[ { "id": "91b5e145-57f2-5307-99e4-eafd75643de4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7b7f7b61-6bd1-500b-bfa7-dcef7ae8a213", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "dd9833d1-8058-5dfc-a9d8-962d9f4c4590", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "973f2910-489a-5526-9d89-4bc72a61abd5", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "b06f7854-4598-50c5-b336-2e7aa2245657", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "32890c9f-ed1d-53a6-a2bb-7aa6f8d1863c", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "02200767-785c-5405-811c-45402a212a8c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3ed86ad8-b15d-5ffb-8627-58d0fc19307e", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "56cca7ab-f77c-55dd-a356-be20fb69494d", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "5d35be6f-8e8f-57d8-9970-401c6ab6dbde", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9c871117-866d-5180-b574-9d5a76869d09", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "153813d4-2c91-58f1-b2a9-bbc97b09b3c7", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "63ae411c-c39b-5859-b15b-ae5a462a8de0", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a6682a0f-c8d7-5a35-82af-6d86b6745c8b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7b01c1e5-3864-5353-ac9a-c8cf239784f1", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d2d5b941-ade8-5cda-bc81-f8f75ee3fff0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f75f92fb-09ee-5221-ad78-a45b9843aa66", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5e0e2fcf-3cbd-524e-b668-2227f04235dd", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3ef1ad1f-0ac0-5a9b-86db-276712ae597a", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1694adaa-ae5d-585d-a9fa-8e6e2ecb6a1d", "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).", "choice_num": 4, "target": "D", "category": 1 }, { "id": "395ec59d-53f2-53ef-a6f1-bd06e381a35a", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b0bdc414-3df4-5a76-82a9-402dc61685c9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "85e6ea56-9a47-55c0-be3a-525ce8ca3849", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1bb76e22-6dbf-5b17-bbdf-0e6cde9f9440", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "fac72e79-03f6-520b-94c2-4c09500cf391", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f269a857-d01c-54fc-9dee-79434cd5ac5f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2815d069-33eb-5903-98fd-bba277c9880f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e82630e5-5655-5e26-aceb-4ae986e17222", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3a35c4f4-622e-5782-867f-66a4f6360dd2", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fe9576d7-21e1-5104-9404-571502b8ab06", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "af8092ac-0458-5cdb-9d74-b15e5cd49855", "question": "The nipple line is at what dermatomal level?", "A": "T2", "B": "T4", "C": "T6", "D": "T8", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d2f697e1-d0dd-59e9-8589-cfe77118d01b", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "08775008-8a33-5102-8fa0-d6851bb113f9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9e243fc2-c65a-5125-9b28-60ad4fef2afc", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "736d2755-56de-5381-9dee-0d5c7b69801b", "question": "When performing a single-shot caudal block, you must first pierce through which ligament?", "A": "Sacrococcygeal", "B": "Sacrotuberous", "C": "Sacrospinous", "D": "Sacroiliac", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6192c7db-cbfe-5281-9fc2-809ecc0bfaab", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "22f45e15-f332-5ee7-b53b-31f00d263e85", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6a4e87ba-ca75-5fec-bc7c-72be52fc70c9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "923b60a5-ccbe-5da1-92ff-37743121ba9f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cf7c7a94-baf5-5694-a608-a9418004cccc", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "09fc3a23-8f56-5191-8781-bfae88b876e9", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "d3ff6708-11e5-58a5-b377-a2448ca5bd40", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "29606f86-158c-5a24-86de-a1343e2ee011", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "865af3ff-862c-5a85-9ef5-0c0cfc6b101d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "35c554b2-cd69-5675-ba31-099039e4d867", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2032b2c8-3eb2-54e0-8797-08534577715a", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "97f809bf-a993-5342-9831-e9a9eae6485c", "question": "Carotid body chemoreceptors communicate with the respiratory centers via which nerve?", "A": "Trigeminal", "B": "Glossopharyngeal", "C": "Vagus", "D": "Hypoglossal", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6995bf51-9581-51f7-ab1c-33b79e791702", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "74bd2e46-7993-5c35-9e9b-1a7f20d47e08", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "126a46d7-fa30-512a-b2c3-cbef3adde1c6", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f30de17e-a6e8-520d-b339-f3b2cba25d6a", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e5e45454-6538-59cb-97e4-19d6427552e5", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a6820714-00fb-546c-a5d2-248f8903545a", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a1a6eb22-5b13-59e8-8642-763fb60c9dd4", "question": "Which layer of the meninges is pain sensitive?", "A": "Dura", "B": "Pia", "C": "Arachnoid", "D": "Subarachnoid", "choice_num": 4, "target": "A", "category": 1 }, { "id": "570c8fe6-c573-5d23-9a4e-6dcf2e55b832", "question": "What is the potential space between the arachnoid and pia mater?", "A": "Epidural", "B": "Subarachnoid", "C": "Subdural", "D": "Arachnoid", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e3235d11-f2ab-552a-a6ce-d074d45645a6", "question": "What is the potential space between the dura and arachnoid mater?", "A": "Epidural", "B": "Subarachnoid", "C": "Subdural", "D": "Arachnoid", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c8d76b17-7cda-5d99-b7f0-98204bf38a06", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "00cbec32-84d9-5d6b-8c90-c0f29bcf6af1", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "e148fa89-5803-5d0c-9dd2-6b316609b463", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "f66f0d22-a5d8-5c5f-82e5-c47be09d5f46", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "aed05d49-45a0-5065-9955-f73a29dbaf91", "question": "Which of the following agents can cause an increase in CBF and CMRO2?", "A": "Nitrous oxide", "B": "Desflurane", "C": "Halothane", "D": "Sevoflurane", "choice_num": 4, "target": "A", "category": 1 }, { "id": "dd131f4e-4745-54e1-be7b-6d4be7e5cdaf", "question": "Which of the following inhalational agents facilitates CSF absorption?", "A": "Halothane", "B": "Isoflurane", "C": "Sevoflurane", "D": "Desflurane", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2c804769-637b-561f-b146-b26f5eb6792a", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5d482672-b41c-52fe-b3e7-0a93af667977", "question": "What is the approximate total CSF volume?", "A": "350-500 mL", "B": "100-150 mL", "C": "200-250 mL", "D": "50-100 mL", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b735c3f9-cb00-5741-ab8c-d9e95f162768", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "4b66a71e-bbc5-54c5-8861-f51a2ede0d18", "question": "All of these medications decrease CSF production EXCEPT which one?", "A": "Acetazolamide", "B": "Furosemide", "C": "Thiopental", "D": "Ketamine", "choice_num": 4, "target": "D", "category": 1 }, { "id": "14ebb09e-da7f-5465-8b88-fc78181c5fe0", "question": "Which of the following inhalational agents impedes CSF absorption?", "A": "Halothane", "B": "Isoflurane", "C": "Sevoflurane", "D": "Desflurane", "choice_num": 4, "target": "A", "category": 1 }, { "id": "aa34c33f-3192-5ab5-ac02-52f206b67475", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "0ba277bc-95e8-53a6-b5db-672860213bbd", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b2b50b7d-017b-5d5d-aef5-e779d0a7b8f3", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "92d4161d-68d0-54c5-ab93-fb015e6af773", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d195090d-0375-5738-91fd-d492253a9c5a", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8e38fa1e-147c-59c1-9dbc-36a77ead502d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "59bf5fef-587d-547a-85d6-e2e4fc4b2cb1", "question": "Activation of which opioid receptor types can provide relief from opioidinduced itching?", "A": "Mu", "B": "Delta", "C": "Sigma", "D": "Kappa", "choice_num": 4, "target": "D", "category": 1 }, { "id": "aa1c69a7-eccd-547e-8c53-ca507a1b9746", "question": "Which of the following drugs does not exhibit N-methyl-D-aspartate (NMDA) receptor antagonism?", "A": "Methadone", "B": "Meperidine", "C": "Ketamine", "D": "Memantine", "choice_num": 4, "target": "B", "category": 1 }, { "id": "79ef2655-96ec-5188-a5e2-f30453b8b475", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "08fe1498-4d78-5063-bd67-353f8ece61d0", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c2677c61-b853-511f-b616-e7a78ff05544", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c9237784-9be5-5fb2-a239-fef05adb1a8f", "question": "Which of the following is the most ubiquitous material in the epidural space?", "A": "Veins", "B": "Arteries", "C": "Fat", "D": "Lymphatics", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1508a61e-f88d-5758-bb01-d0448cf55b3e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c320143f-956d-57fc-930c-5f5ce57a4f79", "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%", "choice_num": 4, "target": "A", "category": 1 }, { "id": "468f58a5-5507-5678-9330-2bb12836095f", "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)", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f45c2d64-8790-57dd-89bd-7dc73309cdb8", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "bce6237a-96f2-5338-a5e8-db4112de5b9f", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a1a92318-3036-5e3e-91d6-e13d117760d5", "question": "6. What volumes comprise TLC?", "A": "Inspiratory reserve volume (IRV) + TV + ERV", "B": "IRV + TV", "C": "ERV + RV", "D": "VC + RV", "choice_num": 4, "target": "D", "category": 1 }, { "id": "de918ad8-d562-5617-aa56-8833e6486d65", "question": "What volumes comprise IC?", "A": "IRV + TV + ERV", "B": "IRV + TV", "C": "ERV + RV", "D": "VC + RV", "choice_num": 4, "target": "B", "category": 1 }, { "id": "23de4414-73eb-546c-b9e4-3a488905992b", "question": "What volumes comprise FRC?", "A": "IRV + TV + ERV", "B": "IRV + TV", "C": "ERV + RV", "D": "VC + RV", "choice_num": 4, "target": "C", "category": 1 }, { "id": "bb6afd84-ef43-5261-83ab-ae5ad2a90dc4", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "cb0d389b-ebaa-5baf-9243-9e3791883dcc", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "67398cd4-f0b3-50e1-9ce1-26744ba4cf12", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6c963083-c759-53ba-9484-9b1b1f15e95d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "91fe16ba-c5a4-5236-838c-fb845036eedd", "question": "Which type of alveolar cells produces surfactant?", "A": "Type I", "B": "Type II", "C": "Type III", "D": "Type IV", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d1a16d6d-04b6-5a9c-85b6-1aaefa963037", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "4adc80db-f79f-5763-8307-d7c5a4bebb4d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "43b27697-7fab-5d14-9d9b-cd35f63544d1", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f7e7cab0-7025-5119-b625-aa9fcf6414ba", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "8a7f4f56-f904-544b-a71f-ebdb49e8fbdf", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8efe0c5c-710e-5d6e-b7ad-1bbf2e9c6d76", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "791d9d32-2d41-518e-99ba-dd5f43326968", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7c7ab101-5a97-5fd5-8d2e-a3050b99683f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "500db74c-4447-56d3-b56b-7864d821de6a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7cd97bc9-a105-5b0d-93df-9cf68cd64bb1", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6aa7cf81-3f82-5d80-9601-1f3f9001f888", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "dee78a7d-9068-5cca-838d-e32f851352f4", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5ea2755f-c289-5768-b72c-743de2849f50", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "245e9c49-eb8e-5e6c-a364-e802a1ae3b83", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "a73f5302-16b8-5477-9de8-8891e00b6c18", "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%", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c6a84037-19bf-583d-8570-e53a101dde94", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3e4772c4-e063-56e0-9773-169ec8e284ce", "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).", "choice_num": 4, "target": "A", "category": 1 }, { "id": "648a40ca-13c8-50e8-a1ec-5efd4aa0fc12", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "53765e0a-d886-5522-8603-7d2f3f5196ce", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f545b1ce-5532-5c13-af94-84c1b31a4036", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0c325aa4-5589-51be-a451-5772e543582f", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "daa73226-a6e0-5a2a-8840-e2b543f5f456", "question": "Interpret this ABG: pH = 7.18, CO2 = 38, HCO3 = 16", "A": "Metabolic acidosis", "B": "Metabolic alkalosis", "C": "Respiratory acidosis", "D": "Respiratory alkalosis", "choice_num": 4, "target": "A", "category": 2 }, { "id": "33df2df2-e193-53a3-bc1d-a39a59c295f6", "question": "Interpret this ABG: pH = 7.60, CO2 = 37, HCO3 = 35", "A": "Metabolic acidosis", "B": "Metabolic alkalosis", "C": "Respiratory acidosis", "D": "Respiratory alkalosis", "choice_num": 4, "target": "B", "category": 2 }, { "id": "c9d529b4-7d4f-5cd7-960d-f159c92a7f40", "question": "The respiratory centers in the brain are located in which one of the following?", "A": "Cerebrum", "B": "Cerebellum", "C": "Brainstem", "D": "Spinal cord", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2273a1a7-2dc9-5014-8071-86c87501b39d", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "02fec6f5-e07d-5db6-aca2-9a1cda5e7886", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "45696ae6-6a1d-5d36-9f7a-6676f8884e85", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "153a64aa-21e5-53fa-b68a-850407518850", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "446e1b82-6738-5687-ba3f-07d07471b3a9", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b291a79f-1aa7-5605-b080-9aea3599a1bf", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5de0c7a5-077c-5075-acb8-242bf65c3c54", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "859b4e21-891a-57f0-8163-c75799c15cbd", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e3256784-65f3-554e-8b3f-16ea7603baf6", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9377e3b9-e1c5-5307-b0e9-8c801d22932a", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1fa884b1-9eee-572a-88d7-99bf05267d17", "question": "Bronchodilators, such as albuterol, act on which type of receptor?", "A": "α1-Adrenergic", "B": "α2-Adrenergic", "C": "β1-Adrenergic", "D": "β2-Adrenergic", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a88329ab-fe85-51f1-9c0c-b8c09551feb1", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1ce44eb6-14db-52ec-9807-24cd1291b059", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a233f290-b124-5f11-b0b5-c550e9333744", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5c92c38e-7c1e-5d9a-b9cc-0473f39f02cd", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ffd67eb3-656e-54d0-8fcb-056e8cddb44e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "92b1d6fe-cea4-509e-8613-6fee0e4fcddd", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7b84091c-17cd-5f26-a0f0-4c31e8d3fef9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "bbe09804-2f99-5a0f-a174-c30959336bb8", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "446af164-074a-5304-8e9d-e9f130cae665", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "fa1bf99a-6af4-59f4-85ef-76407f733016", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e87858f7-7eb2-5d7c-8330-dfaa24380369", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "97e55170-49b9-5d00-b9dd-bb393dfe93cb", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "b97511d5-bc4e-52b9-a670-d087e67fc0c2", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "153b74c5-e0b5-5714-9d93-6152cdbad46c", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8e206f78-f505-524b-87c4-17d79b9e160f", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b7f73e08-2caa-53f1-9a7a-037bdfe47df6", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "89aa5dc1-b5e8-5945-bfe0-e8c4f3fffae3", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5d800ccd-f37e-5545-bfb2-e794d37fbb11", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5ae13f2d-2c5f-5762-aa77-c297b6d822e6", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "18ce551c-277c-55db-b94b-078b09da9083", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2544d08e-68cd-52fe-b846-2f7796feab47", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "998fc416-51f3-5780-9a6f-5cb8f811459f", "question": "Which of the following tissues has the greatest capillary density?", "A": "Fat", "B": "Cartilage", "C": "Bone", "D": "Skeletal muscle", "choice_num": 4, "target": "D", "category": 1 }, { "id": "97e2be7f-20bf-54e9-a7a7-d799c0090ed5", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "048e1af8-5265-5278-acbc-30dfa98fb719", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f3dc9654-da12-5697-a994-088054719a5a", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b4c9c684-3125-574f-907d-98a7ba6197c4", "question": "Approximately what percentage of cardiac output goes to the liver?", "A": "5%", "B": "10%", "C": "15%", "D": "25%", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d309139e-297c-55d1-84ae-39cdf6b8d559", "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)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "94cac3af-5192-5e3f-bb63-5a9f6a90e163", "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.", "choice_num": 4, "target": "A", "category": 2 }, { "id": "8c01f535-537b-5d48-a8e4-6b1a00324ea1", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "db7c5d8c-cb43-513a-b6a4-9aadd1db7b70", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "a6c6bc28-9872-58bc-9039-6140ce3c0f6d", "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.", "choice_num": 4, "target": "D", "category": 2 }, { "id": "95891ae5-2289-52e2-ace0-823b1dfb435f", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "fc463bc8-f1a4-57b9-90b1-28d2a6cbef24", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1498476c-4b64-54e4-aef4-113844344be0", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ed45e887-c68e-5caa-ba2a-83672bee4c4f", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "59b5afe1-1627-50e8-833e-01d88eb45dbf", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "267908ff-fd3f-5062-8054-292434a39112", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0f46c517-62f6-5b91-821c-5878734603a2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "082a7c62-0413-5486-b7e7-4613c45f39da", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5d294523-9bc4-5b07-b8da-067a911fffee", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0206fffe-46dc-5330-90fc-532590eb7e02", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "8329f640-2168-5f66-bfcc-db46c9b209ae", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1e0fc152-7550-5215-b072-00d46909a7ab", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "58f4a919-b2da-549f-80ab-5c2e5e8fe285", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "95722958-fb3d-5b11-b699-9b54b61d5e25", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "acbc7677-9285-520c-adae-d9caf08b079f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "cbfa8a95-cf2a-5285-8eb4-92d5a4bde7f9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "da551c17-2845-5cd6-8075-edb4aa0bc53f", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "360b5ce7-467d-54aa-a2ac-81d7b1fe0905", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "30e0cf97-bd9e-5d9d-a5bf-ee9caf0fed0d", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a25c919c-0522-5a8f-9173-fd86626dbaf9", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "934665f6-da70-53da-956a-12f0b0c526dd", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ad85c279-eff1-59c5-a20d-be846fe2421f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "abb8d19a-e997-500a-9cc5-edc588d54d3d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f8c71180-5d94-51fc-97c7-fbfc021e4d0f", "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 |", "choice_num": 4, "target": "A", "category": 2 }, { "id": "af6faa5c-f2ae-5320-85bc-30101b140df8", "question": "Which of the following is the MOST UNLIKELYcause of myocardial ischemia?", "A": "Severe tachycardia", "B": "Severe hypotension", "C": "Severe anemia", "D": "Severe hypokalemia", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9acac981-dc89-5da4-8383-e6ee53eba163", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f7fdedcc-f38d-5074-9115-5d5650e399c1", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8b9c3fe4-42fe-5a37-903e-6f77a50dc1ef", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "4425c3c4-f0ee-51b5-87df-209e85684de7", "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 |", "choice_num": 4, "target": "A", "category": 2 }, { "id": "4ba8ba4d-c9c0-5299-9aea-05298f5e3f62", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "dd94d180-a557-58fd-b2cc-6ad87901c31a", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "5802cac7-1dc7-5c41-aeb5-d876de59f9ab", "question": "What percentage of hepatic blood flow comes from the portal vein?", "A": "25%", "B": "50%", "C": "75%", "D": "90%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c54e1f2b-bbce-57da-bbad-a608629561a4", "question": "What percentage of oxygen delivery to the liver comes from the hepatic artery?", "A": "25%", "B": "50%", "C": "75%", "D": "90%", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a62536f1-8517-53c9-b5bc-ad57fd301975", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "05ac8484-e000-5207-9231-5aee7b7a38bf", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4a78dc65-d5d7-5755-b4a0-0fafb7020635", "question": "Which of the following signaling factors is decreased in a cirrhotic liver?", "A": "Nitric oxide", "B": "Endothelin", "C": "Norepinephrine", "D": "Thromboxane A2", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d725bd35-f37d-57c9-925b-94cecc9758ad", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "03287ed4-346a-5630-a319-ce084d8c4f12", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e893eec1-777c-5c26-8d6c-d61c220f0254", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "15cf3859-1f54-57fd-a79c-b5e99c04d636", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "66e8a183-22ae-57b6-a950-2b68f3b45ff4", "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)", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d099fe56-4855-5fdc-95b8-0bb18b951461", "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)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5c22413b-0b8d-5825-b20f-8987f0f7be7b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "21ad81ec-c414-5ff7-9084-7dcc69eca92c", "question": "The level of which coagulation factor may not be affected by advanced liver disease?", "A": "II", "B": "V", "C": "VII", "D": "VIII", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9cdc906d-1a75-5039-b7a9-cbb45dad5430", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d8931793-2391-54a9-a3ee-c57dac39cd10", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6765f344-32cf-5234-b788-62793909b5a1", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "048cc8b5-4f65-5659-b039-b8efec3bd577", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e0408564-e497-5016-838a-d90a978ac5dd", "question": "Inducers of cytochrome P450 system include all of the following EXCEPT which one?", "A": "Ethanol", "B": "Phenytoin", "C": "Isoniazid", "D": "Rifampin", "choice_num": 4, "target": "C", "category": 1 }, { "id": "dfb63db2-dbd4-5129-8517-e2d714ad84e4", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "28d37126-1d53-5a7b-8126-26acd2d5cf8d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "67e06cd2-9541-5061-b81c-b7930cae2788", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d47389af-bcc1-548b-af1b-3126a6317b01", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f1bb30d5-4b0c-51e5-bbf2-a33baf2be790", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f5c09835-f5b9-56f4-a0f9-1d4660c60744", "question": "Sodium reabsorption in the distal nephron (connecting the segment and", "A": "Aldosterone", "B": "Angiotensin II", "C": "Vasopressin", "D": "Renin", "choice_num": 4, "target": "A", "category": 1 }, { "id": "24df18b2-9733-5c85-8ae1-056b22d12d42", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "bba94c6b-8526-5739-9abe-9d3bf315d15b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e74d08cf-6cf0-5ece-b604-c443c92e2534", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8d7ac41c-9c1b-57b1-a67f-2f2114d45c0f", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c13f75bb-cdca-5dce-80c5-9a886a338793", "question": "RBF represents what fraction of cardiac output?", "A": "10%", "B": "25%", "C": "40%", "D": "50%", "choice_num": 4, "target": "B", "category": 1 }, { "id": "06348ebd-b381-5269-ad6c-a303ab46ae53", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7a3ce04e-5cb3-56f1-99ce-fc6acfcfc248", "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) |", "choice_num": 4, "target": "D", "category": 2 }, { "id": "8abf576f-873b-521b-8856-e78d29494f8d", "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%", "choice_num": 4, "target": "B", "category": 1 }, { "id": "092ffc73-3572-5ef0-acc6-386caf36723f", "question": "Where is angiotensinogen produced?", "A": "Kidney", "B": "Lung", "C": "Liver", "D": "Muscle", "choice_num": 4, "target": "C", "category": 1 }, { "id": "993619b7-a947-58ae-b287-3bcf58f5be87", "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)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "66490fcf-08ee-530c-989b-8ce53e15868b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f8f9d032-eba2-5279-b717-0eb7b4612bf9", "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 |", "choice_num": 4, "target": "D", "category": 1 }, { "id": "52cf6ead-ad84-52ff-92aa-8d3642654b71", "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 |", "choice_num": 4, "target": "B", "category": 1 }, { "id": "906e8f64-8d29-5046-98a2-f70a540129da", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "003114ff-e336-514e-8621-519789052303", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c0cc840f-8707-53b4-af5d-1fbe9e3b2c57", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "2587235c-01d8-5930-b44a-aedab20adb63", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "aac0a4b5-8981-590a-83dc-1b04474788a6", "question": "An increase in which of the following ions will decrease the strong ion difference (SID)?", "A": "Calcium", "B": "Sodium", "C": "Chloride", "D": "Magnesium", "choice_num": 4, "target": "C", "category": 1 }, { "id": "caae5666-0a8b-5eaf-8220-988c64cef317", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0abac0e5-de25-588d-b9a6-e551373ad5a5", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "046f7b6d-20a3-58ee-8866-a7cb88dad61d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "718153ee-4dc4-53f5-b895-618674ee3671", "question": "Increased levels of normeperidine, seen in patients with renal failure, are associated with what symptoms?", "A": "Emesis", "B": "Seizures", "C": "Bradycardia", "D": "Hypotension", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b854966a-ce0a-5777-95b0-df69a347ddc9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "936ad7b7-7147-5fb8-a247-5e4da776ccca", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6ffbe3f9-0aea-53c2-95ef-4abfa8af5dc5", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e51a49f7-7756-54aa-bc8a-5386182071fc", "question": "What is the primary form of elimination of vecuronium?", "A": "Renal excretion", "B": "Biliary excretion", "C": "Degradation by nonspecific esterases", "D": "Hoffman elimination", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9e589a44-7b04-5a41-99d3-0f409a4414a4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d1754447-b9cb-52d8-b352-33e492f72de6", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "901ebed5-ce68-5896-8197-f0c5adba1122", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c8eddb3f-8985-56b6-9aa6-ebd833a568c4", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3e6005a3-ca56-5777-81bb-2f72ef0b9217", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "848960df-c5f6-55c6-8e08-d8666d6cd558", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f052ddd8-27e9-5960-b507-478325ca4194", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0274741f-1505-5c71-a324-848eaa93b643", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9aae22b9-e40f-50da-89f6-372c346dcb54", "question": "Which of the following electrolyte abnormalities is most likely to be seen with uremia?", "A": "Hypokalemia", "B": "Hypernatremia", "C": "Hyperphosphatemia", "D": "Hypomagnesemia", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a6d3842a-3d61-59c6-ba58-d10fbf0cb63c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b19acb01-ab45-5e7d-8000-f087e7d36bc4", "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)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7e3edd74-e1e5-5675-becf-598db4257243", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6538fe22-08cf-5fd7-8c2a-c0615ad1b2e5", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8b4f9e88-6250-57f2-b156-bd50447b26fe", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d23382d1-754b-5157-8f69-a7b9cca49431", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f2e07e57-8540-5e1d-871a-22892b5a63ef", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "adbd859b-66df-5dd1-8aba-f1117e5d422e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e2a2c722-d6b8-5089-b729-3a85d379aac8", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0f4c02bf-29de-51f6-ac3b-45525895f2f3", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "56f4a95c-4b5f-5f67-9601-6d1d675c355e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "639ab579-0252-5ff6-bcce-f12c40842480", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "957b2369-ceb5-5fe0-856d-4fa34cc182f6", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "deb6367a-356d-58c4-9574-4a9a08f8cf22", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "ffa59f8e-77ab-5413-860b-fbe1428b7802", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2576f3bb-d3cd-5e8c-b74b-a77fddf5bf60", "question": "Eptifibatide (integrellin) is an inhibitor of which of the following?", "A": "Cyclooxygenase", "B": "Phosphodiesterase", "C": "ADP receptors", "D": "GP IIb/IIIa receptors", "choice_num": 4, "target": "D", "category": 1 }, { "id": "240c6416-ab19-562e-936d-d06f583ef0f4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "50568e83-8765-5e0e-affa-79c43ef8714f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "279e7f30-b00b-5658-8c94-b3f871ceecfe", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c1de9c0b-efd2-51a8-b1dc-c9984fd79081", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a96f2832-8f0e-5717-bcb7-8b458abbfd31", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b95ce0f1-be9e-5b6a-b793-a44fa8085017", "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.", "choice_num": 4, "target": "C", "category": 3 }, { "id": "03e59db0-b606-5279-adb7-b1b3ed0047a6", "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%", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ea6db718-69b2-542e-92f1-ca30a63a41d5", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9efd5ff2-da5f-57e2-857d-2769053f2c7b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5d0671ee-499b-5ca9-ae9c-50b957b6f06d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7e2dcd0a-5198-5d1e-b9d1-0878bb8e5697", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fa13d773-3458-54a6-8cd6-7f60acfd0e38", "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).", "choice_num": 4, "target": "A", "category": 1 }, { "id": "546b6255-752b-5e6f-ac19-c2cad07129d6", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c478f37e-b16d-5a26-ad9c-bae749d58211", "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)", "choice_num": 4, "target": "B", "category": 1 }, { "id": "bfabd796-9dfc-57b1-b9c0-a1b01d379c27", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "7071feb3-e583-5691-8595-f354e286cd52", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "66ebc394-a304-5837-a8bd-70f5d8b1262c", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c57e3e9c-5801-5243-baac-0621b1540c13", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b6e46dce-35fc-5290-9daa-e8e2a2245079", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "7ec7bae3-4d5f-5b55-9dbb-beeb0e0ec35a", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "7082c677-c0d4-51cd-ad11-c5a46849cf50", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "b145e766-ab15-5f31-91ba-ed52b52faf9d", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "eaf149d2-70ae-5bdf-8e5f-2aa9522fa5c8", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a1efff1d-18e9-555f-8271-fdcbce172d42", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "4d5f199d-9df8-51bf-9549-fc6e855f2d16", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ff91e6d8-656c-580c-bcdb-8bafec24ae8e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "561314d4-fc38-5ef2-9a25-6980b1dcfe87", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e073e9bf-176e-57c3-bf43-c3c81e6afcac", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ce35483c-34ec-5993-aef6-6501116c139d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "44e5e751-4398-5ecd-85f2-499868b933d0", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b271a8c1-eeed-51b0-a2c9-1554f7a2a9a4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5bf0bd53-fa49-53f4-bf80-7e469a3b923f", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1f68d89a-1547-55d0-83a9-b413f23f8821", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "09c55fbf-4272-5c1e-b52c-740fc738058e", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c710469b-0b0c-5c2e-8df4-390943710671", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1afd7adb-f5e3-51d1-8266-1ea89cfd9c6e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0a9092c4-cc37-5fdd-b315-594dff5c5a46", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "52342534-652b-5339-990b-8b89e2316044", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1b5ebcb5-efa9-5727-ab41-899046f7d0fb", "question": "Which of the following steroids lacks mineralocorticoid activity?", "A": "Hydrocortisone", "B": "Dexamethasone", "C": "Methylprednisolone", "D": "Prednisone", "choice_num": 4, "target": "B", "category": 1 }, { "id": "423f2d0d-10b9-5550-b416-2050b7df9030", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "c1283ad7-42cd-55da-ab63-1adf7cdf3a78", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "27f4d8a9-d0d4-5e5e-a5f3-cc08fd1a6248", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "65b1d2cd-e0e6-53f2-a9f3-190a5a4852f0", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "66052a1c-f3fe-5c08-bede-5a36c94008f3", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "32574c1c-4ccb-5b4f-b438-c38efefc3d07", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "97552047-84fc-58a6-9eec-987f550e94b4", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "557a70cc-1b04-5e62-bafd-a55444698b05", "question": "The process of glycolysis converts glucose into what molecule?", "A": "NADPH", "B": "Acetyl-CoA", "C": "Pyruvate", "D": "Lactate", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4bd79704-403b-5c05-a7ac-77885f031c2e", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3fb44b19-d1f1-554b-bdb6-1d08ac1988d5", "question": "Which of the following molecules accelerates the Krebs cycle via activation of pyruvate dehydrogenase phosphatase?", "A": "Citrate", "B": "ATP", "C": "NADH", "D": "Calcium", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3d82c877-f973-5c93-8c17-521d663e2eb2", "question": "Which of the following is the final acceptor of electrons in the electron transport chain?", "A": "NADH", "B": "NAD+", "C": "Oxygen", "D": "FADH+", "choice_num": 4, "target": "C", "category": 1 }, { "id": "97cf3577-fecc-502d-b53c-758b27b77616", "question": "Which of the following organs is/are responsible for gluconeogenesis?", "A": "Liver only", "B": "Kidney only", "C": "Brain", "D": "Liver and kidney", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9454e8ce-f874-52fe-833a-13e5ed9f6658", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5280a74b-c7d3-5e69-b08a-6a202ee89b2c", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "08ab5d85-c1b3-54da-8e0b-7a967dcf1db2", "question": "Patients with pancreatic exocrine insufficiency are at risk for which vitamin deficiency?", "A": "Thiamine", "B": "Pyridoxine", "C": "Vitamin B12", "D": "Vitamin D", "choice_num": 4, "target": "D", "category": 1 }, { "id": "bfbc5d3d-9d6e-53d2-a0e0-1bbf5c40884f", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "438c91a2-4cc8-5e9d-ae32-bec01b44c50b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8cd5aa45-10fd-5749-800e-b594d0667cd3", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "fb56bf4b-7c88-5009-bc69-bec39627fd79", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "326875f7-9eb9-51b8-a1ec-019f1adf6050", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "77fc4e14-504c-5e92-aa58-495d1fca6b65", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f4882c75-f69b-5ec5-8a79-ff7f104c3d53", "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 )", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d108d930-1daa-5af1-a350-2f67c2a42d04", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "26147abf-0ab1-5b4b-b5bf-a9f0b4621856", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "12b13e09-a62e-5aab-85f5-a76ca888fea3", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "de45b5ba-54f6-5294-8195-34c3258a59e2", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0d3d9164-6e47-553b-bcd3-4026111d407c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6042e6a4-ad35-5994-a0e2-45b36a16d151", "question": "All of the following drugs inhibit nAchRs EXCEPT which one?", "A": "α-Bungarotoxin", "B": "Curare", "C": "Pancuronium", "D": "Atropine", "choice_num": 4, "target": "D", "category": 1 }, { "id": "180544e1-cd65-5d0f-a468-2dd742a6b106", "question": "Ca +2 binding to which component of the NMJ induces muscle contraction?", "A": "Actin", "B": "Thin filaments", "C": "Troponin", "D": "Nicotinic acetylcholine receptor", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d3883a5f-9946-5fd7-a142-d7862136c82c", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "53abfdd5-a5ab-5709-a190-b771b1a9a8eb", "question": "Which subunit of the nAchR is present in receptors located at the endplate", "A": "β", "B": "γ", "C": "δ", "D": "ε", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6a50e318-18ac-562c-ae52-a75978a23ec0", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d0b646aa-a0cf-577a-adba-aa26d8a6eaa5", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "20e6a087-b407-5a78-b42f-15ce68ef46b6", "question": "Synthesis of Ach is facilitated by which enzyme?", "A": "Acetylcholinesterase", "B": "Choline acetyltransferase", "C": "Choline kinase", "D": "Choline transporter", "choice_num": 4, "target": "B", "category": 1 }, { "id": "84207d85-73ae-5d2e-b7f6-d567129086e4", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "dcf08f50-2b5c-5015-9e7c-52537651e43d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "535013b0-01a0-5c1b-8b85-f1cbf168b3c1", "question": "Potential adverse effects of succinylcholine include all of the following", "A": "Myalgia", "B": "Aspiration", "C": "Increased intraocular pressure", "D": "Anaphylaxis", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b00a3661-34d8-5811-80e6-decf62f79ab7", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "54cd671a-a918-5966-8fd9-9e18141dfdaf", "question": "Which of the following agents belongs to the group of benzylisoquinolinium NMBs?", "A": "Rocuronium", "B": "Cisatracurium", "C": "Vecuronium", "D": "Succinylcholine", "choice_num": 4, "target": "B", "category": 1 }, { "id": "45ac23e4-707d-56b0-8201-2b05c045855c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1dde24f4-41ab-55a6-94f8-ce1e221ca57e", "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.", "choice_num": 4, "target": "A", "category": 2 }, { "id": "d44dfadd-73d3-552c-ab86-1d12904f6223", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2f1ba421-ae99-558c-be7e-566bf0016105", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cf9d4ddd-5e1b-5db8-8650-52ba83021002", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "c526c925-cd8f-5c88-bca3-39165f2825a0", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d96f3a35-db60-5a4d-9888-75438d0b1847", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "14f86c97-64ee-527f-b8d1-115f76c54b69", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6132e1c3-39d2-5cbc-ae92-4343884d22dd", "question": "When the TOF ratio is 0.7, what portion of the AchRs is still blocked?", "A": "25%", "B": "50%", "C": "75%", "D": "95%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4ff0e835-3552-5798-99d3-716a87b78538", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "49ff5b5c-0de7-5f5e-a462-9eca8330aee3", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "384a4cb1-5c58-557a-9154-efac08b712a4", "question": "Side effects of neostigmine include all of the following EXCEPT which one?", "A": "Salivation", "B": "Tachycardia", "C": "Nausea/vomiting", "D": "Bowel motility", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c5685d82-1108-5503-827d-4dc7e5bafc47", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5fff6467-2f2a-5947-987f-ded6fcd05c8f", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a0ebfcaf-6d6b-5f94-8aa2-fc2d600700f5", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "a0a13a0b-de7e-519b-bf6a-da9578152d3f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d66fb32e-6a02-565c-bbc9-1957c367b663", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7e29109e-a782-5049-af07-c3951d77a47d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "804c4185-0303-5e8e-9415-715cd5536446", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "60aaaed5-4bbe-591d-8ee2-c6e42f405391", "question": "Which intravenous anesthetic agent should be avoided in patients with mitochondrial myopathy?", "A": "Propofol", "B": "Etomidate", "C": "Ketamine", "D": "Dexmedetomidine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "72019bfe-9bec-5f04-9966-4d254d122ea7", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "15d89010-3b34-536b-985a-ec5ab970c575", "question": "Which intravenous fluid should be avoided in patients with mitochondrial disorder?", "A": "Normal saline", "B": "Lactated Ringer (LR)", "C": "Dextrose", "D": "Albumin", "choice_num": 4, "target": "B", "category": 2 }, { "id": "219b7490-11e7-52ad-9ed2-fddf2a75ef8c", "question": "Psuedocholinesterase activity is increased in which of the following conditions?", "A": "Pregnancy", "B": "Liver failure", "C": "Obesity", "D": "Malignancy", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6865a162-81ed-58a8-86e5-0b0e240f17a5", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3ba83abb-5b8d-5fca-aba7-4518ddc2267e", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "181a188e-7098-51b1-8b8e-2392099efa38", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "493bf095-37ca-5cb0-826e-236fa96be54c", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "43e9629d-7887-5cd7-a593-c7dc10db4fce", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "b6164e9e-c81d-5274-9ac6-dc0a43b8de55", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "57daf25f-78bd-53fa-ab9e-f2f26ceabdb1", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "94fc812f-25f7-58be-944f-f046b91db848", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "657083d9-acc2-5152-89ac-ade610bbdf8a", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4ffab09c-edf4-5368-ad56-9db9b8e799dd", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2d85a6e9-3a47-512f-bc13-af62a46e200b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6f50d02f-773e-55fd-8692-2cca1a8e1f13", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7f3ada42-e493-56a2-adde-f739e200155e", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "919dfe3f-395a-5869-9f76-6d1dd2de4395", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "bf9d10f6-d0b0-5910-b08b-50d8f8cabe71", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "74938152-3c98-56a5-8058-818e5e3b316b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a9f0e0eb-75b2-5474-9228-eea3d0abe091", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b47851e4-ca76-5490-8f40-990b97328344", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3de2842f-5ac4-5fe7-bcc4-5f8304c7d626", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "11fa4608-471d-56ec-adbd-49a7be88dbcd", "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)", "choice_num": 5, "target": "D", "category": 2 }, { "id": "965eb423-d717-5a3f-91c1-867a7a438ed2", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "0555dcfb-033b-5416-9bcd-24184aec7bdc", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "2624a1d4-49ee-5f04-b0ff-645760f589c9", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "16c7afba-a36c-5819-8ac1-baa73775e6b7", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "1fb3db44-d115-5ca7-9577-e5f3f9612bf5", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2f4afaab-46a5-50c2-bcf9-b9f8f003e942", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "81a96f64-4cb6-5100-9460-690ca5c1eab3", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "849f9a29-8bc5-5ee2-8488-05fe97e4c009", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "2e6a9c77-7105-5cef-8b1c-900293a231cf", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cd453c90-5e98-5387-ba45-c4a2835c893d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ad58e752-361a-5439-83a3-bf2136e6964b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9afc5c67-415c-598c-8e8e-4aed27c060cb", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "96139dc6-342c-5a5b-bbc0-f4840d343ab8", "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", "choice_num": 6, "target": "A", "category": 2 }, { "id": "31e53e79-ac63-5544-92f0-5f2ce511382c", "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", "choice_num": 6, "target": "A", "category": 3 }, { "id": "2b38ad39-1833-5b4c-8814-79704fafd75b", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "b3c2b78f-27e0-549f-aab5-700d595a52a3", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "23e4eda4-8077-5840-ac46-55fcac2c360e", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2f805ed4-432d-55c0-9c29-68adfb4eec36", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1f398851-394c-5ba1-876b-3a132c6e65a6", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "396f454e-998b-5be9-8b47-d29badfa466c", "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)", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cee831b2-724d-5fdc-8bd1-57d28cee546e", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "7630e341-f885-5437-9b8a-76fee6e2fe4b", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "fc17c02b-a78a-5abe-bac4-ca098cd019c5", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "dba08939-7f44-57e7-b847-b1034c180b6a", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "87068bb2-34d3-5c75-978d-ec50fe32c0ea", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "9d7e0ca7-cec5-5c8a-afc1-7abea44b8d07", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1f51d995-5367-5e13-a279-a4976ecb1a70", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "dc1d4d32-5993-5189-8ffc-5b97d75a3b1c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "aa5eb5df-b929-5bb7-a9eb-f55496b0c312", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "faa9eb64-1dec-5a3d-84cd-0b01917fe83e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "07cc97b0-102a-59df-afac-85d79f47361e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7d198112-7f21-519a-9857-ae939c257f5c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "456258fb-2196-53d0-bea2-3fa5480c3501", "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%", "choice_num": 4, "target": "A", "category": 2 }, { "id": "c1ea6d13-a4da-5366-aa5a-6ae430d5cc62", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "28e40994-7e57-5f91-bbe6-3080b23448bb", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "a1d1d855-79b4-5ee2-8928-9ad4240eb1c8", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2d48433e-3ccf-5f6b-808f-e59d1657edda", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ebfa64d4-525a-5671-9c0e-b3bbb2cd446b", "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.", "choice_num": 4, "target": "A", "category": 2 }, { "id": "6d35883d-ce9f-5fc3-8bf3-8d3eb44abc69", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "bd4d3267-d8af-5e47-b848-171d39c32f42", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "66dc6c0a-cb3b-589f-ab33-392d32a67739", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "3be699df-499d-5bda-9411-a2a846c15c91", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ca047e42-8f34-58b8-8f0d-33865c012b3b", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "9bd0b727-6186-5853-bfda-11551de0c271", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d535a56b-3d41-5b90-9b6a-769430a16d53", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "b28ca67d-279b-5348-b23d-3bf82681febf", "question": "Which of the following areas is targeted by SCSs?", "A": "Dorsal columns", "B": "Lateral corticospinal tract", "C": "Botzinger complex", "D": "Peripheral nerves", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e5a9b617-9172-5863-a319-fa4a9b457973", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "79575af3-9282-5407-803f-38efd5384065", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "dc4195a9-9b9c-56dc-bf01-cd684b66df31", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "f0845d9b-300d-5502-9249-c79d2e76f557", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "6f3ba33d-56eb-53e3-8e46-e28d6fef4bae", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "59d5f9af-f03c-5751-a624-22acfcc80c2d", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "1821b106-2db3-53f1-80c8-3ae17810686d", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "13b35c56-d551-56b7-8df4-3162aa1c6562", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8ffcf6d7-8375-5e6d-a59c-1864ea4b81d7", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "cf79ad7e-e318-51d8-8a7e-42b58cbbd8e2", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3d0fe68e-b6d2-5e57-994b-b8f60b7ce900", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "3d317223-0b00-59dc-81a7-72d0e1de4267", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "094663f7-8328-53ee-b206-413d78293c2f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b5adba46-2e7d-5265-85c4-bc935af52943", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ec4db7a2-6149-5db7-9ee5-c0555176302f", "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.", "choice_num": 4, "target": "D", "category": 2 }, { "id": "f2144623-db6d-5262-8a59-56fd9842f1ae", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5b1207ed-673c-5753-bd89-239ab967a3a9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7b49ee47-4064-5909-b992-b3588e8521ff", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6d569186-da48-5cda-8c82-c646487f6d0f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0f4f642e-de0f-5fa9-aee3-a54447857675", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9f883f21-29c0-588d-96cd-c12594340b28", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "af21ea2e-c242-5b01-8790-e3fcc1417539", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0ea3218a-2cd3-5223-b99b-28bcf73cf77d", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "15705985-4e9b-5052-83ad-4226def8b51d", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "57420f6d-1618-5dd8-8d2c-fa431ca5a1cc", "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.", "choice_num": 4, "target": "A", "category": 2 }, { "id": "f64f766d-abaf-5ac7-b306-cf6f0c39e490", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "549f1e72-f698-5e64-b18b-ad6f96ab6053", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4626a62e-c709-588f-ac8f-35c085126cd6", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "702bbfa5-8a77-585e-bbc2-604af4c81492", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "69732d9c-fea6-5958-8ecc-7b326d8fd40d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ea295afb-f89c-5889-9e3a-dd7498446130", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e7200a91-dcae-555a-b288-d3c14a0edd8e", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "44c53a0b-b837-5e63-afa7-a9aaa745f040", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "cc880b64-ca00-5e77-ad82-bd6d7611b8ba", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2a963f14-08c2-57f0-a04a-394fa0e4583c", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "671ebcfb-737e-5c8c-913d-0a801b24b412", "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.", "choice_num": 5, "target": "A", "category": 1 }, { "id": "e381e427-f640-59b2-b905-b9ababa26d5b", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3e5f393d-c1e2-5e90-951b-3b50eceaac8b", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "e53f568e-d77c-5d97-b666-be967cf74f30", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "a0f4806b-c919-584b-834e-71bacdfcdde6", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "e71f8351-55a7-5521-8f3f-dd4a859784e1", "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.", "choice_num": 5, "target": "C", "category": 2 }, { "id": "664227d1-ec09-5093-bb43-b1f461b45da8", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "de9b812a-8b70-51d9-aaa1-dcd49045d801", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "76ad2271-407e-530e-94ae-6137ab60861d", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "1ad7d2a8-7aa5-521b-bbfe-cc1df4271fab", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "23fcaf3d-b966-55b2-b14b-7d667b8e784e", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "53dd6d04-80a2-5a8a-8fa0-10063b96f01d", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "6a087fa5-28a3-5012-ab0b-4351f9baecf3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "72155fef-1b52-58cf-95a0-24003eb9027d", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "5bd10b71-3dda-5346-8225-e8121694f394", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "8bc9fcb7-9320-5516-95d1-aa254d4f7541", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "36d3e605-7377-5e69-a804-6134489c7316", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "295c1a77-a534-5cbe-bfc9-e2eddad416e5", "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.", "choice_num": 5, "target": "D", "category": 2 }, { "id": "c846e5f9-1434-57c2-ad29-7e10184e012c", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "a8a5b497-2309-51f3-8cc7-00efad9cc289", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "1bc479c5-c92b-5020-86a8-0362582e7607", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "d5b1846d-23a7-528a-9e20-3ac4fdbb5101", "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.", "choice_num": 5, "target": "A", "category": 1 }, { "id": "159c9ce3-8c5c-59b2-b780-02aeac60a4fa", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "7868657c-40bc-5013-8e72-c3969930699a", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "3f6aceb3-ea06-5a68-bd20-03f33122f62c", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "2ce7f3dd-d4a3-58b3-a8cc-8b4bebd5dcbe", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "15369de9-60dd-5319-8e04-9626c96b93eb", "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)", "choice_num": 5, "target": "A", "category": 1 }, { "id": "c0f185cf-860a-5d65-bf4d-5585546333c6", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "dc00b397-1639-5976-93ba-efaedfcbecd2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a7b67b6f-d3d0-524b-8fbe-61c219e5c731", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9990ebbb-bb9e-5882-9168-510d40602fa7", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "1e8b7948-c561-5c77-a883-8177ab1088b0", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "17c9fb48-688e-5fea-aeb2-66f762b1f655", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ceca468b-7685-5366-85be-948934e975bc", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "4c5b320b-023d-54aa-9b23-14ce311e6a6d", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "9b6fd654-97e2-52e3-92b5-e721cbdc63eb", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4130d7ce-7d15-596d-91b1-8ae4303cbcf4", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "b7013e2b-f325-5bba-8afe-7bc4ff9767e7", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "144a7b6c-681b-53fc-9e0c-322a3a5ad396", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "48a280c8-2eee-5fbc-8bd6-c89e1f015212", "question": "The P50 of fetal hemoglobin is which of the following?", "A": "15", "B": "20", "C": "27", "D": "32", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b12a7975-b8f8-5652-92ba-c07fb0f3f37c", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "71beac74-7b21-5388-a3e4-de91dc989cb5", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "a8518751-83e6-551d-b350-f0ba02a28dea", "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.", "choice_num": 5, "target": "D", "category": 3 }, { "id": "662bb979-77eb-526d-bbfc-ddcd49ecf918", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "73f23b78-cfb9-5324-941a-92f54cdeffcd", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "7bfb30ac-f0bf-5059-8c90-dc6bafd2cf29", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "91c3ad56-2e52-5d63-bd22-550f81b7a339", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "143a02dc-cd1d-5715-a192-3b15e40e178b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0290ee29-306e-5a3b-9173-3f1283858a16", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "8c0dd17f-a6e3-51f2-86cd-70b33645dc3c", "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)", "choice_num": 5, "target": "A", "category": 1 }, { "id": "d1f29e72-3289-5223-be22-2de8478b5d44", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7fce1074-8403-54d0-8f60-f7ff60fc47a8", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "f39189cf-a820-55b8-a922-a13f4b69a915", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "cb25967b-3c34-50d3-be34-8524b8e04dc0", "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.", "choice_num": 5, "target": "A", "category": 1 }, { "id": "aaf2856d-cc60-519c-92f8-cc4de2aa2ebc", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "ff3e02be-95fb-5aa6-81bf-538f17c8b71f", "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.", "choice_num": 5, "target": "E", "category": 1 }, { "id": "5bb35384-1164-5b16-9064-d8903b2b2828", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "223e0e26-1ee2-5841-a3cd-7aee55f8ecc2", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "d720b6c5-5f5b-5b29-a753-9fd679f0476a", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "fc646010-a555-5ad5-bb2e-72e8d0f624eb", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "0a26c3e0-5d9e-5763-acf7-455d70fedd67", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "22a9228f-f15d-5ab1-8713-92c825edbbcb", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "dfe78e90-01ec-5b32-9b52-33f8868582bd", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "88647bbc-c04d-5a6a-8a16-a841cf4b5d2b", "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.", "choice_num": 5, "target": "A", "category": 1 }, { "id": "5f357a70-2a73-531b-9de4-2938e2134f45", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "d3c8f1b5-316a-5e9e-8b87-f7740fa90aef", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "96afea9c-4b55-5fa5-940f-c8d194dd3c9c", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "a88ab7c9-555c-51bd-b956-09c3c8a1c9ce", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2b6d7784-f7c1-5970-a682-8b34e7aa1b2b", "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%", "choice_num": 5, "target": "D", "category": 1 }, { "id": "4b9ad33c-25a9-5273-99fb-9daf6a4d7c14", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "2a7e4f74-197c-5770-9d86-580772e8e565", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "c272098e-4ce3-541a-a36b-31b38270a19a", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "5ece50d2-33c4-5760-a459-bf67e0fe9637", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "9249243e-eb12-5204-8432-eed4bad30447", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ef59cab2-de2b-53ec-aba3-85e63358029f", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "2f2bf7db-fe39-5cda-a1eb-975e172b55d3", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "cf1b4f4e-dfa0-58f8-9ea8-2a3a4c024f91", "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.", "choice_num": 5, "target": "D", "category": 2 }, { "id": "77119422-7141-5769-8cce-eca2c3026482", "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.", "choice_num": 5, "target": "E", "category": 1 }, { "id": "fae4f6a3-fc2b-53b1-96eb-25d45fd3e369", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "93d0fc02-aef4-5cd7-af05-5f3cdeb70159", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "dbc39872-e445-557b-b0a5-afaae47438f2", "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.", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ec1570ce-e82a-51a6-95af-951fda634026", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "91ac74d5-ef6b-5a26-8ad7-332e9b192593", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "34a55d3e-6c05-58f9-955f-3df9ada40412", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "23b633ac-c8ee-59ff-8a45-a9fa225d630a", "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.", "choice_num": 5, "target": "E", "category": 1 }, { "id": "364c3087-0fa0-506f-84ee-c4d8a292296d", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "5c12121d-baba-57aa-8bf7-a35cb9ca3592", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "3e0cbedb-de04-5605-91e5-f719ba0406f0", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "45939f65-726a-5bda-98ae-e2b4aeb0cdcf", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2e447d47-78be-55ff-bc0e-abe3b752234a", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "1b8f385c-f168-54e0-b75f-fcec9cd9f56b", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "50d82b12-6876-5bf9-a843-da17ea50bf24", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "c84fa092-43e4-5a8f-be14-a8dea81a9773", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "fa0c4a80-a347-5122-8330-97cb2cf5b6d0", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "59a0bda3-f4ef-5334-b9d1-d370ab2d9dff", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "ca75dbd4-a6be-586f-9bfc-0f921d5ee1a5", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "d79cadc3-15b6-5f21-b399-e2e22114f5d9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "78f47e09-9b94-5431-a66c-4bc8ad932266", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "157201a3-b2cf-5534-b129-d25587b7e167", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5f162bdd-6680-5783-8131-138d0ca0373e", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "78d1bb52-b5d9-5c3b-a160-00753dbf29a7", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "56ba7314-388f-5951-a4cd-08b39afb751d", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "3b80ebd2-bab9-5660-9031-9a78418f5cd6", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "1d97bff8-af4f-522e-b418-e0b7010df2f2", "question": "When used alone, which ECG lead will most likely detect intraoperative myocardial ischemia?", "A": "aVL", "B": "II", "C": "V4", "D": "V5", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d316e6c7-fd64-5487-8d7f-f365e7b77a3d", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "5f8d574f-60cb-5e25-9171-1909181ce8cc", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "b4e84e23-7570-5708-a6a7-6012fe9af85f", "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.", "choice_num": 4, "target": "C", "category": 2 }, { "id": "f9f44cc8-2710-572b-b681-b5d11efc657c", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "560d3ed0-d42e-590d-a328-5fd67db5edd0", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1e5c7646-839c-54af-92c6-292536382b76", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e6447c4b-c1c7-5a1d-82ca-97cd1282551f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e3934282-4f43-5a00-b816-4b2a8cdc6236", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "eeb42aa7-9f0a-58cc-9ef1-909c3124bec9", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "a1d33b4e-25ab-5166-91ab-d698077064c8", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "7ce216a5-450b-50fb-b1c2-4e6578445e60", "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.", "choice_num": 4, "target": "D", "category": 2 }, { "id": "6b28279d-9d1d-5064-84ac-cebd41de5cd7", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "491ee193-a732-5189-a24f-de27591ee8c4", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "ffa98143-17c7-51fa-9ad9-70fd65848de0", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "18d7b990-5550-5a2a-8d4a-4aa877b6f069", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "fde7962a-930b-57ac-96b1-764338e6e667", "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.", "choice_num": 4, "target": "C", "category": 3 }, { "id": "d2e1d308-7d3d-5e4d-8799-021db5c4636a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2b582a3d-ff9e-500a-8eb5-b28ca84c8cd4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9edb7abf-89c3-5ae0-b8d5-f6c86d2012e9", "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)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d361dfe0-2565-56f7-a3c6-9db07e4beca4", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "cba61d18-0a02-583f-8ffc-1fb090d9280e", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "f575a4f4-9039-5720-b3fb-b413557cd49e", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "97054359-6ab8-526b-bc0c-65839ca1417b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ea276da0-28b5-50f3-b24f-c92c55858e8d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7b0e1ea1-18d4-581b-995e-3ea08520c51a", "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 |", "choice_num": 4, "target": "D", "category": 2 }, { "id": "8d05f78c-6eba-5231-b10c-821f718861ce", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "236acb71-5de5-5419-8b82-68c16984c8de", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "267ee312-185e-599d-87b0-3870db66530b", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7f9598b0-ffb9-5a36-916c-025aca7ead3f", "question": "Which of the following antihypertensives should be held for 12-24 hours preoperatively?", "A": "Captopril", "B": "Labetalol", "C": "Amlodipine", "D": "Clonidine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c7516c0a-2568-54ec-a17c-944974bedb1a", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "6251ac42-e118-52a1-8ece-8783767f8752", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "40fd069a-c716-5de3-9843-9bfe04d694ac", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cba4bc9e-9d22-5b0e-8829-043ecb4e6a5a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "495fae7a-db09-533e-aefb-92b9741a21e7", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c6ba1455-9287-5466-a759-8c66f137d796", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "db51f659-2809-5e76-af93-cc5a0db40dbe", "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.", "choice_num": 4, "target": "D", "category": 2 }, { "id": "0c114dca-492a-5a1f-a2c7-771c57af373b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "87b802a3-5735-5d62-a891-36152fb76adf", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "23b87228-ea5b-552c-a781-456bf501bf52", "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%", "choice_num": 4, "target": "D", "category": 2 }, { "id": "c2916556-c89f-544c-9d62-0b0cdb9d995a", "question": "Which of the following symptoms is most consistent with theophylline toxicity?", "A": "Tinnitus", "B": "Itching", "C": "Tachyarrhythmia", "D": "Heart block", "choice_num": 4, "target": "C", "category": 1 }, { "id": "118c591c-57c6-5fef-b330-ecfa0a12e21b", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "c7990cec-91ec-5739-81e9-aa08040a63ea", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "94a06bae-210f-5383-ab03-87280f04e989", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "210800c0-cadd-502b-884b-424c3a93a866", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "df03dfc7-23af-5eb5-86fb-25e9c93e2cca", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "829b4991-0e59-5917-b0ec-326e26cd62c6", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "96e41ed8-720e-557f-b29f-2b575fb42758", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "df67ec43-0358-5211-a5ce-216949df68f8", "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.", "choice_num": 4, "target": "A", "category": 3 }, { "id": "765b236b-470c-5e3d-ae7b-a5190f95e9e9", "question": "13. Which level of oxygen saturation (SpO2 ) is acceptable for a patient undergoing OLV?", "A": "92%", "B": "90%", "C": "80%", "D": "76%", "choice_num": 4, "target": "B", "category": 1 }, { "id": "52fd4edd-a4d6-5d0f-8982-5b6fc8d29957", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "82b71eec-a413-58eb-bbbf-62951dbb689c", "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.", "choice_num": 4, "target": "A", "category": 3 }, { "id": "30b57887-6b73-5b0f-9189-2f5be4eb510e", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "6e24a393-a581-5f6b-abb9-89f0804191c3", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "eb9959f2-c09a-5af5-9a66-1aeae3982a04", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "5e36b5ff-0da0-528b-9a6b-716965088d98", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "af48a34a-61c6-5b47-8b45-7a35a7404c8d", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "71b5191a-272d-529c-9ea9-66ef050aa02e", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "b675d482-1f7f-55c5-b339-37357c49c04b", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "689454a4-ccc2-588c-9514-d0f36df9e2bd", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "9eb9e4c4-5dc2-5c2b-a6de-acd525457c4c", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "5be785f1-9571-5a46-82e4-9042a01a9817", "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.", "choice_num": 4, "target": "C", "category": 2 }, { "id": "c3bc7b10-3906-5d03-a49d-a5f3b4399a34", "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.", "choice_num": 4, "target": "C", "category": 3 }, { "id": "e799f24e-e1d5-5ffa-9ddd-07026c187501", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "90512188-7dbe-5581-989e-e867ca000a51", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "99fbdb25-bc1d-5882-9640-84c7f5f9eb71", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "076d8674-35b5-5289-b090-58cd32eb0860", "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%", "choice_num": 4, "target": "A", "category": 2 }, { "id": "701d502b-b952-5329-a6e6-e27e9b1d68fc", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3dc10eda-eee1-555e-ad34-ccbbac2021d2", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "83088845-229f-5088-ab61-bcbedefe1b7c", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "fd104f59-7936-567d-8612-884ced590a6f", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "86f1d2c1-f18f-5e20-89b0-49ba82bb240f", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "d5bf6566-26d2-5f6b-b8c4-83c66bf5d452", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e2eac625-0ee1-5420-a73f-6ed10d57d0af", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "858be2af-32ba-557d-b97d-73cb40e27ea2", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "d8e8db3c-d6c0-552f-868d-21d989284650", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "b446e3e9-8edd-503f-a1e1-5c440b2a1615", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "1427c4e1-ab27-55d6-932a-85c8ce6f8274", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ce01b312-e119-556b-973d-27d6a4c0f06a", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "6da8650c-82d0-5e4d-8091-2f00cfcefbd2", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "92bc588a-cd71-513e-a907-b9154db9733a", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "b280df30-cfc7-5961-8e71-67955ab1f79b", "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.", "choice_num": 4, "target": "A", "category": 2 }, { "id": "eb7160fe-6b40-543d-8af0-ea7a26e10bda", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "e9c9a9bf-1992-5144-ac00-43519247e88e", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "65163e5a-dec9-5240-9ec8-856298521fe0", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "44fc63a7-052c-5247-ad6b-65e3b6c3fbad", "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.", "choice_num": 5, "target": "A", "category": 1 }, { "id": "d7ef5db5-59f9-5939-b547-9df4a5f63498", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "a7f960ed-3de3-509f-b32e-782df605c1a2", "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.", "choice_num": 5, "target": "E", "category": 3 }, { "id": "28ef53de-b853-5489-aa3c-6bda92fdfc52", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "5ea44ff8-664b-5350-9913-9ca49ceb3d36", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "16c44888-a7cf-5198-b917-79016b8525ea", "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.", "choice_num": 5, "target": "E", "category": 2 }, { "id": "8d39ae9e-271e-50ef-a067-20924723bc1f", "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.", "choice_num": 5, "target": "D", "category": 3 }, { "id": "35da10bb-c383-504c-94ce-3c97d253de5b", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "7dfd35e3-30d4-5a86-9dd2-1cea5511fe0e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "1a8a7991-76ee-588b-9f36-f8a7871294f0", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "7e34fa18-a0e4-5219-9747-6241072f5cac", "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.", "choice_num": 5, "target": "E", "category": 3 }, { "id": "86cb27bc-5b5a-58b6-afa9-806f3ce01c9d", "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.", "choice_num": 5, "target": "D", "category": 3 }, { "id": "243025fb-3e75-5876-8fd2-dcf93d1dae5e", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "230cdc85-a96f-509e-8204-963dfa814dc5", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "fccfba93-df6a-5011-a741-63bebc0bfedb", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "899e5902-a432-5b52-9cff-b01558c8509e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "1b715f7b-3947-5fc5-a434-ec8429d1ab5b", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "6f2ec914-392a-56c3-9912-eae0d217d8bc", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "b7a2720c-f56d-5bb9-9b5d-a834415a495c", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "8c937a08-bb1a-5a64-bbc8-cd392878506c", "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.", "choice_num": 5, "target": "A", "category": 1 }, { "id": "7be41a97-1cc6-5930-b246-d1227e46d068", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "4c31a850-8d20-57d7-8303-9afe490f0c80", "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.", "choice_num": 5, "target": "E", "category": 1 }, { "id": "c8ecbe29-17f8-5696-b89a-650c0189d578", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "81c93dc6-028b-5421-b844-99807bb64ce0", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "9ef53567-7fb5-5857-a601-20c710bcb1ef", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "290d59c3-0e85-590c-8da7-cf4965ec078d", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "cf1c71d1-569f-5981-be53-96727961da85", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "06363e4b-70ef-525c-909e-54ef9ac21ade", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "59c558b3-4afa-5210-9553-68c10b63947f", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "8991513d-7d0f-5bef-aac5-a030472b5b13", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "212e824b-95fe-538f-b966-e48ff25ac209", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "824e86b3-d6a0-568f-8130-a6bb8af95799", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "102b0158-ccc9-567b-97ea-1f4fd0ff11ee", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ba83765a-5bad-59a0-8589-84ea55705d37", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "56512a8a-8ef3-5045-9f1b-592e72a01df8", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ba65ed13-e863-532b-97cf-6bf92adeed2d", "question": "Which of the following can increase intraocular pressure (IOP)?", "A": "Hypoxia", "B": "Hypotension", "C": "Hypothermia", "D": "Hyperventilation", "E": "Enhanced venous outflow", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3cafbea4-d51a-5d78-ab8d-80241357da5b", "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.", "choice_num": 5, "target": "E", "category": 2 }, { "id": "ef4aa316-c5e2-5e5f-bbd7-c651ec20dd20", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "24e0bdce-ecea-56e9-accc-65de6323f81f", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "5e9453bc-02a2-5564-9be5-1cdd222288bd", "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.", "choice_num": 5, "target": "D", "category": 3 }, { "id": "6cc4df1f-0c49-5e23-8551-1567e200dfe9", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "ab551b18-af7e-53a8-b68c-6fa201a1b064", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "ffc65a4a-cf97-59c9-9f88-9e7335b4485b", "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.", "choice_num": 5, "target": "C", "category": 2 }, { "id": "3f1acaea-f0ae-560a-89c6-7ae1ca0d62d0", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "c18a4b0c-9fd4-566c-b6b4-0cbcfae04d83", "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.", "choice_num": 5, "target": "E", "category": 3 }, { "id": "afd3cf09-b2ec-58e8-b630-1fb2aa6cc406", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "2e206e86-a82a-57e7-876d-2d176b034f8e", "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.", "choice_num": 5, "target": "A", "category": 1 }, { "id": "dd724951-886f-5c43-9dbc-f17bb24bb1eb", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1db27046-6916-5749-b027-c65d4eb8f0bc", "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)", "choice_num": 4, "target": "B", "category": 3 }, { "id": "bf2bad8d-bedb-52c8-826f-6a736fcd37dc", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "f34e4f25-bf2f-5d2a-80cf-3f515f58f752", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "cd1a78b8-4b3e-5b9f-a7ef-93c25b05b506", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "cb66d1a9-bc4c-5588-aafe-cb39068ed519", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "bec075a4-5627-564c-a21d-62dac560b190", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "916d50f4-21d2-5846-8b75-1551370fae07", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2d914f3c-936e-523c-8fc0-0198fc6a6239", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "579c3c66-ce6c-5cc4-a837-293f59c0f9b4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4149a052-36a8-5b04-a489-d9c8b990e5ea", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "9719ad1c-a679-53b3-b90e-aa1511f34fba", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "4fdb615d-c756-5831-83f5-aad573814b0d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "96806999-ea41-5596-a969-911334ea3cee", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "2610403e-8984-5f35-a848-721e1c1b8c61", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c1bb6766-56c7-5284-bf80-a65cac35a596", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2a2c64e0-9ee8-58cf-9770-2b2cc8e1d849", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "d222a5ac-774b-507d-b385-ee9f501e8cc1", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "986c3518-f712-5828-9264-84b25d21bc8a", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "e88ca6f6-d4b7-54d6-b091-db984d7d22d2", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "b6903688-0ca7-55d7-a61e-434244249c01", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1f642da9-e1ca-50a7-8dbf-09f0306196dc", "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.", "choice_num": 4, "target": "C", "category": 3 }, { "id": "d0a49fec-5c1a-5e2e-a5b5-11bfb51d63b4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "485fafbb-30d2-51d4-bb3f-8883d1d7cfb1", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "1e33e94a-207c-547b-9681-d24902f6e671", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "72ad6636-088c-589a-82c5-7a94c173839b", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "38f8e9ee-651d-5ece-bac3-72c01f8e0087", "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", "choice_num": 6, "target": "D", "category": 1 }, { "id": "4bb8c513-0d8b-5809-bd42-d477390c7c50", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "7807014f-2f42-51a4-8daa-ff6de9bde64a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2bfeccc8-b49b-5d8f-ac37-1987a9ba9b1d", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "c3677a6a-f502-5e46-8ce1-f433edc86a10", "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.", "choice_num": 5, "target": "C", "category": 2 }, { "id": "99b0b0f5-6981-5675-864d-e374b93d7b14", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "856166f1-ef0f-5ae9-bbbe-280b0661e9fd", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "b673a421-fe2f-5276-ad46-58e0f6bedaa4", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "78dd13e9-c9e5-5001-b89f-8c467867aeed", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "d3f5eaf4-754e-555a-99af-b8d5e96b887e", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2b52e399-0344-5c90-8a41-1c2835f8389e", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "143d5705-5204-5efa-b23b-c07ce3e1bf09", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "2ebfcaf3-38f6-5d41-8a40-461f7170c12f", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "7db19637-6e0e-5edd-9659-a557bb46087a", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "98f8384f-ba2f-5bca-b997-f8911e7f57bb", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "ca83f284-8a9c-59f8-9c30-c70526f968b2", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "aa63c406-c3c2-54ea-968c-9958094f9f96", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "1d7b0f8b-818f-5469-b3ae-637471e0f44b", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "c293a9ff-9737-5aa4-8fb5-1b5f19c55e13", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "c2175a45-8899-5ff5-942e-52d059889388", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "61c33532-9b20-51e1-af90-93691e4875bf", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "0f71fb9c-037b-5e2f-b491-4e5b73192d6e", "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", "choice_num": 6, "target": "D", "category": 2 }, { "id": "2407b0e6-37f0-57f1-9611-8e6bf131e958", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "7be7e60f-72b6-5964-b6d6-fa5e3bcac990", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "4957907d-82ed-50af-83c1-7ad636ec3157", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b2c98963-45a5-5782-a103-f96721e45b75", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "f8d7174b-b850-58ee-9765-7207757d7553", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "d815714d-5704-5e3f-a343-8aa7ae07fbe2", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "357c1455-08b4-5eb5-a05b-f9acfb929491", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "258126fd-a384-53e7-8a6b-3529725ef069", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "2f26caef-3c34-5cde-b381-b18cf3b7abd7", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "34ce4a14-b161-51ae-a75d-d7c1f8c63607", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "38dcb49e-9432-5cc8-ab34-4ef5c2c89443", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "a0d72f69-9238-5717-85e9-9ec98bd8a8c5", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "87610683-810b-5313-86fa-11e8bdb5e7d8", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "4b1a2a77-eed7-582c-b20a-ed5d3831a25b", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "feb8c651-f8ad-5316-aee1-da438a09ca6d", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "1a77c115-410b-547a-9a59-d14ec4133112", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ab48d31c-f127-5e7c-881c-f8141142299f", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e8a1de9e-5d8b-5f29-b5c8-359d90d1b233", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "1b43cdfc-0c74-5f23-905a-fc6548597b98", "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.", "choice_num": 4, "target": "B", "category": 3 }, { "id": "590cfae8-4730-58a7-8ca2-443fb74f0642", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "dc141cd6-51df-5631-a807-d2b9ce77acbf", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "866f1907-2822-51ad-a462-bfeecab8628a", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "68782b66-1b7a-5cd7-965b-e268a377a04c", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "ad053e89-995a-5ea7-ba49-a6644f54ef96", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "0b08453a-720c-51bb-ba66-ee983a484df6", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "dcd6076c-a9d8-5e2c-bedb-fb2c6233af36", "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.", "choice_num": 4, "target": "C", "category": 2 }, { "id": "aba9ab9a-3eb2-576d-beda-53e92e305bd4", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "b433b7e2-0f52-5af0-983c-90faf9c78c22", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "63f824e6-f71b-59b9-bc6c-f430f8a83ec6", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9293fd9c-8238-5096-819c-d75be592409b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a10d669c-d0f0-505c-8939-b1b251f571b7", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "19069c99-826c-5805-a54f-c59b69b717b4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4a1f2432-c6c7-5953-9c66-9e6905428462", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "c97cbf00-7e16-556a-ba85-db6bd28975c5", "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.", "choice_num": 4, "target": "D", "category": 2 }, { "id": "7138a83d-e8cf-5fe4-9a57-8fe961ece74e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5c779e95-f79c-564c-8fb6-cc0a77cb3a3f", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "e8e04034-569f-55a8-89d5-d048d696cdb1", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "db43f1b1-5fdb-5362-94b1-b8edf8910647", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "9cac743b-8bc8-5fbf-93ac-565377730f8d", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "fe1186ad-e97e-58f6-8170-4c3a354ac641", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "19dd6b84-f8f6-58f8-85c4-bacd481112de", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "84d5dd0f-814d-5239-809f-b442803da65d", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "18fb7b21-a4ee-5eeb-9888-3d2d3602c42d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7b1c3fc4-6b75-5419-b804-b3857196662b", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ce572bfd-2619-53eb-a047-18436efe452f", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "58c46797-2e3f-5d10-abb9-5d5afd6ed050", "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.", "choice_num": 4, "target": "C", "category": 3 }, { "id": "936e2dca-930c-50f1-b4ea-d78f906d8fb0", "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.", "choice_num": 4, "target": "A", "category": 2 }, { "id": "d4bac66d-36f5-528f-9ec9-276aae0c90b0", "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.", "choice_num": 4, "target": "C", "category": 2 }, { "id": "8606e961-5938-5adb-a3bc-74d0a4b586d7", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3d463c35-f98e-5f1b-ab4b-b70f21daeb26", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "71430050-64c5-5033-b953-a02e515cea3c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7c678657-e35a-58f4-a5a2-025207726feb", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "9ceefb9b-f6fb-5477-8b3c-6d621486d219", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cb4a4930-580d-5b44-b225-407a66ee5da0", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d4b9ebc3-96fa-5377-91f7-2e3c792e2003", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2247ab44-ac2d-528e-86ee-225c27d60600", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "47578365-9baa-5644-9a8a-bf53032483d1", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ec2d84f4-e0ca-529b-9bd9-0ba40439628f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f4229d1e-3e9d-5cc2-b23a-5fe904631f1f", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "f4443c9a-569f-5032-bbe3-1bd27de0c020", "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.", "choice_num": 5, "target": "C", "category": 3 }, { "id": "d4e67ab9-2c1a-5f04-830b-d94c329fe393", "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.", "choice_num": 5, "target": "D", "category": 2 }, { "id": "a5c07425-ccd8-50a0-97f0-b08b060c08a4", "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.", "choice_num": 5, "target": "D", "category": 3 }, { "id": "6feeb5de-4fab-5a9a-8086-d16da3ac18da", "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.", "choice_num": 5, "target": "A", "category": 2 }, { "id": "fcdcaa41-3e54-5d40-82fb-8d39c488aa2d", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "5c74d1c5-8f38-58e7-99f1-7b67d5f5e83e", "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.", "choice_num": 5, "target": "E", "category": 2 }, { "id": "0a771324-6f44-5f74-9e13-63829aa786eb", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "7a2a9b98-065f-528c-9ad8-1fe92a4d8bf6", "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.", "choice_num": 5, "target": "E", "category": 3 }, { "id": "dae863f7-c037-5dc4-bb15-55ec6c3a0a8b", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "1220665f-dcfd-58f7-8227-0b288a23ffc2", "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.", "choice_num": 5, "target": "E", "category": 2 }, { "id": "0c3dc24c-7028-5ef6-a0fa-eb9eaa639a87", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "374abd47-7a07-53fb-babe-c9c8194b525c", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "42c6c842-ccec-51c3-9bed-3435a5d12949", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "ce28da7a-1860-550c-91bf-43718809b141", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "99a92e36-9c2e-5b3b-b185-f26e65b7a8ba", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "ec191689-ff06-566e-b075-0b590bc4a98c", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "2e426671-692b-517e-838b-055a029a09fb", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "22dc5452-9747-5d46-ba59-a76971b6a914", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "cea0c723-9183-5e4f-8151-1780bfd3b10a", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "51371bd3-a373-554b-8ba2-74c5486eb876", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "3d739736-6293-5065-a45b-32b921c665d1", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "8beb395d-deea-5d6c-b039-0cc10f385ed8", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "33a868f7-1285-5d6e-8971-6115b23d1297", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "88a6cb40-ece3-5ab3-a62e-d260e7b81972", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "6d8e3483-faaf-563a-a263-8a4d199392aa", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "c60a1a09-a605-5e70-a383-55bb7117bb34", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "62f746fa-397f-57f9-9c44-2263ac0b272c", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6970a036-01aa-5276-8874-993423007d52", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "847094f5-bfd3-51bf-9cf9-162a1eb4f01b", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "f5aa7b5c-23ae-5b91-8e55-e9a3ac78f940", "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%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "bc201de4-1b89-576e-94c9-1e25c945d7d1", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "4da2d9d5-dd9a-5bbe-8cff-856439b9e81c", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "63da3e2b-9aca-52cb-a93f-0a5b725e5c65", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0e187d64-f7c2-5ef4-a845-152393c65cea", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "93bfae81-8b9f-5ec9-ad01-7bf32e734fa0", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "71e47de5-d333-5d6b-a63e-f7ac839c7cd3", "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%.", "choice_num": 4, "target": "C", "category": 2 }, { "id": "fa76cc36-b7c1-529c-999d-aac94250fcb1", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f16aa290-7b11-510c-9737-1537aee4331a", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "d5b48359-6b91-539f-9762-e59c701021f0", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "85de1549-d4b1-5864-bc98-eb3cbc640315", "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.", "choice_num": 4, "target": "D", "category": 2 }, { "id": "514d05d8-8e65-532e-80d7-16f0eee9e00c", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f1e3429d-17e2-57b1-b689-376e7c7d5db3", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "6a78305f-1b05-5cc4-aa86-3e7e4f941aa0", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "8d4cef02-867a-59a1-9ffa-f79e750a5c65", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ec718f37-2172-5a25-835b-3c3bab563825", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c4b1ed80-7943-5a37-a2eb-00a34b14e7b5", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f456be80-a9c9-5870-a11d-2692fcbf65f6", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "062f2b50-8562-5038-9144-18745711dedd", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b5895c05-be57-5ad6-8e60-dab619472991", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d5163a31-629f-5332-b8c2-35f7fc624448", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "052b846d-6362-59b0-b3fb-f77bbad32f4b", "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.", "choice_num": 5, "target": "D", "category": 3 }, { "id": "e76ec597-c1d7-5f92-b7da-10f157dcaf09", "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.", "choice_num": 5, "target": "C", "category": 2 }, { "id": "e4135283-4800-5ade-b4c6-4ea92906c14b", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "f4598c43-29c6-52d4-98da-20b122a5af11", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "60fa98ba-7690-51c3-895a-dd3654986d12", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "b9e68c38-bb74-5de7-8ef5-84f7a414aca1", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "f397d702-bf73-5c06-92f8-69b5ec816ec9", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "26f4fcad-c0a1-5ba9-9e29-51bae7d2c36b", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "f28a8bcc-e6c7-596e-94ad-6924315888b5", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "0cf3063c-eece-54ff-97e8-efc71d7b0bbf", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "4b4944b0-7b42-5279-a9bd-9ef4c68b64b9", "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.", "choice_num": 5, "target": "E", "category": 1 }, { "id": "596a2197-363a-5a6e-84c9-b485251fb840", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "ab9d38e7-88b5-5211-a675-c2cee23c89e9", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "2428e814-f3b5-5f76-afaf-7101df27ac1b", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "f7099fbd-773b-5fe0-b832-d0bf0aa74069", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "c892416a-c1ae-589d-977d-7dd0948807df", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "89d9c8b1-f9ae-5b1d-bbf1-7c7e921f9fec", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "54b88f84-61ad-5506-b1ed-c27e598ecc1a", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "ca9e0057-b422-5ee8-a978-df3fef1e7eb9", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "fafbe627-abb0-59e3-ae24-974f902a7839", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "89cc982f-9c1d-50eb-ad66-b276d06335e7", "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.", "choice_num": 5, "target": "D", "category": 3 }, { "id": "105ea361-e0da-5713-a8d3-38deb8f95878", "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.", "choice_num": 5, "target": "B", "category": 3 }, { "id": "8d65507f-447a-5c81-a9db-6fb20196b7cb", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "bd48d9a0-80f6-544f-a02e-995fd426d3e8", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "150982cf-ff65-5c03-ac86-433c5f3d2df0", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "cc0da6b7-cbae-5d61-9b5c-61de34c0674f", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2c580619-3185-5ba5-9560-3ddaecda3be6", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2133ddfd-0185-5e80-8787-3fcbec708440", "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.", "choice_num": 5, "target": "E", "category": 2 }, { "id": "b8442e7c-2a35-5eaf-b8a3-1aaad3f6456a", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "b31478fe-0412-5b02-abfe-7ca548013149", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "94e14a60-45d8-5eff-951c-6b611a00983b", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "0659025f-0f68-53c1-9d4c-ad8248eb5890", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "1dad364b-ea0d-555d-9be6-3158b57217af", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "42e8522c-5f6e-5148-9136-b5da07da13dc", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "e3f07960-5ec2-5264-8d1d-9cef9c0a288a", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "1a931b6f-0428-5cc4-81ad-7cabb0166bfc", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "2e0f0dcf-c7ff-5930-953b-1ac5b93e8153", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "95222761-b570-5736-8995-d755b3cc7256", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "ce30096b-08c0-5717-bce1-e66ddc3a553d", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6f891439-a52e-5521-aa43-c2e5f1ef044f", "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.", "choice_num": 5, "target": "B", "category": 1 }, { "id": "fb5388ad-f2f9-56ab-9f89-ac5329128f12", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "20016fbf-873a-5996-b652-21c5d88471d6", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "7266f38d-4104-53ed-9dae-fb99a19102df", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "2adc75b4-c4c8-5f9c-8ae1-fdcd0e27d253", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2365b153-6f4b-5f98-aaf2-d88f88c61526", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "0dda6097-2d57-51d4-910e-e0ce3eecbb77", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "bbe6714a-0e9e-51ac-9b27-7611c64c9bf3", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "c2e85d12-d08c-5594-beae-31897b99810e", "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.", "choice_num": 5, "target": "E", "category": 1 }, { "id": "bb649542-1424-569d-859f-56f46a2cdbec", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "6da11878-34d4-5278-9dd5-021a266f23cd", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "631120b2-c1d7-5bf1-9a98-c5f2fcc91d9a", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "dd155e6e-0145-502f-ae53-7fef6f2d7e44", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "5327ee95-4664-51eb-8086-7a7601d07e5d", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "b7d9a94c-eeb8-5973-acd0-2fc5dd00118d", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2cc17799-965f-5564-9a80-b940ae5bf908", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "8ccc748f-ab9e-5e6d-9ffb-b91c76ff6433", "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.", "choice_num": 5, "target": "C", "category": 3 }, { "id": "44f30d51-3042-546b-a402-461058485d6a", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "2bddbac5-2711-505b-9a72-ece562d5d535", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "7d1536e6-cfdb-55a0-8198-5546c905ef48", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "85b079ce-23d3-510e-b7f4-d3790a785144", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "59f1e612-be10-5f19-9f00-df3d2f996b1e", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2d81d53e-097d-5fda-ad39-00704d9d5d13", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "84bc61bf-0c4a-5902-85f9-511c6bcfb387", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "1ba46d03-bbef-5855-9b9a-99d37c92e5df", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "8f100fe0-35a1-55e9-870f-51fefd5fe223", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "2bcfacdb-b04d-5cbf-b755-4378ab4e17f1", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "8ea24c41-d879-5aad-b58e-e731079bf77e", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "0bf5caf6-4209-5924-9a9e-461905de39fc", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "640e49b7-394b-5a70-8673-961ad52ca8ba", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "0d823d9e-c1b5-5932-a7f4-d45d978d6c75", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "eafa6f7c-3df5-5b68-8ec8-2d8ae4af9eee", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "75a41682-b930-5178-8d9a-bdb3f217d582", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "f735d09e-dded-5287-8067-41634a127730", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "7c94c1be-c8b6-5738-8112-d2d2b6b65cfb", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "bcabcf9f-9355-587c-8295-1668833bef66", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "a44563f7-726c-57a3-b370-f357506dc44f", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "538832c0-54b5-5a57-a225-1d6683a7dc5b", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "1fb1d737-afdb-5e3d-bb43-e66a38c002eb", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "ac667218-9fd3-59fc-bb44-f3fb36a5d8c0", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "572a5b4d-ef38-548f-8817-bd57f0c4bb2c", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "b107cc36-79c0-5d93-9779-81b73bc23d0a", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "130d74c0-cc79-5799-9ff8-c08d849f575d", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "f370d653-61f7-5fbb-9b08-f52464f426a3", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ce17dd92-be06-5cbf-bcd6-753a05fb96d6", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "a3820a6e-cdce-5c94-9bfc-a0c850fad333", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "d9fbf38d-e38d-51ed-8b54-1be1fd1bacdb", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "c3418585-d841-5d22-b22b-8724080fe766", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "e162b65a-e625-576f-94e0-52c68f08c1f4", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "f0d2a3ac-0c02-5239-a339-7a95b586b684", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "f2f8ab7a-5375-5c71-ad49-901e2473925f", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "331434d9-d5f6-56ce-9fec-69e4afa6f0f0", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "3429d3d5-c615-588c-856f-f448cef5be14", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "f5af5a4f-9ab6-5276-ad83-50fd6bd44045", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "da9e0a58-44f0-5173-a53d-a43367b92b4b", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "8d5c407a-6a84-5168-bee7-8a91a72b6760", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "d35954db-3260-5f39-ab04-746d4a17f8d4", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "785242be-7a22-5e55-8504-a6d39ccc5e44", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "318aabb4-0ee3-5409-8764-990ea3086727", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ecb30a73-6fc3-560b-82c6-2729ed0bbdc5", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "d2b0f2d1-174a-5921-80d3-f7db7549f74b", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "6a988cb5-fd43-514e-81a8-ec2d835b9cff", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "975c1ff5-d339-52b3-ab9c-22f03eb4cb4f", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "10af43af-b72f-5fb3-8211-ec440ae10a7a", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "f1644bc0-61c8-5837-a95b-81c7fd5b2735", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "d87545c2-d11a-552a-98cf-e4f846c03683", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "2928083e-e2b2-57db-8d57-a4053b73bd57", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "a4e18e1e-1200-5b41-bff3-d75458f92f08", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "385505f0-83fa-5edd-a05e-c6983644df1a", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "1bdf6e32-c16d-54da-b0b8-6331914429af", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "deaf3bba-49fd-55ef-8ff1-c8a75dc1c660", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "50a30478-1880-5f4f-a8a5-0aa31f2c69c4", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "721200d3-1cae-5908-8ccd-970c9be57629", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "72a5253a-8f8c-5d24-ba9c-022c931317d2", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "041275a1-0afe-53d1-b571-d7ac55b7a857", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "8b43d293-b3ca-5cc9-8da8-5e8745a7728a", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "24f2e4bf-26e1-546b-b235-b8c8eb159ffa", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "f6ed4acc-f4e4-5361-b591-b7e178f0494d", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "297409c7-4340-5553-a2ae-8ab46f1e8250", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ec9d214c-1f84-5d29-802e-40b686f5cef6", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "ef9df767-8a91-5921-902b-7a09f495dc4d", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "f976cceb-6a6f-5e89-8cd3-8c309eb760ec", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "35ab40ef-bdd2-5d5d-ba8e-3ca5f3f9102d", "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%", "choice_num": 5, "target": "B", "category": 1 }, { "id": "59a4db4f-63f8-5f4d-ae3b-f2d6a4fbd45d", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "da2ef699-7c7c-59a6-8889-c0c2ea81aa97", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "0821c37d-d6a0-5391-aebf-3e07913e9e89", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "012e2f6f-dcd6-568d-8c63-b2e6c485fba3", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "112ed515-dca6-5faa-9ad1-3580d410648e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "399d848f-2d9c-5d7f-b0b6-db2fccd777ed", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2e0376b5-532d-5ffc-9bfe-ac99b123307d", "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", "choice_num": 4, "target": "E", "category": 2 }, { "id": "da07f4ee-5222-503e-9abe-a10348613502", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "84e8c6d4-744f-58f3-b7f1-399e21370c14", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "34a5c3c3-dfb0-5f00-8261-af9d3dae929a", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "fed72e3d-86e2-51c0-9207-42b46e848c88", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "04b34464-96d7-5ada-84ce-4214604dd11e", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "c67b283e-c5ee-5cea-bbb3-cd40d413bd31", "question": "Which of the following is the most appropriate pharmacologic therapy for trigeminal neuralgia?", "A": "Buprenorphine", "B": "Carbamazepine", "C": "Chlorpromazine", "D": "Pentazocine", "E": "Phenelzine", "choice_num": 5, "target": "B", "category": 1 }, { "id": "e8a530e7-84c4-5f1d-a74d-58dd5350e7b5", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "edc2d74f-31e5-5161-960a-5b6f1c177958", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "f6552280-80fd-5cda-8243-02ee0472a7be", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "6d65a370-a05f-5cfb-be25-fdb3634330e6", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "932b7dee-1760-55ed-a3e7-15083d847c79", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "77926a83-db22-5f82-a7f6-59723f1bd7d0", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "5808b73a-6807-5aee-a9c0-1fb2a2a09ad9", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "e6939849-700c-5de7-b027-d24a34d18129", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "865b1681-1f79-585f-85d1-2e1908e6232b", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "042112cb-5eb2-5f66-9840-b8749116142f", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "63e56994-085b-5f59-a2f1-dbf3483b7e10", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6320372e-04dc-5c12-97cf-55c19d51bfe0", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "9dacfc5e-5c7a-59d9-8f00-a4ec5fe6e2c6", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "3c7164ed-ee13-5ae9-9091-3c12ff2cbfd8", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "42795862-a9da-5433-9248-a5284a1fda3c", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "429e4263-18d5-5c14-9932-6c63d2c0ada8", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "ba168b95-0ccc-5574-8e71-5108700d0f51", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "f5d9b821-ef7a-5716-a8bf-47d9f85aaf24", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "f90c6739-2023-569e-9861-17ddc5f22976", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "21aab6ee-98f3-5e00-a4f3-666896a0d2ff", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "d8a92ebf-09d1-52b2-a97c-1b4e5cd1cfa7", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "2006d9db-5118-5092-a2fb-a7888e4640d4", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2d18ea3a-4a9e-514b-845d-202d5e3fe9a6", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "87a1710e-d29e-5693-863e-9493636339aa", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "b2928ec5-8b70-5cc9-adb5-c0a7cb98be1e", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2de1f3ad-b0b5-5934-85a4-a8aa6bcf885b", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "4dc63d94-cf8c-5279-91a1-4a0f0de360d2", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "8badf02c-18dc-5765-8cf8-f11a65c6cda2", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "bb0eb1b5-dd94-5583-aac8-b69ab06a405a", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "d7057b18-5e01-58c9-b205-a64904143db7", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "efae3631-0a69-5da8-aa39-e0958767b727", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "7b61bcf4-2eba-52ca-a5ad-23e9923dac1b", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "ace215a0-dc53-5761-b3f1-6bfda747d174", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "84ab30a8-6a7d-5e65-96ef-23bb50b1e280", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "9ff9b0d3-fb8e-566f-88d4-c4a874588b9a", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "ef82526a-93f2-57d6-80df-ff20f269c458", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "8574c8d9-8dbb-5fbf-957c-a2b144b5a75b", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "75a19dda-4c86-5a45-a428-12cbbc675a59", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "89b6c326-613e-5d61-a25c-850f383a4e86", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "c3f29e50-e18f-513f-b8b2-4713ce77846a", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "bac89d2d-e709-57ef-b4b3-960e56cf4166", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "f9d0c408-7ba2-538c-ac04-35b00d209ef7", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "857d5b13-ac39-5087-8d3a-d09836d9886f", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "aa85f504-0606-557b-a67c-2e8242c2173e", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "3526b195-3c30-53a5-b805-620d10861ac6", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "d3039d9e-a0a7-5cea-bb0b-abea87b0427b", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "aa4960fa-695c-5f07-a8a0-27460db22fc6", "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)", "choice_num": 5, "target": "D", "category": 1 }, { "id": "8f091c83-f804-537a-95a0-d8032c18023f", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "c0e0dc29-408b-54a0-bd77-7614a027c36f", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "ffcc034a-a192-5ec9-ba44-920ce1fafb82", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "9c3a9fe7-7b4b-5132-a134-6d1f56c6b06b", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "a370f52b-f600-518e-aba1-961aa891890a", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "82fe3512-e2fa-580a-9369-61e42310c3dc", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "e9a8d227-0dcd-5489-9fd2-9fdf6eb2732d", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "f7a35476-ffcf-5be0-9178-4dc10193c2fd", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "465a4fba-bc94-5e3c-b5df-9ccadd268d00", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "bd59883c-796a-573d-bf2f-94289b840db2", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "3c1fcb80-3942-50c9-8b59-9de387b62d1c", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "b8fb8d73-3dde-5852-8f26-02c8f545472e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ab554063-c52a-5d75-8234-232f24676739", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "cf97a69f-ca40-5b2e-b2f6-f03c117b6c9c", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "3ae0b40f-197a-571d-ac26-ca4353a99122", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "b8a00cc5-c6a1-5839-bf82-a9e3b21e6908", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "d6b8ffa5-1ac1-582a-bd84-5a900e81d745", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "9051beed-7216-5475-bdef-f8f7dd984f0b", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "2609a83c-0803-5955-81a3-6ff1eb8732c3", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "6b61bbed-9f0e-5249-9ec6-fbe15dc88775", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3c521ba9-7f31-5719-9b0f-d0ad0f95cecc", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "111260c4-04f0-57b1-9274-176e5f0deb31", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "4978f630-5944-5193-aeb9-c7dfeb25943d", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "d49657dc-540e-5414-be95-68b25cad1f10", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "06cf6b22-49b1-51f6-94e6-247cdb06d731", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "e5639b90-f99f-5804-9e88-ac515194d4b2", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "5bba44f9-debb-5005-a69c-e5890875d272", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "86860281-b1c5-547b-8e56-5ed9dd78e1d7", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "64d0b06a-161c-5a83-8dce-d8ad7588d652", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "88bc1e1f-3a22-5a3e-a2d2-115adecb4ead", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "64d7ad48-3792-508f-8828-0b388d076d0c", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "04844053-d5aa-5a0e-b499-21b1d8a078e0", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "628bb52c-2607-5d2c-a909-49a8dc75073d", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "5d2758b3-f195-5730-a410-34f342298fe9", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "c48d6997-5db1-5e03-af7c-61a05d90dbc4", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "97a3dc73-a7e6-5d66-9ee5-76c35f853312", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "70a2114d-6138-507b-a0d0-34e079ea5554", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "7133a576-283d-5f6e-8601-5d59c37120cf", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "3d032d06-b85e-5083-ad0f-3ad2b0b49200", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2cb4dd86-aba0-5c59-9c43-0124565017d5", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "dfd4c827-a2a3-5d60-8e22-74db52e6570d", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "56d6c62a-2c7c-53f0-b816-23a81bf91d21", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "b7d67706-4c75-5a83-b0bf-2e5f544cb41e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "80b10f0d-34b4-56b1-a57a-2863c14f4c9b", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "4a6f9984-9e90-54fa-a814-fff40908ef60", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "8e39e22e-1527-5a3c-976d-982371e447b5", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "003e6847-48cb-5269-a7dd-96f321b3c48c", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "2db8ca88-1a7e-5cbe-b9dd-02822219b9d7", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "1a91c5d2-2133-5872-b0e8-17ac42a839c2", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "80a70d21-c99b-55b6-8c72-436b81bd2f8f", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "9336c9bf-a997-5d45-84a9-268e8be20c6a", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "0713116e-a86c-57ce-bb66-46713d59bb5a", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "58ca7b58-4e79-5c3c-b304-403bd90b30c9", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "cede7788-f46e-53b7-879c-e07e98e0f118", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "ee262378-6ac0-50dd-a6f7-eaa2dbabf1b6", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "a31e0b7e-fcf7-5067-8b03-0e6d6dab4884", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "35a0685e-c339-5ed4-b0e5-c001d7099377", "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\"", "choice_num": 5, "target": "C", "category": 2 }, { "id": "14e7cb8f-93aa-5a1a-a01b-aca003eeb270", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "91555d17-a25a-5f5e-ac01-47d61a8f01db", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "c9abdde9-727a-5db8-89e9-ba3f61a413ca", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "4bfd778b-3cdd-5f89-90ee-8b46d1234783", "question": "Cerebral blood flow is decreased by", "A": "chronic respiratory acidosis", "B": "hypoxia", "C": "hypoglycemia", "D": "polycythemia", "E": "the postictal state", "choice_num": 5, "target": "D", "category": 1 }, { "id": "31973a0b-cb68-55d3-a677-b2ff84b330bc", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "f3c65334-9059-52d1-8542-5c742e2a4e6a", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "7b6ab6f2-01f5-5efb-9103-d5a2a6ef102a", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "5e475aee-a4aa-5ba0-b3b7-3b43529fd232", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "34676cee-a13b-59aa-a129-631027b0491b", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "7e6cda50-b66e-5b53-8678-f78465bc2eff", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "317d72c7-436a-5e55-ab69-ea10d8982041", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "add6e482-8f5b-5cfd-96ad-d882b41166e3", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "5fd64dfd-c0c0-50d5-a370-53faeb84aaba", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3357a350-6315-5195-b0cc-6e6f31a16846", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "0a4219f7-903a-52b3-acdc-e75a83a0cf62", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "54560f71-970c-5cb4-b236-e22b03177293", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "1028bc8b-7b88-5265-ae9d-9a3b935eae56", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "bd14b314-02bb-5c7e-8474-f28a9c2699bd", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "e32d2fb0-9372-562e-9bda-f620efff2c12", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "cc352083-506b-5ab3-b255-5b613aa92c9e", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "47d101a2-c951-5dc4-a6f9-f01a7972d69d", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "e61705fa-1f3d-5015-8a6a-706a2d64d919", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "3395c697-79aa-5231-86d4-cf9f27aa4e3d", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "44e3d737-c538-561e-aeb2-0f199d1a1a0f", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "b3c9e190-7b42-5e21-aa5a-75aebc848c30", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "7f2fa182-d543-5d53-beb0-9c1a2984c1ec", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "fb551ec2-8a99-554b-87d1-bec2c2585476", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "9f251a10-5dd5-5cae-a1d0-6f6d72011944", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "4949d9b6-7aff-5ce2-a3e0-546d91ee2f6e", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "a257160a-50f7-5eed-b783-67350cf51837", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "8d1e6617-bda0-5fc5-924c-3798a6bcbc1c", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "072ea7f2-cd26-5232-9512-6eca0aba46ec", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "8e1188b1-428e-55f8-a4d2-435727c2c384", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "ae577548-3594-5ad0-87f0-a7de125cd2fd", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "d5a195d1-09e7-5a0b-a71c-719f56c1a8fb", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "e1267a71-b6c9-5812-b063-e48733d0e4dd", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "5ea22fdf-deb4-5cf2-b20b-5c9ce0868f36", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "768e86a3-3ed9-5145-b7a2-9d8bf0ee72b1", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "f03666b9-844d-564f-99ea-70ea6aa4b90e", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "28206443-476e-5fcf-8a31-859765743728", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "ced30b94-fe0a-5560-b634-10f19db72dd1", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "5e0e3957-3eb1-526e-9fa3-bc166aaa5be6", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "91b77a67-7937-5a3a-9134-7d2ba8c0b821", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "c8dd4acc-3f6d-5718-acb5-59fcac724675", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "33fca6ea-af93-5f22-9d1b-3dcbc7bec55a", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "cfd6800e-224f-5d1e-85b5-ef048771a4b6", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "caaad5e8-3d19-5895-a24b-af5c2957e9cf", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2a5f3f32-aca4-5fd8-b245-824019d5c0fd", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "b47b7209-6c23-5b17-bd9e-b73137749d7d", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "4e2784b7-5dfb-5d91-a150-f439e006ce3c", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "fb27306f-f8e9-5bfa-8748-c61780a95704", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "64759a0b-a659-503f-a903-f1e28b0b839a", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "927ed4cd-c53a-5134-aa0e-31d6c3c14ab2", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "c2060981-29aa-5083-bb0a-7d8457f1c83b", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "faead0a2-3aed-55a7-b47f-4b066e0876d9", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "745a50c8-eae0-5a2f-88c3-8de737255d1a", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "69323dea-dc2a-57c5-828b-64f077d0dde8", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "b56b5766-1994-52ff-8033-c9fe4dd75788", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "220c844f-a483-528e-ba69-38608793eac0", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "a59e9867-2ee2-57c7-9af7-af432d72d57e", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "a53b90ce-41f7-5b7a-8369-83408a97fbfa", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "3a8de211-96bf-5d45-b688-cb6ad7257a1d", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "17ea4be7-6efa-570a-b919-62319991ffae", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "d627937e-10ec-59dd-bd12-bb697e68f14c", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "165389a1-0680-5f64-9eff-b8af0780e3b9", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "0911baee-ddfe-5fef-81a4-5953a70c8278", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "96a0f928-9694-5080-a02f-2439ed97dd44", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "4a64a931-74a5-5d27-b29f-f8899cbdd03a", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "0f8233ae-c1c6-533d-b2be-6be6a160cf4f", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "66750711-0bf8-5763-9cd1-d92f7229ab8c", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "661ad5f8-5997-5367-a378-99a12e5e2882", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "53e144d6-b8f9-5760-bf4d-2ea90fd3e755", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "d2b9927b-6390-5a21-b5ac-14175edf335f", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "97681bf7-d984-5c07-9c6f-0f9958a51833", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "97c73293-f41c-54fa-839a-f3d6a79671e9", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "58afbbcb-7eae-5f82-b854-ccdaaaf695bb", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "ba181bb1-312b-5f31-bbe9-499d252d4f3d", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "5ab12a79-41ca-5498-92d6-f6a53cb90acd", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "02432d2a-35f0-5917-ac8e-d0ffdf6ac038", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "6368c3e1-651d-52cb-b69d-eb7b3ecd0875", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "c0f38cb5-d810-5027-8759-aa80b3482cb1", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "5f949385-eac3-5d04-99ca-5d7d48c1022b", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "876764c2-032d-54a7-b407-6089208299a4", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "28e28fb2-3678-5b79-987f-d0a5d8b3f1d2", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "ae31a914-bf4f-5826-815f-06719c981b67", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "d1e0589b-ffac-59fe-a333-6805929770ef", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "4489bca4-f06d-53a4-adaa-f3e6de36d538", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "0ddf40e6-6629-5272-9582-e451f06c7991", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "5e18eb86-80b9-5c94-98f7-d5322b293fa8", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "44d9a726-92af-5c8f-b4b6-3a0a21f781a1", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "9437afda-3cb1-57e7-931e-fb90620a5f53", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "68aecd4f-4167-5464-86f9-e702a511f523", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "9956dc05-70dc-5872-b72f-f5ef99e63b9c", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "5eaf1b12-d3db-514b-9163-5cfc0bcf778f", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "e3c2bda1-cc45-5d60-b9ef-110348f618a2", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "88c86958-2c0c-57b4-bf14-025afe4dfe40", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "8b8b0b9f-0eb1-5111-bf34-d8e46895ac22", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "988010e7-7582-5768-ad0b-4864d5043e45", "question": "Each of the following drugs increases the duration of succinylcholine action EXCEPT", "A": "echothiophate", "B": "gentamicin", "C": "magnesium sulfate", "D": "pyridostigmine", "E": "trimethaphan", "choice_num": 5, "target": "B", "category": 1 }, { "id": "39804efa-c37d-5845-9d6d-c63e7e05c610", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "3a0efbe8-233f-570e-829f-209abddd65f9", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "b3800c10-c47f-5984-b094-1a97ec60139d", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "b5f507c9-db9e-53a8-9eb0-9d9d298b5c58", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "aeb6d102-884a-5937-a958-938aec413718", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "f6060227-67c2-5204-92ef-2368065e0304", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "ecbd4aea-612d-533f-9da5-629e3a770594", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "066b3a6b-9ccd-5ad3-bcf6-2fb2ea4402fe", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "e6b597e1-ce43-541e-8d58-5d9a8447347d", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "3b2201eb-2e5c-59a4-ba03-967a5e36c1b0", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "be134997-1ac1-54df-b393-84fc2816fd65", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "2bafaffb-a671-59fd-bf1f-1e5a2a073a65", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "7df9bd30-4840-5392-9439-ad6f547fd5fe", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "614b6b9f-a6ba-58d7-9bef-457510ea0c3d", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "93385df8-b92c-58db-81c9-bc158f46da6f", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "26669121-c424-5f14-a258-45e21ac44e6d", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "a857537d-608e-5699-9b35-e60d5757965d", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "90e14375-13d6-5bed-a8ff-4dd8adcd381d", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "c578a956-74bf-52f0-8371-5791e0c5dbf1", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "863a041c-6272-51ee-805d-e3f851cc4cda", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "306fd87e-e12a-501d-9b62-807df55e6354", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "4f07ab91-5daa-5fdf-a401-6c4642ebe2c2", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "be9347f8-202e-51d3-a2bb-6293d40b35ab", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "affe9bb4-5a0f-544b-9ae0-8207eb586ecd", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "e524a28a-3be3-5bbe-88d0-1d9154a08f53", "question": "Myofascial pain is an example of", "A": "a central pain state", "B": "neuropathic pain", "C": "psychogenic pain", "D": "somatic pain", "E": "visceral pain", "choice_num": 5, "target": "D", "category": 1 }, { "id": "09dd628d-4798-5fb5-9130-018ce9725e32", "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%", "choice_num": 5, "target": "D", "category": 2 }, { "id": "784eb082-eeaa-53f8-8b96-af87b2458846", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "856677c6-eb03-5f1a-845d-87925e574aab", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "83187d89-4726-5b20-ab4c-5fcf2f5e7009", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "eb06bdee-2744-5fb5-86c7-be9d816d2a81", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "2b4c2697-0458-58aa-8d31-9a0394f80031", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "35518728-a7ef-5a98-9650-597dc86700d8", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "bace3a70-14a5-5bfd-b914-802a8c8d4ba9", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "c9833352-1d14-5523-9e1d-e78bf3ca4ca3", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "122d8809-5832-5dc8-a918-68b38030333b", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "36a2e91b-349f-5d4a-8eee-4706e846fb52", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "1f09cef3-d7cf-5cd7-8185-5d336874ae18", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "9160aa8d-9fd3-5d75-8b6e-755eb62eef60", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "a64a3e12-3ecf-534f-acf2-680398bcc0ec", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "80ccb14c-9f2f-5eec-826c-c5a7fda4f68a", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "c1d76d17-5522-5658-a051-bb4f514d0abb", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "8bcd7d88-fb4b-503d-9b51-c7e303819c6f", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "b732f380-2781-5741-8810-859edbe6f373", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "28c4f771-a8df-5972-9b56-3b5b66c49921", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "226d428b-8d01-5e4a-bb21-3a97b369227a", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "4d3b81af-d9c1-5c93-8bad-6416c624926c", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "e94c1776-f186-5501-af51-826e1b776b4c", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "c965b996-1be6-5606-85ab-16bf1c952aec", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "9799f25d-5aed-50cd-9920-b315b3c6a4e6", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "84d73816-e1f9-593b-a37d-5e49d9332b00", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "9338c146-8bb1-565c-acd7-40662aebcb1a", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "4ebe5bec-4e87-5afd-8525-dbc4789e961e", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "299118c7-b87b-564f-af9f-79cb223da300", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "5babc330-75c9-5045-bfd2-7fe485ede39d", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "2ead731d-e1c3-524a-83fa-405ae3e3a637", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "58b9ecca-1414-5fad-874c-24468d17f4ab", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "dd0771dd-aca2-50db-b7d4-9f72da99f1b7", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "306f498c-c187-5733-a89a-3b94a30438a4", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "11ff2f22-517f-562f-8ccb-c42a3ac18700", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "b6a4e8cf-75b0-5cd3-866b-bf72ee21f53f", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "9ccf16e6-14ec-58a1-ae44-b6bc8d0f5edb", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "cfb63860-dbda-5d91-b204-035798bca476", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "ead7d0df-5317-5c1f-8f6c-0c916a390f62", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "56f994b0-ab40-5453-ab51-06470eaaeb36", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "06e2c149-2ec5-5f4b-a781-3ce2bb54367e", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ea47549d-603a-5969-97b8-b1ab37603c2c", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "4259c820-0f35-56b4-9fc6-dd8599030846", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "26e67943-a475-544d-a990-0cd492674bef", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "49a52c51-922c-5dc3-ab23-e5c7ef2d8636", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "208d138b-ea73-5793-bffe-e9bf066fd298", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "fe351ae6-3d45-56ce-8348-7194207f8907", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "90d84fbb-0a41-5664-8c4b-0892bfbd03ab", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "f5900b86-e669-5cd0-8024-11f07fcd1aa2", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "ce677fa1-df7d-5a25-9e5d-92abae9beb83", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "a48ef704-9fdf-5a0e-ba66-9af7db53f3f4", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "4bffa74d-0e81-571a-9f5e-d2386ed24d50", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "7685d363-cd18-52b7-9079-3aaff51dd0c3", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "36806a70-ec74-5190-98d6-9aa69ebab2d7", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "8e205603-fcbb-5f16-bfc6-e61040730299", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "3a4034dc-5ff2-50f3-a508-259ce6ddd166", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "10a8b7f1-8f23-5e5b-b89a-de287fcaebcc", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "c6cd4b3d-edcc-5ecd-8738-0b0406621c6a", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "2902bf20-7d64-585e-8900-912e316454f7", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "0f3f0c2e-3d64-5f38-bb3a-fbd60224d2c8", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "237aa3b6-6a6f-5f04-a2e0-d81122596e06", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "9ee47c6d-7e02-5a61-910f-65f6a1ddd137", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "39fdb736-6ad2-509d-ba46-28fdbd08ce20", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "33ae59a7-8ab1-57a5-8769-4f6f4a74ae21", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "4767b71d-dc7b-5f8a-a827-f78b91df9448", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "c6745193-0970-5464-ad5f-1a11448139d0", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "8157bcf7-c71e-585b-8813-ad2bdec78d33", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "02e12756-39d6-5eb3-b484-0a3cc52632b9", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "d52fbf45-69aa-5e45-966d-1ecc560d49e0", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "269c2643-9b56-5523-b839-5b4e4b4b4623", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "5ac44ecb-f0c4-55ce-b1d3-161bca562923", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "9423f6d4-eca4-543a-bc42-f3937a32913f", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "992bf8e4-8350-5b1f-81d6-cb969327c0e1", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "a61568d4-0916-5ba9-935f-e440f41aaf15", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "464a0c4c-30d8-598d-bb86-546f6102828a", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "d71fa3ce-e9fa-50e3-b044-a0fc5aba73d2", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "f3462ac2-3332-5ec3-9f32-d878e8aa93a4", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "ed901543-93f6-5e8b-b4b7-12e8918643c6", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e9aa3e89-1765-5a25-8b38-40e32c03ec33", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ac9c559b-3a71-5d43-82f8-adfa9ac351eb", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "2e99c94b-5be1-52a1-a38c-a8a70c7dd134", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "f50bc887-76b2-5851-9e66-9232eec518d6", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "cea8ed7e-0fd8-51b2-8ad8-b4a4c65fb232", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "b88a9f03-3fc1-572f-934d-84cf70aa45ba", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "dc12b3d2-d4ec-5f9c-a160-9716ec57492b", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "accd37cf-0b3d-5db1-9f10-ea467dc836a6", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "77e52a88-ad4a-5fbc-a68f-47ec327b6fa1", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "de1dcd11-31a4-5bbb-90bb-37f0bbde92ba", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "c858d270-1e19-588c-ab14-9a790bbbcd95", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "e4c4d706-d4ad-5b91-8682-464b3c423ec1", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "b29096c5-7341-51f8-b49e-82a46c35bdbb", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "4f0eaeb4-e9c1-5d07-8d2d-7c9206f1f44b", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "6599e7a8-5804-5817-b8da-c1f276b24036", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "21830f18-8943-5e5d-b69d-a051f4ae0873", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "b8c7f0c3-7df7-5ee3-9cb7-d8ce5975be96", "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%", "choice_num": 5, "target": "D", "category": 3 }, { "id": "51087395-6136-53a6-9f8c-bd5b2d6d325b", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "dce2735e-09ef-5a32-b08d-d06be7ca941e", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "a4b75875-647c-5d89-8e43-589952c98f3d", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "8cc4dbe9-c43e-5f47-b540-e9967e7c4f82", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "5586050a-2252-5bc6-aac3-ba529f143b93", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "a6fb5288-c2ef-5eab-9ebf-b1ee8f28843e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "66eab134-f019-53e0-b649-accd88bf7828", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "af2a0f94-b8b8-5926-9c02-8913c72a13a2", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "76328efa-f6f8-51fd-8859-bf8cffe4a94f", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "17e340e9-5e09-5aeb-937b-60178de9ff13", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ff6e9d76-e725-5ae4-ad55-8f8cc3865fd7", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "96068ad8-7754-5c21-9855-1cf7e3ebf1f7", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "3c3f9026-09f6-593f-92d2-7e5d89d7059e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "f438bc24-092e-50ac-8e39-249d5710a071", "question": "Following protamine administration, profound pulmonary hypertension is most likely initiated by release of", "A": "epinephrine", "B": "histamine", "C": "leukotriene", "D": "norepinephrine", "E": "thromboxane", "choice_num": 5, "target": "E", "category": 1 }, { "id": "732721bd-b224-5c81-ae57-627056898dd4", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "1b9d9fd3-57e6-5096-be1f-c67ef43923b5", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "91225942-b178-555c-b557-90ff822b9afc", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "d61dc8fd-22c7-5deb-9dbc-d88012c7a341", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "59856714-d51e-5aae-ab99-1646ae1fb338", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "6c95ef48-0ffb-56e0-8057-30f630934397", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "a8db24a2-7cc9-59e8-be12-ee0de253a638", "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%", "choice_num": 5, "target": "A", "category": 2 }, { "id": "3ce8e87d-44e6-53b2-a3e6-e94eca849316", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "3758ee72-0b59-54b0-b4cd-665b32cc90d3", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "c0f4c1ef-7887-51e8-8d97-00167b649434", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "94420d76-eca8-5d99-bc02-1254a1b4a0f9", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "fa75d957-72bd-5f47-9b42-cc8670f83d4f", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "89949087-7dce-59aa-9ee9-7d5bf7ece6a7", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "9244818e-94b5-527d-98d1-b9f39b4cc3ce", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "24c9a0cc-79bd-59f8-92c1-f7f04d3634a9", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "143f4560-6f36-52ca-8c1c-baf3ad7a8488", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "ec0d9d06-1a4d-5cee-bd1e-f21d0c002c3e", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "e416d2ae-3277-5b27-892a-dc65053b37dd", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "badadf25-c3ee-5aab-9a9a-bc2f1d94f2d6", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "48e59230-dced-50a8-8886-1e29d48b6642", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "0ad3c8f2-900f-59cb-a6e0-a385a5fe1cb1", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "c156823e-4876-5b12-b4ab-21153bd9efda", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "0b55601f-085b-5fa5-855b-a423413b2734", "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%", "choice_num": 5, "target": "B", "category": 2 }, { "id": "50a7a08e-6801-53fe-b756-c62528a1ae2e", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "6dc0267b-d5db-556a-a4d8-ea7913c35b85", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "9cc4849a-1094-5813-ad17-058fe40b0014", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "43915708-ffe7-53a2-a3b9-c08075e43aa7", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "ac60fb02-45a0-58b7-966a-d41e1662ec63", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "eff7c0fb-ccc7-5d44-97ab-c0cff2f04be3", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2c4e238b-52be-59ae-80f7-292a24298d00", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "6533bcf8-6fb6-5e25-a777-e531c4c3e741", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "bb2aaaa4-72ca-5f38-8bf6-26a7bd9f5b29", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "95264c01-0c83-5071-b657-0f79eb5171c9", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "984e5856-0f39-5bc7-947e-fa0274a834fa", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "dec89ce1-29d4-5604-9b94-c5fedd5b9821", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "b4176173-2984-5d25-abe1-771452323ae4", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "a74b93b9-825b-5534-97f9-571f82a787a4", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "60721e9f-c669-5d49-b2dd-bcf16189a944", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "c60f8bd0-820a-59ef-9474-bf3d8b6f871b", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6c133abd-2086-5e60-a1cb-09c7e18a4e92", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "c488e143-26a7-537e-9f01-15e07580c251", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "17c215bb-4566-5ebc-8d36-e36cdaa5d6fe", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "e07d0793-9bcf-5467-a13a-5379325ccf15", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "917c40e3-c1a3-5a12-aa0b-a87c38191d89", "question": "Which of the following drugs has the shortest elimination half-life?", "A": "Diazepam", "B": "Flumazenil", "C": "Flumazepam", "D": "Lorazepam", "E": "Midazolam", "choice_num": 5, "target": "B", "category": 1 }, { "id": "373a5c3d-f9b5-5f87-853c-0b5f13d560e5", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "30f78f62-8dc8-564a-ab61-c1a8e11249bb", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "57f30e65-87f1-5802-a836-013ef7a95df1", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "c60a432b-7824-5c41-ace6-4a3c984a1844", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "289f4748-37e5-50e3-ab30-440633c389e4", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "b3e56d57-dc2f-5bb6-8984-c12316bc0d7c", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "b34c5b40-bd0e-50dd-9aad-acd1ae78f403", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "024f8a71-2f95-568b-9672-56af49a028ca", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "aea3d5da-06d3-5b7a-a91b-1127d535c14d", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "b88990d7-f424-58ec-92c1-46df419816a9", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "76e7148c-e567-5f82-98df-e5876f574dcf", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "82865d4f-c826-5cf0-b983-63a5238681de", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "9b3404ea-b131-507b-8569-ba746e38848f", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "676fcb8a-6dc0-5819-9489-14a94d8715a6", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e752e720-a406-5d2f-9d82-d70dadb0ae2f", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "e125d01d-6b3f-5294-9484-af44fc8a9705", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "0e8b0b5c-8616-58b7-88b0-89046bdd67b4", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "d94a1e45-ab12-5101-8414-2d744eccea80", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "013d3195-6cd1-59a8-b008-aed2e2f5533b", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "9d9c2253-222c-5f34-90b4-5ae35fb6dc02", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "6a802889-8fb2-5a39-86c6-eafe6ed1aa8b", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "31f1df6b-15c1-51ef-91c0-2fd36923adf7", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "facaaaf8-48b9-56c6-8f98-0e28842ce8ff", "question": "Which of the following drugs is LEAST likely to cross the placenta?", "A": "Lidocaine", "B": "Meperidine", "C": "Midazolam", "D": "Thiopental", "E": "Vecuronium", "choice_num": 5, "target": "E", "category": 1 }, { "id": "379d4c8e-08ba-5a90-b60b-1970531db996", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "920258b5-664c-5130-a083-eb5e2c71a9a3", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "48083a60-fb9d-5aea-af90-4be46454db8b", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "cd59ffdd-e87a-5925-8120-1bf9172f3b35", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "5b381199-93ca-5a78-8bef-b985c2225bd0", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "ce7f9af0-8176-5077-877c-db388587ecb4", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "187eb2af-2cfa-58f3-8ef0-04bf7679f6ca", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "5feafc1a-1017-5722-8cde-80c02053fca0", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "6c9fd6a4-b486-5d40-b659-cc7609aae5ef", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "34e7cc10-8c1a-588a-bc21-9b42f94369a4", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "2ed343d9-c73b-52fd-b4e3-9c0e36fed93c", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "631f275e-8c52-5d93-abc1-fbb8600b4862", "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%", "choice_num": 5, "target": "D", "category": 2 }, { "id": "66019076-2749-5e7e-bb38-13f70b98d37c", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "b679852d-96b2-5916-b415-9e226d076fa0", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "ef775182-6f66-5dd7-8417-fcaa4cae295b", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "61a4d172-f5e0-5bd6-b5f6-3317e255ecae", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "701c0f54-77ee-5b2f-b18d-4e7f10762725", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "9efb917b-7db5-534c-9e7f-28a34a4bdbd4", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "6c1ad5b0-cc98-5984-b93e-852e2910a633", "question": "Hypothermia to 29°C will decrease", "A": "hematocrit", "B": "plasma fibrinogen concentration", "C": "plasma pH", "D": "plasma protein concentration", "E": "platelet function", "choice_num": 5, "target": "E", "category": 1 }, { "id": "143b754c-ba86-52e9-a126-84e97951ba3d", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "9f6cf7ec-aa88-5060-843b-f9419b328702", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "a946de80-4197-5017-910b-13900717c771", "question": "Which of the following opioids is vagolytic?", "A": "Morphine", "B": "Meperidine", "C": "Sufentanil", "D": "Nalbuphine", "E": "Alfentanil", "choice_num": 5, "target": "B", "category": 1 }, { "id": "75f54eeb-4676-5f90-97d0-fb3a1a128bf7", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "f4f8bdad-c88c-54b7-b134-4ef8bd5b067e", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "ba29b31d-cf5e-5fe3-8fd5-f933546e992a", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "d1c8e776-fd17-5549-8d5b-7dc06b0bc9d1", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "46559e7a-8ef6-542e-bb18-308c874cd157", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "00ca4cd7-4b15-5ba4-b489-fed4c4a95b3e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "e7ad4398-a7ff-5199-b6f8-c1dc16050dcb", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3a2ca792-7dcf-5de2-9c79-e10235b08fb6", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "2ecca373-41bc-507f-a9a9-2ee0b800ebaf", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "cc907cb4-8689-5efb-ac5d-dc40d7919569", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "0abbcc4a-bd2f-5795-9d4c-77daceaddd96", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "538fea75-6307-5d5d-bc5a-b617e78453dc", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "2da091ec-8531-5b32-a0e4-16e0bcbfb3ec", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "f4e966cb-737c-5100-8ca9-d2db26245e5a", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "b1edc76b-57d9-51b5-8196-bd92a957dbe2", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "128156ff-ffde-5ab1-92c3-9c775ec62b9d", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "50c3e7b8-9821-561a-a4ea-588f2bddb472", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "89e03fa1-52b8-5a82-bb38-4d949fd35c91", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "8c153a1a-03ab-5ba2-80f1-7e0c349ae3fc", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "0dee476c-4e7f-5133-9f1c-26140de77160", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "1d084ae9-ca24-5fea-91a8-4c78ce3962ca", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "5d50e4de-402a-5742-8f48-f888fd3c0dc3", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "4ad50329-8def-5383-aa2b-6c94da71e752", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "334460e2-ce87-5355-820b-aa7faf9865c4", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "1e1c8c0f-9b53-5f71-803f-a56f6571ace1", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "75d77436-a667-5c03-bb42-abea2be017c9", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "2649aaa6-706f-5e8b-bc9f-9e21772f9035", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "f0d0ebbb-9053-5545-8fd9-0f9ff39f73b8", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2c12a2d2-7d1a-51cf-8457-a1667fe77e3a", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "f4691f0b-5389-50cd-a31b-897b4dddf873", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "1a8d30af-3d10-5907-b968-1ca7e3bf4800", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "9c3e929e-d782-5cea-8296-00c548ed7075", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "c6f5aa3a-1f53-5a99-87d5-d84ce4d7b467", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "91c5d077-b577-5aa1-864e-91c94af4c4ae", "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%", "choice_num": 5, "target": "A", "category": 1 }, { "id": "1438a9f6-763c-5837-8695-4300d75ec8ef", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "66e769ec-c961-5959-a2eb-c8a24e8e5539", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "f696ded0-31eb-5508-8b40-5154c628b445", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "41181de5-8ee3-5ab6-af70-974a7bc5980f", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "b67bed51-ea4f-54bd-9357-f09f96f6e46b", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "a124498f-026b-5bd0-908b-403ea6f4952b", "question": "Which of the following chemotherapeutic drugs is a cause of pulmonary fibrosis?", "A": "Bleomycin", "B": "Cisplatin", "C": "Cyclosporine", "D": "Daunorubicin", "E": "Vincristine", "choice_num": 5, "target": "A", "category": 1 }, { "id": "01047263-4f76-5da3-b3ed-487c6be03089", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "75a2f877-c0c8-513e-80ed-3e173e8e43e1", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "e73d1b73-9917-55e2-9b70-4395eafee63e", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "7e9965f6-730f-55dd-ac20-c2721b6bb907", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "e19ebbd3-ea7c-5e4a-819a-c51795a462bf", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "8cb15969-811c-5114-be09-6d22db608517", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "d900a12d-4196-58bb-be96-9ad2dd1a3397", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "8ad9ac35-1f37-537d-8113-2bcd964b6e7d", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3338a552-19e8-589b-8412-7621ceb800f8", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "ad0d0432-3408-5746-be68-5fbd23633908", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "b729489e-b3c6-5721-93fa-bcf502861ef3", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "4f264bf2-6d86-5f60-9ff7-24cf8625aa69", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "c1d5b354-8f41-57bb-a232-592eca2fcfb3", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "27644be8-bff7-5440-a298-54fb566d2040", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "ff41f680-bdf3-5065-b2b5-fb5580090d06", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "b12a7ff1-5782-5aaf-a7f1-cc9895663678", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "67b1305f-4a62-5a6a-9cd9-507287f4c728", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "b9fa1ed5-693d-5a30-a4f0-42dc8b1f087e", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "fe55b255-2859-5c4d-b956-bff0f480a3fd", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "f08628b8-075a-5ce0-8343-1170a67dc12a", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "5a6cf74e-a193-577d-a59f-b43924509b83", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "5f8669cc-582a-59ae-90d7-d2c7aeb1ae79", "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%", "choice_num": 5, "target": "B", "category": 1 }, { "id": "6fe15712-358c-5cc8-a034-599e39597d36", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "e19a6a6f-4b00-5917-a9b2-cfa2a0ecc063", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "88053240-7a4b-5b30-ba87-06ef842c11e0", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "7246704f-57b6-5c73-8074-0763306f30b3", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "51cdf2dd-e943-5d23-960c-9bb2720e0ac5", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "d30122ff-e6c0-5e4e-b587-1bc35daf1124", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "3d64bf4f-e878-5d5d-ba07-07ce00104e00", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "09a943f8-35e2-5fda-8003-e372dd7586e9", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "8ea796e4-cee2-5c12-84c2-4bf85ef1cfad", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "22389f0d-0e6e-57e6-bfa9-67962e9c2538", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "e967a494-e94c-5f59-83ee-6d7b42ff1bd8", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "649899f2-3521-5c3e-8950-22b0996377b3", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "1342ae35-6eee-50d2-afda-f3327b49fd22", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "f655a128-2ef8-5ea4-bb07-2e230c7e2685", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "8f4bd4ad-07b7-5343-af86-5d80c3db566c", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "37d3819e-8460-53ed-b62d-5c79f784bc7f", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "e1f78927-de11-5d51-a80b-244021438c5c", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "fa26e5a8-e008-581c-9835-deb7f4b3701c", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "5dfab547-9fb3-5a9a-90d2-fd55b4d9e98f", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "78450fd5-6a78-5b64-a20b-5f04ef1a0eca", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "87068a2b-7ae0-5932-8e4e-61c8144f9eea", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "c2e26d9e-4cf7-53f4-8831-9ac9841a6f73", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "edaa657a-4f17-5ab9-b10f-bc35075b1504", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "7c114911-e34c-52c3-9287-cabe3e8b283c", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "bc932819-16c6-5fd1-a8ef-7cbfeace8f73", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "2a49a59a-0f45-56ef-aad4-b4806b90b0bb", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "53b3155a-ce48-5d78-9c9a-d4e80c803eb7", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "b033171f-9bbd-50aa-bab1-31de5c554039", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "00a32823-2137-5ec2-930d-1e02402823a0", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "550ffc41-46e2-5df2-8f58-dc62f6504565", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "c69098ab-dd8b-5c97-a2f6-4feb611a5de9", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "9d2efce2-94e4-50d8-bca4-fe87895c623c", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "36fd71e5-f4d9-5e05-aa5b-edc14301308f", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ad5c2ab6-44db-583b-a21f-04ed2ab62f07", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "4ed70d9c-f88e-5796-88da-409c3e104e30", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "0ccea366-62fd-5a9a-93e6-4605e8c64373", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "26cdbc4b-308a-5543-9549-600616978f5d", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "772672de-001f-5755-9dc0-e8002587d8a5", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "be0c5c88-52e6-5d6b-9809-d3b29014842c", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "2b36d2e4-98d6-5589-bf83-e6cae8aaf0d4", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "44d5cf3e-1017-50b9-b6c3-a68e2420336e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "415b1443-d724-5ac0-a2e0-040e70caf520", "question": "Which of the following is an effect of clonidine?", "A": "Agitation", "B": "Salivation", "C": "Tachycardia", "D": "Tachypnea", "E": "Vasodilation", "choice_num": 5, "target": "E", "category": 1 }, { "id": "b7f466c8-8831-517a-ada5-3581c54c440a", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "4bc1e110-915a-553b-819b-262288ce47c3", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "40dd240f-e79b-5416-afd0-b19b87df80e3", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "32601239-99e5-5b73-8355-b4c0e46ad8a4", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "0ebc85e7-1d1a-5ac3-b3d3-e42be69a18c2", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e0895cc8-1ddb-5837-9027-e72af0f5e551", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "d56aacf2-8df9-5d29-bb4b-78ae39bec466", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "5e7fb80d-e525-571d-9453-5e81b1b44913", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "72ebb2fd-ba4c-5b63-9c87-a31d7088cc77", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "15cc18bd-f60d-5d92-a199-67d0463cd687", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "c842c84d-c586-524a-a485-fcf9c46891cf", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "04576a53-0b6b-5211-830b-4f566ffebce8", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "f0fbd88b-0a97-5291-9c87-0854a1b0c756", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "65212e9a-d8bd-5d68-9116-f045d9ead43d", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "ec5d86bd-1fb2-5f0a-9207-2f94078c9b3b", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "566e8c43-bbe8-5012-b4b7-5b4c5a8d40ce", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "d9e7ffb9-1252-548c-98f7-3b356b60a2c9", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "9a4c48d8-ec2f-5e9e-887e-6aee1454e82b", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "a3510232-bd8d-5cd9-b94e-0c55644996bf", "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%", "choice_num": 5, "target": "E", "category": 3 }, { "id": "d5b2eaa2-cf01-56ec-8451-898367408e2d", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "36f2de2b-3a01-5ac5-8232-41bbdeeef18c", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "8620804b-f952-542c-90d8-991d44c19d4e", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "1d09e3ab-3295-5a33-a703-1d957915ec84", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "09bd2d11-52c0-56dc-9f4a-709d29b5428f", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "63a489b6-1cef-507e-b638-3a440ac8415f", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ad00a493-c90a-5709-829a-069d0d4012c1", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "d96afc15-b61e-5e96-aba0-28795b1e499c", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "b8675162-e303-5745-8a2b-804d1cb4bde6", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ae11274e-d617-5db8-a50b-8b986914d5cb", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "5f72ab75-0763-50fc-b9bf-f423ed6c9f8e", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "95f4f40d-4741-5b8f-bdd2-44cd1c3ba7e3", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "6d578b09-9e4e-527a-a53f-ec362ec59af0", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "6be7f60a-40da-5666-ad8a-335d19cbbf34", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "4b10457d-315c-512e-a6f5-949312c55e1b", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "c75e376a-4915-58b0-ae5f-8d57c5c91ac7", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "3cc8d0a3-45c4-5373-b5d3-3cb629943d6c", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "3c1ff444-82a3-53f6-a211-91114ecac7e1", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "7dc735f1-68dc-5863-b225-7d6cb58e8c37", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "6bd3aaea-3d5c-5584-b76b-b260009135a2", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "c26402f0-fe44-50c6-8867-788c9ef9abc6", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "7b539ff4-7251-5aa0-a055-b809d65c187d", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "ed015b48-f69e-5b00-ace5-27a5a7a5cc20", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "4b468083-05e1-5f87-a120-4e4827c2645b", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "b86347ae-5789-5263-9d52-1cfd3b5b0a32", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "f1b7dcfb-4a4e-54c3-b7a9-65c835295e3b", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "1da73490-b326-56fb-8ddf-74fd007248d3", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "7dd206f2-3b8c-5427-ad50-5af74c3d4f97", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "befd2eb8-5cf6-5bb4-85d5-b2b6daa91f0b", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "984cc5c2-16ea-5552-a869-c181db49e454", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6562a982-a37d-56b6-9121-7661f48e3950", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "76f33fe5-eee6-54aa-a62d-d322af085d27", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "705561fa-3304-527a-8471-5196aa8cfe37", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "91270ad7-bfe9-556e-a2bc-ad51aaf54482", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "cfda1815-ab18-5539-8860-0e664d86a4de", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "5c1948fb-87dc-5332-b459-0fa73cc2fad1", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "4d7579c9-c9df-5672-af5b-12efffb499f4", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "10ba8720-7398-5af2-9cdc-b9c2aedbac2e", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "d7d37ff3-b78a-53b9-b1cd-e8a97781bbc7", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "6c2caf14-132d-52bd-9dee-6636effe248e", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "9d6468ec-d188-5833-a4df-4f90181c30a4", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "4b129b0f-7233-5ca8-9ead-0ace13feb5d9", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "83ce3281-e51e-5ef7-a5c8-5dc90cc84cb3", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "73496b04-d38a-5ee7-a1aa-ebd3c7f47bfe", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "c4bf123c-3a51-53a0-b99c-9c166eff4dc1", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "4fb8e16f-f333-5ac6-91ac-73db0e95fbbd", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "8c565987-95f4-55d7-96eb-8f19a3b5626e", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ce51c478-54a0-5d51-8ef6-e549d19cc85a", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "753528e6-2af8-5da4-845b-28c7d68c6cad", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "381ff37c-b62c-5f15-a29e-1368313eae80", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "107a1394-aa9d-5954-aa53-6823d92f3d5e", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "06aaa910-f601-5281-9107-c006be8284fc", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "4a7c08ae-5cf5-58b0-8fc5-2257cd4cc51e", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "9ed616ce-bd86-5b5a-ad2e-2a7c0207dd61", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "663277e8-855f-5e2c-a5d2-08c8ac4f0b41", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "d7c25220-b758-5e03-bf8e-2c614b99064f", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "98329421-86f7-5ab3-af12-9eb295e42371", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "3fe439c5-808d-554f-b45f-bb774b1334be", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "19b2cf50-4ad5-57c6-a4b6-00dccbe2ffa9", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "c7870298-a4ad-59be-ab44-baffb01a6a2d", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "41c1e6d4-a690-5ce1-b719-2d66559e0b7d", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "5218c63b-2be9-58fa-ae62-cdb9542bf25f", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "5f63a9f2-84c9-53c8-9650-2a00cacc4c41", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "a3540407-3f0a-5ce5-9601-0e23af75aab9", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "ae3b51f8-1a90-5d15-b9f3-a05b7c85f515", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "0ee9e40f-484f-5776-b0fe-49578642b371", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "d8980a74-164a-5361-a46e-8a385158b0f4", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "9b780910-c8a1-541a-88d2-b74807dfbc54", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "1ed73bee-216a-572a-9221-7ea122f0fa8a", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "4da0a395-e6eb-5e9d-bf44-c1d50d4818c3", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "d8dc508f-662a-5348-8c11-9f684b35ccb5", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "a56ebece-063f-5404-8808-3051c1e9899d", "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,", "choice_num": 5, "target": "D", "category": 3 }, { "id": "d7d5c819-b56d-5207-9835-46e8754f4027", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "e55453bb-cb87-54f5-88c1-eeecd5b010cd", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "231cf06d-3b3a-520a-99ed-d59b725b0f50", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "d98c8753-7b2b-5362-b300-77944eb69bd5", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "288eefbf-1757-579f-8199-1d39b7e1f675", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "7b13cc86-edaf-54cd-b193-4459de5b31ce", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "da2c8e47-9bd3-5473-a2b3-479193729725", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "807c0be7-3e74-53e5-9c39-ffcbfa97a887", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "e0101d8b-b29c-558a-a034-9bc1472e58ce", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "9f9cb729-056b-59ca-a8bd-74d23d940d0a", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "248f7dbb-c86d-5b60-8c43-800176ce7059", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ce8b424a-6415-5470-8021-68dd9817be93", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "96fad996-5fcd-5ebe-b060-f6df026f02e4", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "e1c45ba1-1677-5e0c-9439-f51dff6d555a", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "d94073ca-e13c-5911-9a43-4afcc1bcfd82", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "d470bb2c-eec6-506d-a793-0ede301b88ad", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "7689bc52-e354-532d-8b95-92c94de2ee81", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "34090ffa-112f-5bb1-8f67-54857e52eeb7", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "f5cadce5-6c45-5680-b8e1-5033925e4173", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "ab366874-fc0a-5394-bdd4-20d3a06149a2", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "23d0e63e-f76d-5b5a-977c-4b0acb626cdf", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "8ea95d4b-08f3-50ab-9f32-dc1459be5df3", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "4ba66aac-1b4a-5f5f-ba94-7c455a2538bb", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "b005876d-bfce-5ca8-9c66-0a35f1a62a23", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "e3a7ff9e-bda5-5dea-afac-64a8c9f57af3", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "0abae771-3763-53e0-818c-90470b836e3d", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "d9041861-672c-5775-98aa-1fd3193faab4", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "d6a2066d-1ff0-54a0-8991-577261bd19f2", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "c2ee9c24-8a20-5728-9a3f-5f18371c7eb3", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "5610df6b-4f68-5605-818c-a770e3b48cf0", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "b494d48e-8e5a-5b40-ad81-cd6dc1d82691", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "accc3a65-56e2-5094-940e-467015ddd509", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "751bbbec-a975-5d44-94b3-f986d6dde98c", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "70fbad04-cea6-5db0-9787-d761e59ed058", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "ce967aec-b965-542f-aedd-1772d8c5049f", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "5f9f29aa-51db-57f8-b14e-9fbb99e8930d", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "42bb1246-83cc-5345-81f0-85253cd8fed5", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "84379cdd-aec3-53d5-9c2f-e807df32309d", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "f14a7820-0f99-5120-97de-c6cc7fd17988", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "afc4d1b2-70ff-5384-b367-904528c73913", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "3ab3aa21-f107-508a-bd6d-25e2d7eefc46", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "c2578935-8174-585a-9de7-4472a7502b93", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "4df7169c-fdbe-548a-bbed-e5fc5095b279", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "eeb43311-52f9-52fe-9692-cb4fdac8710d", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "caaf7563-0cf5-5647-bd16-3d7af8b5eb20", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "76d641c2-3e6c-5f44-8902-70b2d8b5aeb3", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "4fba2294-39d1-54c2-893e-f991772e607d", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "09f5b0c2-d423-5401-abd8-3d299e4de07b", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "7dc46002-743b-575c-85d3-e3047fbc2051", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "e736024e-2845-52f3-bdbf-851602bc87b7", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "3664c9be-011d-5520-b3ee-4f0ad0ef142c", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "5d0b109a-be53-51a1-98de-b5f367cc5628", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "f0f68536-0bb1-5e04-bc5a-48d4cc43b183", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "b8f00c66-471a-59cf-909d-701852054160", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "d1c7860e-501c-57cf-a3d0-ab1754f9e744", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "c667ac71-e567-5548-9528-add36833dd60", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "068c5561-6e41-5ceb-bd37-0e8b4ccefa03", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "44bb0e21-754f-50a1-9216-c5b4f135ad7f", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "9c390154-71b6-52c2-bf50-6f8e9df8a0d5", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "73f61b47-4454-510a-b495-b9caa7faab7f", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2a76c4f1-f571-57a2-ba57-3fd72ce4d4e9", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "e3fd137b-fe4d-5ff1-b4f2-566657551cb2", "question": "Intrabiliary pressure will be increased to the greatest extent by intravenous administration of", "A": "atropine", "B": "glucagon", "C": "naloxone", "D": "fentanyl", "E": "butorphanol", "choice_num": 5, "target": "D", "category": 1 }, { "id": "1d052d02-6bf1-5503-a495-f9aea7a5282f", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "c2dc95cd-ef41-5250-bebf-1e9a89f4a18d", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "81bcf691-b51d-5ce4-a5dc-465145d9c94e", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "602b0320-db22-56d1-a324-7d6025215ca0", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "8a0658b2-33fe-5e67-898b-a33208b4186f", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "df35df73-aaab-5c81-bbde-dfafe18f0019", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "39c7c4e3-6cbf-5461-97e1-0224f3921e8f", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "4091878d-3d58-5090-a26a-15d06c7e8dc2", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "d83b3871-09d9-59dc-ab8d-80bc01076eaf", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "03f1d2ff-714f-5b5c-a01a-558db29b873c", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "e51ff39a-f2f4-5d60-ac3c-e7a8f931ad49", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "c871b4ce-da4f-5fcb-a5a2-a8b269f83f89", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "2fb08a3c-ed2c-5d97-bc6f-caa3f5b14bd5", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "cb4fe7d8-ce40-5865-9021-fd3e7714da7b", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "edb05c0a-e0e7-55a6-8052-1e87d9415fe4", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "93ec0d02-c927-539d-9057-b566b75b713c", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "f2fc429e-4edd-5b59-898a-936dc53d7a2e", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "62cbed71-f125-560d-ba07-153583d1565b", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "acf0b573-0623-5ab8-b9a9-29c0ff5ba8bd", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "01f815d6-ac94-5f45-a8ca-0d605c253c16", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e29eeab1-aabf-5009-99d7-be232acabe01", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "9d1f0e27-3872-5bd8-929b-346dbb8a85cc", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "cb810603-dc25-5a68-b311-576668664473", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e50542e8-2880-5adf-999d-e1b2bbdbdf07", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "e100fedf-86d3-5d11-a979-6fc0da88c9f8", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "46830d20-4e95-5864-b1dc-76167947a502", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "d3765b54-a3a9-5237-b049-bfb3b81ede96", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "f6666614-1846-593c-a9dc-c08175d24b52", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "cac6d9d5-4d64-5680-91bf-0590524bd6ec", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "3d58a62c-197a-5003-a69c-29b80ac0627d", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "6d44a69f-f83f-56a6-bce5-a1504395737b", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "e0dffc5f-4e49-52c0-a31b-6e2a281bcb8f", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "5dcc5eb6-ecbe-50e6-9ca5-2df0e6d21380", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "fc0937b6-f131-568b-886b-5ecdea6ac251", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "03f90816-c37f-5b7f-91f9-1c3c5eda074d", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "a87281be-752d-5747-aeba-182a6c63978d", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "b2d716f7-1f9f-5694-856a-e210c8b6fcb5", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "373aefc5-4b65-548f-b3c5-945eac8b3a1e", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "943765eb-5621-5673-88af-6085b0cf7ac5", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "8fbe76aa-d2d7-53fd-8187-37bc1eb4ddcf", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3a47daac-d0d8-5b09-b9d5-3dfc318b2541", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "ab4a8c4c-e0f1-5310-ab21-454d3a53f31b", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "059db4a2-a003-5c9b-b762-b8b2a65e57a5", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "e6563715-811d-5780-8b85-b34c7d2ced98", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "e59c1191-5329-5ccd-b4b0-3a95d9f686cf", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "d560c58a-1e63-5c8e-a410-2440f88531dc", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "67fc6502-ece5-5a71-952c-537e17317181", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e22fc47c-a60f-53aa-9606-fca3da49cf05", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "f87a3a90-bf14-53b6-abeb-0b8b2386ce42", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "9a7a27b2-dcf2-56ed-851c-669bdc8d92ca", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "12810c49-7d9f-510b-9e3a-affb192e3cdf", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "7eb20ffe-385b-57e0-b487-ab02d20bd7ab", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "da91c774-d3c6-5201-89f3-b81d4e65d26c", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "1d2eb070-b756-50e5-899c-a73d99ef5852", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "36b8597d-607c-5a21-b055-276c6e830ccc", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "86cf338a-5493-532c-9139-e22c175b12f0", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "22a9b632-542b-5870-a77e-9e82173efddb", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "5315dcf1-3f88-5761-ad08-0da3f19d756c", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "0dbeb745-2173-5175-83c5-c4f0f51e6eb0", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "446f276b-cccb-511f-a686-81394b0b51c8", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "ef5a9160-856b-5622-8002-38c3178cc25b", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "23bb1578-78e6-50d0-b57d-0c85210cb980", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "d58d235d-a69f-59b0-8be5-fb23092772e2", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6ac13eee-af4a-5e26-8cfa-bd8501f5b95d", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "eb07a873-10af-5b7b-8f7b-9c53e7271441", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "b9f2a844-39ef-56cc-b261-7f9145e54ba7", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "b3097374-c707-5469-a7e8-6cf79c96b7b8", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "4c5ac962-4596-5ce6-9be4-e5911f0e5de4", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "a08f3318-d632-533d-bd39-e2613b7081f9", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "c9c84e2c-2382-5870-962b-58d06ac5782c", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "fdc10946-d57a-53d2-9af5-2553d96d12de", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e7936885-da11-5f76-929d-2207e0853645", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "fa205502-0fb3-535d-9737-6a773ec0d5b8", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "c152a66b-11a7-5af1-88ac-0eafe479d150", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "ba653fda-714c-5b25-8e76-993d02328f9e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3373745c-5245-5764-98a4-d8783d76ac35", "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\"", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3278c03e-c769-51ca-bcea-78eed129e0b7", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6be14859-8a32-58ff-a643-1f8946224e87", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "4927425d-1590-544f-b255-ba70d22a7cc4", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "b2892b79-1586-5668-b61c-24098c907923", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "3a49c608-6791-5b80-8184-b3cf895d1476", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "fdd11fc2-afcb-579d-a460-77eaf6084243", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "cb7d8983-a40d-5a12-b9d0-2ab2ea0d1171", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "242651d8-8475-5670-9190-2b0441d6cf91", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "3dbc016d-d8c1-58f7-a9d7-86d41600c1e8", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "22cd971d-1868-5eb6-a749-8dbcc842413b", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "9ae5f882-5788-520a-a650-cb19609eca43", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "6bc10c3e-cee0-5884-9f26-04d5a8674899", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "85961afe-5d97-5193-ba18-9da764e60a81", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "eb5b258b-46c9-59a3-85c4-5e5d3d1a1d44", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "97e56d5e-c127-512e-aa66-929ae30d58ed", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "842bb137-f38b-593c-878b-abbf17de65c8", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "ee55104d-6895-51ca-b3f8-923df62dd68e", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "6c9aeb12-7a8f-51ab-81ff-8d9461237731", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "531acb06-8fc0-5f4d-b675-1f4d8eca1a62", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "acc23414-12f4-58a9-b885-6a82d881441c", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "6af88dc5-f009-5017-af7c-cd5517a0c73f", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "b95c1610-932a-5cfb-810e-3bdba7826a73", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "6c20b434-9678-5387-8725-4cb14202f0f6", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "1c26e9fb-aebe-525d-b350-01cfc3e8dbac", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "18fe9ba9-f815-5c32-9a81-92776b16e077", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "599cf8cd-1168-5bfd-a616-9bed2d289506", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3020cafd-2efe-533f-809e-f4229935b935", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "6cdfd240-0512-5aa9-86bf-f9957f640e05", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "8688ce56-09ef-5e96-a618-7d153aaf8604", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "51786f19-75f4-58fe-858f-f65eed5ddcc3", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "7441b671-a3dd-5602-bce5-77bbe18a797d", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "586bfa0f-2a4c-5d45-bd04-e7864992338c", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "f680a758-a2bf-5f1c-8520-01a66cf85e74", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "9e022a24-5519-596d-ba55-be8510c1cc6b", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "31f0b8aa-99ad-503c-a89b-7b03d6f353a0", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "868512b5-20e6-5721-8f3c-91bdd23604ed", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "af831b32-2e3e-553e-936e-e45665d02497", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "26bfb7d0-cd27-5510-b737-055c9174ed68", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "20afcc97-361d-573d-82d1-45cf406e2494", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "cb2834ae-76fd-5591-b395-10f1d6fc1665", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "5567c533-51e2-5c22-9745-be16566d38ad", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "eb06e4fe-56d9-56ce-bbc2-9f30f560e4c7", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "1a54bc3f-19bd-5a38-a376-a8375e52b5a7", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "2e700142-9ceb-5138-913a-20e61a718880", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "5e2f3981-0f2d-5f1f-a22e-2bb373dff4b0", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "423ff0de-2e16-5669-ad46-57da59a01440", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "c79b542e-a755-51c1-bb31-68ddd5fc549f", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "abae331a-50a1-5455-83c8-e8858aa7df13", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "9b51b072-d881-546e-8aed-458683b03402", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "a72050c3-32d6-5574-a895-56e5137fd846", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "dcf37b7c-c174-5d72-ab55-e17cb7677b27", "question": "Miosis, incontinence, excess salivation, and convulsions are toxic effects of", "A": "amphetamines", "B": "phenothiazines", "C": "cocaine", "D": "tricyclic antidepressants", "E": "organophosphate insecticides", "choice_num": 5, "target": "E", "category": 1 }, { "id": "c48c7153-6a46-59ad-bf26-1f755b18d01f", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "175175d9-fcd1-50d5-9d9e-4bab1ad42767", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "b42f3efc-c6b4-5036-892c-c261d559fe44", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "202cabad-b37a-5712-83d4-7fbb303046ba", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "3454a868-7fb8-507d-880a-240b122e6a6f", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "133d4077-1973-50f9-ab7a-64272e70f1b6", "question": "Ketamine decreases", "A": "bronchomotor tone", "B": "intracranial pressure", "C": "intraocular pressure", "D": "salivation", "E": "seizure threshold", "choice_num": 5, "target": "A", "category": 1 }, { "id": "c0c1b975-aaf2-5f04-a067-b5ad84ad8e5d", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "8570f8b7-bcc4-519e-9fa6-7de62b6e00eb", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "f7a11762-a57d-5668-941a-b7fd0a1ce48b", "question": "Each of the following is consistent with exposure to organophosphates EXCEPT", "A": "bronchodilation", "B": "muscle weakness", "C": "salivation", "D": "sweating", "E": "urinary retention", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ef477dcd-d967-5b52-83ed-57bf7baee78e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "9d489c07-1fc1-5150-85b6-725860b0ce49", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "26a06716-8f19-5cbd-a065-becd7822c665", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "7c650baa-9298-5c07-9049-43f5ca120d11", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "e5577db0-aae1-51f2-87cf-e911ca264686", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "1758dd6f-57df-5969-9d08-6e33c842aeef", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "e07766d2-168c-50c6-ad54-20290b4668e8", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "88532865-cafd-525d-a1b8-b358870e9849", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "7dc34298-265c-5aad-b9c6-091781f29982", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "5f142ec6-7795-541f-b392-9e39770116ae", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "a941e31b-a74b-5e07-a9e6-7530f12933a3", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "d1fa6b3c-3573-50ac-8f10-dc1936c8ce52", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "344bb25a-ca09-5547-9c1b-194718c1d978", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "f31902ac-b364-5dc3-846e-b17000f06da3", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "510369ab-777b-571e-a5ec-1141c87f4240", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "9ed89293-0e46-5087-afbb-985f7547cf0e", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "d7a310cd-38fd-541d-9575-12e46381e371", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "78d29de8-91d7-5793-aaf0-313c198e1872", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "ac8b7075-fae1-5e4b-b384-7d98b51809d5", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "eb36991e-54bf-5bc4-b20b-e6936b424f9c", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "d792ca45-231d-51b2-b528-bd27cc28790a", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "57790b70-7d7e-5891-abb0-44ba3a6b2aee", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6a1f3918-f4d1-5a9e-a1f3-d0c8ed8d6a72", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "e283a818-9f4f-510f-ba19-1a286885de26", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "206743b7-512b-5054-947f-9fdd2058f604", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "d123c244-7d86-5d32-a09b-b25718b5fc26", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "6fe0c725-9910-5a6c-ad66-df7df1444e7b", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "45ccc5f1-e5e5-5b72-86d3-1a9c17bd33c2", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "ddff903e-6424-5247-9e2a-356c4f97ca2a", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "609085f4-7735-587f-b198-ced12118e868", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "8934fe9a-b332-5887-8f8d-08a6c76dbf4f", "question": "Which of the following is an effect of ritodrine?", "A": "Anisocoria", "B": "Hypocalcemia", "C": "Hypoglycemia", "D": "Hypokalemia", "E": "Urinary retention", "choice_num": 5, "target": "D", "category": 1 }, { "id": "7702e931-6003-512f-b906-066496c51b23", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e081ac0a-fed9-5162-8c70-97a7f524d709", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "b30de8f6-9bba-523b-a943-28df897efea2", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "616b6554-275d-5f0f-9dc6-d5ffccf25d8d", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "ec14ad80-f634-5a88-99a0-53a645672268", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "b3431a29-a421-5803-b06d-07961351e2f1", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "97722ab4-0c11-516b-b938-45f03cd6597e", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "738ae9be-3e26-59c1-9849-b9e358a6d33f", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "f17893e5-7f04-5c7e-872c-43f6f49a781f", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "502f29cb-4b9d-5df0-aa3e-270ed4a0b945", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "49d0498c-e598-5900-a6fd-10ed38c37d0f", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "e42c3b0b-0c0b-55d0-9312-069206750e92", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "4f050889-e0dc-5e03-a0c2-3c7c0eb40c79", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "19318858-a355-5bfa-ab22-bb1e5105dcd8", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "0c6dbb4b-2790-51f8-9d45-5b02afe161a2", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "f26edd7d-4f49-58d6-b285-678e55ed727b", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "4c3e5a69-5176-5049-84c3-7727b7b3ca31", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "4f0a0cfa-8489-544e-9fd2-c575345007a6", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "77d678bb-d549-5745-acac-c4a6d99a8cae", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "888c55c7-366a-5050-86ae-847f378b713c", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "89e618cc-1480-5ff2-a4a9-b3e09e008ebd", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "77b08b6f-e1ca-573d-b89d-74758c9065df", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "d7088c9b-9be2-5a79-b091-66ffedde865b", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "e38d89d6-ecf7-5496-8e41-fca72e187341", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "b403c0b9-e5d4-5426-9287-a21ae2d13589", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "f2956634-111e-5504-abab-d2bd0f0c7343", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "40a6a0a7-728e-50a2-84aa-2313f48baa11", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "4825872b-5979-5db0-b7d6-a956f63767a3", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "58f76473-a262-57c4-a32d-e2e50cc747bf", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "97932750-4e38-5baf-a0b6-3d732ece0b2d", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "dc4516ea-41df-5d81-9bb6-5f657c8bddad", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "daac56f4-ea7f-5d7b-8d19-4700ed3bd2f4", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2dff275d-35f2-522e-aef4-3636be6a7e25", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "eb108ebf-8d26-5334-9007-7128cce5b9e1", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2b992da9-c919-5c15-970b-acc4700a5b2a", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "4c4399fe-bcff-5c48-97b9-ddad63bfb01d", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "7864fcdc-e27a-51cc-8aef-18d6f4c7f4f0", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ac0a9fe2-c160-5ffc-9b73-ca16d4b993ac", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "0fe60c64-de4b-5d1b-9f1c-00a890290f63", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "51c96382-fc02-569b-a127-7b8c4e21dd16", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "eb0fc0ae-0dca-5329-8014-87d29afe7d62", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "b33c2a5e-1329-5070-8333-cc3aa9a41d88", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "a92b8231-4484-5a37-bd1c-64799ddf78ac", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "df989236-b8d7-5b77-87f1-afd6803df9aa", "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:", "choice_num": 5, "target": "C", "category": 1 }, { "id": "9c8d70f7-c793-52e6-a8bb-cfe339ce7cbc", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "066d216f-db12-5bce-86c4-8de5944d0da6", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ac8a193d-dd15-55d0-9b2a-0126d2909fa1", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "d5438ac2-48a9-57a3-b796-ad62c73f7a64", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "c80f13b2-dcec-584e-bf72-589d9b78de9f", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "f894a097-3efe-5e25-9b76-779b01b707fb", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "42797ce5-b9cd-5e16-8c6e-d43bd1ccf7b2", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "e90fd454-49d5-5026-8791-2684a45dbc9b", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "4f35548f-5add-5d89-8a49-81024b1451fe", "question": "Each of the following factors decreases uterine blood flow EXCEPT", "A": "aortocaval compression", "B": "hypocarbia", "C": "hypoxia", "D": "sympathetic block", "E": "uterine contractions", "choice_num": 5, "target": "C", "category": 1 }, { "id": "9e17d60a-1f6e-5aba-8b23-2e8f44d79cef", "question": "The best premedication regimen for a known active narcotic addict would include", "A": "secobarbital", "B": "diazepam", "C": "nalbuphine", "D": "morphine", "E": "droperidol", "choice_num": 5, "target": "D", "category": 2 }, { "id": "97ea27bf-240d-5f5c-b760-57726d534f60", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "945028b7-3ccc-5365-9358-36a328aa49ca", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e22f57aa-1e29-5eef-b657-577ba33e4aeb", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "194ffbe2-2824-566c-a466-d7823168b667", "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%", "choice_num": 5, "target": "B", "category": 3 }, { "id": "de9129cc-d77e-5233-896e-d3a9230806e3", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "888e6d05-a51c-59b9-8401-be89c8ce8c25", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "12d57f5d-950d-516b-a981-aa03fd696019", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2f578f15-06cf-539e-bf46-f9efcb2d5142", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "4c24e05c-3248-5176-8115-6021e9036cd3", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "c9f59ef5-0dcc-52cf-9b56-694851b9ecd9", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "a2fcf654-7fcc-5185-a65d-acef5169e0fc", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "c8cee1be-e8a7-5712-a672-1e92c609f2e3", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "fad06e2a-bc86-5039-bf88-6f4b4ac10103", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "bdfe993d-e17c-5b3f-aab5-53dd32fe0f00", "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", "choice_num": 5, "target": "A", "category": 3 }, { "id": "23c472cb-74b6-5a7f-bbde-e69520364b1c", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "b3fa3e2d-042f-5cfb-a7cd-ea3f284c409c", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "0c470dbc-1352-5727-89f5-747e81149f96", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "5f2db97c-02d6-5a45-ac5a-393fa80ed446", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "17b6d7c7-78c1-5d91-aff6-988de761b017", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "46aa1b60-f82e-533e-8ef2-59b5e5a3d33f", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "7482c999-510b-5b78-ac3c-ca395bff9a84", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "93598bf9-e3cb-530c-95f7-94088188adc4", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "d75ae1a2-8a7a-5723-823a-5a678039f4f0", "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,", "choice_num": 5, "target": "B", "category": 2 }, { "id": "9adefc24-fac3-505b-8a6c-77e468c79f29", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "d6530e54-8a74-505a-9dbb-1b491a6d6747", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "c1461b01-5544-5881-be4e-17a71472a949", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3816b57d-08f8-5637-9e96-fbd64936a589", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "77b6060a-2d5d-5919-98ab-8c1595c7b1fa", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "396244c3-d9bf-5f74-8e64-ab05a37b76c6", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "b8d4e189-50d0-5b41-936f-2dda70a77060", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "a5c382ba-585a-5a6b-8607-eeaac2e41a65", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "9aa1b123-a847-55a0-b92a-b8b264ba0471", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2271c56d-5a1f-54a6-a313-131cbf573f1c", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3b28f7c9-9f98-538b-a1b6-dd20169ae179", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "d4348e00-fabc-5b6a-a944-ed5351ef3d8f", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "029be89f-ed0f-5be0-b879-e0b3fc7182ef", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "415b6798-47c0-599a-9afb-0db9cd704bb0", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "f12cf1b5-ed2f-58d0-8d27-6258c1973655", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "fae32b8e-d731-5292-818b-3ff4a09734a5", "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", "choice_num": 5, "target": "D", "category": 3 }, { "id": "04fa51f5-fa90-5d35-b2db-f14c2331be80", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "62227d78-2098-56b9-914a-4aaf24be8a4a", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "216c8c38-1101-5636-a319-0719fc5a195d", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "8f3f193a-261e-5501-8889-7175cda87f6d", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "b9909fd7-9399-5a97-afb7-3f05d85ec515", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "6a2f12df-2e97-5ef6-959f-28000d61252e", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "d171c8a5-7df1-528e-86be-04ffdc917509", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6337c6b4-2953-556f-ab45-8f7259040e10", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "394b7e3a-375a-58ec-8235-53c45bd1a400", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "93d2c5c6-df82-5ab3-8cc3-0cbbdd04f441", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "c4513815-336a-5a5d-b47e-a55cc72ad143", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e7164a39-82a1-5e95-b8ed-ae1b28fbdc74", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6a499a51-b2bf-598c-ba0f-501aed9f9cef", "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", "choice_num": 5, "target": "E", "category": 3 }, { "id": "96b35be0-166c-58b0-9e65-0812e133cc57", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "35fcba72-ae2a-5947-808b-d5cc92ff4ff6", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "e4ed6053-900a-5a75-bc2d-68ef39e43c42", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "54a8a13f-6a68-5b81-bb41-870b8f88dccf", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "fd37e468-c1df-590b-a574-1b8f0a5e91fd", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "0b128936-d741-5dee-85c0-6d09ac043e3e", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "6f7890a7-f9b3-5222-9b49-3719ee0e25ef", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "c461e63f-85bc-5eb6-948d-f047c7f0a579", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "c82f4713-f1e4-5deb-9d09-3fac4e9b1a5d", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "e6614686-4c80-5bb5-bd5f-af5cab9f3c0f", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "aa6979ef-f897-5e12-9395-9be05e14d1c9", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "33cffad4-f2f9-5fea-a6a7-554722003f95", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "2f249c15-a71b-52e8-b8ce-0c3b9544bca8", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "ee55db4c-cbae-521c-ad67-a4efc406cba4", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "79f1d264-f243-5ea1-993f-42f9a5f7bc2c", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "4e60871e-8d1c-573e-9538-a754727dd87c", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "7520d17a-6870-540c-94d7-bd41f9b27cbf", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "5e6c083f-0f3d-596c-821e-70d17466e4e7", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "ac301552-26b1-5d70-b04d-58fbc713b197", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "a644849d-33da-56b6-a7bb-12c7051f49fd", "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", "choice_num": 5, "target": "B", "category": 3 }, { "id": "a8c7f798-0653-563e-9ece-cedd1f593f8e", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "6a47397e-4506-54d8-9207-c5c1c377f620", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "4c29d7b1-9307-53e5-8be8-88658cf26ca7", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3ff9959b-90fb-578f-a404-2db6e29ec602", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "42886f8e-420a-577c-86a6-14888d903c38", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "ed37e08d-9d14-58d8-bc5d-0407efa5e865", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "309e10c8-4417-5ed7-bcec-7c830fcfbe6e", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "43013bc8-b090-5c51-b4e8-68661d6065b0", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "a0d06f9f-c8a9-5d06-98cf-51d3804b1f97", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "f8216d21-5c5a-5573-857b-1c0eb260bd40", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "d6fa787e-46b8-5c7d-b6e7-cead45150461", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "5beb24df-229d-5fad-9b21-1c790a27173c", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "e8f364b0-c701-54c9-9f19-ab9b9e3c5414", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "dd4aeb25-7b00-53a5-8ccd-11b8dfe7c948", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "8e823120-ffd6-5291-bcb3-2a313db1b2fc", "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)", "choice_num": 4, "target": "D", "category": 3 }, { "id": "c8609977-7852-5e4f-a18f-b8a07ac955fa", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7dbf6288-9108-5b99-bbb9-ac26965a3157", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a67d8ba0-8edf-5d09-91ef-b3a2c67a2aef", "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%", "choice_num": 4, "target": "D", "category": 2 }, { "id": "02b9c310-fdcb-5008-bf69-13c3d10efb40", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "d427561b-acbf-599e-b760-42161652ab06", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "76ef8163-4e48-5faa-8949-113878acee0c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "89010f19-ab84-513f-9f1f-5ecfd4300c47", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b912c3cb-dc02-5551-87c6-76d9eb402b6e", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "50ecb5fc-5a59-5bfa-ac2b-15551ebfe750", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "1125d0b6-7e5e-5d61-a8ec-cceb5052a439", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "eee07c2a-30d9-579c-8cbd-377d66f00d20", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3354f0ce-d1b6-5041-b48f-69ed8bc05f80", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "3c9ebb57-6330-5e65-8da1-c11a187ccbd7", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "56cf37eb-7ffe-5365-acda-3b8c87756f24", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "85228fe1-95f5-5e15-966b-c125a3798d62", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "681163c7-cfe0-5c49-a828-0cc23ef9e433", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c8e7ba93-adeb-572b-ba00-da5706b7c3e5", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "83fb213d-34e3-50a9-95da-9fdf468bfc37", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "4b32029b-e544-52c5-88aa-bf9d9bd2f30f", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "470ce84f-c1a4-52e3-a183-8cfc120637d4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "89969c1a-e521-5dab-962c-ab44b1a6903a", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a3d7c6a1-bfb0-5a9f-a93a-bb230e770c87", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "70639b04-5e60-531a-a5f5-20f35d3c7932", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b3431ca2-e226-58af-85a4-203d5a1165f0", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "f0d6a408-9188-53f4-abd6-80d2a671d6e9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "bc3375b4-a277-5d6e-abce-705a22de466b", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "ed79b886-a872-51bf-a98c-ac1c05df8445", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5fce774e-5d25-547d-9f07-7cab05f8c586", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2b6c2863-e244-5da7-9fe4-1db4f6fecb04", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "ae9d262b-5c63-55e1-a240-ae573716b19c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "48d78a4e-d5ef-5be7-a8ff-edf70ca3e492", "question": "Gas from an N2O compressed-gas cylinder enters the anesthesia", "A": "60 psi", "B": "45 psi", "C": "30 psi", "D": "15 psi", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f1bddcd5-040f-5c27-bd8c-6f538401cf58", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "364097ce-88c2-5fd2-ba72-bbabd9d9ccf9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ded20345-c460-5549-979e-607b6777263b", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "6f313712-0226-579e-a0da-d383b96525fe", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "004ccdc1-76b4-5870-bfb2-6a090677dcf6", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "631aceab-f2c1-5334-bf7a-e2d1b660c4fc", "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)", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2da3cfd5-7116-59f0-943a-4f7143cf3ab8", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "8c7eb745-c647-5cba-8ed6-a2c561fe0496", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b8d65058-3546-5628-a909-7b7778e8304b", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "1b3bfa47-8864-5d23-b5fb-b0c928f1d0f0", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "17e61f75-dd3d-5cbb-9a42-2da27e5851eb", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "9eb127ed-001f-561d-88e5-7c538687b40b", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "49cc9efa-d329-531d-9f39-e7fad176ffd6", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7e7089f9-8176-5332-9327-d4f44afc1de1", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "5b2ec827-cf96-5fa5-9fe7-1e497a4a2465", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3feb772f-3dec-57e2-834e-41d94428625b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "360450a8-f873-5f10-8d21-a43779fabea5", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7d8264c0-2c82-5eeb-af60-4bd8b917bb2d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "107bb364-f889-57e2-a26f-dc00b9ecbaa6", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "572f02ba-de95-5737-a7e8-3291c7da8208", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "d0bd202b-603e-555d-8525-7179470e86aa", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "b4ff93df-416b-5532-9534-59e2084645d5", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6290773c-b47c-51be-b296-88aa959cddc1", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "109c7c8f-a0b7-5004-a92e-74416a84fef0", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "16eb4c82-c885-5b70-a789-b86746323c54", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "006fbbbb-5c2b-55a3-ad3a-8e32f16affa4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5bd4bf86-69ea-529d-bdc6-07dfdeb48ce2", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "adfbd4b2-db6a-5972-b7de-de785a176f8c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4d8f0de9-0395-5d58-a432-ff4bcc57cc62", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "b691639f-8631-5143-b896-8f0bb7616601", "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%", "choice_num": 4, "target": "A", "category": 2 }, { "id": "3c1740cb-ff83-5d90-97b8-91ab6617dfa4", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "2be25c7a-66db-588e-b314-00bc274ac0a7", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d4eceaa0-c702-5193-bd2b-ab51d528e8d5", "question": "The fundamental difference between microshock and macroshock is related to", "A": "Location of shock", "B": "Duration", "C": "Voltage", "D": "Lethality", "choice_num": 4, "target": "A", "category": 1 }, { "id": "49b1da00-13c2-5f56-af78-647c15cf379e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d1f88d57-e1fb-5106-a0a4-b1a52c9af534", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "f96d8ab9-6c9c-5275-9577-254b74e262f6", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "adbf1178-c312-5575-9a8e-399aee66f9ef", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "03d65210-860d-5cfc-9d87-bc94b7b6fec5", "question": "During normal laminar airflow, resistance is dependent on which characteristic of oxygen?", "A": "Density", "B": "Viscosity", "C": "Molecular weight", "D": "Temperature", "choice_num": 4, "target": "B", "category": 1 }, { "id": "884b6fcf-8dac-51a0-bfee-f1dfc767d2d2", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "24e4d733-353a-541a-a30e-e6f5c1dedc32", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "1e874551-a9a5-583e-8cbb-262b8cce8203", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d23806d6-a00a-5951-b6c7-5e2750407271", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f963c69a-7696-5efd-9595-ca5d037f3f81", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7f38dad2-aa63-5d31-a875-6ce7d5ddc0de", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "bdb09808-ca5b-5cc6-ac7f-b24d2947a9f8", "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": "$$\\mathrm{~3~mL/(cm~H_{2}O)}$$", "choice_num": 4, "target": "D", "category": 2 }, { "id": "67679114-7d88-5fb4-9c27-7211a92d92a3", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9e1d1784-9352-51d2-87be-1a467a4e3a5b", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b2f43a5e-f00c-54c1-9d21-b351b8caefc8", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "979b648e-cea6-596b-b27a-452a2dfcc5d0", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "1bd2d8ad-66ac-53c5-9440-e37cd792fea8", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "98ec5b5d-7297-52eb-95e1-9bf484436352", "question": "The normal FEV1 /FVC ratio is", "A": "0.99", "B": "0.80", "C": "0.60", "D": "0.50", "choice_num": 4, "target": "B", "category": 1 }, { "id": "309e832b-1eca-5db0-806e-4232de081d1f", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b192cff7-2e15-5f1d-9540-59ceec61b64b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "bd6df80b-ec30-517e-9664-3f19cb804f25", "question": "Potential complications associated with total parenteral nutrition (TPN) include all of the following EXCEPT", "A": "Ketoacidosis", "B": "Hyperglycemia", "C": "Hypoglycemia", "D": "Hypophosphatemia", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3cb6259e-f26f-5f6c-aa51-e0b313903155", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c26775bd-38ef-58c6-9d18-08ecd9dbbf60", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4a6eae29-b6ce-53b6-b30c-aaf50fff2af7", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "070d7325-fdbb-56fd-b6a0-d4f10bab4a57", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "d803828b-8002-5e3b-a6fa-e32623c07810", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9ebfcb99-8099-540a-905f-d42f211fece9", "question": "The RIFLE criteria are designed to predict mortality from", "A": "Renal failure", "B": "Sepsis", "C": "Hepatic failure", "D": "Acute respiratory distress syndrome", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4befeb4f-1add-587f-80f8-0499abb4f9ce", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d2eb695c-b0bb-5302-872a-5e3e6a3bc5f1", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "09df25d3-f2f6-512a-965d-a59486d48b32", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0e241120-54c7-54a0-a56d-8fe3f69261b8", "question": "The normal vital capacity for a 70-kg man is", "A": "1 L", "B": "2 L", "C": "5 L", "D": "7 L", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1cc2af1d-5d1f-582b-a90e-f89054af083b", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "b1fafbe6-7816-53c6-97fb-16723829be61", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5c30d07a-21b4-598e-b39e-a6105b52cb0e", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "e57d257a-c2c6-5f76-b625-234e52d8c372", "question": "The P50 of sickle cell hemoglobin is", "A": "19 mm Hg", "B": "26 mm Hg", "C": "31 mm Hg", "D": "35 mm Hg", "choice_num": 4, "target": "C", "category": 1 }, { "id": "59968382-870a-59cc-b839-f9523513bef7", "question": "Data from the ARDS network trial (ARDSNet) showed increased mortality from", "A": "Atelectrauma", "B": "Volutrauma", "C": "Barotrauma", "D": "Inhaled nitric oxide", "choice_num": 4, "target": "B", "category": 1 }, { "id": "67622d0b-8bb9-5f8a-b473-12539956cbdc", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "cf86b44a-8028-51be-bd21-31c872e9e67b", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "a3b4276d-1233-5bf0-af29-74e04f749f31", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a74f611d-4941-5328-9ede-4749a9cb4f7f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "73991c40-130d-5b1b-a16b-a3d5605a3a3a", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "fe2e571c-8ecf-5462-85e0-6ea7a21573e2", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9a2610e3-bd5c-5987-8017-27ddcc4ff0dc", "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%", "choice_num": 4, "target": "D", "category": 1 }, { "id": "818be8a4-f52a-5a9a-8336-97cde7481eb6", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "ea5996f3-0796-599b-8dd8-5ed56b0a3bcc", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8f9239dd-e336-5c6c-a005-342a0b3dcaa0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "eb3ff5a1-8f51-5950-ad53-195b41ad00d8", "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%", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f0c5e319-f794-5d5b-a651-85c33ebf6a76", "question": "The anatomic dead space in a 70-kg man is", "A": "50 mL", "B": "150 mL", "C": "250 mL", "D": "500 mL", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ff140226-eade-5b6d-96f9-61cd791deaf1", "question": "The most important buffering system in the body is", "A": "Hemoglobin", "B": "Plasma proteins", "C": "Phosphate", "D": "[HCO3 − ]", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a25e278d-0191-5802-a393-e3757e047c37", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3f55f994-979a-589f-824a-1a3f258bbfb5", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "1a469abe-2e52-540a-9fc0-62cccc8cd03a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b49305e4-8648-5a66-a1a9-9f4d1690c7fd", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a9184a94-a376-5cdb-abf1-a605a2c2c6b3", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "73c1a04b-8b0a-5467-a7c7-fee46402fc91", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "087b9e50-1b86-5144-96b5-165b3552fac4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7f582ea5-1c74-5ece-9e30-ee9bda21dad2", "question": "Signs of Sarin nerve gas poisoning include all of the following EXCEPT", "A": "Diarrhea", "B": "Urination", "C": "Mydriasis", "D": "Lacrimation", "choice_num": 4, "target": "C", "category": 1 }, { "id": "cf20ecb9-622c-5916-97aa-15c18aba13c1", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "e6752ed6-4511-5d32-a8f5-4e6a9191ed7f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "77404f82-a065-5b63-ba7c-63d51e173c8f", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "ca9de464-9ab3-5915-8d55-8cf3ab823b32", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "d393608a-a667-5bd0-b2e0-ae915bf34091", "question": "Which of the following can cause a rightward shift of the oxyhemoglobin dissociation curve?", "A": "Methemoglobinemia", "B": "Carboxyhemoglobinemia", "C": "Hypothermia", "D": "Pregnancy", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8b6346a8-c6b1-56a1-8ebd-675e4c97bad3", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "550f13a0-1b53-5b70-a5d5-b5b648a8a985", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d391c658-2f6e-568e-9ac5-4a3ca8fa3bfe", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "2021ac00-6e64-50ed-bbb9-d81626a4c24b", "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)", "choice_num": 4, "target": "C", "category": 2 }, { "id": "20fb5600-daf4-5ef6-a23e-69dc7ee1781f", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "501f9e11-a187-5dd4-bf96-8c8bf332a60e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e7aeff23-c401-524f-8059-000e8d985efe", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9d79f4d1-5769-54e8-87b8-3d42615c34fa", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "62284627-0f88-570e-8961-1a7bc51b3003", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a9509a79-a0fd-541f-8fdc-31771f4fac22", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "ba9aa064-d0e4-54e4-a3e9-414300df8fba", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "89d1ed5e-e976-5688-87c3-75606aaa37e1", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e79bf1e3-3bfa-59f4-a4ff-5ac07e7ebf76", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "692ba259-61a8-51ac-adb2-d2177b502d46", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "ce5d4ef9-0c46-58a4-ac27-a72eafc08af7", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "3f0c9a86-c6ae-50e4-895b-4deff1fcc7d0", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "04b35252-b08d-5b8a-a43e-046379ff94b9", "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###", "choice_num": 4, "target": "C", "category": 3 }, { "id": "6c4e621f-82dc-593c-8c6c-c99b355622bf", "question": "Which of the following muscle relaxants is eliminated the most by renal excretion?", "A": "Pancuronium", "B": "Vecuronium", "C": "Atracurium", "D": "Rocuronium", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d4ae8963-a913-5603-977f-b4f05ddc2b58", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "74e3e7cb-465b-5488-b8f0-6b0c743e38e6", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "95b71f1f-7e7d-564c-8856-9eb248e42002", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "50de533f-3f14-5ad5-9d33-134e822cc026", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ec7fa703-42e1-5de4-aae8-7efdd09de397", "question": "Sedation with which of the following drugs is most likely to resemble normal sleep?", "A": "Propofol", "B": "Midazolam", "C": "Dexmedetomidine", "D": "Ketamine", "choice_num": 4, "target": "C", "category": 1 }, { "id": "615ba2d4-d0d4-50fc-bacd-b59c385265d3", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7b833594-7b9e-554b-bdb9-ec96ed91e78a", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "b22e75d9-98d5-59d4-a9e1-d405cfe79171", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "bb150dbf-29ec-59b8-ae4f-38a486bd7578", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "10019042-8561-5c8a-b190-84e981e29c53", "question": "Which of the following drugs is capable of crossing the blood-brain barrier?", "A": "Neostigmine", "B": "Pyridostigmine", "C": "Edrophonium", "D": "Physostigmine", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9fae8d6c-f8dc-5287-9b0a-42d29763c776", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "497e4587-715d-5418-bc22-5b1218ca95d8", "question": "Which of the following opioid-receptor agonists has anticholinergic properties?", "A": "Morphine", "B": "Hydromorphone", "C": "Sufentanil", "D": "Meperidine", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2c0c2f5e-a98c-5ab6-acc6-3626519ed8b5", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9fdb04fa-04b2-574e-9a37-94decd901864", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "05f06f3d-45bf-5288-aba5-82521d2e929f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "112a57cf-a362-5be1-bb58-286cb688f15e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "66c00097-a0a8-5d74-b140-e264e33eb7d2", "question": "Neurokinin-1 (NK1) antagonists such as aprepitant have all the following properties EXCEPT", "A": "Anxiolytic", "B": "Antidepressant", "C": "Analgesic", "D": "Antiemetic", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e6ffbad5-149d-539b-a07e-87b063af615a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a35b6496-30a3-5e00-9aef-4e803e267fa1", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "859eabbc-9cc4-52e5-b690-2b8815bf2a1f", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "76c904ff-8732-55d3-9bb4-978e5b778147", "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)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "73fa0cb5-b65c-5787-8e69-958d26fd65f1", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9d2cdd27-6ce9-57fc-9198-f470ecbe4693", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c178cf61-3d2b-5ab4-8035-ac409042b23a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8e6516f7-0882-528f-9468-2ef5b863e27a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "33e7181e-c1a6-54e5-a290-35ba510dfd83", "question": "The primary site of action of lisinopril is", "A": "Heart", "B": "Lungs", "C": "Kidney", "D": "Metarterioles", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0f9c3b89-63da-5eaa-9733-137a4b245d1b", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e80a19b6-4103-57ae-a455-17103da77f92", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "69b9b3ae-0113-5e16-8112-f83731559203", "question": "Which of the antibiotics below does NOT augment neuromuscular blockade?", "A": "Clindamycin", "B": "Neomycin", "C": "Streptomycin", "D": "Erythromycin", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0879d068-d07c-57c9-bf79-450fe869013d", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "971362e3-a68a-510c-85db-8671b9fb3f93", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "94436d1f-8b2d-51b2-ad2f-1ce4d0d88348", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "19aa9aa2-6af7-5bee-bf24-b76fa7c9810a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6efbd3bc-516e-5fb6-839f-8655b304a202", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fbb91c41-cbbe-5e77-9dff-a69197f9ae03", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0115eb0e-592f-5337-b3f4-04a0836cb003", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "217201f7-64a7-5aaa-8a6f-946f9aa446b5", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a218bac5-0c9d-5332-80a6-35ee35b27324", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "64a6182c-aa00-59a5-b7e5-089e82dda9a5", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ce5ffd84-46f6-52d6-85b2-633eced6c614", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b661d165-28dc-52e9-9e3e-aa2c0725647d", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "becd7d2b-3c36-56ac-b8b4-3b86691d7bf2", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "caecd4ea-ec00-5375-a734-41c5bc268d45", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "5fe175ed-ab96-5ecf-838c-28951575d779", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6a83906d-dbc4-52d4-b36d-a705e6ea1941", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "46c08be3-a92b-5145-97e8-cef5c1c6de59", "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%", "choice_num": 4, "target": "D", "category": 1 }, { "id": "eb0bd4e6-e6c4-515f-a955-8ebbbeb30f36", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "12a413a9-3fdb-55ae-86a8-d62f2c5e64b2", "question": "The half-life of pseudocholinesterase is", "A": "1 hour", "B": "12 hours", "C": "1 week", "D": "2 weeks", "choice_num": 4, "target": "B", "category": 1 }, { "id": "da36f61e-d120-5c31-9515-1a682da1aa0a", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "5b4f646f-c7ae-5652-9cc4-547e9d23349d", "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)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "df7fbfd0-516b-5731-9eb7-47c90ee7a558", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c8aa8a13-3e8f-59bc-948e-fbe93f320059", "question": "Side effects associated with cyclosporine therapy include each of the following EXCEPT", "A": "Nephrotoxicity", "B": "Pulmonary toxicity", "C": "Seizures", "D": "Limb paresthesias", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2c8970a5-cfd9-5002-a0f7-be8225644bf1", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "beb7c198-cc50-5a7a-afb5-6129c259644d", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "19b2095d-ade9-541e-a2ff-58a04a50156f", "question": "Which of the commonly used drugs below is NOT metabolized by nonspecific esterases?", "A": "Propofol", "B": "Esmolol", "C": "Atracurium", "D": "Remifentanil", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4cfd675e-3bf2-5407-962d-3fbd71a32d97", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7404ccdc-ed86-5bb3-9c62-1f7df96bba98", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "299c3162-be5a-51fd-94a2-375818d63da6", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "fc834ce0-8bd7-5f81-a7fb-295e986bedf5", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "08ac173d-edfb-5be6-8653-0d797b485fa1", "question": "Meperidine is contraindicated in patients taking which of the following", "A": "Bromocriptine", "B": "Trihexyphenidyl (Artane)", "C": "Selegiline (Eldepryl)", "D": "Amantadine (Symmetrel)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "df8a5bdf-ed37-5955-a7f5-23c27d51e20b", "question": "Emergence delirium (ED) occurs most often with", "A": "Sevoflurane", "B": "Desflurane", "C": "Ketamine", "D": "Propofol", "choice_num": 4, "target": "A", "category": 1 }, { "id": "115a3920-a623-5c7e-a4c2-628fb234db4b", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "66c7489f-ffd7-544f-b207-6a593f36948c", "question": "Which of the following muscle relaxants inhibits the reuptake of norepinephrine by the adrenergic nerves?", "A": "Pancuronium", "B": "Vecuronium", "C": "Rocuronium", "D": "Atracurium", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5aacfb19-00cd-5619-82d0-78013109c6b8", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "decd7aba-a383-5f43-8d86-c82f16473fc7", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "422a6fd0-7ff0-5d88-ad8a-798b7c6bedb0", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "3d7627cc-edab-54be-8ee4-86e11b6e4cd4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3d51b85b-2759-54fe-8449-e8dfe048447e", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e351ad31-8204-58fd-aa93-da6874fcce8d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "91e7ccb2-efc1-50d1-9705-140c258e3dc1", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ec1c6c8e-fde9-5509-99b4-7484ba989e37", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "df2d4e7a-fe8b-527c-a69d-7a9fdd10772f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "88184fc0-b7a4-5779-a813-ba93247be320", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a42d7642-c060-5c96-bd35-f55fdf4d808d", "question": "The LEAST likely side effect of dexmedetomidine in a healthy patient", "A": "Respiratory arrest", "B": "Bradycardia", "C": "Sinus arrest", "D": "Hypotension", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c899f28d-52ed-5906-bad3-9f38ce1f6fcf", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "161e3c7d-43f1-5a26-bb64-4a0178e0ffa5", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7fe35591-b10c-5a37-b96b-fe0dbc1f1341", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0229d493-9767-5823-aeb8-f717c0a7837f", "question": "Intraoperative allergic reactions are LEAST common after patient exposure to", "A": "Ketamine", "B": "Latex", "C": "Muscle relaxants", "D": "Hydroxyethyl starch", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f6e847da-a045-54a1-a242-9e6e572ff9e9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "266f183c-34ea-5596-9918-ff645f47a386", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3a26e7c7-09e0-5d75-bd9f-1712d0ca6799", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2c36df4f-e115-5f8f-836b-9021b9404073", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d6001d54-702d-5223-b53d-9f2911b5b323", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "314cafa0-c2e5-52ac-a6cd-e6afe7b9da14", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "372190c4-1a90-53b3-a91b-0f4d43881a45", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "09c08768-f279-55d4-a779-113c28ec532d", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "a5d42527-aa97-5609-932d-5813f485957b", "question": "Respiratory depression is LEAST after the induction dose of which of the following drugs?", "A": "Etomidate", "B": "Ketamine", "C": "Fentanyl", "D": "Propofol", "choice_num": 4, "target": "B", "category": 1 }, { "id": "863eeecd-61ad-5b94-8e0e-b7ec38b24fc3", "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)", "choice_num": 4, "target": "C", "category": 3 }, { "id": "997c4b45-e59d-568a-a615-37da0fe3d18e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "21ef59ab-9b7e-5517-8d5a-66c363ffc7c7", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "cb600a06-cac4-5da9-a8fe-4793198b09b7", "question": "Aprepitant exerts its pharmacologic effect by interaction with which receptor?", "A": "Neurokinin-1 (NK1 )", "B": "5-HT3", "C": "Histamine (H1 )", "D": "Dopamine (D2 )", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6e7c0435-76ba-537e-972f-44583b7bc08c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c557efe4-8c04-5872-9a76-c49e63a305dd", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d8563270-6af2-5574-a59d-96e80bd2d0ca", "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)", "choice_num": 4, "target": "C", "category": 2 }, { "id": "1d8d3d58-2ec6-5c84-8fe2-0e3eab1089e9", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "20fcb5e4-48c8-5f77-9a9f-f27d5d15d2c1", "question": "Postanesthetic shivering can be treated with all of the following EXCEPT", "A": "Naloxone", "B": "Physostigmine", "C": "Magnesium sulfate", "D": "Dexmedetomidine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "25d5b321-0618-51ba-8962-40eb4469ab03", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "cf95aba4-7432-5290-879a-38b5c0863af9", "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 )", "choice_num": 4, "target": "A", "category": 1 }, { "id": "59c6e720-3bc7-50b9-9c71-73546bd4a3cf", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "aa84ae40-9a68-5a9e-95e3-4bdb28488b5d", "question": "Amrinone", "A": "Is a positive inotropic drug", "B": "Is antagonized by esmolol", "C": "Is a vasoconstrictor", "D": "All the above", "choice_num": 4, "target": "A", "category": 1 }, { "id": "39a9a323-83de-548c-916c-aa110e2ea99c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d9282a8c-09ee-57e3-95ff-4461b9070272", "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)", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c0c616b7-28db-5efe-a7de-429faefce398", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b8adc1fd-8918-5568-bd91-79a7910cc261", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e8c06a11-417b-591e-a557-ebd39bdad474", "question": "Pain at the intravenous site is LEAST with which IV drug?", "A": "Diazepam", "B": "Etomidate", "C": "Ketamine", "D": "Propofol", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c4e89e85-6cfa-5f5b-9ce8-76a0f8aff96b", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "9421461c-9c7a-5fa1-8650-77672a6763cb", "question": "Which of the following α-antagonists produces an irreversible blockade?", "A": "Phentolamine", "B": "Prazosin", "C": "Phenoxybenzamine", "D": "Labetalol", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1bfd296f-a27b-5bfa-a7b0-c64b3ff11312", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "29f04fcd-303e-5a38-919a-7a3192aa875e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fa401710-3e9e-5771-9171-bcc9e459962d", "question": "Atracurium differs from cisatracurium in which way?", "A": "Molecular weight", "B": "Formation of laudanosine", "C": "Histamine release", "D": "No renal metabolism", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4fb34f12-ce67-5344-88de-86f45ea108a2", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e114f219-e519-53a4-8b4e-be506fc87f8d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "84b37e0b-f283-535e-b96c-0a0880d29842", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6f226fcd-ac13-5090-a85b-183e08868b8e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2281c08e-dd1b-5221-ad57-c9aa59b5a1f1", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "99d0dc09-de47-5e14-9170-5a4ff529b902", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c6fcd356-1155-558a-b126-26e9732cf9fd", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "16dc4d35-f1c0-566e-b2ac-8310f4623b8c", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "fc8e1026-5da9-5be1-bc7a-5d601acd20d6", "question": "Which of the following volatile anesthetics decreases systemic vascular resistance?", "A": "Sevoflurane", "B": "Isoflurane", "C": "Desflurane", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b959174d-1569-55df-9cc3-59d795833c86", "question": "With which of the following inhalational agents is cardiac output moderately increased?", "A": "N2O", "B": "Sevoflurane", "C": "Desflurane", "D": "Isoflurane", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0f52df3c-7cc4-5ea9-8507-2ece3262269e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f5c8b44f-9c71-5733-9b88-702e9c603cb4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f7cd9e0f-2e00-53bb-adaa-bea772b8dbb2", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "2013028b-8fcf-5830-9f64-25ff853e9e64", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "4d262d28-1c2a-5a4c-9857-c7e33b2d5547", "question": "The vessel-rich group receives what percent of the cardiac output?", "A": "45%", "B": "60%", "C": "75%", "D": "90%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c5645fcb-714e-55f5-a06e-520a24d71eb7", "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%", "choice_num": 4, "target": "D", "category": 2 }, { "id": "f6fa22dd-1c4b-519c-b3e7-958e970a0199", "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%", "choice_num": 4, "target": "B", "category": 2 }, { "id": "f33e2c2c-16c8-50d1-9f74-23680ab224aa", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "15b80bbc-fbd2-5891-83bd-0e0a58b58d51", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "52ee1336-834c-5df7-a172-384639b98afb", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b62d5115-92f9-5e88-9817-f19be7eace2d", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "4786b08e-ca39-5382-a812-016ba19dd5ff", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "64c66ed3-a85b-57ce-a3cf-50bbe22f5063", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "63e61cb0-7419-527f-a607-f815b7a6905d", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "9c20b4b8-ef1a-5183-a9f5-0acc90c58723", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "b57f6b35-3af7-59c7-91ef-06f44625c3dd", "question": "Which of the antihypertensives below reduces MAC?", "A": "Lisinopril (Zestril)", "B": "Losartan (Cozaar)", "C": "Triamterene (Dyrenium)", "D": "Verapamil (Calan SR)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ae1e7fc1-b048-5a70-96c8-a984c5d7838f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "fb892898-944d-501c-8ae3-46de27d15122", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0428f289-3224-53ac-8f13-2773b756791c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ab77497f-a6b5-5bff-9f69-a952c3804a8d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "cb55d95c-f768-5068-ab2c-49702c06a3bb", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "d7a1a332-0c1b-53dc-9b7f-080b8a18cf5c", "question": "Which of the following organs is NOT considered a member of the vessel-rich group?", "A": "Lungs", "B": "Brain", "C": "Heart", "D": "Kidney", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ea43b5b3-7962-5256-a1ac-b8b20421fc18", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6da67c87-03b5-5823-8803-35de7ca57284", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "e7b11f9f-a017-592a-8663-1e4e1f563e70", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5d1f5a75-38a8-5539-89f7-251f02ee50de", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "478be4c6-0e05-5c2f-a8cd-28197cca55ec", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "aaddbb38-c8c0-596b-9262-90cb2ec33450", "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 |", "choice_num": 4, "target": "B", "category": 2 }, { "id": "d2f9d1e5-71fd-57e7-bb2b-b590c45ddbd3", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "d51449f4-1a9c-51e1-9686-4c10915fd029", "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%", "choice_num": 4, "target": "C", "category": 2 }, { "id": "b893871a-0736-55fc-958e-6ffb69e66887", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7be65dd3-4ebc-5352-b2f2-9d99fd5e7790", "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)", "choice_num": 4, "target": "D", "category": 3 }, { "id": "72f4877a-0170-5ec3-b4a4-e264340ffa3f", "question": "Which of the following volatile anesthetics is unique in containing preservative?", "A": "Sevoflurane", "B": "Desflurane", "C": "Isoflurane", "D": "None of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "236e3024-5d25-55e1-a16e-f928334029f1", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "ef05abef-c604-548c-b041-555668866fa9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "388991b7-92a9-5673-aa12-7aa16f704e1b", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e4b80b1f-1e9e-5a43-b797-1bef7efc6158", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fa4ada1f-698c-5e24-9cd2-59498bfcbd87", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1680c731-fd07-5d38-9a0c-dd4c992ad34c", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "87a5e5a4-e6b2-57ef-86ad-6dc438373ff8", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f8929926-01df-509e-bc06-604d2e3f8270", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "688399c0-3f15-5f5e-af9e-f12919d18a50", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d118e692-e187-5445-a9e5-bb8c2e3dfcd3", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "59c02103-3431-53c9-8881-ec30c50365da", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5f90c270-1ac0-52fc-a138-d3a517d71b94", "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.", "choice_num": 4, "target": "D", "category": 3 }, { "id": "a985d88a-f509-5a2b-8ac6-9330e1ae42d5", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b1c5c9eb-cf48-5175-98a0-598c4c762873", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "a1dc0cd9-f00d-5c2e-a83e-e108fea85b43", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "2dc927a6-0c7d-558c-983f-4b9547648e27", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e207ce8b-37cc-54b3-b6fd-d0365c2a9936", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "fe3aa550-acd0-5e38-aeef-5ffad84121ba", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "821a316f-2b25-533a-837b-64e3c1aec7c3", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8a3a99a9-7f63-5d12-b6e3-eee179d23d3d", "question": "Which of the following clotting factors has the shortest half-life?", "A": "Factor II", "B": "Factor V", "C": "Factor VII", "D": "Factor IX", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8500754e-5a15-5daa-82da-646c9f7c7db6", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d49eb96e-2409-52e1-bf8a-31e054a7e0ab", "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)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "89c9cccf-5f69-5709-b15f-6491a17aca56", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2e9ea9cd-90f4-5a41-87f1-bab9b0d77386", "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)", "choice_num": 4, "target": "B", "category": 1 }, { "id": "06a3b7d9-47d9-518a-ab8b-34920acaef9d", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "a9b6ded0-6282-5dee-8e96-4710d5b4193d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9ef81354-9a47-5ee4-a07d-cbbe7f78df70", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "052a81e0-f89c-5514-96a7-ed190cd828c2", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e8287f52-0ad6-5c83-8cd0-2ca01211eaba", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a09e8194-55a2-50ef-a0ae-386822046104", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5d9e560f-d227-510e-aca4-c7ad6557f0f5", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "1c7adc77-5ae9-5bb6-89ef-b0adf57a8fac", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f4a4131e-5448-54b0-b959-b7983f9cec12", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "6c268e92-2b40-525d-b375-a8c5c399453f", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "31895ad5-727c-5685-9650-af835efa7e3a", "question": "Hetastarch exerts an anticoagulative effect through interference with the function of", "A": "Antithrombin III", "B": "Factor VIII", "C": "Fibrinogen", "D": "Prostacyclin", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cf827e1b-98b8-5dba-8863-0ef0f8ce4fd4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "eaef7c12-76c3-52dd-8f24-83a8c4a07777", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8f4445f9-a424-552e-a756-8215848bcae0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "66c5128f-f0c9-5674-8bc6-28557b0f795c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6045395f-eb44-5a91-965e-25981522876a", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b92eaf29-0478-52f4-b3ad-d78ae1c5cb8b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a6dd5c71-567f-53de-959a-e946f8d24786", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f6bea6e9-eb84-50fd-b506-45df4a90f868", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1cfbf198-823d-5618-81f6-257951f2fd9b", "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#", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8a7fa05f-087d-536d-b9ff-95cc8c8acd5e", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "a5f78a37-12b3-5eef-96cc-94d691401d2f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fb2c8672-644d-5f89-99db-8af43677f6b8", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3ea9ec06-fa05-5194-96bc-7353fad9c91a", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "da7717ae-64b3-58f3-895a-ee67e1f3c45e", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "546cf858-77bb-5652-82ee-1c459364571c", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "03b34005-eea0-5125-9bc7-9346ce5a4373", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "98052853-5b6a-53e8-a0c4-ea2bca24853b", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "dc435ce7-d0b8-57c7-ab81-a307f2e206bb", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0fc4ff53-d231-566b-a40c-e227d0c54b72", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b41a2c50-fa60-5275-92e4-24428d38651b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c386c191-5503-5110-90e4-284446a23dc4", "question": "Damage to which nerve may lead to wrist drop?", "A": "Radial", "B": "Axillary", "C": "Median", "D": "Ulnar", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d5a5aab5-1296-52e4-9254-d83e507e9b74", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "415b0d39-9787-51c5-8d93-a7770a015243", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "d379024c-2206-5056-baaf-6f6f6b1aa2ce", "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)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6b30a94e-c11f-5238-90d2-e286652cf9d9", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4c2d6c5c-22b4-59f6-a9e3-f91418ac67a7", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "72d82014-1e11-5665-a6ae-d5595bf4335d", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "010bbc6b-5e57-55cd-81ce-d676d5945b6d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "be11c44c-09b3-552e-a816-7c7469a14665", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "15f2f646-37f0-5765-a13d-e38b6ea79d2a", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "1dc81dce-3455-5ea0-a5ea-d7b333f03c5e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8b6cb8b6-d176-5dd9-932c-85fbd8fb4f72", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "0f6fe6ab-a9e6-55b5-99c2-c8f3af566017", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9cd2ea07-7a22-5e21-8461-56a192e4a2c5", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0f0e43cc-1956-5010-8116-df83ae65e7dc", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "dd1bf381-de88-581d-a86b-443fcacb4085", "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)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f68b1281-6a50-5538-8c0f-7d19a9fa41ff", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "489291fb-881c-524f-a9bb-a36c987a9981", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e7672693-a843-5f92-8177-2b43ccbe77a6", "question": "Which of the following diseases is NOT associated with a decrease in DLCO?", "A": "Emphysema", "B": "Obesity", "C": "Pulmonary emboli", "D": "Anemia", "choice_num": 4, "target": "B", "category": 1 }, { "id": "274047ee-7a2b-5d35-85d9-7cdc21ee48c5", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fe6d872e-0578-5352-a5af-7f733bacf22b", "question": "The MOST sensitive early sign of malignant hyperthermia (MH) during", "A": "Tachycardia", "B": "Hypertension", "C": "Fever", "D": "Increased end-expiratory CO2 tension (PECO2 )", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b0e52779-b673-594d-af2c-7a5231193c5a", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "d8cfb00d-cb9b-5f68-8eef-96f3ca98500d", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "ddcff4e4-976d-5848-941f-7f4e2dd82279", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "10182cf3-a6a5-599c-bbd6-baf2621d8fc5", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "033568cb-b4c6-5eb3-8f00-635d5a311021", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3cd9244b-875e-5376-abdb-85052ebef77c", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "6c2f6582-6086-5de4-bf95-2773167e176f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e720670b-968c-5856-bffb-bdeb6973d050", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "9b0a97e0-90bd-53b0-89e8-6f16e135b47f", "question": "MH is believed to involve a generalized disorder of membrane permeability to", "A": "Sodium", "B": "Potassium", "C": "Calcium", "D": "Magnesium", "choice_num": 4, "target": "C", "category": 1 }, { "id": "397878e9-f783-51f3-87db-42fe3e75cbda", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "59086aaa-d8ba-5a05-bb38-bb6042a9e505", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "64599e0f-f87a-5854-87d3-63b7fd42a4dc", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4ec7da92-0f64-5ded-81ab-241ae9ec105d", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "8f15bf5c-078c-5553-88a9-e1eb599f0923", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "d468ab08-0470-5ad4-a2c9-2e52ae7d2de8", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "753360f8-7993-59e7-9efd-6b712764eb07", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "024ad1f1-1d24-5bfa-9db0-cf0018244ed8", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "640ff256-e11d-53f8-a69b-4f2818a89342", "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)", "choice_num": 4, "target": "D", "category": 3 }, { "id": "66084e01-d0c0-556d-a213-53071fb46c24", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "591e2cc0-473e-5aa8-8fb7-0ef659f15d62", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "bfcd5ee3-6e75-5d28-abb9-e391e6b1c403", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "2ce4afbb-7cfd-5af9-8155-9f47b8a3f8ad", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1528f9a4-0547-5f1f-a052-c4913be97992", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "e51598a7-a498-5057-9eff-7c9c3837ee98", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fa4627c6-4d6c-51ff-9fd1-da4da364b0dc", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "0b9524b1-7a1a-5bd9-84a1-bcaa8dd77bd8", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "81514478-8cab-5936-b4eb-3e73cdbe80a5", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "b41d584d-93b6-5b55-8320-b8669a82046b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "dfd07f09-681a-5265-95a1-ed786aa6eb6b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "de747cef-8514-5a26-930d-eb4db464e398", "question": "Remifentanil is metabolized primarily by", "A": "Kidneys", "B": "Liver", "C": "Nonspecific esterases", "D": "Pseudocholinesterase", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8a67ab16-d1b2-528d-80b6-1b050b66de14", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "825dbce1-705f-5f0a-ad72-58d66b66076a", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "daf11f50-801d-57af-ab79-604f3ebea8d6", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "97695799-6984-5d4e-9cbc-22e3f85df8c4", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "09f593cf-2fb1-527c-a618-7d41efba2dba", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8cca68e1-d858-5b31-b606-9c31f0af4138", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c13e4393-e6bf-5640-a739-095844c67f00", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "2dc4d702-8cc7-505e-8076-c401e2e1fc18", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e6fe2e8e-fe0d-5380-9954-6c0bd3b38a4a", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "8eeb584b-f6ae-50d3-ad72-a6d1589445d2", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "85e394c1-e802-5d39-a612-075db7f33d92", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "412fe940-5c4e-5c94-b239-86900fe4f053", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "50ed1df7-f2af-5ea1-9d6a-412fcc4bf201", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5f63f959-b2ba-5b4b-aee7-5c43ee427a88", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "ebb5b8d0-edd3-54ae-99ad-e52c4ac0b042", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "84c9db7c-2c1f-5c00-adbf-0cbf18be6701", "question": "Each of the following may increase MAC for volatile anesthetics EXCEPT", "A": "Cocaine", "B": "Hyperthyroidism", "C": "Hypernatremia", "D": "Tricyclic antidepressants", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9cc01dd8-bafe-5c08-a375-f2d6824b0735", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e65f974d-fbac-563b-913e-8311c533581d", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "76720ba3-c139-55c8-904f-774af1aad8bc", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "e0249eb6-7fe5-557d-98bc-abc2c59c4a5c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e7e86113-0760-5027-907f-0f9eef66866f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1d67a492-ba68-51d0-85fd-50207f589fc6", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a37eb58b-4a81-5c05-8772-66cd93e79931", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c0f4976e-1eea-5d12-813b-91fa7fc261fe", "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)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "47cba30e-1fb9-5a78-ace3-b8b292c71baf", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "5f88629c-3ef1-560a-9220-149490ff85fc", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "674dbe3b-1c49-5b52-abcf-0e9c77d3dece", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7d439f87-6fa6-5faa-9075-f4d7928a966c", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "d0939fe9-6a9b-5ad2-9132-be73cfffb0ac", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f814ff52-68b8-54a8-9b61-fd0ffe823551", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "078082d7-edf7-5211-814a-407cede1b5df", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "fcf5e84a-3eef-5e22-87b1-c98350ca161a", "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)", "choice_num": 4, "target": "D", "category": 2 }, { "id": "7bd4b9f2-6cd0-52cb-8acc-244c14c6ce63", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "06e4e53c-943e-59e4-84b8-7abf128f8868", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "29358418-b03c-59b8-aea9-f6ae3cd2d017", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0717e525-f892-5eeb-8e50-e8aef14f6404", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "0b4e6262-2c23-51d3-872e-8100ee5d856e", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "d5c57e2f-cee3-5062-9311-4fde8c200410", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "97478064-97f3-5aaf-8dad-d78bc0005f66", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6a8c63f4-50a3-5a99-9aaf-8de119abc492", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "2809d232-6053-579f-befb-c88f2e2b41a1", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7da8c8a7-7bb2-53fb-9854-4c8a858f0574", "question": "The greatest number of malpractice claims made against", "A": "Eye injury", "B": "Brain damage", "C": "Nerve damage", "D": "Death", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b65e86dc-c4ca-5841-a2f0-b54de9da6107", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3da29b1e-cd5d-5563-8b7e-73e077a0404b", "question": "The underlying feature in patients with syndrome X is", "A": "Hypertension", "B": "Morbid obesity", "C": "Hypoglycemia", "D": "Insulin resistance", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6251573a-e115-516b-ab93-567be07fb404", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "ba285f60-9a0e-5891-98b6-3fa001576773", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "167c6138-34ee-599e-b376-d27941ceb2c4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ff166983-f386-5a86-a1f6-9cb0cd6d17f7", "question": "Which of the following nerves is NOT derived from a cranial nerve?", "A": "Great auricular", "B": "Infraorbital", "C": "Supratrochlear", "D": "Supraorbital", "choice_num": 4, "target": "A", "category": 1 }, { "id": "05a768bd-e3f2-58f4-8fc5-06f8487c4abe", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "2fc3a7fa-5547-5420-a7a3-32d9df2702fd", "question": "The most common adverse cardiac event in the pediatric population is", "A": "Hypotension", "B": "Bradycardia", "C": "Tachycardia", "D": "Bigeminy", "choice_num": 4, "target": "B", "category": 1 }, { "id": "117fc0bb-9b73-5020-bb18-39cf3c90eaa7", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4e171f2f-1c20-5322-91ce-9a9bd119ad38", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "88626bab-b686-56bf-b58d-45a100090b0a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e10402fa-f11d-5ea0-a898-7eeb6ecc655a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b3e6ed6f-83c6-5b79-ac76-427e91ac657d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "356b9967-6e30-54ae-b52f-7bd7315e7000", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "9451f516-0ecb-59af-8ae3-4adc407a8745", "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#", "choice_num": 4, "target": "D", "category": 3 }, { "id": "9d450e55-d0b9-5ec1-822a-f75948b15d44", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "b3007e00-0d8f-5c1f-badb-c2f1e27eea91", "question": "In the premature newborn, the glottis is at which level relative to the cervical spine?", "A": "C3", "B": "C4", "C": "C5", "D": "C6", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c66fcfd3-206e-5603-9464-09d68ea78b10", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4ea7e7b4-97cc-51cf-8c04-0d035d05fe02", "question": "What percentage of a term newborn's total body weight consists of water?", "A": "45%", "B": "60%", "C": "75%", "D": "90%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "65ab321f-c22d-5376-bcfa-6eddba056930", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "d18af32c-dc1d-550b-af16-c764fa73e408", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "4c274cbc-2b39-5379-b332-5f6f61bfa639", "question": "The predicted blood volume in a 3-kg term newborn is", "A": "100 mL", "B": "150 mL", "C": "250 mL", "D": "300 mL", "choice_num": 4, "target": "C", "category": 1 }, { "id": "832ba56f-c14d-5d7b-9f4d-d245f8d1e0c9", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "7b5d7709-9c43-5ca0-afd4-7ffaa5bd37c8", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "f78a9811-1cab-5d32-bc1f-beabd8f640ea", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b263caf5-d040-50fc-8653-ed3c10da2a24", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "5e85f827-e7ac-5911-96cb-49ae50308a4c", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "75403904-e21a-5ee0-9131-48b92a6674b5", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "bca31b17-24f8-522e-bf58-40e4620dd30d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "55dcb91f-43e4-5b1a-a86d-4d625a4dca5e", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "1266d46f-6e41-58f8-86d5-d0012ce757a6", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "c761b507-3fea-563a-8ee7-b56288c3f07c", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "17bd8bf3-e7ee-5cb2-a145-d4caaeddde9f", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "b5031483-3ce4-53b0-854c-f20e54e6d0be", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "d332f457-7d20-55cb-926a-94a1ae97448c", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "86f0980b-936d-5532-bf58-479a3432d7e2", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "686a76ae-8ec7-58f6-a89e-018d081cdf0b", "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)", "choice_num": 4, "target": "C", "category": 2 }, { "id": "abb0cb36-9cd1-5852-8c3b-ec1f17c9296a", "question": "The spinal cord of newborns extends to the", "A": "L1 vertebra", "B": "L2-L3 vertebrae", "C": "L4-L5 vertebrae", "D": "S1 vertebra", "choice_num": 4, "target": "B", "category": 1 }, { "id": "33029417-0bbc-509f-b498-96fdb6b92656", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "97eb5cfe-9365-592d-8857-655796d671dd", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6fa25e99-2438-5aca-a0d6-0302eee1901e", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "f496c477-21a1-55f4-b0eb-f24b6282a8e1", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "4e40da06-1bf8-5bc3-839f-75b6eb69dba3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1f85caf1-18c4-5c21-af99-cbe85c001c14", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1c7b04fa-580c-5ccb-b545-1e6cc6646ebb", "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)", "choice_num": 4, "target": "D", "category": 2 }, { "id": "8adcbff8-67b8-5fef-a916-d35eb83d1944", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "27f9facf-ae5a-5e92-9d6b-5baaa60dcf45", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b40a9b40-d082-5d33-adde-0f9b61125d90", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "79d484b5-2685-566b-87f2-6c8a7aee2dd2", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "535705b6-967c-5f92-984e-cc642f2b1f25", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "db869d42-6880-5280-aa80-0e66f02ffdb1", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "6702886c-829f-55f2-9105-46b74514bd5c", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "d9af4bf7-a207-500b-bf58-e155d1377ffa", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "b36f268e-b0d4-5a11-8f11-732db3697b9d", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "ea1a5c4b-0160-597c-8df8-b3e37266142c", "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%", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f930c2dd-6002-5c7e-9960-fd7bf3273cd0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9f7112d0-cbea-538c-9f32-aa37d434d168", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b39dfec7-4a51-5ed6-9586-d6040148dfe2", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2db56e0f-839e-577c-8aae-4e3e77151123", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "79e34989-875f-5c67-a61e-21ad32f47604", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "28603776-6631-5e75-ad5c-e77371329bd4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "88cd853b-9818-5fee-82ef-373746357966", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "e479f76c-bdbc-5ada-b02b-673e99087040", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "79c07847-2b69-5050-85be-a20e83862372", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "99e080db-59ee-53d4-8a73-c8abc378e05a", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "da15a022-c3b2-5f9f-a0d2-01b1902cdb9b", "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)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "83ade90d-118d-5533-8495-4d2f13ee016e", "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)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "66a33122-b0e9-55c7-a9e3-92cd56a037ca", "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)", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a423568c-9eb3-5a80-818b-e7aa82c334f0", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7991b6ec-7ff8-542c-8d21-7c0ff1e6f723", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "45326e95-95d7-5503-96c6-9a5a2f4aea63", "question": "Anomalies and features associated with Down syndrome include", "A": "Smaller tracheas", "B": "Atlanto-occipital instability", "C": "Thyroid hypofunction", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "809d9bf2-053b-5685-a49d-60968eb19754", "question": "Congenital syndromes frequently associated with cardiac abnormalities include all of the following EXCEPT", "A": "Tracheoesophageal fistula (TEF)", "B": "Meningomyelocele", "C": "Omphalocele", "D": "Gastroschisis", "choice_num": 4, "target": "D", "category": 1 }, { "id": "218c1573-49b1-5abe-8517-b024c486294d", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "dd72d18a-33f8-5758-adf1-317fd4a67179", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "70faf36d-5d2a-51ea-96be-3538b864731c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6876028a-969f-56cc-8408-6ae0d9a24194", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "7f7c7b12-bf49-5594-8e20-5c21ee3ec697", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "737577b1-fb53-5ed6-9a78-70a71c94e319", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "0b552a43-5451-58d5-a70b-3f31da9824b5", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "01abb434-3e33-57bc-abb4-0412b1d6941e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3a457653-a56f-59be-846d-17c78ed71ee7", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5193a5f3-ead0-5e7c-8b88-ea63a5842622", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "41205312-44f1-5d91-872d-d719b9bcbdd0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4043ba9f-773f-55c5-ad65-0fc19f57bd13", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "93cd66d5-4d5b-56cd-af41-aa6367354f8a", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "bcea7431-9e20-503d-bc49-181c27b98d91", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d295a5c9-be67-5964-b5bd-25ce4686c9e1", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "16111876-3470-5d9b-a669-76d2286918b0", "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%", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c029ee82-c4ac-5768-9e22-f7b659706ba8", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8e189cf5-b6f0-5218-af12-c84a6876b91c", "question": "Which of the following drugs does NOT pass the placenta easily?", "A": "Etomidate", "B": "Ephedrine", "C": "Atropine", "D": "Glycopyrrolate", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e98ce3c4-c686-5d2d-88c8-27700e142622", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "af2e7c62-ddf6-5774-9166-3991631883ba", "question": "What percentage of all pregnancies is affected by hypertension?", "A": "3%-5%", "B": "7%-10%", "C": "15%", "D": "20%", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cc24970a-ebf4-54b5-8045-82060d55e998", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f23b8e4f-741d-592c-a512-a325acb15c61", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "95078886-95de-5f24-952a-5201d3a4b4e2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "991b877d-cc82-5eff-b243-13d19aed57ae", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "9c2cd3e0-cbf4-5845-9002-3aac329472d7", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a7aed22a-9943-5a63-912e-14c603adc69c", "question": "Side effects of terbutaline include all of the following EXCEPT", "A": "Hypertension", "B": "Hyperglycemia", "C": "Pulmonary edema", "D": "Hypokalemia", "choice_num": 4, "target": "A", "category": 1 }, { "id": "febb7327-1d72-56d9-8828-16b5eda08877", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b3a021e8-1b1c-57e1-af15-c16317dd17a9", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "9b75c2d6-4104-54a9-8966-a6adeaf30eda", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f937982b-d93f-514b-95c0-bb1e5fbcea57", "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%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b8064eaa-4ad2-58c1-8a62-700057afb66d", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b3bc590c-81da-56a8-8c1b-000316f4119b", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "cbc57c92-c89f-5565-93e4-0277e2dda81c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e2e6553e-0fe8-52bb-b927-f6e548eb94da", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "80db68b8-9539-5cef-bc64-70a185992908", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2c99aaba-4eb4-5de9-bf51-abdb25628b10", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "fff85a0a-3c53-5794-9676-86deeb257684", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b7df4541-0c4a-56a3-8807-2b9914da6f0f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9cc1df7b-9c70-57ab-a22b-03a7e48bdcfb", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "de3b483c-22e1-52da-b60d-cb301111ffee", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "2098d859-c60d-54fc-b966-343cb72ff124", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "0aa6b0d7-258c-5188-b49b-56d8769da26f", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "91462985-036e-5930-8458-02d77e9c3fa3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "835e3f61-5ea0-53c6-affd-afbd6b95f440", "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)", "choice_num": 4, "target": "B", "category": 2 }, { "id": "ef166ff9-aa93-5221-b765-72eab8c777c6", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "08624a03-6afa-541c-aaea-5591a25f97fc", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "47e2e7b7-f524-5a6f-b30e-97f7e413f265", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "542a739b-7751-5571-b97a-8851efd3a930", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9c1a218a-d67f-5f11-802c-fc05653c3940", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "7fbb0335-3188-529d-aee3-3943552b6f09", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3536d425-e527-5f94-9d4d-9581b433338a", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "486942ac-8bc4-5ec8-9862-0fcd13e4a163", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "4bab1db3-1088-5478-b5fa-6aa1be508cf3", "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)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "96eaf1b4-3fbf-5ace-839d-8eb2be0d03e9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d81188b5-f6c8-5924-87b9-5ba028ffebcd", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "394c3194-8a0c-5d80-a651-72c847df50b8", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "301cbb2c-662f-522e-a614-19ae5d035d68", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "16f71641-fba2-592f-bc8f-781f50ba7b99", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "0d332e14-47c9-5ed6-ac51-e1ed7c3d29ec", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "71b8150b-bc50-53b5-83fb-e870f7183dcd", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4010ca38-d129-5c2f-b9c1-afd7596a35d2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fb719c0e-8cd5-5bfe-ae26-b423caf4971a", "question": "Which inhalation anesthetic does NOT produce uterine relaxation?", "A": "Isoflurane", "B": "Sevoflurane", "C": "Nitrous oxide", "D": "All produce uterine relaxation", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ad17dd7a-6d44-50f3-a98f-b519a5b41b5d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "401a9ab4-474b-5e7e-8066-b0e82c83de90", "question": "Cesarean delivery is associated with a blood loss of about", "A": "250 mL", "B": "500 mL", "C": "750 mL", "D": "1000 mL", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4a0aa139-3d17-52ad-a234-b860d9dd3ab0", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "199c6c09-240d-5c3a-b4ad-2cde815af7e0", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0e07613a-a2d4-57a6-be2a-fcf87d5040bd", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "af8fecdb-52c2-5d58-baa6-e589ffd0a2db", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "57d182bd-2442-5bc9-bdc9-e74d5e2de60e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d9f0637e-d36e-5c4f-bb8a-ddcc53abc6ca", "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%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "edd1cf86-28b0-50f4-b9e0-31db402081be", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2ddfe911-d131-5673-8490-5a177423034d", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e273efe3-c4e7-5878-98c6-b48416eaf497", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "ad13c2d1-3ad6-5932-8ed3-53e2418017d4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9c80f21c-1aeb-51dd-a916-a120d20f53c7", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "468702f4-1b58-5900-8f81-5e3cda2b0b8c", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3d5fb97c-7dc0-5094-bec5-1998816e2b57", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3d62821d-ad1f-59d2-9df3-aaca93738ff4", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0f4ef80c-ae0d-5618-8982-b7ddfe883231", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "36232e30-4d32-515b-b0d0-2abc0a37b2bb", "question": "Early decelerations may occur in response to", "A": "Fetal head compression", "B": "Uteroplacental insufficiency", "C": "Maternal hypotension", "D": "Umbilical cord compression", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b849c55b-4f4b-55d9-8f02-b13605b676e2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f032bed0-9ccb-5ed8-864c-16f5584436a4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e797e0e7-67f9-5862-8ea4-6ae7ab2e909b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "15658b8a-30ca-5d25-9e03-638fbe3ebdec", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e574a396-8aaa-590a-b09b-fa8f7684dd31", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7e9ef673-1038-56dc-918d-b832aee88353", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1d0ad9e0-aba3-503d-8043-e7dbe06e149c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "702deaec-4a0e-5462-ad7f-4dbe62a016a2", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "bf5b6382-3869-5111-b652-798182c3c1d8", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "7ef9368f-55e9-5661-ba53-8883228d79f6", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "60619cae-b9c8-50b3-ae53-13c387ab024c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "651ce2fb-bcca-5d0f-b24a-caa6317a05a9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e2958dfc-6a1a-5efe-8836-36bbce87957c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "83650d57-d4d2-59eb-8bda-4f9fd432f1c0", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c0eb56bf-27fb-55d5-86f3-147c0a639de4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "cdd026b0-0855-5df4-8642-507ce54b0407", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8d49b35c-2e8f-5ba1-918c-66cbdbafeab2", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a8888356-d99e-51a5-91f6-16353a402b45", "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)", "choice_num": 4, "target": "C", "category": 2 }, { "id": "3a53419f-827d-5dc8-b284-6808d8e56985", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "49425ec5-fef5-5d77-b6e8-8b76ca50c8b8", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "7e1159be-4dba-53b4-bb81-6d9412291a78", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "18a85d3d-bf42-593f-8fee-ebd10593f1f2", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5a2409aa-f8ad-5215-98b7-98603ba9eb7c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1e7a67ad-3c42-5f4f-ad44-ca38026f8b1c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "345f3cbe-f838-5b98-89a9-c3dd4687c59d", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "5af58de4-9645-5900-bfec-d20db20ab8ae", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "c4229b2d-14ea-5cad-81fa-af0ba5de0a0c", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "522cde54-ff82-58f0-8279-59ba7e9c14be", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "560649bf-b954-5ac4-b6a9-a156af007871", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "bcd14584-6c0e-5bd4-b0e1-4a42bcd3caa5", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c66528b5-086b-5d77-9d4e-d42a92162f06", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e734e378-4194-554a-ac19-0f33d92b4758", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "bf7297ba-3544-5c5e-b16d-d76542df198c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d3121a9a-773a-5efc-9f9c-a7355d150662", "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%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b7a17dcb-613c-58c9-99c9-7355f8230a79", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7388c7ce-3b45-5a51-8f1e-d61c6aaa9dc3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0a4102cb-09f9-58ec-aa71-d327ae99598b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "84d0af63-0be8-5503-90c5-3e98d59a0084", "question": "Administration of vecuronium during spinal surgery may interfere with monitoring of", "A": "Dorsal columns", "B": "Corticospinal tract", "C": "ECoG (Electrocorticography)", "D": "Bispectral index", "choice_num": 4, "target": "B", "category": 2 }, { "id": "2c1d51ab-03d4-50b6-a5fa-2a3ff246a3c9", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "357078ae-0831-556f-81f9-f7072193facf", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a636dbaf-4855-56cc-ac8e-c0ecc30ace76", "question": "Which of the following drugs at high doses CANNOT produce an isoelectric electroencephalogram (EEG)?", "A": "Etomidate", "B": "Isoflurane", "C": "Midazolam", "D": "Propofol", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c8881f15-0856-5dbf-b84d-44621e582677", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1e0c2835-f7ed-51a8-86dc-efc7274c47db", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a99210c2-02c1-560a-8e38-30045eb1fdf9", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "33ab8c64-c22f-5a15-a908-b5d6316bc625", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ee3e8c13-3f49-569b-8004-31022c35b976", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0757a989-358a-5448-9c04-115925710c19", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8c566ad9-ff5e-5e3d-a93e-caa5410f7118", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "f429c75d-0599-564d-9837-156d6763fa82", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "0e5c50c0-edaa-5d16-80d6-904500e3aa38", "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)", "choice_num": 4, "target": "B", "category": 1 }, { "id": "01cd32d0-d4a1-5e58-8682-551e89b217d4", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "56884fce-6d2d-5c5d-887c-605bd128a4ab", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b1eb7973-ccc2-5ad0-9e38-9223f88eda7c", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "22d2ff40-3320-5bea-aeb0-bea35b79e10f", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "e08b0c19-3a90-5dd7-8806-028e6dac5b27", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9ee244e3-4066-599f-a98a-4e137756f14b", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "17e0839a-991f-5e99-89f7-32f60f068415", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "39d91b14-c0e2-511c-94af-b706df26fe25", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "70728108-dffb-5aef-ba40-8e4c7d56aa11", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "014aee6c-5a25-56a8-94f5-a92fc61e0959", "question": "CMR and CBF are decreased by", "A": "Dexmedetomidine", "B": "Seizure", "C": "Hyperthermia", "D": "Ketamine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8e042ad3-72c7-5e72-b1b5-0e739f916dae", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b63fa2fb-e045-5d35-9214-ff1ee0da2546", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c9e565e5-83dd-546c-b446-818236276289", "question": "Signs and symptoms of intracranial hypertension include", "A": "Papilledema", "B": "Headache", "C": "Nausea and vomiting", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "dc32c71f-71d9-5f4f-aad7-a593e27db47e", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "8e84558d-6b5c-59ba-98ae-ac21268d4832", "question": "Anesthetics that decrease ICP include", "A": "Fentanyl", "B": "Nitrous oxide", "C": "Propofol", "D": "All of the above", "choice_num": 4, "target": "C", "category": 1 }, { "id": "727f6763-69bc-5787-a971-e6ffb998788d", "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)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c3b7b4ff-f274-5b5f-8e65-1185b43bbd88", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e7a8a902-e6a2-5782-af98-b0e820e7a17f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c9ab9a97-41ca-57e6-b316-446c178daabc", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7610e32a-dc1a-5468-9066-02cfb4e6aee0", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e9491f1e-56a4-5e0a-b31d-38ddba49e86a", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "6e4562e1-75e9-5047-971f-d2baef262042", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "f6773a59-36aa-5a15-9233-0a99cfbbefcd", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "5ba0cb41-c234-5845-8b6e-6c319ba5ec89", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "73baa536-953a-5594-841c-82b4b70b5f3c", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "040010c9-c20c-53ce-a2dc-c32be92f1b21", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6ab47fca-fa6c-5721-b764-eac5315e6b52", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "a33a2218-b6ca-5023-9d3a-8b7ae1079696", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "50f6f4f7-5095-5084-a1bb-6efc4599ad61", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "0ad47d38-92c5-575c-8e1e-af29b7c796b6", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5f9b9412-a260-5ace-8e7d-bdc1313fcb76", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "42654d1b-0de9-5566-86cb-6a6d92d576c9", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d90430db-4c1d-55c8-9d66-194857d89b9c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1eaa9c87-fef7-5879-b567-22bdbca4188b", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "21dfaa91-a032-5790-8c55-2c93f9f7da2c", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8a645b2d-ea83-5f52-ad8c-910041b5b246", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cb2e5c23-596f-54a9-8119-04f1925b949d", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "1330bac7-3ac9-5387-b694-5ae511c55511", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "91361c28-6002-535f-93af-1a0ff574dc0f", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "ceba8cf4-8715-5c52-9ecb-e53ef7e02cb9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "78d1dfe6-6549-52d7-8c49-31ea52d118e8", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e06d8cd2-39a7-53b0-9c65-063deb476ac8", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a19be952-1df6-58f7-b11e-ef0c3e2272be", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e5c54631-e4e9-5d04-afa5-12c20d6584d0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "948fbb6f-5e33-5e65-aa92-df138715f239", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "07d30928-7a87-5d5d-8132-f219027fd5ed", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1ca32a72-b9dc-56a3-b362-0b030892344d", "question": "The primary determinant of local anesthetic potency is", "A": "pKa", "B": "Molecular weight", "C": "Lipid solubility", "D": "Protein binding", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4a9471ee-fb51-55dd-afaa-7d9744f7b5b7", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "690433ef-34f5-5ac4-a3a0-de7569886f6e", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "81b2a96f-158a-57b7-8fee-114b9031c9c8", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "cdae2fcd-cd95-561b-916f-b1f9e9eb8c54", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "09e741d8-0144-547c-82ab-381a47d0ab28", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "86df54bb-2883-56a5-ba89-e242bfce0164", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "12a66e40-f503-5f32-bc04-fc879cb5d57c", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "4b236f6d-5c44-584b-a22c-533f2fae2b4e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "29097120-8805-5a92-980e-e70f2b591871", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "450c87c1-e266-560b-9782-e63c7b1035b6", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9227f771-556d-517e-9fe9-3a8341b511eb", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "01753f53-f3cb-5732-a738-63961c3862dc", "question": "Which local anesthetic has the longest elimination half-time (T½)?", "A": "Bupivacaine", "B": "Lidocaine", "C": "Mepivacaine", "D": "Ropivacaine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b386d201-d819-5355-851c-8207f5d0d1c9", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ec0a2475-bb0f-5ae4-897e-febe21a8cc54", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "cad261c1-0278-59b2-abe9-09257dd3e2f6", "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)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0a4b1b04-1811-5bd2-8f02-4245ca238810", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d3cb77cb-94e3-5f66-87f7-3ef83c2421b3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "30e5eb55-a46e-5133-8a7d-c45741c48530", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "65c35646-40f0-59a8-8af3-9d8ff8ad3a9b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7a31da43-6229-545f-a669-65cf8235d07e", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "09f83da6-af03-5437-97a2-ea39d76db88d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c3551e59-462b-5ebb-99d3-a9ca150d715c", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "77c58700-3d3b-50e5-8442-35a510357ebd", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "bc4fae47-f0a4-526b-b180-7eb48cda57e9", "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)", "choice_num": 4, "target": "D", "category": 2 }, { "id": "11e4ddc1-0a65-5c77-a058-9f3d75cd10ce", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "07dff91f-68fe-5dc1-9fb8-21a2d01c79d1", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "58b8dc3a-83ea-5c3d-848b-6331385419dd", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ed27c84f-51c9-5fbe-bf50-62e53084579e", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "91cdfa22-3e6e-5339-a5e7-c6b3e1861b2d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ff8b7284-bb33-5287-928f-1e3ebea144f8", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9fa172f1-278f-5136-9022-6bd25659e784", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0093335f-1d6b-5ba6-81e1-68cc2b63fcac", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b8e49093-72fa-5f92-b6f5-cbb02e47ffdb", "question": "Which section of the brachial plexus is blocked with a supraclavicular block?", "A": "Roots/trunks", "B": "Trunks/divisions", "C": "Cords", "D": "Branches", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9ab34869-997b-5804-8435-217abc31d79e", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b82286e1-7146-51ea-ad63-65927013b19c", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "cebf278b-9146-5136-8475-766f5f88860d", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "a0d93a6a-4d69-51b5-af6a-ff32eedcccb6", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ac7c59b3-02cb-5cba-b70b-17cc768ab419", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d1e22ead-c03e-53b4-813b-6eb0509e7bff", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "79b7d5cd-da8d-5711-85a1-b0e93c03c99c", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "54b9cb73-c5fd-5022-8b47-0ca69f4a406c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e64d5879-46c0-5f0d-a011-c28a5158661f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "83735247-6432-598a-a324-7abbc562e420", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2cdd217b-d692-5327-ad8b-4bf733eb365a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cca9e816-74b4-590f-8e67-f76bf311c053", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b3cb1e5e-b9c4-5089-89d2-9e9ae09875bb", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1ebc8389-aa7c-54cf-a79e-502131771b37", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3da23039-ea9f-5ed3-9ba9-65e9fd6b638b", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "11787521-a3cb-5720-8c69-b90f17195eeb", "question": "The most common complication of a celiac plexus block is", "A": "Hypotension", "B": "Seizure", "C": "Retroperitoneal hematoma", "D": "Constipation", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9ee2e1e9-ba28-51f8-a675-4af849bcd65b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f4cdb28a-c288-5c0b-bb13-a792a3cc5cd4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7ee1b9a2-a6b2-5618-853b-b1cc8a2d60ed", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ca300b9f-c9f6-560c-badd-bedc9f7f72bd", "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)", "choice_num": 4, "target": "B", "category": 3 }, { "id": "5d8cc638-1cb2-512d-8c61-65b7f00e3a87", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "18cde671-87f5-5c02-951e-a5dc689dc2c0", "question": "Para-aminobenzoic acid is a metabolite of", "A": "Mepivacaine", "B": "Ropivacaine", "C": "Bupivacaine", "D": "Procaine", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7d8444f6-5b88-5201-8c86-f531b2a89230", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ba9d60fb-0551-5050-88d9-e52bb27f826c", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "ea33e006-9658-52d6-bcb4-d1a3f7147ac9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f76625c2-918d-588c-bec2-826dcc4c1ffa", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6e852d7c-3502-50d8-82d9-f01433be1a5c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "262cce88-50e0-542b-ac0e-fa14bfbcf0ed", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "34f41584-c7ec-532c-af7f-da6976f8ded5", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b7041366-e924-5e8d-8e3c-00507c876eea", "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%", "choice_num": 4, "target": "D", "category": 2 }, { "id": "297aace8-fa27-5d6a-a3ec-f4ba84d72886", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "80b3b6a0-1eea-5663-9699-3b2cbacbe300", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "a332c376-74b8-5b69-b86f-bc9962569258", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7ce6f370-b201-599c-92b7-5970d5e3ee33", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "fae67c31-9027-52c5-a4b8-15b30c353867", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "16d2cf77-986b-5759-8603-96fa5aede5e9", "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)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3ad2f94d-f230-5ae9-8733-0ea6563317dc", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "20027f43-4b3d-586f-942f-cde048395e9e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0565684c-40df-5f41-a151-81e3741f6dcd", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9a98d381-84fb-5b8e-be46-a0fd8847585b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b6d114ae-5480-5151-9083-a1e1d908dd6f", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "782b5422-a832-58dd-b443-4b346b40670c", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "9672624b-f8c4-5cde-8421-d3e11d1062fa", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "6ac14128-d988-5a03-a590-6f744c0bd41f", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f3fe3219-8873-5ea9-a65f-906bd5c12373", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "bdcbd666-0cf9-5a3e-a103-d57e204874f6", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4d55519c-50e2-5672-83ad-eaf6a66a12aa", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "5c50641d-900e-5f8f-b514-1c181694031e", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "806b3086-0666-5bc6-a11c-e468d762058e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b8be242c-6807-5962-82d3-9156c07f419e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "39200c0a-e743-5601-97c3-7c27c7e97b08", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "02276081-79ed-5dc0-be1a-61fcd840cc97", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2646a111-995f-5250-8ebe-c67b3920e743", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5864dc25-a579-509e-acc4-c171dfde8f1c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1154f109-f750-564a-bbff-ff68c9d85834", "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#", "choice_num": 4, "target": "A", "category": 1 }, { "id": "014573aa-00c5-5303-9843-e25417e6a7b4", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "b4dc711b-eab4-57b0-af28-641340f6a4c7", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "8c33b732-514b-5fb4-8e00-7167707cadc4", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "82bcbca5-b628-5cb0-9022-38a242b15d4e", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "0c863a33-6719-5413-921c-d950b9a44e9b", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "71e358ac-66da-56ce-80cc-dc5a32d20d6c", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "2283e4d1-c169-58da-a872-b9450690f1f0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "473f09f8-aed1-52d5-81b0-c05f72be97de", "question": "By what percentage is tissue metabolic rate reduced during cardiopulmonary bypass at 30° C?", "A": "10%", "B": "25%", "C": "50%", "D": "75%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e4424267-31d2-5b45-8f66-5a64423b477c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b812b8df-6ef8-5f6f-bf16-169b399184eb", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "c56d4a29-9e38-5302-860d-15a0135f9f00", "question": "Administration of protamine to a patient who has not received heparin can result in", "A": "Anticoagulation", "B": "Hypercoagulation", "C": "Profound bradycardia", "D": "Hypertension", "choice_num": 4, "target": "A", "category": 1 }, { "id": "08fdcdfb-212e-5b5f-ae2a-0efd3c5af379", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "66cfe50a-da68-5b78-aa68-5fe5a53481e0", "question": "Cardiac tamponade is associated with", "A": "Pulsus alternans", "B": "Pulsus tardus", "C": "Pulsus parvus", "D": "Pulsus paradoxus", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5552d041-85d5-5c13-a4a4-fd99a00b153e", "question": "Which of the following drugs should NOT be administered via an endotracheal tube?", "A": "Lidocaine", "B": "NaHCO3", "C": "Atropine", "D": "Naloxone", "choice_num": 4, "target": "B", "category": 1 }, { "id": "bec76444-d72c-5214-8c79-9a105a42f709", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "f66b8323-3b03-5019-8d20-8523c7b256d5", "question": "Hypothyroidism and hyperthyroidism could develop in patients receiving which of the following antidysrhythmic drugs?", "A": "Amiodarone", "B": "Verapamil", "C": "Procainamide", "D": "Lidocaine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9479d7ae-4419-505b-8554-1e14a494b692", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "aa5baf8d-d1bb-5944-b611-491c9b5b12d9", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7bda800f-22ea-5d02-a902-2f446d0a4ee8", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ad7b2ccc-5817-5cd3-8538-c89904cd1508", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "4e737ec6-703e-53b5-9188-52293fe74e39", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "e3de9d51-4267-596c-b7c2-facb5cd09f5e", "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%", "choice_num": 4, "target": "A", "category": 1 }, { "id": "72cd138a-6db3-59e3-a3c4-1be446162073", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3d4e0d28-11b4-56be-8250-a1322ba3feb5", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "293083cf-28c1-552d-9ed1-46a853f3b4d7", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "a9844ec7-08cb-5ed8-a068-d5abe12476d8", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "79812b0b-cddc-560e-9534-655352a162c3", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "352e00f0-58fb-5bea-bce1-2e2d804c06d9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3dc8aa0b-80e9-544a-8c33-4d904fb86ec2", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "d4e734d9-7b5b-5064-9357-0e5df17c21a7", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d086452b-8b25-532c-814f-a5510a33b853", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f4dcf969-daac-5bf9-b002-792fe28060fa", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c97c43b4-3451-5a0f-9577-995fd4ee60c9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e93c35c6-bb50-50c2-a14f-8d0d28531ef3", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "358a528d-920e-5baa-a34c-898ac4e494eb", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "69976497-cfd3-5dfc-99e1-911527c2dc83", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0dd46625-3c4d-5697-bbf1-4872c68f4b7a", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "c42e30da-e4a5-505f-9fc2-82f61d13b6e6", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0a3d0efd-c98a-58b2-b169-3d122826b423", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "97867ec3-5e01-573a-80d9-d476b5ce5ead", "question": "Which of the following medications blocks angiotensin at the receptor?", "A": "Losartan (Cozaar)", "B": "Terazosin (Hytrin)", "C": "Lisinopril (Prinivil, Zestril)", "D": "Spironolactone (Aldactone)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9baa5134-43a6-5e87-8ba3-30a1ae5eb44f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b5b31c0d-d26b-5037-92e1-714e6ec99597", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "952c06cc-c4e1-5d9e-9ee3-5f3c56b21cf1", "question": "Sildenafil (Viagra) belongs to the same class of drugs as which of the following?", "A": "Yohimbine", "B": "Hydralazine", "C": "Enalapril", "D": "Milrinone", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c93d01e2-ff62-5787-a9b8-5dfa3c19df76", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3efdbacd-3ab5-5c3b-a51c-726e5357a4cc", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b65f34fc-d655-5149-b60b-9e9e2adb7262", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "facebd43-f7b7-5411-9b2b-2c852e6b1f04", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2880a14c-f7a6-5ef5-a4c3-bfcb518ba201", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "09b0a824-d5f2-5193-b54c-1bab096fec00", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "46dc959b-6fbf-546d-9e57-8d3767666c7f", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "2dfa8d77-bf57-5dc0-ac06-fa5542bd58cf", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "a3831dd6-d4db-5634-8a2b-d251f3656e8d", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "4985ba37-f3d7-5435-85ed-c6cff8d950b0", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "33e9e604-0d3f-5433-9fa7-aa5bb1591ae4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d11558f4-e381-53c5-b4f1-82580c8f1519", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c7c50d0e-5214-5e5e-9270-48d0e33b9e3a", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "d420f6cc-8c04-5853-8f56-7a0d321843cc", "question": "Which of the following terms refers to myocardial relaxation or diastole?", "A": "Inotropy", "B": "Chronotropy", "C": "Dromotropy", "D": "Lusitropy", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6274295f-8d06-5bdd-878a-dbd507a043b2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "aafb5a86-5ebe-51e0-8407-f0d5518716b9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e02b5000-ab03-5991-a079-c5e6516eb3bf", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "a7234dab-9479-5930-9ae2-8dc9a3bbd3a5", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "85c49f73-1671-5d13-9bdd-467cc2aeb75d", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "06a06159-8849-5bfb-9abc-e5d44ee396a3", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "ef304489-c4cc-509f-b590-60e6f28248c8", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "c4479f03-9d3e-5db0-8052-42efadc0bc6f", "question": "Normal or increased PR interval, short QT interval", "A": "Hypokalemia", "B": "Hyperkalemia", "C": "Hyponatremia", "D": "Hypercalcemia# Cardiovascular Physiology and Anesthesia#", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a0a9fd63-3ae6-5f51-83b5-01417e61c4fa", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3ae425ee-8e9f-52bd-8fe6-4a786086a62d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "75af16ed-912d-5483-af01-6e5da1651001", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4812962e-ef27-531f-928f-e18da2c9aa33", "question": "AEP stands for ________", "A": "Auditory Evoked Potential", "B": "Auxiliary Evoked Potential", "C": "Audiovisual Evoked Potential", "D": "Ambulatory Evoked Potential", "choice_num": 4, "target": "A", "category": 1 }, { "id": "91762ee4-a09e-5058-a6cb-b6d3484347c4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5c2f943d-54a3-511d-ad9b-8ede1e668607", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9f64aace-7bd4-5add-b64a-c839c0f48731", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cafb9618-d650-58e3-b740-e4cbd6072736", "question": "_______ is the most commonly used material for vapourizer.", "A": "Steel", "B": "Cast iron", "C": "copper", "D": "Brass", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4ce54ba9-c3b0-5096-aa45-d9df0bdc36ad", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0af44b30-18db-5883-bb0d-019c12e6255b", "question": " Which of the following is known as laughing gas?", "A": "CO2", "B": "N2O", "C": "NO2", "D": "B2O", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d29d2510-1e5c-5b28-acc0-7876ee63d2c9", "question": "After oxygenation of blood, what is the percentage of oxygen carried by hemoglobin?", "A": "70 %", "B": "75 %", "C": "87 %", "D": "97 %", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f80f52dc-a985-5a1b-9359-4345659cbb1e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "351b7f71-e596-55e2-955a-6b643b5d8118", "question": "What is the residual capacity of the lungs?", "A": "2000 ml", "B": "2300 ml", "C": "2500 ml", "D": "2700 ml", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c6b0ef30-64f6-567b-9c22-260c56897987", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8ffe6603-669e-5f19-b7d9-f776334b8f2e", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a133206e-5f1a-561f-ba0a-48b98164b991", "question": "The pump used to pump air mechanically into the respiratory tract __________", "A": "Mechanical Pump", "B": "Ventilator", "C": "Ambulatory Bag", "D": "CPR", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e1423f23-8e0b-5e72-8ee1-a8d38c85d3c2", "question": "A ventilator can sometimes cause a disruption in the normal breathing pattern.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "e2b5a093-3d79-53cf-82ee-b0cd1829de21", "question": "Prolonged bed rest can lead to which problem?", "A": "Tuberculosis", "B": "Diarrhea", "C": "Cholera", "D": "Hyper Tension", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9db9aa09-b961-5ef8-9e2c-d3f24978af21", "question": "The first anesthesia used was ___________", "A": "polyvinyl chloride", "B": "trichloro methane", "C": "chlorofluorocarbon", "D": "tetra fluorocarbon", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0e2dc92f-3a6f-57ea-85cf-f92711605c50", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ae35245e-ce21-56a9-99ee-6f09ce356846", "question": "Obesity can pose a risk of anesthesia.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "041b62a8-1bdc-5c5e-b759-cd6e9ebe3988", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "95e63edc-10ab-53fb-be6d-2c2e859bdb4c", "question": "The anesthesia applied directly to the skin is ___________", "A": "Topical Anesthesia", "B": "Caudal Anesthesia", "C": "Local Blocks", "D": "General Anesthesia", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e943ec63-6841-5bcc-baad-557c813300e7", "question": "In a caudal block, where is the anesthesia injected?", "A": "Thoracic Canal", "B": "Lumbar Canal", "C": "Sacral Canal", "D": "Coccyx Canal", "choice_num": 4, "target": "C", "category": 1 }, { "id": "edcbc842-e02a-5ab3-b552-20418c361ff6", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "72332500-b186-5bbb-816e-714c6f280b82", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "79f2a579-271a-5e73-8856-6f653893b81d", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0194ea2d-4282-5225-99f6-f498d1907770", "question": "Immediately after the surgery, the patient is usually shifted to _____________", "A": "ICU", "B": "PACU", "C": "CCU", "D": "Recovery room", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ad1d73e6-3bb7-5002-af7a-a1d32779b34f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4e229734-b8ec-5d01-8e75-6558d33da16d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "62ec8d85-c9e1-563f-8b18-03824ac11913", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "63ddeb4c-4188-51e0-9de3-105d543a6d25", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5bf6e3d4-93a3-5e9e-bd64-8dcd509d1690", "question": "Spinal Anaesthesia used on a patient needs monitoring for ________", "A": "Oxygen levels", "B": "Hyper tension", "C": "Renal Function", "D": "Brain activity", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4572d0e6-71b6-53b0-acbe-a5cb9ca356a1", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "caa22c74-e36e-572b-bb81-0165c9dc5aa5", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a6de3e4c-69b2-5f03-96a4-a5459837d5de", "question": "A patient with a history of heart disease can be put on a prophylactic antibiotic.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "883fa2d3-ea23-54e1-bf2b-95c87045e71e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5148e746-d06f-5429-b8fa-01debcbdf5f7", "question": "Before reaching the operation theater, how many zones exist?", "A": "1", "B": "3", "C": "5", "D": "7", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f25d8867-c5a5-55c3-ad1e-a7c889e28289", "question": "How many sections are there in the operation table?", "A": "1 – 3", "B": "4 – 5", "C": "6 – 7", "D": "7 – 8", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3f2641f0-5b0d-5c44-a7d4-9a6a18b38e6b", "question": "What kind of lights exists in the OT?", "A": "Fluorescent Lamps", "B": "LED lights", "C": "Tungsten Light", "D": "LCD", "choice_num": 4, "target": "B", "category": 1 }, { "id": "584cf399-c45c-5680-88a3-d0c126aadfdc", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "979081e6-f878-52f6-b1d5-4df1ee8c4d76", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a9557eb7-c44d-5c2a-879f-9418ab16cfd6", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "07473cbd-44ee-52c8-bb4e-5201735432cb", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9ee451bc-155e-51d2-804b-823fa09fb05a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "01eb0e7b-a743-5510-8fda-279ccf49b0ad", "question": "What is the resolution of the microscopes used in neurosurgery?", "A": "1 μm", "B": "1 nm", "C": "1 Åm", "D": "1 pm", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e9534603-25f9-529c-a6b9-e050c4c1cdd0", "question": " For how long can a heart lung machine be used?", "A": "4 hours", "B": "6 hours", "C": "8 hours", "D": "10 hours", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c66b6279-2ba0-5524-b1c1-6e085a2fd71c", "question": " In which of the following is not used for suturing?", "A": "Silk", "B": "Nylon", "C": "Polyester", "D": "Bakelite", "choice_num": 4, "target": "D", "category": 1 }, { "id": "73646513-ff56-5821-bb08-a7e6403de682", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "be97358d-6e54-5259-a998-1c6c0a56d46e", "question": " The following steps are for _______", "A": "sterilization", "B": "disinfection", "C": "antiseptic", "D": "hand washing", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7606e062-c138-524d-8151-a5bcebcea7fe", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "35885303-7421-5569-9195-2ed9a0251a2c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f10f3b53-96ef-59e9-9b5c-d69a98b424ca", "question": "Which machine uses the temperature and pressure of the steam for disinfection?", "A": "Laminar Airflow", "B": "Autoclave", "C": "Oven", "D": "Water Jet", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cc0c9988-f73c-5464-a85a-3f45e3f87006", "question": "Which of the following cannot be autoclaved?", "A": "catheter", "B": "mes", "C": "scalpel", "D": "scissors", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4220a0d9-172c-5745-810a-afab146721ee", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "24873320-ad4c-5c38-a77f-2921833f1086", "question": " How are the gauze and cotton sterilized?", "A": "Hot air sterilization", "B": "Wet Heat Sterilization", "C": "Sterilization Under High Pressure", "D": "Chemical Sterilization", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d2951556-ddf5-5cb2-bba1-88edcb441c13", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "740b658d-5984-5ae1-8c9d-63c265b894ce", "question": " What is sterilized in dry conditions?", "A": "Implant", "B": "Gauze", "C": "Scalpel", "D": "Cannula", "choice_num": 4, "target": "B", "category": 1 }, { "id": "94258dfa-3c87-56ba-b235-3af0ed50b857", "question": "How is dry sterilization done?", "A": "In autoclave", "B": "In oven", "C": "In Magnetic Vibrator", "D": "In Hot Plate", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2ffa576b-7fdc-5485-8921-5d409350b3ff", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "022c67ab-aaf2-5612-882a-e41755b852a1", "question": "Which of the following are natural opiates?", "A": "Codeine", "B": "Oxycodone", "C": "Fentanyl", "D": "Endomorphins", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8a6b165b-2ebe-5f07-84ca-74013f399c52", "question": "Which of the following are semi-synthetic opiates?", "A": "Codeine", "B": "Oxycodone", "C": "Fentanyl", "D": "Endomorphins", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8796fd62-9a77-54d8-9d28-ed9844587848", "question": "Which of the following are fully synthetic opioids?", "A": "Codeine", "B": "Oxycodone", "C": "Fentanyl", "D": "Endomorphins", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3d83b583-0b40-5bee-8f3d-9baeab2100ab", "question": "Which of the following are endogenous opioid peptides?", "A": "Codeine", "B": "Oxycodone", "C": "Fentanyl", "D": "Endomorphins", "choice_num": 4, "target": "D", "category": 1 }, { "id": "70cddefe-6614-5439-a282-37113dedce37", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9465037a-551f-58ad-9f97-b63282a8cd04", "question": "Which of the following side effects of morphine is the most dangerous?", "A": "Excitation", "B": "Nausea", "C": "Constipation", "D": "Tolerance and dependence", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b671687e-da9a-5cdf-9052-7e0640e1e430", "question": "What is opiophobia?", "A": "Fear of opioid plant", "B": "Fear of drugs", "C": "Fear of prescribing opioid drugs", "D": "Fear of anesthesia", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fef2ff6d-fca6-5d2a-bfb2-ff9a6af61ffe", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "03138edf-7755-5e6d-ac29-3d6599ba3570", "question": " Which of the following is the long term effect of heroine?", "A": "Dryness of mouth", "B": "Collapsed veins", "C": "Muscle weakness", "D": "Euphoria", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f9468a53-6066-5fbd-a53d-0d5f3f2fe237", "question": " What is the antagonist for heroin?", "A": "Naloxone", "B": "Oxycodone", "C": "Fentanyl", "D": "Endomorphins", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f2af5c6d-47ab-55ac-96ff-10f2d52be6d7", "question": " Which of the following Fentanyl analogues is ultra-short acting analgesic?", "A": "Alfentanyl", "B": "Sufentanil", "C": "Remifentanil", "D": "Carfentanil", "choice_num": 4, "target": "A", "category": 1 }, { "id": "edf65a4f-ac3e-5795-a3fe-d1f0f9230c3f", "question": " Which of the following fentanyl analogue is used in heart surgery?", "A": "Alfentanyl", "B": "Sufentanil", "C": "Remifentanil", "D": "Carfentanil", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c9873431-dcc9-57aa-abde-1c7ba8abaff1", "question": " Which of the following is the shortest acting fentanyl analogue?", "A": "Alfentanyl", "B": "Sufentanil", "C": "Remifentanil", "D": "Carfentanil", "choice_num": 4, "target": "C", "category": 1 }, { "id": "737a23f7-bd4c-521c-9386-aa0e863467c3", "question": " Which of the following fentanyl analogue is being used in veterinary practice?", "A": "Alfentanyl", "B": "Sufentanil", "C": "Remifentanil", "D": "Carfentanil", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f45f3c35-3076-58aa-a08f-e6df017e45cd", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "216044d9-4979-5f6d-add4-4b1fd61ba6d9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f952996f-b526-5744-96cf-0b84a4f861ae", "question": "Which of the following are natural local anesthetics?", "A": "Cocaine", "B": "Benzocaine", "C": "Benzyl alcohol", "D": "Clove oil", "choice_num": 4, "target": "A", "category": 1 }, { "id": "343b20c8-bc20-5d2a-a8fd-faa9beeb2720", "question": "Which of the following is synthetic nitrogenous local anesthetic?", "A": "Cocaine", "B": "Benzocaine", "C": "Benzyl alcohol", "D": "Clove oil", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1703d589-6d4d-59f5-9caa-cfe102eaf6e7", "question": "Which of the following is synthetic non-nitrogenous anesthetic?", "A": "Cocaine", "B": "Benzocaine", "C": "Benzyl alcohol", "D": "Clove oil", "choice_num": 4, "target": "C", "category": 1 }, { "id": "cd6eb515-3261-51ea-b9e4-08716801b43e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4f1c198a-86dc-56c0-be92-c27965957627", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "dcac3575-0df1-5f1d-a8dc-a37a0de03ea8", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5ef4af04-e046-56ba-8d69-e7b95bfc9f32", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "27592b3a-22c6-5dd7-9d68-e5252c13c0c4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9c5e6db6-ff53-522a-b6b8-6b468fc3117a", "question": " Which is the first local anesthetic?", "A": "Cocaine", "B": "Benzocaine", "C": "Benzyl alcohol", "D": "Clove oil", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5d06e321-15ac-5954-aa98-703ca92005b7", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "a0f33277-47c0-5bd5-877c-4d2051654535", "question": " Which of the following is amide type drug?", "A": "Lignocaine", "B": "Cocaine", "C": "Procaine", "D": "Benzocaine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3fa6e2fe-317b-57c1-b7c0-7e065410bada", "question": " Which of the following is topical with high concentration?", "A": "Lignocaine", "B": "Cocaine", "C": "Procaine", "D": "Benzocaine", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7dcd0dce-3a84-5232-a23b-342e5dc30136", "question": " Cocaine, when used for local anesthetics, has a half-life of 30 minutes.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "93ca7391-a135-5348-add2-838ba1835416", "question": "Which of the following will work as an anesthetic?", "A": "Pantoprazole", "B": "Amlodipine", "C": "Cocaine", "D": "Mannitol", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1c29cc91-d980-5a9c-854c-a1e9b5557240", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "994607fa-e66a-5c2a-82b0-f9d2a6ff83ca", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e9323b2b-46c8-5010-9dc8-038f010e5e80", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c721a35e-0e93-5582-8d10-9ccfc0323016", "question": " Which of the following is not an inhaled anesthetics?", "A": "Haloethane", "B": "Enflurane", "C": "Isoflurane", "D": "Diflurane", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a0c92f1a-6dbf-5337-b445-c23c55039930", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5c1fe3bc-17d8-5b6d-a7ed-ee7d602e3183", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8fe9687e-c9df-55e1-b716-04bc99602cc4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "47190b99-b96d-5c2b-b11a-3fa4306a1413", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "843391b9-0b1e-548e-bd85-feb912145bd1", "question": " Administration of general anesthetics decreases the presynaptic Ca2+ entry.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "757abf0c-02fb-5c34-8200-82e52a67eda4", "question": " Local anesthetics increase the axonal Na+ entry.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "a658460c-5b0f-5087-b44f-a6d4075740b9", "question": " The lower the blood: gas ratio, the more anesthetics will arrive at the brain.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "ee133db3-c6e2-53b1-b601-846c1680ba63", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e53dc56e-55a6-577e-9657-efe14b79e24a", "question": "Which hormone is a major contributor to the symptoms of inflammation?", "A": "Histamine", "B": "Serotonin", "C": "Bradykinin", "D": "Leukotrienes", "choice_num": 4, "target": "C", "category": 1 }, { "id": "eb7e20f8-2242-543b-bd2c-19033bb37ab8", "question": "Which of the following promotes edema?", "A": "Histamine", "B": "Serotonin", "C": "Bradykinin", "D": "Prostaglandins", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7d52c27f-0eca-55bd-a422-aba1ff0ef367", "question": "Which hormone is a major contributor for pain during inflammation reaction?", "A": "Histamine", "B": "Serotonin", "C": "Bradykinin", "D": "Leukotrienes", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f9e96e02-eaa9-5102-8144-6a35951b24c6", "question": "Which hormone is a major contributor to chemotaxis while inflammation reaction?", "A": "Histamine", "B": "Serotonin", "C": "Prostaglandins", "D": "Leukotrienes", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1083988b-5178-579b-a3a1-9bb8014abc84", "question": "Which hormone is a major contributor for increasing vascular permeability during inflammation?", "A": "Histamine", "B": "Serotonin", "C": "Bradykinin", "D": "Leukotrienes", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6c55e33b-a526-56a3-b3ac-ba41005464fd", "question": "Which hormone is a major contributor to vasodilation during inflammation reaction?", "A": "Histamine", "B": "Serotonin", "C": "Bradykinin", "D": "Leukotrienes", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9ff5a8ad-857d-5e67-b097-8975d5e91c32", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0cb46e52-74a7-5916-8462-642aa4cc545d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "caba7840-5bd5-51f7-9950-560d5ef89975", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "74b4dddf-a665-50eb-841d-9f42ed390bac", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ec1fe441-3e32-5f0c-b7bc-f78c0600f5a8", "question": " Which of the following drug is an indole derivative?", "A": "ASA", "B": "Ibuprofen", "C": "Phenylbutazone", "D": "Indomethacin", "choice_num": 4, "target": "D", "category": 1 }, { "id": "aab212cf-43d0-5af0-853d-6a54e05ad5a7", "question": " Which of the following drug is a Phenylpropionic acid derivative?", "A": "ASA", "B": "Ibuprofen", "C": "Phenylbutazone", "D": "Indomethacin", "choice_num": 4, "target": "B", "category": 1 }, { "id": "65e14b67-5527-59e7-8fbf-3fe9ef27e4b2", "question": " Which of the following is an example of salicylates?", "A": "ASA", "B": "Ibuprofen", "C": "Phenylbutazone", "D": "Indomethacin", "choice_num": 4, "target": "A", "category": 1 }, { "id": "221fdfd6-db9c-5517-9ce8-87e4fba0dea4", "question": " Inflammatory response is an abnormal defense mechanism.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "77910d39-7b05-5374-bd8d-3128048b14b1", "question": " Inflammatory switch does not have an off switch.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "42186061-541c-5a7d-837c-6bec6e6965f6", "question": "Which is the predominant form of cyclooxygenase enzyme?", "A": "COX 1", "B": "COX 2", "C": "COX 3", "D": "COX 4", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a5601215-3657-58c8-83df-121e76890dc5", "question": "How does NSAIDs work?", "A": "Inhibit arachidonic acid", "B": "Inhibit Endoperoxide intermediate", "C": "Inhibit Prostaglandin and thromboxane synthesis", "D": "Inhibit cyclooxygenase", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0da92388-08e5-5511-904a-1bb4629e3b91", "question": "Which of the following has a half-life of 45 Hrs?", "A": "Piroxicam", "B": "Phenylbutazone", "C": "Ibuprofen", "D": "Indomethacin", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8eeac021-dd3d-5693-9f1f-03873b2a870a", "question": "Which of the following has the same potency as ASA and better tolerated by patients?", "A": "Piroxicam", "B": "Phenylbutazone", "C": "Ibuprofen", "D": "Indomethacin", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fcea5cb1-a323-59a5-8496-d9abefe0e1d5", "question": "Which of the following cannot be tolerated, rheumatoid arthritis patient?", "A": "Piroxicam", "B": "Phenylbutazone", "C": "Ibuprofen", "D": "Indomethacin", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f5812299-3140-5a9d-883c-9b657f619c79", "question": "Which of the following pyrazolone derivative’s has toxic side effects?", "A": "Piroxicam", "B": "Phenylbutazone", "C": "Ibuprofen", "D": "Indomethacin", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3bae23a2-0c48-5779-ad0e-b9728e81ce5b", "question": "Which of the following is a pro-drug and related to indomethacin?", "A": "Piroxicam", "B": "Phenylbutazone", "C": "Sulindac", "D": "Indomethacin", "choice_num": 4, "target": "C", "category": 1 }, { "id": "257706f0-1659-5282-8742-ab93d615365a", "question": "Which of the following is also known as “housekeeping enzyme”?", "A": "COX 1", "B": "COX 2", "C": "COX 3", "D": "COX 4", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ea2bee76-f95e-54ae-be3c-5069a0704a5d", "question": "Which of the following responsible for inflammatory response mainly?", "A": "COX 1", "B": "COX 2", "C": "COX 3", "D": "COX 4", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3fdb5100-6d96-5ebe-a700-296aa22bd6cd", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5c6e6039-4df1-5400-8db6-6ed55fea71b3", "question": " Which of the following has the least GI effect and derived from parent NSAIDs?", "A": "Piroxicam", "B": "Phenylbutazone", "C": "NO-NSAIDs", "D": "Indomethacin", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d7d42a0d-f12d-5153-8d3f-197028565d56", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c8fd4703-0571-5529-b7c4-81562eed528a", "question": " Macrophages with a high content of EPA produce less TNF and IL-l.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "0f517e47-ab7c-5278-b154-28b6d4c35436", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "8b589961-aa9c-57f1-b3b5-97d1e854ff0e", "question": "What is the last safeguard before the gases reach the patient?", "A": "ETT", "B": "Thorpe tube", "C": "Oxygen analyzer", "D": "Capnograph", "choice_num": 4, "target": "B", "category": 1 }, { "id": "26bbd9cb-6ab3-54af-bcf9-1579d99a405e", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "cb5a056d-78b1-5f2c-9a75-7d66ca60f4f0", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "eb9baa68-5450-5d6c-9015-2473e04d0a19", "question": "What is the minimum o2: N2O ration?", "A": "1:1", "B": "1:2", "C": "1:3", "D": "1:4", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1246d9a5-ca82-536d-8330-e8b4f173fb09", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f6315bc8-063c-5d24-b625-114121ccbdba", "question": "Name the gas that we use as a carrier gas for agents.", "A": "Air", "B": "N2O", "C": "Oxygen", "D": "CO", "E": "CO2", "choice_num": 5, "target": "C", "category": 1 }, { "id": "6cac436b-2357-5403-a2bf-c7ba9caca6c0", "question": "Modern vaporizers are within the breathing circuit. True or false?", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "c6bc635d-57cc-5885-a387-19af08784ea0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fb472fdb-82e4-5145-b511-5208f9266143", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e6917021-7157-5047-8cff-f1f971a195cb", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ddfe62ba-9dc3-5be7-95c2-48eb9ed94ed4", "question": "The approximate water content of Soda Lime is", "A": "10-12%", "B": "12-14%", "C": "14-19%", "D": "23-37%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6f38b5d9-1af7-5c73-b672-904cd4760b30", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "4d36dea3-6084-5da7-a913-9db72cc08416", "question": "The standard size in the U.S. for a scavenger system hose is ________.", "A": "19mm", "B": "20mm", "C": "30mm", "D": "33mm", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f33dc343-acd0-5736-9119-cdadb2e75818", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "64f5eaf8-9759-58d6-beae-9cdc2c5d8cbf", "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!", "choice_num": 4, "target": "A", "category": 1 }, { "id": "cf7ea8e9-eccb-5a61-a55c-2c190b01fa92", "question": "Which of the following regulate gas cylinders?", "A": "FDA", "B": "NIOSH", "C": "OSHA", "D": "DOT", "E": "MLBPA", "choice_num": 5, "target": "D", "category": 1 }, { "id": "5ebad4f8-2bd9-5505-840a-220122e7e752", "question": "Which agency enforces a safe working environment?", "A": "FDA", "B": "NIOSH", "C": "OSHA", "D": "DOT", "E": "MLBPA", "choice_num": 5, "target": "C", "category": 1 }, { "id": "62f8aaf3-2296-5585-9144-e866fdd78aa3", "question": "Name the agency that writes criteria for OSHA to enforce.", "A": "FDA", "B": "MLBPA", "C": "NIOSH", "D": "DOT", "E": "NFPA", "choice_num": 5, "target": "C", "category": 1 }, { "id": "d0c81236-d669-5243-b4f1-d0ed406dfcb5", "question": "Who handles most standards affecting anesthesia?", "A": "FDA", "B": "NIOSH", "C": "ASTM", "D": "CGA", "E": "NFPA", "choice_num": 5, "target": "C", "category": 1 }, { "id": "cfe568bb-8ed5-50bd-8535-554d0304a5fe", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "5e5765e7-87ec-5d4e-b9c8-c8e3b350e13c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9f6c71b6-c2c1-532c-ae43-692a5b34e00f", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "1c486560-2bed-533d-be4e-7508b3b124ad", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "621c5635-b26d-506b-9e97-b911cced0efd", "question": "What is the PISS of N2O?", "A": "1,5", "B": "2,5", "C": "3,5", "D": "4,5", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0ba07e26-6552-54fb-8819-5b455bc0547c", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9252232a-b940-5982-a63b-77ba86a615f3", "question": "Which of the following is NOT a component of the anesthesia machine?", "A": "Vaporizer", "B": "Ventilator", "C": "Defibrillator", "D": "Scavenging system", "choice_num": 4, "target": "C", "category": 1 }, { "id": "83e7377a-e24a-5e15-beff-633311149ea3", "question": "How many liter of O2 are in a G cylinder?", "A": "660", "B": "1500", "C": "1200", "D": "5300", "choice_num": 4, "target": "D", "category": 1 }, { "id": "68853dff-594a-551d-9972-692e9929b563", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "cb3c7d93-0193-5cc8-8ffe-3337933e7dfc", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "10a71806-b51d-5ac2-a08e-03e4ed40fb56", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9034f925-c2a9-57af-9087-0f65bb85aab5", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0c4c58a0-aba4-5f64-8cac-54fd1589530b", "question": "What is the SVP of Sevo?", "A": "175", "B": "238", "C": "160", "D": "243", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9d0a0aee-515d-558c-91d6-8f8e424539f1", "question": "What is the SVP of Isoflurane?", "A": "238", "B": "175", "C": "160", "D": "243", "E": "660", "choice_num": 5, "target": "A", "category": 1 }, { "id": "cccb0a33-be29-5118-8be7-c9b1c7acf7a9", "question": "What is the SVP of Enflurane", "A": "23", "B": "175", "C": "243", "D": "248", "E": "660", "choice_num": 5, "target": "B", "category": 1 }, { "id": "63a70074-7e27-5f40-a5c5-49d57242dd0d", "question": "What increases SVP?", "A": "Cooling", "B": "Heating", "C": "Passing gas over the liquid", "D": "All of the above", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0c8a41f1-76ea-5a6d-8253-70ea46bc3c64", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "679216bd-bfcf-5201-9c16-72a80ffe6ab4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2e6d2444-cb42-5137-bba3-3555c8cf5367", "question": "Which anesthetic agent requires supplied heat.", "A": "Sevo", "B": "Iso", "C": "Des", "D": "Halothane", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b00a05c3-10e1-592f-a388-b81c2159247b", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "83e740f3-f07d-5ffb-96a5-52e1e186a49d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "bab5ce2c-27d6-5817-b418-3e6a3300f7c4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7154ad82-2a8d-5cf3-bdfe-1c250fe2079d", "question": "What is the heat of vaporization of Desflurane?", "A": "20C", "B": "39C", "C": "25C", "D": "10C", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f7ae2296-8111-5ac8-b7f2-441307336beb", "question": "What is the heat of vaporization of Halothane?", "A": "20", "B": "39", "C": "15", "D": "10", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2a1e440c-d049-59b6-8859-d11da0b33a5c", "question": "What is the heat of vaporization of Isoflurane?", "A": "25", "B": "20", "C": "39", "D": "10", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2fcbf0f5-9d03-5b05-938e-545671ee5f9d", "question": "What is the boiling point in celsius of Des?", "A": "50", "B": "23", "C": "48", "D": "58", "choice_num": 4, "target": "B", "category": 1 }, { "id": "40938008-30c3-5ba9-bc76-f43c7a520bc7", "question": "What is the boiling point in celsius of Halothane?", "A": "23", "B": "48", "C": "50", "D": "58", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fe937557-1120-531f-bfb3-cabc357a64b4", "question": "What is the boiling point in celsius of Sevo?", "A": "23", "B": "48", "C": "50", "D": "58", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b6ea6193-2a5d-5c68-8ebe-299c9f230de5", "question": "What is the boiling point in celsius of Iso?", "A": "23", "B": "48", "C": "50", "D": "58", "choice_num": 4, "target": "B", "category": 1 }, { "id": "021bcda2-4a74-5e39-8f99-4d9146768b44", "question": "The most volatile agents have.....", "A": "Low boiling point", "B": "High heat of vaporization", "C": "High specific heats", "D": "All of the above", "choice_num": 4, "target": "A", "category": 1 }, { "id": "514ae68f-07f0-5ed5-918b-3775f8fa5d46", "question": "What is the SVP of Halothane?", "A": "23", "B": "175", "C": "239", "D": "243", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4b324753-9f15-538a-83b0-ababfd6ec028", "question": "What is the SVP of Enflurane?", "A": "243", "B": "239", "C": "175", "D": "23", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6b16bf8d-c602-51e9-aa64-38e4f5139c1c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "bc810c7e-c648-5b9f-ba3e-d42090ed070b", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "598f9eea-2a06-5fe5-9746-119ad53e47e4", "question": "Why would set TV differ from delivered TV", "A": "Compliance", "B": "Losses", "C": "Leaks", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9da2a4a0-252c-5e1f-b78d-abaee7e61ba7", "question": "What is the pressure limit on most ventilators", "A": "200", "B": "100", "C": "40", "D": "20", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5de9d65c-191f-5e92-9cf6-ee66d4f74d53", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4b93561f-c2f3-590d-b2e2-eda07c02e8d2", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6fd7523f-ea17-548c-aaee-95d74bacce71", "question": "Which patient would benefit from a prolonged expiratory time?", "A": "CHF", "B": "COPD", "C": "CAD", "D": "Anterior cruciate ligament tear", "choice_num": 4, "target": "B", "category": 1 }, { "id": "adfaa99f-ddfd-5ee7-b419-1df93529aceb", "question": "Which of the following is part of the high pressure cylinder?", "A": "Pipeline inlet", "B": "Flowmeter", "C": "O2 flush", "D": "Hanger yoke", "choice_num": 4, "target": "D", "category": 1 }, { "id": "725769e7-e483-507d-b2d8-c4bc42225393", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "b09f59a9-ec28-5270-9e57-d45925daa476", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8c3568d8-d087-5b2a-b180-0d2399c940d9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3351ee7c-3312-58a8-83c2-a7b5ec9b2ffb", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "955033a5-0034-5179-bd74-cf1dc3b3ee86", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c4051960-78dd-5e6c-aec1-9c5f98fee57f", "question": "What is the most accurate way of identifying cylinders?", "A": "Weight", "B": "PSIG", "C": "Label", "D": "Olfactory thrshold", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1c8927be-d0c8-5f76-9026-129412f4a3ff", "question": "Which VAA is used in the TEC-6 vaporizer?", "A": "ISO", "B": "DES", "C": "SEVO", "D": "Halothane", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cd9c57f7-f882-576b-a40d-db203d543a7c", "question": "Which VAA is used in the TEC-5 Vaporizer?", "A": "ISO", "B": "DES", "C": "SEVO", "D": "Halothane", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b22e439c-afd1-5ca4-bc39-89b3d51e76ab", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "97699204-eba5-5ff7-9af4-9c27d14deea3", "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\"", "choice_num": 3, "target": "B", "category": 1 }, { "id": "12024ba1-4793-512a-8243-ecc76d3ce3dd", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6642887b-0b16-5f95-a6cd-ba7a5f62113a", "question": "How often must cylinders be inspected?", "A": "2 years", "B": "3 years", "C": "5 years", "D": "15 years", "choice_num": 4, "target": "C", "category": 1 }, { "id": "95f59471-42e0-539e-8afd-ec9ccc1208cd", "question": "How many liters of gas is in a H tank of o2?", "A": "330", "B": "660", "C": "6,600", "D": "13,800", "choice_num": 4, "target": "C", "category": 1 }, { "id": "af9e231e-12f1-5f13-a0df-019a3274591b", "question": "How many liters of gas is in a N2O H tank?", "A": "330", "B": "660", "C": "745", "D": "1590", "E": "13800", "choice_num": 5, "target": "E", "category": 1 }, { "id": "02ed51a0-dec3-5aa8-b371-b5e4597a3e20", "question": "What is a hazard of a pipeline system?", "A": "Foreign material", "B": "Gaseous", "C": "Water", "D": "Bacterial", "E": "All of the above", "choice_num": 5, "target": "E", "category": 1 }, { "id": "6e529438-9ff6-599a-b959-e576fb6cf968", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "75ae1877-2884-5498-8b8c-cd50babe044b", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "fc34fc88-68f4-5849-a61b-ca1f522ddf64", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8d3b4e17-82c7-5478-8710-6fabffbbf91e", "question": "Which monitoring device can not be deactivated?", "A": "Precordial monitor", "B": "Capnometer", "C": "Spirometer", "D": "Pulse oximetry", "E": "EKG", "choice_num": 5, "target": "A", "category": 1 }, { "id": "006e1854-248b-5867-8e64-211778c8d674", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1627b564-7808-568a-b1c7-c730795ce81e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2837f887-71b3-5d4e-9fb3-e6bea11c0b3a", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "7180f21e-d371-5b74-be77-e47b994e9755", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f8de02ab-29d5-5330-b092-4ead7376246d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "60999cd7-0c34-5afa-96f8-c2f4de77a80e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2ffd5db7-febb-5244-8427-17a79313a583", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2493be9f-4aad-55f1-977a-02db5ca24dff", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "1c22fd44-23ca-5f6a-87b1-60bb2f999c84", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "367e1d2f-a966-58b5-848f-716fa002f71d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d7928443-cb38-51a2-a5b2-a41f7bb37077", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "cdb9fc7b-e86b-5eb6-baaa-3e7a7de23a2b", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "0af54671-3dd7-5e71-b479-fee4cc172062", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0be87e07-594c-5999-87c8-ecb91d9c9272", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "31afb88f-6c92-5d74-b369-706dd8595ad9", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "24869527-201a-51bf-bf95-08b887c113a3", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "38c09c9b-81f5-5516-b102-c04e3627d6cc", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "1f5ad08d-8166-573f-80ba-01ea8aeb981c", "question": "Which of the following would be expected to increase contractility?", "A": "Increased PEEP", "B": "Administration of Calcium", "C": "Adenosine", "D": "Amiodarone", "choice_num": 4, "target": "B", "category": 1 }, { "id": "90c4db10-c5e9-541c-9856-d9e7bdabf484", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4a056ed2-95b0-54c5-babf-85383b3bcd2b", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "0db6ab6f-511a-5c85-87d5-71e016833b20", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c9de55f3-61fb-57f2-a4bf-58907ff0b0d4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2f147b65-7d58-5573-8f0e-05ba595efd91", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "87eeff07-5771-57b2-b5e3-c1159d71323e", "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 +", "choice_num": 4, "target": "B", "category": 2 }, { "id": "f653fa9a-dba7-53b4-9694-ac4dc55708a2", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "c86d53be-a137-5c3f-9ca1-e60cf920fb3c", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "90fa1cab-e4aa-5565-a80a-361df728f64d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f4fb291c-491c-5c72-a1b6-643c13ad0733", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e56c909a-8ea3-5bad-ae6a-bbfe126bd5f5", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "939fff3b-9930-5779-99bd-fcd3d2cff373", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a66e7300-031f-5024-91b3-bca91eef7019", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a0e17c69-2bb0-5795-81b3-06c966e93ca0", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a20dae6b-3b38-57cd-b29b-3f3390c7eecf", "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)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5652663e-f2cd-5679-b070-b08d6646d551", "question": "What is the design that modern vaporizers use?", "A": "Wet wick", "B": "Electromagnetic Induction", "C": "Variable bypass", "D": "Copper Kettle", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d42576f1-6d73-56df-84e3-b903b316f20f", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "7b91bba0-e0e7-558b-8bec-f851cc00392a", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "56253714-ea69-566c-ab53-541ace4ca224", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "cbd004e9-78ae-561e-8272-00f57f70c600", "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%)", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8a0222da-f583-5804-a550-bb1fc48b10eb", "question": "Dantrolene should be reconstituted using:", "A": "Sterile Water", "B": "5% Dextrose in Water", "C": "Albumin", "D": "Normal Saline", "choice_num": 4, "target": "A", "category": 1 }, { "id": "230c8348-07eb-5647-b540-546ca80b8f95", "question": "Anectine is the trade name for which medication?", "A": "Remifentanil", "B": "Cefazolin", "C": "Succinylcholine", "D": "Rocuronium", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d1e2da3b-488a-5c46-9d3f-cc68708e73d5", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "48167a3f-5c49-527a-8f40-f0700e551976", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "8cb60f8a-e53d-59fc-903d-a2bd1667d2a6", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b6176c49-13f2-5221-a5f4-87daf4f35e53", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "74f48442-2ae4-5453-a14a-2740ce1e1901", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6a74b111-9cda-522c-94dd-9e1d45539293", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d8a7c8e9-ca72-58ea-a06a-19fb51d621eb", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "dd266f88-a119-55c0-b77b-e4acda1d6f9f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "01edc7bd-f458-5599-b05b-4c3f961ef584", "question": "What is the trade name for oxytocin?", "A": "Gynastrict", "B": "Pregozam", "C": "Pitocin", "D": "Uteropres", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d2f85beb-2c69-523a-adb5-b1166e386b77", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2c4fdf4a-f997-59cd-8c24-73ff4f18be17", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "eb1f8a39-3dd0-5310-8276-a634ff340357", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "5f9f16a6-5f9c-59b4-b664-948da0910d79", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7b10ffe1-f18e-501c-8931-43ec495b663e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9040e7a9-320f-5e42-aac2-34b7734f6249", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "65f265c3-9ac9-5572-9550-8899a5f75907", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "09f076b4-39e2-5dd7-9a7c-e4fd7e73525f", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "28cef2e1-9513-56e3-be96-5978f2ce9372", "question": "What is the trade name for propofol?", "A": "Sedapro", "B": "Versed", "C": "Amidate", "D": "Diprivan", "choice_num": 4, "target": "D", "category": 1 }, { "id": "882bcdfd-6c28-5218-9815-aec1bad4e039", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "85d97a01-68ef-56c5-b2f2-4a56241a00a0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b17e926e-d37b-5fb8-9de2-be4e44f6d90a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f1959c04-8f17-5c74-b4f1-2a20cb6502ea", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "96b467fc-38df-52d7-90b7-96135a3c228f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6407ee8a-c3ed-58b8-a3ee-39357c858444", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "81ab6fed-e97a-53b5-bad3-7d63b2f35e40", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4da61bb6-e647-5041-ac18-7030db1ee8e9", "question": "What is the trade name for remifentanil?", "A": "Sublimaze", "B": "Remizist", "C": "Remazicon", "D": "Ultiva", "choice_num": 4, "target": "D", "category": 1 }, { "id": "78fce303-f800-51e2-866e-26f2a39f96af", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "25a93924-1608-56f7-adcd-9e63e0aa011e", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "20a02ee6-987c-5009-ac6b-2b5f45aef1c3", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5d53c78e-469c-5c1a-a656-1e0aad5f081c", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "d4124be8-5267-5229-9830-61d75ae88420", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f35cb49b-97bf-557f-b0f9-3c4e09090aba", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "0f0d80e4-c073-5b21-b0d9-6c4d83afaed8", "question": "Which type of blood product has the highest risk of bacterial contamination?", "A": "Cryoprecipitate", "B": "PRBC's", "C": "FFP", "D": "Platelets", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9b0d74c0-255e-5573-91a4-763da7fd31c6", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d0b5c1c5-e7e3-5fbb-97a6-c7527e80f46e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d75da3ee-fe5a-537b-9a11-dffcb0136ed9", "question": "OR's have isolated electrical supplies due to:", "A": "Isolation capacitors", "B": "Double circuit breakers", "C": "Faraday cage", "D": "Isolation transformers", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b065a392-eb84-519a-9f0a-384b76c232d2", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "cc7d3af7-6aed-52f8-b931-f8fb8780b900", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3dd0d48a-84db-5b93-b2ab-bd0c604fe794", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "650a4436-4ec5-5a83-bfb3-b83477540bc9", "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)", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c04714de-c46b-5eac-b350-e3f4ce308658", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "a5db76d6-64e6-59bb-b179-95006e2157cf", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9bfe383f-1134-56fd-8e72-d67506415086", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "b9af78ef-a266-581b-b76f-c4c95ef43d09", "question": "What is the trade name for fentanyl?", "A": "Sublimaze", "B": "Sufenta", "C": "Versed", "D": "Norcuron", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e074b60e-8139-541e-9c69-6e8534432155", "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...)", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fe5652f7-d0a0-5b4a-81af-e89e405223c4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e3c75038-5340-5af8-9d7a-e9b72fd25eb9", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4c977b27-e6b5-5dd4-92da-e95ac9cfc91d", "question": "Which medication is a pure alpha-1 agonist?", "A": "Phenylephrine", "B": "Dopamine", "C": "Norepinephrine", "D": "Ephedrine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c403e2e3-4973-5052-9888-0ce111c526f6", "question": "What is the trade name for cefazolin?", "A": "Unasyn", "B": "Moxasyn", "C": "Zosyn", "D": "Ancef", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6b95b47a-c74e-5cbe-bb2f-70e9812aa940", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b890a3b8-036a-50f1-bef2-34938bbc5bad", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "6656b43a-ef07-51ff-b04d-570a149e7a7d", "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", "choice_num": 8, "target": "F", "category": 3 }, { "id": "4d5db762-f64f-5df4-8e54-eff5f3191ff6", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "54d70b8e-825a-56cf-b4e4-bf848d85253b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a0b63624-47d3-5cac-b9bd-99ea00242064", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9f6bdacd-1b20-5ecd-b3cc-920d44223d83", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "96c5545f-cb00-5505-9602-04cc8b6aee67", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "eb6f9cf6-0436-57a1-9bed-956cf1b1b49a", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "a230617d-93ec-55f5-a4ff-90f8eaaa2778", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "31b56f82-2211-58d5-a858-89e8e3eb5fe3", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "09d6773f-7f9a-5bed-941a-ff49a3086bf6", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "23f77be9-9bb0-57aa-935f-d954effdbbe0", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2893d11e-0cb6-5d81-a137-84f5f5e3706a", "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", "choice_num": 6, "target": "D", "category": 1 }, { "id": "3cfbf8b3-52ad-58ac-a75f-01d572804446", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "5a8ae324-bd8f-5400-9d2f-fd125cce89c0", "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", "choice_num": 6, "target": "A", "category": 1 }, { "id": "ad135d32-5a52-545e-b365-e2f825917e92", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2dcafa72-9c85-56ab-85b0-e77f17dbdc2f", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "81de2840-892f-5e21-8d33-2596ba430eb9", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "644fb857-8a79-51a9-96a1-645aef1ee02a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f5b7a500-ece3-5275-a2d4-5897ac1ef1ce", "question": "Which portion of the nerve do local anesthetics work on?", "A": "Neuron", "B": "Dendrites", "C": "Nerve membrane", "D": "Myelinated sheath", "E": "Schwann cells", "choice_num": 5, "target": "C", "category": 1 }, { "id": "5c24f55b-47c1-55c3-815f-d3341299be2c", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "073a849b-578f-5de0-be4d-2ff235e9f580", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "03de0b5d-0408-5e8a-aeff-df1b705da8fd", "question": "Biotransformation of amides takes place where?", "A": "Liver", "B": "Kidneys", "C": "Blood plasma", "D": "Spleen", "E": "Bloodstream", "choice_num": 5, "target": "A", "category": 1 }, { "id": "74500cbc-edd4-5ccc-b7bd-eea4d3dc6e03", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "399ce52a-316a-5175-b3f9-702da1853f8b", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2853400a-5e15-5998-8ca4-f3e0c3ac1941", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "fbe25aed-0266-5649-afb0-7a021ed9afed", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "74dec2c7-429f-5136-a620-dae66e2e03ef", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "c20f1873-7d1f-51dd-ac2b-9c2042d39d0b", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "580b967c-eba7-5eb9-9b10-03cea6f35536", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "462729fd-0b69-5b49-b0f9-1af179b990c5", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6b881f2a-7f9e-5bb5-9731-c35f0583da8f", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "fec26951-3d42-54ed-aca6-94cc113a4ba4", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "c7c25b45-fee0-5991-8600-f99f8f528178", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "7f873bb2-97de-58c2-be93-8a745199ae4a", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "a7fc1256-da39-5ef4-a656-f32e98535d0e", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "df516ab4-bbc9-5164-8531-d1152c203680", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "9ca13342-9b7b-5670-8f17-67b1e35bbe88", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "b7ae8d87-12c3-51e1-93ba-b0bae7d68ab1", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "b14bae2f-9342-5196-96d6-75dded0d3b3b", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "3ffdd2a2-0ed3-542d-8d3d-4e1441d899a6", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "b8e774aa-0895-5461-a3a2-596e6fca4b5d", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "1d716087-03c3-5280-8a03-cd4aa95af3c9", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "65dd5019-1ee4-5d0e-9fd9-30839a441bf2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7e761ef1-3189-5445-9b2c-4822f9ae8eb9", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "76eb9b68-e748-5dee-b3d1-7fc15cacd601", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b75f65fa-b22d-580a-8d08-02b4e978376d", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "fe1cf33e-b52d-5b16-8306-b8a00bf19270", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "c228e1fe-b2cb-5dd0-a5d2-6a356a5dbab6", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "de9d4eab-fe85-5bfd-8fac-ce81138144ab", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fe70d657-e746-5396-850d-bed72642d868", "question": "Which anesthetic agent has analgesic effects?", "A": "Desflurane", "B": "Sevoflurane", "C": "Isoflurane", "D": "Nitrous oxide", "choice_num": 4, "target": "D", "category": 1 }, { "id": "02af059f-3f41-55ed-a7da-77bde29e8f7c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "917294bb-4f47-59a3-bbdf-91b6255635d9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "04502ff0-1950-5be4-964f-27ae4f06d907", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "52ba718d-3367-5a57-8014-8339812efdca", "question": "Which drug has the tendency to potentiate cardiac arrythmias when halothane is used?", "A": "Lidocaine", "B": "Atropine", "C": "Epinepherine", "D": "Adenosine", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5fce192e-1316-5423-b3ae-df97a6830846", "question": "Which inhaled agent can cause renal failure?", "A": "Methoxyflurane", "B": "Enflurane", "C": "Isoflurane", "D": "Desflurane", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5653f786-74d9-54a0-aabc-b97dafc6d0b2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "00cfd55d-6017-5b60-af8d-ff03d5323fce", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3f0f80d5-8a44-523b-81d8-1e3a157a4381", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "e308f3c7-5a6a-5bc3-a01c-b179b66926f0", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "656913b2-32da-558a-b1a7-d581bddf46af", "question": "Which agent is least likely to form carbon monxide when introduced to co2 absorbers?", "A": "N20", "B": "Halothan", "C": "Sevoflurane", "D": "Desflurane", "choice_num": 4, "target": "C", "category": 1 }, { "id": "75b724ca-407a-5464-b003-ba3aafb800ed", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "4583e888-83a3-5234-bc0d-4e8d1f5c5122", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "101e2a8c-fd2f-53bc-a3d1-a42e7f561143", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f412cfb4-48bc-5417-8859-4135f400f5e4", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "ad080796-4548-5bfb-aacb-acc94087a2e1", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "202e0a65-d39d-5d2d-bb73-5b7a32c4c184", "question": "Which inhaled agent causes the largest increase in heart rate", "A": "Desflurane", "B": "Isoflurane", "C": "N2O", "D": "Halothane", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a6481447-4216-5f97-b7d9-d91f7a2c46ee", "question": "Which inhalation agent has the least amount of effects on BP?", "A": "N2O", "B": "Isoflurane", "C": "Desflurane", "D": "Sevoflurane", "choice_num": 4, "target": "D", "category": 1 }, { "id": "feaaa9dc-3b99-51b5-8528-9496bd3ef75c", "question": "Which agent's use has the highest incident of coronary steal?", "A": "Isoflurane", "B": "N2O", "C": "Desflurane", "D": "Sevoflurane", "choice_num": 4, "target": "A", "category": 1 }, { "id": "52775ee5-c806-5353-9e8f-ec3ec0d08665", "question": "Which inhaled agent would be best for a patient with an ischemic CVA", "A": "Sevoflurane", "B": "Desflurane", "C": "Isoflurane", "D": "N2O", "choice_num": 4, "target": "C", "category": 2 }, { "id": "60b7d47e-75f9-5248-9023-339b8239ab29", "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", "choice_num": 2, "target": "A", "category": 1 }, { "id": "c7e4cdc1-90a2-533c-82ee-02a415ba15b9", "question": "Which of the following agents does not have any muscle relaxing properties?", "A": "Isoflurane", "B": "Sevoflurane", "C": "N2O", "D": "Desflurane", "E": "Halothane", "choice_num": 5, "target": "C", "category": 1 }, { "id": "0eb3f572-c952-5f63-bca4-c6d2574f8a36", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b24bac8c-13f3-5b11-a22d-15ea4231a4a4", "question": "At what age is a patients highest MAC levels?", "A": "1 year", "B": "21 years", "C": "6 months", "D": "1 month", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4b010377-c785-5d9b-9e5b-e8725d4cc137", "question": "What is the only inorganic agent used", "A": "N2O", "B": "Sevoflurane", "C": "Isoflurane", "D": "Desflurane", "choice_num": 4, "target": "A", "category": 1 }, { "id": "59ccdc80-8a05-5f6f-9010-0e117d229cb0", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5f101bb6-5cc3-5615-823c-0bf2e13dabdd", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "89a0627b-0b67-5e99-a92d-1cd8548350ed", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "46287bf2-4840-5ef3-bd31-99d707856e3d", "question": "The Pka of the drug delineates what % of a drug is in an ionized form?", "A": "25%", "B": "35%", "C": "50%", "D": "75%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "78efb2de-2a21-5e03-a952-b48242f1e71f", "question": "Does a weak acid inserted into an alkaline medium manifest its desired effects faster?", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 2 }, { "id": "63f7a794-c949-53a8-9617-2cbe94f719a6", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "61bb1057-69c7-502b-b55c-1d69c640d3cb", "question": "A weak acid inserted into an alkaline medium will manifest its desired effect how?", "A": "Faster", "B": "Slower", "C": "No change", "choice_num": 3, "target": "A", "category": 2 }, { "id": "06b21fe8-f3db-5db4-ba05-f3f1fa932b5e", "question": "An ionized medication will be metabolized by the liver.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "ae2958c6-3ba2-5841-bd40-d40bd559efa6", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "25c5514f-e46e-5ba1-90e9-7d51d7c8a1c4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7ed612a8-ebce-5655-b436-4c7e9a0f5f80", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "147adc8e-c5e0-5f6e-a000-a10147bc950c", "question": "Isoflurane is a methyl esther what is halothane.", "A": "Alkyne derivative", "B": "Alkene derivative", "C": "Alkane derivative", "D": "Ethyl methyl terrible", "choice_num": 4, "target": "C", "category": 1 }, { "id": "63e3c68c-801b-59d7-861a-74022a3e5d28", "question": "What is the MAC of sevoflurane?", "A": "1.7", "B": "1.15", "C": "6", "D": "104", "E": "0.77", "choice_num": 5, "target": "A", "category": 1 }, { "id": "f408d804-445e-57ac-965c-0ee6442e97e0", "question": "What is the MAC of Isoflurane", "A": "1.7", "B": "1.15", "C": "6", "D": "105", "E": "0.77", "choice_num": 5, "target": "B", "category": 1 }, { "id": "aa0edf36-7e19-5587-9695-bb7c7845be14", "question": "What is the MAC of Halothane", "A": "1.7", "B": "1.15", "C": "6", "D": "104", "E": "0.77", "choice_num": 5, "target": "E", "category": 1 }, { "id": "a214c296-4485-5bfc-abd6-d6bb04d6f206", "question": "What is the MAC of desflurane", "A": "1.7", "B": "1.15", "C": "6", "D": "105", "E": "0.77", "choice_num": 5, "target": "C", "category": 1 }, { "id": "a6688358-94ee-5b05-95be-4f921127f8fe", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "af14ec82-6ccc-51ce-825e-a4cdb3338b48", "question": "Which gas causes the most coronary steal?", "A": "Desflurane", "B": "Isoflurane", "C": "Sevoflurane", "D": "N2O", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ba4b4ad1-dfef-561e-9021-03f56290fb71", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5b535ca8-7ad7-55be-bff7-eb45528d6286", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f97ffe0c-df40-5526-adf2-205c668a99be", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3c6ba08c-3280-5496-8269-e1ee8029e73e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f2325c77-8d2b-5e8c-ab95-d9c5a3ad75e2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "404ac037-5430-5e73-8b76-ae8c89b0ec06", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "18026cfb-0c66-515c-8368-93a584f3e0c6", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "39a49a68-fefd-5325-9991-75eef66ec21d", "question": "Which inhalation agent is good for pediatric induction?", "A": "Isoflurane", "B": "Sevoflurane", "C": "Desflurane", "D": "Halothane", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e2beb05f-93d9-5ee6-8831-53f77c796d94", "question": "How is elimination of an agent accomplished", "A": "Exhalation", "B": "Bio-transformation", "C": "Transcutaneous loss", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6f9d4cf7-0ded-5577-a0eb-b33ddba687bc", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1c4ba5c2-8a46-50fc-9423-5437d4dafd98", "question": "True or false hyperventilation will decrease the rate of alveolar concentration?", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 2 }, { "id": "626b0c65-fcb1-52aa-a8a0-5eff35e86954", "question": "True or false hypoventilation will decrease the rate of alveolar concentration?", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "b60c3673-586d-5321-9701-7740b44ba974", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6c4bd9ca-07db-57ed-96e9-8b91450623e9", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "60df7196-9dd2-54b6-bb66-23638b18ac81", "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", "choice_num": 3, "target": "C", "category": 1 }, { "id": "8bc0a12d-bfc1-588d-b12a-e732856ca10e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e5d75da0-17a3-5307-8532-234c18e30d67", "question": "At what PaO2 level is a decrease in MAC required?", "A": "80", "B": "60", "C": "40", "D": "30", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a739305c-78f8-5a38-a387-77dd4739b29c", "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", "choice_num": 3, "target": "A", "category": 1 }, { "id": "602faec1-807a-5935-8352-37f1fb3d3a1c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3fa570cd-9ae8-52f9-b580-2def9daaed9d", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "fbe7eff9-2ca5-5e99-9849-8adcbe375ed4", "question": "What is the usual effects of sevoflurane on BP", "A": "Increase", "B": "Decrease", "C": "No change", "choice_num": 3, "target": "B", "category": 1 }, { "id": "cb25b986-dd87-5786-9e5a-bf5cda5fa424", "question": "Isoflurane and Sevoflurane will have what type of effect on respiratory rate?", "A": "Increase", "B": "Decrease", "C": "No change", "choice_num": 3, "target": "A", "category": 1 }, { "id": "628183d6-9020-5cbd-81df-6e8371a9165f", "question": "Isoflurane and Sevoflurane will have what type of effect on tidal volume?", "A": "Increase", "B": "Decrease", "C": "No change", "choice_num": 3, "target": "B", "category": 1 }, { "id": "93c801d4-2de1-50c3-9424-cc75f6cf9793", "question": "Which agent is best for a patient with cerebral ischemia?", "A": "Desflurane", "B": "Sevoflurane", "C": "Isoflurane", "D": "N2O", "choice_num": 4, "target": "C", "category": 2 }, { "id": "da491b6c-7d84-5884-934a-ca4fb2bc9283", "question": "FOr cerebral blood flow what range are you trying to keep", "A": "20-120", "B": "60-160", "C": "90-140", "D": "75-135", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c26437db-3310-5de1-aea0-61bf9c3d6eac", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "cb8dcf8c-0564-5e27-b2f9-330fa91dbf9c", "question": "What does clinical pharmacokinetics describe?", "A": "Absorption", "B": "Distribution", "C": "Metabolism", "D": "Elimination", "E": "All of the above", "choice_num": 5, "target": "E", "category": 1 }, { "id": "10168666-784f-5020-b0a9-5dfb831e7d33", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "04e1ab44-b34d-5fd0-ab7b-819b7d9092b7", "question": "What is ultimately responsible for undesired effects of a drug", "A": "Pharmacokinetics", "B": "Pharmacodynamics", "C": "Plasma levels", "D": "Metabolism", "choice_num": 4, "target": "B", "category": 1 }, { "id": "22f43679-a60a-5e39-8112-f2542ad933f2", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "295625dd-a514-5801-9295-c69aa9a891fa", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2dc04f4e-8f9d-59b0-b968-87e42b88f8d8", "question": "True or false most electrolyte actions do not require energy", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "ea1801b1-e9ab-5565-820a-2028bfd7b3e9", "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", "choice_num": 2, "target": "B", "category": 2 }, { "id": "33fd240c-e832-5efd-b862-ce809767d81c", "question": "True or false.  For a drug to be transported it must be ionized?", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "619785a1-37bb-551f-af08-6b6a2810aecc", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "38a8d2d9-cc08-5a01-aa2c-d2bb9c7b4fbe", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b4b58c95-7912-56a5-abfa-cb84537f8d8c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f80bf2b6-2240-5ee4-8828-d9018a8f8912", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "51896065-7470-57d8-897e-c3f885da6284", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3cf81a92-de98-566b-b5c5-2a4e2847085f", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8a34e0c5-f338-5cd1-b118-4cc62eaeec29", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "976c3f3e-4275-5e7e-bcf0-3f1178374fdd", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "42b1033a-bb89-5de6-8258-3e8805b0475a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5e259bef-6962-5b43-a529-2f51ae18966d", "question": "What makes up the hypothetical central compartment", "A": "Brain", "B": "Lungs", "C": "Liver", "D": "Heart", "E": "All of the above", "choice_num": 5, "target": "E", "category": 1 }, { "id": "240ab438-da34-54d1-bc66-1e2ae016f4f5", "question": "What makes up the peripheral compartment", "A": "Muscle", "B": "Skin", "C": "Fat", "D": "Bone", "E": "All of the above", "choice_num": 5, "target": "E", "category": 1 }, { "id": "dcaade16-629f-5d7e-80d1-0dd446eff187", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "72e3b631-3c83-5f17-bfcc-5fb5884f7398", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "24ba83c7-0d3f-5a0d-922d-b76902904052", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2d10cc26-465e-5c49-b4f1-2dccbeb0e46b", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6743a746-0753-50ff-8827-3ae32b6bcfaf", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5ac3537d-4f3e-5703-ac94-6bd8ae5f586b", "question": "Why are diuretic usually held prior to surgery?", "A": "Volume depletion", "B": "Rebound hypertension", "C": "Intraoperative hypertension", "D": "Intraoperative hyperglycemia", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9f78fe29-aff0-53d5-a9ec-ceecc106827c", "question": "At what diastolic BP will surgery usually be held?", "A": "80", "B": "90", "C": "100", "D": "110", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7102a8ff-ba56-53d2-bae8-c0653bdb9779", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1c98eb16-075f-5424-b8cf-f53b8d0252b5", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "83f4f220-60e9-5e28-a4f2-9738bbc9618c", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "665dbeae-0078-591d-8f8c-47cde773a31d", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "df71562b-df62-585e-a23d-3b239a338965", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "757eb328-06e4-599e-a6e6-bd4e051813c4", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "6f2d511c-ca3a-54f5-bb89-d5e0c2f496c6", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "3780afbf-9f27-50cf-b625-7a3d6b004bde", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "f4e0b2a3-9743-50ec-9b1a-021ea13ff44a", "question": "Higher Vd relates to elimination how?", "A": "Longer elimination", "B": "Shorter elimination", "C": "No change in elimination time", "choice_num": 3, "target": "A", "category": 1 }, { "id": "18b55fa9-223b-5745-8433-47bde3ba0217", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "dd893617-3648-5fa9-ac42-6074886988ef", "question": "Where can elimination of a drug from the body occur", "A": "Central compartment", "B": "Peripheral compartment", "C": "All of the above", "choice_num": 3, "target": "A", "category": 1 }, { "id": "38245fcf-dc44-5e94-ba05-a61a32996cf5", "question": "Emergence is mainly dependent on what?", "A": "Fresh gas flow", "B": "Pulmonary elimination", "C": "Kidney elimination", "D": "Nephrotoxicity", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8b7d1035-ca3c-53e3-a62c-60dc24f34c5f", "question": "Which type of agent is taken up by the blood more readily soluble or insoluble?", "A": "Soluble", "B": "Insoluble", "choice_num": 2, "target": "B", "category": 1 }, { "id": "70a837f2-e9ee-53b6-ad9b-28d606f2170c", "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", "choice_num": 3, "target": "B", "category": 1 }, { "id": "236e363d-bea8-59c8-b60f-0953b866efaa", "question": "What is dead space?", "A": "Perfusion no ventilation", "B": "Perfusion with ventilation", "C": "Ventilation with perfusion", "D": "Ventilation but no perfusion", "choice_num": 4, "target": "D", "category": 1 }, { "id": "474a3094-ec0b-5777-a19d-d392a49a4dda", "question": "What is shunting", "A": "Perfusion no ventilation", "B": "Perfusion with ventilation", "C": "Ventilation with perfusion", "D": "Ventilation but no perfusion", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a67f0c92-2f0c-5e97-9d49-ea9ff16928cd", "question": "How is elimination accomplishes?", "A": "Exhalation", "B": "Biotransformation", "C": "Transcutaneous loss", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a1c1ead2-6ced-5b1e-8fc0-9c8fa3ba82e3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "be24961b-d395-5b56-9af9-75f20b53b170", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8f08cfe1-c738-549d-84f6-dbf46a32491b", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "efe52753-5842-54e7-9373-b6e3d432169f", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "ff486530-b895-5b7c-9c4d-56a2b2afed67", "question": "In which of the following surgeries will N2O be contraindicated?", "A": "Craniotomy", "B": "Eye globe", "C": "Pneumothorax", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5f8e0bce-df39-5905-b52b-4792315b4f46", "question": "What is the MAC of desflurane?", "A": "1", "B": "2", "C": "4", "D": "6", "E": "7", "choice_num": 5, "target": "D", "category": 1 }, { "id": "748b7d13-d207-5816-bbca-f1f7db1e2793", "question": "Which of the following vaporizers is heated?", "A": "Isoflurane", "B": "Halothane", "C": "Sevoflurane", "D": "Desflurane", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8213067a-01f2-5d9d-b9d6-90ca169e6bfb", "question": "True or false minute volume is (RR*V)/minutes", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "b15e994c-fe6c-5970-a1c6-f501af900006", "question": "Which gas is the most irritating to the airway?", "A": "Sevoflurane", "B": "Isoflurane", "C": "Desflurane", "D": "Halothane", "choice_num": 4, "target": "C", "category": 1 }, { "id": "532d2b64-4836-53d3-a5be-73bdb8e9b8f7", "question": "Which gas is the Least irritating to the airway", "A": "Sevoflurane", "B": "Desflurane", "C": "Isoflurane", "D": "Halothane", "choice_num": 4, "target": "A", "category": 1 }, { "id": "839acc1f-2559-5feb-a2f2-3f9924fdb32a", "question": "What factors affect flow inspired", "A": "FGF rate", "B": "Absorption in circuit", "C": "Volume in circuit", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8716519e-749d-51fc-960a-995aec5d6411", "question": "What factors affect flow alveolar", "A": "Concentration", "B": "Uptake", "C": "Ventilation", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0df8fb98-691d-59d3-a780-393afed2c90f", "question": "What factors affect uptake", "A": "Solubility", "B": "Partial pressure difference", "C": "Flow", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1a490eca-ba43-58b9-a459-b554fec1cd32", "question": "What is the blood:gas coefficient of Isoflurane?", "A": "0.47", "B": "0.69", "C": "0.42", "D": "1.43", "choice_num": 4, "target": "D", "category": 1 }, { "id": "69492f91-6d59-5c3b-91ff-5da9a6422970", "question": "What is the blood:gas coefficient of sevoflurane?", "A": "0.47", "B": "0.69", "C": "0.42", "D": "1.43", "choice_num": 4, "target": "B", "category": 1 }, { "id": "200a1948-3570-5cf0-984d-5db5797fe8fd", "question": "What is the gas coefficient of desflurane?", "A": "1.43", "B": "0.69", "C": "0.47", "D": "0.42", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ecd5df2b-b560-579a-a2bd-a2d62df47ff3", "question": "What is the blood:gas coefficient of N2O", "A": "0.42", "B": "0.69", "C": "0.47", "D": "1.43", "choice_num": 4, "target": "A", "category": 1 }, { "id": "34d55533-b160-54e3-8ab5-c2cba4041ddb", "question": "What is the MAC of N2O", "A": "1.15", "B": "2", "C": "6", "D": "104", "choice_num": 4, "target": "D", "category": 1 }, { "id": "eb19c978-7404-53bd-9fac-416e89a1a289", "question": "What is the MAC of Desflurane?", "A": "1.15", "B": "2", "C": "6", "D": "104", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ee6dffaa-5007-5fde-b1cb-1f89f65b7afd", "question": "What factors increase the production of CO", "A": "High temperatures", "B": "Dryness", "C": "Type of absorbent", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6f32034f-02d5-58d1-84c5-8cf0533fb412", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "b79815ac-ea70-5e35-89c6-e01f4ffe5b5d", "question": "The minimum fasting period before anesthesia after consuming breast milk is 4 hours.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "ad37aee6-465c-5efa-b556-11dbdc967b2b", "question": "The minimum time before anesthesia after a heavy meal is 6 hours.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "bf97ba20-d802-5bfa-8ff6-478e8bf597e1", "question": "Minimal sedation impeds a patient's ability to independently maintain an airway.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "ec7068e5-4be5-50e5-8dec-5df4042ba62e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8d2931aa-90ba-5769-b32b-0f55fdd53e4e", "question": "Under which of these states is the patient least responsive?", "A": "General anisthesia", "B": "Minimal sedation", "C": "Moderate sedation", "D": "Deep sedation", "choice_num": 4, "target": "A", "category": 1 }, { "id": "98631d02-3b41-5591-aa18-183d536d4aa4", "question": "Maximum recommended dose of a drug is printed on the FDA-approved label for unmonitored home use.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "c77e1d75-4a2d-5af7-a444-4211495150d3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6fd7dbfb-cc91-5369-976e-578c2b416c64", "question": "A 40 lb dog weighs how many kgs?", "A": "18.18 kgs", "B": "88 kgs", "C": "44 kgs", "D": "13.7 kgs", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9452f54a-b7cd-5b83-98ec-fcdb031e31da", "question": "Anticholinergics reduce or eliminate some of the undesirable effects of anesthesia.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "422e81fc-a330-5cb0-81de-13a99fcbac23", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d2d68c71-0c87-55d1-ab9e-ec1eb57af9e9", "question": "Glycopyrrolate decreases GI motility.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "981e7a9f-89a1-5a4a-b03c-39ba87168cfd", "question": "Laryngoscopes are not used in what animals?", "A": "Cattle and horses", "B": "Sheep and goats", "C": "Cats and dogs", "D": "Pigs", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1a11c404-8d11-54cb-87a6-a6c7445763cb", "question": "Long and intermediate acting barbituates are generally used for anticonvulsant therapy", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "504d86d1-60a2-5130-8e11-66f75341a14e", "question": "Neuroleptoanalgesia is a state of profound sedation and analgesia produced by giving simultaneous administration of an opioid and tranquilizer.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "66a13213-20b4-5fb5-bfd5-7e4f9806028e", "question": "Nitrous oxide tanks are blue.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "63a9d124-88dc-57c9-869d-78b5f88899a9", "question": "Valium lowers the seizure threshold.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "cd2db8d0-e3c4-5cf9-a56b-5ddca53053f8", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "119aa208-dea6-5a9e-9232-de691f66a66a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "533dd6be-6d79-5241-882d-a7e0a7ae0b76", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "55e92859-1b49-5fe5-b613-2c5c132cd307", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "049d98aa-8282-51b1-b30e-bd38f5910904", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "312555d6-0c8a-5bda-b508-34f572dccd6d", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "bd4af48d-e00b-5d56-8ce0-94f4ebe1974c", "question": "Which preanesthetic drug is used more commonly in equine anesthesia?", "A": "Atropine", "B": "Glycopyrolate", "C": "Acepromazine", "D": "Butorphanol", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3572e183-9684-5fdf-878a-d122dc1b90ed", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a62bfabd-62a0-5685-b5d8-1fde6c79404d", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "51ce56aa-8841-5d6a-9004-527572d620d4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "70f4f235-f2fa-53c4-b425-c4d4bb1d90cf", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "dbb42872-67b4-5723-b439-d6fe6b730e06", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e55ee67d-e515-5713-99e1-5abad82d7075", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "304f3ba2-2fe3-5d73-913b-5824429799da", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "234b081c-0919-5b95-ace6-4e5145727d23", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "ed7006bf-664b-533d-b902-e28aa32b8af3", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "5bddf3b4-808c-5806-b441-5d33aae76c3f", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "bde229b4-02db-56db-97ab-ddc59b12399a", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b07cc1a3-be7b-5abf-9996-db982ffa9cd3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1e6679b3-075d-5eb0-a01a-0040bc6960bf", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "6594a6b4-a813-5180-8a3a-e80fe8c6ff14", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2ac5d82a-e0af-5754-af46-43534f575f26", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "49e26699-581c-510b-93ba-d0fcf2a02da4", "question": "MEDICAL CONCEPTS :   MEDICAL TERMINOLOGYWhat part of the neuron receives signals?", "A": "Dendrites", "B": "Cell body", "C": "Myelin sheath", "D": "Axon", "choice_num": 4, "target": "A", "category": 1 }, { "id": "979ed8b2-24bd-53c0-b4c3-89cfa517061c", "question": "Which type of atelectasis is the most common?", "A": "Compression", "B": "Chronic", "C": "Inflammation", "D": "Absorption", "choice_num": 4, "target": "B", "category": 1 }, { "id": "23dee272-8ad4-5913-bf22-b09192894fe3", "question": "What condition is symptomatic of an enlargement of the alveoli and loss of elasticity?", "A": "Emphysema", "B": "Chronic bronchitis", "C": "Empyema", "D": "Asthma", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e9965f27-f7ef-5177-bdf7-c9e5ea1b1728", "question": "A malignant bone tumor :", "A": "Chondrosarcoma", "B": "Multiple myeloma", "C": "Rhabdomyosarcoma", "D": "Osteosarcoma", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9c9949ab-3151-5a8f-9d64-ab732404c3c5", "question": "Name a malignant cartilage-based tumor found in middle-aged and older people.", "A": "Chondrosarcoma", "B": "Osteosarcoma", "C": "Rhabdomyosarcoma", "D": "Chondroblastoma", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ed2c52b8-17bb-5b7a-a46d-24d58c870450", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b1bea13e-0db6-5b90-9766-cab30459912d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9cae646f-3f78-5a3d-a25c-2bc885b47245", "question": "What is another name for a compound fracture?", "A": "Open", "B": "Incomplete", "C": "Complete", "D": "Closed", "choice_num": 4, "target": "A", "category": 1 }, { "id": "bcce054d-4f0b-5261-a3db-5f5c285bcd9e", "question": "Which of the following is not an ear bone?", "A": "Malleus", "B": "Stapes", "C": "Incus", "D": "Styloid", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1b6b40c4-1fb1-506e-b2b7-6c7d4252a601", "question": "The term for a growth plate is?", "A": "Periosteum", "B": "Endosteum", "C": "Metaphysic", "D": "Epiphyseal", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d1834db5-73ca-5fd0-b8eb-8146ce80d4af", "question": "ANATOMY:Which septum divides the upper two chambers of the heart?", "A": "Myocardium", "B": "Interatrial", "C": "Intraventricular", "D": "Tricuspid", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3c1c2038-f85b-5b14-bca1-2a8692fa35af", "question": "What condition has predominant symptoms of rapid, involuntary eye movement?", "A": "Nystagmus", "B": "Astigmatism", "C": "Hyperopia", "D": "Diplopia", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f4843f62-1bbe-5d9b-be5c-3e6dbf7e3a30", "question": "Bacterial cystitis is usually caused by?", "A": "E. Coli", "B": "Proteus", "C": "Staphylococci", "D": "Pseudomonas", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ade5dcc8-c29d-56f7-a48b-ba5f7fcfdb05", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7b32fefa-6cf2-58b5-a430-e0db070fa682", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "85b54c8a-6f96-5483-9488-ff877cffd447", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "bdb22c1c-d66c-5b42-b5e0-a52c4fe6edb1", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f2ce739a-ec90-5bda-8a71-5365a31ad1ba", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "677f0281-6204-5faa-a5e1-1bcb069531f9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0fb213ec-d62c-55d4-ade5-990ed3707a34", "question": "Which combining form refers to the small intestine?", "A": "Enter/o", "B": "Celi/o", "C": "Col/o", "D": "Gastr/o", "choice_num": 4, "target": "A", "category": 1 }, { "id": "bd363ef5-8853-5b74-956e-c3f86b2b5d55", "question": "In which part of the body would you find the choroid?", "A": "Muscles of the hand", "B": "Brain", "C": "Eyeball", "D": "Spinal column", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5445b591-f1a6-56d5-ad96-1cf2837c2229", "question": "An ERG is what type of a procedure?", "A": "Electrorhidogram", "B": "Electroretinograph", "C": "Electroretinography", "D": "Electrorenalography", "choice_num": 4, "target": "C", "category": 1 }, { "id": "76cd2446-eb17-558b-a8ce-1fc30d83d40a", "question": "Which term refers to the anus, rectum, and the cecum?", "A": "Anorectal", "B": "Rectal", "C": "Ilium", "D": "Esophageal", "choice_num": 4, "target": "A", "category": 1 }, { "id": "fc3ad174-f34b-5159-a3ea-44418942fe74", "question": "Which term does not refer to a level of consciousness?", "A": "Syncope", "B": "Sciatica", "C": "Coma", "D": "Stupor", "choice_num": 4, "target": "B", "category": 1 }, { "id": "87bbfd9f-445b-5a46-b288-2dc93aae734b", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "43888bf8-c1c6-5248-8444-78a78d75cc78", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e458b22c-4f02-5eb9-b1af-c6e9275a7d9c", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0225964c-eda5-570f-98e5-8f20e9bc6a7f", "question": "What direction describes raising the foot, pulling the toes toward the shin?", "A": "Pronation", "B": "Plantar flexion", "C": "Protraction", "D": "Dorsiflexion", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ad45bcdb-ecf6-51e0-a102-8a3bdc37b99e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "91cbd707-3e07-5cc8-8047-f40bf5ea782b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d609d71f-314e-5c77-92ba-f9c3747775eb", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0340387a-9826-5d03-96f3-b3caabd0d4ed", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f047a225-80a7-5380-8795-a9b72b3bb4c7", "question": "What term refers to white blood cells?", "A": "Monocytes", "B": "Lymphocytes", "C": "Erythrocytes", "D": "Leukocytes", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0c5d1ed0-37c1-5032-a828-af1d435bdd82", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3d924d94-86d1-5d02-8de0-cf179b27372b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "62f9f401-7912-5ba3-884e-113fc04d93fb", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "b1d67e9d-aab6-52ba-a394-f89973d59315", "question": "Acute bacterial endocarditis due to AIDS.", "A": "421.1, 042", "B": "421.0, 042", "C": "042, 421.0", "D": "042, 421.1", "choice_num": 4, "target": "C", "category": 1 }, { "id": "148ef8e8-fc4f-5968-8a27-db6d9a830fd3", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "81435694-a27c-5076-9638-bc8a33a67ef8", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b75d3081-2894-53a4-89f1-d38c71e6cd7a", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c65856a2-e9e1-5f45-84f3-334a8e16fcb7", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ed7380af-834a-59ef-beda-2f2deac345a4", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6c792dcf-735d-5f0c-a27e-4fab23f2e07a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "69c04eb1-aed1-528e-b422-efa24931ffae", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8d1e1e6d-f77a-51e4-b4a5-b2d0efa5bb7b", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6e4ba9f3-76b5-5c71-bd3b-457ba42ad956", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "c56f23e4-6fab-5916-8210-d9a226bfcf75", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1bf8a598-6105-5366-8c5f-353992529254", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "20b558eb-14b5-5a41-95ed-ced7d7476d59", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "baea3529-9ede-5fb4-a683-01008935b031", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "bacd2256-01d7-5d3e-bf21-b7c0f5244042", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1a390b27-c864-56a9-8dc0-0e6ea13261dc", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "e7a9b4a5-3f3b-5b1f-a689-24da302a5001", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "31db31a3-26f2-5e3a-bb71-e8e8d67c490e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fea9b053-7e0a-593e-a06f-39c357fa6be6", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fcefcce5-80d0-50b9-8bc3-68e9d64bdee3", "question": "HCPCS CODING:Level II HCPCS codes for drugs are administered :", "A": "Intravenously", "B": "Intramuscularly", "C": "Subcutaneously", "D": "All of the above", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7be97777-260b-513a-814c-740d93097b77", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1f1443a1-10c1-5458-bf75-4a5c44e39a4c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2c525e6f-de88-582d-b20a-549821fe34d3", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5aaf2061-caaa-593e-80d1-e85786da9a25", "question": "A Medicare recipient presents for an influenza and pneumococcal vaccination.", "A": "G0008", "B": "G0010, G0008", "C": "G0009", "D": "G0008, G0009", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3d21f24c-5bdb-50b4-89a9-5a0a6f16cc91", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0fbcccd0-acb6-519d-814a-526b049e0bee", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e0ccc1cc-7b78-5e00-9212-6398b3a19fa4", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "aa20db85-2781-587e-8f2f-181874be724f", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "85351a52-0107-5a87-9217-cab5a1b03cad", "question": "Which code describes an addition to the lower extremity, knee disarticulation, and leather socket?", "A": "L5105", "B": "L5640", "C": "L5850", "D": "L5624", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8addb405-3623-5c78-afdc-d5a98cee138a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e7e3fd0c-cab1-5870-9035-79130256c5fe", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "11503019-e0da-5a6c-90ba-d8325e360613", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "525ed140-6f88-5a38-94e9-8c9092b0889f", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "13800c9f-ccfa-527e-b9b2-d114b3af18f5", "question": "CPT has been developed and maintained by", "A": "The cooperating parties", "B": "WHO", "C": "CMS", "D": "AMA", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1e5ceb71-6b81-52cc-87e4-9ce2d272a76e", "question": "This group performs the daily operations for CMS.", "A": "FI (and carriers)", "B": "OIG", "C": "WHO", "D": "PRO", "choice_num": 4, "target": "A", "category": 1 }, { "id": "22c5c09d-ee38-5cf7-b272-afcc9871e1bf", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "cd0c3ede-e76f-5374-bf0a-2ef2aebd263b", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c3ef3d9a-4e9a-53f4-9425-21c869f18083", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9561fa4d-bf5c-5aca-bfe5-0ec2d7b7106c", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "c14c959b-bba5-5f0e-9577-5c0af22bbd55", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "4497e067-0c62-5a77-a415-3eb6e03f11a1", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9955adfb-4c90-522b-9b52-3351050fcdab", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "28afe8ef-f188-54bf-8b51-77914c00a426", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6641c7d2-a6af-593e-826e-b3611d46ae58", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6b31b4e7-44e7-56da-bbcf-5e39e9d36e20", "question": "Excision of the gallbladder is commonly referred to as a :", "A": "Cholecystectomy", "B": "Corpectomy", "C": "Choledochectomy", "D": "Colectomy", "choice_num": 4, "target": "A", "category": 1 }, { "id": "476166a5-8c95-547f-9221-6de69c7c4cec", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "43308b56-0027-50fa-9647-9630a979271a", "question": "Peritonitis is a condition that occurs in which system?", "A": "Integumentary", "B": "Genitourinary", "C": "Cardiovascular", "D": "Digestive", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f3ac551d-3fe6-5df6-bcc7-01735d3edb5d", "question": "What type of infection is Helicobactor pylorus?", "A": "Staphyloccus", "B": "Streptococcus", "C": "Viral", "D": "Bacterial", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9d5f41af-993b-5d21-b995-a5fd9bd664b9", "question": "Which following term describes a congenital absence of a limb?", "A": "Amputation", "B": "Hallux varus", "C": "Genu vagum", "D": "Ectromelia", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a7b56e24-a79c-51d5-abf6-3c76caf451cf", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f52be708-ab28-5e2a-8dd5-1a2726983d49", "question": "The kidneys, bladder, and urethra make up what system?", "A": "Urinary", "B": "Digestive", "C": "Endocrine", "D": "Nervous", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8a5f26ff-3015-573b-80bb-6bb2ffe604fd", "question": "Complete the series : Frontal, Ethmoid, Maxillary, -------------------------------", "A": "Turbinates", "B": "Inferior", "C": "Sphenoid", "D": "Nasopharynx", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4deb68d5-b6ec-5e4f-8b08-dd01e111eff7", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d2a6c273-8667-5175-bc20-ce01716ae9e6", "question": "Adrenal glands are part of which anatomical system?", "A": "Digestive", "B": "Genitourinary", "C": "Circulatory", "D": "Endocrine", "choice_num": 4, "target": "D", "category": 1 }, { "id": "30102d02-d72b-5974-b85d-ba155974bdda", "question": "The basilic vein is located in the :", "A": "Arm", "B": "Leg", "C": "Head", "D": "Foot", "choice_num": 4, "target": "A", "category": 1 }, { "id": "44cb41ad-be6e-5677-860c-a118a7116130", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "36f6111b-469e-50c9-98dd-84b0f7c06ce0", "question": "The right upper quadrant of the abdominal area contains which of the following?", "A": "Pancreas", "B": "Stomach", "C": "Gallbladder", "D": "Appendix", "choice_num": 4, "target": "C", "category": 1 }, { "id": "07b83a65-12cc-5495-9472-402415f0938b", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "4f48cacb-e989-5b2f-afa5-c70b85812da9", "question": "A Cochlear implant is placed in the  :", "A": "Spine", "B": "Cornea", "C": "Heart", "D": "Inner Ear", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1176c8a2-bca9-547f-b5f1-80979c0bc136", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "fd68a541-5a2d-531c-9c1a-cc53168737d7", "question": "What is the meaning of the root word  \"myelo-\"?", "A": "Spinal Cord", "B": "Blood", "C": "Muscle", "D": "Bone", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5227fa61-8235-5689-925d-7c8719aa4d48", "question": "Surgical repair on the levator muscle of the eyelid to correct drooping is called :", "A": "Conjunctivoplasty", "B": "Blepharoplasty", "C": "Blepharoptosis Repair.", "D": "Canthotomy", "choice_num": 4, "target": "C", "category": 1 }, { "id": "398f6de3-e0d9-5058-8540-38674df0ee04", "question": "Dislocation of the scaphoid bone is located in the :", "A": "Elbow", "B": "Shoulder", "C": "Foot", "D": "Knee", "choice_num": 4, "target": "C", "category": 1 }, { "id": "04b120c7-977c-5bdd-ad19-a7e3f07fa388", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "745492fc-8225-5a3d-abc7-289882494950", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6259c9cb-a6a2-5152-87d0-a86c5557b3bf", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d0ae988b-b917-5d4c-a690-26d5d8e01e80", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "83ea2c15-97c8-59e0-8755-1efc19043c39", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f90fd62c-4d28-5e9e-9c54-1863e168363e", "question": "The most commonly used etiology/manifestation combinations are the codes for --------------------------, category 250.", "A": "Heart disease.", "B": "Tachycardia.", "C": "Hypertension.", "D": "Diabetes mellitus.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "21d7bcf6-6982-54aa-9e40-c8cf404ae402", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2e5f5356-930b-5f01-92f2-1c4711e1cc29", "question": "When coding neoplasm (cancer) , \"metastatic from\" means?", "A": "Primary or secondary site.", "B": "Unspecified site.", "C": "Secondary site.", "D": "Primary site.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "dbeb6760-6864-5c33-864d-17d7599c4979", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "b1106d1d-bece-5422-bc16-b5f0390690b0", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "ae5fd5e6-337c-58b1-800c-240821520a50", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "a67e66b8-f5c8-5f05-abaa-5bb5c2666725", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "849c3f6e-879f-51ec-8b56-36153923289e", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "5c4be428-e47e-5b8e-b2aa-0e913f6dadb8", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "fc337d8c-68a4-54e4-9f05-9c9b551997d5", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "85669fba-c307-554a-92b6-b09aa4d93070", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "a47ca0ba-933a-5bf3-a8e2-b69ad5366288", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "f2200cee-c6bd-516b-b402-c3683948c054", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "be51f6a5-1992-50f9-9780-80f1552c8b54", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "a11dec1f-b265-53f2-b435-7f3b2e4c9570", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "8b7865f0-c31b-55b3-850c-f282386b50e6", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "089db057-5981-574f-ae61-2cebe8e66843", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d8571555-1dc0-5655-915e-fd33bf6ec385", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "dd944d2e-f078-5403-b271-30080aed4d17", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "694448a3-2724-55a9-88fa-8fc05975cd72", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5e994310-3fce-5fe6-9e51-03fd41f52e83", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "0cec0b87-0e3a-5929-886c-2a79cad4e234", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "471c0873-99e7-5aa5-b4bc-c39ddc2fa253", "question": "An arterial catheterization is coded how?", "A": "36620", "B": "36600", "C": "36640", "D": "36620, 36625", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8632bece-adac-5ca6-8869-73260c91cafd", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "52a260c1-2b73-5899-86fe-34b7f034c7b7", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "98123be7-c437-5a5b-a059-ac0e3d14c099", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "cfc0f258-5d42-5f18-bc27-555c50f7d7b9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a01788f2-8d68-5e5f-a5d9-57a6fe9edc2c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "62507255-1350-515d-b190-9fff93463baa", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "58e57d16-d6ab-5475-9a55-ffca87392e3b", "question": "DIGESTIVE SYSTEM : 40000 seriesGary is admitted to same-day surgery for a laparoscopic cholecystectomy.", "A": "47562, 47550", "B": "47562", "C": "47560", "D": "47600", "choice_num": 4, "target": "B", "category": 1 }, { "id": "bf4e9e6f-73a8-5350-bdf1-757f0fc651de", "question": "Code an excision of a ruptured appendix with generalized peritonitis.", "A": "44960", "B": "49021", "C": "49020", "D": "44960-22", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5081fd1f-0570-5bdf-88de-87bb7806a571", "question": "Code an ERCP with sphincterotomy", "A": "43262", "B": "43264", "C": "43260", "D": "43262, 43273", "choice_num": 4, "target": "A", "category": 1 }, { "id": "62ecfacb-e8d1-56d6-bf18-99e27f9a81ce", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "f1fcd41a-a2c5-512b-bda1-887b44f0f630", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7673672a-0032-5d07-a387-5a50c6d7a3f9", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "ddb02085-c58b-5188-8f62-067d75035e0d", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "f04c6452-9245-59b9-92e8-8c66a7547838", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "daae82c3-2d3c-5d00-818b-2e82508097f3", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "42a18142-f4fe-5629-ace0-2fbc4b356371", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "24097104-6ca2-5049-869e-d00f3c5b7163", "question": "MALE GENITAL SYSTEM : 50000 SeriesCode reconstruction of the penis for straightening of chordee :", "A": "54328", "B": "54435", "C": "54360", "D": "54300", "choice_num": 4, "target": "D", "category": 1 }, { "id": "720d1277-7e4b-57aa-91c0-00c55f0c5d99", "question": "New born clamp circumcision.", "A": "54161", "B": "54150", "C": "54150-52", "D": "54162", "choice_num": 4, "target": "C", "category": 2 }, { "id": "86209fd6-c34c-595b-9ec1-42cf457d1118", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7acbeae5-5709-5616-8bfa-5485a6d42ff4", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ab83edf3-d9c7-59d5-9e55-47091540b198", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "dcdc72af-7d78-5148-92cc-734a5acb9171", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f5fe9c08-3a08-598b-b2eb-3c9992c78b75", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "7443f8e6-e8b9-5077-b21d-2380e9d9cb6e", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "2bc52ebd-56f7-5e52-926d-f98d1c7be503", "question": "FEMALE GENITAL SYSTEM : 50000 SeriesD & C performed for a woman with dysfunctional bleeding.", "A": "58100", "B": "58120", "C": "59160", "D": "57505", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ea684f5d-c9c9-51ff-a6ad-73b1dd390c12", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "4e79f4bf-cdad-5aad-8ab3-977121cc5afa", "question": "MALE GENITAL SYSTEM : 50000 SeriesIncision into abscess of scrotal wall to drain pus.", "A": "55100", "B": "11006", "C": "11004", "D": "54700", "choice_num": 4, "target": "A", "category": 1 }, { "id": "512f234b-cb17-5b78-9e99-d4a79b12d02f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cbea2fbc-6938-575a-baeb-894e143a1ce2", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "62d05e87-ad22-57fd-8f62-e2cf4ee7660d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a753744f-d0a8-5a74-8e4c-baee66656128", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "219e7c20-20db-5307-b08a-11c4ea9ec7bf", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "4d49328d-5da5-5bd2-a481-0001e2882063", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "545f65b4-b959-530f-af31-2f78d7e33b12", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "830da456-8dad-5754-ae17-2276fa112a92", "question": "Removal of a foreign body embedded in the eyelid.", "A": "67801", "B": "67830", "C": "67938", "D": "67413", "choice_num": 4, "target": "C", "category": 1 }, { "id": "37146bd4-c905-5bef-b3e8-13adbfe79e5a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "22be2755-5714-5075-85d7-e399aa4fa9a9", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "b8afb2d6-fbb7-50df-bb87-9139970eb3cd", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "2448298c-a89a-5312-9b23-651706ccf0f5", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6fbd025a-c35c-58ff-b621-90558f29f503", "question": "ANESTHESIA :The physical status for a patient who had a mild systemic disease would be?", "A": "P4", "B": "P2", "C": "P1", "D": "P3", "choice_num": 4, "target": "B", "category": 1 }, { "id": "466fdf9d-efc0-512c-98c1-b074d8455046", "question": "Biopsy of the upper left eyelid :", "A": "67810, 69990", "B": "67810-E1", "C": "67801", "D": "67700-E1", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a3417a88-4e34-5905-981a-0d01f312d36f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ecdb2790-a7b1-5720-aa42-7a704718319c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8d0b7536-a5e4-5fd7-a0fd-5d05447ed245", "question": "Excisional transverse blepharotomy with one-quarter lid margin rotation graft.", "A": "67961", "B": "67961, 15576", "C": "67966", "D": "67950", "choice_num": 4, "target": "A", "category": 1 }, { "id": "74cc12a5-2e41-5beb-814a-9ccb230f0250", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "064cdd2b-ce02-5dab-955b-7399702946f0", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "790545fb-dfaf-59e4-8a3e-aaa5b9dba2f3", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2a974108-939e-592d-b1ae-c4df0a5671b0", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1b171826-1116-5124-af5f-615f05ef7122", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "dd4efdce-499b-5830-9560-258ff73756fd", "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", "choice_num": 3, "target": "B", "category": 1 }, { "id": "34a24b2f-b94c-5238-97b8-14432a8d570c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f80953d1-6465-56c5-9887-a73b34f37010", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5b370628-f05c-533f-b2ec-91146f27f8c7", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c2eac929-40bf-5414-b5d1-1f6b8190d410", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "edc47109-aff0-5b28-a332-dcf64c599811", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e830ebb4-5d1f-52a8-a492-8560ae67b584", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0cbfcc71-a725-5fda-b252-c69049030b0f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cb83c27d-d392-5b1d-b26b-7f02f348fb1b", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9b929498-7bd0-5cbd-8f31-51e4601a2f4f", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "4abbf096-3bdf-548a-bc1e-83f8b58fca9f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "93ea55d3-1a16-5c27-bad2-3468a677dff0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e54f9785-7970-5d63-b455-340b74c916c6", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f4e1d2e7-ee7d-57aa-9d92-ed63e7a6821c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "072be14c-4413-570e-bdef-97f51e1dfb02", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7535a202-7c5a-575a-a1fb-c5c236e566a3", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "0c91cd0a-9e82-52db-b777-6d9a19b52334", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "9dd50ddf-9b72-581e-9005-f79b25c9278f", "question": "Code for an IM influenza vaccine, inactivated, subunit, adjuvanted.", "A": "90655", "B": "90654", "C": "90656", "D": "90653", "choice_num": 4, "target": "D", "category": 1 }, { "id": "969458c5-5165-55f1-ad0b-186ae85b8902", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "1682d6b4-e568-5df6-afa4-3df3d4dbd341", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "a2a2cb34-6f8c-52ce-b2b5-7e26831ebaad", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "37d6ea4b-af6f-5329-bf77-3c7b1e27f7e6", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c098bab6-f06b-5fd8-8b0e-ebfa7d0685a5", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "80718453-dd32-56a1-87e8-dc0972657a6f", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "b112a205-8cfe-5028-ad34-e303c1df861d", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2b55be43-5c88-55ce-b861-818b851a86dd", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "33d7d5c7-09d0-5fa4-adf5-edaf38dc63a1", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9e03223e-8a50-5929-955d-7e6e796da450", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "7addaaae-f236-5e11-b2f0-880067e25b2c", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "b2e4db4d-0297-5e55-9688-55b8a40a8ded", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "dc694814-0559-5181-9ace-43833a2fe82a", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6cf46f34-4c87-5716-8c2b-735bab351c35", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "3ce89564-265e-5a15-ba21-40a0416c9a89", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ce613532-ee23-55c5-936e-586742d79910", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "6b8f3f3a-1eb7-5c20-9fdc-b9515dd6c07e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "35a47a19-4281-51c0-aed4-d11d727d3542", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "23bdf05d-fa18-57db-9fb8-d175067c17e8", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "8a1fba05-567f-5f37-85f7-3678f5ecac3a", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "28e9ebed-1bbd-5242-a5ea-d708ed9ff6e2", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "c091b8d9-31e0-57d2-841a-06ac7d3d5afb", "question": "Which service is not included with anesthesia services?", "A": "Swan-Ganz monitoring.", "B": "Blood pressure", "C": "Mass spectrometry.", "D": "Administration of blood", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d896e799-6ddd-55b6-bba0-d2d4c80dbb4e", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "65e7894e-7f70-5247-9cdc-b0ba0a51d07f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "99c29594-5626-5ebb-8f66-bd691a7b1060", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "1e973c0b-265e-5d69-8b00-504d4493152b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ffb8a398-359e-5e54-a100-ae3cbc9b87cb", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8de8e3c0-e2a5-5812-a7ef-caa8ffdc9cc4", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "27f9f127-54a6-53d0-929a-e3d93eca44ab", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c0ba4a53-05e8-51ac-b39c-c81bd426a91f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6833da00-a47f-5fbc-9a01-060120df465a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7585db12-3dd0-5722-a0bb-7e50462a3a9c", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "1a774616-de04-56a9-8277-3df14f8c2cc2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "af29141d-b029-50ef-b44c-1ec1f0d88cdd", "question": "What is the MAIN component of Soda-lime?", "A": "CaOH", "B": "NaOH", "C": "KOH", "D": "H2O", "choice_num": 4, "target": "B", "category": 1 }, { "id": "aa49d116-0f71-59cb-a370-ed2a429c3cd3", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a1621646-fd86-56a4-b99c-5d6ef1e31c58", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "24cb7b8f-b9b7-5ab8-b901-55b235c8f0a0", "question": "What are the measurement units used to define Macroshock?", "A": "Volts", "B": "Ampere", "C": "Milliampere (mA)", "D": "Hertz", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7daac878-566e-5dd9-9c2c-a58b35458a35", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "760e3a32-b76d-5642-ba2f-53c9efe637e4", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "e9316c71-17fe-5a12-962a-132514b3acf7", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3c4ac451-c3ad-50d7-aa96-e5d80b33a1d6", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "042e38c5-3ea7-523d-bd8b-06e743d850cc", "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", "choice_num": 3, "target": "C", "category": 1 }, { "id": "f27264c8-7fba-5965-bba2-1bcfd6fd8bae", "question": "Give an Example of a colloid.", "A": "0.9 NS", "B": "Cough Syrup", "C": "Hespan", "D": "Lactated ringers", "choice_num": 4, "target": "C", "category": 1 }, { "id": "774f6093-bacb-56d2-8d54-46e3cdb89c28", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8336c504-51ad-5675-9646-59339bb89929", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "36399cd7-c583-5330-bd55-7df2e05bed39", "question": "Which of the following facilitates the flow of electrons?", "A": "Inductance", "B": "Capacitance", "C": "Insulators", "D": "Reflection", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e6725f63-8cf6-51ff-a4f4-f52b8e85e301", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "42af13a4-9d1e-53c7-9ad9-c9b5b08a2da9", "question": "Which type of solution will precipitate upon cooling?", "A": "Saturated", "B": "Super Saturated", "C": "Unsaturated", "D": "Super Unsaturated", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7cedceba-ea9d-5158-8952-8a0494437398", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "56405859-a9ff-5be3-b6b8-ce8da8f14aca", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "fbe03295-4ce7-5c42-a61a-0a0bfc281ed0", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "009ec42e-7116-5758-b46c-d0fd218367fe", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "b3b08ab9-ef49-5afe-9a16-f1628c940652", "question": "The Sagittal plane divides the body into", "A": "Left and Right", "B": "Superior and Inferior", "C": "Anterior and Posterior", "D": "Right and Wrong", "choice_num": 4, "target": "A", "category": 1 }, { "id": "eead570f-c7b5-50c8-83f2-f1154c66bc28", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f3b791c0-dcc7-58c2-ba80-4c02d6822dfd", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fb6f6254-dfba-5a59-8788-0a626fdd14a4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a199e0a4-ba27-51e6-a4dc-a0a094ca19eb", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "75393ca0-82ae-50ce-bf2f-b2187e6cc404", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "01d660c0-0573-5056-bd44-adb1e499ed30", "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", "choice_num": 3, "target": "C", "category": 1 }, { "id": "991a5d64-62f3-5fcd-a152-ef48dfdf984f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f7f5b5de-09ff-5611-8732-b113ef9c62bf", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "e2f6a333-a471-5838-aff0-59482d40ef79", "question": "What agent revolutionized anesthesia in 1846?", "A": "Cocaine", "B": "Cannabis", "C": "Diethyl Ether", "D": "Propane", "choice_num": 4, "target": "C", "category": 1 }, { "id": "63da2bde-caaf-54f9-a033-9c410b615bc9", "question": "The three basic phases of anesthesia.", "A": "Pre medication, intubation, O2", "B": "Induction,Emergence, Awakening", "C": "IV, Intubation,Emergence", "D": "Induction, Maintenace, Emergence", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b24c1278-e3e9-5fea-a1f3-d94ba446ff8f", "question": "Name a neuromuscular blocking agent.", "A": "Rocuranium", "B": "Fentanyl", "C": "Neostigmine", "D": "Ketamine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "111b8f51-28d0-59fc-901a-608a5e274f8b", "question": "Muscle strength returns in reverse, smaller ones( eyelid muscles) regain strength last.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "63db2f1d-c965-5316-83c7-207165a773f4", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "af42e013-658a-5fb5-b3cc-3ee6eabc4a97", "question": "The Triad of Anesthesia include following, Except", "A": "Analgesia", "B": "Sleep / Hypnosis", "C": "Muscle Relaxation", "D": "Memory Loss", "E": "Non of Above", "choice_num": 5, "target": "D", "category": 1 }, { "id": "54f49e75-add5-5944-96d6-3041a7dc4bca", "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", "choice_num": 2, "target": "A", "category": 1 }, { "id": "b5d12a4a-91d6-5502-8c88-3b4e43218117", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "595456eb-57f9-535c-8bea-1d5718b4f50a", "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", "choice_num": 2, "target": "A", "category": 1 }, { "id": "eef02949-1bf1-5d9f-b3c8-502117911010", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "13fdbe57-5b6d-5031-9563-d9bcb52b6b59", "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", "choice_num": 6, "target": "A", "category": 1 }, { "id": "98e307f3-11fe-5155-b918-d343086e5cd3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e097e217-f999-5dc4-9d62-b1ae09baeb24", "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", "choice_num": 2, "target": "A", "category": 1 }, { "id": "64907339-480b-508b-b1e6-556b93013d86", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "2bab52a9-6d4f-5d56-9131-133fd5eabf6a", "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", "choice_num": 3, "target": "B", "category": 1 }, { "id": "70ce7af5-8c2b-5875-ac07-06403c20e1b6", "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", "choice_num": 6, "target": "C", "category": 1 }, { "id": "556edc7d-5ad7-5058-9559-a8a5b28e1909", "question": "Types of Anesthesia.", "A": "General Anesthesia", "B": "Local Anesthesia", "C": "Regional Anestehsia", "D": "Spinal or Epidural Anesthesia", "E": "All of Above", "choice_num": 5, "target": "E", "category": 1 }, { "id": "54601bdd-d081-5a3e-9012-0844b893dd39", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "29b6625f-1d04-54a5-8943-ee1705c21fee", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "7822395a-4aea-5bef-a2c1-834fb4c72ed9", "question": "Unconsciousness occurs before MAC is reached.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "9fef8640-fa8d-539a-8190-862b5a0c9e11", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "23340af4-8623-52c7-8cb9-aae08360076c", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "3b413562-0015-5e5b-9fc4-e07ee263bf19", "question": "Which of these is MAC a measure of?", "A": "Homeostasis", "B": "Movement", "C": "Analgesia", "D": "Amnesia", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c5b5d180-b7e6-5f75-9cfe-4624e8281b1c", "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", "choice_num": 8, "target": "C", "category": 1 }, { "id": "51a843a4-5929-53d0-9d83-7047a22a46c1", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "308c82e8-cb99-51fd-abc0-1a59562b1da0", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "fb08dcb2-d7e3-5f1a-9e33-21cf89bb0067", "question": "Duration of anesthesia can change MAC.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "a35cf18d-8e92-56df-9b38-73f73b7be4fb", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "94df844e-bc4e-5cb2-8a6e-a818f8525539", "question": "MAC is the level at which 50% of patients do not move on...", "A": "Intubation", "B": "Incision", "C": "Extubation", "D": "Excision", "choice_num": 4, "target": "B", "category": 1 }, { "id": "0695e63f-2aaf-56f1-bb06-16b466da487e", "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%", "choice_num": 9, "target": "D", "category": 2 }, { "id": "9c86b50e-b76c-5631-b117-260fff890b6d", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "851ac931-252e-5a16-a68a-f20d508e5bed", "question": "Anesthesia is the drug-induced reversible depression of the CNS resulting in the loss of response to external stimuli.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "e4a49de8-7a50-5fe2-8b6f-be4c691cb2c0", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "624c1d65-b12b-5d9f-995e-e2416ccbc8a8", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "09a30a3a-2a6d-5094-b52e-f6319c3947b3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fe271dc6-34f4-501f-990e-643791957d7b", "question": "Peripheral sensory receptors are affected by inhalation anesthesia.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "db2cbb9a-836e-57e1-bfe5-38f1eca3aecc", "question": "Studies have shown that inhaled anesthetics have some teratogenic/carcinogenic effects.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "968b3eab-4830-5a72-afd0-18507ee46785", "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.", "choice_num": 6, "target": "F", "category": 1 }, { "id": "498d6fb9-748c-5090-b2cc-4750274461cb", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "ee703227-4fdf-5cd8-ac8d-83eb0b2a7b53", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ea924538-88fc-566a-98cf-062262cb7435", "question": "Minimum anesthesia concentration of an anesthetic at one ATM that prevents movement in response to surgical incision.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "f4767518-3a72-5a69-918a-74a3a0f84ddc", "question": "MAC of isoflurane", "A": "1.51", "B": "2.5", "C": "1.15", "D": "2", "E": "6", "F": "105", "choice_num": 6, "target": "C", "category": 1 }, { "id": "cd93d77e-9c52-5254-9f1c-475db2efd58f", "question": "Large carbon chains are better at attenuating movement in the spinal cord than small carbon chains.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "dfc9f5d5-ce26-5c8f-b26b-058a1e94f856", "question": "Supraspinal action of inhaled anesthetics will sensitize the spinal cord to pain at lower doses.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "2ecd870d-590f-592c-8ce3-4fddb7b9775f", "question": "MAC changes how much per decade?", "A": "16%", "B": "8%", "C": "3%", "D": "6%", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8b4b8076-662c-5510-b04f-69f01dc1f52d", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "6a971000-a694-56dc-9f27-74fc01bd7fd3", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "57cd943e-4287-5915-bc31-3d11026dca06", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "e8f0f2f2-f176-5591-9dfa-13fde31ebe4e", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "de4c4897-3f2c-5ae7-9b65-bd8eaaad17c8", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "aec4c9f1-82d4-513c-bda8-803744977046", "question": "Which of the following injection types will provide the longest duration?", "A": "Nerve block", "B": "Field block", "C": "Supraperiosteal", "D": "Infiltration", "E": "Intrasseptal", "choice_num": 5, "target": "A", "category": 1 }, { "id": "567c5a85-7dd6-51cf-bef6-d41be2bb9851", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "e8d3e9d9-00c5-5865-88b3-297d06f99e63", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "2cc6d58a-d15c-5c73-81c4-aaa308f3a84e", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "bfbe4a75-c27a-564c-aadf-d4001169a4cf", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "09c0565d-b726-53f0-98a2-7d68f84e4d35", "question": "Pressure syringes are primarily designed to deliver what type of injection?", "A": "Palatal", "B": "Intraosseous", "C": "Intraseptal", "D": "Periodontal ligament", "E": "Incisive/mental", "choice_num": 5, "target": "D", "category": 1 }, { "id": "8190785d-27f4-5b09-84e5-67edd587edf9", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "ad383791-2ecf-50f0-b7cb-02558ef212d3", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "3cc8304a-e96b-5b29-b025-b032c859ed5e", "question": "What type of injection is contraindicated in primary teeth?", "A": "Intraosseous", "B": "Infraorbital", "C": "Periodontal ligament", "D": "Posterior superior alveolar", "E": "Inferior alveolar", "choice_num": 5, "target": "C", "category": 1 }, { "id": "cb367961-578d-5ae7-bd04-4548ef4d1fc4", "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", "choice_num": 6, "target": "A", "category": 1 }, { "id": "f8c7925a-7c6f-5f25-9445-1ab60c56d3a6", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "2c0d0406-087b-543b-8a67-b4ff4684150c", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "ef056820-cb57-5d5c-b781-aaeec877b44c", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "911eca9b-bca9-54a7-8b42-e50ad038a6ec", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "821b46b6-7fb9-5889-96aa-692ef6f50dfc", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "1e2ae0e1-5275-5a2b-8de6-c797d89c9f33", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "b1ef77ff-f8b5-56b9-863d-6f1a2b477cf6", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "4cfba8d7-97c7-5fc3-b3c6-49be956f61a8", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "e9544558-0ac6-540f-9e33-ccca0b400e71", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "67e70879-09b6-50b3-a91d-9a6a9781a034", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "f6a2d993-e74a-54e8-97e9-66122eeeb4a9", "question": "Which of these is the most potent?", "A": "Remifentanil", "B": "Meperidine", "C": "Sufentanil", "D": "Morphine", "choice_num": 4, "target": "C", "category": 1 }, { "id": "451fe29d-4efc-5b17-b3da-72b2c612a4e7", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "697a2f5e-96cd-5e64-b0b1-73ae2ef1cb9d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "10a03488-49ce-5c51-ad78-7ba6b5854036", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "1a782497-75ba-5ec0-a4db-5bd1a68d4028", "question": "Which class of drugs would you NOT give to a patient undergoing a cholangiogram?", "A": "Opioids", "B": "Barbituates", "C": "NSAIDs", "D": "Benzo's", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e550a43e-dd75-5c3d-9da9-f407b6eef351", "question": "Enkephalin is responsible for stimulating which opioid receptors?", "A": "Mu and delta", "B": "Mu and kappa", "C": "Delta and kappa", "choice_num": 3, "target": "A", "category": 1 }, { "id": "8b335410-4703-59aa-9ca1-e8e31e851f64", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "f63d3b78-7bd5-5756-b40a-a17181930788", "question": "Which drug when combined with benzodiazepine's causes the greatest drop in MAP?", "A": "Alfentanil", "B": "Fentanyl", "C": "Sufentanil", "choice_num": 3, "target": "A", "category": 1 }, { "id": "125ae5d6-a7c5-5a84-81ca-124cf47b2c8e", "question": "Which of these is the greatest histamine releaser?", "A": "Codeine", "B": "Meperidine", "C": "Fentanyl", "D": "Morphine", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0f3add6c-64a2-5f45-8567-16a8ddbb9f16", "question": "Which of these is a highly protein-bound drug?", "A": "Sufentanil", "B": "Fentanyl", "C": "Remifentanil", "D": "Morphine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "9fec687b-0efd-511e-9c2d-4997f0ff0492", "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.", "choice_num": 3, "target": "B", "category": 1 }, { "id": "98296461-8522-5680-8016-96be14aaae42", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "322ce98e-9647-5bb8-b675-3a69704c558a", "question": "Which of these is not a site of synthesis for Pro-opiomelanocortin?", "A": "Pituitary", "B": "Pancreas", "C": "Placenta", "D": "Adrenal medulla", "choice_num": 4, "target": "D", "category": 1 }, { "id": "870e178a-f7c7-5422-928a-0a0d592f0198", "question": "Dynorphin is responsible for stimulating which opioid receptor?", "A": "Kappa", "B": "Mu", "C": "Delta", "choice_num": 3, "target": "A", "category": 1 }, { "id": "3d9c8750-44c5-560b-9026-9fb9ba30e9e2", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c3d9b5ca-e47b-58a8-ac23-c5947f438a84", "question": "Which of these is not an endogenous opioid peptide?", "A": "Dynorphin", "B": "Epinorphin", "C": "Enkephalin", "D": "Endorphin", "choice_num": 4, "target": "B", "category": 1 }, { "id": "fcf0d933-9ff0-5bbb-ba2b-0b0425b7efdc", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "6d5c540a-c163-52d1-bc0b-73c71d0a4c9b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c566cabe-96c0-5891-aedd-563be1e15810", "question": "Which of these will not cause miosis?", "A": "Sufentanil", "B": "Morphine", "C": "Meperidine", "D": "Fentanyl", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8e244b91-a4d9-528e-bf79-8a84e57e4b3e", "question": "Morphine causes itching by releasing large amounts of histamine.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "6a64bf30-c642-5713-9092-054e2f9c73c4", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "aa823a79-47a7-5c52-ba94-5eee53eb87f4", "question": "Which opioid receptor causes diuresis?", "A": "Mu2", "B": "Kappa", "C": "Mu1", "D": "Delta", "choice_num": 4, "target": "B", "category": 1 }, { "id": "446c511f-e0a2-520e-b5c3-0b452b04da24", "question": "Remifentanil needs pseudocholinesterase for metabolism.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "4fee9263-48ab-5389-a961-39aa62c169e5", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5039ca6f-66df-5ce7-9238-e236c0085e49", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "80694282-060e-5af9-8bbd-caba117b96d1", "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?\"", "choice_num": 4, "target": "C", "category": 2 }, { "id": "af100187-ebbe-5fd2-99f8-5a459f484406", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "dca3e548-e305-5fe0-9b7b-5c9424bda0ef", "question": "Dehydration increses the risk of hypotension.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "f4985a3b-509e-50e6-ab8e-f76033ad2ed3", "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", "choice_num": 2, "target": "B", "category": 2 }, { "id": "fc5f1239-24c6-5443-9ba7-fd92e5b0a9ea", "question": "Anemia predisposes the patient to hypoxemia.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "6597fbd6-98a4-5ead-a5ca-88cbfc684198", "question": "Patients with bruising may be at higher risk for potentially life-threatening intraoperative and postoperative bleeding.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "d38fb5ff-2e84-51cc-8965-285156860311", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0f5e639b-1057-5a9e-9abf-c3dff7b35283", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "356df21b-08b2-5a8b-a0a0-217f47ca3408", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a62a64a4-5127-5992-98f3-bd6f99e32da5", "question": "Which of the following is not a Crystalloid solution?", "A": "Lactated Ringer's solution", "B": "Normal saline solution", "C": "Dextran", "D": "5% Dextrose", "choice_num": 4, "target": "C", "category": 1 }, { "id": "895b0f46-1c18-5412-9bea-6b27ac34d6cc", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "9c2742d7-db37-5694-89dd-e936769a2b4d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "80d6a479-a28b-541a-8f4b-970457895c93", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ee5eae0b-0b52-55a1-8f3c-06c0779e847d", "question": "About two-thirds of the total body water is inside the cells.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "ed7bdfdc-f13f-506e-bdf2-5f006e02d206", "question": "Blood plasma makes up about 5% of the total body weight.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "41b7addc-7da0-59ab-9e36-c49223d4d511", "question": "The extracellular fluid contains more sodium than intracellular fluid.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "139e6cbb-33f2-56a5-93e8-ae096cca6251", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9390c792-26f0-57c6-93fe-e7ec946dea67", "question": "The intracellular fluid contains more potassium than intravascular fluid.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "0deaaa03-c623-5779-85e6-0474199e53c3", "question": "The intravascular fluid has more negatively charged particles than positively charged particles.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "3244cee4-f751-5a4c-b41c-529856a4f2c8", "question": "The osmolarity of intracellular fluid is similar to that of extracellular fluid.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "6b5a67c4-0dd4-59b9-8a47-4856de09e4f7", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "31ffcec9-c373-5413-b269-68bcc9bdd3e9", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "a1e5ecd8-176b-5a45-9e86-2f0e98a3627e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7656c56d-45ad-50dd-adea-305ae59fca7a", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "52bc7f7d-fde5-5a7b-9ba8-ea032eaeaa92", "question": "Most pre-anesthetic will not cross the placental barrier.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "3721bdfc-31e0-5c9f-89fe-e3018a70b07f", "question": "It is recommended that atropine not be given to an animal that has tachycardia.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "c15ffa03-9495-5a5f-b07b-37a2f42c4752", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "40285c73-3c20-5bf5-9fd5-11a38774b071", "question": "High doses of opioids can cause bradycardia and respiratory depression.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "ce0d48e7-9cb5-543e-85e1-8e808830623e", "question": "Severe bradycardia caused by dexmedetomidine is best treated with the following drug:", "A": "Atropine", "B": "Naloxone", "C": "Epinephrine", "D": "Atipamezole", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5f05ce1b-86a8-5b52-8b1e-10a5412676f1", "question": "Opioids are reversed with:", "A": "Atipamezole", "B": "Naloxone", "C": "Atropine", "D": "Yohimbine", "choice_num": 4, "target": "B", "category": 1 }, { "id": "09e0b575-0dbb-5cf4-a1cc-27d04b763dcb", "question": "Which of the following drugs will precipitate out when mixed with other drugs or solutions?", "A": "Atropine", "B": "Acepromazine", "C": "Diazepam", "D": "Butorphanol", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2eaacb8b-6303-5552-a7b6-bc16353b1339", "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)", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ccb4dd1e-4ae3-5b59-8bfd-529f83a498ef", "question": "Which of the following is an example of a dissociative anesthetic?", "A": "Thiopental sodium", "B": "Pentobarbital sodium", "C": "Ketamine hydrochloride", "D": "Propofol", "choice_num": 4, "target": "C", "category": 1 }, { "id": "775c5da1-2e8c-559b-9f3a-325172827c72", "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", "choice_num": 2, "target": "A", "category": 1 }, { "id": "534753e8-5f88-521a-b127-699800105145", "question": "Compared with methoxyflurane, isoflurane is considered to have a:", "A": "Higher vapor pressure", "B": "Similar vapor pressure", "C": "Lower vapor pressure", "choice_num": 3, "target": "A", "category": 1 }, { "id": "1341d7d1-14ef-579b-8b5f-38a95a96a9f5", "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", "choice_num": 3, "target": "C", "category": 1 }, { "id": "23e4e6d8-4242-5926-8c40-77e094a955a5", "question": "Which of the following has the lowest blood-gas partition coefficient?", "A": "Halothane", "B": "Isoflurane", "C": "Methoxyflurane", "D": "Sevoflurane", "choice_num": 4, "target": "D", "category": 1 }, { "id": "dc1e2a3d-e869-5148-ae9b-8f49f50ad6e7", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "aa4b0ca2-50e2-54bb-87af-9740ee18c2e1", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "51b88ac6-75d6-5e6b-9c51-3c9b60090ce0", "question": "Adverse effects common with isoflurane include:", "A": "Hepatic toxicity", "B": "Accumulation in body fat stores", "C": "Depression of respiration", "D": "Seizures during recovery", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ec066ee2-066b-5878-8c0b-81536e6c4c57", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "80649589-9e17-5aeb-8127-fa8aaa05902e", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "635dc608-ca30-54c8-afdc-538088249a2d", "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.", "choice_num": 5, "target": "C", "category": 1 }, { "id": "b6623745-5dea-58c1-bdee-52439c350278", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3179fe1b-1532-5747-8d8a-3595cfccdaf0", "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.", "choice_num": 5, "target": "A", "category": 1 }, { "id": "627ab5f9-f524-589a-9c1e-f8aa2b611382", "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.", "choice_num": 4, "target": "C", "category": 2 }, { "id": "2262695b-12b2-55d1-9182-f39d5c75b523", "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", "choice_num": 3, "target": "C", "category": 2 }, { "id": "16ebb224-4614-5771-a3da-7e7eb94c499d", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "65e29523-d294-59a1-9030-b1110702f85d", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "6063b1d8-74b6-50f8-ba63-ab505e02dd81", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "690d43dc-9ee8-580f-ab07-3f94126462b6", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "c7e26ff7-4977-5702-8016-e1e6aa5f9ab4", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "8be467f9-f6f1-56db-9b00-4aa403c9e071", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "b8c5c68e-1296-5a46-ad97-a5e8d4e87e06", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "0694e281-8f03-56ae-8e3a-786df156ac73", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "b8022542-fbc7-5c6c-9a04-b2d6e65f9f8a", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "3cefbb10-9144-5fe3-974f-016330494fc9", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "8d86c448-a40a-529d-bc10-8f54272a1a91", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "55d3bb53-590a-5db1-8996-d8868356bb4d", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "e28f0623-c1a2-5229-8e89-3636ab0bc0ad", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "c2a39e59-32c4-5a3c-884b-8ccaa44abe40", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "03e59c9c-8e3c-5f9f-a48e-977fa65ab667", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "78805c73-5cbc-56eb-a944-63b817da51ab", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "3c605d0f-9d62-54bc-8d68-842069a80e32", "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", "choice_num": 5, "target": "C", "category": 3 }, { "id": "8e74a9b1-4c1f-5a5a-b95b-424cae3df544", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "dae2f06f-7191-59e1-b265-dc63760ac1db", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "d49e65ac-5632-5a3c-9306-7e30386c3a39", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "a174af6d-7045-5202-9223-ed4115c950e2", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "6406604f-85dd-5af9-951a-cd248fb40256", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "f33d371b-2045-5574-9a34-11157ab02503", "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.", "choice_num": 5, "target": "B", "category": 2 }, { "id": "e242e100-0100-5b81-aafc-7b52e947c202", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "2d71922c-0cd7-5deb-99f7-729f55c39179", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "ef7ace92-233d-5315-96c5-3149d00d553a", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "7980c49b-7c7c-5cf7-9618-d2f7da716c6d", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "cb39553b-3cc3-50b6-b499-37aebaaf306a", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "c7fe9640-792c-55cb-b5d3-63b7a1ab6097", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "2da43f9f-9f58-5071-aaec-aa28846af250", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "59f18720-e5b0-5e33-9049-3a7bc3896eb6", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "91bfbb1b-304b-5349-8287-98e1ba4607f1", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "0c3346f5-04cc-5a6b-a839-3ca294879028", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "6ac1f2a4-2198-5e5a-be0d-2ca7465f5a48", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "81dde5a7-0420-50d3-9eb4-cacf4b8d6953", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "ed11337f-cce8-55f3-aa82-f54f54eba4a4", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "af07b719-9674-5fff-b37c-bf1102e9ec14", "question": "The predominant component of baralyme granules is", "A": "Water", "B": "Silica", "C": "Barium hydroxide", "D": "Calcium hydroxide", "E": "Potassium hydroxide", "choice_num": 5, "target": "D", "category": 1 }, { "id": "d05159c0-21bb-542c-8afb-404d1fd33797", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "042c2042-a499-5ca2-8ce5-1ea9f3ea00ac", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "00dfb7d1-3cfd-55ef-a5e9-02bbf3b87bfa", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "fe4b1e1e-862e-518e-96fe-3a13ed04d669", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "5176cb7c-e6a5-5f92-94be-1ace058fb749", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "333e66da-6ffd-5adc-8c2f-dc292764984e", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "b3d68f10-75cd-51fe-a9ca-32b984f34d05", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "e983ab02-a64c-530d-a0eb-48648a67db89", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "84d3609d-e4da-5fad-a82f-742c4e29b4dc", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "b37ef682-bd56-5a5f-b12d-2873f7bc842e", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "0aef5e3a-d977-54db-94e2-7134652c1868", "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%", "choice_num": 5, "target": "C", "category": 2 }, { "id": "37888314-7a67-54fe-a8c8-2e9221e3cbf9", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "b224e301-67f0-541d-bdb7-6a32b4914b89", "question": "An incompetent ventilator pressure-relief valve can result in", "A": "Hypoxia", "B": "Barotrauma", "C": "A low-circuit-pressure signal", "D": "Hypoventilation", "E": "Hyperventilation", "choice_num": 5, "target": "D", "category": 2 }, { "id": "586a5936-d73a-55e2-b741-3b11b72de8e5", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "28c4ba5d-1c69-5dec-84b3-7318f5f2812c", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "8475e0aa-208e-507f-a2ea-7d362ef31e19", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "01a6b801-69f8-540a-b749-1861046a58b6", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "f9f81feb-3fc6-58df-a693-973dfaca26d3", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "3d86dc5a-87a4-5ea2-a92c-f74a7cfa9e56", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "54b7d780-35d6-508d-8c4c-1d9dbc7c94d0", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "e49904f0-282c-5db5-9ada-04961c92f616", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "4e0d6f9d-7641-5a12-9c76-2c3c250566fd", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "20eb5ef4-1915-5c04-80a8-76076253d040", "question": "Which of the following materials will not ignite during the laseer surgery of the airway?", "A": "Rubber", "B": "Silicone", "C": "Polyvinylchloride", "D": "Metal", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9945435e-2d0d-50d4-8c63-d922df966700", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ba2d0d17-a9c7-5934-b35d-d4d4d0a4e4f2", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "bb717302-d170-5e63-862d-e7ef2d9c2741", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "31009ab0-26e1-5e90-977c-88cde7ab2654", "question": "A 15 kg dog weighs how many pounds?", "A": "30.3 lbs", "B": "33 lbs", "C": "6.8 lbs", "D": "28 lbs", "choice_num": 4, "target": "B", "category": 1 }, { "id": "115c5042-577e-50be-a80e-ff8466155330", "question": "A 65 kg dog weighs how many pounds?", "A": "151 lbs", "B": "143 lbs", "C": "29.5 lbs", "D": "33 lbs", "choice_num": 4, "target": "B", "category": 2 }, { "id": "c6f8664e-6f7d-5e3b-a92a-d577d4690232", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "2f5c2c39-3c20-53d8-bdd1-15e44080c851", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "5e7edd1f-5c69-5449-bf90-c9ef3b3b1e48", "question": "Active scavengers used activated charcoal to remove waste anesthetic gas.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "4c6a7295-1dc9-5476-86b6-b2c0f49d95ba", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d5783805-d653-5c5b-b6e0-e7e53da71b45", "question": "General anesthesia is defined as the loss of feeling or sensation to a specific area.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "25b8dc0b-65b5-52a8-aa6a-0c1eb86ff236", "question": "It is recommended most patients be fasted for about ____ hours before the surgery.", "A": "6", "B": "12", "C": "18", "D": "24", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c078ff15-36a0-5f41-9378-fa4f2a9805bd", "question": "Ketamine is always used with a(n)", "A": "Anticholinergic", "B": "Sedative", "C": "Opioid", "D": "Tranquilizer", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9ef5fa23-654f-5065-9f74-77447069b28c", "question": "Long and intermediate-acting barbiturates are generally used for anticonvulsant therapy.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "57e5b8be-19b2-55d7-ac5b-e4a0e8c33701", "question": "Scavenger units safely filter/route waste gas from induction chambers.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "21c65847-3e11-5b08-9fa2-477160ff9242", "question": "The manometer is measured in", "A": "G/dl", "B": "Cm/h20", "C": "Mmhg", "D": "Mph", "choice_num": 4, "target": "B", "category": 1 }, { "id": "99e5a20a-24dc-5dbb-a282-ad5eedcb9c54", "question": "What drug will often make patients vomit after 5-10 minutes?", "A": "Butorphanol", "B": "Valium", "C": "Morphine", "D": "Atropine", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1b2fe1c7-61b2-558a-9744-fb6d8cb617d3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f917de6b-3ead-5d3f-a349-dff9c248200a", "question": "Which of the following preanesthetic drugs lowers the seizure threshold?", "A": "Acepromazine", "B": "Valium", "C": "Xylazine", "D": "Fentanyl", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8fd8a55b-2d0d-5f34-9f06-26bcdd68ae98", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "71d4b34c-c45b-5553-ae4d-fc5abf5a44ab", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9d80a081-b7c7-59a2-8d35-ce018c50f30d", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "0759d79b-e264-5427-92f5-a64bf720e9cf", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "7c158303-f7a5-5f8b-b931-733be0afccb9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "493dd2de-388e-52a3-bbb0-6962dcd8426d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3c837b95-6080-58f0-ab41-e560f46a3235", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "9fc70cf1-54c9-50f5-9649-4aa2e64b21fe", "question": "The non-depolarizing agent that has a predictable rate of metabolism is:", "A": "Atracurium", "B": "D-tubocurarine", "C": "Vecruonium", "D": "Pancuronium", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c5b09ea6-c400-5cc2-8bcd-b3471c758e47", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d5555f35-19ed-5c8a-ab2e-f5c106cd441e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5cc837ec-d1be-5a33-bd6e-08fb9a5d629d", "question": "The most significant side effect of pancuronium is:", "A": "Hyperkalemia", "B": "Renal insufficiency", "C": "Hyperthermia", "D": "Sympathetic stimulation", "choice_num": 4, "target": "D", "category": 1 }, { "id": "12f9fca1-5df0-59d0-bcc2-d49bdbd7f07c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "646bc5ea-4108-5a2a-883b-ab933042c397", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "062d6790-3334-502c-86b1-0cd4c6a223a8", "question": "A contraindication for spinal anesthesia is:", "A": "Elderly patients", "B": "Sepsis", "C": "Infants", "D": "Diabetics", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7047b7b4-1915-5d7b-8281-8c6db605ccc2", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "6ba0ed06-1baf-5674-85e9-85bd7c556c56", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "b946d4cd-7fb2-5c6b-a2e8-7a7fb296fa2d", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "1ff3c9d1-a74a-5068-b8c3-f9c4d2c0f370", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "b9030ce2-a1de-50a7-94dd-a7bb03f115b1", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "dfd11a01-427f-5155-baa4-5c36fd2c3a1a", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "7052948d-d14d-5735-9ebe-05652fda695e", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "fbf0d01c-4ed1-54c9-b2dd-6a697ca24d43", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "8281e61a-5ced-5706-852a-eb925263882d", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "e25ba197-4c7f-5262-846c-a4e9c7e49711", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "6b794f67-7b2c-5574-870d-1e2f963b917e", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "d30b06af-b494-534f-9eae-4041154b6d86", "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.", "choice_num": 5, "target": "D", "category": 1 }, { "id": "9f8409fc-bd53-5be2-a604-2cba5109a479", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "c417e5bb-69e5-5108-bb61-c22fe8edb321", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "250b2396-7c75-58e0-ab30-dd08671d429c", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "0f538c6c-a389-50ab-8a39-4a1e4beb553d", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "815cb4c2-31ed-54ee-b3cf-d806198846b6", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "6ef72aa3-4c9f-56b7-9fef-355f18002c02", "question": "Which of the following is NOT a stage of general anesthesia?", "A": "Induction", "B": "Maintenance", "C": "Emergence", "D": "Exacerbation", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1cb84b85-5641-5469-a592-2af81a426859", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "a95f36a8-57db-5498-ae1c-e189da1efa96", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "b6b082b6-6ced-504f-b615-c0b11128d41b", "question": "Which of the following anesthetic increases respiration?", "A": "Isoflurane", "B": "Halothane", "C": "Thiopental", "D": "Sevoflurane", "E": "None of the above", "choice_num": 5, "target": "D", "category": 1 }, { "id": "431f1b88-bf8b-5ca9-bc2d-d212b184f2c2", "question": "The following are all types of controls (drive mechanisms) except for:", "A": "Pneumatic", "B": "Galvanic", "C": "Fluidic", "D": "Electronic", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9f9aac9d-df59-5b4f-88a7-3021475baa9a", "question": "In an ascending bellows during exhalation, the driving gas will vent to:", "A": "Scavenging System", "B": "Breathing Bag", "C": "Atmosphere", "D": "Descending Bellows", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4d427cb0-d9fb-5c6e-9181-025c6647ff96", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "edebe4f5-6a7f-5635-942b-8bd1ceb764a4", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ef647a9d-37cd-5ac2-abe4-76d4f11937db", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fed27253-64a8-5b28-a537-ea99b263f790", "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%", "choice_num": 4, "target": "D", "category": 1 }, { "id": "153ed577-cced-521b-9f58-4ae1c1e09413", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "959a4494-9873-54b5-845d-4e3d64ce7076", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "fdfbbd57-6783-50e9-aa89-7cf3a9ad38af", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "a4256aad-ad98-5c96-aca6-00de0a0254e9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "73dead6a-ec99-5ccc-beef-7da37aa9d9d5", "question": "Which of the following disease is not commonly associated with pts undergoing CEA?", "A": "CAD", "B": "Diabetes", "C": "CVA", "D": "Liver dx", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b8d6da53-7ace-5c75-a97d-4fc1d0adeda6", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "a3c38c28-eafc-50c6-ac08-ac554c8d5568", "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%", "choice_num": 4, "target": "C", "category": 2 }, { "id": "0300fe6e-b215-5273-848b-517373a79191", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "4a7661d9-6621-544f-b70f-29be5b2541a9", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0ab9049f-d85b-5734-9b64-20e5b9ea0238", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2a674c91-e8d4-50b1-adc4-1d53cb4cdc8c", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d2b30078-8b1c-5bc2-8350-6538f7ea13ac", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f6aea869-23c8-5df3-a8ba-82dde654bd0f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "adcc0821-484e-537a-8ec1-72c05eb6dbc3", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "d27626a5-9999-55d7-902b-079319772aa9", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "6c2f2a35-929e-5293-9c2e-bffd3a888998", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7173d069-740f-5abb-8ef3-6bd37ff34441", "question": "Lactic acid build-up distal to the aortic clamp will cause:", "A": "Vasodilation", "B": "Bronchodilation", "C": "Vasoconstriction", "D": "Myocardial stimulation", "choice_num": 4, "target": "A", "category": 1 }, { "id": "71e22728-f97d-5105-8d82-5c151b669e99", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "18092b62-0f80-5752-be26-820be359382d", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "fdc5a771-567a-5e43-98b9-7b5ecf3284a4", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "9612c252-6fab-52d9-865f-b4f4c7daa79e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "bd41d073-a0ed-53a9-8aa2-db13576d29d4", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "86781538-8090-5cc1-9b53-3f097be91201", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "bdba7292-8fc5-5e07-9025-7ba511b133a9", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "afdc559d-c9ff-51c4-a70a-63bc4b7ae219", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "327d7920-30fb-5440-bab4-05f5131dabc4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "26a44136-d562-56ea-b38d-62c1c274d6df", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "746c2027-d0b0-5931-b3da-58daee78ecd3", "question": "90-95% of AAA's involve which part of the abdominal aorta?", "A": "Suprarenal", "B": "Juxtarenal", "C": "Infrarenal", "D": "Pararenal", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e4d01207-f438-5920-963f-1496d8277eb7", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "6e7dc8b5-70de-5050-bbc3-c99b42a7362b", "question": "What is the most common side effect associated with the administration of protamine?", "A": "Hypotension", "B": "Bradycardia", "C": "Hemorrhage", "D": "Allergic reaction", "choice_num": 4, "target": "A", "category": 1 }, { "id": "bb8cce38-057d-5ed9-b279-0110923924fc", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "1f69df8b-cb8d-53df-bf3b-02a491583f8b", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3dab1eae-9524-5a25-94ce-3d8a18944f5c", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "af1c6c99-6c06-5f5d-ba1a-e334a4577ff3", "question": "What is the most common cause of Mitral Stenosis?", "A": "Hypertension", "B": "Aortic Regurge", "C": "Left Ventricular Hypertrophy", "D": "Rheumatic Fever", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5169fa98-3f37-5fb1-a38b-dcbc55646762", "question": "Acute mitral regurge is most commonly due to…", "A": "Myocardial Infarction", "B": "Rheumatic fever", "C": "Mitral Stenosis", "D": "Severe hypertensive episodes", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6a8d8506-f851-5f9c-8527-7b4e991eb7bb", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2d9a6641-5edf-5a3d-9c2f-7884b27067b5", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2f5e7874-c758-5518-b485-6391e7173db3", "question": "The most common cause of postoperative mortality associated with AAA repair is", "A": "CVA", "B": "Mesenteric thrombosis", "C": "Acute renal failure", "D": "MI", "choice_num": 4, "target": "D", "category": 1 }, { "id": "dec1d236-e9a9-5d86-b6b7-84796f193a36", "question": "The most effective method to preserve renal function during aortic cross-clamping is:", "A": "Mannitol", "B": "Lasix", "C": "Fenoldopam", "D": "Hydration", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f3b77827-ffbb-5c18-a67f-a3a22da5d6db", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2b93484d-ed53-5f14-aa2a-a6d0d0a3605c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5010925d-e408-587b-ba84-e73f65dc6f65", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1060c2d9-f091-550a-99ad-e01ca92f114b", "question": "What is the most common hemodynamic response following CEA?", "A": "Hypotension", "B": "Myocardial Ischemia", "C": "Hypertension", "D": "Pulmonary HTN", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5a782526-629d-574b-a414-e3de1455a575", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "87fdcc85-90b4-5f91-b877-8b7290f3c420", "question": "Which of the following is the least dangerous of valvular disorders?", "A": "Aortic Stenosis", "B": "Mitral Regurge", "C": "Aortic Regurge", "D": "Mitral Stenosis", "choice_num": 4, "target": "C", "category": 1 }, { "id": "75f1e6fa-4bfb-565c-a54d-c10b1313c06a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "53893469-7464-5a1a-9710-8e5e3ba3a8f7", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "12bef2b5-52f7-5a50-a79a-564e4cebe174", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a7d690f1-df89-51aa-b468-9a552d8488a7", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c351b1b0-5292-5d65-8335-84e7117f4033", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "eb6567cf-84cb-5435-a55d-f0120cae1f8c", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e11353ca-4519-5f01-ab18-3491a4194ca1", "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!!!", "choice_num": 4, "target": "B", "category": 1 }, { "id": "868a7bf9-210b-5232-b403-8d1f60c9f188", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "59256c9e-3500-5856-9b37-e6bf9179cd92", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ddf73a89-d0f5-586a-af22-99c8703eff5b", "question": "Which nonparticulate antacid is commonly given to pregnant pts undergoing general anesthesia?", "A": "Metaclopromide", "B": "Bicitra", "C": "Calcium Carbonate", "D": "Pepcid", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5231d0a9-eb5c-576c-9117-871718ba5d18", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "6bb15f19-69ef-583a-97f5-46a77cf6bd8c", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "99a705ea-1ace-5969-9347-23f13d7cdcb1", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "f252dacf-21b7-5fb3-bdd2-68241611bf5f", "question": "Which of the following is not an indication for cesarean section?", "A": "Fetal Distress", "B": "Failed regional block", "C": "Dystocia", "D": "Cephalopelvic disproportion", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1d5ead35-6eec-5d4c-a17f-a5417ba33826", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8bdddf7f-7442-53b5-a9c2-a8bef746552f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9a0fa547-214c-55db-aaa5-91872180c69d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3a9f072b-6d64-538e-bdde-e26de2aef374", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "736fe313-a5b7-56bd-a5a1-541cc9bd56c9", "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", "choice_num": 2, "target": "A", "category": 1 }, { "id": "6fcd1052-a659-596e-b13c-c79fda447c55", "question": "Minimum NPO status for an elective C-section is ____ hours.", "A": "4", "B": "8", "C": "6", "D": "10", "choice_num": 4, "target": "C", "category": 1 }, { "id": "85e415e4-3dcb-50b8-b6ed-fc3ca7f27f8e", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "181fb2a0-00c5-5535-bede-bcc14644f003", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "cf8efe44-0ac1-5ead-bedb-597a4f186343", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e16dfc8d-01f9-55e9-9849-b6f518a3d0d8", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "625af6fd-dff9-5b37-b255-eb705d19439a", "question": "Which of the following is considered unsafe to give during pregnancy?", "A": "Vecuronium", "B": "Ephedrine", "C": "Sevoflurane", "D": "Versed", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6be58304-224f-5faa-b7e6-474d767114e3", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "73149ff7-a81c-5e51-a27b-290a71f604f2", "question": "During the first and second trimesters, pregnant pts are not considered to be at an increased aspiration risk.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "8d2ad6ea-7d8e-5d28-a2e6-2b31620587b8", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "75638e99-a133-5b66-98c2-1b58fb85d426", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "c5f64e03-511a-5c9a-84aa-2424a1a1037e", "question": "Succinylcholine will normally last longer during pregnancy.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "9907dec4-0b3d-58ae-8234-e974db74e884", "question": "How will pregnancy affect the MAC of anesthetics?", "A": "Decrease MAC", "B": "Increase MAC", "C": "No effect on MAC", "choice_num": 3, "target": "A", "category": 1 }, { "id": "a0bdd206-2571-5d3b-beaf-c2090afefb7d", "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.", "choice_num": 4, "target": "D", "category": 2 }, { "id": "9d0ccd73-799a-5923-a800-74063b874270", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "fe0e378b-77fd-525b-b354-f92522c0121c", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "9d7b76a2-e017-52bc-96c8-e1ab4e152875", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3fd06392-536e-556a-8b69-fd46f6409af4", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d595bfa8-0268-585a-8580-429dc35ddc24", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "766dd982-1afb-5701-ae88-bcf10192f524", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "143695cd-2bc0-5985-bc14-27461c1db572", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6d13c2a9-1a74-5e6d-b682-7424704c20b3", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1297d74f-f6f0-5636-987d-b12c230b68aa", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f21b53a4-32d2-59b9-9e3d-d4e2f5dd2da4", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "938584bb-d6e3-5c42-964d-0522c0991773", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6702c74f-f0b3-53a1-b624-bfd4547a164d", "question": "Uterine Blood flow is autoregulated.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "2e1bcdd8-7264-5461-8573-d1b7d950501b", "question": "What percentage of cardiac output goes to the uterus?", "A": "10%", "B": "20%", "C": "30%", "D": "5%", "choice_num": 4, "target": "A", "category": 1 }, { "id": "db53a136-9d0a-5087-ab74-b1c51238a769", "question": "Spinal and Epidural anesthesia are known to decrease uterine blood flow.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "ad256c9c-360a-509f-ab22-5334fb7e46f4", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "ec42162e-9227-5203-b3d2-a8ee7b4f87b8", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fad48752-038c-5961-b713-bb25204e395a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1952567e-dbd1-5059-a659-759a0b9159b8", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6e9e0908-6556-50f4-861e-4c9de481a38a", "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", "choice_num": 3, "target": "C", "category": 2 }, { "id": "5632de21-16f7-511f-96a0-4b8f2c030b8a", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "669fa136-d7b7-5bd2-bdbc-d6fd919fbb6e", "question": "The incidence of maternal aspiration is higher for emergent c-sections.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "9610ad2f-b169-58cf-ae59-dc9cf40353be", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d1d1f6fd-fd28-59e3-91f2-db38fbd0c928", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "cc76319a-1d9b-5c9d-aa8a-2b49c77d72f7", "question": "Umbilical cord prolapse may be evidenced by..", "A": "Early fetal decelerations", "B": "Fetal tachyarrythmias", "C": "Late fetal decelerations", "D": "Meconium in amniotic fluid", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7533f3fd-0fa1-56b4-8191-0464843318cd", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "5c0dd8d3-8465-5154-b080-799b74225fe6", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "51789d74-5846-567c-99a8-8e743cf984d3", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "53499c17-2303-529d-a44e-8c501edfb55d", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b035c326-7e1d-53e4-a8fd-18234c4363b6", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "4263ed24-cdb9-5fc9-bcd3-b85b32780a2a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "10aceeba-bb32-5a52-90c8-023dedeee389", "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", "choice_num": 3, "target": "C", "category": 1 }, { "id": "ebd48967-7944-5943-a1b9-71578dcf92c3", "question": "The fetus is most sensitive to drugs during which trimester?", "A": "3rd", "B": "2nd", "C": "1st", "D": "Equally sensitive during all trimesters", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ad86e723-8b60-5655-9a99-9f7f3dd8250e", "question": "What is age of viability for a Fetus?", "A": "28 weeks", "B": "30 weeks", "C": "26 weeks", "D": "24 weeks", "choice_num": 4, "target": "D", "category": 1 }, { "id": "52550c0c-e15a-50ea-bff8-8efca31839f6", "question": "What would be the muscle relaxant of choice for induction of a pregnant pt?", "A": "Succinylcholine", "B": "Rocuronium", "C": "Cisatracurium", "D": "Pancuronium", "choice_num": 4, "target": "A", "category": 1 }, { "id": "dedde660-d630-52e9-b65a-30cbb8046f7b", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8eeea928-b897-5552-98ea-7251cdd27238", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "6abbbb6a-d560-56e5-914e-b1215fda6c39", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "80d51828-6b7b-5946-83c6-e33b1b9e3eea", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e7f51602-afe5-5d7d-96df-ee7d376a08fd", "question": "Morbid Obesity is defined as any BMI greater than what?", "A": "28", "B": "30", "C": "35", "D": "40", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9711a0ba-de84-5ef1-9765-fa4e1bfc4246", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "34578aac-5124-5c93-ae22-1b545632b80b", "question": "Which of the following will not cross the placenta?", "A": "Glycopyrolate", "B": "Fentanyl", "C": "Ephedrine", "D": "Metaclopromide", "choice_num": 4, "target": "A", "category": 1 }, { "id": "3a96a1e0-859c-54ca-a221-1d756f2e5850", "question": "Which of the following coagulation factors will not increase during pregnancy?", "A": "Factor X", "B": "Factor XI", "C": "Factor VII", "D": "Fibrinogen", "choice_num": 4, "target": "B", "category": 1 }, { "id": "056786f0-7ca1-5d3e-a31b-3eb9df8b2524", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a9a42fd0-e9b0-5724-a00e-c8a2b9357a3d", "question": "Local anesthetics all have the suffix:", "A": "One", "B": "Caine", "C": "Ine", "D": "Ane", "choice_num": 4, "target": "B", "category": 1 }, { "id": "586031e2-e197-5543-855f-d7abf617769d", "question": "Esters are metabolized by ____ while amides are metabolized by _____", "A": "Liver; blood", "B": "Liver; liver", "C": "Blood; blood", "D": "Blood; liver", "choice_num": 4, "target": "D", "category": 1 }, { "id": "dd51f4d0-2172-572b-92c6-d8b83eb38078", "question": "The tertiary amine of local anesthetics is", "A": "Hydrophobic", "B": "Hydrophylic", "choice_num": 2, "target": "B", "category": 1 }, { "id": "b3b1113e-e6d2-5400-b5b6-b5528f6985c9", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d5f66a50-5c68-5f1d-b875-6edc40f3a565", "question": "TTX and saxitoxin work on sodium channels by", "A": "Binding outside the membrane", "B": "Making the membrane swell", "C": "Binding inside the membrane", "choice_num": 3, "target": "A", "category": 1 }, { "id": "5783a583-e6c3-5842-a034-a9045b5a32ca", "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", "choice_num": 3, "target": "C", "category": 1 }, { "id": "74b906e3-4017-5c16-b8e1-8dc557201880", "question": "Local anesthetics work on sodium channels by", "A": "Binding outside the membrane", "B": "Making the membrane swell", "C": "Binding inside the membrane", "choice_num": 3, "target": "C", "category": 1 }, { "id": "798f7274-5b03-573b-8ab1-938aa27f9166", "question": "Local anesthetics are", "A": "Weak acids", "B": "Weak bases", "C": "Strong acids", "D": "Strong bases", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2470117c-11fe-5280-a28a-d18b2d5b85c3", "question": "At rest, m gates are ____ and h gates are _____", "A": "Open; open", "B": "Open; closed", "C": "Closed; closed", "D": "Closed; open", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e3566472-d834-5373-baf2-ae300140f041", "question": "When inactive, m gates are ___ and h gates are ___", "A": "Open; open", "B": "Open; closed", "C": "Closed; closed", "D": "Closed; open", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5201dcfc-9918-56b5-9f96-423676bfd04c", "question": "The active form of a local anesthetic is the", "A": "Base", "B": "Salt", "choice_num": 2, "target": "B", "category": 1 }, { "id": "6c496470-0d45-5fee-a2c4-541ed3f9aa6b", "question": "The form of local anesthetic that can cross the membrane is the", "A": "Base", "B": "Salt", "choice_num": 2, "target": "A", "category": 1 }, { "id": "3c9e8f4b-534b-53f9-9c2d-6645ab3b08a0", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5fc5fcc8-d3ec-523b-936d-44ad9606ea58", "question": "Anesthetics (except cocaine) are vaso-", "A": "Dilators", "B": "Constrictors", "choice_num": 2, "target": "A", "category": 1 }, { "id": "e88d25ff-c990-59aa-8049-8b899e93c5f2", "question": "Epi is given as a vaso-", "A": "Dilator", "B": "Constrictor", "choice_num": 2, "target": "B", "category": 1 }, { "id": "32b38ad6-9145-5c6d-82a7-9cb637e79472", "question": "A good pre-op anti-anxiety medication is", "A": "Isofluorane", "B": "Cocaine", "C": "Midazolam", "D": "Suxinylcholam", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6f364f9a-1ce6-5fd3-8425-c32d517998e7", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "edad14e4-d46f-52e1-bdf7-4b8a1b9507dd", "question": "For intubation, ____ is administered.", "A": "Cocaine", "B": "Fentanyl", "C": "Suxinylcholine", "D": "Midazolam", "choice_num": 4, "target": "C", "category": 1 }, { "id": "375efa5c-949d-533e-976b-7a455b5caa95", "question": "A depolarizing blockade caused by succinylcholine works by", "A": "Keeping sodium channels active", "B": "Keeping sodium channels resting", "C": "Keeping sodium channels inactive", "choice_num": 3, "target": "C", "category": 1 }, { "id": "244e7c62-ee46-510b-8844-a4ebfcba9868", "question": "To reverse a gas anesthetic, give the patient", "A": "0% O2", "B": "10% O2", "C": "50% O2", "D": "70% O2", "E": "100% O2", "choice_num": 5, "target": "E", "category": 1 }, { "id": "31b74cb5-8e99-5496-a95e-88cd6858406b", "question": "The best general anesthetic is", "A": "Midazolam", "B": "Thiopental", "C": "Propofol", "D": "Ketamine", "choice_num": 4, "target": "C", "category": 1 }, { "id": "70d1e917-a7b3-53c2-a876-38b9f86581c6", "question": "A seizing patient would best be given:", "A": "Thiopental", "B": "Etomidate", "C": "Ketamine", "D": "Midazolam", "choice_num": 4, "target": "C", "category": 2 }, { "id": "1e7986a8-faa8-54f8-8fd0-f4a6a1f47549", "question": "A heart surgery patient would best be given:", "A": "Midazolam", "B": "Propofol", "C": "Thiopental", "D": "Etomidate", "choice_num": 4, "target": "D", "category": 2 }, { "id": "f5599ff9-6847-5a2d-be12-7999c002f6f2", "question": "You want solubility in the blood to be ____ so that the gas may reach the brain fast.", "A": "High", "B": "Low", "C": "Medium", "choice_num": 3, "target": "B", "category": 1 }, { "id": "e9ec8382-8e9b-5577-91d0-fe7de7737f91", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "c3dbacd0-336f-5724-9e41-ad01f2f1d494", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5676b044-de3f-564c-a499-07ac31df353e", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "450fdef8-d1eb-5ecb-9399-6b5a590ae6b6", "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.", "choice_num": 4, "target": "C", "category": 3 }, { "id": "5fbd2ea3-1d83-590e-b970-8d824bff316e", "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!", "choice_num": 4, "target": "D", "category": 3 }, { "id": "e2aec607-f8a1-5ada-b8bc-eeaf6182bacb", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6adff6f5-1312-57b1-aee0-434ca71876a3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "741c190d-1641-53b9-bae6-f84b7921fb99", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "aae3c075-1a84-589b-bdf7-4704a895419c", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "70f9899b-1173-591a-b145-85638cc603b7", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "b303ab05-f589-5f49-9742-9b27e97b8114", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "d8210cba-8763-5d61-a87c-f2636cf50a8a", "question": "What would be an appropriate size LMA for a child weighing 27 kg?", "A": "3", "B": "1.5", "C": "4", "D": "2.5", "choice_num": 4, "target": "D", "category": 2 }, { "id": "e9ba99f4-981f-556f-be26-5279f3fca54e", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "0c01acc0-7004-5e7f-8419-4b2a1e50d186", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "2faa194e-3403-52a0-89a7-a648ee698463", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5cdb982d-148c-5931-997a-6164d7b34d00", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f7944a4c-037c-588c-912b-bc1e9c3aacd4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2e39e4cf-d926-5d7b-93ef-7d5e6050f649", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "ef404b75-b985-590d-9292-edfe504ab737", "question": "When doing a pedi drug set up, it is recommended to draw up your drugs in ‘unit dose’ syringes.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "cf3fa010-da48-58a9-8fc0-7b55ddab6c57", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "a338222b-2078-573d-a5f2-e55765d364a0", "question": "The majority of pediatric cardiac arrests occur when?", "A": "Induction", "B": "Maintenance", "C": "Emergence", "D": "Rates are equal during all 3 phases", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8e2738af-d013-5592-96fd-7027a5a5c443", "question": "Most pediatric arrests are due to ________ causes in children.", "A": "Cardiac", "B": "Respiratory", "C": "Congenital defects", "D": "Circulatory collapse", "choice_num": 4, "target": "B", "category": 1 }, { "id": "91f6094f-304a-5f94-8577-22bff13b7808", "question": "What is the most common cause of respiratory arrest in pediatric patients?", "A": "Airway Obstruction", "B": "Difficult intubation", "C": "Laryngospasm", "D": "Bronchospasm", "choice_num": 4, "target": "C", "category": 1 }, { "id": "4940309d-2411-50e0-86f8-87859a78efd3", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "aa5c6829-72d9-5b86-b8e2-a3df370401db", "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.", "choice_num": 4, "target": "A", "category": 2 }, { "id": "2663cb6a-be3b-5d9f-b752-f20cfd8198d0", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f48b57dc-76c7-56b6-9523-2ed95c5c91b1", "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", "choice_num": 2, "target": "A", "category": 1 }, { "id": "0b083e64-2f57-5ed0-a0a6-ecfc1486f14f", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "0c86d64d-abfe-5414-ba94-dce8598bc2f8", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "b6bc57ae-6916-55e5-99ae-02db86948e25", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5c7c8927-7482-5c54-822e-a677b58331ef", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "112da783-37f0-5cbc-9813-d236e7a40b32", "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", "choice_num": 2, "target": "B", "category": 1 }, { "id": "389f4a72-d1ce-5c1c-b089-8997499c05d6", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9befe191-e3bb-5eec-9a5c-1fc5b5932119", "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.", "choice_num": 4, "target": "C", "category": 3 }, { "id": "f048a270-4bb9-51a4-89d4-f922be8150b3", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "966a3dda-0035-5d49-951f-4153c800fbcc", "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 %", "choice_num": 4, "target": "A", "category": 1 }, { "id": "cadf018f-df6c-5c09-a164-bc8f0b11dcd3", "question": "What size IV catheter would be best to use on a 3 yr old child?", "A": "24", "B": "22", "C": "20", "D": "18", "choice_num": 4, "target": "B", "category": 1 }, { "id": "b8c7d810-4628-58cc-94da-7dfc85e91bc6", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "1044c71b-a2fb-5e86-a042-ac01af3d2154", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "57a1ac42-158d-5d58-81b0-45eba41856e8", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "cd73f40a-437f-5ec6-bb9c-d91a5c2c105f", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b9f5e39b-ba87-5ca2-b4d8-f771d0835a0d", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "49cecbd9-20ea-5070-b53c-475f4fc79f5f", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "eb47d635-e3cf-5330-846c-33876f5a0df1", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "18a93b5d-298c-5942-8c2e-a3486ad4e1f5", "question": "Which of the inhalational agents had the highest incidence of  emergence delirum?", "A": "Sevoflurane", "B": "Isoflurane", "C": "Desflurane", "D": "Halothane", "choice_num": 4, "target": "C", "category": 1 }, { "id": "740e65fc-1a10-5194-979c-d80ad8015295", "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.", "choice_num": 4, "target": "D", "category": 2 }, { "id": "daeefa5b-b54b-5034-abc6-30723ed410ee", "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.", "choice_num": 4, "target": "A", "category": 3 }, { "id": "2523b4cf-b4cf-5b55-a3aa-aaf6d5c251b8", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "f8b81838-8a44-58fc-836e-aa4211b67112", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9d669539-0d01-5272-b7f8-06d0964ae5f4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "12eb49c6-b2e9-541b-9f30-bacf09f962ec", "question": "A normal healthy child may be transported to PACU without any supplemental oxygen.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "76a67102-83f4-50db-9a9a-ea9d654d3119", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "a37a3539-c480-58eb-8c99-93c885d50c5e", "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.", "choice_num": 4, "target": "C", "category": 3 }, { "id": "cf58886c-376e-59ea-bce0-39ffefe1fa86", "question": "Inhalational induction should not be done on children with asthma due to increased risk of bronchospasm.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "86404d92-fc28-5317-9169-abe340c734f2", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "3d828c48-91ee-585b-9051-233ba9014e8e", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "5a9e9fcd-c740-5db0-8f18-6db149ad3bd0", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "fb643d48-7822-5a46-8a88-401fb3251df0", "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", "choice_num": 4, "target": "C", "category": 3 }, { "id": "f4bc7a2d-3b89-50d4-b30c-68506dd2e6c3", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "3fc9355c-cad8-58f6-99cf-ef8539f512ce", "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.", "choice_num": 4, "target": "C", "category": 2 }, { "id": "43198044-b3d7-5e97-9912-1fbd693f50b6", "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.", "choice_num": 4, "target": "C", "category": 2 }, { "id": "eb442d08-194b-5335-8dff-331a9d751572", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8a84b71a-307d-5c32-956b-432bb9196aa7", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "5258178a-aab9-513f-9ec1-c74e6e58b0ba", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7d826213-d206-5161-97dd-b1ebc65cc054", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "13e051e2-bcfd-53c3-b012-30483ec74477", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1c2eb6ac-e883-5a25-ac7b-d3f041c5325d", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ff5c3fd6-f0e8-5088-9525-624d7534eb24", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "065a816b-54e2-5bdd-a20f-077c185db04f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "490e3a31-50db-5538-8fea-a53e180f8532", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2e6bbe4a-47f4-5df3-901d-778e122b7163", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "16a3d25a-2a22-5297-9965-be13b78284fe", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "2e22ca4b-d0d4-53dd-abaa-5eee4d39f431", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "7667bfea-39b8-5d4f-a98d-d6fbcc256e51", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "38954424-ac6b-5985-9145-4e4195579ecd", "question": "At what level is the larynx located in infants?", "A": "C4", "B": "C5", "C": "C2", "D": "C3", "choice_num": 4, "target": "A", "category": 1 }, { "id": "fe6ddeda-943f-509c-93e4-3253dfdc5a08", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "62395f56-b873-5465-a551-0d5233fb81fc", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "de6ef070-493c-57a0-b91b-d552c27f12c1", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8865ecc3-9f42-5378-8ca7-85f371b3beff", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a076859f-7146-5370-ac3a-36b357237b28", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "4ff84751-f369-5420-9dbd-c5825bcb3396", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e852f592-165a-5819-9bce-544a889ee9d1", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "234061cd-9df9-52c4-ab88-2f40f1c528c8", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9331a4c6-de4a-56af-aa68-c01e2adf9d60", "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", "choice_num": 2, "target": "A", "category": 1 }, { "id": "15f6b25b-e1b9-560c-8014-763244470a62", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d8c7ae26-e6d6-5e3d-93ca-afd449f24579", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9a2b9e9c-8c81-59dd-ba4b-1a8aab6f0b4e", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "92ae78a4-88a8-545d-a2ec-14eeacb4b19b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6124f06d-56fd-57ee-bd89-26b2f6d1bd7c", "question": "Which of the following will not trigger Malignant Hyperthermia?", "A": "Desflurane", "B": "Succinylcholine", "C": "Isoflurane", "D": "Vecuronium", "choice_num": 4, "target": "D", "category": 1 }, { "id": "168d4b1d-f83b-52a9-b382-0a49ab2b3e57", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "1c74034f-95e9-5d20-9bdf-29af290c28ea", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "699d5f2f-3fd6-5937-a14e-37731a1a0e7b", "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", "choice_num": 4, "target": "A", "category": 3 }, { "id": "8275cb85-79bb-530e-a462-66c88aff5036", "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", "choice_num": 4, "target": "B", "category": 3 }, { "id": "d5f8d158-200a-5654-8c2b-7e806c1b185c", "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%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f6ccae3a-b08d-5b1e-807a-57b09af24b18", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0e3a7024-0287-5e66-afff-45efb77e1b23", "question": "Which of the following is not a sign of latex allergy?", "A": "Bradycardia and arrhythmias", "B": "Laryngeal Edema", "C": "Pruritis", "D": "Bronchospasm", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4e433536-bd3b-5892-ad36-00a9fd484431", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "25f6989c-c802-590f-9308-0f479037870c", "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.", "choice_num": 4, "target": "D", "category": 2 }, { "id": "3dc1116c-3df9-5bd3-b3a7-f627f868e2d5", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2c63f866-81be-54b9-9234-287c9693ba7d", "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", "choice_num": 2, "target": "A", "category": 1 }, { "id": "b214f93b-7ea7-5051-a7a1-e0c368f20321", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "f187643d-83cf-5954-bf07-0e140405b5a8", "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.", "choice_num": 4, "target": "A", "category": 2 }, { "id": "fd602557-4f4f-5df2-afba-21abbd83bd3d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8486ff59-def2-5196-ae64-ffc9d80cdb75", "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", "choice_num": 3, "target": "A", "category": 1 }, { "id": "1167a25e-8e48-5a35-8754-761c85087766", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e242e8af-8aa8-5f7b-b355-0ec70775e33c", "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", "choice_num": 5, "target": "A", "category": 2 }, { "id": "2b8b728c-0af8-5c6e-a593-8394d2adac17", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e064c046-6cb2-5053-be7f-8983e6e67494", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "27b4c6a7-6b3e-51e8-bab3-341880191daf", "question": "Which of the following is a depolarizing muscle relaxant?", "A": "Rocuronium", "B": "Mivacurium", "C": "Succinylcholine", "D": "Vecuronium", "choice_num": 4, "target": "C", "category": 1 }, { "id": "9407a874-5056-5c79-bb72-896503b6d67c", "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", "choice_num": 3, "target": "C", "category": 2 }, { "id": "7e2de840-8305-5c32-b27d-62645aa9b517", "question": "Succinylcholine is rapidly metabolized to succinylmonocholine which is known to cause:", "A": "Hyperkalemia", "B": "Increase ICP", "C": "Bradycardia", "D": "Malignant hyperthermia", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fd426de7-a17d-577a-9075-f400f61f55f7", "question": "At what percentage of blockade by non-depolarizing muscle relaxants would you achieve surgical relaxation?", "A": "99%", "B": "75%", "C": "90%", "D": "60%", "choice_num": 4, "target": "C", "category": 1 }, { "id": "d4d4e758-681f-5487-9489-f42601c03388", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "557070cf-2df0-5642-a8c5-5b5f3d73e18f", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "2ee8ea55-7728-56c7-86b8-fdcd6f30d186", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "cab10576-155e-5cf2-9f6d-367827601c6d", "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%", "choice_num": 3, "target": "A", "category": 2 }, { "id": "0cdc7fd1-f121-5dc0-af4a-5357520f4968", "question": "Which of the following has the shortest duration of action?", "A": "Vecuronium", "B": "Rocuronium", "C": "Pancuronium", "D": "Succinylcholine", "choice_num": 4, "target": "D", "category": 1 }, { "id": "9b97b9ab-368f-5377-890c-e4a22e160334", "question": "Dantrolene should be continued for ____ Hours post MH episode.", "A": "24", "B": "12", "C": "48", "D": "6", "choice_num": 4, "target": "A", "category": 1 }, { "id": "21625f41-0117-55af-b5ac-e7666cb82bd7", "question": "This non-barb will increase salivation, inclusion of a antisialagogue is recommended.", "A": "Etomidate", "B": "Ketamine", "C": "Propofol", "choice_num": 3, "target": "B", "category": 1 }, { "id": "d825214d-6c24-5dba-9cb9-289ca2dbb0b1", "question": "Which of the following drugs is metabolized by pseudocholinesterase?", "A": "Atracurium", "B": "Mivacurium", "C": "Rocuronium", "D": "Vecuronium", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d35a9a5b-8d52-57c3-a3d0-d74843a7a795", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "08398c99-cc2b-53ad-ab3e-0ffc1a951d40", "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.", "choice_num": 4, "target": "C", "category": 2 }, { "id": "2222a296-d25f-5662-975e-95c1b049809b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "33f6f51b-d715-5c65-945d-34f6aa4362c0", "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.", "choice_num": 3, "target": "C", "category": 2 }, { "id": "60118c45-afa2-5936-9a03-e5a942940de9", "question": "Hyperthermia is an early sign of MH.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "beecc252-0478-5d0a-b4f6-093a1b08639b", "question": "Which non-barb can supress adrenal cortical function?", "A": "Etomidate", "B": "Ketamine", "C": "Propofol", "choice_num": 3, "target": "A", "category": 1 }, { "id": "ca2eee53-8525-5907-8b55-95a3b6d206c3", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "8d4dc32a-bfaf-566c-84b7-8106070d2d73", "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", "choice_num": 5, "target": "C", "category": 2 }, { "id": "7334d064-3412-525d-9130-b1ef053d93a4", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "6a526385-2ff0-5d01-8505-3c629dafd5d8", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "cc033297-664b-5cde-b17f-b321353011ca", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "96fbc4fb-f0f3-5afa-a0e7-5bf044dfdee8", "question": "This non-barb is know to inhibit PLT aggregation.", "A": "Etomidate", "B": "Ketamine", "C": "Propofol", "choice_num": 3, "target": "B", "category": 1 }, { "id": "880dda42-8430-5b5c-9600-26518239048b", "question": "Which non-barb induction agent has analgesic and bronchodilator effects?", "A": "Ketamine", "B": "Propofol", "C": "Etomidate", "choice_num": 3, "target": "A", "category": 1 }, { "id": "b15a4e4e-e04f-5987-bb6d-98bab8fdebad", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "20e66ebe-9fb1-5d3e-b3b6-4f334c014be1", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "67ac7333-909e-5d4f-9630-5f54bd8be2a7", "question": "The non-barbituate agents have short duration of action mainly due to…", "A": "Redistribution", "B": "Metabolism", "C": "Low lipid solubility", "D": "Low potency", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a1a0ed65-7e73-5f49-bf79-4a5c01ea8adb", "question": "This non-barb has a high incidence of emergence delirium, 12%.", "A": "Etomidate", "B": "Propofol", "C": "Ketamine", "choice_num": 3, "target": "C", "category": 1 }, { "id": "1265d949-64c4-5327-9776-1b98a6457edc", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "1328d11c-ae0a-5d46-885a-3a605a92af9c", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e22a41f1-534c-5225-bfbc-5705347291ae", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "4ff18a04-37a4-5c3a-a7d6-8ffacce0331f", "question": "Which of the following non-barbituate agents do we use as a racemic mixture?", "A": "Etomidate", "B": "Propofol", "C": "Ketamine", "D": "Thiopental", "choice_num": 4, "target": "C", "category": 1 }, { "id": "6ec72ee7-858d-57e4-8b86-84549e7efda3", "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.", "choice_num": 4, "target": "A", "category": 2 }, { "id": "58d0c52c-0ae3-5a36-a4ce-57445ee0aa58", "question": "What class of medications is contraindicated in MH?", "A": "Calcium Channel blockers", "B": "Beta Blockers", "C": "Calcium gluconate", "D": "NSAIDS", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e5e2494f-54c5-552b-9308-8e8587221850", "question": "This non-barb hypnotic is good for patients with a history of PONV.", "A": "Etomidate", "B": "Propofol", "C": "Ketamine", "choice_num": 3, "target": "B", "category": 1 }, { "id": "a4ca2d81-a0a6-5937-a270-4f9928ad494e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "53edb623-5dc6-5b18-8e38-0c1c4b499b6a", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e65d20da-3696-517e-87df-4613e1bb37c6", "question": "All muscle relaxants are quaternary ammonium compounds that mimic the effects of…", "A": "Pseudocholinesterase", "B": "Acetylcholine", "C": "Monocholine", "D": "Muscarinic receptors", "choice_num": 4, "target": "B", "category": 1 }, { "id": "f5df7b60-3185-59db-a66d-972a53f7111e", "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", "choice_num": 5, "target": "E", "category": 1 }, { "id": "d7935564-beb0-5a20-b649-1c2232053abc", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "bd9f857a-e64d-53d5-b032-6d6a536dc5f6", "question": "Which of the following will have the most rapid onset?", "A": "Neostigmine", "B": "Edrophonium", "C": "Pyrdiostigmine", "D": "All have same onset time.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "429a6652-26e4-50b2-ad53-a8fc7bfc4a2a", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "7b3513c2-a3e5-59f6-8f8f-82c689aee9f5", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "fe21043e-ab08-53f8-9987-f5825dd0d362", "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", "choice_num": 5, "target": "D", "category": 2 }, { "id": "0b343376-4806-590d-9885-599ccc6a8d8c", "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.", "choice_num": 3, "target": "A", "category": 1 }, { "id": "08145547-ea98-55e8-8ca1-4a07f9ed242b", "question": "The chemical structure of this drug is 2,6-diisopropylphenol.", "A": "Etomidate", "B": "Ketamine", "C": "Propofol", "choice_num": 3, "target": "C", "category": 1 }, { "id": "8f742321-5945-5b93-98b5-b7995005280f", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9fcd3c74-5169-50e2-9cf6-296e1f5ea7ed", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "75233c16-31e2-52d0-962f-6ad3afa26725", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "28ce95d7-c79a-5c47-b52a-7662e528d958", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "2a91536f-22c6-53eb-a025-adb1d790061b", "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", "choice_num": 5, "target": "B", "category": 2 }, { "id": "977e04c7-5574-5abb-9e0b-a7d328d7f849", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "500be121-2d11-5c86-be9b-9131b726f3a3", "question": "The MH gene is passed via:", "A": "Autosomal dominant gene", "B": "Autosomal recessive gene", "choice_num": 2, "target": "A", "category": 1 }, { "id": "99146466-851c-5a4c-9e4e-d866a7e3ea75", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ea36af35-61a0-5d61-9b7b-56b57f7c6750", "question": "Which of the following is commonly used in the treatment of myasthenia gravis?", "A": "Edrophonium", "B": "Physostigmine", "C": "Pyridostigmine", "D": "Glycopyrolate", "choice_num": 4, "target": "C", "category": 1 }, { "id": "cf7eb717-5c4f-580d-92d9-24648dce7c7a", "question": "You can safely administer glycopyrolate without a cholinesterase inhibitor.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "1a1bc6a8-bc79-5f90-83c9-f3c3594a522d", "question": "Which of the following will increase your ICP?", "A": "Propofol", "B": "Etomidate", "C": "Ketamine", "D": "All of the above", "choice_num": 4, "target": "C", "category": 1 }, { "id": "37709950-0081-5c70-90f2-f4ca3bd50220", "question": "Which agents is known for its HIGH degree of individual variability?", "A": "Rocuronium", "B": "Nimbex", "C": "Vecuronium", "D": "Succinylcholine", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4201dfca-e53f-50bb-98cf-84d5c94386d3", "question": "Ketamine is a NMDA agonist or antagonist?", "A": "Agonist", "B": "Antagonist", "C": "Neither, works on GABA receptors", "choice_num": 3, "target": "B", "category": 1 }, { "id": "c6833874-05f4-59ca-be3c-03739b1167e0", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "deebb693-5eab-5946-a70e-53f15df00033", "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", "choice_num": 5, "target": "D", "category": 1 }, { "id": "336b0834-3b77-51f5-b809-a32dda6b8e27", "question": "What is the half life of Dantrolene?", "A": "1 hour", "B": "6 hours", "C": "30 minutes", "D": "2 hours", "choice_num": 4, "target": "B", "category": 1 }, { "id": "3fa3da67-56ba-5801-b50b-d25e0797980a", "question": "How is Etomidate metabolized?", "A": "By pseudocholinesterase", "B": "By the kidneys", "C": "By hepatic microsomal enzymes", "D": "Via exhalation through the lungs", "choice_num": 4, "target": "C", "category": 1 }, { "id": "aff9af8c-dc47-5c1e-827b-e02bcd03c4d5", "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", "choice_num": 2, "target": "A", "category": 2 }, { "id": "4e30228f-1dbd-53d2-b50e-6c954b537676", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "e8e2eaa8-ebec-55a5-a8a8-22e4b63b8c66", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "e6573a44-f359-5d24-a91d-3aa1a3d5ee6c", "question": "For a patient who is borderline tachycardic it is recommended to administer neostigmine without glycopyrolate.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 2 }, { "id": "1f81ac6b-88d9-5818-a545-d676ed536388", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "55c0f8ae-b7c4-5414-ba5b-d2da563f9fec", "question": "Which of the following agents is eliminated via Hoffman Elimination?", "A": "Mivacurium", "B": "Pancuronium", "C": "Atracurium", "D": "Rocuronium", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7d7ae10d-f72e-563e-9479-9732269b6c01", "question": "It is perfectly safe to use regional anesthetics on malignant hyperthermia susceptible patients.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "2a45a17f-e342-5712-aac9-6e495c5ceee3", "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", "choice_num": 5, "target": "E", "category": 2 }, { "id": "4e7d2e4f-517b-5a47-835d-fb8258ec03ce", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "24e108c2-b627-5ada-bfd6-7f432e6326cc", "question": "What is the half life of etomidate?", "A": "2-5 hours", "B": "30-90 minutes", "C": "5-10 hours", "D": "10-20 minutes", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6da04a18-b42f-533f-8c56-02c15cf00c8d", "question": "The majority of incidences of MH occur in patients under 15.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "eba296ea-2684-55b3-8c94-0bd224dbfc2e", "question": "What is the name of the receptor that is responsible for MH?", "A": "Ranitidine", "B": "Ryanodine", "C": "Cyanide", "D": "Muscarinic", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2a47f8bb-119b-5a92-b82b-2aeca9abba7d", "question": "Which of the non-barbituate agents has analgesic properties?", "A": "Ketamine", "B": "Etomidate", "C": "Propofol", "D": "Thiopental", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a8c8b20a-af17-5c1e-8c61-794eebd38339", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "6500718d-4ffd-5131-8ba5-d9149e2dfb29", "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.", "choice_num": 4, "target": "C", "category": 3 }, { "id": "23b6e45b-86bd-5e26-865a-a848dab94ce7", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ac82ebd0-c517-59ee-9e04-688b420eb349", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a7d3287d-a7e6-51ed-8666-e0cd1c053f29", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "0a51f137-f5b2-5c4b-93d6-bcf0c8c8a127", "question": "Which of the following has the longest duration of effect?", "A": "Nimbex", "B": "Vecuronium", "C": "Succinylcholine", "D": "Pancuronium", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f93094ae-4a43-5df3-bf52-6475c1db7aef", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "57c945f5-a5b6-5789-b38d-2a3868a9b696", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "956cc563-f8d0-510d-85a2-e68f83bda3e0", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d83f4f04-7112-52b1-aabf-3aff1610c7d4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "c5a32c89-8287-5255-acc4-b9d1dc923564", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "c9ee1620-6173-5c11-a23d-46d8bafac821", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "92036d0d-450c-5217-8888-c187dcd43b69", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1268fc00-0a07-5dd6-8b83-54e47164ac8f", "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", "choice_num": 2, "target": "B", "category": 2 }, { "id": "cafaf1b2-4da2-5584-9095-dbfce49810b0", "question": "When caring for children you should ALWAYS give the anticholinergic and the cholinesterase inhibitor together  in one syringe.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "18847cbd-93de-5ec8-a131-46a33bb3362f", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "edc0ab7f-94ff-5b29-91f9-9a8c04d4260c", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "3c81ff92-3355-53f6-b206-72b609a79c84", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "13a99971-4bd2-50f4-96ff-5a8640694b04", "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", "choice_num": 3, "target": "A", "category": 2 }, { "id": "f0ed30a0-b7b6-59b4-b975-e8b861df8f39", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7dd2c400-b856-57dd-9a83-5103c99fe427", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "ab770253-7ccb-5a6b-8bee-1bfc12a39611", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d96c6b91-08c3-5a61-a465-5c2a01707a24", "question": "Which of the following muscle relaxants allows you to skip use of a reversal agent?", "A": "Mivacurium", "B": "Vecuronium", "C": "Pancuronium", "D": "Rocuronium", "choice_num": 4, "target": "A", "category": 1 }, { "id": "11f72922-24d4-56e6-81cb-4e71085ddef3", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "fbc50605-97e6-544e-9e95-bb0275117aff", "question": "Which opioid receptor causes dysphoria, miosis, diuresis & sedation?", "A": "Mu1", "B": "Mu2", "C": "Kappa", "D": "Delta", "choice_num": 4, "target": "C", "category": 1 }, { "id": "fc770dd3-3374-57f6-8386-a95eb0dd3487", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "cc956756-d615-50b1-baf9-5bcd745c1821", "question": "What is the onset of action for Morphine?", "A": "2 hours", "B": "30-60 seconds", "C": "15-30 minutes", "D": "5-10 minutes", "choice_num": 4, "target": "C", "category": 1 }, { "id": "550a41ef-c4ec-5982-ba46-d99717a70c23", "question": "Which of the following effects is NOT associated with morphine.", "A": "Facial Redness", "B": "Stop Shivering", "C": "Hypotension", "D": "All of the above", "choice_num": 4, "target": "B", "category": 1 }, { "id": "96d1fbf1-1ce3-5831-ab9b-d3ebbf451d73", "question": "Which of the opioids will NOT cause miosis?", "A": "Morphine", "B": "Fentanyl", "C": "Meperidine", "D": "Narcan", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b39f27f1-7405-5227-bf8c-a5cd5e405003", "question": "Which opioid has the highest degree of lipid solubility?", "A": "Sufentanil", "B": "Remifentanil", "C": "Fentanyl", "D": "Morphine", "choice_num": 4, "target": "C", "category": 1 }, { "id": "568deac3-febe-5b30-a319-a83117511fcd", "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", "choice_num": 4, "target": "D", "category": 3 }, { "id": "7c8ad3dd-3f5c-5741-998f-30d78eed62b9", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1d6b1166-5636-5e26-bee4-4b2eee990063", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "59b3690b-7c69-5c64-a46b-52c55f029abb", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "9114db64-e294-5b5b-9abf-12cb74148b90", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3821c09a-0648-5ebe-a01b-362ecfb1c82c", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6d87489e-0f64-57fb-889e-42f24df8ad8a", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8473d9d5-042f-5114-a363-18c3254e80f7", "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", "choice_num": 5, "target": "C", "category": 1 }, { "id": "773f100d-92cf-5148-9d9f-7db08f66a71f", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "5015fb3b-f571-5df3-982f-815c8ca71784", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "e8bca84d-bb57-50b0-a895-8a47ad7ca930", "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", "choice_num": 2, "target": "B", "category": 1 }, { "id": "91f7b8e1-a099-5779-8339-fb4db0dc90cf", "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.", "choice_num": 3, "target": "B", "category": 2 }, { "id": "9aa91ec0-5546-5e47-be41-0d2f736c5e85", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "7f87ba2e-3a41-54ec-9e52-2d128a069d85", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0ab33f4d-bf06-540e-9910-58879406e5e7", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "357a17e4-443e-5b3a-b277-41b6ef9b1d55", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "89f05e21-88ce-59e5-afe9-e42a81706922", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "36d134d4-cf0b-5371-83b9-6af036a8e57e", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "8d12d7c2-228d-55b2-9010-23fd96675870", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c585f8b9-5484-5762-a307-1f20f611ab8b", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "747468b2-6765-577d-be37-dc14ca79a624", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "76b8c0e9-d2e3-5a1d-b896-638d60ae3a56", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a8198545-da9e-51f8-a90e-429be2f0d846", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d65ff90d-1ca6-5c2a-be33-f9c845008248", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "25f2f4cf-b955-5b02-84e8-6e21554c9be3", "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.", "choice_num": 3, "target": "A", "category": 1 }, { "id": "f64badad-21d4-5c13-8d5f-64485ab52f7c", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "e8a0dd46-5175-5d80-8174-f3be61fc1512", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "0c01de2d-2e67-5485-9ebd-dca92118b4d9", "question": "Which benzo would be used to treat panic attacks?", "A": "Lorazepam", "B": "Alprazolam", "C": "Flurazepam", "D": "Diazepam", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9cf178f3-0b10-5f0b-a906-1885eb2a307c", "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", "choice_num": 4, "target": "C", "category": 2 }, { "id": "0e69aae9-08e5-5bf8-9c2a-ef8f34193ffe", "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.", "choice_num": 3, "target": "A", "category": 1 }, { "id": "d2ed33c8-8b86-5998-9fb3-fabbe409b76a", "question": "A Barbituate with a sulfur atom on the #2 carbon is called a...", "A": "Thiobarbituates", "B": "Oxybarbituates", "C": "Pentabarbituate", "D": "Sulbarbituates", "choice_num": 4, "target": "A", "category": 1 }, { "id": "296a5893-d98e-58c3-83ed-bdca13329b49", "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.", "choice_num": 3, "target": "B", "category": 1 }, { "id": "ef347e06-8405-5d91-86a6-d02a77c7c235", "question": "Duration of action of highly lipid soluble barbituates is determined by...", "A": "Hepatic Oxidation", "B": "Lipid Solubility", "C": "Renal Excretion", "D": "Redistribution", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ff127121-6c5f-5f20-88cf-470aed6df2d0", "question": "The elimination half time of Methohexital is ~4 hours.", "A": "True", "B": "False", "choice_num": 2, "target": "A", "category": 1 }, { "id": "55eaaf89-b6e2-53c4-a345-a270ebfa034d", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "b4abb820-f0d8-597b-b326-750b651f8daf", "question": "Unlike the benzo's, Barbituates are known to increase CBF and ICP.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "92280ffb-4481-5ee8-b9c3-f40075ae4ffa", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "3a5922c2-09c3-5e77-9979-1da83eb3d319", "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.", "choice_num": 3, "target": "A", "category": 1 }, { "id": "ba4422c4-0ff2-5ea3-a1f6-15bbf8aa78b4", "question": "Which of the following is NOT an endogenous peptide?", "A": "Endorphin", "B": "Ekephalin", "C": "Dynorphine", "D": "Epinorphin", "choice_num": 4, "target": "D", "category": 1 }, { "id": "b91cb59b-88e0-5535-be68-de7648bd5688", "question": "Which opioid receptor produces ONLY spinal analgesia.", "A": "Mu2", "B": "Kappa", "C": "Mu1", "D": "Delta", "choice_num": 4, "target": "A", "category": 1 }, { "id": "32c39b6d-3c89-5e96-a0bb-40918ad2950c", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "a50c7caa-fbd5-5481-86df-0b215296523b", "question": "30mg of Ketorolac would be equivalent to how much morphine?", "A": "1 mg", "B": "30 mg", "C": "15 mg", "D": "10 mg", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ba9d9317-179e-5beb-8395-c067ce4bad12", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "eea2956f-9c9a-5188-8527-244527257dcb", "question": "Which opioid receptors are responsible for physical dependence?", "A": "Mu1 & Mu2", "B": "Mu2 & Delta", "C": "Mu1 & Kappa", "D": "Kappa & Delta", "choice_num": 4, "target": "B", "category": 1 }, { "id": "d942e7f5-2491-5395-ab9d-8cc420622540", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "ab0b5120-5aa1-5c3e-9dd4-8718b2a4b255", "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.", "choice_num": 3, "target": "C", "category": 2 }, { "id": "d312e61a-01ce-553b-aaaa-c52203bde507", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1946abb2-552f-584b-b6f7-f460cdbd2bf6", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "6d75c970-2b1c-5c13-887b-46530dd4f375", "question": "Which benzodiazepine is primarily used for induction of anesthesia?", "A": "Midazolam", "B": "Propofol", "C": "Thiopental", "D": "Etomidate", "choice_num": 4, "target": "A", "category": 1 }, { "id": "1fd46658-3ada-5cae-b597-4c220ec5c08f", "question": "Which of the following is not an effect of opiods?", "A": "Chest wall rigidity", "B": "Fetal respiratory depression", "C": "Anterograde Amnesia", "D": "Constipation", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8bd9ba5c-b64e-55d3-a014-ee345c484534", "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", "choice_num": 5, "target": "B", "category": 1 }, { "id": "dcc7cad1-cf8b-5461-878b-32965d9f73cc", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "465938ed-19df-5bad-a437-ad3254c8dc05", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "eaadfcb9-138d-5418-aa29-c43e98128240", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5f898723-e0de-5c56-bd73-a8861a97e113", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "ea601da0-3d77-5146-9a29-cb01ff06251a", "question": "A  barbituate with an oxygen atom on the #2 carbon would be called a...", "A": "Thiobarbituates", "B": "Malobarbituates", "C": "Pentabarbituates", "D": "Oxybarbituate", "choice_num": 4, "target": "D", "category": 1 }, { "id": "19a320af-699f-5ca4-b2b8-40b04d8a732b", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c79c49eb-7cab-5b5c-8e8f-dee1ce484a5a", "question": "Which opioid receptor causes depression of ventilation, physical dependence, minimal constipation & urinary retention?", "A": "Mu1", "B": "Mu2", "C": "Kappa", "D": "Delta", "choice_num": 4, "target": "D", "category": 1 }, { "id": "e40d163a-bf9c-5137-beee-a73edcad95b1", "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.", "choice_num": 4, "target": "C", "category": 1 }, { "id": "8d5e280a-2e1f-57c5-80ef-debc16cabd47", "question": "Benzodiazepines are preferred as a pre-medication for anesthesia because they do not cause any respiratory depression in patients.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "3f3bde22-a38a-5cea-ae48-f44a7acc5e53", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "dd9aadf8-d9ec-584b-913f-6a811d951de5", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "2f825960-94d1-5973-ba51-5a64494402aa", "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", "choice_num": 3, "target": "A", "category": 1 }, { "id": "bdf0f8f2-9787-57bc-9704-df783841293d", "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?", "choice_num": 4, "target": "C", "category": 1 }, { "id": "f2da649e-ae0c-5ac9-891f-bbc37e84fa4c", "question": "A Competitive antagonist binds to a site other than the agonist binding domain.", "A": "True", "B": "False", "choice_num": 2, "target": "B", "category": 1 }, { "id": "f817846f-6736-5d23-b43f-7dc734999f79", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "4a0833f1-e61a-5d08-8a7f-f1601fc72a97", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "6708492a-04e5-56e6-867a-b915c3f11dc1", "question": "Which of the following is NOT a pharmacological effect of benzodiazepines?", "A": "Amnesia", "B": "Anxiolysis", "C": "Analgesia", "D": "Anticonvulsant", "choice_num": 4, "target": "C", "category": 1 }, { "id": "3947f0e1-574f-5c9c-87ba-8658fe995031", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "8dfa4aa3-1282-55f9-b7ee-2c706bc0c71a", "question": "Endorphin stimulates which opioid receptor?", "A": "Mu", "B": "Kappa", "C": "Delta", "choice_num": 3, "target": "A", "category": 1 }, { "id": "dba1b1f8-07d3-5050-a1fc-7a306e0580f1", "question": "Distribution of barbituates depends on all of the following except...", "A": "Lipid Solubility", "B": "Protein binding", "C": "Hepatic oxidation", "D": "Degree of ionization", "choice_num": 4, "target": "C", "category": 1 }, { "id": "bd4ecc93-bfa5-5650-ac00-702f9d4ed957", "question": "Which benzodiazepine is primarily used to treat anxiety?", "A": "Lorazepam", "B": "Midazolam", "C": "Diazepam", "D": "Temazepam", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b868440d-d858-50e2-852c-a37217501a84", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "30e67074-ffaa-50df-8be7-1430dd919d76", "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", "choice_num": 4, "target": "D", "category": 2 }, { "id": "87788817-1cff-5141-b623-ae3ac003fea0", "question": "Epidural or subarachnoid placement of opioids is based on activation of which receptors?", "A": "Kappa", "B": "Mu", "C": "Delta", "D": "All the above", "choice_num": 4, "target": "B", "category": 1 }, { "id": "2bd18367-c09f-5f20-abd4-c462f65cef55", "question": "What is the half life of Narcan?", "A": "60-90 minutes", "B": "30-45 minutes", "C": "3 hours", "D": "4-6 hours", "choice_num": 4, "target": "A", "category": 1 }, { "id": "8ac20f59-b87d-554f-b095-60841da1b8b3", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "5c9903b3-c33e-5b71-ae59-4c3ed675566b", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "16b6e98c-f287-5400-8015-c6f2daf42d50", "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", "choice_num": 5, "target": "A", "category": 1 }, { "id": "9c517e99-9526-52fb-b1a9-96aab63571b1", "question": "Which class of drug would to NOT give to a pt undergoing a cholangiogram?", "A": "Benzo's", "B": "Barbituates", "C": "Opioids", "choice_num": 3, "target": "C", "category": 2 }, { "id": "a558ef56-6df9-50df-918d-84f9f448a782", "question": "How are barbituate metabolized?", "A": "Hepatic Oxidation", "B": "Renal oxidation", "C": "Glomerular filtration", "D": "Broken down in small intestines and excreted in feces", "choice_num": 4, "target": "A", "category": 1 }, { "id": "a97f4627-8e2b-536c-9392-f44cc43f848d", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2e6c8076-6a98-51e7-8a25-4129103b483a", "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", "choice_num": 4, "target": "A", "category": 2 }, { "id": "6b8566c0-6247-5622-ae82-197ff6b7d19e", "question": "The drug most commonly prescribed to treat opioid overdose is?", "A": "Flumazenil", "B": "Nalbuphine", "C": "Naloxone", "D": "Butorphanol", "choice_num": 4, "target": "C", "category": 1 }, { "id": "e86542d1-271e-5edc-bd50-e6b2cd553370", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ae835a26-8c13-5a5c-8565-9b0a5bcfe4a0", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "c260765d-afac-5fe0-ab7e-558118cdec9d", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "17fff495-3956-5737-b7f4-e3d1421588d6", "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.", "choice_num": 4, "target": "D", "category": 2 }, { "id": "f6592ee6-7444-53f6-8f6f-350c7e96110c", "question": "Enkephalin is responsible for stimulating which opioid receptor?", "A": "Mu", "B": "Kappa", "C": "Delta", "choice_num": 3, "target": "C", "category": 1 }, { "id": "175ce3b9-65dd-59f7-89e1-7c17f75cf94f", "question": "How much methohexital would you expect to find excreted unchanged in the urine?", "A": "< 1%", "B": "1-3 %", "C": "5-10 %", "D": "95%", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e412968a-1f1b-5f53-9ba8-0c440fc8ea8f", "question": "How long can Methohexital be refrigerated and stable for after mixing?", "A": "2 weeks", "B": "6 weeks", "C": "6 days", "D": "1 month", "choice_num": 4, "target": "B", "category": 1 }, { "id": "76f82048-c36c-5828-b31a-e7c17928cf95", "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", "choice_num": 2, "target": "B", "category": 1 }, { "id": "27456300-2e8b-52a9-9e2c-4403da30af41", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "2b3e7860-97f3-5a18-886d-a3fe6d8bc6fa", "question": "Which of the opioid receptors causes Euphoria, Miosis, Bradycardia, Urinary retention & Hypothermia?", "A": "Delta", "B": "Mu1", "C": "Mu2", "D": "Kappa", "choice_num": 4, "target": "B", "category": 1 }, { "id": "9c0f3a8d-556c-5459-a3cf-8b9634a364a5", "question": "Meperidine acts on which opioid receptors?", "A": "Mu & Delta", "B": "Only the Mu receptors", "C": "Delta & Kappa", "D": "Mu & Kappa", "choice_num": 4, "target": "D", "category": 1 }, { "id": "60d1dc88-4f6b-5cac-9abe-f1f160612af5", "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.", "choice_num": 4, "target": "B", "category": 1 }, { "id": "c9064c97-b99d-5c48-8a06-91dd03ea502a", "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", "choice_num": 4, "target": "B", "category": 1 }, { "id": "5ccb58b1-6c36-53c3-8e84-092e79936dd0", "question": "Where would you find Laminar flow in the body?", "A": "Terminal Bronchioles", "B": "Carina", "C": "Larger Airways", "D": "Blood Flowing into the heart", "choice_num": 4, "target": "A", "category": 1 }, { "id": "56bf510b-1a89-53ba-b7ae-a7c8727645a4", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "f1fb6cbc-6aa1-59fa-aa75-b84471b3a5da", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "a905185f-306b-577c-b253-0146ecbcd6d9", "question": "The Sagital plane divides the body into...", "A": "Left and Right", "B": "Superior and Inferior", "C": "Anterior and Posterior", "D": "Right and Wrong", "choice_num": 4, "target": "A", "category": 1 }, { "id": "d3ba9605-21d7-5f3e-b402-3b24a1edb58f", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "1e577532-ebbf-5b84-af0b-605ee6feb419", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "204578c1-4139-50fd-a528-de1c8e32507a", "question": "What is the hydration of SodaLyme?", "A": "14-19%", "B": "8-10%", "C": "19-23%", "D": "33%", "choice_num": 4, "target": "A", "category": 1 }, { "id": "e0795ac7-c24b-54ac-a422-5d50f115c934", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "7885d8b2-c955-5126-a77a-008daa92cb14", "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.", "choice_num": 3, "target": "C", "category": 1 }, { "id": "033af2af-e909-5f0b-ad73-c424ec6e87b0", "question": "What is the chemical reaction that occurs within the C02 absorber?", "A": "Reduction", "B": "Oxidation", "C": "Neutralization", "D": "Hydrolysis", "choice_num": 4, "target": "C", "category": 1 }, { "id": "1185dae5-42fe-5f6e-91f2-9e4222de7211", "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", "choice_num": 4, "target": "C", "category": 1 }, { "id": "ff686457-fd20-56ec-971a-4622691fff30", "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", "choice_num": 4, "target": "B", "category": 2 }, { "id": "0ed665bc-be42-5212-a026-42a127a1112a", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "671544d2-476d-5d95-8bc8-3d79299186e7", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "84e36cab-6658-5f92-b8ea-121a3eec0007", "question": "What is the MAIN component of SodaLyme?", "A": "CaOH", "B": "NaOH", "C": "KOH", "D": "H2O", "choice_num": 4, "target": "A", "category": 1 }, { "id": "b0a01a75-6b65-5248-8f94-9155195c4b31", "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.", "choice_num": 4, "target": "A", "category": 1 }, { "id": "2f25eeb3-c166-52f4-a132-3c0a23c575e5", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "f622f261-1ccc-507a-9c51-7ce602dac318", "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", "choice_num": 4, "target": "A", "category": 1 }, { "id": "33c58654-0add-5ed7-a1f6-4d788b419036", "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.", "choice_num": 4, "target": "D", "category": 1 }, { "id": "0f0ac9bf-a72e-57cc-be90-b968199657f8", "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.", "choice_num": 4, "target": "B", "category": 2 }, { "id": "170d3b76-85e3-5e0e-8574-91149befaa84", "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", "choice_num": 4, "target": "D", "category": 1 }, { "id": "c1f7e23b-fcc2-50dc-8cbb-49ef13bbad23", "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", "choice_num": 4, "target": "C", "category": 2 } ]