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e6939849-700c-5de7-b027-d24a34d18129 | 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 | administration of naloxone 50 mcg intramuscularly | increasing the FiO2 to 0.4 | intubation and mechanical ventilation at an FiO2 of 0.5 | administration of oxygen 50% with 5 cm H2O continuous positive airway pressure | 5 | E | 3 | observation, with no action at present | null | null | null | null |
865b1681-1f79-585f-85d1-2e1908e6232b | 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 | greater decrease in blood pressure | higher risk for neurotoxicity | higher risk for systemic toxicity | lower risk for spinal cord injury | 5 | E | 2 | shorter duration of action | null | null | null | null |
042112cb-5eb2-5f66-9840-b8749116142f | In the operating room | conductive floors are necessary for electrical safety | the ECG monitor may be used as a grounding source | an improperly grounded electrocautery causes ventricular fibrillation | an isolation transformer offers no protection against microelectrocution | 5 | D | 1 | a line isolation monitor will interrupt power automatically if excessive leakage to ground is detected | null | null | null | null |
63e56994-085b-5f59-a2f1-dbf3483b7e10 | A 45-year-old man with chronic liver failure is scheduled for liver transplantation. Which of the following preoperative findings is most likely? | Hypoxemia | Increased platelet count | Increased systemic vascular resistance | Increased serum factor VIII concentration | 5 | A | 1 | Metabolic alkalosis | null | null | null | null |
6320372e-04dc-5c12-97cf-55c19d51bfe0 | 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 | remove the nasogastric tube | insert a chest tube on the right side | withdraw the endotracheal tube 1 cm | deflate the cuff on the endotracheal tube | 5 | A | 3 | replace the endotracheal tube with one of larger internal diameter | null | null | null | null |
9dacfc5e-5c7a-59d9-8f00-a4ec5fe6e2c6 | 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 | bed rest | administration of a nonsteroidal anti-inflammatory agent | epidural administration of a corticosteroid | epidural administration of a local anesthetic | 5 | E | 2 | surgical decompression | null | null | null | null |
3c7164ed-ee13-5ae9-9091-3c12ff2cbfd8 | Each of the following statements about pheochromocytoma is true EXCEPT: | Preoperative administration of alpha-adrenergic inhibitors will usually reverse EKG changes due to catecholamine myocarditis | Preoperative administration of alpha-adrenergic inhibitors decreases operative mortality | Beta-adrenergic inhibitors should be administered preoperatively only in conjunction with alpha-adrenergic inhibitors | Vasopressor therapy may be necessary postoperatively for treatment of hypotension | 5 | E | 1 | Nasal congestion is a sign of inadequate alpha-adrenergic block | null | null | null | null |
42795862-a9da-5433-9248-a5284a1fda3c | 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? | Aspiration pneumonitis | Chronic obstructive pulmonary disease | Decreased cardiac output | Decreased VD/VT ratio | 5 | C | 3 | Increased QS/QT ratio | null | null | null | null |
429e4263-18d5-5c14-9932-6c63d2c0ada8 | 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? | Hyperventilation to a PaCO2 of 15 to 20 mmHg | Administration of furosemide 20 mg intravenously | Administration of mannitol 0.5 g/kg | Administration of thiopental 250 mg in increments | 5 | D | 3 | Addition of halothane 1% to deepen anesthesia | null | null | null | null |
ba168b95-0ccc-5574-8e71-5108700d0f51 | 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 | no intervention unless symptoms occur | prophylactic antibiotics | epidural corticosteroids | dye contrast study of the epidural space | 5 | A | 1 | neurosurgical exploration | null | null | null | null |
f5d9b821-ef7a-5716-a8bf-47d9f85aaf24 | 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 | acute tubular necrosis | chronic renal insufficiency | dehydration | obstruction of the bladder outlet | 5 | C | 2 | recent gastrointestinal hemorrhage | null | null | null | null |
f90c6739-2023-569e-9861-17ddc5f22976 | Which of the following nerves is most likely to be injured by a fracture of the shaft of the humerus? | Axillary | Median | Musculocutaneous | Radial | 5 | D | 1 | Ulnar | null | null | null | null |
21aab6ee-98f3-5e00-a4f3-666896a0d2ff | In a 5-kg boy with Treacher Collins syndrome who is to undergo cleft palate repair, endotracheal intubation is best accomplished with | awake nasal intubation after topical anesthesia | halothane anesthesia with spontaneous ventilation | light isoflurane anesthesia and a muscle relaxant | thiopental and succinylcholine sequence intravenously | 5 | B | 2 | nasal intubation after administration of ketamine intramuscularly | null | null | null | null |
d8a92ebf-09d1-52b2-a97c-1b4e5cd1cfa7 | 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? | Enflurane nephrotoxicity | Hypovolemia | Intraoperative renal ischemia | Positive pressure ventilation | 5 | C | 3 | Unilateral ureteral obstruction | null | null | null | null |
2006d9db-5118-5092-a2fb-a7888e4640d4 | Which of the following statements about patient-controlled analgesia using opioids is true? | It is not associated with respiratory depression | It obviates loading doses | It requires a background opioid infusion to be effective | It requires intravenous administration to be effective | 5 | E | 1 | It requires less drug than intramuscular dosing for similar analgesia | null | null | null | null |
2d18ea3a-4a9e-514b-845d-202d5e3fe9a6 | Which of the following pre-existing conditions predisposes to new-onset third-degree heart block during pulmonary artery catheterization? | First-degree heart block | Left bundle branch block | Sick sinus syndrome | Sinus bradycardia | 5 | B | 1 | Wenckebach second-degree heart block | null | null | null | null |
87a1710e-d29e-5693-863e-9493636339aa | 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 | albuterol | isoflurane | midazolam | nitroglycerin | 5 | E | 3 | succinylcholine | null | null | null | null |
b2928ec5-8b70-5cc9-adb5-c0a7cb98be1e | With respect to mechanical ventilation, which of the following statements concerning the portion of tidal volume known as compression volume is true? | It is calculated by dividing the volume of gas delivered to the patient by the peak pressure | It does not contribute to the volume of gas entering the patient | It is not included in the volume measured by a spirometer on the inspiratory limb | It decreases with the addition of a humidifier to the breathing circuit | 5 | B | 1 | It decreases with the addition of one-way valves at the Y connector of the breathing circuit | null | null | null | null |
2de1f3ad-b0b5-5934-85a4-a8aa6bcf885b | 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 | external branch of the superior laryngeal nerve | internal branch of the superior laryngeal nerve | recurrent laryngeal nerve | glossopharyngeal nerve | 5 | C | 1 | vocal cords | null | null | null | null |
4dc63d94-cf8c-5279-91a1-4a0f0de360d2 | Which of the following is the most reliable indicator of adequate reversal of neuromuscular block? | Inspiratory force equal to -30 cmH20 | Sustained head lift for 5 seconds | Train-of-four ratio of 0.7 | Twitch height at 100% of control | 5 | B | 1 | Vital capacity of 15 ml/kg | null | null | null | null |
8badf02c-18dc-5765-8cf8-f11a65c6cda2 | Which of the following conditions is a contraindication to the use of succinylcholine? | Burns of 50% body surface area occurring 12 hours ago | Cirrhosis | Myotonic dystrophy | Seizure disorder | 5 | C | 1 | Spinal cord transection within the past six hours | null | null | null | null |
bb0eb1b5-dd94-5583-aac8-b69ab06a405a | Desflurane is delivered using a vaporizer that contains internal heaters because | heat decreases the drug's viscosity | heat reduces thermal loss in the patient | heat increases the drug's oil-gas partition coefficient | heat prevents fluctuations of vapor pressure | 5 | D | 1 | it does not vaporize adequately at room temperature | null | null | null | null |
d7057b18-5e01-58c9-b205-a64904143db7 | The speed of induction of anesthesia with an inhalational agent is increased by | decreased cardiac output | decreased minute ventilation | increased functional residual capacity | right-to-left intracardiac shunt | 5 | A | 1 | use of a more soluble agent | null | null | null | null |
efae3631-0a69-5da8-aa39-e0958767b727 | During extracorporeal shock wave lithotripsy, the shock wave should be synchronized with | the P wave of the ECG | the R wave of the ECG | the T wave of the ECG | peak inspiration | 5 | B | 1 | end-expiration | null | null | null | null |
7b61bcf4-2eba-52ca-a5ad-23e9923dac1b | 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 | spinal anesthesia | inhalational anesthesia | thiopental intravenously | methyldopa intravenously | 5 | E | 3 | nitroprusside intravenously | null | null | null | null |
ace215a0-dc53-5761-b3f1-6bfda747d174 | Which of the following malfunctions causes the line isolation monitor to alarm? | Discharge of static electricity | Flow of current to ground in the isolated circuit | Interruption of current to electrical outlets caused by a circuit breaker | Surge of current in the main power supply | 5 | B | 1 | Total electrical current exceeding circuit capacity | null | null | null | null |
84ab30a8-6a7d-5e65-96ef-23bb50b1e280 | 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 | marked hypoglycemia | mild hypoglycemia | normoglycemia | mild hyperglycemia | 5 | D | 2 | marked hyperglycemia | null | null | null | null |
9ff9b0d3-fb8e-566f-88d4-c4a874588b9a | Which of the following limits the use of nalbuphine for relief of postoperative pain? | High incidence of nausea and vomiting | High incidence of delayed respiratory depression | Potential for inducing seizures with repeated doses | Relatively low maximal analgesic effect | 5 | D | 1 | Short duration of action | null | null | null | null |
ef82526a-93f2-57d6-80df-ff20f269c458 | 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 | hypoxic circulatory depression | inadequate expiratory time | increased pulmonary vascular resistance | respiratory alkalosis | 5 | B | 2 | tension pneumothorax | null | null | null | null |
8574c8d9-8dbb-5fbf-957c-a2b144b5a75b | 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? | Decreased PaCO2 | Increased cardiac output | Increased fresh gas flow | Increased solubility of the volatile agent | 5 | C | 2 | Presence of a ventricular septal defect | null | null | null | null |
75a19dda-4c86-5a45-a428-12cbbc675a59 | The most important anesthetic consideration in Pierre Robin syndrome is | anterior tilt of the larynx | hyperplasia of the internal surface of the maxilla | mandibular hypoplasia | hypertrophy of the epiglottis | 5 | C | 1 | tracheomalacia | null | null | null | null |
89b6c326-613e-5d61-a25c-850f383a4e86 | 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? | Oral ketamine | Oral midazolam | Rectal methohexital | Intramuscular droperidol | 5 | B | 2 | Intramuscular promethazine | null | null | null | null |
c3f29e50-e18f-513f-b8b2-4713ce77846a | Cardiac output measured by thermodilution with a pulmonary artery catheter most accurately reflects systemic blood flow in a patient with | aortic regurgitation | atrial septal defect | patent ductus arteriosus | tricuspid insufficiency | 5 | A | 3 | ventricular septal defect | null | null | null | null |
bac89d2d-e709-57ef-b4b3-960e56cf4166 | Which of the following is most likely to increase hepatic blood flow during general anesthesia? | Addition of positive end-expiratory pressure | Discontinuation of isoflurane and administration of enflurane | Increased PaCO2 | Moderate controlled hypotension | 5 | C | 1 | Subarachnoid administration of morphine | null | null | null | null |
f9d0c408-7ba2-538c-ac04-35b00d209ef7 | 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 | change from oxygen and nitrous oxide to air | fill the oropharynx with water | instill water into the endotracheal tube | remove the endotracheal tube | 5 | D | 3 | ventilate with carbon dioxide | null | null | null | null |
857d5b13-ac39-5087-8d3a-d09836d9886f | Addition of 20 cmH2O positive end-expiratory pressure to a patient receiving controlled mechanical ventilation decreases cardiac output and left ventricular function by | increasing right ventricular preload | increasing right ventricular afterload | increasing left ventricular preload | increasing left ventricular afterload | 5 | D | 3 | producing myocardial ischemia | null | null | null | null |
aa85f504-0606-557b-a67c-2e8242c2173e | Each of the following is an adverse effect of ritodrine used for suppression of labor EXCEPT | dysrhythmias | hyperglycemia | hyperkalemia | hypotension | 5 | C | 1 | pulmonary edema | null | null | null | null |
3526b195-3c30-53a5-b805-620d10861ac6 | 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 dibucaine number of 20 | incomplete antagonism of pancuronium | prolongation of the action of succinylcholine by neostigmine | spinal cord damage caused by the abrupt arousal | 5 | C | 2 | synergism between succinylcholine and pancuronium | null | null | null | null |
d3039d9e-a0a7-5cea-bb0b-abea87b0427b | Which of the following factors is the LEAST important determinant of postdural puncture headache? | Age of the patient | Gauge of the spinal needle | Gender of the patient | Pregnancy | 5 | E | 1 | Time until ambulation | null | null | null | null |
aa4960fa-695c-5f07-a8a0-27460db22fc6 | The alveolar concentrations of anesthetics increase more rapidly in children than in adults because of a greater | blood volume (per kg body mass) | cardiac index | MAC | ratio of alveolar ventilation to functional residual capacity | 5 | D | 1 | tidal volume (per kg body mass) | null | null | null | null |
8f091c83-f804-537a-95a0-d8032c18023f | Which of the following statements regarding fetal heart rate patterns is true? | Early decelerations suggest umbilical cord compression | Fetal heart rates between 160 and 180 bpm are normal | Fetal heart rate unaffected by uterine contraction suggests fetal well-being | Late decelerations indicate inadequate uteroplacental perfusion | 5 | D | 1 | Variable decelerations indicate need for urgent delivery | null | null | null | null |
c0e0dc29-408b-54a0-bd77-7614a027c36f | 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 | nitrous oxide | etomidate | ketamine | methohexital | 5 | B | 2 | midazolam | null | null | null | null |
ffcc034a-a192-5ec9-ba44-920ce1fafb82 | Dantrolene | antagonizes the effect of nondepolarizing muscle relaxants | produces clinically detectable muscle weakness when administered intravenously prior to anesthesia | is indicated for neuroleptic malignant syndrome | may cause hepatic failure when used prophylactically before anesthesia | 5 | B | 1 | has increased effectiveness when combined with calcium entry blockers | null | null | null | null |
9c3a9fe7-7b4b-5132-a134-6d1f56c6b06b | 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 | metabolic acidosis | pulmonary embolism | increased body temperature | interstitial pulmonary edema | 5 | C | 3 | aspiration pneumonia | null | null | null | null |
a370f52b-f600-518e-aba1-961aa891890a | 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? | Administration of naloxone | Administration of physostigmine | Induction of general anesthesia | Determination of serum electrolyte concentrations | 5 | B | 2 | CT scan of the head | null | null | null | null |
82fe3512-e2fa-580a-9369-61e42310c3dc | Which of the following statements concerning autonomic hyperreflexia after spinal cord transection is true? | It occurs within 24 hours after the injury | It occurs with lesions below T10 | It is caused by a reflex increase in parasympathetic outflow | It is characterized by paroxysmal hypotension and tachycardia | 5 | E | 1 | It is prevented by blocking afferent visceral pathways | null | null | null | null |
e9a8d227-0dcd-5489-9fd2-9fdf6eb2732d | Which of the following is true of both the neonatal and adult airways? | Epiglottic innervation is primarily vagal | Sniffing position requires placement of a pillow under the occiput | The cricoid ring is the narrowest part of the airway | The epiglottis has a relatively similar size and shape | 5 | A | 1 | The glottis is located at C3-4 | null | null | null | null |
f7a35476-ffcf-5be0-9178-4dc10193c2fd | Which of the following combinations of anesthetic and incorrect vaporizer results in the smallest error in delivered concentration? | Sevoflurane in a halothane vaporizer | Sevoflurane in an isoflurane vaporizer | Halothane in a desflurane vaporizer | Isoflurane in a halothane vaporizer | 5 | D | 2 | Sevoflurane in a desflurane vaporizer | null | null | null | null |
465a4fba-bc94-5e3c-b5df-9ccadd268d00 | 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? | Esmolol | Hydralazine | Isoflurane | Nitroglycerin | 5 | A | 1 | Sodium nitroprusside | null | null | null | null |
bd59883c-796a-573d-bf2f-94289b840db2 | Increasing preload, systemic vascular resistance and heart rate will best maintain hemodynamic stability in patients with | aortic stenosis | asymmetric septal hypertrophy (IHSS) | cardiac tamponade | mitral regurgitation | 5 | C | 2 | mitral stenosis | null | null | null | null |
3c1fcb80-3942-50c9-8b59-9de387b62d1c | Which of the following is an effect of magnesium sulfate at the neuromuscular junction? | Augmentation of acetylcholine reuptake | Decrease in acetylcholine binding | Decrease in acetylcholine metabolism | Decrease in the prejunctional release of acetylcholine | 5 | D | 1 | Potentiation of the effects of ionized calcium | null | null | null | null |
b8fb8d73-3dde-5852-8f26-02c8f545472e | A patient with end-stage renal disease has prolonged ventilatory depression after administration of morphine. The most likely cause is increased | serum concentration of morphine-6-glucuronide | elimination half-life of morphine | opioid receptors | receptor affinity | 5 | A | 1 | volume of distribution | null | null | null | null |
ab554063-c52a-5d75-8234-232f24676739 | Fentanyl-induced bradycardia is | independent of the speed of injection | independent of dose | caused by direct inhibition of adrenal catecholamine release | caused by vagal stimulation | 5 | D | 1 | caused by direct SA node depression | null | null | null | null |
cf97a69f-ca40-5b2e-b2f6-f03c117b6c9c | 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? | Doubling the length of circle system hoses | Decreasing the barometric pressure | Changing from rubber to plastic breathing hoses | Decreasing fresh gas flow | 5 | D | 2 | Exhaustion of the soda lime | null | null | null | null |
3ae0b40f-197a-571d-ac26-ca4353a99122 | Which of the following findings is most likely in patients with acute transection of the spinal cord at the level of C6? | Autonomic hyperreflexia | Hyperkalemia with administration of succinylcholine | Hypotension | Increased pulmonary blood flow | 5 | C | 1 | Tachycardia | null | null | null | null |
b8a00cc5-c6a1-5839-bf82-a9e3b21e6908 | Which of the following decreases the clearance of atracurium? | Administration of cimetidine | Cholinesterase deficiency | Hepatic insufficiency | Hypothermia | 5 | D | 1 | Renal insufficiency | null | null | null | null |
d6b8ffa5-1ac1-582a-bd84-5a900e81d745 | 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? | Pulmonary artery occlusion pressure | Serum fluoride concentration | Serum osmolality | Response to antidiuretic hormone | 5 | D | 3 | Response to fluid restriction | null | null | null | null |
9051beed-7216-5475-bdef-f8f7dd984f0b | The primary purpose of denitrogenation prior to anesthetic induction is to | blunt hypoxic pulmonary vasoconstriction | improve ventilation and perfusion matching | increase contribution of second gas effect to rate of induction | increase oxygen reserve in the functional residual capacity | 5 | D | 1 | maximize arterial oxygen content | null | null | null | null |
2609a83c-0803-5955-81a3-6ff1eb8732c3 | Which of the following findings would be considered normal in the EEG of an adult? | Decreased frequency during induction with halogenated anesthetics | Decreased frequency in frontal areas with administration of nitrous oxide 50% | Dominance of beta rhythm at 20 to 30 Hz during the awake relaxed state | Electrical silence with administration of isoflurane 2.5 MAC | 5 | D | 1 | The presence of burst-suppression during natural sleep | null | null | null | null |
6b61bbed-9f0e-5249-9ec6-fbe15dc88775 | Which of the following statements concerning a patient who has been receiving nitroprusside for several days is true? | Biotransformation of cyanide requires a sulfur donor | Formation of methemoglobin increases cyanide toxicity | Increased serum thiocyanate concentrations are innocuous | Mixed venous P02 decreases as cyanide toxicity develops | 5 | A | 1 | Serum thiocyanate concentrations reflect the degree of cyanide toxicity | null | null | null | null |
3c521ba9-7f31-5719-9b0f-d0ad0f95cecc | Each of the following statements about the blood supply of the spinal cord is true EXCEPT: | The anterior spinal artery is made up of branches from the vertebral, intercostal, and iliac arteries | The segmental blood supply of the cord depends upon the location of the arteria radicularis magna (Adamkiewicz) | The posterior spinal arteries supply most of the spinal cord | Obstruction of the inferior vena cava increases blood flow through the epidural venous plexus | 5 | C | 1 | The spinal cord is supplied by one anterior spinal artery and two posterior spinal arteries | null | null | null | null |
111260c4-04f0-57b1-9274-176e5f0deb31 | Which of the following statements concerning pressure support ventilation is true? | It augments gas inflow in response to spontaneous inspiration | It increases inspiratory airway pressure during controlled mandatory ventilation | It requires the use of positive end-expiratory pressure | It functions independently of airway resistance/lung compliance | 5 | A | 1 | It correlates linearly with spontaneously achieved tidal volume | null | null | null | null |
4978f630-5944-5193-aeb9-c7dfeb25943d | 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? | Decreasing sevoflurane concentration | Infusion of nitroglycerin | Intravenous administration of a fluid bolus | Intravenous administration of esmolol | 5 | D | 3 | Intravenous administration of phenylephrine | null | null | null | null |
d49657dc-540e-5414-be95-68b25cad1f10 | Alveolar dead space is decreased by | halothane anesthesia | positive end-expiratory pressure | deliberate hypotension | atropine premedication | 5 | E | 2 | decreased tidal volume | null | null | null | null |
06cf6b22-49b1-51f6-94e6-247cdb06d731 | 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 | hyperventilation | low cardiac output | the second-gas effect | tissue solubility of halothane | 5 | D | 3 | vaporizer temperature less than 19°C | null | null | null | null |
e5639b90-f99f-5804-9e88-ac515194d4b2 | 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? | If the oropharynx is clear, observation for respiratory effort | Placement of an oxygen mask and application of positive pressure to clear the airway | Nasotracheal suctioning | Tracheal suctioning using the endotracheal tube | 5 | D | 2 | Intubation and ventilation with 100% oxygen | null | null | null | null |
5bba44f9-debb-5005-a69c-e5890875d272 | Each of the following statements concerning norepinephrine is true EXCEPT: | Extraneuronal uptake is important in the termination of its activity | It is formed from dopamine | Its release is facilitated by ephedrine | Its uptake is affected by cocaine | 5 | A | 1 | It has minimal beta2-adrenergic activity | null | null | null | null |
86860281-b1c5-547b-8e56-5ed9dd78e1d7 | 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? | Increasing ventilatory frequency | Increasing suction on the chest tube | Applying 10 cmH2O positive end-expiratory pressure | Using a double-lumen tube for differential ventilation | 5 | D | 3 | Starting negative-pressure ventilation | null | null | null | null |
64d0b06a-161c-5a83-8dce-d8ad7588d652 | 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 | administer furosemide | administer labetalol | administer 3% sodium chloride | change the irrigating solution to normal saline | 5 | A | 2 | induce general endotracheal anesthesia | null | null | null | null |
88bc1e1f-3a22-5a3e-a2d2-115adecb4ead | In the absence of coronary artery disease, isoflurane-induced vasodilation and tachycardia are beneficial hemodynamic goals for which of the following cardiac diseases? | Aortic regurgitation | Aortic stenosis | Asymmetric septal hypertrophy (IHSS) | Mitral stenosis | 5 | A | 2 | Pulmonary regurgitation | null | null | null | null |
64d7ad48-3792-508f-8828-0b388d076d0c | 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 | measure cardiac output | increase fluid administration | infuse dopamine | administer propranolol | 5 | A | 3 | switch from enflurane to isoflurane | null | null | null | null |
04844053-d5aa-5a0e-b499-21b1d8a078e0 | Which of the following statements concerning postspinal headache is true? | Cerebrospinal fluid leukocytosis occurs | Intravenous caffeine therapy is more effective than epidural blood patch | The incidence decreases with age | The incidence is higher in males than in females of all ages | 5 | C | 1 | The incidence is the same after single or multiple dural punctures | null | null | null | null |
628bb52c-2607-5d2c-a909-49a8dc75073d | At term which of the following would produce the greatest increase in uterine blood flow? | Increasing PaO2 to greater than 100 mmHg | Administering ritodrine intravenously | Administering halothane to 1 MAC | Administering magnesium sulfate intravenously | 5 | C | 3 | Increasing PaCO2 from 35 to 40 mmHg | null | null | null | null |
5d2758b3-f195-5730-a410-34f342298fe9 | 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? | Intercostobrachial | Median | Musculocutaneous | Radial | 5 | B | 2 | Ulnar | null | null | null | null |
c48d6997-5db1-5e03-af7c-61a05d90dbc4 | 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? | Femoral | Lateral femoral cutaneous | Obturator | Pudendal | 5 | C | 1 | Sciatic | null | null | null | null |
97a3dc73-a7e6-5d66-9ee5-76c35f853312 | A successful ankle block for transmetatarsal amputation of the first and second toes should include each of the following nerves EXCEPT the | saphenous | deep peroneal | superficial peroneal | sural | 5 | D | 1 | tibial | null | null | null | null |
70a2114d-6138-507b-a0d0-34e079ea5554 | Each of the following is an effect of rapid infusion of mannitol EXCEPT | depletion of electrolytes | impaired platelet adhesiveness | increased intracranial pressure | increased intravascular fluid volume | 5 | B | 1 | increased renal blood flow | null | null | null | null |
7133a576-283d-5f6e-8601-5d59c37120cf | Which of the following is an effect of metoclopramide? | Decreased lower esophageal sphincter tone | Decreased MAC for enflurane | Extrapyramidal signs | Increased gastric pH | 5 | C | 1 | Relief of intestinal obstruction | null | null | null | null |
3d032d06-b85e-5083-ad0f-3ad2b0b49200 | The rate of induction with inhalational agents is more rapid in neonates than adults because of a relatively increased | cardiac output | cerebral blood flow | functional residual capacity | metabolic rate | 5 | E | 1 | minute ventilation | null | null | null | null |
2cb4dd86-aba0-5c59-9c43-0124565017d5 | Which of the following decreases the risk for burns during electrocauterization? | Conductive flooring | Grounding of the patient to the operating table | Increased resistance at the return electrode | Isolation of the current output of the electrosurgical unit | 5 | E | 1 | Placement of the return electrode at a distance from the surgical site | null | null | null | null |
dfd4c827-a2a3-5d60-8e22-74db52e6570d | Which of the following is a complication of glycine used for irrigation during transurethral resection of the prostate? | Epileptiform activity on EEG | Peripheral neuropathy | Tachycardia | Transient blindness | 5 | D | 1 | Transient deafness | null | null | null | null |
56d6c62a-2c7c-53f0-b816-23a81bf91d21 | When antagonizing neuromuscular block produced by pancuronium, the combination of simultaneously administered anticholinergic and anticholinesterase drugs that is most likely to produce bradycardia is | glycopyrrolate and pyridostigmine | atropine and edrophonium | glycopyrrolate and edrophonium | atropine and neostigmine | 5 | C | 3 | glycopyrrolate and neostigmine | null | null | null | null |
b7d67706-4c75-5a83-b0bf-2e5f544cb41e | Which of the following is a characteristic of phase II neuromuscular block? | It is diagnosed by the intravenous administration of calcium | It is potentiated by edrophonium | It produces nondepolarizing train-of-four characteristics | It requires evaluation for pseudocholinesterase deficiency | 5 | A | 1 | It requires less succinylcholine than a phase I block | null | null | null | null |
80b10f0d-34b4-56b1-a57a-2863c14f4c9b | 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? | Decreased rate of rise of alveolar anesthetic tension | Decreased anesthetic concentration in pulmonary artery blood | Decreased cerebral blood flow | Increased anesthetic concentration in vena cava blood | 5 | E | 2 | No difference in time for anesthetic induction | null | null | null | null |
4a6f9984-9e90-54fa-a814-fff40908ef60 | 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? | Decreased isoflurane concentration | Furosemide | Hyperventilation to a PaCO: of 25 mmHg | Mannitol | 5 | E | 2 | Nitroprusside | null | null | null | null |
8e39e22e-1527-5a3c-976d-982371e447b5 | Assignment of a patient to an ASA physical status category is used to | facilitate comparisons among different patient groups and institutions | guide the choice of anesthetic technique | permit accurate determination of charges for professional services | predict anesthetic risk | 5 | A | 1 | predict perioperative mortality | null | null | null | null |
003e6847-48cb-5269-a7dd-96f321b3c48c | 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 | intravascular injection of bupivacaine | subarachnoid injection of bupivacaine | myocardial ischemia | oculocardiac reflex | 5 | D | 3 | retrobulbar hemorrhage | null | null | null | null |
2db8ca88-1a7e-5cbe-b9dd-02822219b9d7 | 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? | Biliary obstruction | Gilbert's disease | Halothane-associated hepatitis | Hematoma resorption | 5 | A | 3 | Infectious hepatitis | null | null | null | null |
1a91c5d2-2133-5872-b0e8-17ac42a839c2 | 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 | postpone the procedure and consult a cardiologist | postpone the procedure and obtain an echocardiogram | proceed with the procedure after administration of digitalis | proceed with the procedure but avoid inhalational agents | 5 | E | 2 | proceed without intervention since this is a normal finding | null | null | null | null |
80a70d21-c99b-55b6-8c72-436b81bd2f8f | Compared with epidural administration of hydrophilic opioids, epidural administration of lipophilic opioids is associated with | earlier onset of pruritus | greater motor block when combined with local anesthetics | higher incidence of delayed respiratory depression | lesser sensitivity to reversal of analgesia by naloxone | 5 | A | 1 | slower onset of analgesia | null | null | null | null |
9336c9bf-a997-5d45-84a9-268e8be20c6a | 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? | During injection of the local anesthetic | After the patient complains of tourniquet pain | Coincident with inflation of the proximal tourniquet | After the proximal tourniquet is deflated | 5 | B | 1 | Prior to exsanguination of the limb | null | null | null | null |
0713116e-a86c-57ce-bb66-46713d59bb5a | 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? | Observe until the patient recovers spontaneously | Monitor until PetC02 reaches 50 mmHg | Determine dibucaine number | Administer fresh frozen plasma | 5 | A | 2 | Administer glycopyrrolate and neostigmine | null | null | null | null |
58ca7b58-4e79-5c3c-b304-403bd90b30c9 | When the inspired gas is changed from air to 20% oxygen and 80% nitrous oxide, PaO2 increases because | increased pulmonary artery pressure perfuses alveoli that previously enhanced dead space | nitrous oxide stimulates the respiratory center | rapid absorption of nitrous oxide increases alveolar oxygen concentration | replacement of nitrogen by nitrous oxide expands atelectatic alveoli | 5 | C | 1 | respiratory depression from nitrous oxide shifts the oxyhemoglobin dissociation curve | null | null | null | null |
cede7788-f46e-53b7-879c-e07e98e0f118 | 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? | Crystalloid | Ephedrine | Esmolol | Nitroglycerin | 5 | E | 3 | Phenylephrine | null | null | null | null |
ee262378-6ac0-50dd-a6f7-eaa2dbabf1b6 | Which of the following will occur if the top of the oxygen flowmeter is cracked and leaking during anesthesia with nitrous oxide and oxygen? | The back-pressure check valve will protect against a hypoxic gas mixture | The fail-safe mechanism will protect against a hypoxic gas mixture | The inspired oxygen concentration will be less than that set by the flowmeters | The leak will be detected if the circle is pressurized prior to use | 5 | C | 2 | The rotameter will accurately reflect the fresh gas flow to the patient | null | null | null | null |
a31e0b7e-fcf7-5067-8b03-0e6d6dab4884 | If administered prior to induction of anesthesia, which of the following drugs is most likely to cause tachycardia? | Fentanyl | Meperidine | Midazolam | Morphine | 5 | B | 1 | Sufentanil | null | null | null | null |
35a0685e-c339-5ed4-b0e5-c001d7099377 | 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 | carotid sinus massage | intravenous administration of bretylium | intravenous administration of amiodarone | intravenous administration of propranolol | 5 | C | 2 | precordial "thump" | null | null | null | null |
14e7cb8f-93aa-5a1a-a01b-aca003eeb270 | Which of the following statements regarding innervation of the upper extremity is true? | Blockade of the radial nerve decreases the patient's ability to spread the fingers apart | The brachial plexus receives preganglionic sympathetic fibers arising from C5 through T2 | Interscalene injection of the brachial plexus at C6 is likely to spare the axillary nerve. | The musculocutaneous nerves receive contributions from C5 and C6 | 5 | D | 1 | The vertebral artery lies posterior to the nerve roots of the brachial plexus | null | null | null | null |
91555d17-a25a-5f5e-ac01-47d61a8f01db | 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? | Alveolar-to-arterial oxygen tension difference (A-aDO2) less than 100 mmHg while breathing pure oxygen | FEV1/FVC ratio less than 50% | Forced vital capacity less than 2000 ml | Intrapulmonary shunt less than 10% | 5 | C | 1 | Normal pulmonary vascular resistance | null | null | null | null |
c9abdde9-727a-5db8-89e9-ba3f61a413ca | The duration of action of an induction dose of thiopental is determined primarily by its | rate of elimination | rate of metabolism | redistribution from brain to fat | redistribution from brain to muscle | 5 | D | 1 | hepatic extraction | null | null | null | null |
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