + }, + "zh": { + "question": "美国国家职业安全卫生研究所（NIOSH）允许在手术室空气中存在的最高N2O痕量浓度是：", + "A": "1 ppm", + "B": "5 ppm", + "C": "25 ppm", + "D": "50 ppm", + "E": "100 ppm" + } + }, + { + "id": "0694e281-8f03-56ae-8e3a-786df156ac73", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Halothane vaporizer will deliver an accurate concentration of an unknown volatile anesthetic if the latter shares which property with halothane?", + "A": "Molecular weight", + "B": "Viscosity", + "C": "Vapor pressure", + "D": "Blood/Gas partition coefficient", + "E": "Oil/Gas partition coefficient" + }, + "zh": { + "question": "如果一种未知挥发性麻醉剂与氟烷共享哪种特性，氟烷蒸发器将提供准确的浓度？", + "A": "分子量", + "B": "粘度", + "C": "蒸气压", + "D": "血/气分配系数", + "E": "油/气分配系数" + } + }, + { + "id": "b8022542-fbc7-5c6c-9a04-b2d6e65f9f8a", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "After entering the anesthesia machine at 45 to 55 psia (from a compressed-gas cylinder), O2 is directed to provide for which of the following functions of the anesthesia machine?", + "A": "A pneumatic source for the gas-driven anesthesia ventilator", + "B": "The O2 supply fail-safe system", + "C": "To open the pressure-sensor shutoff valve", + "D": "O2 to the O2 rotameters", + "E": "All of above" + }, + "zh": { + "question": "在以 45 到 55 psia（从压缩气体钢瓶）进入麻醉机后，O2 被引导用于麻醉机的以下哪项功能？", + "A": "气动驱动麻醉呼吸机的气源", + "B": "氧气供应失效保护系统", + "C": "打开压力传感器关闭阀", + "D": "氧气流量计的氧气供应", + "E": "以上所有" + } + }, + { + "id": "3cefbb10-9144-5fe3-974f-016330494fc9", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following rotameter flow indicators is read in the middle of the dial?", + "A": "Bobbin", + "B": "\"H\" float", + "C": "Ball float", + "D": "Skirted float", + "E": "Nonrotating float" + }, + "zh": { + "question": "以下哪种转子流量计指示器在刻度盘的中间读取？", + "A": "圆柱形浮子", + "B": "\"H\"型浮子", + "C": "球形浮子", + "D": "裙边浮子", + "E": "非旋转浮子" + } + }, + { + "id": "8d86c448-a40a-529d-bc10-8f54272a1a91", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "When the pressure gauge on size \"E\" compressed-gas cylinder, containing N2O begins to fall from its previous constant pressure of 750 psia, how many liters of gas remain in cylinder?", + "A": "200", + "B": "400", + "C": "600", + "D": "800", + "E": "Cannot be calculated" + }, + "zh": { + "question": "当装有N2O的“E”型压缩气瓶上的压力表开始从之前的750 psia恒定压力下降时，气瓶中还剩多少升气体？", + "A": "200", + "B": "400", + "C": "600", + "D": "800", + "E": "无法计算" + } + }, + { + "id": "55d3bb53-590a-5db1-8996-d8868356bb4d", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The maximum volume of CO2 that can be absorbed by 100 g of absorbent granules is:", + "A": "5 L", + "B": "10 L", + "C": "15 L", + "D": "20 L", + "E": "25 L" + }, + "zh": { + "question": "100克吸收剂颗粒能吸收的最大CO2体积是：", + "A": "5升", + "B": "10升", + "C": "15升", + "D": "20升", + "E": "25升" + } + }, + { + "id": "e28f0623-c1a2-5229-8e89-3636ab0bc0ad", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "If the diameter of any intravenous catheter is doubled, flow through the catheter will", + "A": "Decrease by factor of 2", + "B": "Decrease by factor of 4", + "C": "Increase by factor of 8", + "D": "Increase by factor of 16", + "E": "Increase by factor of 32" + }, + "zh": { + "question": "如果任何静脉导管的直径加倍，通过导管的流量将会", + "A": "减少2倍", + "B": "减少4倍", + "C": "增加8倍", + "D": "增加16倍", + "E": "增加32倍" + } + }, + { + "id": "c2a39e59-32c4-5a3c-884b-8ccaa44abe40", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Of the following statements concerning the safe storage of compressed-gas cylinders, choose the one that is false.", + "A": "Should not be handled with oily hands", + "B": "Should not be stored near flammable material", + "C": "Should not be stored in extreme heat or cold", + "D": "Paper or plastic covers should not be removed from the cylinders before storage", + "E": "All of the above statements are true" + }, + "zh": { + "question": "在以下关于压缩气体钢瓶安全储存的陈述中，选择一个错误的。", + "A": "不应以油腻的手处理", + "B": "不应存放在易燃材料附近", + "C": "不应存放在极端高温或低温环境中", + "D": "在储存前不应去除钢瓶上的纸或塑料盖", + "E": "以上所有陈述都正确" + } + }, + { + "id": "03e59c9c-8e3c-5f9f-a48e-977fa65ab667", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Compliance is defined as", + "A": "A change in pressure per unit change in volume", + "B": "A change in volume per unit change in pressure", + "C": "A change in pressure per unit change in flow", + "D": "A change in flow per unit change in pressure", + "E": "A change in volume per unit change in flow" + }, + "zh": { + "question": "顺应性定义为", + "A": "每单位体积变化的压力变化", + "B": "每单位压力变化的体积变化", + "C": "每单位流量变化的压力变化", + "D": "每单位压力变化的流量变化", + "E": "每单位流量变化的体积变化" + } + }, + { + "id": "78805c73-5cbc-56eb-a944-63b817da51ab", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "A mechanical ventilator is set to deliver a Vt of 500 ml at a rate of 10 breaths/min and an inspiratory-to-expiratory (I:E) ratio of 1:2. The fresh-gas flow into the breathing circuit is 6 L/min. In a patient with normal total pulmonary compliance, the actual Vt delivered to the patient be", + "A": "400 ml", + "B": "500 ml", + "C": "600 ml", + "D": "700 ml", + "E": "800 ml" + }, + "zh": { + "question": "机械通气器设置为每分钟10次呼吸，潮气量（Vt）为500毫升，吸气与呼气（I:E）比为1:2。呼吸回路中的新鲜气体流量为6升/分钟。在肺总顺应性正常的患者中，实际送达患者的潮气量为", + "A": "400毫升", + "B": "500毫升", + "C": "600毫升", + "D": "700毫升", + "E": "800毫升" + } + }, + { + "id": "3c605d0f-9d62-54bc-8d68-842069a80e32", + "choice_num": 5, + "answer": "C", + "level": 3, + "en": { + "question": "A mechanical ventilator is set to deliver a Vt of 500 ml at a rate of 6 breaths/min and an inspiratory-to-expiratory (I:E) ratio of 1:2. The fresh-gas flow into the breathing circuit is 6 L/min. In a patient with normal total pulmonary compliance, the actual Vt delivered to the patient be", + "A": "600 ml", + "B": "700 ml", + "C": "800 ml", + "D": "900 ml", + "E": "1000 ml" + }, + "zh": { + "question": "机械通气器设置为每分钟6次呼吸，潮气量（Vt）为500毫升，吸气与呼气（I:E）比为1:2。呼吸回路中的新鲜气体流量为6升/分钟。在肺总顺应性正常的患者中，实际送达患者的潮气量为", + "A": "600毫升", + "B": "700毫升", + "C": "800毫升", + "D": "900毫升", + "E": "1000毫升" + } + }, + { + "id": "8e74a9b1-4c1f-5a5a-b95b-424cae3df544", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Vaporizers for which of the following volatile anesthetics could be used interchangeably with accurate delivery o the concentration of anesthetic set on the vaporizer dial?", + "A": "Halothane, enflurane, and isoflurane", + "B": "Enflurane, isoflurane", + "C": "Halothane, enflurane", + "D": "Halothane, isoflurane", + "E": "None of above" + }, + "zh": { + "question": "以下哪种挥发性麻醉剂的蒸发器可以互换使用，并准确传递蒸发器刻度盘上设定的麻醉剂浓度？", + "A": "氟烷、恩氟烷和异氟烷", + "B": "恩氟烷、异氟烷", + "C": "氟烷、恩氟烷", + "D": "氟烷、异氟烷", + "E": "以上都不是" + } + }, + { + "id": "dae2f06f-7191-59e1-b265-dc63760ac1db", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "According to National Institute for Occupational Safety and Health (NIOSH) regulations, the highest concentration of volatile anesthetic contamination allowed in the operating room atmosphere when administred in conjunction with N2O is", + "A": "0,5 ppm", + "B": "2 ppm", + "C": "5 ppm", + "D": "25 ppm", + "E": "50 ppm" + }, + "zh": { + "question": "根据国家职业安全与健康研究所（NIOSH）的规定，当与N2O一起使用时，手术室空气中允许的挥发性麻醉剂污染的最高浓度是", + "A": "0.5 ppm", + "B": "2 ppm", + "C": "5 ppm", + "D": "25 ppm", + "E": "50 ppm" + } + }, + { + "id": "d49e65ac-5632-5a3c-9306-7e30386c3a39", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The device on anesthesia machines that most reliably detects delivery of hypoxic gas mixtures is the", + "A": "Fail-safe valve", + "B": "O2 analyser", + "C": "Second-stage O2 pressure regulator", + "D": "Promotion-limiting control system", + "E": "Diameter index safety system" + }, + "zh": { + "question": "麻醉机上最可靠检测低氧气体混合物输送的装置是", + "A": "失效保护阀", + "B": "氧气分析仪", + "C": "二级氧气压力调节器", + "D": "促销限制控制系统", + "E": "直径指数安全系统" + } + }, + { + "id": "a174af6d-7045-5202-9223-ed4115c950e2", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The agency responsible for manufacturing and testing compressed gases is the", + "A": "Compressed Gas Association", + "B": "Department of Transportation", + "C": "Food and Drug Administration", + "D": "National Fire Protection Association", + "E": "Joint Commission on Accreditation of Healthcare Organizations" + }, + "zh": { + "question": "负责制造和测试压缩气体的机构是", + "A": "压缩气体协会", + "B": "交通部", + "C": "食品药品监督管理局", + "D": "国家消防协会", + "E": "医疗机构认证联合委员会" + } + }, + { + "id": "6406604f-85dd-5af9-951a-cd248fb40256", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The ratio of the density of a solution to the density of cerebrospinal fluid (CSF) is called", + "A": "Specific gravity", + "B": "Mass", + "C": "Baricity", + "D": "Absolute density", + "E": "None of above" + }, + "zh": { + "question": "溶液的密度与脑脊液（CSF）密度的比值称为", + "A": "比重", + "B": "质量", + "C": "比重性", + "D": "绝对密度", + "E": "以上都不是" + } + }, + { + "id": "f33d371b-2045-5574-9a34-11157ab02503", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Select the false statement.", + "A": "If a Magill forceps is used for nasotracheal intubation, the right nares is preferable of the nasotracheal tube.", + "B": "Extension of the neck can convert an endotracheal intubation to an endobronchial intubation.", + "C": "Bucking signifies the return of coughing reflex.", + "D": "Postintubation pharyngitis is more likely to occur in females.", + "E": "Stenosis becomes symptomatic when the adult tracheal lumen is reduced to less than 5 mm." + }, + "zh": { + "question": "选择错误的陈述。", + "A": "如果使用Magill镊子进行鼻气管插管，右鼻孔是鼻气管插管的首选。", + "B": "颈部伸展可以将气管插管转变为支气管插管。", + "C": "呛咳表示咳嗽反射的恢复。", + "D": "插管后咽炎在女性中更容易发生。", + "E": "当成人气管腔缩小到小于5毫米时，狭窄会出现症状。" + } + }, + { + "id": "e242e100-0100-5b81-aafc-7b52e947c202", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Gas from an N2O compressed-gas cylinder enters the anesthesia machine through a pressure regulator that reduces the pressure to", + "A": "60 psia", + "B": "45 psia", + "C": "30 psia", + "D": "15 psia", + "E": "10 psia" + }, + "zh": { + "question": "来自N2O压缩气瓶的气体通过减压器进入麻醉机，压力被降低到", + "A": "60 psia", + "B": "45 psia", + "C": "30 psia", + "D": "15 psia", + "E": "10 psia" + } + }, + { + "id": "2d71922c-0cd7-5deb-99f7-729f55c39179", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following factors is least responsible for killing bacteria in anesthesia mechines?", + "A": "Metallic ions", + "B": "High O2 concentration", + "C": "Anesthetic gases (a clinical concentrations)", + "D": "Shifts in humidity", + "E": "Shifts in temperature" + }, + "zh": { + "question": "以下哪种因素对麻醉机中细菌的杀灭作用最小？", + "A": "金属离子", + "B": "高氧浓度", + "C": "麻醉气体（临床浓度）", + "D": "湿度变化", + "E": "温度变化" + } + }, + { + "id": "ef7ace92-233d-5315-96c5-3149d00d553a", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following systems prevents attachment of gas-amdinistering equipment to the wrong type of gas line?", + "A": "Pin-index safety system", + "B": "Diameter index safety system", + "C": "Fail-safe system", + "D": "Proportion-limiting control system", + "E": "None of above" + }, + "zh": { + "question": "以下哪种系统可以防止气体输送设备连接到错误类型的气体管线？", + "A": "销孔安全系统", + "B": "直径索引安全系统", + "C": "失效保护系统", + "D": "比例限制控制系统", + "E": "以上都不是" + } + }, + { + "id": "7980c49b-7c7c-5cf7-9618-d2f7da716c6d", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A volatile anesthetic has a satureted vapor pressure of 360 mm Hg at room temperature. At what flow would this agent be delivered from a bubble-through vaporizer if the carrier-gas flow through vaporizing chamber is 100 ml/min?", + "A": "30 ml/min", + "B": "60 ml/min", + "C": "90 ml/min", + "D": "120 ml/min", + "E": "150 ml/min" + }, + "zh": { + "question": "一种挥发性麻醉剂在室温下的饱和蒸气压为360 mm Hg。如果载气通过汽化室的流量为100 ml/min，该药剂从气泡式汽化器中被输送的流量是多少？", + "A": "30 ml/min", + "B": "60 ml/min", + "C": "90 ml/min", + "D": "120 ml/min", + "E": "150 ml/min" + } + }, + { + "id": "cb39553b-3cc3-50b6-b499-37aebaaf306a", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "The total saturated vapor pressure in half-full size \"E\" compressed-gas cylinder containing 50% O2 and 50% N2O by volume (Entonox) is 1,100 psia. The partial saturated vapor pressure of N2O within this cylinder is", + "A": "375 psia", + "B": "450 psia", + "C": "500 psia", + "D": "550 psia", + "E": "Cannot be calculated" + }, + "zh": { + "question": "一个半满的“E”型压缩气体钢瓶中含有50% O2和50% N2O（Entonox），其总饱和蒸气压为1,100 psia。该钢瓶中N2O的部分饱和蒸气压是", + "A": "375 psia", + "B": "450 psia", + "C": "500 psia", + "D": "550 psia", + "E": "无法计算" + } + }, + { + "id": "c7fe9640-792c-55cb-b5d3-63b7a1ab6097", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "High-pressure endotracheal tube cuffs must be inflated to what pressure to produce an adequate seal between the cuff and the wall of the trachea?", + "A": "30-50 mm Hg", + "B": "75-125 mm Hg", + "C": "130-175 mm Hg", + "D": "180-250 mm Hg", + "E": "300-500 mm Hg" + }, + "zh": { + "question": "高压气管插管套囊必须充气到什么压力才能在套囊和气管壁之间形成足够的密封？", + "A": "30-50 mm Hg", + "B": "75-125 mm Hg", + "C": "130-175 mm Hg", + "D": "180-250 mm Hg", + "E": "300-500 mm Hg" + } + }, + { + "id": "2da43f9f-9f58-5071-aaec-aa28846af250", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Body plethysmography can be used to measure lung volumes by application of", + "A": "Boyle's law", + "B": "Dalton's law", + "C": "Newton's law", + "D": "Laplace's law", + "E": "Bernoulli's law" + }, + "zh": { + "question": "体积描记法可以通过应用以下哪种定律来测量肺容量？", + "A": "波义耳定律", + "B": "道尔顿定律", + "C": "牛顿定律", + "D": "拉普拉斯定律", + "E": "伯努利定律" + } + }, + { + "id": "59f18720-e5b0-5e33-9049-3a7bc3896eb6", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Which of the following combinations would result in delivery of a higher-than-expected concentration of volatile anesthetic to the patient?", + "A": "Halothane vaporizer filled with enflurane", + "B": "Halothane vaporizer filled with isoflurane", + "C": "Isoflurane vaporizer filled with halothane", + "D": "Isoflurane vaporizer filled with enflurane", + "E": "Enflurane vaporizer filled with halothane" + }, + "zh": { + "question": "以下哪种组合会导致患者吸入的挥发性麻醉剂浓度高于预期？", + "A": "装有恩氟烷的氟烷蒸发器", + "B": "装有异氟烷的氟烷蒸发器", + "C": "装有氟烷的异氟烷蒸发器", + "D": "装有恩氟烷的异氟烷蒸发器", + "E": "装有氟烷的恩氟烷蒸发器" + } + }, + { + "id": "91bfbb1b-304b-5349-8287-98e1ba4607f1", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The principles that determine the net flow of fluid across capillary membranes are described in", + "A": "Fick's law", + "B": "Graham's law", + "C": "Fick's principle", + "D": "Starling's law", + "E": "Henry's law" + }, + "zh": { + "question": "决定液体通过毛细血管膜净流动的原理是", + "A": "菲克定律", + "B": "格雷厄姆定律", + "C": "菲克原理", + "D": "斯达林定律", + "E": "亨利定律" + } + }, + { + "id": "0c3346f5-04cc-5a6b-a839-3ca294879028", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The most important determinant of resistance to laminar gas flow through a tube is the", + "A": "Length of the tube", + "B": "Radius of the tube", + "C": "Viscosity of the gas", + "D": "Density of the gas", + "E": "Mass of the gas" + }, + "zh": { + "question": "对管道内层流气体流动阻力最重要的决定因素是", + "A": "管道的长度", + "B": "管道的半径", + "C": "气体的粘度", + "D": "气体的密度", + "E": "气体的质量" + } + }, + { + "id": "6ac1f2a4-2198-5e5a-be0d-2ca7465f5a48", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "All of the following would result in less trace gas pollution of the operating room atmosphere EXCEPT", + "A": "Using a high gas flow in circular system", + "B": "Tight mask seal during mask induction", + "C": "Use of scavenger system", + "D": "Periodic maintenance of the anesthesia machine", + "E": "Allow patient to breathe 100% O2 as long as possible before extubation" + }, + "zh": { + "question": "以下所有措施都可以减少手术室环境中的痕量气体污染，除了", + "A": "在循环系统中使用高气流", + "B": "面罩诱导时紧密的面罩密封", + "C": "使用废气收集系统", + "D": "定期维护麻醉机", + "E": "在拔管前尽可能长时间让患者吸入100%氧气" + } + }, + { + "id": "81dde5a7-0420-50d3-9eb4-cacf4b8d6953", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The greatest source for contamination of the operating room atmosphere is leakage of volatile anesthetics", + "A": "Around the anesthesia mask", + "B": "At the vaporizer", + "C": "At the rotameter", + "D": "At the CO2 absorber", + "E": "At the endotracheal tube" + }, + "zh": { + "question": "手术室空气污染的最大来源是挥发性麻醉剂的泄漏", + "A": "在麻醉面罩周围", + "B": "在蒸发器处", + "C": "在流量计处", + "D": "在二氧化碳吸收器处", + "E": "在气管插管处" + } + }, + { + "id": "ed11337f-cce8-55f3-aa82-f54f54eba4a4", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "Uptake of enflurane from the lungs during the first minute of general anesthesia is 200 ml. How much enflurane would be taken up from the lungs between the 16th and 36th minutes?", + "A": "100 ml", + "B": "200 ml", + "C": "400 ml", + "D": "700 ml", + "E": "2000 ml" + }, + "zh": { + "question": "在全身麻醉的第一分钟内，从肺部吸收的恩氟烷为200毫升。在第16到第36分钟之间，从肺部吸收的恩氟烷是多少？", + "A": "100毫升", + "B": "200毫升", + "C": "400毫升", + "D": "700毫升", + "E": "2000毫升" + } + }, + { + "id": "af07b719-9674-5fff-b37c-bf1102e9ec14", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The predominant component of baralyme granules is", + "A": "Water", + "B": "Silica", + "C": "Barium hydroxide", + "D": "Calcium hydroxide", + "E": "Potassium hydroxide" + }, + "zh": { + "question": "巴拉石灰颗粒的主要成分是", + "A": "水", + "B": "硅石", + "C": "氢氧化钡", + "D": "氢氧化钙", + "E": "氢氧化钾" + } + }, + { + "id": "d05159c0-21bb-542c-8afb-404d1fd33797", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Select the FALSE statement regarding iatrogenic bacterial infections from anesthetic equipment", + "A": "Even low concentrations of O2 are lethal to airborne bacteria", + "B": "Bacteria that are released from the airway during violent exhalation originate almost exclusively from anterior oropharynx", + "C": "Of all the bacteria forms, acid-fast bacteria the most resistant to destruction", + "D": "Shifts in temperature and humidity are probably the most important factors responsible for bacterial killing", + "E": "Bacterial filters in the anesthesia-breathing system lower the incidence of postoperative pulmonary infections" + }, + "zh": { + "question": "选择关于麻醉设备医源性细菌感染的错误陈述", + "A": "即使是低浓度的氧气对空气中的细菌也是致命的", + "B": "在剧烈呼气时从气道释放的细菌几乎完全来自前口咽部", + "C": "在所有细菌形式中，抗酸细菌对破坏最具抵抗力", + "D": "温度和湿度的变化可能是导致细菌杀灭的最重要因素", + "E": "麻醉呼吸系统中的细菌过滤器降低了术后肺部感染的发生率" + } + }, + { + "id": "042c2042-a499-5ca2-8ce5-1ea9f3ea00ac", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The least reliable site for central temperature monitoring is the", + "A": "Rectum", + "B": "Skin of forehead", + "C": "Distal third of esophagus", + "D": "Nasopharynx", + "E": "Tympanic membrane" + }, + "zh": { + "question": "最不可靠的中心温度监测部位是", + "A": "直肠", + "B": "前额皮肤", + "C": "食管远端三分之一", + "D": "鼻咽", + "E": "鼓膜" + } + }, + { + "id": "00dfb7d1-3cfd-55ef-a5e9-02bbf3b87bfa", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "A balanced anesthetic is administered to an otherwise healthy 38-year-old patient undergoing repair of a right inguinal hernia. During mechanical ventilation, the anesthesiologist notices that the scavenging-reservoir bag is distented during inspiration. The most likely cause of this is", + "A": "An incompetent pressure-relief valve in the mechanical ventilator", + "B": "An incompetent pressure-relief valve in the patient breathing circuit", + "C": "An incompetent inspiratory unidirectional valve in the patient breathing circuit", + "D": "An incompetent expiratory unidirectional valve in patient breathing circuit", + "E": "None of above; the scavenging-reservoir bag is supposed to distend during inspiration" + }, + "zh": { + "question": "一名身体健康的38岁患者在进行右侧腹股沟疝修补术时接受了平衡麻醉。在机械通气期间，麻醉师注意到废气收集袋在吸气时膨胀。最可能的原因是", + "A": "机械呼吸机的压力释放阀失效", + "B": "患者呼吸���路的压力释放阀失效", + "C": "患者呼吸回路的吸气单向阀失效", + "D": "患者呼吸回路的呼气单向阀失效", + "E": "以上都不是；废气收集袋在吸气时本应膨胀" + } + }, + { + "id": "fe4b1e1e-862e-518e-96fe-3a13ed04d669", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The reason a 40:60 mixture of helium:O2 is more desirable than a 40:60 mixture of nitrogen:O2 for a spontaneously breathing patient with tracheal stenosis is", + "A": "Helium has lower density than nitrogen", + "B": "Helium is smaller molecule than O2", + "C": "Absorption atelectasis decreases", + "D": "Helium has a lower critical velocity for turbulent flow than does O2", + "E": "Helium is toxic to most microorganisms" + }, + "zh": { + "question": "对于自发呼吸的气管狭窄患者，40:60的氦气:氧气混合物比40:60的氮气:氧气混合物更理想的原因是", + "A": "氦气的密度比氮气低", + "B": "氦气分子比氧气小", + "C": "吸收性肺不张减少", + "D": "氦气的湍流临界速度比氧气低", + "E": "氦气对大多数微生物有毒" + } + }, + { + "id": "5176cb7c-e6a5-5f92-94be-1ace058fb749", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The maximum FiO2 that can be delivered by a nasal cannula is", + "A": "0.25", + "B": "0.30", + "C": "0.35", + "D": "0.40", + "E": "0.45" + }, + "zh": { + "question": "鼻导管可以提供的最大吸入氧浓度（FiO2）是", + "A": "0.25", + "B": "0.30", + "C": "0.35", + "D": "0.40", + "E": "0.45" + } + }, + { + "id": "333e66da-6ffd-5adc-8c2f-dc292764984e", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following statements concerning rotameters are true EXCEPT which one?", + "A": "Rotation of the bobbin within the Thorpe tube is important for accurate function", + "B": "The Thorpe tube increases in diameter from bottom to top", + "C": "Its accuracy is affected by changes in temperature and atmospheric pressure", + "D": "The rotameter for N2O and CO2 are interchangeable", + "E": "The rotameter for O2 should be the last in the series" + }, + "zh": { + "question": "以下关于流量计的陈述中，除了哪一个以外，其他都是正确的？", + "A": "在Thorpe管内旋转的转子对于准确功能很重要", + "B": "Thorpe管从底部到顶部直径增加", + "C": "其准确性受温度和大气压变化的影响", + "D": "N2O和CO2的流量计可以互换", + "E": "O2的流量计应是系列中的最后一个" + } + }, + { + "id": "b3d68f10-75cd-51fe-a9ca-32b984f34d05", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which color of nail polish would have the greatest effect on the accuracy of dual-wavelength pulse oxymeters?", + "A": "Red", + "B": "Yellow", + "C": "Blue", + "D": "Green", + "E": "White" + }, + "zh": { + "question": "哪种颜色的指甲油对双波长脉搏血氧仪的准确性影响最大？", + "A": "红色", + "B": "黄色", + "C": "蓝色", + "D": "绿色", + "E": "白色" + } + }, + { + "id": "e983ab02-a64c-530d-a0eb-48648a67db89", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The minimum macroshock current required to elicit ventricular fibrillation is", + "A": "1 mAmp", + "B": "10 mAmp", + "C": "100 mAmp", + "D": "500 mAmp", + "E": "5,000 mAmp" + }, + "zh": { + "question": "引发心室颤动所需的最小宏电击电流是", + "A": "1 毫安", + "B": "10 毫安", + "C": "100 毫安", + "D": "500 毫安", + "E": "5,000 毫安" + } + }, + { + "id": "84d3609d-e4da-5fad-a82f-742c4e29b4dc", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "The line isolation monitor", + "A": "Prevents microshock", + "B": "Prevents macroshock", + "C": "Provides electrical isolation in the operating room", + "D": "Sounds an alarm when grounding occurs in the operating room", + "E": "Provides a safe electrical ground" + }, + "zh": { + "question": "线路隔离监测器", + "A": "防止微电击", + "B": "防止宏电击", + "C": "在手术室提供电气隔离", + "D": "当手术室发生接地时发出警报", + "E": "提供安全的电气接地" + } + }, + { + "id": "b37ef682-bd56-5a5f-b12d-2873f7bc842e", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Kinking of the transfer tubing from the patient breathing circuit to the closed scavenging-system interface can result in", + "A": "Barotrauma", + "B": "Hypoventilation", + "C": "Hypoxia", + "D": "Hyperventilation", + "E": "None of above" + }, + "zh": { + "question": "从患者呼吸回路到封闭式排气系统接口的传输管扭曲可能导致", + "A": "气压伤", + "B": "通气不足", + "C": "缺氧", + "D": "通气过度", + "E": "以上都不是" + } + }, + { + "id": "0aef5e3a-d977-54db-94e2-7134652c1868", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "At what concentration should the isoflurane vaporizer dial be set to deliver 1 minimal alveolar concentration (MAC) of isoflurane in Denver, Colorado (assume Pb is 630 mm Hg)", + "A": "0.75%", + "B": "0.9%", + "C": "1.15%", + "D": "1.4%", + "E": "1.6%" + }, + "zh": { + "question": "在丹佛，科罗拉多州，异氟醚蒸发器的刻度盘应设置为何种浓度以提供1个最小肺泡浓度（MAC）的异氟醚（假设Pb为630 mm Hg）", + "A": "0.75%", + "B": "0.9%", + "C": "1.15%", + "D": "1.4%", + "E": "1.6%" + } + }, + { + "id": "37888314-7a67-54fe-a8c8-2e9221e3cbf9", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Select the FALSE statement regarding noninvasive arterial blood-pressure-monitoring devices", + "A": "If the width of the blood-pressure cuff is too narrow, the measured blood pressure will be falsely lowered", + "B": "The width of the blood-pressure cuff should be 40% of th circumference of the patient's arm", + "C": "If the blood-pressure cuff is too loosely wrapped around the arm, the measured pressure will be falsely elevated", + "D": "Oscillometric blood-pressure measurements are accurate in neonates", + "E": "Frequent cycling of automated blood-pressure monitoring devices can result in edema distal to the cuff" + }, + "zh": { + "question": "选择关于无创动脉血压监测设备的错误陈述", + "A": "如果血压袖带的宽度过窄，测得的血压将被错误地降低", + "B": "血压袖带的宽度应为患者手臂周长的40%", + "C": "如果血压袖带在手臂上缠得过松，测得的压力将被错误地升高", + "D": "示波法血压测量在新生儿中是准确的", + "E": "自动血压监测设备的频繁循环可能导致袖带远端的水肿" + } + }, + { + "id": "b224e301-67f0-541d-bdb7-6a32b4914b89", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "An incompetent ventilator pressure-relief valve can result in", + "A": "Hypoxia", + "B": "Barotrauma", + "C": "A low-circuit-pressure signal", + "D": "Hypoventilation", + "E": "Hyperventilation" + }, + "zh": { + "question": "通气机压力释放阀失效可能导致", + "A": "缺氧", + "B": "气压伤", + "C": "低回路压力信号", + "D": "通气不足", + "E": "通气过度" + } + }, + { + "id": "586a5936-d73a-55e2-b741-3b11b72de8e5", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "The pressure gauge of a size \"E\" compressed-gas cylinder containing air shows a pressure of 900 psia. How long could air be delivered from thi cylinder at rate of 10 L/min?", + "A": "10 minutes", + "B": "20 minutes", + "C": "30 minutes", + "D": "40 minutes", + "E": "50 minutes" + }, + "zh": { + "question": "一个装有空气的“E”型压缩气瓶的压力表显示压力为900 psia。以10 L/min的速率从该气瓶中输送空气可以持续多长时间？", + "A": "10分钟", + "B": "20分钟", + "C": "30分钟", + "D": "40分钟", + "E": "50分钟" + } + }, + { + "id": "28c4ba5d-1c69-5dec-84b3-7318f5f2812c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The most frequent cause of mechanical failure of the anesthesia delivery system to deliver adequate O2 to the patient is", + "A": "Attachment of the wrong compressed-gas cylinder to the O2 yoke", + "B": "Crossing of pipelines during construction of the operating room", + "C": "Improperly assembled O2 rotameter", + "D": "Fresh gas line disconnection from anesthesia machine to the in-line hosing", + "E": "Disconnection of the O2 supply system from the patient" + }, + "zh": { + "question": "麻醉输送系统无法向患者提供足够氧气的最常见机械故障原因是", + "A": "将错误的压缩气瓶连接到氧气接口", + "B": "手术室建设期间管道交叉", + "C": "氧气流量计组装不当", + "D": "从麻醉机到管道的新鲜气体管线断开", + "E": "氧气供应系统与患者断开连接" + } + }, + { + "id": "8475e0aa-208e-507f-a2ea-7d362ef31e19", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "How  much vapor will 1 mL of liquid enflurane produce at room temperature?", + "A": "100 mL", + "B": "200 mL", + "C": "300 mL", + "D": "400 mL", + "E": "500 mL" + }, + "zh": { + "question": "1毫升液态恩氟烷在室温下会产生多少蒸气？", + "A": "100毫升", + "B": "200毫升", + "C": "300毫升", + "D": "400毫升", + "E": "500毫升" + } + }, + { + "id": "01a6b801-69f8-540a-b749-1861046a58b6", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "The expression that the rate of passive diffusion of gas across a lipid membrane is inversely proportional to the square root of the molecular weight of the gas is known as", + "A": "Dalton's law", + "B": "Graham's law", + "C": "Boyle's law", + "D": "Hagen-Poiseuille's law", + "E": "Fick's law" + }, + "zh": { + "question": "气体通过脂质膜的被动扩散速率与气体分子量的平方根成反比的表达式被称为", + "A": "道尔顿定律", + "B": "格雷厄姆定律", + "C": "波义耳定律", + "D": "哈根-泊肃叶定律", + "E": "菲克定律" + } + }, + { + "id": "f9f81feb-3fc6-58df-a693-973dfaca26d3", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "The volume of O2 in half-full compressed-gas cylinder can be calculated by application of", + "A": "Boyle's law", + "B": "Dalton's law", + "C": "Dalton's law", + "D": "Charle's law", + "E": "None of above" + }, + "zh": { + "question": "可以通过应用以下哪种定律计算半满压缩气瓶中的氧气体积？", + "A": "波义耳定律", + "B": "道尔顿定律", + "C": "道尔顿定律", + "D": "查理定律", + "E": "以上都不是" + } + }, + { + "id": "3d86dc5a-87a4-5ea2-a92c-f74a7cfa9e56", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "The ratio of the density of a solution to the density of water is called", + "A": "Mass", + "B": "Baricity", + "C": "Specific gravity", + "D": "Relative density", + "E": "None of the above" + }, + "zh": { + "question": "溶液的密度与水的密度之比称为", + "A": "质量", + "B": "比重", + "C": "比重", + "D": "相对密度", + "E": "以上都不是" + } + }, + { + "id": "54b7d780-35d6-508d-8c4c-1d9dbc7c94d0", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "At high altitudes, the flow of a gas through a rotameter will be", + "A": "Greater than expected", + "B": "Less than expected", + "C": "Greater than expected at high flows but less than expected at low\nflows", + "D": "Less than expected at high flows but greater than expected at low\nflows", + "E": "Greater than expected at high flows but accurate at low flows" + }, + "zh": { + "question": "在高海拔地区，通过流量计的气体流量将会是", + "A": "大于预期", + "B": "小于预期", + "C": "在高流量时大于预期，但在低流量时小于预期", + "D": "在高流量时小于预期，但在低流量时大于预期", + "E": "在高流量时大于预期，但在低流量时准确" + } + }, + { + "id": "e49904f0-282c-5db5-9ada-04961c92f616", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The volume N2O in a half-full compressed-gas cylinder can be calculated by application of", + "A": "Boyle's Law", + "B": "Dalton's Law", + "C": "Graham's Law", + "D": "Charles' Law", + "E": "None of the above" + }, + "zh": { + "question": "可以通过应用以下哪一项来计算半满压缩气体钢瓶中的N2O体积？", + "A": "波义耳定律", + "B": "道尔顿定律", + "C": "格雷厄姆定律", + "D": "查尔斯定律", + "E": "以上都不是" + } + }, + { + "id": "4e0d6f9d-7641-5a12-9c76-2c3c250566fd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Turbulent gas flow through a tube increases", + "A": "Lineary with the pressure gradient down the tube", + "B": "Lineary with the density of the gas", + "C": "To the forth power of the radius of the tube", + "D": "Approximately to the square of the radius of the tube" + }, + "zh": { + "question": "通过管道的湍流气体流量增加", + "A": "与管道内的压力梯度线性增加", + "B": "与气体的密度线性增加", + "C": "与管道半径的四次方成正比", + "D": "大约与管道半径的平方成正比" + } + }, + { + "id": "20eb5ef4-1915-5c04-80a8-76076253d040", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following materials will not ignite during the laseer surgery of the airway?", + "A": "Rubber", + "B": "Silicone", + "C": "Polyvinylchloride", + "D": "Metal" + }, + "zh": { + "question": "以下哪种材料在气道激光手术中不会燃烧？", + "A": "橡胶", + "B": "硅胶", + "C": "聚氯乙烯", + "D": "金属" + } + }, + { + "id": "9945435e-2d0d-50d4-8c63-d922df966700", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "True statements concerning a closed scavenging-system interface include which of the following?", + "A": "Failure to connect the system interface to the wall suction will result in barotrauma to the patient", + "B": "Excessive wall suction will result in hypoventilation to the lungs", + "C": "The scavenging reservoir bag will distend during inspiration", + "D": "The scavenging reservoir bag will distend during expiration" + }, + "zh": { + "question": "关于封闭式排气系统接口的正确陈述包括以下哪项？", + "A": "未将系统接口连接到墙壁吸引将导致患者气压伤", + "B": "过度的墙壁吸引将导致肺部通气不足", + "C": "在吸气过程中，排气储气袋会膨胀", + "D": "在呼气过程中，排气储气袋会膨胀" + } + }, + { + "id": "ba2d0d17-a9c7-5934-b35d-d4d4d0a4e4f2", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The pin-index safety system prevents", + "A": "Attachment of gas-administration equipment to the wrong gas line", + "B": "Delivery of a hypoxic mixture from the rotameters to the patient", + "C": "Delivery of the wrong gas from the central supply source", + "D": "Incorrect yoke to compressed-gas cylinder connections" + }, + "zh": { + "question": "插销索引安全系统可以防止", + "A": "将气体输送设备连接到错误的气体管线", + "B": "从流量计向患者输送缺氧混合物", + "C": "从中央供应源输送错误的气体", + "D": "压缩气瓶与不正确的支架连接" + } + }, + { + "id": "bb717302-d170-5e63-862d-e7ef2d9c2741", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Lasers capable of damaging all tissues include which of the following", + "A": "Ruby", + "B": "Argon", + "C": "Neodymium-yttrium-aluminium-garnet(Nd-YAG)", + "D": "CO2 laser" + }, + "zh": { + "question": "能够损伤所有组织的激光包括以下哪种？", + "A": "红宝石激光", + "B": "氩激光", + "C": "钕-钇-铝-石榴石激光（Nd-YAG）", + "D": "二氧化碳激光" + } + }, + { + "id": "31009ab0-26e1-5e90-977c-88cde7ab2654", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 15 kg dog weighs how many pounds?", + "A": "30.3 lbs", + "B": "33 lbs", + "C": "6.8 lbs", + "D": "28 lbs" + }, + "zh": { + "question": "一只15公斤的狗重多少磅？", + "A": "30.3 磅", + "B": "33 磅", + "C": "6.8 磅", + "D": "28 磅" + } + }, + { + "id": "115c5042-577e-50be-a80e-ff8466155330", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A 65 kg dog weighs how many pounds?", + "A": "151 lbs", + "B": "143 lbs", + "C": "29.5 lbs", + "D": "33 lbs" + }, + "zh": { + "question": "一只65公斤的狗重多少磅？", + "A": "151磅", + "B": "143磅", + "C": "29.5磅", + "D": "33磅" + } + }, + { + "id": "c6f8664e-6f7d-5e3b-a92a-d577d4690232", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "A normal, healthy patient that is undergoing a spay surgery would fall where on the ARA scale?", + "A": "1--minimal risk", + "B": "2--low risk", + "C": "3--moderate risk", + "D": "4--high risk", + "E": "5--extreme risk" + }, + "zh": { + "question": "一名正常健康的患者正在接受绝育手术，在 ARA 量表上属于哪一类？", + "A": "1--最小风险", + "B": "2--低风险", + "C": "3--中等风险", + "D": "4--高风险", + "E": "5--极高风险" + } + }, + { + "id": "2f5c2c39-3c20-53d8-bdd1-15e44080c851", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "A patient with severe systemic disease, such as anemia, moderate dehydration, and compensated organ disease would fall where on the ARA scale?", + "A": "1--minimial risk", + "B": "2--low risk", + "C": "3--moderate risk", + "D": "4--high risk", + "E": "5--extreme risk" + }, + "zh": { + "question": "患有严重全身性疾病的患者，例如贫血、中度脱水和代偿性器官疾病，在ARA量表上属于哪个等级？", + "A": "1--最低风险", + "B": "2--低风险", + "C": "3--中等风险", + "D": "4--高风险", + "E": "5--极高风险" + } + }, + { + "id": "5e7edd1f-5c69-5449-bf90-c9ef3b3b1e48", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Active scavengers used activated charcoal to remove waste anesthetic gas.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "主动清除器使用活性炭去除废弃麻醉气体。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "4c6a7295-1dc9-5476-86b6-b2c0f49d95ba", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Cone-shaped devices that allow you to deliver oxygen and/or anesthetic gases to the patient without intubating them.", + "A": "Induction chamber", + "B": "Mask", + "C": "Vaporizer", + "D": "Flow meter" + }, + "zh": { + "question": "锥形装置，允许您在不插管的情况下向患者输送氧气和/或麻醉气体。", + "A": "诱导箱", + "B": "面罩", + "C": "蒸发器", + "D": "流量计" + } + }, + { + "id": "d5783805-d653-5c5b-b6e0-e7e53da71b45", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "General anesthesia is defined as the loss of feeling or sensation to a specific area.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "全身麻醉被定义为对特定区域的感觉或知觉的丧失。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "25b8dc0b-65b5-52a8-aa6a-0c1eb86ff236", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "It is recommended most patients be fasted for about ____ hours before the surgery.", + "A": "6", + "B": "12", + "C": "18", + "D": "24" + }, + "zh": { + "question": "建议大多数患者在手术前禁食大约 ____ 小时。", + "A": "6", + "B": "12", + "C": "18", + "D": "24" + } + }, + { + "id": "c078ff15-36a0-5f41-9378-fa4f2a9805bd", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Ketamine is always used with a(n)", + "A": "Anticholinergic", + "B": "Sedative", + "C": "Opioid", + "D": "Tranquilizer" + }, + "zh": { + "question": "氯胺酮总是与以下哪种药物一起使用？", + "A": "抗胆碱药", + "B": "镇静剂", + "C": "阿片类药物", + "D": "镇定剂" + } + }, + { + "id": "9ef5fa23-654f-5065-9f74-77447069b28c", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Long and intermediate-acting barbiturates are generally used for anticonvulsant therapy.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "长效和中效巴比妥类药物通常用于抗惊厥治疗。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "57e5b8be-19b2-55d7-ac5b-e4a0e8c33701", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Scavenger units safely filter/route waste gas from induction chambers.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "清除装置可以安全地过滤/引导来自诱导室的废气。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "21c65847-3e11-5b08-9fa2-477160ff9242", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The manometer is measured in", + "A": "G/dl", + "B": "Cm/h20", + "C": "Mmhg", + "D": "Mph" + }, + "zh": { + "question": "压力计的测量单位是", + "A": "克/分升", + "B": "厘米/水柱", + "C": "毫米汞柱", + "D": "英里/小时" + } + }, + { + "id": "99e5a20a-24dc-5dbb-a282-ad5eedcb9c54", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What drug will often make patients vomit after 5-10 minutes?", + "A": "Butorphanol", + "B": "Valium", + "C": "Morphine", + "D": "Atropine" + }, + "zh": { + "question": "哪种药物通常会在5-10分钟后引起患者呕吐？", + "A": "布托啡诺", + "B": "安定", + "C": "吗啡", + "D": "阿托品" + } + }, + { + "id": "1b2fe1c7-61b2-558a-9744-fb6d8cb617d3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "___________ allow us to deliver oxygen and anesthetic gas to the patient which maintains them at a surgical plane of anesthesia.", + "A": "Vaporizers", + "B": "Rebreathing bags", + "C": "Endotracheal tubes", + "D": "Scavenger units" + }, + "zh": { + "question": "___________ 使我们能够向患者输送氧气和麻醉气体，从而使他们保持在手术麻醉平面。", + "A": "挥发器", + "B": "呼吸囊", + "C": "气管插管", + "D": "废气排放装置" + } + }, + { + "id": "f917de6b-3ead-5d3f-a349-dff9c248200a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following preanesthetic drugs lowers the seizure threshold?", + "A": "Acepromazine", + "B": "Valium", + "C": "Xylazine", + "D": "Fentanyl" + }, + "zh": { + "question": "以下哪种术前用药会降低癫痫发作阈值？", + "A": "氯丙嗪", + "B": "安定", + "C": "赛拉嗪", + "D": "芬太尼" + } + }, + { + "id": "8fd8a55b-2d0d-5f34-9f06-26bcdd68ae98", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Overall, considering both spontaneous and controlled ventilation, the Mapleson circuit requiring the lowest fresh gas flow rates is the", + "A": "A", + "B": "B", + "C": "C", + "D": "D" + }, + "zh": { + "question": "总体而言，考虑到自发通气和控制通气，Mapleson回路中所需新鲜气体流量最低的是", + "A": "A", + "B": "B", + "C": "C", + "D": "D" + } + }, + { + "id": "71d4b34c-c45b-5553-ae4d-fc5abf5a44ab", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Regarding monitoring for pediatric inhalation induction:", + "A": "Temperature monitoring is essential during induction.", + "B": "It is unwise to upset anxious children by placing a blood pressure cuff before induction.", + "C": "A baseline ECG must be obtained before induction, especially in anxious children", + "D": "It is unnecessary to obtain pre-induction blood pressures in neonates, often difficult to obtain due to motion." + }, + "zh": { + "question": "关于儿童吸入诱导的监测：", + "A": "在诱导期间，温度监测是必不可少的。", + "B": "在诱导前放置血压袖带可能会让焦虑的儿童不安，这是不明智的。", + "C": "在诱导前必须获得基线心电图，尤其是对焦虑的儿童。", + "D": "在新生儿中不需要获得诱导前的血压，因为由于运动通常难以获得。" + } + }, + { + "id": "9d80a081-b7c7-59a2-8d35-ce018c50f30d", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "In a 12-year-old child the length of an oral endotracheal tube (from the lips to the mid trachea) should be:", + "A": "12 cm", + "B": "14 cm", + "C": "16 cm", + "D": "18 cm", + "E": "20 cm" + }, + "zh": { + "question": "在一名12岁的儿童中，口腔气管插管的长度（从嘴唇到气管中部）应为：", + "A": "12 厘米", + "B": "14 厘米", + "C": "16 厘米", + "D": "18 厘米", + "E": "20 厘米" + } + }, + { + "id": "0759d79b-e264-5427-92f5-a64bf720e9cf", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "A 6-year-old, 20-kg girl develops pulseless ventricular tachycardia after induction of anesthesia with halothane, nitrous oxide, and oxygen for a tonsillectomy. The anesthesiologist intubates the child, administers 100% oxygen, and starts chest compressions. When the defibrillator quickly arrives in the OR the defibrillator should be charged to what energy level for the initial shock?", + "A": "20 joules", + "B": "40 joules", + "C": "60 joules", + "D": "80 joules", + "E": "120 joules" + }, + "zh": { + "question": "一名6岁、20公斤的女孩在用氟烷、氧化亚氮和氧气进行扁桃体切除术麻醉诱导后出现无脉性室性心动过速。麻醉师为孩子插管，给予100%氧气，并开始胸外按压。当除颤器迅速到达手术室时，初次电击应将除颤器充电到什么能量水平？", + "A": "20 焦耳", + "B": "40 焦耳", + "C": "60 焦耳", + "D": "80 焦耳", + "E": "120 焦耳" + } + }, + { + "id": "7c158303-f7a5-5f8b-b931-733be0afccb9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the first sign of inhalation anesthetic induction in a child?", + "A": "Disappearance of eyelash reflex", + "B": "Shallow, rapid breathing", + "C": "Appearance of nystagmus", + "D": "The patient does not react to verbal stimuli" + }, + "zh": { + "question": "儿童吸入麻醉诱导的第一个征象是什么？", + "A": "睫毛反射消失", + "B": "呼吸浅快", + "C": "眼球震颤出现", + "D": "患者对语言刺激无反应" + } + }, + { + "id": "493dd2de-388e-52a3-bbb0-6962dcd8426d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "In ambient conditions, the most important determinant of oxygen content is:", + "A": "Increased pH", + "B": "2,3 DPG levels", + "C": "Elevated temperature", + "D": "Hemoglobin concentration" + }, + "zh": { + "question": "在环境条件下，氧含量的最重要决定因素是：", + "A": "pH值升高", + "B": "2,3 DPG水平", + "C": "温度升高", + "D": "血红蛋白浓度" + } + }, + { + "id": "3c837b95-6080-58f0-ab41-e560f46a3235", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A patient develops auditory hallucinations and has a convulsion while you are reducing a nasal fracture and packing the nares.  Spray and mucosal application of cocaine was used as an anesthetic.  Appropriate management is:", + "A": "Call 911 and wait for EMT transport", + "B": "Airway management and IV diazepam", + "C": "Succinylcholine IV", + "D": "Epinephrine IV" + }, + "zh": { + "question": "在您为一名患者复位鼻骨骨折并填塞鼻腔时，患者出现听觉幻觉并发生抽搐。使用可卡因喷雾和粘膜应用作为麻醉剂。适当的处理是：", + "A": "拨打911并等待急救人员运输", + "B": "气道管理和静脉注射地西泮", + "C": "静脉注射琥珀胆碱", + "D": "��脉注射肾上腺素" + } + }, + { + "id": "9fc70cf1-54c9-50f5-9649-4aa2e64b21fe", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The non-depolarizing agent that has a predictable rate of metabolism is:", + "A": "Atracurium", + "B": "D-tubocurarine", + "C": "Vecruonium", + "D": "Pancuronium" + }, + "zh": { + "question": "具有可预测代谢率的非去极化药物是：", + "A": "阿曲库铵", + "B": "筒箭毒碱", + "C": "维库溴铵", + "D": "潘库溴铵" + } + }, + { + "id": "c5b09ea6-c400-5cc2-8bcd-b3471c758e47", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The best method to determine the proper placement of an endotracheal tube is:", + "A": "Exhaust tube capnography", + "B": "Auscultation of the chest", + "C": "Observation of chest motion with ventilation", + "D": "Visualization of the chords" + }, + "zh": { + "question": "确定气管插管正确放置的最佳方法是：", + "A": "呼气末二氧化碳监测", + "B": "听诊胸部", + "C": "观察通气时胸部运动", + "D": "可视化声带" + } + }, + { + "id": "d5555f35-19ed-5c8a-ab2e-f5c106cd441e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A characteristic of first-order kinetics is:", + "A": "Steady state levels cannot be predicted", + "B": "A loading dose is determined by the desired plasma level", + "C": "The half-life of a drug is equal to the rate of elimination", + "D": "First order kinetics applies to all drugs" + }, + "zh": { + "question": "一级动力学的一个特征是：", + "A": "稳态水平无法预测", + "B": "负荷剂量由所需的血浆水平决定", + "C": "药物的半衰期等于消除速率", + "D": "一级动力学适用于所有药物" + } + }, + { + "id": "5cc837ec-d1be-5a33-bd6e-08fb9a5d629d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The most significant side effect of pancuronium is:", + "A": "Hyperkalemia", + "B": "Renal insufficiency", + "C": "Hyperthermia", + "D": "Sympathetic stimulation" + }, + "zh": { + "question": "潘库溴铵最显著的副作用是：", + "A": "高钾血症", + "B": "肾功能不全", + "C": "高热", + "D": "交感神经刺激" + } + }, + { + "id": "12f9fca1-5df0-59d0-bcc2-d49bdbd7f07c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The risk factor most responsible for increased morbidity and mortality is:", + "A": "Age greater than 70", + "B": "Smoking 20 plus years", + "C": "Diabetes mellitus on insulin", + "D": "Prednisone 20mg for 6 months" + }, + "zh": { + "question": "最主要导致发病率和死亡率增加的危险因素是：", + "A": "年龄大于70岁", + "B": "吸烟超过20年", + "C": "使用胰岛素的糖尿病", + "D": "服用20mg泼尼松6个月" + } + }, + { + "id": "646bc5ea-4108-5a2a-883b-ab933042c397", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Preoperative preparation of a 70 yr old smoker with a normal EKG should include:", + "A": "Coronary angiography", + "B": "MRI", + "C": "Stress test", + "D": "Pulmonary function tests" + }, + "zh": { + "question": "对一名70岁吸烟者进行术前准备，且其心电图正常，应包括：", + "A": "冠状动脉造影", + "B": "核磁共振", + "C": "压力测试", + "D": "肺功能测试" + } + }, + { + "id": "062d6790-3334-502c-86b1-0cd4c6a223a8", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A contraindication for spinal anesthesia is:", + "A": "Elderly patients", + "B": "Sepsis", + "C": "Infants", + "D": "Diabetics" + }, + "zh": { + "question": "椎管内麻醉的禁忌症是：", + "A": "老年患者", + "B": "败血症", + "C": "婴儿", + "D": "糖尿病患者" + } + }, + { + "id": "7047b7b4-1915-5d7b-8281-8c6db605ccc2", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following supports the membrane lipid theory used to describe the mechanism of action of general anesthetics?", + "A": "Anesthetics produce different levels or components of anesthesia at different anatomical loci", + "B": "Hyperbaric condition reverses anesthesia", + "C": "Anesthetics can be enantioselective and display steriochemical preference", + "D": "Some lipid soluble, halogenated compounds do not have anesthetic activity", + "E": "Anesthetic agents have cellular mechanisms, such as ability to hyperpolarize neurons, inhibit transmitter release, enhance inhibitory neurotransmission" + }, + "zh": { + "question": "以下哪项支持用于描述全身麻醉药作用机制的膜脂理论？", + "A": "麻醉药在不同的解剖部位产生不同水平或成分的麻醉", + "B": "高压条件下麻醉作用被逆转", + "C": "麻醉药可以是对映选择性的，并显示立体化学偏好", + "D": "一些脂溶性卤化合物没有麻醉活性", + "E": "麻醉剂具有细胞机制，例如能够使神经元超极化、抑制递质释放、增强抑制性神经传递" + } + }, + { + "id": "6ba0ed06-1baf-5674-85e9-85bd7c556c56", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following explains some of the actions of general anesthetics on ion channels?", + "A": "Activation of a certain class of K+ channel", + "B": "Increases the sensitivity of GABAa receptor to GABA", + "C": "Inhibit excitatory current in NMDA receptor", + "D": "Enhance the action of glycine on glycine receptor", + "E": "All of the above" + }, + "zh": { + "question": "以下哪项解释了全身麻醉药对离子通道的一些作用？", + "A": "激活某类K+通道", + "B": "增加GABAa受体对GABA的敏感性", + "C": "抑制NMDA受体的兴奋性电流", + "D": "增强甘氨酸对甘氨酸受体的作用", + "E": "以上所有" + } + }, + { + "id": "b946d4cd-7fb2-5c6b-a2e8-7a7fb296fa2d", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following conditions would require a decrease in anesthetic dosing to produce anesthetic effects except:", + "A": "Old age (elderly)", + "B": "Young age (children)", + "C": "Pregnancy", + "D": "Stress & anxiety", + "E": "All of the above" + }, + "zh": { + "question": "以下所有情况都需要减少麻醉剂量以产生麻醉效果，除了：", + "A": "老年（老人）", + "B": "年轻（儿童）", + "C": "怀孕", + "D": "压力和焦虑", + "E": "以上所有" + } + }, + { + "id": "1ff3c9d1-a74a-5068-b8c3-f9c4d2c0f370", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "General anesthetics are available in the following dosage forms except:", + "A": "Oral", + "B": "Intravenous", + "C": "Inhaled gases and volatile liquids", + "D": "Intramuscular", + "E": "Intrarectal" + }, + "zh": { + "question": "全身麻醉剂可用于以下剂型，除了：", + "A": "口服", + "B": "静脉注射", + "C": "吸入气体和挥发性液体", + "D": "肌肉注射", + "E": "直肠内给药" + } + }, + { + "id": "b9030ce2-a1de-50a7-94dd-a7bb03f115b1", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Place the following stages of anesthesia in order (from stage 1 to stage 4)\nA. Surgical anesthesia\n\nB. Amnesia, irregular respiration\n\nC. Medullary depression\n\nD. Analgesia", + "A": "D, A, B, C", + "B": "D, C, B, A", + "C": "B, D, A, C", + "D": "D, B, A, C", + "E": "C, A, B, D" + }, + "zh": { + "question": "将以下麻醉阶段按顺序排列（从第1阶段到第4阶段）\nA. 手术麻醉\n\nB. 失忆，呼吸不规则\n\nC. 延髓抑制\n\nD. 镇痛", + "A": "D, A, B, C", + "B": "D, C, B, A", + "C": "B, D, A, C", + "D": "D, B, A, C", + "E": "C, A, B, D" + } + }, + { + "id": "dfd11a01-427f-5155-baa4-5c36fd2c3a1a", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following describes the P3 plane or substage of anesthesia?", + "A": "Loss of muscle tone", + "B": "Intercostal muscle paralysis", + "C": "Sensory Loss", + "D": "Sleep", + "E": "Amnesia" + }, + "zh": { + "question": "以下哪项描述了麻醉的 P3 平面或亚阶段？", + "A": "肌肉张力丧失", + "B": "肋间肌麻痹", + "C": "感觉丧失", + "D": "睡眠", + "E": "遗忘" + } + }, + { + "id": "7052948d-d14d-5735-9ebe-05652fda695e", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following describes the P1 plane or substage of anesthesia?", + "A": "Loss of muscle tone", + "B": "Intercostal muscle paralysis", + "C": "Sensory loss", + "D": "Sleep", + "E": "Amnesia" + }, + "zh": { + "question": "以下哪项描述了麻醉的P1平面或亚阶段？", + "A": "肌肉张力丧失", + "B": "肋间肌麻痹", + "C": "感觉丧失", + "D": "睡眠", + "E": "遗忘" + } + }, + { + "id": "fbf0d01c-4ed1-54c9-b2dd-6a697ca24d43", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following describes the P4 plane or substage of anesthesia?", + "A": "Loss of muscle tone", + "B": "Intercostal muscle paralysis", + "C": "Sensory loss", + "D": "Sleep", + "E": "Amnesia" + }, + "zh": { + "question": "以下哪项描述了麻醉的 P4 平面或亚阶段？", + "A": "肌肉张力丧失", + "B": "肋间肌麻痹", + "C": "感觉丧失", + "D": "睡眠", + "E": "遗忘" + } + }, + { + "id": "8281e61a-5ced-5706-852a-eb925263882d", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following stages of anesthesia is the best stage for surgery?", + "A": "Stage 1", + "B": "Stage 2", + "C": "Stage 3", + "D": "Stage 4", + "E": "Stage 5" + }, + "zh": { + "question": "以下哪一个麻醉阶段是手术的最佳阶段？", + "A": "阶段 1", + "B": "阶段 2", + "C": "阶段 3", + "D": "阶段 4", + "E": "阶段 5" + } + }, + { + "id": "e25ba197-4c7f-5262-846c-a4e9c7e49711", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following describes the mechanism for stage 4 (medullary depression) of anesthesia?", + "A": "Neurons in medulla, normally insensitive, except at high concentrations", + "B": "Higher center - increased excitatory neurotransmitters", + "C": "Anesthetic stops pain transmission in spinal tract - dorsal horn, spinal cord, nociceptors", + "D": "Decreased spinal reflex and decreased firing of ascending pathways", + "E": "None of the above" + }, + "zh": { + "question": "以下哪项描述了麻醉的第4阶段（延髓抑制）的机制？", + "A": "延髓中的神经元通常不敏感，除非在高浓度下", + "B": "高级中枢 - 兴奋性神经递质增加", + "C": "麻醉剂阻止疼痛在脊髓束中的传递 - 背角、脊髓、伤害感受器", + "D": "脊髓反射减少和上行通路的放电减少", + "E": "以上都不是" + } + }, + { + "id": "6b794f67-7b2c-5574-870d-1e2f963b917e", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following describes the mechanism for stage 2 (amnesia, irregular respiration) of anesthesia?", + "A": "Neurons in medulla, normally insensitive, except at high concentrations", + "B": "Higher centers - increased excitatory neurotransmitters", + "C": "Anesthetic stops pain transmission in spinal tract - dorsal horn, spinal cord, nociceptors", + "D": "Decreased spinal reflex and decreased firing of ascending pathways", + "E": "None of the above" + }, + "zh": { + "question": "以下哪项描述了麻醉的第二阶段（遗忘，呼吸不规则）的机制？", + "A": "延髓中的神经元，通常不敏感，除非在高浓度下", + "B": "高级中枢 - 兴奋性神经递质增加", + "C": "麻醉剂阻止脊髓束中的疼痛传递 - 背角，脊髓，伤害感受器", + "D": "脊髓反射减少和上行通路的放电减少", + "E": "以上都不是" + } + }, + { + "id": "d30b06af-b494-534f-9eae-4041154b6d86", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not a parenteral anesthetic?", + "A": "Propofol", + "B": "Thiopental", + "C": "Katamine", + "D": "Ether", + "E": "All of the above answers are parenteral anesthetics." + }, + "zh": { + "question": "以下哪一项不是肠外麻醉剂？", + "A": "丙泊酚", + "B": "硫喷妥钠", + "C": "氯胺酮", + "D": "乙醚", + "E": "以上所有答案都是肠外麻醉剂。" + } + }, + { + "id": "9f8409fc-bd53-5be2-a604-2cba5109a479", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is NOT a characteristic of katamine?", + "A": "Highly lipid soluble", + "B": "Produces hallucinations, illusions, and vivid dreams, especially in children.", + "C": "A congener of phencyclidine (PCD) which was taken off the market due to side effects", + "D": "Good for patients at risk for hypotension and bronchiospasm", + "E": "All of the following are characteristics of katamine" + }, + "zh": { + "question": "以下哪项不是氯胺酮的特征？", + "A": "高度脂溶性", + "B": "产生幻觉、错觉和生动的梦境，尤其是在儿童中。", + "C": "是苯环利定（PCD）的类似物，因副作用被市场撤回", + "D": "适用于有低血压和支气管痉挛风险的患者", + "E": "以下所有都是氯胺酮的特征" + } + }, + { + "id": "c417e5bb-69e5-5108-bb61-c22fe8edb321", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Which of the following is the most commonly used parenteral anesthetic in the US?", + "A": "Ether", + "B": "Thiopental", + "C": "Katamine", + "D": "Etomidate", + "E": "Propofol" + }, + "zh": { + "question": "以下哪种是美国最常用的非肠道麻醉剂？", + "A": "乙醚", + "B": "硫喷妥钠", + "C": "氯胺酮", + "D": "依托咪酯", + "E": "丙泊酚" + } + }, + { + "id": "250b2396-7c75-58e0-ab30-dd08671d429c", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "The depth of anesthesia of inhalation anesthetics depends on:", + "A": "The alveolar concentration of the agent", + "B": "The concentration of the agent in the inspired gas mixture", + "C": "The solubility of the agent in the blood", + "D": "Pulmonary blood flow (i.e. cardiac output)", + "E": "All of the above" + }, + "zh": { + "question": "吸入麻醉药的麻醉深度取决于：", + "A": "药物的肺泡浓度", + "B": "吸入气体混合物中药物的浓度", + "C": "药物在血液中的溶解度", + "D": "肺血流量（即心输出量）", + "E": "以上所有因素" + } + }, + { + "id": "0f538c6c-a389-50ab-8a39-4a1e4beb553d", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "A major disadvantage of using inhalation anesthetics includes", + "A": "Rapid onset", + "B": "Limited amount of inhalation anesthetics available as compared to parenteral anesthetics available", + "C": "High therapeutic index", + "D": "Low margin of safety, therefore one of the most dangerous class of drugs", + "E": "Doesn't cross BBB" + }, + "zh": { + "question": "使用吸入麻醉剂的一个主要缺点是", + "A": "起效快", + "B": "与可用的肠外麻醉剂相比，可用的吸入麻醉剂数量有限", + "C": "高治疗指数", + "D": "安全范围低，因此是最危险的药物类别之一", + "E": "不穿过血脑屏障" + } + }, + { + "id": "815cb4c2-31ed-54ee-b3cf-d806198846b6", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Minimal Alveolar Concentration (MAC) is:", + "A": "The concentration necessary to produce amnesia in 100% of the population", + "B": "The concentration necessary to inhibit bacterial growth", + "C": "The concentration necessary to prevent the elimination of inhalation anesthetics", + "D": "The concentration necessary to prevent responding (to the scalpel) in 50% of the population", + "E": "None of the above" + }, + "zh": { + "question": "最小肺泡浓度（MAC）是：", + "A": "在100%的人群中产生遗忘所需的浓度", + "B": "抑制细菌生长所需的浓度", + "C": "防止吸入麻醉剂被消除所需的浓度", + "D": "在50%的人群中防止对手��刀反应所需的浓度", + "E": "以上都不是" + } + }, + { + "id": "6ef72aa3-4c9f-56b7-9fef-355f18002c02", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is NOT a stage of general anesthesia?", + "A": "Induction", + "B": "Maintenance", + "C": "Emergence", + "D": "Exacerbation" + }, + "zh": { + "question": "以下哪一项不是全身麻醉的阶段？", + "A": "诱导期", + "B": "维持期", + "C": "苏醒期", + "D": "加重期" + } + }, + { + "id": "1cb84b85-5641-5469-a592-2af81a426859", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not a reason for using adjuncts for anesthetics?", + "A": "Prevent undesirable effects", + "B": "Reduces amount of anesthetic needed", + "C": "Increase effectiveness of anesthetic", + "D": "Increases anxiety", + "E": "All of the above are reasons for using adjuncts for anesthetics" + }, + "zh": { + "question": "以下哪一项不是使用麻醉辅助药物的原因？", + "A": "防止不良反应", + "B": "减少所需麻醉剂量", + "C": "提高麻醉效果", + "D": "增加焦虑", + "E": "以上都是使用麻醉辅助药物的原因" + } + }, + { + "id": "a95f36a8-57db-5498-ae1c-e189da1efa96", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "All of the following are characteristics of Xenon except", + "A": "Minimal side effects", + "B": "Relatively inexpensive", + "C": "Ideal anesthetic", + "D": "Extremely insoluble in blood", + "E": "Very rare drug" + }, + "zh": { + "question": "以下哪项不是氙气的特征", + "A": "副作用小", + "B": "相对便宜", + "C": "理想的麻醉剂", + "D": "在血液中极不溶解", + "E": "非常稀有的药物" + } + }, + { + "id": "b6b082b6-6ced-504f-b615-c0b11128d41b", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following anesthetic increases respiration?", + "A": "Isoflurane", + "B": "Halothane", + "C": "Thiopental", + "D": "Sevoflurane", + "E": "None of the above" + }, + "zh": { + "question": "以下哪种麻醉剂会增加呼吸？", + "A": "异氟醚", + "B": "氟烷", + "C": "硫喷妥钠", + "D": "七氟醚", + "E": "以上都不是" + } + }, + { + "id": "431f1b88-bf8b-5ca9-bc2d-d212b184f2c2", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The following are all types of controls (drive mechanisms) except for:", + "A": "Pneumatic", + "B": "Galvanic", + "C": "Fluidic", + "D": "Electronic" + }, + "zh": { + "question": "以下都是控制（驱动机制）的类型，除了：", + "A": "气动", + "B": "电流", + "C": "流体", + "D": "电子" + } + }, + { + "id": "9f9aac9d-df59-5b4f-88a7-3021475baa9a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "In an ascending bellows during exhalation, the driving gas will vent to:", + "A": "Scavenging System", + "B": "Breathing Bag", + "C": "Atmosphere", + "D": "Descending Bellows" + }, + "zh": { + "question": "在呼气期间上升的风箱中，驱动气体将排放到：", + "A": "废气收集系统", + "B": "呼吸袋", + "C": "大气", + "D": "下降的风箱" + } + }, + { + "id": "4d427cb0-d9fb-5c6e-9181-025c6647ff96", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following statements are true:", + "A": "If you have a machine driven by air and a leak occcurs in the bellows you will get an increase in FiO2", + "B": "If you have a machine driven by oxygen and a leak occurs in the bellows you will get a decreased FiO2", + "C": "If you have a machine driven by air and a leak occurs in the bellows you will have no change in FiO2", + "D": "If you have a machine driven by air and a leak occurs in the bellows you will have a decrease in FiO2" + }, + "zh": { + "question": "以下哪项陈述是正确的：", + "A": "如果您有一台由空气驱动的机器，并且波纹管发生泄漏，您将获得FiO2的增加", + "B": "如果您有一台由氧气驱动的机器，并且波纹管发生泄漏，您将获得FiO2的减少", + "C": "如果您有一台由空气驱动的机器，并且波纹管发生泄漏，您的FiO2将没有变化", + "D": "如果您有一台由空气驱动的机器，并且波纹管发生泄漏，您的FiO2将减少" + } + }, + { + "id": "edebe4f5-6a7f-5635-942b-8bd1ceb764a4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following statements are false:", + "A": "A piston is similar to an ascending bellows in the fact that they both move up during inspiration.", + "B": "The Fabius GS is a continuous flow anesthesia machine in which gas delivery is purely pneumatic and electronically measured.", + "C": "In event of an electrical power failure, an anesthetic can still be given to the patient using the Fabius GS.", + "D": "An air entrainment valve protects the patient from negative pressures." + }, + "zh": { + "question": "以下哪些陈述是错误的：", + "A": "活塞与上升式风箱相似，因为它们在吸气时都会向上移动。", + "B": "Fabius GS 是一种连续流麻醉机，其气体输送完全是气动的，并通过电子测量。", + "C": "在电力故障的情况下，仍然可以使用 Fabius GS 给患者施行麻醉。", + "D": "空气引入阀保护患者免受负压影响。" + } + }, + { + "id": "ef647a9d-37cd-5ac2-abe4-76d4f11937db", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The S-ORC Assembly is responsible for:", + "A": "Protecting the patient from extremely high breathing pressures", + "B": "Eliminating the APL valve during ventilatory modes.", + "C": "Ensuring that the hypoxic mixtures are not given to the patient", + "D": "Calibrating the O2 sensor" + }, + "zh": { + "question": "S-ORC组件负责：", + "A": "保护患者免受极高呼吸压力的影响", + "B": "在通气模式下消除APL阀。", + "C": "确保不给患者提供低氧混合物", + "D": "校准氧气传感器" + } + }, + { + "id": "fed27253-64a8-5b28-a537-ea99b263f790", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "During anesthetic management of a pt with HTN, you should seek to keep the intra-op BP within _____ of your baseline BP.", + "A": "You should seek to reduce BP to normal range.", + "B": "10%", + "C": "5%", + "D": "20%" + }, + "zh": { + "question": "在对高血压患者进行麻醉管理时，您应努力将术中血压保持在基线血压的_____范围内。", + "A": "您应努力将血压降低到正常范围。", + "B": "10%", + "C": "5%", + "D": "20%" + } + }, + { + "id": "153ed577-cced-521b-9f58-4ae1c1e09413", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following does not typify the response expected when managing a pt with HTN?", + "A": "Exaggerated hypotensive response to induction", + "B": "Hypertension upon intubation of pt", + "C": "Chronic volume depletion requiring fluid boluses during surgery", + "D": "Resistance to vasoactive medications, requiring higher doses" + }, + "zh": { + "question": "以下哪项不符合管理高血压患者时预期的反应？", + "A": "诱导时出现夸张的低血压反应", + "B": "插管时出现高血压", + "C": "慢性容量不足，手术期间需要液体推注", + "D": "对血管活性药物有抵抗力，需要更高剂量" + } + }, + { + "id": "959a4494-9873-54b5-845d-4e3d64ce7076", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "A patient with critical mitral stenosis develops atrial fibrillation with an uncontrolled ventricular rate averaging 150 beats per minute and pulmonary edema. Which of the following courses of action would be most appropriate?", + "A": "Administer a diuretic", + "B": "Administer a positive inotropic agent", + "C": "Administer a positive inotropic agent in combination with vasodilator", + "D": "Administer a negative chronotropic agent" + }, + "zh": { + "question": "一名患有严重二尖瓣狭窄的患者出现心房颤动，伴有平均心室率150次/分钟和肺水肿。以下哪种处理方式最为合适？", + "A": "给予利尿剂", + "B": "给予正性肌力药物", + "C": "给予正性肌力药物联合血管扩张剂", + "D": "给予负性变时药物" + } + }, + { + "id": "fdfbbd57-6783-50e9-aa89-7cf3a9ad38af", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "In which condition would sodium nitroprusside be the MOST beneficial to increase cardiac output?", + "A": "Mitral stenosis", + "B": "Aortic stenosis", + "C": "Aortic regurgitation", + "D": "Coronary artery disease" + }, + "zh": { + "question": "在以下哪种情况下，硝普钠对增加心输出量最有益？", + "A": "二尖瓣狭窄", + "B": "主动脉瓣狭窄", + "C": "主动脉瓣关闭不全", + "D": "冠状动脉疾病" + } + }, + { + "id": "a4256aad-ad98-5c96-aca6-00de0a0254e9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "At what stage of hypertension would a patient begin to experience renal dysfunction?", + "A": "Stage 4", + "B": "Stage 3", + "C": "Stage 2", + "D": "Stage 1" + }, + "zh": { + "question": "患者在高血压的哪个阶段会开始出现肾功能障碍？", + "A": "阶段 4", + "B": "阶段 3", + "C": "阶段 2", + "D": "阶段 1" + } + }, + { + "id": "73dead6a-ec99-5ccc-beef-7da37aa9d9d5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following disease is not commonly associated with pts undergoing CEA?", + "A": "CAD", + "B": "Diabetes", + "C": "CVA", + "D": "Liver dx" + }, + "zh": { + "question": "以下哪种疾病与接受颈动脉内膜切除术的患者不常相关？", + "A": "冠心病", + "B": "糖尿病", + "C": "脑血管意外", + "D": "肝病" + } + }, + { + "id": "b8d6da53-7ace-5c75-a97d-4fc1d0adeda6", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Appropriate interventions with surgical traction on the carotid sinus include:", + "A": "Atropine", + "B": "Infiltration with local anesthestic", + "C": "Release of traction by surgeon", + "D": "All the above are acceptable interventions" + }, + "zh": { + "question": "对颈动脉窦进行手术牵引的适当干预措施包括：", + "A": "阿托品", + "B": "局部麻醉药浸润", + "C": "由外科医生释放牵引", + "D": "以上所有都是可接受的干预措施" + } + }, + { + "id": "a3c38c28-eafc-50c6-ac08-ac554c8d5568", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "All of the following hemodynamic changes should be anticipated during aortic cross-clamping in a patient with normal left ventricular function except:", + "A": "Increased SVR", + "B": "Increased MAP", + "C": "Increased CO", + "D": "Decreased EF%" + }, + "zh": { + "question": "在左心室功能正常的患者中，主动脉夹闭期间应预期出现以下所有血流动力学变化，除了：", + "A": "SVR增加", + "B": "MAP增加", + "C": "CO增加", + "D": "EF%减少" + } + }, + { + "id": "0300fe6e-b215-5273-848b-517373a79191", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "Which of the following parameters will best assist you to decide the best anesthetic technique to use for a cardiac patient?", + "A": "The type of surgery", + "B": "Left ventricle function", + "C": "The patient’s blood pressure", + "D": "The patients’ heart rate" + }, + "zh": { + "question": "以下哪个参数最能帮助您决定为心脏病患者使用最佳麻醉技术？", + "A": "手术类型", + "B": "左心室功能", + "C": "患者的血压", + "D": "患者的心率" + } + }, + { + "id": "4a7661d9-6621-544f-b70f-29be5b2541a9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Hemodynamic goals for a CEA are:", + "A": "Hypotension to prevent blood loss within the surgical field", + "B": "Hypertension and tachycardia to maintain CPP", + "C": "High-normal BP range to maintain CPP", + "D": "No blood pressure concerns" + }, + "zh": { + "question": "CEA 的血流动力学目标是：", + "A": "低血压以防止手术区域内的失血", + "B": "高血压和心动过速以维持脑灌注压", + "C": "高正常血压范围以维持脑灌注压", + "D": "没有血压方面的担忧" + } + }, + { + "id": "0ab9049f-d85b-5734-9b64-20e5b9ea0238", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is not true regarding the management of a pt undergoing AAA repair?", + "A": "During cross-clamp, vasoconstrict to keep BP slightly elevated and restrict fluids", + "B": "You should have a central line, A-line, and large bore IV’s", + "C": "During cross clamp you should turn off heating blankets", + "D": "All the above are true" + }, + "zh": { + "question": "以下关于进行 AAA 修复的患者管理哪一项是不正确的？", + "A": "在夹闭期间，收缩血管以保持血压略微升高并限制液体", + "B": "你应该有中心静脉导管、动脉导管和大口径静脉通路", + "C": "在夹闭期间应关闭加热毯", + "D": "以上全部正确" + } + }, + { + "id": "2a674c91-e8d4-50b1-adc4-1d53cb4cdc8c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Surgery on the ascending aorta involves:", + "A": "Median sternotomy and CPB", + "B": "Median sternontomy with deep hypothermic circulatory arrest", + "C": "Cross clamping with thoractomy using OLV", + "D": "Cross clamping using retroperitoneal approach" + }, + "zh": { + "question": "升主动脉手术涉及：", + "A": "正中开胸和体外循环", + "B": "正中开胸与深低温循环停滞", + "C": "使用单肺通气的开胸夹闭", + "D": "使用腹膜后途径的夹闭" + } + }, + { + "id": "d2b30078-8b1c-5bc2-8350-6538f7ea13ac", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "At what level should you seek to maintain your ETCO2 waveform on the anesthesia monitor during a CEA?", + "A": "ETCO2 27", + "B": "ETCO2 36", + "C": "ETCO2 48", + "D": "Wherever the pt tolerates best" + }, + "zh": { + "question": "在进行颈动脉内膜切除术（CEA）时，应将麻醉监护仪上的ETCO2波形维持在什么水平？", + "A": "ETCO2 27", + "B": "ETCO2 36", + "C": "ETCO2 48", + "D": "患者耐受最佳的水平" + } + }, + { + "id": "f6aea869-23c8-5df3-a8ba-82dde654bd0f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A systolic murmur auscultated at 2nd intercostal space is typical for which type of valvular heart lesion?", + "A": "Mitral stenosis", + "B": "Aortic stenosis", + "C": "Mitral prolapse", + "D": "Aortic regurgitation" + }, + "zh": { + "question": "在第2肋间隙听诊到的收缩期杂音典型地与哪种类型的心脏瓣膜病变有关？", + "A": "二尖瓣狭窄", + "B": "主动脉瓣狭窄", + "C": "二尖瓣脱垂", + "D": "主动脉瓣关闭不全" + } + }, + { + "id": "adcc0821-484e-537a-8ec1-72c05eb6dbc3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "All of the following are post-op complications related to CEA except:", + "A": "Hemorrhage", + "B": "HTN due to denervation of carotid baroreceptors", + "C": "Injury to RLN", + "D": "Injury to the optic nerve due to hypoperfusion" + }, + "zh": { + "question": "以下哪项不是与颈动脉内膜切除术（CEA）相关的术后并发症：", + "A": "出血", + "B": "由于颈动脉压力感受器去神经引起的高血压", + "C": "喉返神经损伤", + "D": "由于低灌注引起的视神经损伤" + } + }, + { + "id": "d27626a5-9999-55d7-902b-079319772aa9", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following drugs would you most likely administer after aortic clamping during elective AAA repair?", + "A": "Neosynephrine", + "B": "Apresoline", + "C": "NTG", + "D": "Dobutamine" + }, + "zh": { + "question": "在选择性腹主动脉瘤修复术中，主动脉夹闭后您最有可能给予以下哪种药物？", + "A": "新福林", + "B": "阿普唑林", + "C": "硝酸甘油", + "D": "多巴酚丁胺" + } + }, + { + "id": "df369ebe-4f4f-5a7b-9513-6b3a5202721f", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "Where would you listen for a murmur on a patient with Mitral Regurge?", + "A": "1", + "B": "2", + "C": "3", + "D": "4", + "E": "5" + }, + "zh": { + "question": "在二尖瓣返流患者身上，您会在哪里听到杂音？", + "A": "1", + "B": "2", + "C": "3", + "D": "4", + "E": "5" + } + }, + { + "id": "6c2f2a35-929e-5293-9c2e-bffd3a888998", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Appropriate interventions to counteract the effects of \"unclamping\" are all of the following except:", + "A": "Vasodilators", + "B": "Increase minute ventilation", + "C": "Calcium Chloride", + "D": "Sodium Bicarb" + }, + "zh": { + "question": "以下所有措施均可用于抵消“解夹”效应，除了：", + "A": "血管扩张剂", + "B": "增加每分钟通气量", + "C": "氯化钙", + "D": "碳酸氢钠" + } + }, + { + "id": "7173d069-740f-5abb-8ef3-6bd37ff34441", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Lactic acid build-up distal to the aortic clamp will cause:", + "A": "Vasodilation", + "B": "Bronchodilation", + "C": "Vasoconstriction", + "D": "Myocardial stimulation" + }, + "zh": { + "question": "主动脉夹远端的乳酸堆积会导致：", + "A": "血管扩张", + "B": "支气管扩张", + "C": "血管收缩", + "D": "心肌刺激" + } + }, + { + "id": "71e22728-f97d-5105-8d82-5c151b669e99", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A rumbling diastolic murmur heard at the apex of the heart is characteristic of which of the valvular lesions?", + "A": "Mitral stenosis", + "B": "Mitral regurgitation", + "C": "Aortic stenosis", + "D": "Aortic regurgitation" + }, + "zh": { + "question": "在心尖部听到的隆隆舒张期杂音是哪个瓣膜病变的特征？", + "A": "二尖瓣狭窄", + "B": "二尖瓣关闭不全", + "C": "主动脉瓣狭窄", + "D": "主动脉瓣关闭不全" + } + }, + { + "id": "18092b62-0f80-5752-be26-820be359382d", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "In which cardiac condition is maintaining a normal sinus rhythm not an important contribution to a better stroke volume?", + "A": "Mitral stenosis", + "B": "Mitral regurgitation", + "C": "Aortic stenosis", + "D": "Idiopathic hypertrophied subaortic stenosis" + }, + "zh": { + "question": "在以下哪种心脏病中，维持正常窦性心律对改善每搏输出量不是重要的贡献？", + "A": "二尖瓣狭窄", + "B": "二尖瓣关闭不全", + "C": "主动脉瓣狭窄", + "D": "特发性肥厚性主动脉下狭窄" + } + }, + { + "id": "fdc5a771-567a-5e43-98b9-7b5ecf3284a4", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is not necessary for an ASA 3 pt undergoing an Aorta-life bypass?", + "A": "Serial H&H and ABG’s", + "B": "Bair Hugger for lower extremities", + "C": "A-Line", + "D": "Fluid Warmer" + }, + "zh": { + "question": "以下哪项对于接受主动脉-生命旁路手术的ASA 3级患者不是必需的？", + "A": "连续的血红蛋白和动脉血气分析", + "B": "下肢使用Bair Hugger", + "C": "动脉导管", + "D": "液体加温器" + } + }, + { + "id": "9612c252-6fab-52d9-865f-b4f4c7daa79e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Surgery on the transverse aorta involves:", + "A": "Median sternotomy and CPB", + "B": "Median sternontomy with deep hypothermic circulatory arrest", + "C": "Cross clamping with thoractomy using OLV", + "D": "Cross clamping using retroperitoneal approach" + }, + "zh": { + "question": "横主动脉手术涉及：", + "A": "正中开胸和体外循环", + "B": "正中开胸与深低温循环停滞", + "C": "使用单肺通气的开胸交叉钳夹", + "D": "使用腹膜后途径的交叉钳夹" + } + }, + { + "id": "bd41d073-a0ed-53a9-8aa2-db13576d29d4", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Your patient is having a left-sided CEA, the A-line should be placed:", + "A": "On the right side because in case occlusion to left occurs", + "B": "In femoral site due to risk of occluding the innominate", + "C": "On the left side because you want to know how well the operative side is perfusing", + "D": "Either side is acceptable" + }, + "zh": { + "question": "您的患者正在进行左侧颈动脉内膜切除术，动脉线应放置在：", + "A": "右侧，因为如果左侧发生闭塞", + "B": "股动脉部位，因为有闭塞无名动脉的风险", + "C": "左侧，因为您想知道手术侧的灌注情况", + "D": "任一侧都可以接受" + } + }, + { + "id": "86781538-8090-5cc1-9b53-3f097be91201", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Prior to aortic cross-clamp, you administered 7,500 units of heparin to your pt. It has now been one hour and the surgeon is asking you to give protamine. How much should you give?", + "A": "26 mg", + "B": "75 mg", + "C": "90 mg", + "D": "38 mg" + }, + "zh": { + "question": "在主动脉阻断前，你给病人注射了7,500单位的肝素。现在已经过了一个小时，外科医生要求你给普鲁卡因。你应该给多少？", + "A": "26毫克", + "B": "75毫克", + "C": "90毫克", + "D": "38毫克" + } + }, + { + "id": "bdba7292-8fc5-5e07-9025-7ba511b133a9", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Where should you keep the HR on a pt with Mitral stenosis?", + "A": "Equal to or slightly below baseline", + "B": "Keep HR elevated above baseline", + "C": "Aim for a HR >80 bpm", + "D": "Aim for HR" + }, + "zh": { + "question": "在二尖瓣狭窄患者中，心率应保持在什么水平？", + "A": "等于或略低于基线", + "B": "保持心率高于基线", + "C": "目标心率 >80 bpm", + "D": "目标心率" + } + }, + { + "id": "afdc559d-c9ff-51c4-a70a-63bc4b7ae219", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is not true regarding patients with Mitral Regurgitation?", + "A": "Ketamine may be used for induction of MR patients", + "B": "Decreases in SVR should be avoided", + "C": "Decreases in HR should be avoided", + "D": "Reversal of NMB may be done as usual" + }, + "zh": { + "question": "关于二尖瓣关闭不全患者，下列哪项是不正确的？", + "A": "氯胺酮可用于二尖瓣关闭不全患者的诱导", + "B": "应避免全身血管阻力的降低", + "C": "应避免心率的降低", + "D": "神经肌肉阻滞的逆转可以照常进行" + } + }, + { + "id": "327d7920-30fb-5440-bab4-05f5131dabc4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A pt with Aortic stenosis is most likely to experience which of the following?", + "A": "Concentric Hypertrophy", + "B": "Ischemic Cardiomyopathy", + "C": "Eccentric Hypertrophy", + "D": "Tamponade" + }, + "zh": { + "question": "患有主动脉瓣狭窄的患者最有可能出现以下哪种情况？", + "A": "向心性肥厚", + "B": "缺血性心肌病", + "C": "离心性肥厚", + "D": "心脏压塞" + } + }, + { + "id": "26a44136-d562-56ea-b38d-62c1c274d6df", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Surgery on the descending aorta involves:", + "A": "Median sternotomy and CPB", + "B": "Median sternontomy with deep hypothermic circulatory arrest", + "C": "Cross clamping with thoractomy using OLV", + "D": "Cross clamping using retroperitoneal approach" + }, + "zh": { + "question": "降主动脉手术涉及：", + "A": "正中开胸和体外循环", + "B": "正中开胸与深低温循环停滞", + "C": "使用单肺通气的开胸交叉钳夹", + "D": "使用腹膜后途径的交叉钳夹" + } + }, + { + "id": "746c2027-d0b0-5931-b3da-58daee78ecd3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "90-95% of AAA's involve which part of the abdominal aorta?", + "A": "Suprarenal", + "B": "Juxtarenal", + "C": "Infrarenal", + "D": "Pararenal" + }, + "zh": { + "question": "90-95%的腹主动脉瘤涉及腹主动脉的哪个部分？", + "A": "肾上", + "B": "近肾", + "C": "肾下", + "D": "旁肾" + } + }, + { + "id": "e4d01207-f438-5920-963f-1496d8277eb7", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which of the following is true regarding anesthetic management of a pt with Mitral Stenosis?", + "A": "Ketamine is drug of choice for induction of pts with severe MS", + "B": "Narcotics and propofol infusions should be avoided due to myocardial suppression", + "C": "Rocuronium or Sux would be drugs of choice for intubation of MS pts", + "D": "Aggressive fluid therapy is necessary due to chronic fluid depleted state and risk for hypotension" + }, + "zh": { + "question": "关于二尖瓣狭窄患者的麻醉管理，下列哪项是正确的？", + "A": "氯胺酮是重度二尖瓣狭窄患者诱导的首选药物", + "B": "应避免使用麻醉性镇痛药和丙泊酚输注，因为它们会抑制心肌", + "C": "罗库溴铵或琥珀胆碱是二尖瓣狭窄患者插管的首选药物", + "D": "由于慢性液体缺乏状态和低血压风险，需要积极的液体治疗" + } + }, + { + "id": "6e7dc8b5-70de-5050-bbc3-c99b42a7362b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the most common side effect associated with the administration of protamine?", + "A": "Hypotension", + "B": "Bradycardia", + "C": "Hemorrhage", + "D": "Allergic reaction" + }, + "zh": { + "question": "与鱼精蛋白的使用相关的最常见副作用是什么？", + "A": "低血压", + "B": "心动过缓", + "C": "出血", + "D": "过敏反应" + } + }, + { + "id": "bb8cce38-057d-5ed9-b279-0110923924fc", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "Which of the following would you choose for the induction of a patient with severe aortic stenosis?", + "A": "Inhalational induction with desflurane", + "B": "Ketamine IV induction", + "C": "Propofol IV Induction", + "D": "High dose fentanyl induction" + }, + "zh": { + "question": "对于严重主动脉瓣狭窄的患者，您会选择以下哪种诱导方法？", + "A": "吸入诱导使用地氟烷", + "B": "静脉注射氯胺酮诱导", + "C": "静脉注射丙泊酚诱导", + "D": "高剂量芬太尼诱导" + } + }, + { + "id": "1f69df8b-cb8d-53df-bf3b-02a491583f8b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "During Carotid vascular surgery, BP should be maintained…", + "A": "Slightly above pre-op levels", + "B": "Slightly below pre-op levels", + "C": "Equal to pre-op levels", + "D": "Ummm, there is no BP on bypass." + }, + "zh": { + "question": "在颈动脉血管手术期间，血压应维持在…", + "A": "略高于术前水平", + "B": "略低于术前水平", + "C": "等于术前水平", + "D": "呃，体外循环时没有血压。" + } + }, + { + "id": "3dab1eae-9524-5a25-94ce-3d8a18944f5c", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is not true regarding pts with Mitral Stenosis?", + "A": "These patients are more prone to a-fib", + "B": "Pavulon is a good choice for facilitating intubation", + "C": "Sedative drugs should be given at a reduced dose, due to increased risk for ventilator depression", + "D": "Use caution with fluid therapy as these pts are more prone to fluid overload" + }, + "zh": { + "question": "关于二尖瓣狭窄患者，下列哪项是不正确的？", + "A": "这些患者更容易发生房颤", + "B": "Pavulon 是促进插管的好选择", + "C": "由于增加了呼吸抑制的风险，镇静药物应减少剂量", + "D": "使用液体治疗时要小心，因为这些患者更容易发生液体超负荷" + } + }, + { + "id": "af1c6c99-6c06-5f5d-ba1a-e334a4577ff3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the most common cause of Mitral Stenosis?", + "A": "Hypertension", + "B": "Aortic Regurge", + "C": "Left Ventricular Hypertrophy", + "D": "Rheumatic Fever" + }, + "zh": { + "question": "二尖瓣狭窄最常见的原因是什么？", + "A": "高血压", + "B": "主动脉返流", + "C": "左心室肥厚", + "D": "风湿热" + } + }, + { + "id": "5169fa98-3f37-5fb1-a38b-dcbc55646762", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Acute mitral regurge is most commonly due to…", + "A": "Myocardial Infarction", + "B": "Rheumatic fever", + "C": "Mitral Stenosis", + "D": "Severe hypertensive episodes" + }, + "zh": { + "question": "急性二尖瓣反流最常见的原因是…", + "A": "心肌梗死", + "B": "风湿热", + "C": "二尖瓣狭窄", + "D": "严重的高血压发作" + } + }, + { + "id": "6a8d8506-f851-5f9c-8527-7b4e991eb7bb", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How will Mitral regurge affect the Wedge waveform on your Swan line?", + "A": "Absent A wave", + "B": "Will show decrease wedge pressure", + "C": "Prominent V wave", + "D": "Large A wave" + }, + "zh": { + "question": "二尖瓣反流将如何影响 Swan 导管的楔形波形？", + "A": "A 波消失", + "B": "楔压降低", + "C": "V 波显著", + "D": "A 波增大" + } + }, + { + "id": "2d9a6641-5edf-5a3d-9c2f-7884b27067b5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "All of the following are characteristics of aortic stenosis except:", + "A": "Concentric hypertrophy", + "B": "Increased LVEDP", + "C": "Increased ventricular compliance", + "D": "Increased dependence on artial contraction" + }, + "zh": { + "question": "以下哪项不是主动脉瓣狭窄的特征：", + "A": "向心性肥厚", + "B": "左心室舒张末期压升高", + "C": "心室顺应性增加", + "D": "对心房收缩的依赖性增加" + } + }, + { + "id": "2f5e7874-c758-5518-b485-6391e7173db3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The most common cause of postoperative mortality associated with AAA repair is", + "A": "CVA", + "B": "Mesenteric thrombosis", + "C": "Acute renal failure", + "D": "MI" + }, + "zh": { + "question": "与AAA修复相关的术后死亡最常见的原因是", + "A": "脑血管意外", + "B": "肠系膜血栓", + "C": "急性肾衰竭", + "D": "心肌梗死" + } + }, + { + "id": "dec1d236-e9a9-5d86-b6b7-84796f193a36", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "The most effective method to preserve renal function during aortic cross-clamping is:", + "A": "Mannitol", + "B": "Lasix", + "C": "Fenoldopam", + "D": "Hydration" + }, + "zh": { + "question": "在主动脉夹闭期间保护肾功能的最有效方法是：", + "A": "甘露醇", + "B": "速尿", + "C": "非诺多泮", + "D": "补液" + } + }, + { + "id": "f3b77827-ffbb-5c18-a67f-a3a22da5d6db", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not required for symptomatic Aortic Stenosis pts?", + "A": "Swan Ganz line", + "B": "A-Line", + "C": "Large Bore IV’s", + "D": "All the above are required" + }, + "zh": { + "question": "以下哪项不是症状性主动脉瓣狭窄患者所需的？", + "A": "Swan Ganz 导管", + "B": "动脉导管", + "C": "大口径静脉通路", + "D": "以上都是必需的" + } + }, + { + "id": "2b93484d-ed53-5f14-aa2a-a6d0d0a3605c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not true of patients with Aortic Stenosis?", + "A": "Sudden decreases in SVR should be avoided", + "B": "For reversal, Atropine is preferred over Robinul", + "C": "There is an increase in myocardial O2 demand", + "D": "Maintenance is preferable with N2O and high dose narcotic" + }, + "zh": { + "question": "以下哪项不适用于主动脉瓣狭窄患者？", + "A": "应避免突然降低SVR", + "B": "逆转时，阿托品优于罗贝林", + "C": "心肌氧需求增加", + "D": "维持时优选使用N2O和高剂量麻醉药" + } + }, + { + "id": "5010925d-e408-587b-ba84-e73f65dc6f65", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not a necessity to monitor a pt undergoing a right CEA?", + "A": "Left A-line", + "B": "Femoral Central catheter", + "C": "Large bore IV’s", + "D": "Serial ABG’s" + }, + "zh": { + "question": "以下哪项不是监测接受右侧颈动脉内膜切除术患者的必需品？", + "A": "左侧动脉导管", + "B": "股动脉中心导管", + "C": "大口径静脉通路", + "D": "连续动脉血气分析" + } + }, + { + "id": "1060c2d9-f091-550a-99ad-e01ca92f114b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the most common hemodynamic response following CEA?", + "A": "Hypotension", + "B": "Myocardial Ischemia", + "C": "Hypertension", + "D": "Pulmonary HTN" + }, + "zh": { + "question": "CEA后最常见的血流动力学反应是什么？", + "A": "低血压", + "B": "心肌缺血", + "C": "高血压", + "D": "肺动脉高压" + } + }, + { + "id": "5a782526-629d-574b-a414-e3de1455a575", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How will Mitral stenosis affect the Wedge waveform on your Swan line?", + "A": "Prominent V wave", + "B": "Absent A wave", + "C": "Will show decrease wedge pressure", + "D": "Large A wave" + }, + "zh": { + "question": "二尖瓣狭窄将如何影响 Swan 导管的楔形波形？", + "A": "明显的 V 波", + "B": "缺失的 A 波", + "C": "楔压降低", + "D": "大的 A 波" + } + }, + { + "id": "87fdcc85-90b4-5f91-b877-8b7290f3c420", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is the least dangerous of valvular disorders?", + "A": "Aortic Stenosis", + "B": "Mitral Regurge", + "C": "Aortic Regurge", + "D": "Mitral Stenosis" + }, + "zh": { + "question": "以下哪种瓣膜疾病最不危险？", + "A": "主动脉狭窄", + "B": "二尖瓣反流", + "C": "主动脉反流", + "D": "二尖瓣狭窄" + } + }, + { + "id": "75f1e6fa-4bfb-565c-a54d-c10b1313c06a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not an indication to perform endovascular grafting procedure?", + "A": "Active Infection", + "B": "AAA rupture", + "C": "Severe COPD", + "D": "Severe cardiac Disease" + }, + "zh": { + "question": "以下哪项不是进行血管内移植物手术的适应症？", + "A": "活动性感染", + "B": "腹主动脉瘤破裂", + "C": "严重慢性阻塞性肺病", + "D": "严重心脏病" + } + }, + { + "id": "53893469-7464-5a1a-9710-8e5e3ba3a8f7", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What changes would you expect to see in your pt following the release of the aortic cross-clamp?", + "A": "Alkalotic ABG", + "B": "Sudden increase in SVR", + "C": "A sudden increase in ETCO2", + "D": "Need for NTG drip" + }, + "zh": { + "question": "在解除主动脉交叉钳后，您预计会在患者身上看到哪些变化？", + "A": "碱性动脉血气", + "B": "SVR突然增加", + "C": "ETCO2突然增加", + "D": "需要使用NTG滴注" + } + }, + { + "id": "12bef2b5-52f7-5a50-a79a-564e4cebe174", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The most common arrhythmia seen in rheumatic mitral valve disease associated with left atrial enlargement is:", + "A": "Atrial flutter", + "B": "Atrial tachycardia", + "C": "Atrial fibrillation", + "D": "Paroxysmal atrial tachycardia" + }, + "zh": { + "question": "与左心房扩大相关的风湿性二���瓣病最常见的心律失常是：", + "A": "心房扑动", + "B": "心房心动过速", + "C": "心房颤动", + "D": "阵发性心房心动过速" + } + }, + { + "id": "a7d690f1-df89-51aa-b468-9a552d8488a7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the primary effect of aortic cross-clamping?", + "A": "Decrease in preload", + "B": "Increase in contractility", + "C": "Increase in afterload", + "D": "Mitral regurgitation" + }, + "zh": { + "question": "主动脉夹闭的主要影响是什么？", + "A": "前负荷减少", + "B": "心肌收缩力增加", + "C": "后负荷增加", + "D": "二尖瓣返流" + } + }, + { + "id": "c351b1b0-5292-5d65-8335-84e7117f4033", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Regional anesthesia is sometimes preferred when performing a CEA primarily because:", + "A": "Less post-op complications", + "B": "Continuous neurological assessment", + "C": "Less incidence of transient ischemia", + "D": "Less hemodynamic fluctuations" + }, + "zh": { + "question": "在进行颈动脉内膜切除术时，有时首选区域麻醉，主要是因为：", + "A": "术后并发症较少", + "B": "可持续进行神经系统评估", + "C": "短暂性缺血的发生率较低", + "D": "血流动力学波动较小" + } + }, + { + "id": "eb6567cf-84cb-5435-a55d-f0120cae1f8c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following describes the proper intubation technique for a pregnant pet undergoing general anesthesia?", + "A": "Rapid Sequence induction", + "B": "Awake Fiber Optic Intubation", + "C": "Regular induction, but have glidescope ready is needed", + "D": "Perform all cases with LMA’s due to airway difficulty" + }, + "zh": { + "question": "以下哪项描述了怀孕宠物在全身麻醉下的正确插管技术？", + "A": "快速序贯诱导", + "B": "清醒纤维光学插管", + "C": "常规诱导，但准备好视频喉镜以备需要", + "D": "由于气道困难，所有病例均使用喉罩通气" + } + }, + { + "id": "e11353ca-4519-5f01-ab18-3491a4194ca1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "If intubation should fail, as an anesthetist you should be most concerned with saving the life of the…", + "A": "Fetus", + "B": "Mother", + "C": "Neither is more important than the other", + "D": "Myself!!!" + }, + "zh": { + "question": "如果插管失败，作为麻醉师，您最关心的是拯救……的生命", + "A": "胎儿", + "B": "母亲", + "C": "两者同等重要", + "D": "我自己！！！" + } + }, + { + "id": "868a7bf9-210b-5232-b403-8d1f60c9f188", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "You are the SRNA for Ms. Tiyarah who is coming down for an emergent c-section due to fetal distress. She does not have an epidural, so must undergo general anesthesia since there is no time to insert one. You do a rapid sequence induction and are unable to intubate the pt. You are able to maintain ventilation with cricoids pressure but can’t get a tube in. What do you do?", + "A": "Perform retrograde intubation", + "B": "Perform Transtracheal Jet Ventilation", + "C": "Wake pt up, then do an awake fiberoptic intubation", + "D": "Maintain ventilation with cricoid pressure and proceed with surgery" + }, + "zh": { + "question": "您是负责Tiyarah女士的麻醉护士，她因胎儿窘迫需要紧急剖腹产。她没有硬膜外麻醉，因此必须进行全身麻醉，因为没有时间插入硬膜外导管。您进行了快速序贯诱导，但无法插管。您可以通过环状软骨压力维持通气，但无法插入导管。您会怎么做？", + "A": "进行逆行插管", + "B": "进行经气管喷射通气", + "C": "唤醒患者，然后进行清醒纤维支气管镜插管", + "D": "在环状软骨压力下维持通气并继续手术" + } + }, + { + "id": "59256c9e-3500-5856-9b37-e6bf9179cd92", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is not an indication for general anesthesia?", + "A": "Precipitous labor", + "B": "Fetal Distress", + "C": "Pt hemorrhaging", + "D": "Failed regional block" + }, + "zh": { + "question": "以下哪项不是全身麻醉的适应症？", + "A": "急产", + "B": "胎儿窘迫", + "C": "患者出血", + "D": "区域阻滞失败" + } + }, + { + "id": "ddf73a89-d0f5-586a-af22-99c8703eff5b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which nonparticulate antacid is commonly given to pregnant pts undergoing general anesthesia?", + "A": "Metaclopromide", + "B": "Bicitra", + "C": "Calcium Carbonate", + "D": "Pepcid" + }, + "zh": { + "question": "哪种非颗粒性抗酸剂常用于接受全身麻醉的孕妇？", + "A": "甲氧氯普胺", + "B": "Bicitra", + "C": "碳酸钙", + "D": "Pepcid" + } + }, + { + "id": "5231d0a9-eb5c-576c-9117-871718ba5d18", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "How should the pregnant pt be extubated upon emergence from general anesthesia?", + "A": "Deep extubation", + "B": "All pregnant pts should remain intubated until cleared by OB/GYN", + "C": "Awake extubation", + "D": "Extubate of jet stylet so re-intubation easier if necessary" + }, + "zh": { + "question": "孕妇在全身麻醉苏醒后应如何拔管？", + "A": "深度拔管", + "B": "所有孕妇都应保持插管状态，直到得到妇产科医生的许可", + "C": "清醒拔管", + "D": "使用喷射导丝拔管，以便在必要时更容易重新插管" + } + }, + { + "id": "6bb15f19-69ef-583a-97f5-46a77cf6bd8c", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "In the obese patient in labor, it is of particular importance to…", + "A": "Avoid regional blocks due to difficulty in locating anatomical landmarks", + "B": "Administer anxiolytic and opioids as soon as possible to initiate pain control", + "C": "Talk to them about how to lose the baby weight (and then some) after birth", + "D": "Make every effort to initiate early regional anesthetic" + }, + "zh": { + "question": "对于肥胖的产妇，特别重要的是…", + "A": "避免区域阻滞，因为解剖标志定位困难", + "B": "尽快给予抗焦虑药和阿片类药物以开始镇痛", + "C": "与她们谈论产后如何减掉婴儿体重（以及更多）", + "D": "尽一切努力尽早启动区域麻醉" + } + }, + { + "id": "99a705ea-1ace-5969-9347-23f13d7cdcb1", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "You are doing general anesthesia on Mrs. Maritt who is having a lap chole today. She is also 7 months pregnant and morbidly obese. Which of the following would not be an airway consideration with this patient?", + "A": "More anterior larynx", + "B": "Limited flexion", + "C": "Narrowed view of pharyngeal opening", + "D": "Limited mouth opening" + }, + "zh": { + "question": "您正在为今天要进行腹腔镜胆囊切除术的Maritt女士进行全身麻醉。她怀孕7个月且病态肥胖。以下哪项不是该患者的气道考虑因素？", + "A": "喉部更靠前", + "B": "屈曲受限", + "C": "咽部开口视野变窄", + "D": "张口受限" + } + }, + { + "id": "f252dacf-21b7-5fb3-bdd2-68241611bf5f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not an indication for cesarean section?", + "A": "Fetal Distress", + "B": "Failed regional block", + "C": "Dystocia", + "D": "Cephalopelvic disproportion" + }, + "zh": { + "question": "以下哪项不是剖宫产的指征？", + "A": "胎儿窘迫", + "B": "区域阻滞失败", + "C": "难产", + "D": "头盆不称" + } + }, + { + "id": "1d5ead35-6eec-5d4c-a17f-a5417ba33826", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "For cesarean section with epidural in place, you want to achieve a sensory blockade at what level?", + "A": "T6", + "B": "T2", + "C": "T4", + "D": "T8" + }, + "zh": { + "question": "对于已经放置硬膜外导管的剖宫产手术，您希望达到哪个水平的感觉阻滞？", + "A": "T6", + "B": "T2", + "C": "T4", + "D": "T8" + } + }, + { + "id": "8bdddf7f-7442-53b5-a9c2-a8bef746552f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Duty, Breach, Injury, and Proximate cause are all elements that are necessary to establish what?", + "A": "Sentinel Event", + "B": "Obstetric risk", + "C": "Culpability", + "D": "Medical Malpractice" + }, + "zh": { + "question": "责任、违约、伤害和直接原因都是建立什么的必要要素？", + "A": "重大事件", + "B": "产科风险", + "C": "罪责", + "D": "医疗事故" + } + }, + { + "id": "9a0fa547-214c-55db-aaa5-91872180c69d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What are the most common precipitating events leading to adverse outcome in obstetric anesthesia?", + "A": "Respiratory Events", + "B": "Cardiac Events", + "C": "Fetal Distress", + "D": "Abnormal fetal presentation" + }, + "zh": { + "question": "导致产科麻醉不良后果的最常见诱发事件是什么？", + "A": "呼吸事件", + "B": "心脏事件", + "C": "胎儿窘迫", + "D": "胎位异常" + } + }, + { + "id": "3a9f072b-6d64-538e-bdde-e26de2aef374", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the preferred anesthetic method for the obstetric patient?", + "A": "MAC sedation", + "B": "Regional Anesthesia", + "C": "General Anesthesia", + "D": "All the above are equally good options" + }, + "zh": { + "question": "对于产科患者，首选的麻醉方法是什么？", + "A": "MAC镇静", + "B": "区域麻醉", + "C": "全身麻醉", + "D": "以上都是同样好的选择" + } + }, + { + "id": "736fe313-a5b7-56bd-a5a1-541cc9bd56c9", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "All OB patients going for a c-section are considered to have full stomachs regardless of how long they have been NPO.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "所有准备进行剖腹产的产科患者都被认为是胃部充盈的，无论他们禁食了多长时间。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "6fcd1052-a659-596e-b13c-c79fda447c55", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Minimum NPO status for an elective C-section is ____ hours.", + "A": "4", + "B": "8", + "C": "6", + "D": "10" + }, + "zh": { + "question": "择期剖宫产的最低禁食状态是 ____ 小时。", + "A": "4", + "B": "8", + "C": "6", + "D": "10" + } + }, + { + "id": "85e415e4-3dcb-50b8-b6ed-fc3ca7f27f8e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following does not contribute to increases risk of aspiration during anesthesia for pregnant patients?", + "A": "Increased intragastric pressure", + "B": "Lower esophageal sphincter tone", + "C": "Delayed Gastric emptying", + "D": "All the above contribute." + }, + "zh": { + "question": "以下哪项不会增加孕妇在麻醉期间误吸的风险？", + "A": "胃内压增加", + "B": "食管下括约肌张力降低", + "C": "胃排空延迟", + "D": "以上都增加风险。" + } + }, + { + "id": "181fb2a0-00c5-5535-bede-bcc14644f003", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Aspiration is more likely to occur for all of the following pregnant patients except?", + "A": "Pt who is overdue by 2 weeks", + "B": "Emergent c-section", + "C": "Eclamptic pt", + "D": "Difficult intubation" + }, + "zh": { + "question": "以下哪位孕妇患者更不容易发生误吸？", + "A": "超过预产期2周的患者", + "B": "紧急剖宫产", + "C": "子痫患者", + "D": "困难插管" + } + }, + { + "id": "cf8efe44-0ac1-5ead-bedb-597a4f186343", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "The hallmark sign of post dural puncture headache is a headache that is relieved by what position?", + "A": "Sitting while leaning forward", + "B": "Laying flat", + "C": "Laying on the left side", + "D": "Standing and walking" + }, + "zh": { + "question": "硬膜穿刺后头痛的标志性症状是通过哪种姿势缓解的头痛？", + "A": "坐着向前倾", + "B": "平躺", + "C": "左侧卧", + "D": "站立和行走" + } + }, + { + "id": "e16dfc8d-01f9-55e9-9849-b6f518a3d0d8", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "When does organogenesis occur?", + "A": "First 4 months of pregnancy", + "B": "3rd – 5th months of pregnancy", + "C": "First two months of pregnancy", + "D": "Throughout the entire pregnancy" + }, + "zh": { + "question": "器官发生在什么时候？", + "A": "怀孕的前4个月", + "B": "怀孕的第3到第5个月", + "C": "怀孕的前两个月", + "D": "整个怀孕期间" + } + }, + { + "id": "625af6fd-dff9-5b37-b255-eb705d19439a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is considered unsafe to give during pregnancy?", + "A": "Vecuronium", + "B": "Ephedrine", + "C": "Sevoflurane", + "D": "Versed" + }, + "zh": { + "question": "以下哪种药物被认为在怀孕期间使用不安全？", + "A": "维库溴铵", + "B": "麻黄碱", + "C": "七氟醚", + "D": "咪达唑仑" + } + }, + { + "id": "6be58304-224f-5faa-b7e6-474d767114e3", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "When attempting to maintain fetal safety during anesthesia, we are concerned with all of the following except….", + "A": "Maintaining deep maternal sedation and fetal relaxation during procedures", + "B": "Prevention of preterm labor", + "C": "Avoidance of teratogenic medications, such as nitrous oxide", + "D": "Maintaining optimal uteroplacental perfusion" + }, + "zh": { + "question": "在麻醉过程中试图保持胎儿安全时，我们关注以下所有事项，除了……", + "A": "在手术过程中保持母体深度镇静和胎儿放松", + "B": "预防早产", + "C": "避免使用致畸药物，如一氧化二氮", + "D": "保持最佳的子宫胎盘灌注" + } + }, + { + "id": "73149ff7-a81c-5e51-a27b-290a71f604f2", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "During the first and second trimesters, pregnant pts are not considered to be at an increased aspiration risk.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "在妊娠的第一和第二个三个月期间，孕妇不被认为有增加的误吸风险。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "8d2ad6ea-7d8e-5d28-a2e6-2b31620587b8", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Why must nitrous oxide be avoided during pregnancy?", + "A": "N2O diffuses into and expands uterus, increasing risk for uterine rupture", + "B": "Nitrous oxide causes fetal bradycardia and increasing risk of spontaneous abortion", + "C": "N2O interferes with folic acid metabolism, thus impairing DNA synthesis", + "D": "All the above" + }, + "zh": { + "question": "为什么在怀孕期间必须避免使用一氧化二氮？", + "A": "N2O扩散并扩张子宫，增加子宫破裂的风险", + "B": "一氧化二氮导致胎儿心动过缓，增加自然流产的风险", + "C": "N2O干扰叶酸代谢，从而损害DNA合成", + "D": "以上全部" + } + }, + { + "id": "75638e99-a133-5b66-98c2-1b58fb85d426", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Success in outcome of pregnancy following surgery is determined by all of the following except…", + "A": "Maternal well-being", + "B": "Timing of surgery", + "C": "Choice of anesthetic agents", + "D": "Maternal age" + }, + "zh": { + "question": "手术后妊娠结果的成功与以下所有因素有关，除了…", + "A": "母体健康", + "B": "手术时机", + "C": "麻醉药物的选择", + "D": "母体年龄" + } + }, + { + "id": "c5f64e03-511a-5c9a-84aa-2424a1a1037e", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Succinylcholine will normally last longer during pregnancy.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "琥珀胆碱在怀孕期间通常会持续更长时间。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "9907dec4-0b3d-58ae-8234-e974db74e884", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "How will pregnancy affect the MAC of anesthetics?", + "A": "Decrease MAC", + "B": "Increase MAC", + "C": "No effect on MAC" + }, + "zh": { + "question": "妊娠会如何影响麻醉药的MAC？", + "A": "降低MAC", + "B": "增加MAC", + "C": "对MAC没有影响" + } + }, + { + "id": "a0bdd206-2571-5d3b-beaf-c2090afefb7d", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "You are performing an epidural on a patient in labor. As you begin to administer your test dose you see pts heart rate go up. She is now breathing deeply and rubbing her stomach. Is it OK to proceed?", + "A": "No, elevated HR is a sign of intravascular injection. Stop injection.", + "B": "Elevated HR is an expected side effect and It is OK to proceed.", + "C": "This is a sign of accidental dural puncture, just give a smaller dose.", + "D": "She is probably having a contraction, wait a few minutes and see." + }, + "zh": { + "question": "您正在为一位分娩中的患者进行硬膜外麻醉。当您开始注射试验剂量时，看到患者的心率上升。她现在深呼吸并揉肚子。可以继续吗？", + "A": "不，心率升高是血管内注射的迹象。停止注射。", + "B": "心率升高是预期的副作用，可以继续。", + "C": "这是意外硬膜穿刺的迹象，只需给较小剂量。", + "D": "她可能正在经历宫缩，等几分钟再看。" + } + }, + { + "id": "9d0ccd73-799a-5923-a800-74063b874270", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "You are giving a test dose of lido with epi to a patient receiving an epidural. Within 3 minutes of injection the pt complains of numbness in their lower extremities. Is it OK to proceed with the injection?", + "A": "This is a sign of accidental dural puncture, you will need to adjust your dose.", + "B": "The epidural is *supposed* to produce numbess, continue with injection", + "C": "This is a sign of intravascular injection, stop injection.", + "D": "None of above" + }, + "zh": { + "question": "您正在给接受硬膜外麻醉的患者注射含有肾上腺素的利多卡因试验剂量。注射后3分钟内，患者抱怨下肢麻木。可以继续注射吗？", + "A": "这是意外硬膜穿刺的迹象，您需要调整剂量。", + "B": "硬膜外麻醉*应该*产生麻木感，继续注射。", + "C": "这是血管内注射的迹象，停止注射。", + "D": "以上都不是" + } + }, + { + "id": "fe0e378b-77fd-525b-b354-f92522c0121c", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following is not a good candidate for Spinal anesthesia?", + "A": "Pt with a known difficult airway", + "B": "Pt with Aortic stenosis", + "C": "Pt with history of asthma and bronchitis", + "D": "Pt who is terrified of general anesthesia" + }, + "zh": { + "question": "以下哪一位不是脊椎麻醉的良好候选者？", + "A": "已知气道困难的患者", + "B": "主动脉瓣狭窄的患者", + "C": "有哮喘和支气管炎病史的患者", + "D": "对全身麻醉感到恐惧的患者" + } + }, + { + "id": "9d7b76a2-e017-52bc-96c8-e1ab4e152875", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not an appropriate treatment for Post dural Puncture headache?", + "A": "Blood Patch, at same interspace prior epidural was performed", + "B": "Oral/IV hydration", + "C": "IV Caffeine", + "D": "Maintaining pt in upright position, on bedrest" + }, + "zh": { + "question": "以下哪项不是硬膜穿刺后头痛的适当治疗方法？", + "A": "在先前硬膜外麻醉进行的同一间隙进行血液补片", + "B": "口服/静脉补液", + "C": "静脉注射咖啡因", + "D": "保持患者在床上休息时处于直���位置" + } + }, + { + "id": "3fd06392-536e-556a-8b69-fd46f6409af4", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How far should your epidural catheter be inserted?", + "A": "Until pt begins to feel an ‘electric shock’ sensation", + "B": "3-5 cm", + "C": "1-2 cm", + "D": "5-10 cm" + }, + "zh": { + "question": "硬膜外导管应插入多远？", + "A": "直到患者开始感到“电击”感觉", + "B": "3-5 厘米", + "C": "1-2 厘米", + "D": "5-10 厘米" + } + }, + { + "id": "d595bfa8-0268-585a-8580-429dc35ddc24", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following will not help to decrease the incidence of PDPH?", + "A": "Use of rounded point needle", + "B": "Use of smaller gauge needle", + "C": "Making sure the point of the needle used to puncture the dura is oriented PARALLEL rather than perpendicular to the meningeal fibers", + "D": "Placing pt in lateral position during administration of epidural" + }, + "zh": { + "question": "以下哪项不会有助于减少 PDPH 的发生率？", + "A": "使用圆头针", + "B": "使用较小规格的针", + "C": "确保用于穿刺硬脑膜的针尖方向与脑膜纤维平行而不是垂直", + "D": "在硬膜外麻醉施行过程中让患者处于侧卧位" + } + }, + { + "id": "766dd982-1afb-5701-ae88-bcf10192f524", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "How much volume would you inject for a blood patch to treat PDPH?", + "A": "10-20 cc’s", + "B": "5-10 cc’s", + "C": "25-30 cc’s", + "D": "Depends upon size of pt and severity of headache" + }, + "zh": { + "question": "对于治疗硬膜穿刺后头痛（PDPH）的血贴，您会注射多少体积？", + "A": "10-20 毫升", + "B": "5-10 毫升", + "C": "25-30 毫升", + "D": "取决于患者的体型和头痛的严重程度" + } + }, + { + "id": "143695cd-2bc0-5985-bc14-27461c1db572", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not true of CV changes that occur during pregnancy?", + "A": "Increase in intravascular volume", + "B": "Decrease in SVR", + "C": "Increase in HR", + "D": "Largest increase in CO is during third trimester" + }, + "zh": { + "question": "以下哪项关于妊娠期间心血管变化的描述是不正确的？", + "A": "血管内容量增加", + "B": "全身血管阻力降低", + "C": "心率增加", + "D": "心输出量在第三孕期增加最大" + } + }, + { + "id": "6d13c2a9-1a74-5e6d-b682-7424704c20b3", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is not true of respiratory changes during pregnancy?", + "A": "Pts will need larger ETT’s", + "B": "O2 dissociation curve shifts to right", + "C": "Decrease in FRC", + "D": "Respiratory Alkalosis may be normal" + }, + "zh": { + "question": "以下哪项关于妊娠期间呼吸变化的说法是不正确的？", + "A": "患者需要更大的气管导管", + "B": "氧气解离曲线向右移", + "C": "功能残气量减少", + "D": "呼吸性碱中毒可能是正常的" + } + }, + { + "id": "1297d74f-f6f0-5636-987d-b12c230b68aa", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following patients is an Absolute contraindication to spinal anesthesia?", + "A": "Mrs. A what has severe mitral stenosis.", + "B": "Mr. B who has advanced HIV disease", + "C": "Mrs. C who weighs 350 pounds.", + "D": "Mr. D who suffers from chronic back pain." + }, + "zh": { + "question": "以下哪位患者是脊椎麻醉的绝对禁忌症？", + "A": "A女士，患有严重的二尖瓣狭窄。", + "B": "B先生，患有晚期HIV疾病。", + "C": "C女士，体重350磅。", + "D": "D先生，患有慢性背痛。" + } + }, + { + "id": "f21b53a4-32d2-59b9-9e3d-d4e2f5dd2da4", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What happens to coagulation factors during pregnancy?", + "A": "Decreased plasma concentration", + "B": "No change in plasma concentration", + "C": "Increase in plasma concentration", + "D": "Look.... Honestly I am sooooooo not motivated to study right now." + }, + "zh": { + "question": "怀孕期间凝血因子会发生什么变化？", + "A": "血浆浓度降低", + "B": "血浆浓度不变", + "C": "血浆浓度增加", + "D": "看……老实说，我现在真的一点学习的动力都没有。" + } + }, + { + "id": "938584bb-d6e3-5c42-964d-0522c0991773", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not true regarding GI changes during pregnancy?", + "A": "Gastric fluid volume increase", + "B": "Insulin secretion increases", + "C": "Gastroesophageal tone decreases", + "D": "Gastric pH increases" + }, + "zh": { + "question": "以下哪项关于妊娠期胃肠道变化的描述是不正确的？", + "A": "胃液量增加", + "B": "胰岛素分泌增加", + "C": "胃食管括约肌张力降低", + "D": "胃酸pH值增加" + } + }, + { + "id": "6702c74f-f0b3-53a1-b624-bfd4547a164d", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Uterine Blood flow is autoregulated.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "子宫血流是自动调节的。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "2e1bcdd8-7264-5461-8573-d1b7d950501b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What percentage of cardiac output goes to the uterus?", + "A": "10%", + "B": "20%", + "C": "30%", + "D": "5%" + }, + "zh": { + "question": "子宫获得的心输出量百分比是多少？", + "A": "10%", + "B": "20%", + "C": "30%", + "D": "5%" + } + }, + { + "id": "db53a136-9d0a-5087-ab74-b1c51238a769", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Spinal and Epidural anesthesia are known to decrease uterine blood flow.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "脊髓麻醉和硬膜外麻醉已知会减少子宫血流。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "ad256c9c-360a-509f-ab22-5334fb7e46f4", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What is the optimal surgical position for a pt undergoing c-section to prevent hypotension?", + "A": "Reverse trendelenburg", + "B": "Lithotomy", + "C": "Supine and slightly lateral", + "D": "Trendelenburg" + }, + "zh": { + "question": "剖腹产手术中，为防止低血压，最佳的手术体位是什么？", + "A": "反特伦德伦堡体位", + "B": "截石位", + "C": "仰卧并稍微侧卧", + "D": "特伦德伦堡体位" + } + }, + { + "id": "ec42162e-9227-5203-b3d2-a8ee7b4f87b8", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following fetal shunts directs blood from the umbilical vein to the inferior vena cava?", + "A": "Foramen Ovale", + "B": "Hepatic shunt", + "C": "Ductuc Arteriosus", + "D": "Ductuc Venosus" + }, + "zh": { + "question": "以下哪种胎儿分流将血液从脐静脉引导至下腔静脉？", + "A": "卵圆孔", + "B": "肝分流", + "C": "动脉导管", + "D": "静脉导管" + } + }, + { + "id": "fad48752-038c-5961-b713-bb25204e395a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "During the first stage of labor, the pain felt is visceral in origin and derived from nerve fibers originating where?", + "A": "T10-L1", + "B": "L3-L5", + "C": "S1-S4", + "D": "T6-T8" + }, + "zh": { + "question": "在分娩的第一阶段，感受到的疼痛是内脏性的，其来源于哪些神经纤维？", + "A": "T10-L1", + "B": "L3-L5", + "C": "S1-S4", + "D": "T6-T8" + } + }, + { + "id": "1952567e-dbd1-5059-a659-759a0b9159b8", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "During vaginal delivery of the baby, pain is somatic in origin and mainly derived from nerve fibers originating where?", + "A": "L3-L5", + "B": "S1-S4", + "C": "T10-L1", + "D": "T6-T8" + }, + "zh": { + "question": "在阴道分娩过程中，疼痛起源于体感，主要来源于哪些神经纤维？", + "A": "L3-L5", + "B": "S1-S4", + "C": "T10-L1", + "D": "T6-T8" + } + }, + { + "id": "6e9e0908-6556-50f4-861e-4c9de481a38a", + "choice_num": 3, + "answer": "C", + "level": 2, + "en": { + "question": "You are caring for Mrs. Lincinia who is in active labor. While looking at the fetal HR tracing you notice fetal HR decelerations. There doesn’t appear to be any pattern in regards to onset, in fact most seem to be short and vary in the magnitude.  However, when it does occur the descents in fetal HR are steep. Is this baby in distress?", + "A": "Yes!! We should prepare for c-section", + "B": "This is a sign Mom must be fully dilated and ready to push, totally normal.", + "C": "No, just change Mom’s position and make sure decelerations do not become prolonged" + }, + "zh": { + "question": "您正在照顾正在积极分娩的林西尼娅女士。在查看胎儿心率追踪时，您注意到胎儿心率减速。似乎没有任何关于开始的模式，事实上大多数看起来很短并且变化很大。然而，当它发生时，胎儿心率的下降是陡峭的。这个婴儿有危险吗？", + "A": "是的！我们应该准备剖腹产", + "B": "这是一个迹象，说明妈妈必须完全扩张并准备好推，这是完全正常的。", + "C": "不，只需改变妈妈的姿势，并确保减速不会变得持久" + } + }, + { + "id": "5632de21-16f7-511f-96a0-4b8f2c030b8a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following scenarios would indicate fetal distress?", + "A": "Fetal deceleration that are short, and variable in nature with steep descent in FHR", + "B": "Fetal deceleration that occur with onset of uterine contractions", + "C": "FHR that varies by 15 beats each minute", + "D": "Fetal deceleration that occur 30 seconds after onset of uterine contraction" + }, + "zh": { + "question": "以下哪种情况表明胎儿窘迫？", + "A": "胎儿减速短暂且变化多端，胎心率急剧下降", + "B": "胎儿减速与子宫收缩的开始同时发生", + "C": "胎心率每分钟变化15次", + "D": "胎儿减速在子宫收缩开始30秒后发生" + } + }, + { + "id": "669fa136-d7b7-5bd2-bdbc-d6fd919fbb6e", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "The incidence of maternal aspiration is higher for emergent c-sections.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "紧急剖宫产的孕妇误吸发生率更高。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "9610ad2f-b169-58cf-ae59-dc9cf40353be", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the leading cause of maternal death under general anesthesia?", + "A": "Aspiration", + "B": "Amniotic Fluid Embolism", + "C": "Uterine rupture and Hemorrhage", + "D": "Myocardial Infarction" + }, + "zh": { + "question": "在全身麻醉下导致孕产妇死亡的主要原因是什么？", + "A": "误吸", + "B": "羊水栓塞", + "C": "子宫破裂和出血", + "D": "心肌梗死" + } + }, + { + "id": "d1d1f6fd-fd28-59e3-91f2-db38fbd0c928", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "At what point during labor is an epidural usually performed?", + "A": "Whenever Mom asks", + "B": "When pt is 3-4 cm dilated", + "C": "When pt is 8-9 cm dilated", + "D": "As soon as pt admitted, regardless of dilation" + }, + "zh": { + "question": "在分娩的哪个阶段通常进行硬膜外麻醉？", + "A": "只要妈妈要求", + "B": "当患者宫口扩张到3-4厘米时", + "C": "当患者宫口扩张到8-9厘米时", + "D": "一旦患者入院，不论宫口扩张情况" + } + }, + { + "id": "cc76319a-1d9b-5c9d-aa8a-2b49c77d72f7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Umbilical cord prolapse may be evidenced by..", + "A": "Early fetal decelerations", + "B": "Fetal tachyarrythmias", + "C": "Late fetal decelerations", + "D": "Meconium in amniotic fluid" + }, + "zh": { + "question": "脐带脱垂可能表现为..", + "A": "早期胎儿减速", + "B": "胎儿心动过速", + "C": "晚期胎儿减速", + "D": "羊水中有胎粪" + } + }, + { + "id": "7533f3fd-0fa1-56b4-8191-0464843318cd", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Primary dysfunctional labor occurs when the patient is completely effaced but not dilated and has been laboring for more than _____ hours.", + "A": "12", + "B": "48", + "C": "4", + "D": "20" + }, + "zh": { + "question": "当患者完全消退但未扩张并且已经分娩超过_____小时时，发生原发性功能障碍性分娩。", + "A": "12", + "B": "48", + "C": "4", + "D": "20" + } + }, + { + "id": "5c0dd8d3-8465-5154-b080-799b74225fe6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is not a cause of antepartum hemorrhage?", + "A": "Amniotic Fluid Embolism", + "B": "Placenta Previa", + "C": "Uterine Rupture", + "D": "Abruptio Placentae" + }, + "zh": { + "question": "以下哪项不是产前出血的原因？", + "A": "羊水栓塞", + "B": "前置胎盘", + "C": "子宫破裂", + "D": "胎盘早剥" + } + }, + { + "id": "51789d74-5846-567c-99a8-8e743cf984d3", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "You are caring for Mrs. Berri who is fully dilated and about to deliver her baby. She has a past history of gestational diabetes, and 2 prior deliveries. Her first child delivered vaginally and her second child born via c-section.  As Mrs. Berri is pushing she suddenly screams and start to complain of a very severe pain. She says ‘something’s wrong’ and that it doesn’t feel like labor pain.  You look at the FHR monitor and notice the baby’s HR going down. What is happening?", + "A": "Amniotic Fluid Embolism", + "B": "Uterine Rupture", + "C": "Umbilical Cord prolapsed", + "D": "Abruptio Placentae" + }, + "zh": { + "question": "您正在照顾即将分娩的Berri女士，她已经完全扩张并准备分娩。她有妊娠期糖尿病的病史，并且有过两次分娩经历。她的第一个孩子是阴道分娩，第二个孩子是剖腹产。当Berri女士用力时，她突然尖叫并开始抱怨非常剧烈的疼痛。她说‘有问题’，并且感觉不像是分娩痛。您查看胎心率监测器，注意到婴儿的心率正在下降。发生了什么？", + "A": "羊水栓塞", + "B": "子宫破裂", + "C": "脐带脱垂", + "D": "胎盘早剥" + } + }, + { + "id": "53499c17-2303-529d-a44e-8c501edfb55d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Preterm labor is defined as any active labor occurring between ___ and ____ weeks gestation.", + "A": "15 , 34", + "B": "16, 32", + "C": "20, 37", + "D": "24, 40" + }, + "zh": { + "question": "早产定义为在妊娠___到____周之间发生的任何活跃分娩。", + "A": "15 , 34", + "B": "16, 32", + "C": "20, 37", + "D": "24, 40" + } + }, + { + "id": "b035c326-7e1d-53e4-a8fd-18234c4363b6", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "You are now going in for an emergent c-section for Mrs. Gudro, no time to an epidural you must do GA. Mrs. Gudro had premature rupture of membrane at 28 weeks and has been on a Magnesium drip to stop contractions. How will this affect you anesthetic technique?", + "A": "Must keep FiO2 low to prevent pulmonary alveolitis", + "B": "Pt is prone to electrolyte imbalances and cardiac arrhythmias", + "C": "Pt is at increased risk of bleeding since Mag will cause a low plt count", + "D": "Duration of action of muscle relaxants will be prolonged" + }, + "zh": { + "question": "您现在要为Gudro女士进行紧急剖腹产，没有时间进行硬膜外麻醉，您必须进行全身麻醉。Gudro女士在28周时发生胎膜早破，并一直在使用镁滴注以停止宫缩。这将如何影响您的麻醉技术？", + "A": "必须保持低FiO2以防止肺泡炎", + "B": "患者易发生电解质失衡和心律失常", + "C": "由于镁会导致血小板计数低，患者出血风险增加", + "D": "肌肉松弛剂的作用时间将延长" + } + }, + { + "id": "4263ed24-cdb9-5fc9-bcd3-b85b32780a2a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The presence of the placenta in the cervical opening is known as what?", + "A": "Placenta Previa", + "B": "HELLP Syndrome", + "C": "Abruptio Placentea", + "D": "Uterine Atony" + }, + "zh": { + "question": "胎盘位于宫颈口被称为什么？", + "A": "前置胎盘", + "B": "HELLP综合征", + "C": "胎盘早剥", + "D": "子宫收缩乏力" + } + }, + { + "id": "10aceeba-bb32-5a52-90c8-023dedeee389", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "What is the cure for Pregnancy induced Hypertension?", + "A": "Inducing labor and vaginal delivery", + "B": "C-section delivery of baby", + "C": "Any of the above" + }, + "zh": { + "question": "妊娠期高血压的治疗方法是什么？", + "A": "引产和阴道分娩", + "B": "剖腹产分娩", + "C": "以上皆是" + } + }, + { + "id": "ebd48967-7944-5943-a1b9-71578dcf92c3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The fetus is most sensitive to drugs during which trimester?", + "A": "3rd", + "B": "2nd", + "C": "1st", + "D": "Equally sensitive during all trimesters" + }, + "zh": { + "question": "胎儿在怀孕的哪个三个月期间对药物最敏感？", + "A": "第三个三个月", + "B": "第二个三个月", + "C": "第一个三个月", + "D": "在所有三个月期间同样敏感" + } + }, + { + "id": "ad86e723-8b60-5655-9a99-9f7f3dd8250e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is age of viability for a Fetus?", + "A": "28 weeks", + "B": "30 weeks", + "C": "26 weeks", + "D": "24 weeks" + }, + "zh": { + "question": "胎儿的存活年龄是多少？", + "A": "28周", + "B": "30周", + "C": "26周", + "D": "24周" + } + }, + { + "id": "52550c0c-e15a-50ea-bff8-8efca31839f6", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What would be the muscle relaxant of choice for induction of a pregnant pt?", + "A": "Succinylcholine", + "B": "Rocuronium", + "C": "Cisatracurium", + "D": "Pancuronium" + }, + "zh": { + "question": "对于孕妇患者的诱导，首选的肌肉松弛剂是什么？", + "A": "琥珀胆碱", + "B": "罗库溴铵", + "C": "西酰胺", + "D": "潘库溴铵" + } + }, + { + "id": "dedde660-d630-52e9-b65a-30cbb8046f7b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A pregnant pt with pre-eclampsia would most likely be placed on which of the following drips?", + "A": "Labetolol", + "B": "Magnesium Sulfate", + "C": "Hydralyzine", + "D": "Sodium Nitroprusside" + }, + "zh": { + "question": "患有子痫前期的孕妇最有可能被安排使用以下哪种滴注？", + "A": "拉贝洛尔", + "B": "硫酸镁", + "C": "肼屈嗪", + "D": "硝普钠" + } + }, + { + "id": "8eeea928-b897-5552-98ea-7251cdd27238", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "What would be your preferred anesthetic method for a pt undergoing c-section who has a past history of mitral valve regurge?", + "A": "General", + "B": "MAC", + "C": "Regional", + "D": "Don't know, Don't care" + }, + "zh": { + "question": "对于一位有二尖瓣反流病史的患者进行剖宫产，您首选的麻醉方法是什么？", + "A": "全身麻醉", + "B": "监测麻醉护理", + "C": "区域麻醉", + "D": "不知道，不关心" + } + }, + { + "id": "6abbbb6a-d560-56e5-914e-b1215fda6c39", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "What would be the preferred anesthetic technique for a pt undergoing c-section who has a past history of aortic stenosis?", + "A": "General", + "B": "MAC", + "C": "Regional", + "D": "Don't know, Don't care" + }, + "zh": { + "question": "对于有主动脉瓣狭窄病史的患者进行剖宫产，首选的麻醉技术是什么？", + "A": "全身麻醉", + "B": "监测麻醉护理", + "C": "区域麻醉", + "D": "不知道，不关心" + } + }, + { + "id": "80d51828-6b7b-5946-83c6-e33b1b9e3eea", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following could not be safely given to prevent aspiration in a pregnant pt?", + "A": "Ranitidine", + "B": "Compazine", + "C": "Metaclopromide", + "D": "Bicitra" + }, + "zh": { + "question": "以下哪种药物不能安全用于预防孕妇误吸？", + "A": "雷尼替丁", + "B": "康帕嗪", + "C": "甲氧氯普胺", + "D": "碳酸氢钠柠檬酸盐" + } + }, + { + "id": "e7f51602-afe5-5d7d-96df-ee7d376a08fd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Morbid Obesity is defined as any BMI greater than what?", + "A": "28", + "B": "30", + "C": "35", + "D": "40" + }, + "zh": { + "question": "病态肥胖被定义为任何BMI大于多少？", + "A": "28", + "B": "30", + "C": "35", + "D": "40" + } + }, + { + "id": "9711a0ba-de84-5ef1-9765-fa4e1bfc4246", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following interventions would be appropriate to manage an obstetric pt who has just aspirated?", + "A": "Administration of steroids", + "B": "Administration of antibiotics", + "C": "Suction", + "D": "All the above" + }, + "zh": { + "question": "以下哪项干预措施适合处理刚刚误吸的产科患者？", + "A": "使用类固醇", + "B": "使用抗生素", + "C": "吸引", + "D": "以上全部" + } + }, + { + "id": "34578aac-5124-5c93-ae22-1b545632b80b", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following will not cross the placenta?", + "A": "Glycopyrolate", + "B": "Fentanyl", + "C": "Ephedrine", + "D": "Metaclopromide" + }, + "zh": { + "question": "下列哪一项不会通过胎盘？", + "A": "格隆溴铵", + "B": "芬太尼", + "C": "麻黄碱", + "D": "甲氧氯普胺" + } + }, + { + "id": "3a96a1e0-859c-54ca-a221-1d756f2e5850", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following coagulation factors will not increase during pregnancy?", + "A": "Factor X", + "B": "Factor XI", + "C": "Factor VII", + "D": "Fibrinogen" + }, + "zh": { + "question": "以下哪种凝血因子在妊娠期间不会增加？", + "A": "凝血因子X", + "B": "凝血因子XI", + "C": "凝血因子VII", + "D": "纤维蛋白原" + } + }, + { + "id": "056786f0-7ca1-5d3e-a31b-3eb9df8b2524", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "HELLP Syndrome may be characterized by all of the following except..", + "A": "Hemolysis", + "B": "Elevated liver Enzymes", + "C": "Hypotension", + "D": "Greater susceptibility to bleeding" + }, + "zh": { + "question": "HELLP综合征的特征可能包括以下所有内容，除了..", + "A": "溶血", + "B": "肝酶升高", + "C": "低血压", + "D": "更易出血" + } + }, + { + "id": "61330158-6b0a-54cf-9134-d1a870bb5d76", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "COMIC RELIEF: Shamelessly stolen from those watching it in class last week. :-)", + "A": "AAaggghh!! Scary!!!!", + "B": "Butterface!", + "C": "You know, for a dude he is pretty hot...", + "D": "All the above" + }, + "zh": { + "question": "喜剧解脱：无耻地从上周在课堂上观看的人那里偷来的。:-)", + "A": "AAaggghh!! 好可怕!!!!", + "B": "黄油脸！", + "C": "你知道，对于一个男的来说，他还挺帅的……", + "D": "以上全部" + } + }, + { + "id": "a9a42fd0-e9b0-5724-a00e-c8a2b9357a3d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Local anesthetics all have the suffix:", + "A": "One", + "B": "Caine", + "C": "Ine", + "D": "Ane" + }, + "zh": { + "question": "局部麻醉药的后缀都是：", + "A": "One", + "B": "Caine", + "C": "Ine", + "D": "Ane" + } + }, + { + "id": "586031e2-e197-5543-855f-d7abf617769d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Esters are metabolized by ____ while amides are metabolized by _____", + "A": "Liver; blood", + "B": "Liver; liver", + "C": "Blood; blood", + "D": "Blood; liver" + }, + "zh": { + "question": "酯类由____代谢，而酰胺类由_____代谢", + "A": "肝脏；血液", + "B": "肝脏；肝脏", + "C": "血液；血液", + "D": "血液；肝脏" + } + }, + { + "id": "dd51f4d0-2172-572b-92c6-d8b83eb38078", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "The tertiary amine of local anesthetics is", + "A": "Hydrophobic", + "B": "Hydrophylic" + }, + "zh": { + "question": "局部麻醉药的三级胺是", + "A": "疏水性", + "B": "亲水性" + } + }, + { + "id": "b3b1113e-e6d2-5400-b5b6-b5528f6985c9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Benzocaine is different because it lacks a _____ and ___ water-soluble.", + "A": "Aromatic; isn't", + "B": "Tertiary amine; isn't", + "C": "Aromatic; is", + "D": "Aromatic; isn't" + }, + "zh": { + "question": "苯佐卡因不同，因为它缺乏_____并且___水溶性。", + "A": "芳香族; 不是", + "B": "三级胺; 不是", + "C": "芳香族; 是", + "D": "芳香族; 不是" + } + }, + { + "id": "d5f66a50-5c68-5f1d-b875-6edc40f3a565", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "TTX and saxitoxin work on sodium channels by", + "A": "Binding outside the membrane", + "B": "Making the membrane swell", + "C": "Binding inside the membrane" + }, + "zh": { + "question": "TTX和麻痹性贝毒通过以下方式作用于钠通道", + "A": "结合在膜外", + "B": "使膜膨胀", + "C": "结合在膜内" + } + }, + { + "id": "5783a583-e6c3-5842-a034-a9045b5a32ca", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "Benzocaine, alcohol, and general anesthetics work on sodium channels by", + "A": "Binding outside the membrane", + "B": "Binding inside the membrane", + "C": "Making the membrane swell" + }, + "zh": { + "question": "苯佐卡因、酒精和全身麻醉剂通过以下方式作用于钠通道", + "A": "结合在膜外", + "B": "结合在膜内", + "C": "使膜膨胀" + } + }, + { + "id": "74b906e3-4017-5c16-b8e1-8dc557201880", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "Local anesthetics work on sodium channels by", + "A": "Binding outside the membrane", + "B": "Making the membrane swell", + "C": "Binding inside the membrane" + }, + "zh": { + "question": "局部麻醉药通过以下方式作用于钠通道", + "A": "结合在膜外", + "B": "使膜膨胀", + "C": "结合在膜内" + } + }, + { + "id": "798f7274-5b03-573b-8ab1-938aa27f9166", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Local anesthetics are", + "A": "Weak acids", + "B": "Weak bases", + "C": "Strong acids", + "D": "Strong bases" + }, + "zh": { + "question": "局部麻醉剂是", + "A": "弱酸", + "B": "弱碱", + "C": "强酸", + "D": "强碱" + } + }, + { + "id": "2470117c-11fe-5280-a28a-d18b2d5b85c3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "At rest, m gates are ____ and h gates are _____", + "A": "Open; open", + "B": "Open; closed", + "C": "Closed; closed", + "D": "Closed; open" + }, + "zh": { + "question": "在静息状态下，m 门是____，h 门是_____", + "A": "打开的；打开的", + "B": "打开的；关闭的", + "C": "关闭的；关闭的", + "D": "关闭的；打开的" + } + }, + { + "id": "e3566472-d834-5373-baf2-ae300140f041", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When inactive, m gates are ___ and h gates are ___", + "A": "Open; open", + "B": "Open; closed", + "C": "Closed; closed", + "D": "Closed; open" + }, + "zh": { + "question": "当不活跃时，m 门是___，h 门是___", + "A": "打开的；打开的", + "B": "打开的；关闭的", + "C": "关闭的；关闭的", + "D": "关闭的；打开的" + } + }, + { + "id": "5201dcfc-9918-56b5-9f96-423676bfd04c", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "The active form of a local anesthetic is the", + "A": "Base", + "B": "Salt" + }, + "zh": { + "question": "局部麻醉药的活性形式是", + "A": "碱", + "B": "盐" + } + }, + { + "id": "6c496470-0d45-5fee-a2c4-541ed3f9aa6b", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "The form of local anesthetic that can cross the membrane is the", + "A": "Base", + "B": "Salt" + }, + "zh": { + "question": "能够穿过膜的局部麻醉药形式是", + "A": "碱基", + "B": "盐" + } + }, + { + "id": "3c9e8f4b-534b-53f9-9c2d-6645ab3b08a0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Low doses of local anesthetic block ____ information and high doses block ____ information.", + "A": "Motor; sensory", + "B": "Sensory; sensory and motor", + "C": "Sensory and motor; sensory and motor", + "D": "Sensory and motor; motor only" + }, + "zh": { + "question": "低剂量的局部麻醉药阻断____信息，高剂量阻断____信息。", + "A": "运动；感觉", + "B": "感觉；感觉和运动", + "C": "感觉和运动；感觉和运动", + "D": "感觉和运动；仅运动" + } + }, + { + "id": "5fc5fcc8-d3ec-523b-936d-44ad9606ea58", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Anesthetics (except cocaine) are vaso-", + "A": "Dilators", + "B": "Constrictors" + }, + "zh": { + "question": "麻醉剂（可卡因除外）是血管-", + "A": "扩张剂", + "B": "收缩剂" + } + }, + { + "id": "e88d25ff-c990-59aa-8049-8b899e93c5f2", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Epi is given as a vaso-", + "A": "Dilator", + "B": "Constrictor" + }, + "zh": { + "question": "Epi 被用作血管-", + "A": "扩张剂", + "B": "收缩剂" + } + }, + { + "id": "32b38ad6-9145-5c6d-82a7-9cb637e79472", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "A good pre-op anti-anxiety medication is", + "A": "Isofluorane", + "B": "Cocaine", + "C": "Midazolam", + "D": "Suxinylcholam" + }, + "zh": { + "question": "一种好的术前抗焦虑药物是", + "A": "异氟醚", + "B": "可卡因", + "C": "咪达唑仑", + "D": "琥珀胆碱" + } + }, + { + "id": "6f364f9a-1ce6-5fd3-8425-c32d517998e7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Nicotinic blockers that mimic curare are given as muscle relaxants.  Vecuronium and rocuronium are preferred because pancuronium ____ by blocking NE reuptake.", + "A": "Raises bp", + "B": "Lowers bp", + "C": "Raises hr", + "D": "Lowers hr" + }, + "zh": { + "question": "模仿箭毒的烟碱受体阻滞剂被用作肌肉松弛剂。由于潘库溴铵通过阻止去甲肾上腺素再摄取而____，因此维库溴铵和罗库溴铵更受欢迎。", + "A": "升高血压", + "B": "降低血压", + "C": "升高心率", + "D": "降低心率" + } + }, + { + "id": "edad14e4-d46f-52e1-bdf7-4b8a1b9507dd", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "For intubation, ____ is administered.", + "A": "Cocaine", + "B": "Fentanyl", + "C": "Suxinylcholine", + "D": "Midazolam" + }, + "zh": { + "question": "用于插管，____ 被给予。", + "A": "可卡因", + "B": "芬太尼", + "C": "琥珀胆碱", + "D": "咪达唑仑" + } + }, + { + "id": "375efa5c-949d-533e-976b-7a455b5caa95", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "A depolarizing blockade caused by succinylcholine works by", + "A": "Keeping sodium channels active", + "B": "Keeping sodium channels resting", + "C": "Keeping sodium channels inactive" + }, + "zh": { + "question": "琥珀胆碱引起的去极化阻滞的作用机制是", + "A": "保持钠通道活跃", + "B": "保持钠通道静息", + "C": "保持钠通道不活跃" + } + }, + { + "id": "244e7c62-ee46-510b-8844-a4ebfcba9868", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "To reverse a gas anesthetic, give the patient", + "A": "0% O2", + "B": "10% O2", + "C": "50% O2", + "D": "70% O2", + "E": "100% O2" + }, + "zh": { + "question": "为了逆转气体麻醉，给病人", + "A": "0% O2", + "B": "10% O2", + "C": "50% O2", + "D": "70% O2", + "E": "100% O2" + } + }, + { + "id": "31b74cb5-8e99-5496-a95e-88cd6858406b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The best general anesthetic is", + "A": "Midazolam", + "B": "Thiopental", + "C": "Propofol", + "D": "Ketamine" + }, + "zh": { + "question": "最佳的全身麻醉药是", + "A": "咪达唑仑", + "B": "硫喷妥钠", + "C": "丙泊酚", + "D": "氯胺酮" + } + }, + { + "id": "70d1e917-a7b3-53c2-a876-38b9f86581c6", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "A seizing patient would best be given:", + "A": "Thiopental", + "B": "Etomidate", + "C": "Ketamine", + "D": "Midazolam" + }, + "zh": { + "question": "对于癫痫发作的患者，最佳给药选择是：", + "A": "硫喷妥钠", + "B": "依托咪酯", + "C": "氯胺酮", + "D": "咪达唑仑" + } + }, + { + "id": "1e7986a8-faa8-54f8-8fd0-f4a6a1f47549", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "A heart surgery patient would best be given:", + "A": "Midazolam", + "B": "Propofol", + "C": "Thiopental", + "D": "Etomidate" + }, + "zh": { + "question": "心脏手术患者最好给予：", + "A": "咪达唑仑", + "B": "丙泊酚", + "C": "硫喷妥钠", + "D": "依托咪酯" + } + }, + { + "id": "f5599ff9-6847-5a2d-be12-7999c002f6f2", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "You want solubility in the blood to be ____ so that the gas may reach the brain fast.", + "A": "High", + "B": "Low", + "C": "Medium" + }, + "zh": { + "question": "你希望气体在血液中的溶解度为____，以便气体快速到达大脑。", + "A": "高", + "B": "低", + "C": "中等" + } + }, + { + "id": "e9ec8382-8e9b-5577-91d0-fe7de7737f91", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "If you have inflammation, the skin is ____ and doesn't accept anesthetic well.  You should instead inject ____ the nerve.", + "A": "Acidic; below", + "B": "Acidic; above", + "C": "Basic; below", + "D": "Basic; above" + }, + "zh": { + "question": "如果你有炎症，皮肤是____的，并且不容易接受麻醉。你应该注射在神经的____。", + "A": "酸性；下方", + "B": "酸性；上方", + "C": "碱性；下方", + "D": "碱性；上方" + } + }, + { + "id": "c3dbacd0-336f-5724-9e41-ad01f2f1d494", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What should be your first action when preparing to do a pre-op assessment on a 3 yr old child?", + "A": "Review the chart", + "B": "Introduce yourself to the child’s parents and obtain a thorough history", + "C": "Introduce yourself to child, and attempt to play a game or comfort them", + "D": "Get your blow gun ready, and load it with a ketamine dart." + }, + "zh": { + "question": "在为一名3岁儿童进行术前评估时，你的首要行动应该是什么？", + "A": "查看病历", + "B": "向孩子的父母介绍自己并获取详细病史", + "C": "向孩子介绍自己，并尝试玩游戏或安慰他们", + "D": "准备好吹管，并装上氯胺酮飞镖。" + } + }, + { + "id": "5676b044-de3f-564c-a499-07ac31df353e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is the most common reason for the cancellation of pediatric procedures?", + "A": "Asthma Exacerbation", + "B": "Upper Respiratory Infections", + "C": "Non-compliance with NPO requirements", + "D": "Instability due to illness" + }, + "zh": { + "question": "以下哪项是儿童手术取消的最常见原因？", + "A": "哮喘加重", + "B": "上呼吸道感染", + "C": "不遵守禁食要求", + "D": "因疾病导致的不稳定" + } + }, + { + "id": "450fdef8-d1eb-5ecb-9399-6b5a590ae6b6", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "You are assessing 4 yr old Madelyn prior to her going in for enucleation of her left eye. When you see her in pre-op she appears to be a little under the weather. She is sneezing and has yellow mucus coming to her nose. You listen to her lungs and hear a slight wheeze while her mom says she began to run a temperature late last night. She appears fine and is watching and giggling at a children's show on a portable DVD player her mother brought to calm her.  What do you do for this patient?", + "A": "Give a dose of Tylenol and a respiratory treatement pre-op before continuing with procedure.", + "B": "It is only an eye surgery, not thoracic so she will be fine.", + "C": "Talk to the surgeon regarding possibly cancelling the surgery", + "D": "That depends entirely upon whether Madelyn was a premature baby or has any other coexisting diseases." + }, + "zh": { + "question": "你正在评估4岁的Madelyn，她即将进行左眼摘除术。当你在术前见到她时，她似乎有些不舒服。她在打喷嚏，鼻子流出黄色的粘液。你听她的肺部，听到轻微的喘息声，而她的妈妈说她昨晚开始发烧。她看起来很好，正在看母亲带来的便携式DVD播放器上的儿童节目，并咯咯地笑。你会为这个病人做什么？", + "A": "在继续手术前，给予一剂泰诺和呼吸治疗。", + "B": "这只是眼科手术，不是胸科手术，所以她会没事的。", + "C": "与外科医生讨论可能取消手术的事宜。", + "D": "这完全取决于Madelyn是否是早产儿或有其他共存疾病。" + } + }, + { + "id": "5fbd2ea3-1d83-590e-b970-8d824bff316e", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "You are going to do a pre-op on 5 yr old Trevor who is going in today for a repair of an inguinal hernia. When you go to assess him pre-op you see he is sniffly. His mother says he has seasonal allergies and has a constant runny nose. You go to look at Trevor and indeed his little nose is red and he has clear mucus coming from his nose, but no fever or wheezes. He does not appear to be otherwise ill and in fact, is playing with his stuffed dinosaur. Is it safe to proceed with the procedure?", + "A": "Not enough information to decide at this time.", + "B": "No, he is displaying signs of an upper respiratory infection.", + "C": "Only safe to proceed if pt is given a respiratory treatment and an arterial line inserted to closely monitor hemodynamic stability.", + "D": "Yeah, he’s fine. We can proceed!" + }, + "zh": { + "question": "你将为5岁的特雷弗进行术前检查，他今天要进行腹股沟疝修补手术。当你去术前评估他时，发现他有些流鼻涕。他的母亲说他有季节性过敏症，并且一直流鼻涕。你去看特雷弗，确实他的小鼻子是红的，并且有清鼻涕流出，但没有发烧或喘息。他看起来并没有其他不适，事实上，他正在玩他的毛绒恐龙。现在进行手术是否安全？", + "A": "目前信息不足，无法决定。", + "B": "不，他表现出上呼吸道感染的症状。", + "C": "只有在给予呼吸治疗并插入动脉导管以密切监测血流动力学稳定性的情况下才安全进行。", + "D": "是的，他没事。我们可以继续进行手术！" + } + }, + { + "id": "e2aec607-f8a1-5ada-b8bc-eeaf6182bacb", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A 7 yr old child must not eat solid food for how many hours prior to procedure?", + "A": "6 hours", + "B": "8 hours", + "C": "3 hours", + "D": "4 hours" + }, + "zh": { + "question": "7岁儿童在手术前多少小时不能进食固体食物？", + "A": "6小时", + "B": "8小时", + "C": "3小时", + "D": "4小时" + } + }, + { + "id": "6adff6f5-1312-57b1-aee0-434ca71876a3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following would not be an appropriate way to reduce intra-op heat loss in the pediatric patient?", + "A": "Use of an overhead radiant heating unit", + "B": "Use of a water mattress, with circulating warm water", + "C": "Use cloths dipped in 40o C water and place onto child’s head during procedure", + "D": "Use a Bair hugger placed on the child’s body" + }, + "zh": { + "question": "以下哪种方法不适合用于减少小儿患者术中热量流失？", + "A": "使用头顶辐射加热装置", + "B": "使用循环温水的水垫", + "C": "使用浸泡在40摄氏度水中的布料并在手术过程中放在孩子的头上", + "D": "使用放置在孩子身体上的Bair hugger" + } + }, + { + "id": "741c190d-1641-53b9-bae6-f84b7921fb99", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "What type of breathing circuit would you choose for a child weighing less than 10 kg?", + "A": "Small semi-closed Circuit", + "B": "Mapleson A", + "C": "Standard adult semi closed system", + "D": "Jackson-Rees Circuit" + }, + "zh": { + "question": "对于体重小于10公斤的儿童，您会选择哪种类型的呼吸回路？", + "A": "小型半闭合回路", + "B": "Mapleson A", + "C": "标准成人半闭合系统", + "D": "Jackson-Rees 回路" + } + }, + { + "id": "aae3c075-1a84-589b-bdf7-4704a895419c", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "What type of circuit would you choose for a pediatric patient weighing more than 10 kg?", + "A": "Small semi-closed Circuit", + "B": "Mapleson A", + "C": "Standard adult semi closed system", + "D": "Jackson-Rees Circuit" + }, + "zh": { + "question": "对于体重超过10公斤的儿童患者，您会选择哪种类型的回路？", + "A": "小型半闭合回路", + "B": "Mapleson A", + "C": "标准成人半闭合系统", + "D": "Jackson-Rees 回路" + } + }, + { + "id": "70f9899b-1173-591a-b145-85638cc603b7", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "When setting an adult vent for pediatric use in pressure-controlled mode, which of the following would be inappropriate?", + "A": "Set I:E ratio 1:2", + "B": "Pop off limit to vent to 30 cm H2O", + "C": "VT to minimum of 200 ml/kg/min", + "D": "All the above are correct" + }, + "zh": { + "question": "在压力控制模式下将成人呼吸机设置为儿科使用时，以下哪项是不合适的？", + "A": "设置I:E比为1:2", + "B": "呼吸机的压力释放限制为30 cm H2O", + "C": "潮气量最低为200 ml/kg/min", + "D": "以上全部正确" + } + }, + { + "id": "b303ab05-f589-5f49-9742-9b27e97b8114", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What would be an appropriate size LMA for an infant weighing 9 kg?", + "A": "0.5", + "B": "1", + "C": "1.5", + "D": "2.5" + }, + "zh": { + "question": "对于体重9公斤的婴儿，合适的喉罩大小是什么？", + "A": "0.5", + "B": "1", + "C": "1.5", + "D": "2.5" + } + }, + { + "id": "d8210cba-8763-5d61-a87c-f2636cf50a8a", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "What would be an appropriate size LMA for a child weighing 27 kg?", + "A": "3", + "B": "1.5", + "C": "4", + "D": "2.5" + }, + "zh": { + "question": "对于体重27公斤的儿童，合适的LMA尺寸是什么？", + "A": "3", + "B": "1.5", + "C": "4", + "D": "2.5" + } + }, + { + "id": "e9ba99f4-981f-556f-be26-5279f3fca54e", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "What would be an appropriate sized ETT for a 3 yr old child weighing 18 kg?", + "A": "4.5", + "B": "4", + "C": "3.5", + "D": "3" + }, + "zh": { + "question": "对于一名体重18公斤的3岁儿童，合适的气管导管尺寸是多少？", + "A": "4.5", + "B": "4", + "C": "3.5", + "D": "3" + } + }, + { + "id": "0c01acc0-7004-5e7f-8419-4b2a1e50d186", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "What would be an appropriate size ETT for a 9 yr old child weighing  33 kg?", + "A": "5", + "B": "6", + "C": "4.5", + "D": "7" + }, + "zh": { + "question": "对于一个体重33公斤的9岁儿童，合适的气管导管尺寸是多少？", + "A": "5", + "B": "6", + "C": "4.5", + "D": "7" + } + }, + { + "id": "2faa194e-3403-52a0-89a7-a648ee698463", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What size laryngoscope blade would you choose to intubate a 3 yr old child?", + "A": "1 mil", + "B": "2 mac", + "C": "1.5 mil", + "D": "0 mac" + }, + "zh": { + "question": "您会选择多大尺寸的喉镜片来为一名3岁儿童插管？", + "A": "1号 Miller", + "B": "2号 Macintosh", + "C": "1.5号 Miller", + "D": "0号 Macintosh" + } + }, + { + "id": "5cdb982d-148c-5931-997a-6164d7b34d00", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What size laryngoscope blade would you choose to intubate an 8  yr old child?", + "A": "1.5 mil", + "B": "3 mac", + "C": "2.5 mil", + "D": "2 mac" + }, + "zh": { + "question": "你会选择多大尺寸的喉镜片来为一个8岁的孩子插管？", + "A": "1.5 mil", + "B": "3 mac", + "C": "2.5 mil", + "D": "2 mac" + } + }, + { + "id": "f7944a4c-037c-588c-912b-bc1e9c3aacd4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "In order to work well EMLA cream must be applied at least how many minutes prior to IV start?", + "A": "45 minutes", + "B": "2 hours", + "C": "30 minutes", + "D": "15 minutes" + }, + "zh": { + "question": "为了有效发挥作用，EMLA乳膏必须在静脉注射开始前至少涂抹多少分钟？", + "A": "45分钟", + "B": "2小时", + "C": "30分钟", + "D": "15分钟" + } + }, + { + "id": "2e39e4cf-d926-5d7b-93ef-7d5e6050f649", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "What is an appropriate hourly maintenance fluid rate for a child weighing 15 kg?", + "A": "60 ml", + "B": "50 ml", + "C": "25 ml", + "D": "15 ml" + }, + "zh": { + "question": "对于体重15公斤的儿童，适当的每小时维持液体速率是多少？", + "A": "60 毫升", + "B": "50 毫升", + "C": "25 毫升", + "D": "15 毫升" + } + }, + { + "id": "ef404b75-b985-590d-9292-edfe504ab737", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "When doing a pedi drug set up, it is recommended to draw up your drugs in ‘unit dose’ syringes.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "在进行儿科药物准备时，建议将药物抽入“单位剂量”注射器。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "cf3fa010-da48-58a9-8fc0-7b55ddab6c57", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What would be an appropriate dose of pre-op versed for a 6 yr old child weighing 24 kg?", + "A": "24 mg IV", + "B": "6 mg PO", + "C": "12 mg PO", + "D": "48 mg PO" + }, + "zh": { + "question": "对于一名体重24公斤的6岁儿童，术前给予适当的咪达唑仑剂量是多少？", + "A": "24 mg 静脉注射", + "B": "6 mg 口服", + "C": "12 mg 口服", + "D": "48 mg 口服" + } + }, + { + "id": "a338222b-2078-573d-a5f2-e55765d364a0", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The majority of pediatric cardiac arrests occur when?", + "A": "Induction", + "B": "Maintenance", + "C": "Emergence", + "D": "Rates are equal during all 3 phases" + }, + "zh": { + "question": "大多数儿童心脏骤停发生在什么时候？", + "A": "诱导期", + "B": "维持期", + "C": "苏醒期", + "D": "在所有三个阶段的发生率相等" + } + }, + { + "id": "8e2738af-d013-5592-96fd-7027a5a5c443", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Most pediatric arrests are due to ________ causes in children.", + "A": "Cardiac", + "B": "Respiratory", + "C": "Congenital defects", + "D": "Circulatory collapse" + }, + "zh": { + "question": "大多数儿童心脏骤停是由于儿童的________原因引起的。", + "A": "心脏", + "B": "呼吸", + "C": "先天缺陷", + "D": "循环崩溃" + } + }, + { + "id": "91f6094f-304a-5f94-8577-22bff13b7808", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the most common cause of respiratory arrest in pediatric patients?", + "A": "Airway Obstruction", + "B": "Difficult intubation", + "C": "Laryngospasm", + "D": "Bronchospasm" + }, + "zh": { + "question": "在儿科患者中，呼吸骤停最常见的原因是什么？", + "A": "气道阻塞", + "B": "插管困难", + "C": "喉痉挛", + "D": "支气管痉挛" + } + }, + { + "id": "4940309d-2411-50e0-86f8-87859a78efd3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not a risk factor associated with cardiac arrests in the pediatric patient?", + "A": "Emergency Surgery", + "B": "ASA 3-5", + "C": "Congenital Airway Deformities", + "D": "Children 1-4 yrs old" + }, + "zh": { + "question": "以下哪项不是与儿科患者心脏骤停相关的风险因素？", + "A": "急诊手术", + "B": "ASA 3-5", + "C": "先天性气道畸形", + "D": "1-4岁儿童" + } + }, + { + "id": "aa5c6829-72d9-5b86-b8e2-a3df370401db", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "You are going to do a pre-op on a 6 yr old patient about to undergo a Left nephrectomy to remove a tumor.You walk into the room and find a very nervous little boy clutching a bear and hiding under the covers, the father also looks very upset and nervous. What should your approach be to do this pre-op?", + "A": "Approach the parent and attempt to calm him first", + "B": "Come back later when both are feeling a bit better", + "C": "Approach the child, and attempt to calm him first.", + "D": "Give the child some versed." + }, + "zh": { + "question": "你要为一名即将接受左肾切除术以去除肿瘤的6岁患者进行术前检查。你走进房间，发现一个非常紧张的小男孩紧抱着一只熊，躲在被子下，父亲也看起来非常不安和紧张。你应该如何进行这次术前检查？", + "A": "先接近家长并试图安抚他", + "B": "等两人情绪好一点时再回来", + "C": "先接近孩子，并试图安抚他。", + "D": "给孩子一些镇静药。" + } + }, + { + "id": "2663cb6a-be3b-5d9f-b752-f20cfd8198d0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "A child with a recent URI would be at an increased risk for all of the following except:", + "A": "Laryngospasm", + "B": "Pneumonia", + "C": "Atelectasis", + "D": "Wheezing" + }, + "zh": { + "question": "最近有上呼吸道感染的儿童，除了以下哪项外，其他都有增加的风险：", + "A": "喉痉挛", + "B": "肺炎", + "C": "肺不张", + "D": "喘息" + } + }, + { + "id": "f48b57dc-76c7-56b6-9523-2ed95c5c91b1", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "A healthy pediatric patient with no pre-existing congenital anomalies does not need any preop lab tests if the procedure is expected to have minimal blood loss.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "如果手术预���失血量很少，健康的儿科患者且无先天性异常，不需要进行术前实验室检查。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "0b083e64-2f57-5ed0-a0a6-ecfc1486f14f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "You are auscultating heart sounds on a 7 yr old child and hear a short, soft, systolic murmur.  How would you classify this murmur?", + "A": "Pathologic", + "B": "Detrimental", + "C": "Innocent", + "D": "None of above" + }, + "zh": { + "question": "您在一名7岁儿童身上听诊心音，听到短促、柔和的收缩期杂音。您如何分类这种杂音？", + "A": "病理性", + "B": "有害的", + "C": "无害的", + "D": "以上都不是" + } + }, + { + "id": "0c86d64d-abfe-5414-ba94-dce8598bc2f8", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "What pre-op medication would you choose for a 3 week old child, who weighs 4 kg, undergoing  surgery to  correct a pyloric stenosis?", + "A": "Ketamine 8 mg IM", + "B": "Versed 0.4mg IM", + "C": "Fentanyl lollipop 40 mcg PO", + "D": "Atropine 0.08 mg IM" + }, + "zh": { + "question": "对于一个3周大的孩子，体重4公斤，正在接受幽门狭窄矫正手术，你会选择哪种术前用药？", + "A": "氯胺酮 8 mg 肌注", + "B": "咪达唑仑 0.4 mg 肌注", + "C": "芬太尼棒棒糖 40 mcg 口服", + "D": "阿托品 0.08 mg 肌注" + } + }, + { + "id": "b6bc57ae-6916-55e5-99ae-02db86948e25", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "When monitoring the pediatric patient, where should the precordial stethoscope be placed?", + "A": "Left sternal border 2nd or 3rd intercostals space", + "B": "Right sterna border 2nd or 3rd intercostals space", + "C": "Left midclavicular line 5th intercostals space", + "D": "Depends upon what you are trying to monitor" + }, + "zh": { + "question": "在监测小儿患者时，心前区听诊器应放置在哪里？", + "A": "左胸骨缘第2或第3肋间隙", + "B": "右胸骨缘第2或第3肋间隙", + "C": "左锁骨中线第5肋间隙", + "D": "取决于您想监测什么" + } + }, + { + "id": "5c7c8927-7482-5c54-822e-a677b58331ef", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "You are the SRNA for a 2 week old child undergoing repair of a patent PDA. Which of the following is not true regarding proper monitor placement?", + "A": "A precordial stethoscope should be used to evaluate heart tone, rate, and murmurs.", + "B": "O2 sat probe should be placed on the left hand for the procedure", + "C": "Twitch monitor should be placed along ulnar nerve at the wrist", + "D": "The only change to ECG monitoring is the use of pediatric ECG leads and changing alarm limits." + }, + "zh": { + "question": "你是负责一名2周大儿童进行动脉导管未闭修复手术的麻醉护士学员。关于正确的监测仪放置，下列哪项是不正确的？", + "A": "应使用前胸听诊器评估心音、心率和杂音。", + "B": "手术过程中，氧饱和度探头应放置在左手。", + "C": "肌肉刺激监测器应放置在手腕的尺神经上。", + "D": "心电监测的唯一变化是使用儿科心电导联并更改报警限值。" + } + }, + { + "id": "112da783-37f0-5cbc-9813-d236e7a40b32", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "The best way to administer an IV fluid bolus to an infant is through use of a pressure bag to administer fluid quickly.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "给婴儿输注静脉输液推注的最佳方法是使用压力袋快速输液。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "389f4a72-d1ce-5c1c-b089-8997499c05d6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following children would likely experience the greatest amount of separation anxiety?", + "A": "A 4 month old child", + "B": "An 11 month old child", + "C": "A 5 yr old child", + "D": "A 13 yr old child" + }, + "zh": { + "question": "以下哪个孩子可能会经历最大的分离焦虑？", + "A": "4个月��的孩子", + "B": "11个月大的孩子", + "C": "5岁大的孩子", + "D": "13岁大的孩子" + } + }, + { + "id": "9befe191-e3bb-5eec-9a5c-1fc5b5932119", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "What would be the ideal position for induction of a 4 yr old child who is frightened and refuses to lie flat on the OR table?", + "A": "Use a couple nurses to make the child lie down and then induce", + "B": "Stand next to the child, as they sit on the side of the OR table and then apply the mask to induce.", + "C": "Have the child sit in center of OR table while you sit nearby and wrap your arm around child to induce via mask inhalation.", + "D": "Use reason, tell the child if they do not lie down you will have to give them a shot instead." + }, + "zh": { + "question": "对于一个害怕并拒绝平躺在手术台上的4岁儿童，理想的诱导姿势是什么？", + "A": "让几个护士强迫孩子躺下，然后进行诱导", + "B": "站在孩子旁边，让他们坐在手术台边缘，然后戴上面罩进行诱导。", + "C": "让孩子坐在手术台中央，而你坐在旁边，用手臂环绕孩子，通过面罩吸入进行诱导。", + "D": "讲道理，告诉孩子如果不躺下就要打针。" + } + }, + { + "id": "f048a270-4bb9-51a4-89d4-f922be8150b3", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not true regarding use of Brutane?", + "A": "You should apply face mask using two hands in order to have a tight grip", + "B": "Children induced this way are more prone to larnygospasm", + "C": "You should have sux and atropine drawn up and within easy reach", + "D": "This technique is not appropriate for hysterical children" + }, + "zh": { + "question": "以下关于使用Brutane的说法哪一项是不正确的？", + "A": "你应该用双手握住面罩以确保紧密贴合", + "B": "通过这种方式诱导的儿童更容易发生喉痉挛", + "C": "你应该准备好琥珀胆碱和阿托品，并放在容易拿到的地方", + "D": "这种技术不适用于歇斯底里的儿童" + } + }, + { + "id": "966a3dda-0035-5d49-951f-4153c800fbcc", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "For a normal inhalational induction your N2O should be at ______ and your O2 should be at ________ to start out with.", + "A": "70%, 30%", + "B": "50%, 50%", + "C": "40%, 60%", + "D": "0 %, 100 %" + }, + "zh": { + "question": "对于正常的吸入诱导，您的N2O应为______，O2应为______开始。", + "A": "70%, 30%", + "B": "50%, 50%", + "C": "40%, 60%", + "D": "0%, 100%" + } + }, + { + "id": "cadf018f-df6c-5c09-a164-bc8f0b11dcd3", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What size IV catheter would be best to use on a 3 yr old child?", + "A": "24", + "B": "22", + "C": "20", + "D": "18" + }, + "zh": { + "question": "对于一个3岁的孩子，使用多大尺寸的静脉导管最好？", + "A": "24", + "B": "22", + "C": "20", + "D": "18" + } + }, + { + "id": "b8c7d810-4628-58cc-94da-7dfc85e91bc6", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "During an inhalational induction, once your pediatric patient is tubed your first priority should be…", + "A": "Inserting the precordial stethoscope", + "B": "Applying nerve monitor to assess paralysis", + "C": "Starting an IV", + "D": "Turning up the sevo higher" + }, + "zh": { + "question": "在吸入诱导过程中，一旦为儿童患者插管，您的首要任务应该是…", + "A": "插入心前区听诊器", + "B": "应用神经监测器评估麻痹", + "C": "开始静脉注射", + "D": "提高七氟醚浓度" + } + }, + { + "id": "1044c71b-a2fb-5e86-a042-ac01af3d2154", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is incorrect regarding maintenance of survival position?", + "A": "The jaw and chin should be rotated downward to further open the airway", + "B": "Using tips of your fingers, jaw thrust should be applied bilaterally", + "C": "Fingers should be placed on bony prominence of face", + "D": "Downward pressure should not be applies to mask, instead lift jaw up to form tight seal" + }, + "zh": { + "question": "以下关于维持生存体位的说法哪一项不正确？", + "A": "下颌和下巴应向下旋转以进一步打开气道", + "B": "使用指尖，双侧施加下颌推举", + "C": "手指应放在面部的骨性隆起处", + "D": "不应向面罩施加向下的压力，而应抬起下颌以形成紧密的密封" + } + }, + { + "id": "57a1ac42-158d-5d58-81b0-45eba41856e8", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "You are the SRNA for a 6 yr old child coming in from the ER for an emergent appendectomy. Which of the following is the best choice for induction?", + "A": "Inhalational induction as patient Is not likely to cooperate with IV placement", + "B": "IV must be placed prior to procedure for safe induction.", + "C": "IM induction with ketamine", + "D": "None of above are appropriate" + }, + "zh": { + "question": "您是从急诊室来的6岁儿童的麻醉护士，准备进行紧急阑尾切除术。以下哪种是最佳的诱导选择？", + "A": "吸入诱导，因为患者可能不愿配合静脉置管", + "B": "在手术前必须放置静脉通路以确保安全诱导。", + "C": "使用氯胺酮进行肌肉注射诱导", + "D": "以上都不合适" + } + }, + { + "id": "cd73f40a-437f-5ec6-bb9c-d91a5c2c105f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The first step in the pediatric RSI sequence is….", + "A": "Preoxygenation with spontaneous ventilation", + "B": "Application of cricoids pressure", + "C": "Pretreatment with atropine", + "D": "Delivery of induction agent" + }, + "zh": { + "question": "小儿快速序贯插管的第一步是……", + "A": "自发通气下的预氧合", + "B": "施加环状软骨压迫", + "C": "用阿托品进行预处理", + "D": "给予诱导药物" + } + }, + { + "id": "b9f5e39b-ba87-5ca2-b4d8-f771d0835a0d", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "What would be an appropriate IM stun dose ketamine for a 14 yr old boy weighing 40 kg?", + "A": "320 mg", + "B": "200 mg", + "C": "160 mg", + "D": "80 mg" + }, + "zh": { + "question": "对于一个体重40公斤的14岁男孩，适合的肌肉注射氯胺酮剂量是多少？", + "A": "320 毫克", + "B": "200 毫克", + "C": "160 毫克", + "D": "80 毫克" + } + }, + { + "id": "49cecbd9-20ea-5070-b53c-475f4fc79f5f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The MAC for all anesthetic agents are highest at what age?", + "A": "6-12 months", + "B": "4-6 yrs", + "C": "1-4 yrs", + "D": "0-6 months" + }, + "zh": { + "question": "所有麻醉剂的MAC在什么年龄最高？", + "A": "6-12个月", + "B": "4-6岁", + "C": "1-4岁", + "D": "0-6个月" + } + }, + { + "id": "eb47d635-e3cf-5330-846c-33876f5a0df1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following inhalational anesthetic agents may cause bradycardia, vasodilation and myocardial depression in infants?", + "A": "Desflurane", + "B": "Isoflurane", + "C": "Sevoflurane", + "D": "Opioids" + }, + "zh": { + "question": "下列哪种吸入性麻醉剂可能导致婴儿心动过缓、血管扩张和心肌抑制？", + "A": "地氟烷", + "B": "异氟烷", + "C": "七氟烷", + "D": "阿片类药物" + } + }, + { + "id": "18a93b5d-298c-5942-8c2e-a3486ad4e1f5", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the inhalational agents had the highest incidence of  emergence delirum?", + "A": "Sevoflurane", + "B": "Isoflurane", + "C": "Desflurane", + "D": "Halothane" + }, + "zh": { + "question": "哪种吸入性麻醉剂的苏醒谵妄发生率最高？", + "A": "七氟醚", + "B": "异氟醚", + "C": "地氟醚", + "D": "卤烷" + } + }, + { + "id": "740e65fc-1a10-5194-979c-d80ad8015295", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "You are the nurse for a premature child who was born at full term. The child is now 10 weeks old and doing very well. The child is having a minor procedure and was maintained with fentanyl 2mcg/kg and 0.5 MAC  Isoflurane. The childs mother wants to know when the child can come home. What do you tell her?", + "A": "As soon as I wheel her out of the OR you can take her!", + "B": "We will watch her in the PACU for 2-3 hours after the procedure and then she may go home.", + "C": "We will keep her for 48-72 hours just to monitor her for safety.", + "D": "We will most likely keep her overnight on a pulse oximeter just to watch her." + }, + "zh": { + "question": "你是一个足月出生的早产儿的护士。这个孩子现在10周大，状况良好。孩子正在进行一个小手术，使用芬太尼2mcg/kg和0.5 MAC异氟醚进行维持。孩子的母亲想知道孩子什么时候可以回家。你会怎么告诉她？", + "A": "一旦我把她从手术室推出来，你就可以带她回家！", + "B": "手术后我们会在恢复室观察她2-3小时，然后她就可以回家了。", + "C": "我们会留她48-72小时以确保安全。", + "D": "我们很可能会让她过夜，使用脉搏血氧仪监测她。" + } + }, + { + "id": "daeefa5b-b54b-5034-abc6-30723ed410ee", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "High dose opioid therapy during maintenance of anesthesia may be appropriate for which of the following?", + "A": "Child with cardiac instability who requires surgical intervention", + "B": "Pt who will be extubated after surgery and requires pain control", + "C": "A healthy 2 yr old who is no longer at risk for post-op apnea", + "D": "A child with respiratory insufficiency who may not have sufficient gas exchange for inhalational agents." + }, + "zh": { + "question": "在麻醉维持期间，高剂量阿片类药物治疗可能适用于以下哪种情况？", + "A": "需要手术干预的心脏不稳定儿童", + "B": "术后将拔管且需要疼痛控制的患者", + "C": "不再有术后呼吸暂停风险的健康2岁儿童", + "D": "可能没有足够气体交换能力以使用吸入性麻醉剂的呼吸功能不全儿童" + } + }, + { + "id": "2523b4cf-b4cf-5b55-a3aa-aaf6d5c251b8", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "Which of the following children is the best candidate for a deep extubation?", + "A": "An 18 month old child who just had a minor procedure, no past HX and spontaneous ventilation for whole case.", + "B": "A 9 yr old healthy child with asthma (no attacks in one year and no wheezes) having a minor elective procedure, spontaneous ventilation maintained throughout procedure", + "C": "An 5 yr old healthy child with no medical history, needed paralysis during procedure but has now been fully reversed.", + "D": "A 7 yr old child who came for emergent appendectomy" + }, + "zh": { + "question": "以下哪位儿童是深度拔管的最佳候选者？", + "A": "18个月大的孩子刚做了一个小手术，没有既往病史，整个过程自发通气。", + "B": "9岁健康儿童患有哮喘（一年内无发作且无喘息），进行小型择期手术，整个手术过程中保持自发通气。", + "C": "5岁健康儿童无病史，手术期间需要麻痹但现已完全逆转。", + "D": "7岁儿童因急诊阑尾切除术入院" + } + }, + { + "id": "f8b81838-8a44-58fc-836e-aa4211b67112", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following properly describes the Sundown Sign?", + "A": "When toddlers become confused at night and start climbing out of bed.", + "B": "A sign commonly seen in pts with a PPFO where the pt will turn blue (sundown) while coughing or bucking and creating a temporary shunt.", + "C": "Contraction of the inferior rectus muscle of the eye causing the eyeball to look downward toward the toes.", + "D": "Just before waking up when the child begins to move and both feet point down as their back arches upward due to stimulation from ETT." + }, + "zh": { + "question": "以下哪项正确描述了日落征？", + "A": "当幼儿在夜间感到困惑并开始爬出床时。", + "B": "在患有PPFO的患者中常见的体征，患者在咳嗽或挣扎时会变蓝（如日落），并产生暂时性分流。", + "C": "眼睛的下直肌收缩导致眼球向下看向脚趾。", + "D": "在醒来之前，当孩子开始移动时，由于ETT的刺激，双脚向下指，背部向上弓起。" + } + }, + { + "id": "9d669539-0d01-5272-b7f8-06d0964ae5f4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is not helpful in preventing laryngospasm?", + "A": "Suction secretions immediately after extubation", + "B": "Extubate deep", + "C": "Extubate totally awake", + "D": "Immediately after extubation, stretch the larynx" + }, + "zh": { + "question": "以下哪项对预防喉痉挛没有帮助？", + "A": "拔管后立即吸引分泌物", + "B": "在深麻醉时拔管", + "C": "在完全清醒时拔管", + "D": "拔管后立即牵拉喉部" + } + }, + { + "id": "12eb49c6-b2e9-541b-9f30-bacf09f962ec", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "A normal healthy child may be transported to PACU without any supplemental oxygen.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "一个正常健康的儿童可以在没有任何补充氧气的情况下被送往PACU。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "76a67102-83f4-50db-9a9a-ea9d654d3119", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not part of stage 2 PACU’s standard monitoring?", + "A": "Heart Rate", + "B": "Fluid Balance", + "C": "O2 Sat", + "D": "Blood pressure" + }, + "zh": { + "question": "以下哪项不属于第二阶段PACU的标准监测？", + "A": "心率", + "B": "液体平衡", + "C": "氧饱和度", + "D": "血压" + } + }, + { + "id": "a37a3539-c480-58eb-8c99-93c885d50c5e", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "You are the SRNA for 8 yr old Camryn who is in today to have a Tympanoplasty. She has a PMH of asthma, and she had her adenoids removed at age 3. You listen to her lungs and hear wheezing. You ask her mom about the wheezing and her mother says that Camryn has a constant wheeze that does not clear, this is normal for her. What do you now?", + "A": "Administer an albuterol treatment prior to surgery to help stabilize her and then proceed.", + "B": "Cancel the surgery.", + "C": "Obtain medical clearance from her pulmonologist prior to proceeding with surgery.", + "D": "Administer hydrocortisone prior to procedure and give albuterol treatment once induced." + }, + "zh": { + "question": "你是8岁Camryn的麻醉护士，她今天要做鼓室成形术。她有哮喘病史，3岁时切除了腺样体。你听她的肺部，听到喘息声。你问她妈妈关于喘息的情况，她妈妈说Camryn有持续的喘息声，无法清除，这对她来说是正常的。你现在该怎么做？", + "A": "在手术前给予沙丁胺醇治疗以帮助稳定她，然后继续手术。", + "B": "取消手术。", + "C": "在进行手术前获得她的肺科医生的医疗许可。", + "D": "在手术前给予氢化可的松，并在诱导后给予沙丁胺醇治疗。" + } + }, + { + "id": "cf58886c-376e-59ea-bce0-39ffefe1fa86", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Inhalational induction should not be done on children with asthma due to increased risk of bronchospasm.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "由于支气管痉挛风险增加，不应对哮喘儿童进行吸入诱导。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "86404d92-fc28-5317-9169-abe340c734f2", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "You are the SRNa for 11 yr old Shaheem who has a PMH of asthma. Immediately after induction and intubation you hear wheezing develop. What should be your first action?", + "A": "Deliver 100% FiO2", + "B": "Administer hydrocortisone 5-7mg/kg IV to relieve wheezing", + "C": "Turn off anesthetic and start propofol gtt to maintain anesthesia", + "D": "Give B2 agonist such as albuterol 4-8 puffs through ETT" + }, + "zh": { + "question": "你是11岁Shaheem的麻醉护士，他有哮喘病史。在诱导和插管后，你听到出现喘息。你应该采取的第一个行动是什么？", + "A": "给予100% FiO2", + "B": "静脉注射氢化可的松5-7mg/kg以缓解喘息", + "C": "关闭麻醉剂并开始丙泊酚滴注以维持麻醉", + "D": "通过气管插管给予B2激动剂如沙丁胺醇4-8喷" + } + }, + { + "id": "3d828c48-91ee-585b-9051-233ba9014e8e", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "You are nearing the end of surgery for 13 yr old Kami who started wheezing part way through her surgery. You gave albuterol and started her on steroid therapy but she is still wheezing. Her O2 sats are good and she is breathing adequate tidal volumes. What should you do?", + "A": "Do not extubate, take her to PACU and they can extubate when wheezing goes away", + "B": "Extubate deep to help prevent laryngospasm", + "C": "Deliver another albuterol treatment and extubate fully awake", + "D": "Give Fentanyl 1-2mcg/kg IV to help smooth out extubation" + }, + "zh": { + "question": "你正在为13岁的Kami进行手术，手术过程中她开始喘息。你给了沙丁胺醇并开始了类固醇治疗，但她仍在喘息。她的氧饱和度良好，呼吸潮气量充足。你应该怎么做？", + "A": "不要拔管，将她送到PACU，等喘息消失后再拔管", + "B": "深麻醉拔管以帮助防止喉痉挛", + "C": "再进行一次沙丁胺醇治疗并在完全清醒时拔管", + "D": "给予芬太尼1-2mcg/kg静脉注射以帮助顺利拔管" + } + }, + { + "id": "5a9e9fcd-c740-5db0-8f18-6db149ad3bd0", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "What is the most important factor when examining a patient with cystic fibrosis?", + "A": "Asking parent about age of onset and severity of illness.", + "B": "The physical exam, and checking for signs of chronic hypoxia", + "C": "The CXR, to check for lung scarring, and the PFT", + "D": "Check labs and ECG results" + }, + "zh": { + "question": "在检查囊性纤维化患者时，最重要的因素是什么？", + "A": "询问父母关于发病年龄和疾病严重程度。", + "B": "体格检查，并检查慢性缺氧的迹象。", + "C": "胸部X光检查，以检查肺部瘢痕和肺功能测试。", + "D": "检查实验室和心电图结果。" + } + }, + { + "id": "fb643d48-7822-5a46-8a88-401fb3251df0", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "Which of the following is not true regarding children with cystic fibrosis?", + "A": "No routine lab test are indicated unless there is significant organ system involvement", + "B": "You will almost always hear rhonchi and wheezes with these patient", + "C": "ETT placement may increase airway swelling and thus these patients are much better to have LMA’s and spontaneous ventilations if at all possible", + "D": "N2O should be avoided with these patients" + }, + "zh": { + "question": "关于患有囊性纤维化的儿童，下列哪项是不正确的？", + "A": "除非有显著的器官系统受累，否则不需要常规实验室检查", + "B": "几乎总是可以在这些患者中听到干啰音和喘息声", + "C": "气管插管可能会增加气道肿胀，因此如果可能的话，这些患者更适合使用喉罩和自发通气", + "D": "应避免使用一氧化二氮" + } + }, + { + "id": "f4bc7a2d-3b89-50d4-b30c-68506dd2e6c3", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "You are the SRNA for 14 yr old Nathan who has a PMH of cerebral palsy. The mother of states he has reflux and takes medication at home to help control this. He currently has a PEG tube due to difficulty swallowing. When you examine the pt you notice copious amounts of drool coming from his mouth. What sort of induction would be best for this patient?", + "A": "Inhalational induction", + "B": "Awake intubation", + "C": "Give atropine pre-op and then do IM induction", + "D": "Rapid sequence induction with succinylcholine" + }, + "zh": { + "question": "你是14岁Nathan的麻醉护士，他有脑瘫的病史。他的母亲说他有反流，并在家中服药以帮助控制。他目前由于吞咽困难而使用PEG管。当你检查病人时，你注意到他嘴里流出大量口水。对于这个病人，哪种诱导方式最好？", + "A": "吸入诱导", + "B": "清醒插管", + "C": "术前给予阿托品，然后进行肌肉注射诱导", + "D": "使用琥珀胆碱的快速序列诱导" + } + }, + { + "id": "3fc9355c-cad8-58f6-99cf-ef8539f512ce", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "When placing a nerve stimulator on a child with cerebral palsy, which of the following is true?", + "A": "The nerve stimulator should be placed on a spastic extremity as these are best indicators of childs TRUE response to NMB", + "B": "Placing stimulator on a spastic extremity will cause falsely low readings and may lead to underdosing of NMB", + "C": "Placing stimulator on a spastic extremity may cause falsely high readings and may lead to overdosing of NMB’s", + "D": "Children with CP do not need nerve stimulators due to their condition." + }, + "zh": { + "question": "在为患有脑瘫的儿童放置神经刺激器时，下列哪项是正确的？", + "A": "神经刺激器应放置在痉挛的肢体上，因为这些是儿童对神经肌肉阻滞剂真实反应的最佳指标", + "B": "将刺激器放置在痉挛的肢体上会导致读数偏低，可能导致神经肌肉阻滞剂的剂量不足", + "C": "将刺激器放置在痉挛的肢体上可能导致读数偏高，可能导致神经肌肉阻滞剂的剂量过高", + "D": "由于他们的病情，脑瘫儿童不需要神经刺激器。" + } + }, + { + "id": "43198044-b3d7-5e97-9912-1fbd693f50b6", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "You are the SRNA for 15 yr old Valerie who has cerebral palsy. Due to the CP she has a past history lung infections and seizures. She currently takes dilantin to help control the seizures. Will this affect your case management?", + "A": "I will not be able to use any succinylcholine due to dangerous drug interaction", + "B": "I will need to use a much lower dose of ND-NMB’s due to enzyme inhibition", + "C": "I will need to use a much higher dose of ND-NMB’s due to enzyme induction", + "D": "Due to CP, I can not use any NMB’s so the dilantin doesn’t really matter anyway." + }, + "zh": { + "question": "你是15岁患有脑瘫的Valerie的麻醉护士学员。由于脑瘫，她有肺部感染和癫痫的病史。她目前服用苯妥英钠来帮助控制癫痫发作。这会影响你的病例管理吗？", + "A": "由于危险的药物相互作用，我将无法使用琥珀胆碱", + "B": "由于酶抑制，我需要使用更低剂量的非去极化肌松药", + "C": "由于酶诱导，我需要使用更高剂量的非去极化肌松药", + "D": "由于脑瘫，我不能使用任何肌松药，所以苯妥英钠并不重要。" + } + }, + { + "id": "eb442d08-194b-5335-8dff-331a9d751572", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not commonly associated with Trisomy 21?", + "A": "Endocardial Cushion Defects", + "B": "Hirschsprungs disease", + "C": "Frequent upper respiratory infections", + "D": "Stiff joints and neck resulting in limited mobility" + }, + "zh": { + "question": "以下哪项与21三体综合征不常见相关？", + "A": "心内膜垫缺损", + "B": "先天性巨结肠病", + "C": "频繁的上呼吸道感染", + "D": "关节和颈部僵硬导致活动受限" + } + }, + { + "id": "8a84b71a-307d-5c32-956b-432bb9196aa7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the most important componenent of the physical exam for down syndrome patients?", + "A": "Airway examination and neck stability", + "B": "Assessing degree of mental retardation", + "C": "Obtaining history from parents regarding any heart conditions", + "D": "Assessing for reflux and sings of URI" + }, + "zh": { + "question": "唐氏综合症患者体检中最重要的组成部分是什么？", + "A": "气道检查和颈部稳定性", + "B": "评估智力迟钝的程度", + "C": "从父母处获取有关心脏病的病史", + "D": "评估反流和上呼吸道感染的迹象" + } + }, + { + "id": "5258178a-aab9-513f-9ec1-c74e6e58b0ba", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not true regarding pre-op treatment of a patient with down syndrome?", + "A": "Atropine PO should be given as soon as possible to these patients.", + "B": "Neck X-rays should be obtained for all down syndrome patients", + "C": "Patients with heart disease should receive antibiotic prophylaxis against SBE", + "D": "All the above are true" + }, + "zh": { + "question": "以下关于唐氏综合症患者的术前处理，哪一项是不正确的？", + "A": "应尽快给这些患者口服阿托品。", + "B": "所有唐氏综合症患者都应进行颈部X光检查。", + "C": "有心脏病的患者应接受预防亚急性细菌性心内膜炎的抗生素预防。", + "D": "以上全部正确。" + } + }, + { + "id": "7d826213-d206-5161-97dd-b1ebc65cc054", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "You are SRNA for 17 yr old Sarah who has a past history of down syndrome. Her mother tells you that during previous procedures it had been told to her that Sarah has a very difficult airway and an unstable neck. You look at the airway and it does indeed look to be very difficult. How will you choose to intubate sarah?", + "A": "Via retrograde intubation", + "B": "Awake intubation, with airway numbed", + "C": "Use LMA fasttrach to place ETT", + "D": "Fiberoptic nasal intubation" + }, + "zh": { + "question": "你是17岁Sarah的麻醉护士，她有唐氏综合症的病史。她的母亲告诉你，在之前的手术中，有人告诉她Sarah的气道非常困难且颈部不稳定。你查看了气道，确实看起来非常困难。你将如何选择为Sarah插管？", + "A": "通过逆行插管", + "B": "在清醒状态下插管，并对气道进行麻醉", + "C": "使用LMA快速通道放置气管导管", + "D": "纤维光鼻腔插管" + } + }, + { + "id": "13e051e2-bcfd-53c3-b012-30483ec74477", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is not true regarding muscular dystrophy patients?", + "A": "Succinylcholine should be avoided, but VAA are still considered safe for most patients unless past history indicates otherwise", + "B": "Cardiomyopathy is a constant feature of the diease and these children may be prone to dysrhythmias.", + "C": "Dose of ND-NMB’s should be cut by 1/3 to ½ due to decreased muscle mass.", + "D": "Atropine or robinul should be given to patients who have trouble managing their own secretions." + }, + "zh": { + "question": "以下关于肌营养不良患者的说法哪一项是不正确的？", + "A": "应避免使用琥珀胆碱，但挥发性麻醉剂对大多数患者仍被认为是安全的，除非有既往病史表明不宜使用。", + "B": "心肌病是该疾病的一个恒定特征，这些儿童可能容易发生心律失常。", + "C": "由于肌肉质量减少，非去极化肌松药的剂量应减少1/3到1/2。", + "D": "对于无法自行管理分泌物的患者，应给予阿托品或罗比伦。" + } + }, + { + "id": "1c2eb6ac-e883-5a25-ac7b-d3f041c5325d", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not true regarding management of a patient with sickle cell disease?", + "A": "After inserting an IV, you should consider giving a 10-15 ml/kg fluid bolus", + "B": "Narcotics should be avoided due to respiratory depression and the need to avoid hypoxemia in these patients", + "C": "Sickled cells cause vaso-occlusion in microvasculature which ultimately results in ned-organ damage", + "D": "Sickle cell children may be given clear liquids up to 2 hours before surgery to help maintain hydration" + }, + "zh": { + "question": "以下关于镰状细胞病患者管理的说法哪一项是不正确的？", + "A": "插入静脉注射后，应考虑给予10-15 ml/kg的液体推注", + "B": "应避免使用麻醉药物，因为它们会导致呼吸抑制，并且需要避免这些患者出现低氧血症", + "C": "镰状细胞会在微血管中引起血管闭塞，最终导致器官损伤", + "D": "镰状细胞病儿童可以在手术前2小时内饮用清液，以帮助维持水分" + } + }, + { + "id": "ff5c3fd6-f0e8-5088-9525-624d7534eb24", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following children would be at an increased risk Latex Allergy", + "A": "Nika who is allergic to Egg yolk", + "B": "Tyler, whose mom is a nurse", + "C": "Charlie who has muscular dystrophy", + "D": "Olivia who has spina bifida" + }, + "zh": { + "question": "以下哪位儿童对乳胶过敏的风险增加？", + "A": "对蛋黄过敏的尼卡", + "B": "妈妈是护士的泰勒", + "C": "患有肌营养不良症的查理", + "D": "患有脊柱裂的奥利维亚" + } + }, + { + "id": "065a816b-54e2-5bdd-a20f-077c185db04f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What would be appropriate pre-op medication for a child with a latex allergy?", + "A": "Benadryl 1mg/kg PO", + "B": "Prednisone 1 mg/kg PO", + "C": "Zantac 1-2mg/kg PO", + "D": "All the above" + }, + "zh": { + "question": "对于有乳胶过敏的儿童，适合的术前用药是什么？", + "A": "苯海拉明 1mg/kg 口服", + "B": "泼尼松 1mg/kg 口服", + "C": "雷尼替丁 1-2mg/kg 口服", + "D": "以上皆是" + } + }, + { + "id": "490e3a31-50db-5538-8fea-a53e180f8532", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What should be your first action for a suspected anaphylactic response during anesthesia?", + "A": "Switch to 100% O2", + "B": "Discontinue anesthetics and any antibiotic or blood infusions", + "C": "Give epi 0.5-5mcg/kg IV", + "D": "Give benedryl 0.5-1 mg/kg IV" + }, + "zh": { + "question": "在麻醉期间怀疑过敏性反应时，你的首要行动应该是什么？", + "A": "切换到100%氧气", + "B": "停止麻醉剂和任何抗生素或输血", + "C": "给予肾上腺素0.5-5微克/公斤静脉注射", + "D": "给予苯海拉明0.5-1毫克/公斤静脉注射" + } + }, + { + "id": "2e6bbe4a-47f4-5df3-901d-778e122b7163", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "In the pediatric population, the greatest amount of heat loss during surgery comes from…", + "A": "Conduction", + "B": "Radiation", + "C": "Convection", + "D": "All above are equal contributors to heat loss." + }, + "zh": { + "question": "在儿科人群中，手术期间最大的热量损失来自于……", + "A": "传导", + "B": "辐射", + "C": "对流", + "D": "以上都是热量损失的相等贡献者。" + } + }, + { + "id": "16a3d25a-2a22-5297-9965-be13b78284fe", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Why is it not safe to use an adult semi-closed system on an infant who weighs less than 10 kg?", + "A": "Too much pressure, risk of barotrauma", + "B": "Too large, circuit will not fit the pedi ETT properly", + "C": "Too much dead space, and increased work of breathing", + "D": "Absorber acts to remove almost all gases due to small tidal volume and pt will be undermedicated" + }, + "zh": { + "question": "为什么对体重小于10公斤的婴儿使用成人半闭合系统不安全？", + "A": "压力过大，存在气压伤的风险", + "B": "太大，回路不能正确适配儿童气管导管", + "C": "死腔过多，增加呼吸工作量", + "D": "由于潮气量小，吸收器几乎去除所有气体，导致患者药物不足" + } + }, + { + "id": "2e22ca4b-d0d4-53dd-abaa-5eee4d39f431", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How is the pediatric airway different from that of adults?", + "A": "Airway has smaller tongue and very stiff epiglottis making visualization difficult", + "B": "Airway is more superior and has a more acute angulation between plane of tongue and epiglottis", + "C": "Narrowest portion of airway is the vocal cords, making passage of the ETT much more difficult", + "D": "None of above" + }, + "zh": { + "question": "小儿气道与成人气道有何不同？", + "A": "气道有较小的舌头和非常僵硬的会厌，导致可视化困难", + "B": "气道更靠上，舌面与会厌之间的角度更急", + "C": "气道最窄的部分是声带，使气管导管的通过更加困难", + "D": "以上都不是" + } + }, + { + "id": "7667bfea-39b8-5d4f-a98d-d6fbcc256e51", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "At how much pressure should you observe an air leak in pediatric ETT’s?", + "A": "No air leak should be observed", + "B": "Air leak obersved at 5-10 cm H2O", + "C": "Air leak observed at 15-20 cm H2O", + "D": "Air leak observed at 25-30 cm H2O" + }, + "zh": { + "question": "在多少压力下应观察到儿童气管导管的漏气？", + "A": "不应观察到漏气", + "B": "在5-10 cm H2O时观察到漏气", + "C": "在15-20 cm H2O时观察到漏气", + "D": "在25-30 cm H2O时观察到漏气" + } + }, + { + "id": "38954424-ac6b-5985-9145-4e4195579ecd", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "At what level is the larynx located in infants?", + "A": "C4", + "B": "C5", + "C": "C2", + "D": "C3" + }, + "zh": { + "question": "婴儿的喉部位于哪个水平？", + "A": "C4", + "B": "C5", + "C": "C2", + "D": "C3" + } + }, + { + "id": "fe6ddeda-943f-509c-93e4-3253dfdc5a08", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "You are doing an inhalation induction on 6 yr old Tessie when she begins to cough and goes into laryngospasm. She begins to desaturate, how do you treat her?", + "A": "Apply jaw thrust and positive pressure with 100% O2.", + "B": "Administer sux 4-6 mg/kg IM", + "C": "Administer rocuronium 0.6 mg/kg IV", + "D": "Administer atropine 0.02 mg/kg IM" + }, + "zh": { + "question": "您正在对6岁的Tessie进行吸入诱导时，她开始咳嗽并出现喉痉挛。她开始脱饱和，您如何治疗她？", + "A": "应用下颌抬举和100%氧气的正压通气。", + "B": "肌肉注射琥珀胆碱4-6 mg/kg。", + "C": "静脉注射罗库溴铵0.6 mg/kg。", + "D": "肌肉注射阿托品0.02 mg/kg。" + } + }, + { + "id": "62395f56-b873-5465-a551-0d5233fb81fc", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Neonates and infants have less effective ventilation due to all of the following except what?", + "A": "Larger tongue and head", + "B": "Weak intercostals and diaphragmatic musculature", + "C": "More pliable and horizontal ribs", + "D": "Protuberant abdomen" + }, + "zh": { + "question": "新生儿和婴儿的通气效果较差，以下哪项不是原因？", + "A": "较大的舌头和头部", + "B": "肋间肌和膈肌肌肉较弱", + "C": "肋骨更柔软且水平", + "D": "腹部隆起" + } + }, + { + "id": "de6ef070-493c-57a0-b91b-d552c27f12c1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Due to decreased FRC, infants are more prone to all of the following except:", + "A": "Atelectasis", + "B": "Laryngospasm", + "C": "Hypoxemia and rapid desaturation", + "D": "All the above" + }, + "zh": { + "question": "由于功能残气量（FRC）减少，婴儿更容易出现以下所有情况，除了：", + "A": "肺不张", + "B": "喉痉挛", + "C": "低氧血症和快速脱氧", + "D": "以上所有情况" + } + }, + { + "id": "8865ecc3-9f42-5378-8ca7-85f371b3beff", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What response will infants typically have to exogenously administered catecholamines such as ephedrine?", + "A": "Exagerrated response and risk for subdural hemorrhage", + "B": "Infants and kids respond in same manner as adults would", + "C": "Blunted response due to lower catecholamine stores", + "D": "More prone to allergic and anaphylactic responses" + }, + "zh": { + "question": "婴儿对外源性给予的儿茶酚胺（如麻黄碱）通常会有什么反应？", + "A": "反应过度且有硬膜下出血的风险", + "B": "婴儿和儿童的反应与成人相同", + "C": "由于儿茶酚胺储备较低，反应减弱", + "D": "更容易发生过敏和过敏性反应" + } + }, + { + "id": "a076859f-7146-5370-ac3a-36b357237b28", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "You are the SRNA for 10 yr old Jacob who is coming in for an emergent appendectomy. Due to the surgery being emergent, he is being induced with IV rapid sequence induction. Almost immediately folloring administration of Succinycholine Jacob develops a severe arrhythmia and then goes into cardiac arrest. What caused this and what do you do?", + "A": "Begin immediate treatment for MH as you run code", + "B": "Run standard code and administer 100% O2 as you ventilate", + "C": "Give fluid boluses and volume to treat hypovolemia as you run code", + "D": "Immediately begin treatment for hyperkalemia as you run code" + }, + "zh": { + "question": "你是10岁男孩Jacob的麻醉护士，他因急性阑尾炎需要进行紧急手术。由于手术紧急，他正在接受静脉快速诱导。几乎在注射琥珀胆碱后，Jacob出现严重心律失常，随后心脏骤停。是什么原因导致的，你该怎么做？", + "A": "在进行抢救的同时立即开始治疗恶性高热", + "B": "进行标准抢救并在通气时给予100%氧气", + "C": "在进行抢救的同时给予液体推注和容量以治疗低血容量", + "D": "在进行抢救的同时立即开始治疗高钾血症" + } + }, + { + "id": "4ff84751-f369-5420-9dbd-c5825bcb3396", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the overall incidence of cardiac arrest in the pediatric population?", + "A": "1.4 per 10,000", + "B": "2.7 per 100,000", + "C": "0.5 per 1,000", + "D": "16 per 1,000,000" + }, + "zh": { + "question": "在儿科人群中，心脏骤停的总体发生率是多少？", + "A": "1.4 每 10,000", + "B": "2.7 每 100,000", + "C": "0.5 每 1,000", + "D": "16 每 1,000,000" + } + }, + { + "id": "e852f592-165a-5819-9bce-544a889ee9d1", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "In children, ETCO2 is particularly important to monitor because of which of the following reasons?", + "A": "Will give you earliest indication of MH", + "B": "Will detect hypoxia which is most common cause of pediatric arrest", + "C": "Allows to asses adequacy of your ventilation", + "D": "All the above" + }, + "zh": { + "question": "在儿童中，监测ETCO2特别重要是因为以下哪个原因？", + "A": "会给你最早的MH指示", + "B": "会检测缺氧，这是儿童心脏骤停最常见的原因", + "C": "可以评估通气的充分性", + "D": "以上全部" + } + }, + { + "id": "234061cd-9df9-52c4-ab88-2f40f1c528c8", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not an advantage associated with IV induction?", + "A": "Helps to avoid cardiac depressant effects of VAA", + "B": "Less pain and anxiety for children with IV starts then with inhalational induction", + "C": "Helps to avoid airway problems associated with inhalational induction", + "D": "Allows for safer induction for emergent procedures" + }, + "zh": { + "question": "以下哪项不是与静脉诱导相关的优点？", + "A": "有助于避免挥发性麻醉剂的心脏抑制作用", + "B": "与吸入诱导相比，静脉注射对儿童的疼痛和焦虑较少", + "C": "有助于避免与吸入诱导相关的气道问题", + "D": "允许在紧急手术中更安全的诱导" + } + }, + { + "id": "9331a4c6-de4a-56af-aa68-c01e2adf9d60", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "Halothane causes more myocardial depression than any of the other inhalational agents and increases the risk of arrhythmia associated with epinephrine by 4 times.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "氟烷比其他任何吸入性麻醉剂都更容易引起心肌抑制，并使与肾上腺素相关的心律失常风险增加4倍。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "15f6b25b-e1b9-560c-8014-763244470a62", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The preferred combination of narcotics and inhalational agents, commonly the “bread and butter” of many ped anesthetists is ______  & _________.", + "A": "1-2 mcg/kg Fentanyl & O.5 MAC isoflurane", + "B": "2-4 mcg/kg fentanyl & propfol gtt", + "C": "0.25-0.5 mcg/kg Dilaudid and 0.3 MAC sevoflurane", + "D": "1-2 mg/kg dialudid and .6 MAC desflurane" + }, + "zh": { + "question": "许多小儿麻醉师常用的麻醉药和吸入剂的首选组合，通常被称为“家常便饭”是 ______ & _________。", + "A": "1-2 mcg/kg 芬太尼 & 0.5 MAC 异氟醚", + "B": "2-4 mcg/kg 芬太尼 & 丙泊酚滴注", + "C": "0.25-0.5 mcg/kg 迪劳瑞丁和 0.3 MAC 七氟醚", + "D": "1-2 mg/kg 迪劳瑞丁和 0.6 MAC 地氟醚" + } + }, + { + "id": "d8c7ae26-e6d6-5e3d-93ca-afd449f24579", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What side effect is commonly associated with fentanyl that we are concerned about during anesthesia?", + "A": "Myocardial depression", + "B": "Chest Wall Rigidity", + "C": "Renal Toxicity", + "D": "Cytochrome P450 induction" + }, + "zh": { + "question": "在麻醉过程中，我们担心芬太尼常见的副作用是什么？", + "A": "心肌抑制", + "B": "胸壁僵硬", + "C": "肾毒性", + "D": "细胞色素P450诱导" + } + }, + { + "id": "9a2b9e9c-8c81-59dd-ba4b-1a8aab6f0b4e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the incidence of Malignant Hyperthermia in children?", + "A": "1: 50,000", + "B": "1: 100,000", + "C": "1: 15,000", + "D": "1: 250,000" + }, + "zh": { + "question": "儿童恶性高热的发生率是多少？", + "A": "1: 50,000", + "B": "1: 100,000", + "C": "1: 15,000", + "D": "1: 250,000" + } + }, + { + "id": "92ae78a4-88a8-545d-a2ec-14eeacb4b19b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Malignant Hyperthermia is a severe reaction which results in ryanodine receptor activation leading to…", + "A": "Intracellular Hyperkalemia", + "B": "Intracellular Hypernatremia", + "C": "Intracellular Hypercalcemia", + "D": "Intracellular Hyperglycemia" + }, + "zh": { + "question": "恶性高热是一种严重反应，导致钙通道受体激活，进而导致……", + "A": "细胞内高钾血症", + "B": "细胞内高钠血症", + "C": "细胞内高钙血症", + "D": "细胞内高血糖症" + } + }, + { + "id": "6124f06d-56fd-57ee-bd89-26b2f6d1bd7c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following will not trigger Malignant Hyperthermia?", + "A": "Desflurane", + "B": "Succinylcholine", + "C": "Isoflurane", + "D": "Vecuronium" + }, + "zh": { + "question": "以下哪一项不会引发恶性高热？", + "A": "地氟烷", + "B": "琥珀胆碱", + "C": "异氟烷", + "D": "维库溴铵" + } + }, + { + "id": "168d4b1d-f83b-52a9-b382-0a49ab2b3e57", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following disease states is associated with an increased risk of Malignant hyperthermia?", + "A": "Cystic Fibrosis", + "B": "Muscular Dystrophy", + "C": "Sickle Cell Anemia", + "D": "Latex Allergy" + }, + "zh": { + "question": "以下哪种疾病状态与恶性高热的风险增加有关？", + "A": "囊性纤维化", + "B": "肌营养不良", + "C": "镰状细胞贫血", + "D": "乳胶过敏" + } + }, + { + "id": "1c74034f-95e9-5d20-9bdf-29af290c28ea", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What would be an appropriate starting dose of dantrolene to give to a 3 yr old child weighing 14 kg?", + "A": "14 mg", + "B": "140 mg", + "C": "35 mg", + "D": "280 mg" + }, + "zh": { + "question": "对于一名体重14公斤的3岁儿童，适合的丹曲林起始剂量是多少？", + "A": "14 毫克", + "B": "140 毫克", + "C": "35 毫克", + "D": "280 毫克" + } + }, + { + "id": "699d5f2f-3fd6-5937-a14e-37731a1a0e7b", + "choice_num": 4, + "answer": "A", + "level": 3, + "en": { + "question": "You are the SRNA for 16-month-old Arturo, who is about to be extubated. As he is waking up from anesthesia you deliver 100% FiO2, but then Arturo begins to cough. He becomes cyanotic as you suction your tube to rule out any kind of obstruction. Your FiO2 is100% and the pt is ventilating but still blue. What do you do?", + "A": "Just wait, it will go away in a moment once he stops coughing", + "B": "Administer sux to break laryngospasm", + "C": "Give albuterol 4 puffs via ETT", + "D": "Call code and begin PALS protocol" + }, + "zh": { + "question": "你是16个月大的Arturo的麻醉护士，他即将拔管。当他从麻醉中醒来时，你提供100%的FiO2，但Arturo开始咳嗽。当你吸引管道以排除任何阻塞时，他变得发绀。你的FiO2是100%，病人正在通气但仍然发青。你会怎么做？", + "A": "等一下，一旦他停止咳嗽就会好转", + "B": "给予琥珀胆碱以解除喉痉挛", + "C": "通过气��插管给予4次吸入沙丁胺醇", + "D": "呼叫代码并开始PALS协议" + } + }, + { + "id": "8275cb85-79bb-530e-a462-66c88aff5036", + "choice_num": 4, + "answer": "B", + "level": 3, + "en": { + "question": "Which of the following would be the best choice for the induction of a pediatric patient coming in for emergent surgery following an MVA? The child is currently wheezing and according to his father, the child has a history of severe asthma.", + "A": "Propofol", + "B": "Ketamine", + "C": "Inhalational induction with Sevoflurane", + "D": "Fentanyl & Versed" + }, + "zh": { + "question": "以下哪种选择最适合用于因车祸需要紧急手术的儿科患者的麻醉诱导？该儿童目前正在喘息，并且根据其父亲的说法，该儿童有严重哮喘的病史。", + "A": "丙泊酚", + "B": "氯胺酮", + "C": "七氟醚吸入诱导", + "D": "芬太尼和咪达唑仑" + } + }, + { + "id": "d5f8d158-200a-5654-8c2b-7e806c1b185c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Approximately what percentage of children with down syndrome will have associated cardiac anomalies?", + "A": "5-15%", + "B": "65-75%", + "C": "40-60%", + "D": "80-95%" + }, + "zh": { + "question": "大约有多少百分比的唐氏综合症儿童会有相关的心脏异常？", + "A": "5-15%", + "B": "65-75%", + "C": "40-60%", + "D": "80-95%" + } + }, + { + "id": "f6ccae3a-b08d-5b1e-807a-57b09af24b18", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Why are patients with muscular dystrophy more prone to cardiac arrhythmias?", + "A": "Due to conduction node abnormalities which are common genetic issues associated with MD", + "B": "Due to chest wall rigidity and propensity toward effusions, predisposing pts to tamponade", + "C": "Due to hyperkalemia and upregulation of pts, making pts more prone to electrolyte abnormalities", + "D": "Due to lack of dystrophin which is essential for proper cardiac function" + }, + "zh": { + "question": "为什么肌营养不良患者更容易发生心律失常？", + "A": "由于传导结异常，这是与肌营养不良相关的常见遗传问题", + "B": "由于胸壁僵硬和易发生积液，使患者易发生心脏压塞", + "C": "由于高钾血症和受体上调，使患者更容易出现电解质异常", + "D": "由于缺乏抗肌萎缩蛋白，这对正常的心脏功能至关重要" + } + }, + { + "id": "0e3a7024-0287-5e66-afff-45efb77e1b23", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is not a sign of latex allergy?", + "A": "Bradycardia and arrhythmias", + "B": "Laryngeal Edema", + "C": "Pruritis", + "D": "Bronchospasm" + }, + "zh": { + "question": "以下哪项不是乳胶过敏的表现？", + "A": "心动过缓和心律失常", + "B": "喉头水肿", + "C": "瘙痒", + "D": "支气管痉挛" + } + }, + { + "id": "4e433536-bd3b-5892-ad36-00a9fd484431", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following reasons explains why opioids appear to be more potent in neonates?", + "A": "Easier entry across blood brain barrier", + "B": "Decreased metabolic capabilities", + "C": "Increased sensitivity of respiratory centers", + "D": "All the above" + }, + "zh": { + "question": "以下哪种原因解释了为什么阿片类药物在新生儿中显得更有效？", + "A": "更容易穿过血脑屏障", + "B": "代谢能力降低", + "C": "呼吸中枢的敏感性增加", + "D": "以上全部" + } + }, + { + "id": "25f6989c-c802-590f-9308-0f479037870c", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "You are the SRNA for Ms. Cartaya today who has a past medical history of seizures, which are controlled through dilantin. How will this effect your muscle relaxants?", + "A": "I should not give any muscle relaxants.", + "B": "Will not affect my medication at all", + "C": "Will prolong the effect of the medication. So will need less.", + "D": "Will shorten the effect of the medication. So will need more." + }, + "zh": { + "question": "今天您是 Ms. Cartaya 的麻醉护士，她有癫痫病史，通过苯妥英钠控制。 这将如何影响您的肌肉松弛剂？", + "A": "我不应该给予任何肌肉松弛剂。", + "B": "不会对我的药物产生任何影响。", + "C": "会延长药物的效果。所以需要更少。", + "D": "会缩短药物的效果。所以需要更多。" + } + }, + { + "id": "3dc1116c-3df9-5bd3-b3a7-f627f868e2d5", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which drugs are potentiated by dantrolene?", + "A": "Neuromuscular blockers like vecuronium", + "B": "NSAIDS like ketoralac", + "C": "Steroids like prednisone", + "D": "Beta blockers like esmolol" + }, + "zh": { + "question": "哪些药物的作用会被丹曲林增强？", + "A": "神经肌肉阻滞剂如维库溴铵", + "B": "非甾体抗炎药如酮咯酸", + "C": "类固醇如泼尼松", + "D": "β受体阻滞剂如艾司洛尔" + } + }, + { + "id": "2c63f866-81be-54b9-9234-287c9693ba7d", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "The mixing of Lidocaine w/ Propofol may result in coalescence of oil droplets which may pose risk of pulmonary embolism.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "利多卡因与丙泊酚混合可能导致油滴聚集，这可能增加肺栓塞的风险。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "b214f93b-7ea7-5051-a7a1-e0c368f20321", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What is an appropriate intubating dose of Atracurium?", + "A": "1-1.5 mg/kg", + "B": ".08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + }, + "zh": { + "question": "阿曲库铵的适当插管剂量是多少？", + "A": "1-1.5 mg/kg", + "B": "0.08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + } + }, + { + "id": "f187643d-83cf-5954-bf07-0e140405b5a8", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "You are the SRNA for Mr. Joe, a 20 yr old male having repair of a torn ACL tendon.  You paralyzed the patient using succinylcholine to intubate, and currently have your Sevo going at 2%. Right as the makes his incision into the patients knee you notice your HR has jumped and the patient is tachycardic. His BP has also jumped up considerably. What does this mean?", + "A": "He may be too light on anesthesia, give some fentanyl and go up on your sevo.", + "B": "This may be the beginning stages of Malignant hyperthermia. Call for Help.", + "C": "He is not paralyzed enough, give some vec.", + "D": "Do nothing, the tachycardia will go away once the incision portion is over." + }, + "zh": { + "question": "你是为20岁男性乔先生进行撕裂的ACL肌腱修复手术的麻醉护士。你使用琥珀胆碱使患者麻痹以便插管，目前你的Sevo设置为2%。就在医生在患者膝盖上切开时，你注意到心率上升，患者出现心动过速。他的血压也显著上升。这意味着什么？", + "A": "他可能麻醉不够深，给一些芬太尼并增加Sevo的浓度。", + "B": "这可能是恶性高热的早期阶段。呼叫帮助。", + "C": "他麻痹不够，给一些维库溴铵。", + "D": "什么都不做，心动过速会在切开部分结束后消失。" + } + }, + { + "id": "fd602557-4f4f-5df2-afba-21abbd83bd3d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the MOA of Etomidate?", + "A": "GABAa agonist", + "B": "Non-competitive binding to the phencyclidine recognition site on the NMDA receptor & acts on opioid receptors", + "C": "Through binding to and activating alpha subunit receptors to cause sustained depolarization.", + "D": "Inhibition on GABAa receptors" + }, + "zh": { + "question": "依托咪酯的作用机制是什么？", + "A": "GABAa 受体激动剂", + "B": "非竞争性结合于NMDA受体的苯环利定识别位点并作用于阿片受体", + "C": "通过结合并激活α亚基受体引起持续去极化。", + "D": "对GABAa受体的抑制作用" + } + }, + { + "id": "8486ff59-def2-5196-ae64-ffc9d80cdb75", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "This non-barb has a chemical structure of carboxylated imidazole-containing compound that (like versed) is water solule at acidic pH and lipid soluble at physiologic pH.", + "A": "Etomidate", + "B": "Ketamine", + "C": "Propofol" + }, + "zh": { + "question": "这种非巴比妥类药物具有羧化咪唑化合物的化学结构，在酸性pH下（如咪达唑仑）是水溶性的，在生理pH下是脂溶性的。", + "A": "依托咪酯", + "B": "氯胺酮", + "C": "丙泊酚" + } + }, + { + "id": "1167a25e-8e48-5a35-8754-761c85087766", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the mechanism of action of non-depolarizing muscle relaxants?", + "A": "Works at spinal nerve roots to cause paralysis and NMJ", + "B": "Bind to alpha subunit receptors but do not activate them, merely tie up the receptors to block acetylcholine.", + "C": "By potentiating the inhibitory effects of GABA", + "D": "Through binding to and activating alpha subunit receptors to cause sustained depolarization." + }, + "zh": { + "question": "非去极化肌松药的作用机制是什么？", + "A": "作用于脊神经根导致麻痹和神经肌肉接头", + "B": "结合到α亚基受体但不激活它们，仅仅占据受体以阻断乙酰胆碱。", + "C": "通过增强GABA的抑制作用", + "D": "通过结合并激活α亚基受体以引起持续去极化。" + } + }, + { + "id": "e242e8af-8aa8-5f7b-b355-0ec70775e33c", + "choice_num": 5, + "answer": "A", + "level": 2, + "en": { + "question": "You are the SRNA for a 58 yr old female having open heart surgery. She is 5’4” and  70 kg. What would be an appropriate intubating dose of pancuronium?", + "A": "7 mg", + "B": "105 mg", + "C": "84 mg", + "D": "14 mg", + "E": "35 mg" + }, + "zh": { + "question": "您是为一位58岁女性进行心脏直视手术的麻醉护士。她身高5英尺4英寸，体重70公斤。适合的潘库溴铵插管剂量是多少？", + "A": "7毫克", + "B": "105毫克", + "C": "84毫克", + "D": "14毫克", + "E": "35毫克" + } + }, + { + "id": "2b8b728c-0af8-5c6e-a593-8394d2adac17", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the non-barbituate agents is unique due to the fact it has no stereoisomers?", + "A": "Etomidate", + "B": "Propofol", + "C": "Ketamine", + "D": "Thiopental" + }, + "zh": { + "question": "以下哪种非巴比妥类药物因没有立体异构体而独特？", + "A": "依托咪酯", + "B": "丙泊酚", + "C": "氯胺酮", + "D": "硫喷妥" + } + }, + { + "id": "e064c046-6cb2-5053-be7f-8983e6e67494", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "You are caring for Mr. Wren today who has a past medical history of DM, HTN and renal failure. You are asked to choose an appropriate muscle relaxing agents for him. Which do you choose as the BEST agent for Mr. Wren?", + "A": "Vecuronium", + "B": "Succinylcholine", + "C": "Rocuronium", + "D": "Pancuronium" + }, + "zh": { + "question": "您今天负责照顾Wren先生，他有糖尿病、高血压和肾衰竭的病史。您被要求为他选择一种合适的肌肉松弛剂。您选择哪种作为Wren先生的最佳药物？", + "A": "维库溴铵", + "B": "琥珀胆碱", + "C": "罗库溴铵", + "D": "潘库溴铵" + } + }, + { + "id": "27b4c6a7-6b3e-51e8-bab3-341880191daf", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is a depolarizing muscle relaxant?", + "A": "Rocuronium", + "B": "Mivacurium", + "C": "Succinylcholine", + "D": "Vecuronium" + }, + "zh": { + "question": "以下哪一项是去极化肌肉松弛剂？", + "A": "罗库溴铵", + "B": "米库氯铵", + "C": "琥珀胆碱", + "D": "维库溴铵" + } + }, + { + "id": "9407a874-5056-5c79-bb72-896503b6d67c", + "choice_num": 3, + "answer": "C", + "level": 2, + "en": { + "question": "Propofol can lead to significant bradycardia that is resistant to atropine. Which of the following drugs would you give?", + "A": "Dopamine", + "B": "Esmolol", + "C": "Isoproterenol" + }, + "zh": { + "question": "丙泊酚可能导致对阿托品耐药的显著心动过缓。你会给予以下哪种药物？", + "A": "多巴胺", + "B": "艾司洛尔", + "C": "异丙肾上腺素" + } + }, + { + "id": "7e2de840-8305-5c32-b27d-62645aa9b517", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Succinylcholine is rapidly metabolized to succinylmonocholine which is known to cause:", + "A": "Hyperkalemia", + "B": "Increase ICP", + "C": "Bradycardia", + "D": "Malignant hyperthermia" + }, + "zh": { + "question": "琥珀酰胆碱迅速代谢为琥珀酰单胆碱，已知会导致：", + "A": "高钾血症", + "B": "颅内压增高", + "C": "心动过缓", + "D": "恶性高热" + } + }, + { + "id": "fd426de7-a17d-577a-9075-f400f61f55f7", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "At what percentage of blockade by non-depolarizing muscle relaxants would you achieve surgical relaxation?", + "A": "99%", + "B": "75%", + "C": "90%", + "D": "60%" + }, + "zh": { + "question": "非去极化肌松药达到多少百分比的阻滞可以实现手术松弛？", + "A": "99%", + "B": "75%", + "C": "90%", + "D": "60%" + } + }, + { + "id": "d4d4e758-681f-5487-9489-f42601c03388", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is recommended dose of Edrophonium?", + "A": "0.1-0.4 mg/kg", + "B": "0.08 mg/Kg", + "C": "0.5-1.0 mg/Kg", + "D": "0.01-0.03 mg/Kg" + }, + "zh": { + "question": "推荐的依酚氯铵剂量是多少？", + "A": "0.1-0.4 mg/kg", + "B": "0.08 mg/Kg", + "C": "0.5-1.0 mg/Kg", + "D": "0.01-0.03 mg/Kg" + } + }, + { + "id": "557070cf-2df0-5642-a8c5-5b5f3d73e18f", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "What would be a proper dose of ketamine to give to a patient who is having pain and weighs 50 kg?", + "A": "100 mg", + "B": "25 mg", + "C": "150 mg", + "D": "50 mg" + }, + "zh": { + "question": "对于一位体重50公斤且正在疼痛的患者，适当的氯胺酮剂量是多少？", + "A": "100毫克", + "B": "25毫克", + "C": "150毫克", + "D": "50毫克" + } + }, + { + "id": "2ee8ea55-7728-56c7-86b8-fdcd6f30d186", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "What would be the most appropriate reversal agent for a child weighing 20 kg?", + "A": "Neo 1.6 mg, atropine 0.2 mg", + "B": "Pyridostigmine 2 mg, no cholinergic agent", + "C": "Do not use agents which require reversal on pediatric patients.", + "D": "Edrophonium 20 mg, Atropine 0.28 mg" + }, + "zh": { + "question": "对于体重20公斤的儿童，最合适的拮抗剂是什么？", + "A": "新斯的明 1.6 mg，阿托品 0.2 mg", + "B": "吡啶斯的明 2 mg，无胆碱能药物", + "C": "不要对儿科患者使用需要拮抗的药物。", + "D": "依酚氯铵 20 mg，阿托品 0.28 mg" + } + }, + { + "id": "cab10576-155e-5cf2-9f6d-367827601c6d", + "choice_num": 3, + "answer": "A", + "level": 2, + "en": { + "question": "You are caring for a 82 yr old woman who is about to be induced for surgery. You plan to use propofol for your induction and would plan that….", + "A": "You would reduce your dose by 25-50%", + "B": "With no prior medical history you could use the standard dosage of propofol", + "C": "You would increase your dose by 25-50%" + }, + "zh": { + "question": "您正在照顾一位即将进行手术诱导的82岁女性。您计划使用丙泊酚进行诱导，并计划……", + "A": "您将减少剂量25-50%", + "B": "在没有既往病史的情况下，您可以使用丙泊酚的标准剂量", + "C": "您将增加剂量25-50%" + } + }, + { + "id": "0cdc7fd1-f121-5dc0-af4a-5357520f4968", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following has the shortest duration of action?", + "A": "Vecuronium", + "B": "Rocuronium", + "C": "Pancuronium", + "D": "Succinylcholine" + }, + "zh": { + "question": "以下哪种药物的作用时间最短？", + "A": "维库溴铵", + "B": "罗库溴铵", + "C": "潘库溴铵", + "D": "琥珀胆碱" + } + }, + { + "id": "9b97b9ab-368f-5377-890c-e4a22e160334", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Dantrolene should be continued for ____ Hours post MH episode.", + "A": "24", + "B": "12", + "C": "48", + "D": "6" + }, + "zh": { + "question": "在恶性高热（MH）发作后，应继续使用丹曲林 ____ 小时。", + "A": "24", + "B": "12", + "C": "48", + "D": "6" + } + }, + { + "id": "21625f41-0117-55af-b5ac-e7666cb82bd7", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "This non-barb will increase salivation, inclusion of a antisialagogue is recommended.", + "A": "Etomidate", + "B": "Ketamine", + "C": "Propofol" + }, + "zh": { + "question": "这种非巴比妥类药物会增加唾液分泌，建议加入抗唾液药。", + "A": "依托咪酯", + "B": "氯胺酮", + "C": "丙泊酚" + } + }, + { + "id": "d825214d-6c24-5dba-9cb9-289ca2dbb0b1", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following drugs is metabolized by pseudocholinesterase?", + "A": "Atracurium", + "B": "Mivacurium", + "C": "Rocuronium", + "D": "Vecuronium" + }, + "zh": { + "question": "下列哪种药物是由假胆碱酯酶代谢的？", + "A": "阿曲库铵", + "B": "米库氯铵", + "C": "罗库溴铵", + "D": "维库溴铵" + } + }, + { + "id": "d35a9a5b-8d52-57c3-a3d0-d74843a7a795", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "Which of the following patients could you use succinylcholine on?", + "A": "A burn patient admitted 3 hours ago.", + "B": "A spinal cord injury patient in the ICU admitted 1 week ago", + "C": "Dialysis patient who is mildly hyperkalemic", + "D": "Patient with past history of Muscular Dystrophy", + "E": "None of the above" + }, + "zh": { + "question": "以下哪位患者可以使用琥珀胆碱？", + "A": "3小时前入院的烧伤患者。", + "B": "1周前入院ICU的脊髓损伤患者。", + "C": "轻度高钾血症的透析患者。", + "D": "有肌营养不良病史的患者。", + "E": "以上都不是。" + } + }, + { + "id": "08398c99-cc2b-53ad-ab3e-0ffc1a951d40", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "You are the SRNA for a patient currently undergoing biopsy and removal and liver mass. You paralyzed the patient with vecuronium and are using Sevoflurance for sedation. You notice your patient suddenly becomes tachycardic and the ETCO2 goes way up. You attempt to increase your RR to decrease ETCO2 but it does not work. At the same time you notice the patients muscles are becoming rigid. What is the FIRST thing you should do now?", + "A": "Give a beta blocker to decrease HR and increase O2 to 100%", + "B": "Start mixing dantrolene and apply a hypothermic blanket", + "C": "Call for Help, tell surgeon to stop procedure.", + "D": "Turn off your sevoflurane and draw an ABG." + }, + "zh": { + "question": "您是目前正在进行活检和肝脏肿块切除手术的患者的麻醉护士。您使用维库溴铵使患者麻痹，并使用七氟醚进行镇静。您注意到患者突然出现心动过速，呼气末二氧化碳分压急剧上升。您尝试增加呼吸频率以降低呼气末二氧化碳分压，但无效。同时，您注意到患者的肌肉变得僵硬。现在您应该首先做什么？", + "A": "给予β受体阻滞剂以降低心率，并将氧气增加到100%", + "B": "开始混合丹曲林并使用低温毯", + "C": "呼叫帮助，告诉外科医生停止手术。", + "D": "关闭七氟醚并抽取动脉血气。" + } + }, + { + "id": "2222a296-d25f-5662-975e-95c1b049809b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What drug could you give to decrease the incidence of emergence delirum in patients receiving ketamine?", + "A": "Propofol", + "B": "Thiopental", + "C": "Versed", + "D": "All of the above" + }, + "zh": { + "question": "在接受氯胺酮的患者中，您可以给予哪种药物来减少术后谵妄的发生率？", + "A": "丙泊酚", + "B": "硫喷妥钠", + "C": "咪达唑仑", + "D": "以上皆是" + } + }, + { + "id": "33f6f51b-d715-5c65-945d-34f6aa4362c0", + "choice_num": 3, + "answer": "C", + "level": 2, + "en": { + "question": "Https://www.youtube.com/watch?v=c1JzCDqt3BM", + "A": "Love it", + "B": "Now I have that song stuck in my head....", + "C": "All of the above." + }, + "zh": { + "question": "Https://www.youtube.com/watch?v=c1JzCDqt3BM", + "A": "喜欢它", + "B": "现在这首歌在我脑海中挥之不去……", + "C": "以上全部。" + } + }, + { + "id": "60118c45-afa2-5936-9a03-e5a942940de9", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Hyperthermia is an early sign of MH.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "高热是恶性高热的早期征兆。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "beecc252-0478-5d0a-b4f6-093a1b08639b", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Which non-barb can supress adrenal cortical function?", + "A": "Etomidate", + "B": "Ketamine", + "C": "Propofol" + }, + "zh": { + "question": "哪种非巴比妥类药物可以抑制肾上腺皮质功能？", + "A": "依托咪酯", + "B": "氯胺酮", + "C": "丙泊酚" + } + }, + { + "id": "ca2eee53-8525-5907-8b55-95a3b6d206c3", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "What is an appropriate intubating dose of Succinylcholine?", + "A": "1-1.5 mg/kg", + "B": ".08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + }, + "zh": { + "question": "琥珀胆碱的适当插管剂量是多少？", + "A": "1-1.5 mg/kg", + "B": "0.08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + } + }, + { + "id": "8d4dc32a-bfaf-566c-84b7-8106070d2d73", + "choice_num": 5, + "answer": "C", + "level": 2, + "en": { + "question": "You are the SRNA for a 75 yr old female going in for a bowel resection. She is 5’2” and 50 kg. What would be an appropriate intubating dose of Rocuronium?", + "A": "75 mg", + "B": "5 mg", + "C": "30 mg", + "D": "10 mg", + "E": "90 mg" + }, + "zh": { + "question": "您是为一名75岁女性进行肠切除术的麻醉护士。她身高5英尺2英寸，体重50公斤。合适的罗库溴铵插管剂量是多少？", + "A": "75 毫克", + "B": "5 毫克", + "C": "30 毫克", + "D": "10 毫克", + "E": "90 毫克" + } + }, + { + "id": "7334d064-3412-525d-9130-b1ef053d93a4", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "What is an appropriate intubating dose of Pancuronium?", + "A": "1-1.5 mg/kg", + "B": ".08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + }, + "zh": { + "question": "Pancuronium 的适当插管剂量是多少？", + "A": "1-1.5 mg/kg", + "B": "0.08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + } + }, + { + "id": "6a526385-2ff0-5d01-8505-3c629dafd5d8", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "What would be an appropriate intubating dose of Atracurium for a 5’1” 48 yr old female weight 60 kg?", + "A": "90 mg", + "B": "6 mg", + "C": "70 mg", + "D": "12 mg", + "E": "30 mg" + }, + "zh": { + "question": "对于一名身高5英尺1英寸、48岁、体重60公斤的女性，适合的阿曲库铵插管剂量是多少？", + "A": "90 毫克", + "B": "6 毫克", + "C": "70 毫克", + "D": "12 毫克", + "E": "30 毫克" + } + }, + { + "id": "cc033297-664b-5cde-b17f-b321353011ca", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "What is the most important clinical s/s that would lead you to suspect MH?", + "A": "Increased temperature", + "B": "Increased ETCO2", + "C": "Hypoxia", + "D": "Muscle rigidity", + "E": "Increased HR" + }, + "zh": { + "question": "什么是最重要的临床症状/体征，会让你怀疑恶性高热？", + "A": "体温升高", + "B": "呼气末二氧化碳增加", + "C": "缺氧", + "D": "肌肉僵硬", + "E": "心率增加" + } + }, + { + "id": "96fbc4fb-f0f3-5afa-a0e7-5bf044dfdee8", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "This non-barb is know to inhibit PLT aggregation.", + "A": "Etomidate", + "B": "Ketamine", + "C": "Propofol" + }, + "zh": { + "question": "这种非巴比妥类药物已知可抑制血小板聚集。", + "A": "依托咪酯", + "B": "氯胺酮", + "C": "丙泊酚" + } + }, + { + "id": "880dda42-8430-5b5c-9600-26518239048b", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Which non-barb induction agent has analgesic and bronchodilator effects?", + "A": "Ketamine", + "B": "Propofol", + "C": "Etomidate" + }, + "zh": { + "question": "哪种非巴比妥诱导剂具有镇痛和支气管扩张作用？", + "A": "氯胺酮", + "B": "丙泊酚", + "C": "依托咪酯" + } + }, + { + "id": "b15a4e4e-e04f-5987-bb6d-98bab8fdebad", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following non-barbituate agents would be the BEST choice for a trauma patient?", + "A": "Thiopental", + "B": "Etomidate", + "C": "Propofol", + "D": "Ketamine" + }, + "zh": { + "question": "以下哪种非巴比妥类药物是创伤患者的最佳选择？", + "A": "硫喷妥钠", + "B": "依托咪酯", + "C": "丙泊酚", + "D": "氯胺酮" + } + }, + { + "id": "20e66ebe-9fb1-5d3e-b3b6-4f334c014be1", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which of the following muscle relaxing agents would be BEST to give to a patient in multi-system organ failure?", + "A": "Succinylcholine", + "B": "Mivacurium", + "C": "Vecuronium", + "D": "Rocuronium" + }, + "zh": { + "question": "以下哪种肌肉松弛剂最适合用于多系统器官衰竭的患者？", + "A": "琥珀胆碱", + "B": "米库氯铵", + "C": "维库溴铵", + "D": "罗库溴铵" + } + }, + { + "id": "67ac7333-909e-5d4f-9630-5f54bd8be2a7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The non-barbituate agents have short duration of action mainly due to…", + "A": "Redistribution", + "B": "Metabolism", + "C": "Low lipid solubility", + "D": "Low potency" + }, + "zh": { + "question": "非巴比妥类药物作用时间短主要是由于…", + "A": "重新分布", + "B": "代谢", + "C": "低脂溶性", + "D": "低效力" + } + }, + { + "id": "a1a0ed65-7e73-5f49-bf79-4a5c01ea8adb", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "This non-barb has a high incidence of emergence delirium, 12%.", + "A": "Etomidate", + "B": "Propofol", + "C": "Ketamine" + }, + "zh": { + "question": "这种非巴比妥药物具有12%的高发生率的苏醒谵妄。", + "A": "依托咪酯", + "B": "丙泊酚", + "C": "氯胺酮" + } + }, + { + "id": "1265d949-64c4-5327-9776-1b98a6457edc", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "What is an appropriate intubating dose of Vecuronium?", + "A": "1-1.5 mg/kg", + "B": ".08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + }, + "zh": { + "question": "维库溴铵的适当插管剂量是多少？", + "A": "1-1.5 mg/kg", + "B": "0.08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + } + }, + { + "id": "1328d11c-ae0a-5d46-885a-3a605a92af9c", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following lab values would not help to confirm diagnosis of Malignant hyperthermia?", + "A": "Serum K 6.5", + "B": "Ph 7.10", + "C": "Base excess –10", + "D": "PCO2 50" + }, + "zh": { + "question": "以下哪项实验室数值不有助于确认恶性高热的诊断？", + "A": "血清钾 6.5", + "B": "pH 7.10", + "C": "碱剩余 -10", + "D": "PCO2 50" + } + }, + { + "id": "e22a41f1-534c-5225-bfbc-5705347291ae", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "What would be a proper  IV induction dose for ketamine on a patient who is 5’9” and 80 kg?", + "A": "120 mg", + "B": "40 mg", + "C": "240 mg", + "D": "200 mg" + }, + "zh": { + "question": "对于一名身高5英尺9英寸、体重80公斤的患者，适当的静脉注射氯胺酮诱导剂量是多少？", + "A": "120 毫克", + "B": "40 毫克", + "C": "240 毫克", + "D": "200 毫克" + } + }, + { + "id": "4ff18a04-37a4-5c3a-a7d6-8ffacce0331f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following non-barbituate agents do we use as a racemic mixture?", + "A": "Etomidate", + "B": "Propofol", + "C": "Ketamine", + "D": "Thiopental" + }, + "zh": { + "question": "以下哪种非巴比妥类药物是以外消旋混合物形式使用的？", + "A": "依托咪酯", + "B": "丙泊酚", + "C": "氯胺酮", + "D": "硫喷妥钠" + } + }, + { + "id": "6ec72ee7-858d-57e4-8b86-84549e7efda3", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "You are the SRNA for a patient with a known pseudocholinesterase deficiency who needs a rapid sequence induction due to past medical history of GERD which is poorly controlled. The patient weighs 80 kg. What medication would you choose for this induction?", + "A": "Rocuronium 90 mg", + "B": "Succinylcholine 120 mg", + "C": "Mivacurium 20 mg", + "D": "Rapid sequence can not be done on this patient without prolonged effect of muscle relaxant." + }, + "zh": { + "question": "你是一个麻醉护士学员，负责一名已知有假性胆碱酯酶缺乏症的患者，该患者因既往有控制不佳的胃食管反流病史需要快速序贯诱导。患者体重80公斤。你会选择哪种药物进行诱导？", + "A": "罗库溴铵 90 mg", + "B": "琥珀胆碱 120 mg", + "C": "米库氯铵 20 mg", + "D": "在没有肌肉松弛剂的延长作用下，无法对该患者进行快速序贯诱导。" + } + }, + { + "id": "58d0c52c-0ae3-5a36-a4ce-57445ee0aa58", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What class of medications is contraindicated in MH?", + "A": "Calcium Channel blockers", + "B": "Beta Blockers", + "C": "Calcium gluconate", + "D": "NSAIDS" + }, + "zh": { + "question": "哪一类药物在恶性高热中禁用？", + "A": "钙通道阻滞剂", + "B": "β受体阻滞剂", + "C": "葡萄糖酸钙", + "D": "非甾体抗炎药" + } + }, + { + "id": "e5e2494f-54c5-552b-9308-8e8587221850", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "This non-barb hypnotic is good for patients with a history of PONV.", + "A": "Etomidate", + "B": "Propofol", + "C": "Ketamine" + }, + "zh": { + "question": "这种非巴比妥类催眠药适用于有术后恶心呕吐史的患者。", + "A": "依托咪酯", + "B": "丙泊酚", + "C": "氯胺酮" + } + }, + { + "id": "a4ca2d81-a0a6-5937-a270-4f9928ad494e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following could you give to counteract delirium cause by benzodiazepines and CNS effects of anticholinergic drugs?", + "A": "Neostigmine", + "B": "Edrophonium", + "C": "Pyridostigmine", + "D": "Physostigmine" + }, + "zh": { + "question": "下列哪种药物可以用来对抗由苯二氮卓类药物和抗胆碱能药物的中枢神经系统效应引起的谵妄？", + "A": "新斯的明", + "B": "依酚氯铵", + "C": "吡啶斯的明", + "D": "毒扁豆碱" + } + }, + { + "id": "53edb623-5dc6-5b18-8e38-0c1c4b499b6a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the recommended dose of propofol for maintenance of anesthesia?", + "A": "1.5-2.5 mg/kg", + "B": "3-5 mg/kg", + "C": "25-100 mcg/kg/min", + "D": "100-300 mcg/kg/min" + }, + "zh": { + "question": "推荐的丙泊酚维持麻醉剂量是多少？", + "A": "1.5-2.5 mg/kg", + "B": "3-5 mg/kg", + "C": "25-100 mcg/kg/min", + "D": "100-300 mcg/kg/min" + } + }, + { + "id": "e65d20da-3696-517e-87df-4613e1bb37c6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "All muscle relaxants are quaternary ammonium compounds that mimic the effects of…", + "A": "Pseudocholinesterase", + "B": "Acetylcholine", + "C": "Monocholine", + "D": "Muscarinic receptors" + }, + "zh": { + "question": "所有肌肉松弛剂都是季铵化合物，它们模拟……的作用", + "A": "假性胆碱酯酶", + "B": "乙酰胆碱", + "C": "单胆碱", + "D": "毒蕈碱受体" + } + }, + { + "id": "f5df7b60-3185-59db-a66d-972a53f7111e", + "choice_num": 5, + "answer": "E", + "level": 1, + "en": { + "question": "What are the common side effects of Dantrolene?", + "A": "Muscle weakness including difficulty swallowing or choking", + "B": "Pulmonary edema", + "C": "Anaphylaxis", + "D": "Rhabdomyolysis", + "E": "All of the above" + }, + "zh": { + "question": "Dantrolene 的常见副作用是什么？", + "A": "肌肉无力，包括吞咽困难或窒息", + "B": "肺水肿", + "C": "过敏反应", + "D": "横纹肌溶解", + "E": "以上所有" + } + }, + { + "id": "d7935564-beb0-5a20-b649-1c2232053abc", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the recommended dose of neostigmine?", + "A": "0.08 mg/kg", + "B": "1 mg/kg", + "C": "0.014 mg/kg", + "D": "0.2 mg/kg" + }, + "zh": { + "question": "新斯的明的推荐剂量是多少？", + "A": "0.08 mg/kg", + "B": "1 mg/kg", + "C": "0.014 mg/kg", + "D": "0.2 mg/kg" + } + }, + { + "id": "bd9f857a-e64d-53d5-b032-6d6a536dc5f6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following will have the most rapid onset?", + "A": "Neostigmine", + "B": "Edrophonium", + "C": "Pyrdiostigmine", + "D": "All have same onset time." + }, + "zh": { + "question": "以下哪一种药物的起效最快？", + "A": "新斯的明", + "B": "依酚氯铵", + "C": "吡啶斯的明", + "D": "所有药物的起效时间相同。" + } + }, + { + "id": "429a6652-26e4-50b2-ad53-a8fc7bfc4a2a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "How much glycopyrolate should you give to a patient receiving 3 mg of neostigmine?", + "A": "0.6 mg", + "B": "0.32 mg", + "C": "0.021 mg", + "D": "3 mg" + }, + "zh": { + "question": "对于接受 3 mg 新斯的明的患者，您应该给予多少格隆溴铵？", + "A": "0.6 mg", + "B": "0.32 mg", + "C": "0.021 mg", + "D": "3 mg" + } + }, + { + "id": "7b3513c2-a3e5-59f6-8f8f-82c689aee9f5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which isomer of ketamine is known to cause delirium and combatance on emergence?", + "A": "Both isomers can cause this.", + "B": "Neither isomer can cause this", + "C": "S isomer", + "D": "R isomer" + }, + "zh": { + "question": "哪种异构体的氯胺酮在苏醒时会导致谵妄和战斗性行为？", + "A": "两种异构体都可能导致这种情况。", + "B": "没有异构体会导致这种情况。", + "C": "S 异构体", + "D": "R 异构体" + } + }, + { + "id": "fe21043e-ab08-53f8-9987-f5825dd0d362", + "choice_num": 5, + "answer": "D", + "level": 2, + "en": { + "question": "What is an appropriate intubating dose of Nimbex for a 50 yr old 5’11” male weighing 110 kg?", + "A": "165 mg", + "B": "11 mg", + "C": "100 mg", + "D": "22 mg", + "E": "55 mg" + }, + "zh": { + "question": "对于一名50岁、身高5英尺11英寸、体重110公斤的男性，合适的Nimbex插管剂量是多少？", + "A": "165 毫克", + "B": "11 毫克", + "C": "100 毫克", + "D": "22 毫克", + "E": "55 毫克" + } + }, + { + "id": "0b343376-4806-590d-9885-599ccc6a8d8c", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "You  were  a very good SRNA this morning and drew up all your drugs, including the propofol, at 6:15 am.  At the last minute your first case of the day was cancelled and you did not get another case until 1:30 pm. Can you still use your propofol on this patient?", + "A": "No, too much time has passed", + "B": "Yes, but only if you remembered to refrigerate the propofol.", + "C": "Yes, propofol is good for 12 hours after opening." + }, + "zh": { + "question": "你今天早上是一名非常优秀的麻醉护士学员，早上6:15就准备好了所有药物，包括丙泊酚。就在最后一刻，你的第一个手术被取消了，直到下午1:30才有新的手术。你还能在这个病人身上使用你的丙泊酚吗？", + "A": "不，时间过得太久了", + "B": "可以，但前提是你记得把丙泊酚放进冰箱。", + "C": "可以，丙泊酚开封后12小时内有效。" + } + }, + { + "id": "08145547-ea98-55e8-8ca1-4a07f9ed242b", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "The chemical structure of this drug is 2,6-diisopropylphenol.", + "A": "Etomidate", + "B": "Ketamine", + "C": "Propofol" + }, + "zh": { + "question": "这种药物的化学结构是2,6-二异丙基苯酚。", + "A": "依托咪酯", + "B": "氯胺酮", + "C": "丙泊酚" + } + }, + { + "id": "8f742321-5945-5b93-98b5-b7995005280f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How much can your temperature increase every 5 minutes in MH? (pick best answer)", + "A": "1 degree C", + "B": "1-2 degrees C", + "C": "0.5-1 degree C", + "D": "0.1 degree C" + }, + "zh": { + "question": "在恶性高热（MH）中，每5分钟你的体温可以升高多少？（选择最佳答案）", + "A": "1摄氏度", + "B": "1-2摄氏度", + "C": "0.5-1摄氏度", + "D": "0.1摄氏度" + } + }, + { + "id": "9fcd3c74-5169-50e2-9cf6-296e1f5ea7ed", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following agents has the highest degree of protein binding?", + "A": "Etomidate", + "B": "Propofol", + "C": "Ketamine", + "D": "All have similar protein binding" + }, + "zh": { + "question": "以下哪种药物具有最高程度的蛋白结合？", + "A": "依托咪酯", + "B": "丙泊酚", + "C": "氯胺酮", + "D": "都具有相似的蛋白结合" + } + }, + { + "id": "75233c16-31e2-52d0-962f-6ad3afa26725", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "In a patient with MH, what would you expect their serum myoglobin to be?", + "A": "> 100 mg", + "B": "> 170 mcg", + "C": "> 180 mg", + "D": ">2200 mcg" + }, + "zh": { + "question": "在患有恶性高热的患者中，您预计他们的血清肌红蛋白会是多少？", + "A": "> 100 毫克", + "B": "> 170 微克", + "C": "> 180 毫克", + "D": "> 2200 微克" + } + }, + { + "id": "28ce95d7-c79a-5c47-b52a-7662e528d958", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "What would be an appropriate induction dose of etomidate for a 58 yr old female who is 5’6” and weighs 90 kg?", + "A": "18 mg", + "B": "180 mg", + "C": "45 mg", + "D": "90 mg" + }, + "zh": { + "question": "对于一名58岁、身高5英尺6英寸、体重90公斤的女性，适当的依托咪酯诱导剂量是多少？", + "A": "18 毫克", + "B": "180 毫克", + "C": "45 毫克", + "D": "90 毫克" + } + }, + { + "id": "2a91536f-22c6-53eb-a025-adb1d790061b", + "choice_num": 5, + "answer": "B", + "level": 2, + "en": { + "question": "You are the SRNA for a 12 yr old male who is 5’0” and weighs 45 kg. What would be an appropriate intubating dose of  vecuronium?", + "A": "45 mg", + "B": "4.5 mg", + "C": "54 mg", + "D": "9 mg", + "E": "22.5 mg" + }, + "zh": { + "question": "你是负责一名12岁男孩的麻醉护士，该男孩身高5英尺，体重45公斤。适合的维库溴铵插管剂量是多少？", + "A": "45 毫克", + "B": "4.5 毫克", + "C": "54 毫克", + "D": "9 毫克", + "E": "22.5 毫克" + } + }, + { + "id": "977e04c7-5574-5abb-9e0b-a7d328d7f849", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "What is the maximum dose of Dantrolene which can be given to a 10 yr old child weighing 30 kg?", + "A": "75 mg", + "B": "300 mg", + "C": "600 mg", + "D": "30 mg" + }, + "zh": { + "question": "10岁体重30公斤的儿童最大可给予多少剂量的丹曲林？", + "A": "75毫克", + "B": "300毫克", + "C": "600毫克", + "D": "30毫克" + } + }, + { + "id": "500be121-2d11-5c86-be9b-9131b726f3a3", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "The MH gene is passed via:", + "A": "Autosomal dominant gene", + "B": "Autosomal recessive gene" + }, + "zh": { + "question": "MH基因的遗传方式是：", + "A": "常染色体显性基因", + "B": "常染色体隐性基因" + } + }, + { + "id": "99146466-851c-5a4c-9e4e-d866a7e3ea75", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "If you give your pt an intubating dose of succynocholine and they have a MH reaction, what type of muscle rigidity can you see prior to actually intubating the patient?", + "A": "Masseter", + "B": "Chest wall", + "C": "Diaphragm", + "D": "Bicep" + }, + "zh": { + "question": "如果你给病人注射了插管剂量的琥珀胆碱，并且他们出现了恶性高热反应，在实际插管之前你可以看到哪种类型的肌肉僵硬？", + "A": "咬肌", + "B": "胸壁", + "C": "膈肌", + "D": "肱二头肌" + } + }, + { + "id": "ea36af35-61a0-5d61-9b7b-56b57f7c6750", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is commonly used in the treatment of myasthenia gravis?", + "A": "Edrophonium", + "B": "Physostigmine", + "C": "Pyridostigmine", + "D": "Glycopyrolate" + }, + "zh": { + "question": "以下哪种药物常用于治疗重症肌无力？", + "A": "依酚氯铵", + "B": "毒扁豆碱", + "C": "吡啶斯的明", + "D": "东莨菪碱" + } + }, + { + "id": "cf7eb717-5c4f-580d-92d9-24648dce7c7a", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "You can safely administer glycopyrolate without a cholinesterase inhibitor.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "您可以在没有胆碱酯酶抑制剂的情况下安全地给予格隆溴铵。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "1a1bc6a8-bc79-5f90-83c9-f3c3594a522d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following will increase your ICP?", + "A": "Propofol", + "B": "Etomidate", + "C": "Ketamine", + "D": "All of the above" + }, + "zh": { + "question": "下列哪一项会增加你的颅内压？", + "A": "丙泊酚", + "B": "依托咪酯", + "C": "氯胺酮", + "D": "以上全部" + } + }, + { + "id": "37709950-0081-5c70-90f2-f4ca3bd50220", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which agents is known for its HIGH degree of individual variability?", + "A": "Rocuronium", + "B": "Nimbex", + "C": "Vecuronium", + "D": "Succinylcholine" + }, + "zh": { + "question": "哪种药物以其高度的个体差异性而闻名？", + "A": "罗库溴铵", + "B": "尼美西", + "C": "维库溴铵", + "D": "琥珀胆碱" + } + }, + { + "id": "4201dfca-e53f-50bb-98cf-84d5c94386d3", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "Ketamine is a NMDA agonist or antagonist?", + "A": "Agonist", + "B": "Antagonist", + "C": "Neither, works on GABA receptors" + }, + "zh": { + "question": "氯胺酮是NMDA受体的激动剂还是拮抗剂？", + "A": "激动剂", + "B": "拮抗剂", + "C": "都不是，作用于GABA受体" + } + }, + { + "id": "c6833874-05f4-59ca-be3c-03739b1167e0", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the recommended dose of physostigmine?", + "A": "0.1-0.4 mg/kg", + "B": "0.08 mg/kg", + "C": "0.5-1.0 mg/Kg", + "D": "0.01-0.03 mg/Kg" + }, + "zh": { + "question": "推荐的毒扁豆碱剂量是多少？", + "A": "0.1-0.4 mg/kg", + "B": "0.08 mg/kg", + "C": "0.5-1.0 mg/Kg", + "D": "0.01-0.03 mg/Kg" + } + }, + { + "id": "deebb693-5eab-5946-a70e-53f15df00033", + "choice_num": 5, + "answer": "D", + "level": 1, + "en": { + "question": "What is an appropriate intubating dose of Nimbex?", + "A": "1-1.5 mg/kg", + "B": ".08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + }, + "zh": { + "question": "Nimbex 的适当插管剂量是多少？", + "A": "1-1.5 mg/kg", + "B": "0.08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + } + }, + { + "id": "336b0834-3b77-51f5-b809-a32dda6b8e27", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the half life of Dantrolene?", + "A": "1 hour", + "B": "6 hours", + "C": "30 minutes", + "D": "2 hours" + }, + "zh": { + "question": "丹曲林的半衰期是多少？", + "A": "1小时", + "B": "6小时", + "C": "30分钟", + "D": "2小时" + } + }, + { + "id": "3fa3da67-56ba-5801-b50b-d25e0797980a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How is Etomidate metabolized?", + "A": "By pseudocholinesterase", + "B": "By the kidneys", + "C": "By hepatic microsomal enzymes", + "D": "Via exhalation through the lungs" + }, + "zh": { + "question": "依托咪酯是如何代谢的？", + "A": "通过假性胆碱酯酶", + "B": "通过肾脏", + "C": "通过肝微粒体酶", + "D": "通过肺部呼出" + } + }, + { + "id": "aff9af8c-dc47-5c1e-827b-e02bcd03c4d5", + "choice_num": 2, + "answer": "A", + "level": 2, + "en": { + "question": "A patient with a sulfite allergy should not be given the generic propofol because of the metabisulfite preservative in it, but it is ok to give Diprovan.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "患有亚硫酸盐过敏的患者不应使用含有偏亚硫酸盐防腐剂的普通丙泊酚，但可以使用Diprovan。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "4e30228f-1dbd-53d2-b50e-6c954b537676", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Which of the following muscle relaxants would you choose to give to a patient having cardiac surgery in order to counteract the bradycardia caused by narcotics?", + "A": "Succinylcholine", + "B": "Rocuronium", + "C": "Mivacurium", + "D": "Pancuronium" + }, + "zh": { + "question": "在心脏手术中，为了对抗麻醉药物引起的心动过缓，你会选择使用以下哪种肌肉松弛剂？", + "A": "琥珀胆碱", + "B": "罗库溴铵", + "C": "米库氯铵", + "D": "潘库溴铵" + } + }, + { + "id": "e8e2eaa8-ebec-55a5-a8a8-22e4b63b8c66", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "You are the SRNA for Mrs. Nannit who is currently having a fem pop done. You have used vecuronium to paralyze the patient and she is receiving Desflurane for sedation.  Her heart rate is currently NSR 60, blood pressure is stable, but your ETCO2 is climbing. What should you do?", + "A": "Send an ABG immediately to evaluate for malignant hyperthermia, call for help.", + "B": "Increase the patient respiratory rate, she is hypoventilating.", + "C": "Give some fentanyl and increase your des.", + "D": "Wait and watch the patient for further signs of MH." + }, + "zh": { + "question": "您是负责Nannit女士的麻醉护士，目前她正在进行股动脉-腘动脉旁路手术。您使用了维库溴铵使患者瘫痪，并给予地氟醚进行镇静。她的心率目前为窦性心律60，血压稳定，但您的呼气末二氧化碳正在上升。您应该怎么做？", + "A": "立即发送动脉血气分析以评估恶性高热，并呼叫帮助。", + "B": "增加患者的呼吸频率，她正在通气不足。", + "C": "给予一些芬太尼并增加地氟醚。", + "D": "等待并观察患者是否有进一步的恶性高热迹象。" + } + }, + { + "id": "e6573a44-f359-5d24-a91d-3aa1a3d5ee6c", + "choice_num": 2, + "answer": "B", + "level": 2, + "en": { + "question": "For a patient who is borderline tachycardic it is recommended to administer neostigmine without glycopyrolate.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "对于一个心动过速边缘的患者，建议在没有使用羟丁酸的情况下给予新斯的明。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "1f81ac6b-88d9-5818-a545-d676ed536388", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What test could be done on a patient suspected to have MH?", + "A": "DNA Hyperthermia test", + "B": "Succinylcholine challenge test", + "C": "There are no tests available.", + "D": "Caffeine Halothane Test" + }, + "zh": { + "question": "可以对怀疑患有恶性高热的患者进行什么测试？", + "A": "DNA高热测试", + "B": "琥珀胆碱挑战测试", + "C": "没有可用的测试。", + "D": "咖啡因卤烷测试" + } + }, + { + "id": "55c0f8ae-b7c4-5414-ba5b-d2da563f9fec", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following agents is eliminated via Hoffman Elimination?", + "A": "Mivacurium", + "B": "Pancuronium", + "C": "Atracurium", + "D": "Rocuronium" + }, + "zh": { + "question": "以下哪种药物通过霍夫曼消除代谢？", + "A": "米库氯铵", + "B": "潘库溴铵", + "C": "阿曲库铵", + "D": "罗库溴铵" + } + }, + { + "id": "7d7ae10d-f72e-563e-9479-9732269b6c01", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "It is perfectly safe to use regional anesthetics on malignant hyperthermia susceptible patients.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "对恶性高热易感患者使用区域麻醉是完全安全的。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "2a45a17f-e342-5712-aac9-6e495c5ceee3", + "choice_num": 5, + "answer": "E", + "level": 2, + "en": { + "question": "You suspect your patient has MH, what do you expect to see on their ABG?", + "A": "CO2 42, BE +3, Ph 7.34", + "B": "CO2 62, BE 0, Ph 7.60", + "C": "CO2 65, BE -10, Ph 7.43", + "D": "CO2 32, BE -9, Ph 7.18", + "E": "CO2 61, BE -11, Ph 7.20" + }, + "zh": { + "question": "你怀疑你的病人有恶性高热（MH），你期望在他们的动脉血气分析（ABG）中看到什么？", + "A": "CO2 42, BE +3, Ph 7.34", + "B": "CO2 62, BE 0, Ph 7.60", + "C": "CO2 65, BE -10, Ph 7.43", + "D": "CO2 32, BE -9, Ph 7.18", + "E": "CO2 61, BE -11, Ph 7.20" + } + }, + { + "id": "4e7d2e4f-517b-5a47-835d-fb8258ec03ce", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Why is gylcopyrolate the anticholinergic agent of choice for neostigmine?", + "A": "Onset of action is very similar to neo", + "B": "Only cholinergic which can be safely mixed with neo", + "C": "Only cholinergic which will counteract bradycardia caused by neo", + "D": "Because of it’s ability to cross blood brain barrier." + }, + "zh": { + "question": "为什么选择使用甘氯铵作为新斯的明的抗胆碱能药物？", + "A": "起效时间与新斯的明非常相似", + "B": "唯一可以安全与新斯的明混合的胆碱能药物", + "C": "唯一可以抵消新斯的明引起的心动过缓的胆碱能药物", + "D": "因为它能够穿过血脑屏障。" + } + }, + { + "id": "24e108c2-b627-5ada-bfd6-7f432e6326cc", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the half life of etomidate?", + "A": "2-5 hours", + "B": "30-90 minutes", + "C": "5-10 hours", + "D": "10-20 minutes" + }, + "zh": { + "question": "依托咪酯的半衰期是多少？", + "A": "2-5 小时", + "B": "30-90 分钟", + "C": "5-10 小时", + "D": "10-20 分钟" + } + }, + { + "id": "6da04a18-b42f-533f-8c56-02c15cf00c8d", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "The majority of incidences of MH occur in patients under 15.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "大多数恶性高热（MH）病例发生在15岁以下的患者中。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "eba296ea-2684-55b3-8c94-0bd224dbfc2e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the name of the receptor that is responsible for MH?", + "A": "Ranitidine", + "B": "Ryanodine", + "C": "Cyanide", + "D": "Muscarinic" + }, + "zh": { + "question": "负责恶性高热的受体叫什么名字？", + "A": "雷尼替丁", + "B": "雷诺定", + "C": "氰化物", + "D": "毒蕈碱" + } + }, + { + "id": "2a47f8bb-119b-5a92-b82b-2aeca9abba7d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the non-barbituate agents has analgesic properties?", + "A": "Ketamine", + "B": "Etomidate", + "C": "Propofol", + "D": "Thiopental" + }, + "zh": { + "question": "以下哪种非巴比妥类药物具有镇痛特性？", + "A": "氯胺酮", + "B": "依托咪酯", + "C": "丙泊酚", + "D": "硫喷妥钠" + } + }, + { + "id": "a8c8b20a-af17-5c1e-8c61-794eebd38339", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Pre-treatment with a non-depolarizer may help to lessen all side effects from succinylcholine except:", + "A": "Arrythmias", + "B": "Hyperkalemia", + "C": "Myalgia", + "D": "Elevated Intraocular Pressure" + }, + "zh": { + "question": "使用非去极化药物进行预处理可能有助于减轻琥珀胆碱的所有副作用，除了：", + "A": "心律失常", + "B": "高钾血症", + "C": "肌痛", + "D": "眼内压升高" + } + }, + { + "id": "6500718d-4ffd-5131-8ba5-d9149e2dfb29", + "choice_num": 4, + "answer": "C", + "level": 3, + "en": { + "question": "You are the SRNA for a 16 yr old boy coming in for appendectomy. After administering succinylcholine to the pt you can not open the patients mouth the intubate him. What should you do next?", + "A": "Wait for sux to wear off, and give a different paralytic agent", + "B": "Plan to mask the case. Place face mask on pt and turn on the sevo.", + "C": "Immediately notify MD and send an ABG and labs to assess for MH. Cancel case.", + "D": "Trach the patient immediately." + }, + "zh": { + "question": "你是为一名16岁男孩进行阑尾切除术的麻醉护士。在给患者注射琥珀胆碱后，你无法打开患者的嘴进行插管。你接下来应该怎么做？", + "A": "等待琥珀胆碱失效，然后给予不同的麻醉药", + "B": "计划使用面罩进行麻醉。给患者戴上面罩并打开七氟醚。", + "C": "立即通知医生并发送动脉血气和实验室检查以评估恶性高热。取消手术。", + "D": "立即为患者进行气管切开。" + } + }, + { + "id": "23b6e45b-86bd-5e26-865a-a848dab94ce7", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the recommended dose of Pyridostigmine?", + "A": "0.1-0.4 mg/kg", + "B": ".08 mg/kg", + "C": "0.5-1 mg/kg", + "D": "0.01-0.03 mg/kg" + }, + "zh": { + "question": "吡啶斯的明的推荐剂量是多少？", + "A": "0.1-0.4 mg/kg", + "B": "0.08 mg/kg", + "C": "0.5-1 mg/kg", + "D": "0.01-0.03 mg/kg" + } + }, + { + "id": "ac82ebd0-c517-59ee-9e04-688b420eb349", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the mechanism of action of succinylcholine?", + "A": "Works at spinal nerve roots to cause paralysis and NMJ", + "B": "Bind to alpha subunit receptors but do not activate them, merely tie up the receptors to block acetylcholine.", + "C": "By potentiating the inhibitory effects of GABA", + "D": "Through binding to and activating alpha subunit receptors to cause sustained depolarization." + }, + "zh": { + "question": "琥珀胆碱的作用机制是什么？", + "A": "作用于脊神经根以引起麻痹和神经肌肉接头", + "B": "结合到α亚基受体但不激活它们，仅仅占据受体以阻断乙酰胆碱。", + "C": "通过增强GABA的抑制作用", + "D": "通过结合并激活α亚基受体以引起持续去极化。" + } + }, + { + "id": "a7d3287d-a7e6-51ed-8666-e0cd1c053f29", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What be an appropriate induction dose of propofol for a 75 yr old female who is 5’4” and weighs 75 kg? (Be careful here…)", + "A": "150 mg", + "B": "225 mg", + "C": "75 mg", + "D": "15 mg" + }, + "zh": { + "question": "对于一位75岁、身高5英尺4英寸、体重75公斤的女性，适当的丙泊酚诱导剂量是多少？（请注意…）", + "A": "150 毫克", + "B": "225 毫克", + "C": "75 毫克", + "D": "15 毫克" + } + }, + { + "id": "0a51f137-f5b2-5c4b-93d6-bcf0c8c8a127", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following has the longest duration of effect?", + "A": "Nimbex", + "B": "Vecuronium", + "C": "Succinylcholine", + "D": "Pancuronium" + }, + "zh": { + "question": "以下哪种药物的作用持续时间最长？", + "A": "Nimbex", + "B": "维库溴铵", + "C": "琥珀胆碱", + "D": "潘库溴铵" + } + }, + { + "id": "f93094ae-4a43-5df3-bf52-6475c1db7aef", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Whta is MOA of Ketamine?", + "A": "Selective modulation of GABA receptors", + "B": "Non-competitive antagonist binding to the phencyclidine recognition site on the NMDA receptor & acts on opioid receptors", + "C": "Through binding to and activating alpha subunit receptors to cause sustained depolarization.", + "D": "Inhibition of acetycholinesterase" + }, + "zh": { + "question": "氯胺酮的作用机制是什么？", + "A": "选择性调节GABA受体", + "B": "作为非竞争性拮抗剂结合于NMDA受体的苯环利定识别位点，并作用于阿片受体", + "C": "通过结合并激活α亚基受体引起持续去极化。", + "D": "抑制乙酰胆碱酯酶" + } + }, + { + "id": "57c945f5-a5b6-5789-b38d-2a3868a9b696", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the non-barbituate agents has the lowest amount of protein binding & works on NMDA receptors?", + "A": "Propofol", + "B": "Ketamine", + "C": "Etomidate", + "D": "Thiopental" + }, + "zh": { + "question": "以下哪种非巴比妥类药物具有最低的蛋白结合率并作用于NMDA受体？", + "A": "丙泊酚", + "B": "氯胺酮", + "C": "依托咪酯", + "D": "硫喷妥钠" + } + }, + { + "id": "956cc563-f8d0-510d-85a2-e68f83bda3e0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not at an increased risk for Malignant Hyperthermia?", + "A": "Patient with Muscular Dystrophy", + "B": "Patient who is immunosuppressed", + "C": "Patient who had a heat stroke last year while playing outdoors", + "D": "Patients whose mother has MH." + }, + "zh": { + "question": "以下哪项不属于恶性高热的高风险因素？", + "A": "患有肌营养不良的患者", + "B": "免疫抑制的患者", + "C": "去年在户外活动时中暑的患者", + "D": "母亲有恶性高热病史的患者" + } + }, + { + "id": "d83f4f04-7112-52b1-aabf-3aff1610c7d4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the incidence of Malignant hyperthermia in adults?", + "A": "1: 50,000", + "B": "1: 100,000", + "C": "1: 15,000", + "D": "1: 250,000" + }, + "zh": { + "question": "成人恶性高热的发生率是多少？", + "A": "1: 50,000", + "B": "1: 100,000", + "C": "1: 15,000", + "D": "1: 250,000" + } + }, + { + "id": "c5a32c89-8287-5255-acc4-b9d1dc923564", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "How much atropine would you give to a patient receiving 40mg Edrophoinium?", + "A": "0.28 mg", + "B": "0.56 mg", + "C": "0.8 mg", + "D": "4 mg" + }, + "zh": { + "question": "对于接受40mg依酚氯铵的患者，你会给予多少阿托品？", + "A": "0.28 mg", + "B": "0.56 mg", + "C": "0.8 mg", + "D": "4 mg" + } + }, + { + "id": "c9ee1620-6173-5c11-a23d-46d8bafac821", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "What is an appropriate induction dose of propofol for a 50 yr old male who is 5’10” and weighs 80 kg?", + "A": "80 mg", + "B": "160 mg", + "C": "16 mg", + "D": "400 mg" + }, + "zh": { + "question": "对于一名50岁、身高5英尺10英寸、体重80公斤的男性，适当的丙泊酚诱导剂量是多少？", + "A": "80 毫克", + "B": "160 毫克", + "C": "16 毫克", + "D": "400 毫克" + } + }, + { + "id": "92036d0d-450c-5217-8888-c187dcd43b69", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How do we prevent the muscarinic effects of cholinesterase inhibitors?", + "A": "By delivering small doses calculated on patient weight", + "B": "By pre-medication with an opioid", + "C": "Through inactivation of acetylcholinesterase", + "D": "By concurrently administering an anticholinergic drug" + }, + "zh": { + "question": "我们如何预防胆碱酯酶抑制剂的毒蕈碱效应？", + "A": "通过根据患者体重计算的小剂量给药", + "B": "通过使用阿片类药物进行术前用药", + "C": "通过失活乙酰胆碱酯酶", + "D": "通过同时给予抗胆碱药" + } + }, + { + "id": "1268fc00-0a07-5dd6-8b83-54e47164ac8f", + "choice_num": 2, + "answer": "B", + "level": 2, + "en": { + "question": "Regaining 4/4 twitches after administration of a non-depolarizing muscle relaxant means that you no longer need to administer a reversal agent.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "在使用非去极化肌松药后恢复4/4次抽搐意味着您不再需要使用拮抗剂。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "cafaf1b2-4da2-5584-9095-dbfce49810b0", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "When caring for children you should ALWAYS give the anticholinergic and the cholinesterase inhibitor together  in one syringe.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "在护理儿童时，您应该始终将抗胆碱药和胆碱酯酶抑制剂一起放在一个注射器中。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "18847cbd-93de-5ec8-a131-46a33bb3362f", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "What would be an appropriate starting dose of dantrolene to give to a 2 yr old child weighing 14 kg?", + "A": "14 mg", + "B": "140 mg", + "C": "35 mg", + "D": "280 mg" + }, + "zh": { + "question": "对于一名体重14公斤的2岁儿童，适合的丹曲林起始剂量是多少？", + "A": "14毫克", + "B": "140毫克", + "C": "35毫克", + "D": "280毫克" + } + }, + { + "id": "edc0ab7f-94ff-5b29-91f9-9a8c04d4260c", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "You have a patient in the PACU who has been receiving morphine and is now itching from the pain medications. What might you give to help relieve the itching?", + "A": "Ketamine 0.2 mg/kg", + "B": "Propofol 10 mg", + "C": "Etomidate 0.1 mg/kg", + "D": "Propofol 50 mg" + }, + "zh": { + "question": "你有一位在术后恢复室的病人，他一直在使用吗啡，现在因止痛药而感到瘙痒。你可能会给什么来帮助缓解瘙痒？", + "A": "氯胺酮 0.2 mg/kg", + "B": "丙泊酚 10 mg", + "C": "依托咪酯 0.1 mg/kg", + "D": "丙泊酚 50 mg" + } + }, + { + "id": "3c81ff92-3355-53f6-b206-72b609a79c84", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "What is an appropriate intubating dose of Rocuronium?", + "A": "1-1.5 mg/kg", + "B": ".08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + }, + "zh": { + "question": "罗库溴铵的适当插管剂量是多少？", + "A": "1-1.5 mg/kg", + "B": "0.08-0.1 mg/kg", + "C": "0.6-1.2 mg/kg", + "D": "0.15-0.2 mg/kg", + "E": "0.4-0.5 mg/kg" + } + }, + { + "id": "13a99971-4bd2-50f4-96ff-5a8640694b04", + "choice_num": 3, + "answer": "A", + "level": 2, + "en": { + "question": "Propofol is metabolized extensively in the liver, as well as in the lungs and other sites. How will hepatic disease affect the half life of Propofol?", + "A": "Effects can be prolonged", + "B": "Decrease the half life", + "C": "Contraindicated in liver disease" + }, + "zh": { + "question": "丙泊酚在肝脏、肺部及其他部位广泛代谢。肝病将如何影响丙泊酚的半衰期？", + "A": "作用可能延长", + "B": "减少半衰期", + "C": "肝病患者禁用" + } + }, + { + "id": "f0ed30a0-b7b6-59b4-b975-e8b861df8f39", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the purpose of giving lidocaine prior to administration of propofol?", + "A": "To make the propofol slightly more acidic", + "B": "To prevent allergic reaction to egg lecithin", + "C": "To prevent burning upon injection", + "D": "To decrease ability of bacteria to grow in propofol" + }, + "zh": { + "question": "在给予丙泊酚之前使用利多卡因的目的是什么？", + "A": "使丙泊酚略微更酸性", + "B": "防止对卵磷脂的过敏反应", + "C": "防止注射时的烧灼感", + "D": "减少细菌在丙泊酚中生长的能力" + } + }, + { + "id": "7dd2c400-b856-57dd-9a83-5103c99fe427", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is an appropriate dose of propofol sedation during a MAC case?", + "A": "25-100 mcg/kg/min", + "B": "1.5-2.5 mg/kg", + "C": "100-300 mcg/kg/min", + "D": "3-5 mg/kg" + }, + "zh": { + "question": "在MAC手术中，适当的丙泊酚镇静剂量是多少？", + "A": "25-100 mcg/kg/min", + "B": "1.5-2.5 mg/kg", + "C": "100-300 mcg/kg/min", + "D": "3-5 mg/kg" + } + }, + { + "id": "ab770253-7ccb-5a6b-8bee-1bfc12a39611", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the mechanism of action of the cholinesterase inhibitors?", + "A": "Attenuate the peripheral muscarinic effects of NMBA's.", + "B": "Inhibition of the hydrolysis of acetylcholine resulting in greater availability at its sites of action", + "C": "Through binding to and activating alpha subunit receptors to cause sustained depolarization.", + "D": "Selective inhibition of GABA" + }, + "zh": { + "question": "胆碱酯酶抑制剂的作用机制是什么？", + "A": "减弱NMBA的外周毒蕈碱效应。", + "B": "抑制乙酰胆碱的水解，从而在其作用位点增加可用性。", + "C": "通过结合并激活α亚基受体引起持续去极化。", + "D": "选择性抑制GABA。" + } + }, + { + "id": "d96c6b91-08c3-5a61-a465-5c2a01707a24", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following muscle relaxants allows you to skip use of a reversal agent?", + "A": "Mivacurium", + "B": "Vecuronium", + "C": "Pancuronium", + "D": "Rocuronium" + }, + "zh": { + "question": "以下哪种肌肉松弛剂可以不使用拮抗剂？", + "A": "米库氯铵", + "B": "维库溴铵", + "C": "潘库溴铵", + "D": "罗库溴铵" + } + }, + { + "id": "11f72922-24d4-56e6-81cb-4e71085ddef3", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "When can your reversal agents be administered?", + "A": "When you have 0/4 twitches", + "B": "When you have at least 1 /4 twitches", + "C": "You must have 4/4 twitches prior to administration", + "D": "After your anesthetic agent has been turned off." + }, + "zh": { + "question": "何时可以给予拮抗剂？", + "A": "当你有0/4次抽搐时", + "B": "当你至少有1/4次抽搐时", + "C": "在给药前必须有4/4次抽搐", + "D": "在麻醉剂关闭后" + } + }, + { + "id": "fbc50605-97e6-544e-9e95-bb0275117aff", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which opioid receptor causes dysphoria, miosis, diuresis & sedation?", + "A": "Mu1", + "B": "Mu2", + "C": "Kappa", + "D": "Delta" + }, + "zh": { + "question": "哪种阿片受体会导致烦躁不安、瞳孔缩小、利尿和镇静？", + "A": "Mu1", + "B": "Mu2", + "C": "Kappa", + "D": "Delta" + } + }, + { + "id": "fc770dd3-3374-57f6-8386-a95eb0dd3487", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "You are caring for Mr. X who is currently having a Left BKA. You notice his HR increasing and take a quick glance at his pupils to see they are normal size. His train of four is currently 0/4. What does this tell you?", + "A": "He is too light, Increase the sevo.", + "B": "Maybe he could use some more opioids, to relieve pain.", + "C": "Maybe he could use some more paralytic.", + "D": "He needs a little more midazolam, to calm him." + }, + "zh": { + "question": "您正在照顾正在进行左侧小腿截肢术的X先生。您注意到他的心率增加，并快速查看他的瞳孔，发现它们大小正常。他的四个刺激反应目前是0/4。这告诉您什么？", + "A": "他太轻了，增加七氟醚。", + "B": "也许他需要更多的阿片类药物来缓解疼痛。", + "C": "也许他需要更多的肌松药。", + "D": "他需要多一点咪达唑仑来使他平静。" + } + }, + { + "id": "cc956756-d615-50b1-baf9-5bcd745c1821", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the onset of action for Morphine?", + "A": "2 hours", + "B": "30-60 seconds", + "C": "15-30 minutes", + "D": "5-10 minutes" + }, + "zh": { + "question": "吗啡的起效时间是多久？", + "A": "2小时", + "B": "30-60秒", + "C": "15-30分钟", + "D": "5-10分钟" + } + }, + { + "id": "550a41ef-c4ec-5982-ba46-d99717a70c23", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following effects is NOT associated with morphine.", + "A": "Facial Redness", + "B": "Stop Shivering", + "C": "Hypotension", + "D": "All of the above" + }, + "zh": { + "question": "以下哪种效果与吗啡无关。", + "A": "面部潮红", + "B": "停止发抖", + "C": "低血压", + "D": "以上皆是" + } + }, + { + "id": "96d1fbf1-1ce3-5831-ab9b-d3ebbf451d73", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the opioids will NOT cause miosis?", + "A": "Morphine", + "B": "Fentanyl", + "C": "Meperidine", + "D": "Narcan" + }, + "zh": { + "question": "哪种阿片类药物不会引起瞳孔缩小？", + "A": "吗啡", + "B": "芬太尼", + "C": "哌替啶", + "D": "纳洛酮" + } + }, + { + "id": "b39f27f1-7405-5227-bf8c-a5cd5e405003", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which opioid has the highest degree of lipid solubility?", + "A": "Sufentanil", + "B": "Remifentanil", + "C": "Fentanyl", + "D": "Morphine" + }, + "zh": { + "question": "哪种阿片类药物具有最高的脂溶性？", + "A": "舒芬太尼", + "B": "瑞芬太尼", + "C": "芬太尼", + "D": "吗啡" + } + }, + { + "id": "568deac3-febe-5b30-a319-a83117511fcd", + "choice_num": 4, + "answer": "D", + "level": 3, + "en": { + "question": "You are caring for Mrs. Tica who has a past history of A-fib, DM, pancreatitis & asthma. Which drug would you choose to relieve her pain?", + "A": "Toradol", + "B": "Morphine", + "C": "Ethanol", + "D": "Fentanyl" + }, + "zh": { + "question": "您正在照顾有房颤、糖尿病、胰腺炎和哮喘病史的Tica女士。您会选择哪种药物来缓解她的疼痛？", + "A": "托拉多尔", + "B": "吗啡", + "C": "乙醇", + "D": "芬太尼" + } + }, + { + "id": "7c8ad3dd-3f5c-5741-998f-30d78eed62b9", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Why is remifentanil unique among the opioids?", + "A": "Can be safely given to asthmatics and those on MAOI's", + "B": "Does not cause miosis", + "C": "Context sensitive half time independent of infusion time.", + "D": "Most rapid onset with large Vd." + }, + "zh": { + "question": "为什么瑞芬太尼在阿片类药物中是独特的？", + "A": "可以安全地给哮喘患者和服用单胺氧化酶抑制剂的人使用", + "B": "不会引起瞳孔缩小", + "C": "上下文敏感半衰期与输注时间无关。", + "D": "起效最快，分布容积大。" + } + }, + { + "id": "1d6b1166-5636-5e26-bee4-4b2eee990063", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Fentanyl has a much more rapid onset but a longer elimination half time than Morphine. Why?", + "A": "Because of fentanyl high lipid solubility", + "B": "Because fentanyl is highly protein bound", + "C": "Because Morphine has a much high lipid solubility and thus is excreted more rapidly", + "D": "Because morphine has a much larger Vd." + }, + "zh": { + "question": "芬太尼的起效更快，但消除半衰期比吗啡长。为什么？", + "A": "因为芬太尼的高脂溶性", + "B": "因为芬太尼高度蛋白结合", + "C": "因为吗啡具有更高的脂溶性，因此排泄更快", + "D": "因为吗啡具有更大的分布容积" + } + }, + { + "id": "59b3690b-7c69-5c64-a46b-52c55f029abb", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which medication would you give to reliev post-op itching caused by Morphine?", + "A": "Narcan 1-4 mcg/kg IV", + "B": "Flumazenil, titrate by doses of 0.2 mg", + "C": "Nubain 10-20 mg IV", + "D": "Meperidine" + }, + "zh": { + "question": "您会给予哪种药物来缓解由吗啡引起的术后瘙痒？", + "A": "纳洛酮 1-4 mcg/kg 静脉注射", + "B": "氟马西尼，按 0.2 mg 剂量滴定", + "C": "纳布啡 10-20 mg 静脉注射", + "D": "哌替啶" + } + }, + { + "id": "9114db64-e294-5b5b-9abf-12cb74148b90", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following benzodiazepines is most commonly used during the preoperative period and for IV conscious sedation?", + "A": "Diazepam", + "B": "Lorazepam", + "C": "Midazolam", + "D": "Alprazolam" + }, + "zh": { + "question": "以下哪种苯二氮䓬类药物最常用于术前期和静脉镇静？", + "A": "地西泮", + "B": "劳拉西泮", + "C": "咪达唑仑", + "D": "阿普唑仑" + } + }, + { + "id": "3821c09a-0648-5ebe-a01b-362ecfb1c82c", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which adverse reaction is a patient most likely to experience after receiving general anesthesia?", + "A": "Nauseau & Vomiting", + "B": "Seizures", + "C": "Cyanosis", + "D": "Increased HR" + }, + "zh": { + "question": "患者在接受全身麻醉后最有可能出现哪种不良反应？", + "A": "恶心和呕吐", + "B": "癫痫发作", + "C": "发绀", + "D": "心率增加" + } + }, + { + "id": "6d87489e-0f64-57fb-889e-42f24df8ad8a", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is responsible for the pain reaction elicited when diazepam is given IM?", + "A": "Any IM injection is painful", + "B": "Ethyl alcohol component", + "C": "Propylene glycol component", + "D": "Solubility component" + }, + "zh": { + "question": "当地西泮以肌肉注射方式给药时，是什么引起了疼痛反应？", + "A": "任何肌肉注射都会疼痛", + "B": "乙醇成分", + "C": "丙二醇成分", + "D": "溶解性成分" + } + }, + { + "id": "8473d9d5-042f-5114-a363-18c3254e80f7", + "choice_num": 5, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is not one of the Five Principle pharmacological effects of Benzodiazepines?", + "A": "Sedation", + "B": "Anxiolysis", + "C": "Retrograde Amnesia", + "D": "Anticonvulsant", + "E": "Spinal Cord mediated skeletal muscle relaxation" + }, + "zh": { + "question": "以下哪一项不是苯二氮卓类药物的五大药理作用之一？", + "A": "镇静", + "B": "抗焦虑", + "C": "逆行性遗忘", + "D": "抗惊厥", + "E": "脊髓介导的骨骼肌松弛" + } + }, + { + "id": "773f100d-92cf-5148-9d9f-7db08f66a71f", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "While doing a pre-op assessment on an inpatient you find that the pt is currently taking Tagamet (cimetidine) and is on a Heparin regimen. With this knowledge you know to avoid which of the benzodiazepines?", + "A": "Lorazepam", + "B": "Diazepam", + "C": "Midazolam", + "D": "Thiopental" + }, + "zh": { + "question": "在对住院病人进行术前评估时，你发现病人目前正在服用Tagamet（西咪替丁）并正在接受肝素治疗。基于此信息，你知道应该避免使用哪种苯二氮䓬类药物？", + "A": "劳拉西泮", + "B": "地西泮", + "C": "咪达唑仑", + "D": "硫喷妥钠" + } + }, + { + "id": "5015fb3b-f571-5df3-982f-815c8ca71784", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "In regards to the adjustments of Benzodiazepines in respect to the elderly patient.  Would you expect to have:", + "A": "Significant increase in initial dose and anticipate marked decrease in duration of action", + "B": "Modest decrease in initial dose and anticipate marked increase in duration of action", + "C": "No change in dose or frequency or duration from that of an healthy 25 year old patient.", + "D": "None of above" + }, + "zh": { + "question": "关于苯二氮卓类药物在老年患者中的调整，您会预期：", + "A": "初始剂量显著增加，并预期作用持续时间显著减少", + "B": "初始剂量略微减少，并预期作用持续时间显著增加", + "C": "剂量、频率或持续时间与健康的25岁患者无变化。", + "D": "以上都不是" + } + }, + { + "id": "e8bca84d-bb57-50b0-a895-8a47ad7ca930", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "The dose of Benzodiazepines required to reach a desired clinical end point is increased in the elderly compared to the younger patient.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "与年轻患者相比，老年患者达到预期临床终点所需的苯二氮卓类药物剂量增加。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "91f7b8e1-a099-5779-8339-fb4db0dc90cf", + "choice_num": 3, + "answer": "B", + "level": 2, + "en": { + "question": "Benzodiazepines are extensively protein bound.  Therefore, in the presence of renal failure their clinical effect will be:", + "A": "Shortened", + "B": "Prolonged", + "C": "No significant change." + }, + "zh": { + "question": "苯二氮䓬类药物广泛结合蛋白质。因此，在肾功能衰竭的情况下，其临床效果将是：", + "A": "缩短", + "B": "延长", + "C": "无显著变化。" + } + }, + { + "id": "9aa91ec0-5546-5e47-be41-0d2f736c5e85", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A drug that alters the physiology of a cell by binding to the plasma membrane or intracellular receptors is known as what?", + "A": "Antagonist", + "B": "Competitive Agonist", + "C": "Competitive Antagonist", + "D": "Agonist" + }, + "zh": { + "question": "通过与质膜或细胞内受体结合来改变细胞生理的药物被称为什么？", + "A": "拮抗剂", + "B": "竞争性激动剂", + "C": "竞争性拮抗剂", + "D": "激动剂" + } + }, + { + "id": "7f87ba2e-3a41-54ec-9e52-2d128a069d85", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is an antagonist?", + "A": "Inhibit or block responses caused by an agonist", + "B": "A drug which alters the physiology of a cell by binding to plasma membrane or intracellular receptors", + "C": "Biochemical messengers, often called 2ndmessengers", + "D": "The strength of binding between drug and receptor" + }, + "zh": { + "question": "什么是拮抗剂？", + "A": "抑制或阻断由激动剂引起的反应", + "B": "通过与质膜或细胞内受体结合来改变细胞生理的药物", + "C": "生化信使，通常称为第二信使", + "D": "药物与受体之间结合的强度" + } + }, + { + "id": "0ab33f4d-bf06-540e-9910-58879406e5e7", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the MOA of Benzos?", + "A": "Blockade of chloride channels leading to depolarization and inhibition of neurotransmitter", + "B": "Inhibition of cyclooxygenase activity", + "C": "Inhibition of GABA receptor binding which leads to degredation of GABA, preventing it from exerting it's effect.", + "D": "Enhances the inhibitory effects of various neurotransmitter by facilitating GABA receptor binding. This opens chloride channels and causes hyperpolarization." + }, + "zh": { + "question": "苯二氮卓类药物的作用机制是什么？", + "A": "阻断氯离子通道导致去极化和神经递质的抑制", + "B": "抑制环氧合酶活性", + "C": "抑制GABA受体结合，导致GABA降解，阻止其发挥作用。", + "D": "通过促进GABA受体结合增强各种神经递质的抑制作用。这会打开氯离子通道并导致超极化。" + } + }, + { + "id": "357a17e4-443e-5b3a-b277-41b6ef9b1d55", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "All benzos share what similarities?", + "A": "All are highly alkaline solutions", + "B": "Composed of a benzene ring fused to a seven-membered diazepine ring", + "C": "They are safe to be given during pregnancy", + "D": "Composed of malonic acid and urea" + }, + "zh": { + "question": "所有苯二氮卓类药物有什么相似之处？", + "A": "都是高度碱性溶液", + "B": "由苯环与七元二氮杂环融合而成", + "C": "在怀孕期间使用是安全的", + "D": "由丙二酸和尿素组成" + } + }, + { + "id": "89f05e21-88ce-59e5-afe9-e42a81706922", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How is midazolam unique in comparison to other benzos?", + "A": "It is the only benzo safe to give to pregnant women.", + "B": "Is known to cause pain upon injection, but has minimal respiratory depression", + "C": "It is hydrophilic and becomes lipid soluble upon exposure to blood.", + "D": "It is not highly protein bound like the other benzo's and thus more is available for use by the body." + }, + "zh": { + "question": "与其他苯二氮卓类药物相比，咪达唑仑有何独特之处？", + "A": "它是唯一一种可以安全用于孕妇的苯二氮卓类药物。", + "B": "已知会引起注射时疼痛，但呼吸抑制作用最小。", + "C": "它是亲水性的，暴露于血液后变为脂溶性。", + "D": "它不像其他苯二氮卓类药物那样高度蛋白结合，因此更多可供身体使用。" + } + }, + { + "id": "36d134d4-cf0b-5371-83b9-6af036a8e57e", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following drugs will cause pain upon injection due to the solvent propylene glycol?", + "A": "Lorazepam", + "B": "Flumazenil", + "C": "Midazolam", + "D": "Diazepam" + }, + "zh": { + "question": "以下哪种药物由于溶剂丙二醇会在注射时引起疼痛？", + "A": "劳拉西泮", + "B": "氟马西尼", + "C": "咪达唑仑", + "D": "地西泮" + } + }, + { + "id": "8d12d7c2-228d-55b2-9010-23fd96675870", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What would be an appropirate Adult IV induction dose for midazolam?", + "A": "0.5 mg/kg", + "B": "0.1 mg/kg", + "C": "2-3 mg", + "D": "4 mg/kg" + }, + "zh": { + "question": "咪达唑仑适合的成人静脉诱导剂量是多少？", + "A": "0.5 mg/kg", + "B": "0.1 mg/kg", + "C": "2-3 mg", + "D": "4 mg/kg" + } + }, + { + "id": "c585f8b9-5484-5762-a307-1f20f611ab8b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is the elimination half time of Midazolam?", + "A": "21-37 hours", + "B": "1-4 hours", + "C": "10-20 hours", + "D": "5-10 hours" + }, + "zh": { + "question": "咪达唑仑的消除半衰期是多少？", + "A": "21-37 小时", + "B": "1-4 小时", + "C": "10-20 小时", + "D": "5-10 小时" + } + }, + { + "id": "747468b2-6765-577d-be37-dc14ca79a624", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the elimination half time of Diazepam?", + "A": "5-10 hours", + "B": "1-4 hours", + "C": "10-20 hours", + "D": "21-37 hours" + }, + "zh": { + "question": "地西泮的消除半衰期是多少？", + "A": "5-10小时", + "B": "1-4小时", + "C": "10-20小时", + "D": "21-37小时" + } + }, + { + "id": "76b8c0e9-d2e3-5a1d-b896-638d60ae3a56", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Describe the metabolism and excretion of the benzodiazepines?", + "A": "Metabolized by liver and excreted in the urine", + "B": "Metabolized in kidneys and excreted in feces", + "C": "Metabolized by liver and excreted in feces", + "D": "Metabolized in kidneys and excreted by urine" + }, + "zh": { + "question": "描述苯二氮䓬类药物的代谢和排泄方式？", + "A": "在肝脏代谢并通过尿液排泄", + "B": "在肾脏代谢并通过粪便排泄", + "C": "在肝脏代谢并通过粪便排泄", + "D": "在肾脏代谢并通过尿液排泄" + } + }, + { + "id": "a8198545-da9e-51f8-a90e-429be2f0d846", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What effects do benzodiazepines exert upon the cardiovascular system?", + "A": "No effect on cardiovascular system, even at high doses.", + "B": "Decrease BP & PVR, especially in hypovolemic pt", + "C": "Decrease ABP, CO & HR", + "D": "Increase HR and decrease SV" + }, + "zh": { + "question": "苯二氮䓬类药物对心血管系统有什么影响？", + "A": "即使在高剂量下，对心血管系统无影响。", + "B": "降低血压和外周血管阻力，尤其是在低血容量患者中。", + "C": "降低动脉血压、心输出量和心率。", + "D": "增加心率并降低每搏输出量。" + } + }, + { + "id": "d65ff90d-1ca6-5c2a-be33-f9c845008248", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is not a cerebral effect of benzodiazepines?", + "A": "Reduce CMRO2 & CBF", + "B": "Increase the seizure threshold to prevent seizure", + "C": "Anti-anxiety & sedative effects", + "D": "Direct Analgesic Effects" + }, + "zh": { + "question": "下列哪项不是苯二氮卓类药物的脑部效应？", + "A": "降低CMRO2和CBF", + "B": "提高癫痫阈值以防止癫痫发作", + "C": "抗焦虑和镇静作用", + "D": "直接镇痛作用" + } + }, + { + "id": "25f2f4cf-b955-5b02-84e8-6e21554c9be3", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Where would you find benzodiazepine receptors?", + "A": "Primarily on the postsynaptic nerve endings in the cerebral cortex", + "B": "Pre-synaptic nerve endings in the brain stem and spinal cord.", + "C": "Brain, spinal cord and peripheral tissue: pre-synaptic and post synaptic." + }, + "zh": { + "question": "苯二氮䓬受体主要存在于哪里？", + "A": "主要在大脑皮层的突触后神经末梢", + "B": "脑干和脊髓的突触前神经末梢。", + "C": "大脑、脊髓和外周组织：突触前和突触后。" + } + }, + { + "id": "f64badad-21d4-5c13-8d5f-64485ab52f7c", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What is a non-competitive antagonist?", + "A": "A drug which alters the physiology of a cell by binding to plasma membrane or intracellular receptors", + "B": "Binds to a site other than the agonist-binding domain", + "C": "A drug which really hates playing sports, and instead takes a bunch of art classes.", + "D": "A drug which inhibits a normal cellular function by competing with agonists for receptors" + }, + "zh": { + "question": "什么是非竞争性拮抗剂？", + "A": "通过与质膜或细胞内受体结合来改变细胞生理的药物", + "B": "结合到激动剂结合域以外的位点", + "C": "一个非常讨厌运动而选择上很多艺术课的药物。", + "D": "通过与激动剂竞争受体来抑制正常细胞功能的药物" + } + }, + { + "id": "e8a0dd46-5175-5d80-8174-f3be61fc1512", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What drug would you choose to treat a pt with a benzodiazepine overdose?", + "A": "Flumazenil, slow titration of 0.2 mg doses IV", + "B": "Narcan, slow titration of 1-4mcg/kg", + "C": "Flurazepam 15-30 mg", + "D": "Just wait it out." + }, + "zh": { + "question": "你会选择哪种药物来治疗苯二氮卓类药物过量的患者？", + "A": "氟马西尼，缓慢滴定0.2 mg剂量静脉注射", + "B": "纳洛酮，缓慢滴定1-4 mcg/kg", + "C": "氟西泮 15-30 mg", + "D": "等待其自然消退。" + } + }, + { + "id": "0c01de2d-2e67-5485-9ebd-dca92118b4d9", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which benzo would be used to treat panic attacks?", + "A": "Lorazepam", + "B": "Alprazolam", + "C": "Flurazepam", + "D": "Diazepam" + }, + "zh": { + "question": "哪种苯二氮卓类药物用于治疗惊恐发作？", + "A": "劳拉西泮", + "B": "阿普唑仑", + "C": "氟西泮", + "D": "地西泮" + } + }, + { + "id": "9cf178f3-0b10-5f0b-a906-1885eb2a307c", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "How much oral midazolam would you give to a child weighing 40 kg?", + "A": "40 mg", + "B": "4 mg", + "C": "20 mg", + "D": "60 mg" + }, + "zh": { + "question": "你会给一个体重40公斤的孩子服用多少口服咪达唑仑？", + "A": "40毫克", + "B": "4毫克", + "C": "20毫克", + "D": "60毫克" + } + }, + { + "id": "0e69aae9-08e5-5bf8-9c2a-ef8f34193ffe", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "You are holding a room temperature bottle of thiopental that was mixed 5 days ago. Can you still use it?", + "A": "Yes, still good!", + "B": "Nope, it is only stable for 2 days", + "C": "If it had been refrigerated it would be good, but now it is not. Don't use." + }, + "zh": { + "question": "你手里拿着一瓶在室温下放置了5天的硫喷妥钠。你还能使用它吗？", + "A": "是的，还可以用！", + "B": "不行，它只能稳定2天", + "C": "如果冷藏过就可以用，但现在不行。不要用。" + } + }, + { + "id": "d2ed33c8-8b86-5998-9fb3-fabbe409b76a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "A Barbituate with a sulfur atom on the #2 carbon is called a...", + "A": "Thiobarbituates", + "B": "Oxybarbituates", + "C": "Pentabarbituate", + "D": "Sulbarbituates" + }, + "zh": { + "question": "在第2号碳上有一个硫原子的巴比妥酸盐被称为...", + "A": "硫代巴比妥酸盐", + "B": "氧代巴比妥酸盐", + "C": "戊巴比妥酸盐", + "D": "硫巴比妥酸盐" + } + }, + { + "id": "296a5893-d98e-58c3-83ed-bdca13329b49", + "choice_num": 3, + "answer": "B", + "level": 1, + "en": { + "question": "What is the MOA of barbituates?", + "A": "Act at stereospecific receptors at presynaptic and postsynaptic sites in the central nervous system– brain(periaqueductal gray, amygdala, corpus striam, and hypothalmus) and spinal cord(substanstantia geltinosa) and in the peripheral tissues.", + "B": "Depression of the reticulcar activating system, suppression of excitatory neurotranmitters and enhancement of inhibitory neurotransmitters.", + "C": "Receptor binding enhances the inhibitory effects of various neurotransmitter by facilitating GABA receptor binding. This opens chloride gating channels, producing hyperpolarization of post synaptic cell membranes and rendering post synaptic neurons more resistant to excitation." + }, + "zh": { + "question": "巴比妥类药物的作用机制是什么？", + "A": "在中枢神经系统（脑的导水管周围灰质、杏仁核、纹状体和下丘脑）和脊髓（���状质）以及外周组织的突触前和突触后部位的立体特异性受体上起作用。", + "B": "抑制网状激活系统，抑制兴奋性神经递质并增强抑制性神经递质。", + "C": "受体结合通过促进GABA受体结合增强各种神经递质的抑制效应。这打开氯离子通道，使突触后细胞膜超极化，使突触后神经元更难被激发。" + } + }, + { + "id": "ef347e06-8405-5d91-86a6-d02a77c7c235", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Duration of action of highly lipid soluble barbituates is determined by...", + "A": "Hepatic Oxidation", + "B": "Lipid Solubility", + "C": "Renal Excretion", + "D": "Redistribution" + }, + "zh": { + "question": "高脂溶性巴比妥类药物的作用持续时间取决于...", + "A": "肝脏氧化", + "B": "脂溶性", + "C": "肾脏排泄", + "D": "重新分布" + } + }, + { + "id": "ff127121-6c5f-5f20-88cf-470aed6df2d0", + "choice_num": 2, + "answer": "A", + "level": 1, + "en": { + "question": "The elimination half time of Methohexital is ~4 hours.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "Methohexital 的消除半衰期约为 4 小时。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "55eaaf89-b6e2-53c4-a345-a270ebfa034d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is responsible for the quick awakening associated with a single dose of thiopental?", + "A": "Rapid hepatic oxidation", + "B": "Rapid renal excretion", + "C": "Redistribution", + "D": "Patient respiratory rate" + }, + "zh": { + "question": "是什么导致与单剂量硫喷妥钠相关的快速苏醒？", + "A": "快速肝脏氧化", + "B": "快速肾脏排泄", + "C": "重新分布", + "D": "患者呼吸频率" + } + }, + { + "id": "b4abb820-f0d8-597b-b326-750b651f8daf", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Unlike the benzo's, Barbituates are known to increase CBF and ICP.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "与苯二氮卓类药物不同，巴比妥类药物已知会增加脑血流量（CBF）和颅内压（ICP）。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "92280ffb-4481-5ee8-b9c3-f40075ae4ffa", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How much methohexital should be given to a pt undergoing ECT?", + "A": "0.5 mg/kg IV", + "B": "20 mg/kg via rectal suppository", + "C": "5 mg/kg PO", + "D": "> 1mg/kg IV" + }, + "zh": { + "question": "接受电休克治疗的患者应给予多少甲己酯？", + "A": "0.5 mg/kg 静脉注射", + "B": "20 mg/kg 直肠栓剂", + "C": "5 mg/kg 口服", + "D": "> 1mg/kg 静脉注射" + } + }, + { + "id": "3a5922c2-09c3-5e77-9979-1da83eb3d319", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "What is the MOA of opioids?", + "A": "Act at stereospecific receptors at presynaptic and postsynaptic sites in the central nervous system. mimic the endogenous endorphines to inhibit pain transmission.", + "B": "Receptor binding enhances the inhibitory effects of various neurotransmitter by facilitating GABA receptor binding.", + "C": "Depression of the reticulcar activating system, suppression of excitatory neurotranmitters and enhancement of inhibitory neurotransmitters." + }, + "zh": { + "question": "阿片类药物的作用机制是什么？", + "A": "在中枢神经系统的突触前和突触后部位的立体特异性受体上起作用。模仿内源性内啡肽以抑制疼痛传递。", + "B": "受体结合通过促进GABA受体结合来增强各种神经递质的抑制作用。", + "C": "抑制网状激活系统，抑制兴奋性神经递质并增强抑制性神经递质。" + } + }, + { + "id": "ba4422c4-0ff2-5ea3-a1f6-15bbf8aa78b4", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is NOT an endogenous peptide?", + "A": "Endorphin", + "B": "Ekephalin", + "C": "Dynorphine", + "D": "Epinorphin" + }, + "zh": { + "question": "以下哪一项不是内源性肽？", + "A": "内啡肽", + "B": "脑啡肽", + "C": "强啡肽", + "D": "肾上腺啡肽" + } + }, + { + "id": "b91cb59b-88e0-5535-be68-de7648bd5688", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which opioid receptor produces ONLY spinal analgesia.", + "A": "Mu2", + "B": "Kappa", + "C": "Mu1", + "D": "Delta" + }, + "zh": { + "question": "哪种阿片受体仅产生脊髓镇痛。", + "A": "Mu2", + "B": "Kappa", + "C": "Mu1", + "D": "Delta" + } + }, + { + "id": "32c39b6d-3c89-5e96-a0bb-40918ad2950c", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What are the metabolites of morphine?", + "A": "Morphine 3-gluconiride which is active and induces analgesia and resp depression, & Mophine 6-gluconiride which is inactive", + "B": "Morphine 3-gluconiride & Mophine 6-gluconiride both of which are inactive.", + "C": "Morphine 3-gluconiride which is inactive, & Mophine 6-gluconiride which is active and induces analgesia and resp depression", + "D": "Morphine 3-gluconiride & Mophine 6-gluconiride both of which are active and cause respiratory depression and analgesia" + }, + "zh": { + "question": "吗啡的代谢产物是什么？", + "A": "吗啡-3-葡萄糖苷酸是活性的，诱导镇痛和呼吸抑制，吗啡-6-葡萄糖苷酸是非活性的", + "B": "吗啡-3-葡萄糖苷酸和吗啡-6-葡萄糖苷酸都是非活性的。", + "C": "吗啡-3-葡萄糖苷酸是非活性的，吗啡-6-葡萄糖苷酸是活性的，诱导镇痛和呼吸抑制", + "D": "吗啡-3-葡萄糖苷酸和吗啡-6-葡萄糖苷酸都是活性的，导致呼吸抑制和镇痛" + } + }, + { + "id": "a50c7caa-fbd5-5481-86df-0b215296523b", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "30mg of Ketorolac would be equivalent to how much morphine?", + "A": "1 mg", + "B": "30 mg", + "C": "15 mg", + "D": "10 mg" + }, + "zh": { + "question": "30毫克酮咯酸氨丁三醇相当于多少吗啡？", + "A": "1 毫克", + "B": "30 毫克", + "C": "15 毫克", + "D": "10 毫克" + } + }, + { + "id": "ba9d9317-179e-5beb-8395-c067ce4bad12", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Put these medications in order of shortest elimination half time to longest: Midazolam, Diazepam, Lorazepam", + "A": "Midazolam < Diazepam < Lorazepam", + "B": "Diazepam < Lorazepam < Midazolam", + "C": "Lorazepam < Midazolam < Diazepam", + "D": "Midazolam < Lorazepam < Diazepam" + }, + "zh": { + "question": "将这些药物按消除半衰期从短到长的顺序排列：咪达唑仑，地西泮，劳拉西泮", + "A": "咪达唑仑 < 地西泮 < 劳拉西泮", + "B": "地西泮 < 劳拉西泮 < 咪达唑仑", + "C": "劳拉西泮 < 咪达唑仑 < 地西泮", + "D": "咪达唑仑 < 劳拉西泮 < 地西泮" + } + }, + { + "id": "eea2956f-9c9a-5188-8527-244527257dcb", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which opioid receptors are responsible for physical dependence?", + "A": "Mu1 & Mu2", + "B": "Mu2 & Delta", + "C": "Mu1 & Kappa", + "D": "Kappa & Delta" + }, + "zh": { + "question": "哪些阿片受体负责身体依赖？", + "A": "Mu1 和 Mu2", + "B": "Mu2 和 Delta", + "C": "Mu1 和 Kappa", + "D": "Kappa 和 Delta" + } + }, + { + "id": "d942e7f5-2491-5395-ab9d-8cc420622540", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the respiratory pattern associated with barbituates upon awakening?", + "A": "Decrease Tv and Increase RR", + "B": "Increase Tv and RR", + "C": "Increase Tv and decrease RR", + "D": "Decrease Tv and RR" + }, + "zh": { + "question": "巴比妥类药物苏醒时的呼吸模式是什么？", + "A": "潮气量减少，呼吸频率增加", + "B": "潮气量和呼吸频率增加", + "C": "潮气量增加，呼吸频率减少", + "D": "潮气量和呼吸频率减少" + } + }, + { + "id": "ab0b5120-5aa1-5c3e-9dd4-8718b2a4b255", + "choice_num": 3, + "answer": "C", + "level": 2, + "en": { + "question": "When doing a pre-op evaluation for a pt you notice the pt has low albumin levels. How would this effect the amount of Midazolam given to the pt for pre-medication?", + "A": "You would need to increase the amount given in order to reach the desired effect", + "B": "You would not change the dose at all.", + "C": "You would decrease the amount of drug given since this pt may be at risk for overdose." + }, + "zh": { + "question": "在进行术前评估时，你注意到患者的白蛋白水平较低。这将如何影响给予患者咪达唑仑作为术前用药的剂量？", + "A": "你需要增加给药量以达到预期效果。", + "B": "你不会改变剂量。", + "C": "你会减少给药量，因为该患者可能有过量的风险。" + } + }, + { + "id": "d312e61a-01ce-553b-aaaa-c52203bde507", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is GABA?", + "A": "The major excitatory neurotransmitter and is important in agonizing the effects of amino acid transmitter.", + "B": "Proteins or glycoproteins that are present on the cell surface, on an organelle within the cell, or in the cytoplasm.", + "C": "The major inhibitory neurotransmitter and is important in antagonizing the effects of amino acid transmitter.", + "D": "Refers to the portion of the chemical structured composed of a benzene ring fused to a seven-membered diazepine ring" + }, + "zh": { + "question": "什么是GABA？", + "A": "主要的兴奋性神经递质，对氨基酸递质的作用有重要的激动作用。", + "B": "存在于细胞表面、细胞内的细胞器或细胞质中的蛋白质或糖蛋白。", + "C": "主要的抑制性神经递质，对氨基酸递质的作用有重要的拮抗作用。", + "D": "指的是由苯环与七元二氮杂卓环融合而成的化学结构部分。" + } + }, + { + "id": "1946abb2-552f-584b-b6f7-f460cdbd2bf6", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "How does Sufentanil compare to Morphine?", + "A": "1/10 as potent", + "B": "10 times as potent", + "C": "100 times as potent", + "D": "1,000 as potent" + }, + "zh": { + "question": "舒芬太尼与吗啡相比如何？", + "A": "效力为1/10", + "B": "效力为10倍", + "C": "效力为100倍", + "D": "效力为1,000倍" + } + }, + { + "id": "6d75c970-2b1c-5c13-887b-46530dd4f375", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which benzodiazepine is primarily used for induction of anesthesia?", + "A": "Midazolam", + "B": "Propofol", + "C": "Thiopental", + "D": "Etomidate" + }, + "zh": { + "question": "哪种苯二氮䓬类药物主要用于麻醉诱导？", + "A": "咪达唑仑", + "B": "丙泊酚", + "C": "硫喷妥钠", + "D": "依托咪酯" + } + }, + { + "id": "1fd46658-3ada-5cae-b597-4c220ec5c08f", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is not an effect of opiods?", + "A": "Chest wall rigidity", + "B": "Fetal respiratory depression", + "C": "Anterograde Amnesia", + "D": "Constipation" + }, + "zh": { + "question": "以下哪项不是阿片类药物的作用？", + "A": "胸壁僵硬", + "B": "胎儿呼吸抑制", + "C": "顺行性遗忘", + "D": "便秘" + } + }, + { + "id": "8bd9ba5c-b64e-55d3-a014-ee345c484534", + "choice_num": 5, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following is not a factor which increases risk of respiratory depression with opioids?", + "A": "High opioid dose", + "B": "High lipid solubility", + "C": "Administration of other sedatives", + "D": "Lack of tolerance", + "E": "Advanced age" + }, + "zh": { + "question": "以下哪项不是增加阿片类药物引起呼吸抑制风险的因素？", + "A": "高剂量阿片类药物", + "B": "高脂溶性", + "C": "使用其他镇静剂", + "D": "缺乏耐受性", + "E": "高龄" + } + }, + { + "id": "dcc7cad1-cf8b-5461-878b-32965d9f73cc", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How is remifentanil different than other opioids?", + "A": "Shortest acting opioid", + "B": "Stronger acting than Fentanyl", + "C": "Structurally unique due to ester linkage", + "D": "Few side effects" + }, + "zh": { + "question": "瑞芬太尼与其他阿片类药物有何不同？", + "A": "作用时间最短的阿片类药物", + "B": "作用强于芬太尼", + "C": "由于酯键而结构独特", + "D": "副作用少" + } + }, + { + "id": "465938ed-19df-5bad-a437-ad3254c8dc05", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Substitutions on the carbon atoms of barbituates determine all of the following except:", + "A": "Hypnotic potency", + "B": "Anti-convulsant properties", + "C": "Protein binding", + "D": "Duration of action" + }, + "zh": { + "question": "巴比妥类药物的碳原子上的取代基决定了以下所有特性，除了：", + "A": "催眠效力", + "B": "抗惊厥特性", + "C": "蛋白结合", + "D": "作用持续时间" + } + }, + { + "id": "eaadfcb9-138d-5418-aa29-c43e98128240", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What would be an appropriate loading dose for remifentanil?", + "A": "5-20 microgram", + "B": "1 mcg/kg", + "C": "0.5 mg/kg", + "D": "5 mcg/kg" + }, + "zh": { + "question": "瑞芬太尼的合适负荷剂量是多少？", + "A": "5-20 微克", + "B": "1 微克/公斤", + "C": "0.5 毫克/公斤", + "D": "5 微克/公斤" + } + }, + { + "id": "5f898723-e0de-5c56-bd73-a8861a97e113", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Is Thiopental safe to give during pregnancy?", + "A": "No!", + "B": "Up to 4mg/kg, yes", + "C": "Yes, it does not cross the placental barrier and even a high dose will not effect the fetus", + "D": "Only minimal dose of 0.5 mg/kg." + }, + "zh": { + "question": "硫喷妥钠在怀孕期间使用是否安全？", + "A": "不安全！", + "B": "是的，最多4mg/kg", + "C": "是的，它不会穿过胎盘屏障，即使是高剂量也不会影响胎儿", + "D": "仅限于0.5 mg/kg的最小剂量。" + } + }, + { + "id": "ea601da0-3d77-5146-9a29-cb01ff06251a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "A  barbituate with an oxygen atom on the #2 carbon would be called a...", + "A": "Thiobarbituates", + "B": "Malobarbituates", + "C": "Pentabarbituates", + "D": "Oxybarbituate" + }, + "zh": { + "question": "在第2号碳上有一个氧原子的巴比妥酸盐被称为...", + "A": "硫代巴比妥酸盐", + "B": "麦洛巴比妥酸盐", + "C": "戊巴比妥酸盐", + "D": "氧巴比妥酸盐" + } + }, + { + "id": "19a320af-699f-5ca4-b2b8-40b04d8a732b", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Sodium Thiopental is a contraindication in which patients?", + "A": "History of neurologic distrubances", + "B": "History of hemolytic amenia", + "C": "Acute intermittent porphyria", + "D": "Immunosuppression" + }, + "zh": { + "question": "硫喷妥钠在哪些患者中是禁忌症？", + "A": "有神经系统障碍病史", + "B": "有溶血性贫血病史", + "C": "急性间歇性卟啉症", + "D": "免疫抑制" + } + }, + { + "id": "c79c49eb-7cab-5b5c-8e8f-dee1ce484a5a", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which opioid receptor causes depression of ventilation, physical dependence, minimal constipation & urinary retention?", + "A": "Mu1", + "B": "Mu2", + "C": "Kappa", + "D": "Delta" + }, + "zh": { + "question": "哪种阿片受体会导致通气抑制、身体依赖、轻微便秘和尿潴留？", + "A": "Mu1", + "B": "Mu2", + "C": "Kappa", + "D": "Delta" + } + }, + { + "id": "e40d163a-bf9c-5137-beee-a73edcad95b1", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How is midazolam unique in comparison to other benzo's?", + "A": "It is the only benzo safe to give to pregnant women.", + "B": "Is known to cause pain upon injection, but has minimal respiratory depression", + "C": "It is hydrophilic and becomes lipid soluble upon exposure to blood.", + "D": "It is not highly protein bound like the other benzo's and thus more is available for use by the body." + }, + "zh": { + "question": "与其他苯二氮卓类药物相比，咪达唑仑有何独特之处？", + "A": "它是唯一一种对孕妇安全的苯二氮卓类药物。", + "B": "已知会引起注射时疼痛，但呼吸抑制最小。", + "C": "它是亲水性的，暴露于血液后变为脂溶性。", + "D": "它不像其他苯二氮卓类药物那样高度蛋白结合，因此更多可供身体使用。" + } + }, + { + "id": "8d5e280a-2e1f-57c5-80ef-debc16cabd47", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "Benzodiazepines are preferred as a pre-medication for anesthesia because they do not cause any respiratory depression in patients.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "苯二氮䓬类药物作为麻醉前用药的首选是因为它们不会导致患者呼吸抑制。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "3f3bde22-a38a-5cea-ae48-f44a7acc5e53", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "How do midazolam and diazepam compare to one another?", + "A": "Midazolam has 2 times the affinity for benzo receptors", + "B": "Diazepam has 3 times the affinity for benzo receptors", + "C": "Diazepam is hydrophilic", + "D": "Midazolam has a much londer elimination half time" + }, + "zh": { + "question": "咪达唑仑和地西泮如何相互比较？", + "A": "咪达唑仑对苯二氮卓受体的亲和力是地西泮的2倍", + "B": "地西泮对苯二氮卓受体的亲和力是咪达唑仑的3倍", + "C": "地西泮是亲水性的", + "D": "咪达唑仑的消除半衰期更长" + } + }, + { + "id": "dd9aadf8-d9ec-584b-913f-6a811d951de5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is the MOA of Benzo's?", + "A": "Blockade of chloride channels leading to depolarization and inhibition of neurotransmitter", + "B": "Inhibition of cyclooxygenase activity", + "C": "Inhibition of GABA receptor binding which leads to degredation of GABA, preventing it from exerting it's effect.", + "D": "Enhances the inhibitory effects of various neurotransmitter by facilitating GABA receptor binding. This opens chloride channels and causes hyperpolarization." + }, + "zh": { + "question": "苯二氮卓类药物的作用机制是什么？", + "A": "阻断氯离子通道导致去极化和神经递质的抑制", + "B": "抑制环氧合酶活性", + "C": "抑制GABA受体结合，导致GABA降解，阻止其发挥作用。", + "D": "通过促进GABA受体结合增强各种神经递质的抑制作用。这会打开氯离子通道并导致超极化。" + } + }, + { + "id": "2f825960-94d1-5973-ba51-5a64494402aa", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the Benzodiazepines reviewed has the slowest onset of action and why?", + "A": "Lorazepam- due to lower lipid solubility", + "B": "Midazolam- due to its water solubility", + "C": "Diazepam- due to rapid redistribution" + }, + "zh": { + "question": "在所审查的苯二氮䓬类药物中，哪一种的起效最慢，为什么？", + "A": "劳拉西泮-由于较低的脂溶性", + "B": "咪达唑仑-由于其水溶性", + "C": "地西泮-由于快速再分布" + } + }, + { + "id": "bdf0f8f2-9787-57bc-9704-df783841293d", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is Substance P?", + "A": "The major inhibitory neurotransmitter.", + "B": "An active metabolite of opioid metabolism which relieves pain", + "C": "An excitatory neurotransmitter presumed to be released by terminals of pain fibers", + "D": "A rapper?" + }, + "zh": { + "question": "什么是P物质？", + "A": "主要的抑制性神经递质。", + "B": "阿片类药物代谢的活性代谢产物，可缓解疼痛。", + "C": "一种兴奋性神经递质，推测由疼痛纤维末端释放。", + "D": "一个说唱歌手？" + } + }, + { + "id": "f2da649e-ae0c-5ac9-891f-bbc37e84fa4c", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "A Competitive antagonist binds to a site other than the agonist binding domain.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "竞争性拮抗剂结合在激动剂结合域以外的位点。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "f817846f-6736-5d23-b43f-7dc734999f79", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "How does meperidine compare to morphine?", + "A": "1/10 as potent", + "B": "10 times as potent", + "C": "100 time as potent", + "D": "1,000 times as potent" + }, + "zh": { + "question": "哌替啶与吗啡相比如何？", + "A": "效力为1/10", + "B": "效力为10倍", + "C": "效力为100倍", + "D": "效力为1,000倍" + } + }, + { + "id": "4a0833f1-e61a-5d08-8a7f-f1601fc72a97", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is true regarding benzodiazepines?", + "A": "Amnesitic effects are greater than sedative effects", + "B": "Produce sufficient skeletal muscle relaxation for surgery", + "C": "Have a high tendency of tolerance compared to barbiturates", + "D": "Longer duration of sedation than amnesia" + }, + "zh": { + "question": "关于苯二氮䓬类药物，下列哪项是正确的？", + "A": "遗忘效应大于镇静效应", + "B": "产生足够的骨骼肌松弛以用于手术", + "C": "与巴比妥类药物相比，耐受性倾向较高", + "D": "镇静持续时间长于遗忘" + } + }, + { + "id": "6708492a-04e5-56e6-867a-b915c3f11dc1", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is NOT a pharmacological effect of benzodiazepines?", + "A": "Amnesia", + "B": "Anxiolysis", + "C": "Analgesia", + "D": "Anticonvulsant" + }, + "zh": { + "question": "下列哪一项不是苯二氮䓬类药物的药理作用？", + "A": "遗忘", + "B": "抗焦虑", + "C": "镇痛", + "D": "抗惊厥" + } + }, + { + "id": "3947f0e1-574f-5c9c-87ba-8658fe995031", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How is remifentanil metabolized?", + "A": "90% metabolized to normeperidine,1/2 as active as a analgesic", + "B": "By nonspecific plasma esterase inactive metabolites", + "C": "Metabolized via conjugation with glucuronic acid", + "D": "Metabolized via hepatic oxidation" + }, + "zh": { + "question": "瑞芬太尼是如何代谢的？", + "A": "90%代谢为去甲哌替啶，作为镇痛剂活性为其一半", + "B": "通过非特异性血浆酯酶代谢为无活性代谢物", + "C": "通过与葡萄糖醛酸结合代谢", + "D": "通过肝脏氧化代谢" + } + }, + { + "id": "8dfa4aa3-1282-55f9-b7ee-2c706bc0c71a", + "choice_num": 3, + "answer": "A", + "level": 1, + "en": { + "question": "Endorphin stimulates which opioid receptor?", + "A": "Mu", + "B": "Kappa", + "C": "Delta" + }, + "zh": { + "question": "内啡肽刺激哪种阿片受体？", + "A": "μ受体", + "B": "κ受体", + "C": "δ受体" + } + }, + { + "id": "dba1b1f8-07d3-5050-a1fc-7a306e0580f1", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Distribution of barbituates depends on all of the following except...", + "A": "Lipid Solubility", + "B": "Protein binding", + "C": "Hepatic oxidation", + "D": "Degree of ionization" + }, + "zh": { + "question": "巴比妥类药物的分布取决于以下所有因素，除了...", + "A": "脂溶性", + "B": "蛋白结合", + "C": "肝脏氧化", + "D": "电离程度" + } + }, + { + "id": "bd4ecc93-bfa5-5650-ac00-702f9d4ed957", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which benzodiazepine is primarily used to treat anxiety?", + "A": "Lorazepam", + "B": "Midazolam", + "C": "Diazepam", + "D": "Temazepam" + }, + "zh": { + "question": "哪种苯二氮䓬类药物主要用于治疗焦虑？", + "A": "劳拉西泮", + "B": "咪达唑仑", + "C": "地西泮", + "D": "替马西泮" + } + }, + { + "id": "b868440d-d858-50e2-852c-a37217501a84", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "How does fentanyl compare to morphine?", + "A": "1/10 as potent", + "B": "10 times as potent", + "C": "100 times as potent", + "D": "1000 times as potent" + }, + "zh": { + "question": "芬太尼与吗啡相比如何？", + "A": "效力为1/10", + "B": "效力为10倍", + "C": "效力为100倍", + "D": "效力为1000倍" + } + }, + { + "id": "30e67074-ffaa-50df-8be7-1430dd919d76", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "Why should you be cautious when giving both an opioid and a benzo together?", + "A": "You increase risk for arrythmias", + "B": "Patient may lose respiratory drive", + "C": "You may increase ICP & SVR", + "D": "You may severely reduce ABP" + }, + "zh": { + "question": "为什么在同时给予阿片类药物和苯二氮卓类药物时要谨慎？", + "A": "你增加了心律失常的风险", + "B": "患者可能会失去呼吸驱动", + "C": "你可能会增加颅内压和全身血管阻力", + "D": "你可能会严重降低动脉血压" + } + }, + { + "id": "87788817-1cff-5141-b623-ae3ac003fea0", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Epidural or subarachnoid placement of opioids is based on activation of which receptors?", + "A": "Kappa", + "B": "Mu", + "C": "Delta", + "D": "All the above" + }, + "zh": { + "question": "硬膜外或蛛网膜下腔放置阿片类药物是基于激活哪种受体？", + "A": "κ受体", + "B": "μ受体", + "C": "δ受体", + "D": "以上所有" + } + }, + { + "id": "2bd18367-c09f-5f20-abd4-c462f65cef55", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the half life of Narcan?", + "A": "60-90 minutes", + "B": "30-45 minutes", + "C": "3 hours", + "D": "4-6 hours" + }, + "zh": { + "question": "Narcan 的半衰期是多少？", + "A": "60-90 分钟", + "B": "30-45 分钟", + "C": "3 小时", + "D": "4-6 小时" + } + }, + { + "id": "8ac20f59-b87d-554f-b095-60841da1b8b3", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Define Affinity:", + "A": "Inhibit or block responses caused by an agonist", + "B": "Drugs which alter the physiology of a cell by binding to plasma membrane or intracellular receptors", + "C": "The strength of binding between drug and receptor", + "D": "Binds to a site other than the agonist-binding domain" + }, + "zh": { + "question": "定义亲和力：", + "A": "抑制或阻断由激动剂引起的反应", + "B": "通过与质膜或细胞内受体结合来改变细胞生理的药物", + "C": "药物与受体之间结合的强度", + "D": "结合到激动剂结合域以外的位点" + } + }, + { + "id": "5c9903b3-c33e-5b71-ae59-4c3ed675566b", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "All benzo's share what similarities?", + "A": "All are highly alkaline solutions", + "B": "Composed of a benzene ring fused to a seven-membered diazepine ring", + "C": "They are safe to be given during pregnancy", + "D": "Composed of malonic acid and urea" + }, + "zh": { + "question": "所有苯二氮卓类药物有什么相似之处？", + "A": "都是高度碱性溶液", + "B": "由一个苯环和一个七元二氮杂卓环融合而成", + "C": "在怀孕期间使用是安全的", + "D": "由丙二酸和尿素组成" + } + }, + { + "id": "16b6e98c-f287-5400-8015-c6f2daf42d50", + "choice_num": 5, + "answer": "A", + "level": 1, + "en": { + "question": "Which of the following is not one of the Top 4 side effects of neuraxial opioids?", + "A": "Sedation", + "B": "Pruritis", + "C": "Nausea/Vomitting", + "D": "Urinary retention", + "E": "Depressed ventilation" + }, + "zh": { + "question": "以下哪一项不是神���轴麻醉阿片类药物的四大副作用之一？", + "A": "镇静", + "B": "瘙痒", + "C": "恶心/呕吐", + "D": "尿潴留", + "E": "呼吸抑制" + } + }, + { + "id": "9c517e99-9526-52fb-b1a9-96aab63571b1", + "choice_num": 3, + "answer": "C", + "level": 2, + "en": { + "question": "Which class of drug would to NOT give to a pt undergoing a cholangiogram?", + "A": "Benzo's", + "B": "Barbituates", + "C": "Opioids" + }, + "zh": { + "question": "在进行胆管造影的患者中，哪一类药物不应给予？", + "A": "苯二氮卓类", + "B": "巴比妥类", + "C": "阿片类" + } + }, + { + "id": "a558ef56-6df9-50df-918d-84f9f448a782", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "How are barbituate metabolized?", + "A": "Hepatic Oxidation", + "B": "Renal oxidation", + "C": "Glomerular filtration", + "D": "Broken down in small intestines and excreted in feces" + }, + "zh": { + "question": "巴比妥类药物是如何代谢的？", + "A": "肝脏氧化", + "B": "肾脏氧化", + "C": "肾小球过滤", + "D": "在小肠中分解并通过粪便排出" + } + }, + { + "id": "a97f4627-8e2b-536c-9392-f44cc43f848d", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is an appropriate oral dose for pediatric pre-medication with midazolam?", + "A": "0.5 mg/kg", + "B": "1 mg/kg", + "C": "2-3 mg", + "D": "10 - 20 mcg/ kg" + }, + "zh": { + "question": "咪达唑仑用于儿童术前镇静的合适口服剂量是多少？", + "A": "0.5 mg/kg", + "B": "1 mg/kg", + "C": "2-3 mg", + "D": "10 - 20 mcg/ kg" + } + }, + { + "id": "2e6c8076-6a98-51e7-8a25-4129103b483a", + "choice_num": 4, + "answer": "A", + "level": 2, + "en": { + "question": "Which medication would you give to reverse post-op ventilatory depression of Fentanyl while maintaining analgesia?", + "A": "Nalbuphine", + "B": "Narcan, carefully titrated", + "C": "Flumazenil", + "D": "Switch to Meperidine" + }, + "zh": { + "question": "在维持镇痛的同时，您会给予哪种药物来逆转芬太尼术后呼吸抑制？", + "A": "纳布啡", + "B": "小心滴定纳洛酮", + "C": "氟马西尼", + "D": "换用哌替啶" + } + }, + { + "id": "6b8566c0-6247-5622-ae82-197ff6b7d19e", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "The drug most commonly prescribed to treat opioid overdose is?", + "A": "Flumazenil", + "B": "Nalbuphine", + "C": "Naloxone", + "D": "Butorphanol" + }, + "zh": { + "question": "最常用于治疗阿片类药物过量的药物是？", + "A": "氟马西尼", + "B": "纳布啡", + "C": "纳洛酮", + "D": "布托啡诺" + } + }, + { + "id": "e86542d1-271e-5edc-bd50-e6b2cd553370", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the elimination half time of Lorazepam?", + "A": "1-4 hours", + "B": "21-37 hours", + "C": "10-20 hours", + "D": "5-10 hours" + }, + "zh": { + "question": "洛拉西泮的消除半衰期是多少？", + "A": "1-4小时", + "B": "21-37小时", + "C": "10-20小时", + "D": "5-10小时" + } + }, + { + "id": "ae835a26-8c13-5a5c-8565-9b0a5bcfe4a0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "You have just given you pt Midazolam, how long would you expect to wait to see onset of the drug?", + "A": "3-5 minutes", + "B": "20-25 minutes", + "C": "30-60 seconds", + "D": "2 minutes" + }, + "zh": { + "question": "你刚给病人使用了咪达唑仑，你预计需要等待多长时间才能看到药物的起效？", + "A": "3-5分钟", + "B": "20-25分钟", + "C": "30-60秒", + "D": "2分钟" + } + }, + { + "id": "c260765d-afac-5fe0-ab7e-558118cdec9d", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What medication would you give to treat an opioid overdose?", + "A": "Flumazenil, slow titration of 0.2 mg doses", + "B": "Nubain 10-20 mg", + "C": "Lithium", + "D": "Narcan 1-4 mcg/kg" + }, + "zh": { + "question": "你会给什么药物来治疗阿片类药物过量？", + "A": "氟马西尼，缓慢滴定0.2毫克剂量", + "B": "纳布啡 10-20 毫克", + "C": "锂", + "D": "纳洛酮 1-4 微克/千克" + } + }, + { + "id": "17fff495-3956-5737-b7f4-e3d1421588d6", + "choice_num": 4, + "answer": "D", + "level": 2, + "en": { + "question": "You are the SRNA for Mr. Chaviano who is just our of surgery. He has a past medical histort of HTN, palpitations, schizophrenia, & GERD. He is shivering in the PACU and the nurse requests something to help. What do you do?", + "A": "Give some Narcan to reverse your opioids.", + "B": "Give Meperidine to treat the shivering", + "C": "Give Fentanyl to treat shivering", + "D": "Find some warm blankets and cover him up." + }, + "zh": { + "question": "您是刚刚做完手术的Chaviano先生的麻醉护士。他有高血压、心悸、精神分裂症和胃食管反流病的病史。他在术后恢复室发抖，护士请求一些帮助。您会怎么做？", + "A": "给一些纳洛酮来逆转阿片类药物。", + "B": "给哌替啶来治疗发抖。", + "C": "给芬太尼来治疗发抖。", + "D": "找一些温暖的毯子盖住他。" + } + }, + { + "id": "f6592ee6-7444-53f6-8f6f-350c7e96110c", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "Enkephalin is responsible for stimulating which opioid receptor?", + "A": "Mu", + "B": "Kappa", + "C": "Delta" + }, + "zh": { + "question": "脑啡肽负责刺激哪种阿片受体？", + "A": "Mu", + "B": "Kappa", + "C": "Delta" + } + }, + { + "id": "175ce3b9-65dd-59f7-89e1-7c17f75cf94f", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "How much methohexital would you expect to find excreted unchanged in the urine?", + "A": "< 1%", + "B": "1-3 %", + "C": "5-10 %", + "D": "95%" + }, + "zh": { + "question": "你预计在尿液中排泄的未改变的甲己酯是多少？", + "A": "< 1%", + "B": "1-3 %", + "C": "5-10 %", + "D": "95%" + } + }, + { + "id": "e412968a-1f1b-5f53-9ba8-0c440fc8ea8f", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How long can Methohexital be refrigerated and stable for after mixing?", + "A": "2 weeks", + "B": "6 weeks", + "C": "6 days", + "D": "1 month" + }, + "zh": { + "question": "混合后，甲己酯可以在冰箱中保存并保持稳定多长时间？", + "A": "2周", + "B": "6周", + "C": "6天", + "D": "1个月" + } + }, + { + "id": "76f82048-c36c-5828-b31a-e7c17928cf95", + "choice_num": 2, + "answer": "B", + "level": 1, + "en": { + "question": "The dose of Benzodiazepines required to reach a desired clinical endpoint is increased in the elderly compared to the younger patient.", + "A": "True", + "B": "False" + }, + "zh": { + "question": "与年轻患者相比，老年患者达到预期临床终点所需的苯二氮卓类药物剂量增加。", + "A": "正确", + "B": "错误" + } + }, + { + "id": "27456300-2e8b-52a9-9e2c-4403da30af41", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What respiratory effects are associated with opioid?", + "A": "Chest wall flaccidity", + "B": "Increase RR with decrease Tv", + "C": "Decrease RR and increase Tv", + "D": "Increased response to CO2" + }, + "zh": { + "question": "阿片类药物与哪些呼吸效应相关？", + "A": "胸壁松弛", + "B": "呼吸频率增加，潮气量减少", + "C": "呼吸频率减少，潮气量增加", + "D": "对二氧化碳反应增强" + } + }, + { + "id": "2b3e7860-97f3-5a18-886d-a3fe6d8bc6fa", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the opioid receptors causes Euphoria, Miosis, Bradycardia, Urinary retention & Hypothermia?", + "A": "Delta", + "B": "Mu1", + "C": "Mu2", + "D": "Kappa" + }, + "zh": { + "question": "哪种阿片受体会导致欣快感、瞳孔缩小、心动过缓、尿潴留和体温过低？", + "A": "Delta", + "B": "Mu1", + "C": "Mu2", + "D": "Kappa" + } + }, + { + "id": "9c0f3a8d-556c-5459-a3cf-8b9634a364a5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Meperidine acts on which opioid receptors?", + "A": "Mu & Delta", + "B": "Only the Mu receptors", + "C": "Delta & Kappa", + "D": "Mu & Kappa" + }, + "zh": { + "question": "哌替啶作用于哪些阿片受体？", + "A": "Mu 和 Delta", + "B": "仅 Mu 受体", + "C": "Delta 和 Kappa", + "D": "Mu 和 Kappa" + } + }, + { + "id": "60d1dc88-4f6b-5cac-9abe-f1f160612af5", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "How much air space should there be in a CO2 absorber?", + "A": "Equal to Tidal Volume", + "B": "2-3 times the Tidal Volume", + "C": "2 L/min", + "D": "Minimal air space should be allowed." + }, + "zh": { + "question": "CO2 吸收器中应有多少空气空间？", + "A": "等于潮气量", + "B": "潮气量的2-3倍", + "C": "2 L/min", + "D": "应允许最小的空气空间。" + } + }, + { + "id": "c9064c97-b99d-5c48-8a06-91dd03ea502a", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "What does Henry's law state?", + "A": "At a constant volume, the pressure of gas is directly proportional to the temperature.", + "B": "The amount of gas dissolved in a liquid is directly proportional to the partial pressure of the gas over the liquid and indirectly proportional to temperature", + "C": "At a constant temperature, the volume of gas varies inversely with the pressure.", + "D": "The total pressure of a mixture of gases in a closed container at a given temperature is equal to the sum of the pressure that each gas exerts" + }, + "zh": { + "question": "亨利定律表述了什么？", + "A": "在恒定体积下，气体的压力与温度成正比。", + "B": "溶解在液体中的气体量与气体在液体上方的分压成正比，与温度成反比。", + "C": "在恒定温度下，气体的体积与压力成反比。", + "D": "在给定温度下，密闭容器中气体混合物的总压力等于每种气体所施加压力的总和。" + } + }, + { + "id": "5ccb58b1-6c36-53c3-8e84-092e79936dd0", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Where would you find Laminar flow in the body?", + "A": "Terminal Bronchioles", + "B": "Carina", + "C": "Larger Airways", + "D": "Blood Flowing into the heart" + }, + "zh": { + "question": "在身体的哪个部位可以找到层流？", + "A": "终末细支气管", + "B": "隆突", + "C": "较大的气道", + "D": "流入心脏的血液" + } + }, + { + "id": "56bf510b-1a89-53ba-b7ae-a7c8727645a4", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Which of these is NOT a distinguishing property of gases?", + "A": "Strong intermolecular forces", + "B": "High Velocity", + "C": "Expand & compress easily", + "D": "High degree of random Motion" + }, + "zh": { + "question": "以下哪一项不是气体的特性？", + "A": "强的分子间作用力", + "B": "高速度", + "C": "容易膨胀和压缩", + "D": "高度随机运动" + } + }, + { + "id": "f1fb6cbc-6aa1-59fa-aa75-b84471b3a5da", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What is a good example of Grahams Law in Anesthesia practice?", + "A": "The Venturi Mask effect where increasing velocity of flow decreases pressure exerted on walls of tube.", + "B": "Being aware of how air flows through larger (turbulent) and smaller (laminar) airways within lungs.", + "C": "Determining the partial pressure of O2 in a cylinder of air.", + "D": "Realizing that CO2 diffuses 20x faster than O2 due to increased solubility of CO2." + }, + "zh": { + "question": "在麻醉实践中，Grahams定律的一个好例子是什么？", + "A": "Venturi面罩效应，其中流速增加会降低施加在管壁上的压力。", + "B": "了解空气如何通过肺内较大的（湍流）和较小的（���流）气道流动。", + "C": "确定空气钢瓶中氧气的分压。", + "D": "意识到由于CO2的溶解度增加，CO2的扩散速度比O2快20倍。" + } + }, + { + "id": "a905185f-306b-577c-b253-0146ecbcd6d9", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "The Sagital plane divides the body into...", + "A": "Left and Right", + "B": "Superior and Inferior", + "C": "Anterior and Posterior", + "D": "Right and Wrong" + }, + "zh": { + "question": "矢状面将身体分为...", + "A": "左和右", + "B": "上和下", + "C": "前和后", + "D": "对和错" + } + }, + { + "id": "d3ba9605-21d7-5f3e-b402-3b24a1edb58f", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which of the following is NOT TRUE about turbulent flow:", + "A": "It is governed by Reynold’s number (>2000)", + "B": "Results when molecules of a soltuion encounter walls of a tube in a rough tumbling pattern.", + "C": "It is caused by high flows, when tube wall is corrugated, & kinks or bends in the system", + "D": "Occurs when the density of a solution is decreased, and the radius is small" + }, + "zh": { + "question": "以下哪项关于湍流是不正确的：", + "A": "它由雷诺数（>2000）决定", + "B": "当溶液分子的运动遇到管壁时呈现粗糙的翻滚模式", + "C": "由高流速、管壁波纹、系统中的扭结或弯曲引起", + "D": "当溶液的密度降低且半径较小时发生" + } + }, + { + "id": "1e577532-ebbf-5b84-af0b-605ee6feb419", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following will show a FALSE desaturation on your pulse ox monitor?", + "A": "Carbon Monoxide Poisoning", + "B": "Hypocarbia", + "C": "Administration of Methylene Blue dye", + "D": "Anemia" + }, + "zh": { + "question": "以下哪项会在脉搏血氧仪上显示假性脱氧饱和？", + "A": "一氧化碳中毒", + "B": "低碳酸血症", + "C": "注射亚甲蓝染料", + "D": "贫血" + } + }, + { + "id": "204578c1-4139-50fd-a528-de1c8e32507a", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the hydration of SodaLyme?", + "A": "14-19%", + "B": "8-10%", + "C": "19-23%", + "D": "33%" + }, + "zh": { + "question": "SodaLyme的水合度是多少？", + "A": "14-19%", + "B": "8-10%", + "C": "19-23%", + "D": "33%" + } + }, + { + "id": "e0795ac7-c24b-54ac-a422-5d50f115c934", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which other gas laws are part of Fick's law?", + "A": "Charles, Gay-Lusaacs & Boyles Law", + "B": "Nouba's & Lambert Beer's Law", + "C": "Henry's & Grahams law", + "D": "Ohm's & Daltons Law" + }, + "zh": { + "question": "哪些其他气体定律是菲克定律的一部分？", + "A": "查尔斯定律、盖-吕萨克定律和波义耳定律", + "B": "努巴定律和朗伯-比尔定律", + "C": "亨利定律和格雷厄姆定律", + "D": "欧姆定律和道尔顿定律" + } + }, + { + "id": "7885d8b2-c955-5126-a77a-008daa92cb14", + "choice_num": 3, + "answer": "C", + "level": 1, + "en": { + "question": "How do OR electrical systems work?", + "A": "Through a Line isolation monitor which grounds the electrical supply to protect staff and patients from shock.", + "B": "By providing a ground within each individual piece of equipment as well as in plugs for addition safety.", + "C": "Through an Isolation transformer which seperates electrical system from OR and provides no ground so you can safely touch one wire." + }, + "zh": { + "question": "手术室的电气系统如何工作？", + "A": "通过线路隔离监视器接地电源，以保护工作人员和患者免受电击。", + "B": "通过在每个设备以及插头中提供接地，以增加安全性。", + "C": "通过隔离变压器将电气系统与手术室隔离，并且不提供接地，因此您可以安全地触摸一根电线。" + } + }, + { + "id": "b66a47e8-d9cd-5d1c-80c3-4fe2bebc7bf6", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the following Facilitates the flow of electrons?", + "A": "Inductance", + "B": "Capacitance", + "C": "Insulators", + "D": "Reflection" + }, + "zh": { + "question": "以下哪项有助于电子流动？", + "A": "电感", + "B": "电容", + "C": "绝缘体", + "D": "反射" + } + }, + { + "id": "033af2af-e909-5f0b-ad73-c424ec6e87b0", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "What is the chemical reaction that occurs within the C02 absorber?", + "A": "Reduction", + "B": "Oxidation", + "C": "Neutralization", + "D": "Hydrolysis" + }, + "zh": { + "question": "在CO2吸收剂中发生的化学反应是什么？", + "A": "还原", + "B": "氧化", + "C": "中和", + "D": "水解" + } + }, + { + "id": "1185dae5-42fe-5f6e-91f2-9e4222de7211", + "choice_num": 4, + "answer": "C", + "level": 1, + "en": { + "question": "Which of the following is not one of the four factors which may change Laminar to Turbulent flow?", + "A": "High Gas Flows", + "B": "Changes in Diameter", + "C": "Volume of Solution", + "D": "Branching of tubes" + }, + "zh": { + "question": "以下哪一项不是可能将层流变为湍流的四个因素之一？", + "A": "高气流", + "B": "直径变化", + "C": "溶液体积", + "D": "管道分支" + } + }, + { + "id": "ff686457-fd20-56ec-971a-4622691fff30", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "What will happen to your flow if you double the length of your tubing?", + "A": "You will have 1/16 of flow", + "B": "You will have 1/2 flow", + "C": "You will double flow", + "D": "It will stay the same due to decrease pressure gradient" + }, + "zh": { + "question": "如果将管道长度加倍，流量会发生什么变化？", + "A": "流量将是原来的1/16", + "B": "流量将是原来的1/2", + "C": "流量将加倍", + "D": "由于压力梯度减小，流量将保持不变" + } + }, + { + "id": "0ed665bc-be42-5212-a026-42a127a1112a", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "Which one of the following is a good example of Bernoulli's law?", + "A": "Being aware of how air flows through larger (turbulent) and smaller (laminar) airways within lungs.", + "B": "The Venturi Mask effect where increasing velocity of flow decreases pressure exerted on walls of tube.", + "C": "Determining the partial pressure of O2 in a cylinder of air.", + "D": "Realizing that CO2 diffuses 20x faster than O2 due to increased solubility of CO2." + }, + "zh": { + "question": "以下哪一项是伯努利定律的一个好例子？", + "A": "了解空气如何通过肺内较大（湍流）和较小（层流）气道流动。", + "B": "文丘里面罩效应，其中流速增加会降低对管壁的压力。", + "C": "确定气瓶中氧气的分压。", + "D": "意识到由于二氧化碳的溶解度增加，二氧化碳的扩散速度比氧气快20倍。" + } + }, + { + "id": "671544d2-476d-5d95-8bc8-3d79299186e7", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What harmful substance is Desflurane known to cause more than other anesthetic agents upon breakdown in a CO2 aborber?", + "A": "Trifluoroacetylic acid", + "B": "Compound A", + "C": "Your gramma's perfume", + "D": "Carbon Monoxide" + }, + "zh": { + "question": "与其他麻醉剂相比，Desflurane 在 CO2 吸收器中分解时更容易产生哪种有害物质？", + "A": "三氟乙酸", + "B": "化合物 A", + "C": "你奶奶的香水", + "D": "一氧化碳" + } + }, + { + "id": "fd232d97-0515-568f-b164-c89fc62e5104", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "A galvanic cell contains two electrodes and is used to measure O2. Describe the reaction which occurs inside the Galvanic cell.", + "A": "The gold and lead electrodes are consumed when electricity is produced.", + "B": "The lead electrode is consumed by the reactions of the galvanic cell.", + "C": "The gold electrode is consumed by the reactions of the galvanic cell.", + "D": "Exposure to room air will shorten the life of the galvanic cell since this will increase consumption of the elctrode." + }, + "zh": { + "question": "一个原电池包含两个电极，用于测量O2。描述在原电池内发生的反应。", + "A": "当产生电流时，金和铅电极被消耗。", + "B": "铅电极被原电池的反应消耗。", + "C": "金电极被原电池的反应消耗。", + "D": "暴露在室内空气中会缩短原电池的寿命，因为这会增加电极的消耗。" + } + }, + { + "id": "84e36cab-6658-5f92-b8ea-121a3eec0007", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "What is the MAIN component of SodaLyme?", + "A": "CaOH", + "B": "NaOH", + "C": "KOH", + "D": "H2O" + }, + "zh": { + "question": "SodaLyme的主要成分是什么？", + "A": "CaOH", + "B": "NaOH", + "C": "KOH", + "D": "H2O" + } + }, + { + "id": "b0a01a75-6b65-5248-8f94-9155195c4b31", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Define Suspension.", + "A": "A solution in which a solute can not be dissolved", + "B": "The substance which is dissolved in a solution", + "C": "Homogenous mix of 2 or more substances in equal proportions.", + "D": "The principal kicking you out of school." + }, + "zh": { + "question": "定义悬浮液。", + "A": "一种溶质不能溶解的溶液", + "B": "在溶液中溶解的物质", + "C": "两种或多种物质按相同比例的均匀混合物。", + "D": "把你赶出学校的校长。" + } + }, + { + "id": "2f25eeb3-c166-52f4-a132-3c0a23c575e5", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Vaporization is NOT dependent upon...", + "A": "Vapor Pressure of Agent", + "B": "Temperature of environment", + "C": "Amount of carrier gas used", + "D": "Density of Agent" + }, + "zh": { + "question": "蒸发不依赖于...", + "A": "药剂的蒸气压", + "B": "环境温度", + "C": "使用的载气量", + "D": "药剂的密度" + } + }, + { + "id": "f622f261-1ccc-507a-9c51-7ce602dac318", + "choice_num": 4, + "answer": "A", + "level": 1, + "en": { + "question": "Electrocautery (Bovie) is used in surgery to provide homeostasis by burning blood vessels via an electrical current discharged from the machine to the patient. The energy is returned to the patient via a dispersive plate. Which surface is the best choice, from below, to place the dispersive plate?", + "A": "Thigh or Back", + "B": "On Big toe", + "C": "Neck", + "D": "Wrap around pointer finger" + }, + "zh": { + "question": "电烧（Bovie）在手术中通过从机器到患者的电流烧灼血管来提供止血。能量通过分散板返回给患者。以下哪个表面是放置分散板的最佳选择？", + "A": "大腿或背部", + "B": "大脚趾", + "C": "颈部", + "D": "缠绕在食指上" + } + }, + { + "id": "d41c3e79-edfd-534e-8a6a-46031bd1a00e", + "choice_num": 4, + "answer": "B", + "level": 1, + "en": { + "question": "Which of the follow is NOT a method of heat transfer?", + "A": "Convection", + "B": "Condensation", + "C": "Radiation", + "D": "Conduction" + }, + "zh": { + "question": "以下哪一项不是热传递的方法？", + "A": "对流", + "B": "凝结", + "C": "辐射", + "D": "传导" + } + }, + { + "id": "33c58654-0add-5ed7-a1f6-4d788b419036", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Right now you are:", + "A": "Pretty darn tired of all this studying.", + "B": "Desperately wanting an alcoholic beverage.", + "C": "Praying to god you pass these tests.", + "D": "All of the above." + }, + "zh": { + "question": "现在你是：", + "A": "对所有这些学习感到非常厌倦。", + "B": "非常想要一杯酒精饮料。", + "C": "祈祷你能通过这些考试。", + "D": "以上全部。" + } + }, + { + "id": "56e42c10-9ce2-5c4b-842a-f2a7a5eef8ca", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "Which is the formula for Ohm's Law?", + "A": "PV=nrT", + "B": "Area x solubility x pressure gradient / MW x Distance x temp", + "C": "W = E x I", + "D": "E = I x R" + }, + "zh": { + "question": "欧姆定律的公式是什么？", + "A": "PV=nrT", + "B": "面积 x 溶解度 x 压力梯度 / 分子量 x 距离 x 温度", + "C": "W = E x I", + "D": "E = I x R" + } + }, + { + "id": "0f0ac9bf-a72e-57cc-be90-b968199657f8", + "choice_num": 4, + "answer": "B", + "level": 2, + "en": { + "question": "During your pre-op assessment you find your pt has pulmonary edema. How will this affect Diffusion of your gases?", + "A": "Increase Distance across membrane, and Increase diffusion", + "B": "Increase Distance across membrane and decrease diffusion", + "C": "Decrease distance across membrane and increase diffusion.", + "D": "Decrease distance across membrane and decrease diffusion." + }, + "zh": { + "question": "在术前评估中，你发现患者有肺水肿。这将如何影响气体的扩散？", + "A": "增加膜的距离，增加扩散", + "B": "增加膜的距离，减少扩散", + "C": "减少膜的距离，增加扩散", + "D": "减少膜的距离，减少扩散" + } + }, + { + "id": "170d3b76-85e3-5e0e-8574-91149befaa84", + "choice_num": 4, + "answer": "D", + "level": 1, + "en": { + "question": "What are the end products of the CO2 absorber?", + "A": "CO, H2O, and Heat", + "B": "Salts, Carbonates, and H2O", + "C": "CO, Carbonates, and Heat", + "D": "Carbonates, H20, Heat" + }, + "zh": { + "question": "CO2吸收剂的最终产物是什么？", + "A": "CO、H2O和热量", + "B": "盐类、碳酸盐和H2O", + "C": "CO、碳酸盐和热量", + "D": "碳酸盐、H2O、热量" + } + }, + { + "id": "c1f7e23b-fcc2-50dc-8cbb-49ef13bbad23", + "choice_num": 4, + "answer": "C", + "level": 2, + "en": { + "question": "Which statement is NOT TRUE regarding the flow of solutions?", + "A": "The greater the inflow is on one side of the tube than the outflow pressure is on the opposite side of the tube (pressure gradient)the greater the flow", + "B": "Doubling the radius leads to 16-fold increase in flow", + "C": "Halving of the radius decreases flow by half", + "D": "Tripling the radius increases flow 81 fold" + }, + "zh": { + "question": "关于溶液流动，哪个说法是不正确的？", + "A": "管道一侧的流入压力大于另一侧的流出压力（压力梯度）时，流量越大", + "B": "将半径加倍会导致流量增加16倍", + "C": "将半径减半会使流量减少一半", + "D": "将半径增加三倍会使流量增加81倍" + } + } +] \ No newline at end of file