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4bfd778b-3cdd-5f89-90ee-8b46d1234783 | Cerebral blood flow is decreased by | chronic respiratory acidosis | hypoxia | hypoglycemia | polycythemia | 5 | D | 1 | the postictal state | null | null | null | null |
31973a0b-cb68-55d3-a677-b2ff84b330bc | 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? | An effective cordotomy will produce motor block | A series of stellate ganglion blocks will provide permanent relief | Cordotomy must be performed with the patient awake | Cordotomy will effectively relieve phantom limb pain | 5 | E | 1 | Spinal opioids are an alternative treatment of this pain | null | null | null | null |
f3c65334-9059-52d1-8542-5c742e2a4e6a | 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? | Maximum effect occurs one hour after injection | Maximum effect occurs when drug concentration peaks in cerebrospinal fluid | Maximum effect occurs during the acute phase of the disease | The beneficial effect results primarily from sympathetic neurolysis | 5 | C | 1 | It is contraindicated if the patient has had prior surgical procedures on the lumbar disks | null | null | null | null |
7b6ab6f2-01f5-5efb-9103-d5a2a6ef102a | Mismatching of ventilation to perfusion in the lung is greatest in which of the following situations? | Awake patient, spontaneous ventilation, lateral decubitus position | Anesthetized patient, controlled ventilation, supine position | Anesthetized patient, controlled ventilation, lateral decubitus position | Anesthetized patient, controlled ventilation, sitting position | 5 | C | 3 | Anesthetized patient, spontaneous ventilation, prone position | null | null | null | null |
5e475aee-a4aa-5ba0-b3b7-3b43529fd232 | In patients with blunt head trauma, cerebral perfusion pressure is determined by the gradient between | diastolic pressure and central venous pressure | intracranial pressure and central venous pressure | mean arterial pressure and central venous pressure | mean arterial pressure and intracranial pressure | 5 | D | 1 | systolic pressure and intracranial pressure | null | null | null | null |
34676cee-a13b-59aa-a129-631027b0491b | During therapy for eclampsia, toxic blood levels of magnesium sulfate can be distinguished from therapeutic levels by the presence of | diminished knee jerk reflex | a widened QRS complex on EKG | fetal tachycardia | maternal drowsiness | 5 | B | 1 | uterine rigidity | null | null | null | null |
7e6cda50-b66e-5b53-8678-f78465bc2eff | During transurethral resection of the prostate, intravascular absorption of glycine irrigant most commonly produces | alkalosis | hemolysis | hypertension | tachycardia | 5 | C | 1 | wheezing | null | null | null | null |
317d72c7-436a-5e55-ab69-ea10d8982041 | 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 | atrial fibrillation (ventricular rate 100 bpm) | paroxysmal atrial tachycardia (150 bpm) | sinus bradycardia | piloerection above the level of C6 | 5 | C | 3 | sweating above the level of C6 | null | null | null | null |
add6e482-8f5b-5cfd-96ad-d882b41166e3 | 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? | The gas mixture will contain equal partial pressures of halothane and isoflurane | The gas mixture will produce a greater depth of anesthesia than 1.5% isoflurane alone | The gas mixture will produce a greater depth of anesthesia than 1.5% halothane alone | The liquid mixture will have a higher vapor pressure than 1.5% halothane alone | 5 | B | 2 | The liquid mixture will have a higher vapor pressure if it is placed in a halothane-specific vaporizer | null | null | null | null |
5fd64dfd-c0c0-50d5-a370-53faeb84aaba | Recommendations for maximal allowable trace anesthesia gases are based on | achievable levels with modern scavenging systems | data from animal studies | data on methionine synthetase levels in anesthesiologists | evidence for an association with malignancy in anesthesiologists | 5 | A | 1 | evidence for an association with spontaneous abortion In operating room personnel | null | null | null | null |
3357a350-6315-5195-b0cc-6e6f31a16846 | If minute ventilation is held constant, which of the following is LEAST likely to alter PaCO2? | General anesthesia | Hypothermia | Increased dead space | Increased pulmonary shunt | 5 | D | 3 | Induced hypotension | null | null | null | null |
0a4219f7-903a-52b3-acdc-e75a83a0cf62 | 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? | Delivery of the shock wave is timed by the R wave of the ECG | Continuous epidural anesthesia is contraindicated because of the risk for infection | If a regional technique is used, a T10 sensory level is required for adequate anesthesia | If general anesthesia is used, high tidal volumes and low respiratory rate are preferred | 5 | A | 1 | Removal of the patient from the bath is accompanied by an increase in blood pressure | null | null | null | null |
54560f71-970c-5cb4-b236-e22b03177293 | Which of the following is the greatest disadvantage of pressure-cycled ventilation? | Increased I:E ratio | Increased mechanical dead space | Increased risk for barotrauma | Variable respiratory rates | 5 | E | 1 | Variable tidal volumes | null | null | null | null |
1028bc8b-7b88-5265-ae9d-9a3b935eae56 | 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 | absence of the central temperature control mechanism | conductive heat loss | convective heat loss | evaporative heat loss | 5 | D | 2 | radiant heat loss | null | null | null | null |
bd14b314-02bb-5c7e-8474-f28a9c2699bd | Each of the following is a complication of celiac plexus block with 0.5% lidocaine 40 ml EXCEPT | hematuria | ileus | postural hypotension | retroperitoneal hematoma | 5 | B | 1 | weakness of hip flexors | null | null | null | null |
e32d2fb0-9372-562e-9bda-f620efff2c12 | 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? | Injury to the thoracic duct | Injury to the recurrent laryngeal nerve | Injury to the phrenic nerve | Perforation of the esophagus | 5 | A | 1 | Pneumothorax | null | null | null | null |
cc352083-506b-5ab3-b255-5b613aa92c9e | 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, ... | position the patient head down, right side up and aspirate the CVP catheter | withdraw the CVP catheter 5 cm | infuse potassium chloride rapidly | administer furosemide | 5 | B | 2 | ask the neurosurgeon to reevaluate the patient immediately | null | null | null | null |
47d101a2-c951-5dc4-a6f9-f01a7972d69d | 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 | blunted sensitivity to low pH in the medullary respiratory center | chronic carbon dioxide retention | decreased lung volume from supine positioning | depression of carotid body chemoreceptors by halothane | 5 | A | 3 | suppression of hypoxic ventilatory drive by supplemental oxygen | null | null | null | null |
e61705fa-1f3d-5015-8a6a-706a2d64d919 | Which of the following procedures is most specific for diagnosing reflex sympathetic dystrophy in a patient with pain of the lower extremity? | Caudal epidural local anesthetic block | Differential spinal anesthesia | Intravenous regional administration of bretylium | Lumbar epidural administration of a corticosteroid | 5 | C | 1 | Paramedian L1-L5 facet injections of lidocaine | null | null | null | null |
3395c697-79aa-5231-86d4-cf9f27aa4e3d | Bronchospasm occurring during anesthesia in a patient with an ileal carcinoid is best treated by administration of | aminophylline | dexamethasone | halothane | ketamine | 5 | A | 1 | somatostatin | null | null | null | null |
44e3d737-c538-561e-aeb2-0f199d1a1a0f | A 50-year-old woman develops stridor 10 hours after undergoing thyroidectomy. The most appropriate management is administration of which of the following drugs? | Albuterol | Calcium chloride | Ipratropium bromide | Racemic epinephrine | 5 | B | 2 | Triiodothyronine | null | null | null | null |
b3c9e190-7b42-5e21-aa5a-75aebc848c30 | 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? | Axillary | Median | Musculocutaneous | Radial | 5 | C | 2 | Ulnar | null | null | null | null |
7f2fa182-d543-5d53-beb0-9c1a2984c1ec | 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 | atropine administration | sodium bicarbonate administration | naloxone administration | controlled ventilation | 5 | E | 2 | tracheal suctioning | null | null | null | null |
fb551ec2-8a99-554b-87d1-bec2c2585476 | 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... | shunt fraction is greater than 10% | catheter is in the wedged position | catheter has entered a pulmonary vein | cardiac output is abnormally high | 5 | B | 2 | oxygen electrode is malfunctioning | null | null | null | null |
9f251a10-5dd5-5cae-a1d0-6f6d72011944 | 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 foll... | Fluid overload with 5% dextrose in water | Inappropriate secretion of antidiuretic hormone | Increased free water clearance | Nephrogenic diabetes insipidus | 5 | B | 2 | Neurogenic diabetes insipidus | null | null | null | null |
4949d9b6-7aff-5ce2-a3e0-546d91ee2f6e | In a patient with adult respiratory distress syndrome who is being mechanically ventilated, which of the following findings indicates the most severe disease? | Decreased functional residual capacity | Decreased lung compliance | Hypercarbia | Hypoxemia | 5 | C | 3 | Increased dead space | null | null | null | null |
a257160a-50f7-5eed-b783-67350cf51837 | 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 | administer additional opioid | decrease PaCO2 from 25 to 15 mmHg | drain cerebrospinal fluid | discontinue nitrous oxide | 5 | C | 3 | induce hypotension | null | null | null | null |
8d1e6617-bda0-5fc5-924c-3798a6bcbc1c | 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? | Normal muscle tone | Bradycardia | Opisthotonos | Respiratory depression | 5 | A | 1 | Seizures | null | null | null | null |
072ea7f2-cd26-5232-9512-6eca0aba46ec | 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? | Decreasing the fresh gas flow | Increasing respiratory minute volume | Opening the pressure release valve | Removing the reservoir bag | 5 | A | 2 | Substituting larger bore tubing | null | null | null | null |
8e1188b1-428e-55f8-a4d2-435727c2c384 | 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 | reaction to epinephrine in the anesthetic solution | anaphylactoid reaction to bupivacaine | subarachnoid injection of bupivacaine | peridural venous injection of bupivacaine | 5 | E | 3 | vertebral artery injection of bupivacaine | null | null | null | null |
ae577548-3594-5ad0-87f0-a7de125cd2fd | A sensory level of T2 is achieved after administration of spinal anesthesia. Which of the following lung volumes is LEAST likely to be affected? | Expiratory reserve volume | Inspiratory reserve volume | Inspiratory capacity | Tidal volume | 5 | D | 2 | Vital capacity | null | null | null | null |
d5a195d1-09e7-5a0b-a71c-719f56c1a8fb | 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,... | Decreased cardiac output | Increased dead space ventilation | Inhibition of hypoxic pulmonary vasoconstriction | Mainstem intubation | 5 | C | 3 | Second gas effect | null | null | null | null |
e1267a71-b6c9-5812-b063-e48733d0e4dd | Each of the following is a physiologic effect of intra-aortic balloon pump therapy EXCEPT | decreased peak systolic pressure | increased cardiac output | increased coronary perfusion | increased diastolic pressure | 5 | E | 1 | increased total peripheral resistance | null | null | null | null |
5ea22fdf-deb4-5cf2-b20b-5c9ce0868f36 | Patients with acute alcohol intoxication are at increased risk for each of the following complications of general anesthesia EXCEPT | aspiration of gastric contents | hyperglycemia | hypothermia | ketoacidosis | 5 | B | 1 | respiratory depression | null | null | null | null |
768e86a3-3ed9-5145-b7a2-9d8bf0ee72b1 | 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 | aerosol administration of terbutaline | intravenous infusion of phenylephrine and nitroglycerin | intravenous infusion of esmolol | intravenous infusion of epinephrine and nitroprusside | 5 | D | 3 | volume loading with lactated Ringer's solution | null | null | null | null |
f03666b9-844d-564f-99ea-70ea6aa4b90e | 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 nasogast... | additional intravenous fluids | furosemide diuresis | administration of ammonium chloride | reinstitution of mechanical ventilation | 5 | E | 2 | administration of potassium chloride | null | null | null | null |
28206443-476e-5fcf-8a31-859765743728 | Pulmonary artery diastolic pressure is an unreliable indicator of left ventricular end-diastolic pressure in patients with | acute cardiogenic pulmonary edema | aortic stenosis | acute mitral regurgitation | myocardial ischemia | 5 | E | 1 | severe emphysema | null | null | null | null |
ced30b94-fe0a-5560-b634-10f19db72dd1 | Neostigmine administered intravenously without atropine can produce each of the following EXCEPT | arousal | bradycardia | bronchoconstriction | increased gastric motility | 5 | A | 1 | increased urinary bladder tone | null | null | null | null |
5e0e3957-3eb1-526e-9fa3-bc166aaa5be6 | Which of the following is the most effective treatment of shivering following general anesthesia? | Administration of droperidol | Administration of morphine | Administration of midazolam | Administration of warm intravenous fluids | 5 | E | 1 | Skin-surface warming | null | null | null | null |
91b77a67-7937-5a3a-9134-7d2ba8c0b821 | The accuracy of oxyhemoglobin saturation determined by digital pulse oximetry is affected significantly by each of the following EXCEPT | movement of the patient | isovolemic hemodilution to a hematocrit of 23% | position of the operating room light | intravenous administration of methylene blue | 5 | B | 1 | infusion of phenylephrine | null | null | null | null |
c8dd4acc-3f6d-5718-acb5-59fcac724675 | The syndrome of inappropriate ADH secretion is characterized by | ADH secretion unrelated to serum osmolality | decreased ADH secretion in response to hypovolemia | highly dilute urine | hypernatremia | 5 | A | 1 | negative water balance | null | null | null | null |
33fca6ea-af93-5f22-9d1b-3dcbc7bec55a | 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? | Respiratory insufficiency | Sensory and motor block at T4-S1 | Sensory and motor block at L1-S5 | Sensory loss without motor block at L1-S5 | 5 | C | 2 | Sensory and motor block at S3-S5 | null | null | null | null |
cfd6800e-224f-5d1e-85b5-ef048771a4b6 | Each of the following conditions is a complication of mediastinoscopy EXCEPT | air embolism | hemorrhage | injury to the left recurrent laryngeal nerve | occlusion of the left carotid artery | 5 | D | 1 | tension pneumothorax | null | null | null | null |
caaad5e8-3d19-5895-a24b-af5c2957e9cf | Which of the following factors is the major cause of hypotension following release of the infrarenal aortic cross-clamp during aortic reconstruction? | Abnormal myocardial function | Decreased systemic vascular resistance | Down-regulation of adrenergic receptors | Increased PaCO2 | 5 | B | 1 | Suppression of the renin-angiotensin system | null | null | null | null |
2a5f3f32-aca4-5fd8-b245-824019d5c0fd | Following hypothermic cardiopulmonary bypass, adequacy of total body rewarming is best indicated by normothermia recorded from the | upper esophagus | lower esophagus | pulmonary artery | rectum | 5 | E | 1 | great toe | null | null | null | null |
b47b7209-6c23-5b17-bd9e-b73137749d7d | 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 | administration of carbamazepine | epidural injection of morphine | local infiltration with bupivacaine | lumbar sympathetic blockade | 5 | C | 2 | peroneal nerve blockade | null | null | null | null |
4e2784b7-5dfb-5d91-a150-f439e006ce3c | Compared with blood anticoagulated with CPD, blood stored in CPDA-1 has | better preservation of 2,3-DPG concentration | better preservation of ATP concentration in erythrocytes | shorter erythrocyte survival | shorter shelf life | 5 | B | 1 | decreased platelet aggregation | null | null | null | null |
fb27306f-f8e9-5bfa-8748-c61780a95704 | 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 | 10 | 25 | 33 | 50 | 5 | B | 1 | 75 | null | null | null | null |
64759a0b-a659-503f-a903-f1e28b0b839a | Compared with adults, neonatal respiratory function is characterized by | a lower ratio of dead space to tidal volume | a more compliant chest wall | a more positive intrapleural pressure at end-expiration | less susceptibility to atelectasis | 5 | B | 1 | the same oxygen requirement per kilogram of body weight | null | null | null | null |
927ed4cd-c53a-5134-aa0e-31d6c3c14ab2 | During laser excision of a vocal cord polyp, the tracheal tube ignites. Which of the following is the most appropriate next step? | Continue ventilation with air | Ensure patency of the endotracheal tube | Extubate the trachea | Flood the surgical field with saline solution | 5 | C | 2 | Increase the concentration of nitrous oxide | null | null | null | null |
c2060981-29aa-5083-bb0a-7d8457f1c83b | 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 | epidural hematoma | common peroneal nerve injury | sacral nerve root injury | sacral plexus injury | 5 | B | 2 | sciatic nerve injury | null | null | null | null |
faead0a2-3aed-55a7-b47f-4b066e0876d9 | 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? | Cerebral edema | Cerebral embolism | Cerebral vasospasm | Hypertensive encephalopathy | 5 | E | 2 | Second subarachnoid hemorrhage | null | null | null | null |
745a50c8-eae0-5a2f-88c3-8de737255d1a | 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 | cephalad displacement of the diaphragm | decreased production of carbon dioxide | increased cardiac output | increased shunting of blood through dependent lung zones | 5 | E | 3 | increased ventilation of nondependent lung zones | null | null | null | null |
69323dea-dc2a-57c5-828b-64f077d0dde8 | 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? | Epidural hematoma | L5 nerve root injury | Obturator nerve injury | Peroneal nerve injury | 5 | E | 3 | Sciatic nerve injury | null | null | null | null |
b56b5766-1994-52ff-8033-c9fe4dd75788 | 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 | if left untreated, muscle atrophy may develop in the involved limb | if left untreated, the pain will remain well localized | physical therapy is not indicated | the symptoms are directly related to the severity of the initial injury | 5 | A | 2 | the symptoms are most likely secondary to underlying peripheral vascular disease | null | null | null | null |
220c844f-a483-528e-ba69-38608793eac0 | Hyperkalemia in response to the administration of an intubating dose of succinylcholine is associated with each of the following disorders EXCEPT | poliomyelitis | multiple sclerosis | hemiplegia | acute cervical cord transection | 5 | D | 1 | familial periodic paralysis | null | null | null | null |
a59e9867-2ee2-57c7-9af7-af432d72d57e | Which of the following is the most likely beneficial effect of hyperbaric oxygen therapy in a 24-year-old scuba diver with decompression sickness? | Decreased production of carbon dioxide | Decreased size of gas bubbles | Increased functional residual capacity | Reversal of membrane pressure effects | 5 | B | 2 | Shift of the oxyhemoglobin dissociation curve to the left | null | null | null | null |
a53b90ce-41f7-5b7a-8369-83408a97fbfa | Which of the following is suggestive of epiglottitis rather than croup? | A 2-year-old child with a harsh, barking cough | A 4-year-old child who insists on sitting up and leaning forward | Leukocyte count of 10,000/mm3 with marked lymphocytosis | Rectal temperature of 38.5°C | 5 | B | 1 | Subglottic narrowing (steeple sign) on lateral neck radiograph | null | null | null | null |
3a8de211-96bf-5d45-b688-cb6ad7257a1d | In calculating the fluid requirements for a newborn undergoing repair of an omphalocele, the third-space loss should be replaced by | 0.9% saline solution | 2.5% dextrose in 0.45% saline solution | 5% dextrose in lactated Ringer's solution | 5% dextrose in water | 5 | A | 1 | 5% dextrose in 0.25% saline solution | null | null | null | null |
17ea4be7-6efa-570a-b919-62319991ffae | The most important factor regulating blood flow to ischemic cerebral tissue is | systolic blood pressure | PaO2 | cerebral perfusion pressure | PaCO2 | 5 | C | 1 | cerebral oxygen consumption | null | null | null | null |
d627937e-10ec-59dd-bd12-bb697e68f14c | Measurement of which of the following provides the most reliable information about the severity of bronchospasm? | Diffusing capacity | Expiratory reserve volume | Forced expiratory volume in 1 second | Residual volume | 5 | C | 1 | Total lung capacity | null | null | null | null |
165389a1-0680-5f64-9eff-b8af0780e3b9 | When inspired anesthetic gases are humidified | most particles 1 to 2 microns in size are deposited in the trachea | respiratory epithelial cilia become less active | alveolar water vapor pressure is unchanged | respiratory heat loss is abolished | 5 | C | 1 | sterilization of breathing apparatus is mandatory | null | null | null | null |
0911baee-ddfe-5fef-81a4-5953a70c8278 | 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 | forced expiratory volume in 1 second | forced midexpiratory flow | forced vital capacity | maximal voluntary ventilation | 5 | B | 2 | peak flow rate | null | null | null | null |
96a0f928-9694-5080-a02f-2439ed97dd44 | 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? | 140 | 250 | 420 | 600 | 5 | A | 1 | 740 | null | null | null | null |
4a64a931-74a5-5d27-b29f-f8899cbdd03a | 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? | Trigeminal | Facial | Glossopharyngeal | Vagus | 5 | C | 1 | Hypoglossal | null | null | null | null |
0f8233ae-c1c6-533d-b2be-6be6a160cf4f | Which of the following is most likely in a 30-year-old patient with untreated hypothyroidism? | Cardiac arrhythmias with ketamine administration | Decreased ventilatory response to hypoxia | Hypoglycemia | Increased MAC of inhalational anesthetics | 5 | B | 1 | Peripheral vasodilatation | null | null | null | null |
66750711-0bf8-5763-9cd1-d92f7229ab8c | The most medial of the following components in the antecubital fossa is the | brachial artery | brachioradialis muscle | cephalic vein | median nerve | 5 | D | 1 | radial nerve | null | null | null | null |
661ad5f8-5997-5367-a378-99a12e5e2882 | 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 | controlled ventilation | increased airway resistance | inhibition of hypoxic pulmonary vasoconstriction | intraoperative hypothermia | 5 | E | 3 | preferential ventilation of nondependent lung | null | null | null | null |
53e144d6-b8f9-5760-bf4d-2ea90fd3e755 | 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 | lumbar epidural block with bupivacaine 8 ml of 0.5% solution | chlorpromazine 2.5 mg administered intravenously | avoidance of narcotics | lumbar epidural block with 2-chloroprocaine 8 ml of 3% solution | 5 | A | 3 | chlorpromazine 10 mg administered intramuscularly | null | null | null | null |
d2b9927b-6390-5a21-b5ac-14175edf335f | 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 | epidural hematoma | intrapelvic nerve trauma | lithotomy positioning | reaction to the preservative in the anesthetic solution | 5 | B | 3 | trauma from the epidural needle | null | null | null | null |
97681bf7-d984-5c07-9c6f-0f9958a51833 | Long-term use of cimetidine is associated with | delayed emergence after thiopental induction | increased hypotension after morphine | increased risk for isoflurane-induced nephrotoxicity | prolonged action of succinylcholine | 5 | E | 1 | prolonged sedation with diazepam | null | null | null | null |
97c73293-f41c-54fa-839a-f3d6a79671e9 | 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 | administer lidocaine intravenously | decrease ventilatory rate | discontinue halothane | lower the patient's head | 5 | D | 3 | inspect the ventilator bellows | null | null | null | null |
58afbbcb-7eae-5f82-b854-ccdaaaf695bb | 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 i... | hypovolemic shock | intracerebral hemorrhage | nitroprusside toxicity | overdose of magnesium sulfate | 5 | B | 3 | pituitary necrosis | null | null | null | null |
ba181bb1-312b-5f31-bbe9-499d252d4f3d | Which of the following is the most likely cause of the rapid onset of local anesthesia when sodium bicarbonate is added to lidocaine? | Decreased extracellular calcium ion concentration | Increased extracellular pH | Increased intracellular pH | Increased ionized lidocaine diffusion | 5 | E | 2 | Increased nonionized lidocaine concentration | null | null | null | null |
5ab12a79-41ca-5498-92d6-f6a53cb90acd | 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 addi... | Axillary nerve | Intercostobrachial nerve | Lateral antebrachial cutaneous nerve | Musculocutaneous nerve | 5 | B | 2 | Stellate ganglion | null | null | null | null |
02432d2a-35f0-5917-ac8e-d0ffdf6ac038 | Uterine blood flow is | autoregulated in normal unanesthetized parturients | decreased by the addition of epinephrine 1:200,000 to lidocaine administered epidurally | decreased by intravenous infusion of ritodrine in unanesthetized parturients | increased by administration of magnesium sulfate to patients with preeclampsia | 5 | D | 1 | unchanged after paracervical injection of lidocaine without epinephrine | null | null | null | null |
6368c3e1-651d-52cb-b69d-eb7b3ecd0875 | 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 | discontinue isoflurane | administer edrophonium | administer esmolol | administer lidocaine | 5 | C | 2 | administer propylthiouracil | null | null | null | null |
c0f38cb5-d810-5027-8759-aa80b3482cb1 | Which of the following statements concerning caudal anesthesia in children is true? | The dural sac extends further caudad than in adults | Delay of postoperative micturition occurs in most patients | The sensory level of analgesia is poorly correlated with the dose of local anesthetic | It is technically difficult because of poorly defined sacral anatomy | 5 | A | 1 | It is contraindicated in infants younger than 1 year of age | null | null | null | null |
5f949385-eac3-5d04-99ca-5d7d48c1022b | Compared with adults, caudal anesthesia in children is associated with | higher risk for subarachnoid puncture | more severe hypotension | more rapid onset of sensory block | smaller volume of anesthetic per kilogram of body weight | 5 | A | 1 | toxic effects at lower serum levels of bupivacaine | null | null | null | null |
876764c2-032d-54a7-b407-6089208299a4 | 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 | the risk for fetal intraventricular hemorrhage is increased | the risk for neonatal hypoglycemia is increased | placental glucose transport is insulin dependent | the neonate should be given dextrose 50% in water if depressed at delivery | 5 | B | 2 | the mother should be given insulin prior to delivery | null | null | null | null |
28e28fb2-3678-5b79-987f-d0a5d8b3f1d2 | 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? | Intercostobrachial | Median | Musculocutaneous | Ulnar | 5 | A | 2 | Radial | null | null | null | null |
ae31a914-bf4f-5826-815f-06719c981b67 | 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 | longer duration | more rapid onset | more intense block | more difficult reversibility | 5 | A | 2 | similar pharmacokinetics | null | null | null | null |
d1e0589b-ffac-59fe-a333-6805929770ef | 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? | Decreased cardiac output | Endobronchial intubation | Hyperinflation of the lungs | Partial disconnect of the capnograph sample tubing | 5 | D | 2 | Venous air embolism | null | null | null | null |
4489bca4-f06d-53a4-adaa-f3e6de36d538 | Which of the following increases during infusion of epinephrine? | Glycogen synthesis | Intracellular glucose concentration | Intracellular potassium concentration | Lipogenesis | 5 | C | 1 | Protein synthesis | null | null | null | null |
0ddf40e6-6629-5272-9582-e451f06c7991 | Alveolar stability at varying lung volumes is maintained by | constant surface tension | increased surface tension at low lung volume | decreased surface tension at high lung volume | decreased surface tension at low lung volume | 5 | D | 1 | none of the above | null | null | null | null |
5e18eb86-80b9-5c94-98f7-d5322b293fa8 | 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? | The risk for development of HIV infection is greater than the risk for development of hepatitis | Hepatitis immune globulin is indicated if the health care worker is HBcAg positive | Hepatitis B vaccine should be administered | Hepatitis immune globulin will protect equally against hepatitis B and hepatitis C (non-A, non-B) | 5 | C | 1 | Hepatitis B vaccine carries a risk for transmission of HIV | null | null | null | null |
44d9a726-92af-5c8f-b4b6-3a0a21f781a1 | Compared with thiopental, methohexital is characterized by | better absorption after rectal administration | greater protein binding | greater hepatic clearance | larger volume of distribution | 5 | C | 1 | more complete biotransformation | null | null | null | null |
9437afda-3cb1-57e7-931e-fb90620a5f53 | 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 manage... | administer propranolol | administer nitroglycerin | administer dopamine | administer crystalloid fluid | 5 | E | 3 | return the patient to cardiopulmonary bypass | null | null | null | null |
68aecd4f-4167-5464-86f9-e702a511f523 | 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? | Air embolism with the presence of a probe-patent foramen ovale | Compression of the cervical cord related to neck flexion | Jugular venous obstruction | Postoperative tension pneumocephalus | 5 | B | 2 | Sustained elevation of cerebral perfusion pressure | null | null | null | null |
9956dc05-70dc-5872-b72f-f5ef99e63b9c | In an unpremedicated, spontaneously breathing patient, an alveolar halothane concentration of 0.74% in oxygen is consistently associated with | absence of overt response to skin incision | constricted pupils | flaccidity of abdominal muscles | normal glomerular filtration rate | 5 | B | 1 | normal myocardial contractility | null | null | null | null |
5eaf1b12-d3db-514b-9163-5cfc0bcf778f | Which of the following detects the smallest volume of venous air embolization? | Changing the precordial Doppler ultrasound signal | Decreasing PetC02 | Decreasing Sp02 | Increasing central venous pressure | 5 | A | 1 | Increasing pulmonary artery pressure | null | null | null | null |
e3c2bda1-cc45-5d60-b9ef-110348f618a2 | 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? | Precipitation when mixed with an equal volume of pancuronium = local anesthetic | pH 7.1 = saline solution | Glucose 120 mg/dl = CSF | Sodium 130 mEq/L = CSF | 5 | D | 1 | PCO2 51 mmHg = CSF | null | null | null | null |
88c86958-2c0c-57b4-bf14-025afe4dfe40 | 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? | Decreased pulmonary vascular resistance | Decreased ratio of dead space to tidal volume | Increased ventilation of nondependent alveoli | Increased perfusion of nondependent alveoli | 5 | C | 2 | Improved matching of ventilation to perfusion | null | null | null | null |
8b8b0b9f-0eb1-5111-bf34-d8e46895ac22 | A subarachnoid block to a sensory level of the second thoracic dermatome is associated with each of the following EXCEPT | total sympathetic block | decreased gastrointestinal smooth muscle tone | bradycardia | relaxation of gastrointestinal sphincters | 5 | B | 2 | decreased renal blood flow | null | null | null | null |
988010e7-7582-5768-ad0b-4864d5043e45 | Each of the following drugs increases the duration of succinylcholine action EXCEPT | echothiophate | gentamicin | magnesium sulfate | pyridostigmine | 5 | B | 1 | trimethaphan | null | null | null | null |
39804efa-c37d-5845-9d6d-c63e7e05c610 | 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? | Aspiration of gastric contents must have occurred | Hypoventilation alone can explain the acidosis and hypoxemia | The hypoxemia is probably due to noncardiogenic pulmonary edema | Naloxone should be administered only if the patient is normothermic | 5 | B | 2 | Pure oxygen is contraindicated | null | null | null | null |
3a0efbe8-233f-570e-829f-209abddd65f9 | 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? | Atropine | Epinephrine | Isoproterenol | Metaraminol | 5 | B | 2 | Phenylephrine | null | null | null | null |
b3800c10-c47f-5984-b094-1a97ec60139d | 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? | Placement of an orogastric tube | Insertion of a chest tube | Controlled ventilation by face mask | Controlled ventilation through an endotracheal tube | 5 | D | 2 | Spontaneous ventilation through an endotracheal tube | null | null | null | null |
b5f507c9-db9e-53a8-9eb0-9d9d298b5c58 | The muscular action most likely to remain intact following an axillary brachial plexus block is | flexion at the elbow | extension at the wrist | flexion of digits 3, 4, and 5 | extension of digits 1, 2, and 3 | 5 | A | 1 | extension at the elbow | null | null | null | null |
aeb6d102-884a-5937-a958-938aec413718 | 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 d... | endobronchial intubation | excessive expiratory time | excessive tidal volume | low cardiac output | 5 | D | 3 | pulmonary aspiration | null | null | null | null |
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