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f6060227-67c2-5204-92ef-2368065e0304 | Compared with normal adults, which of the following characteristics of neonates best explains the more rapid inhalation induction in neonates? | Greater cardiac index | Greater metabolic rate | Greater perfusion of vessel-rich tissues | Greater ratio of alveolar ventilation to functional residual capacity | 5 | D | 1 | Less lean body mass | null | null | null | null |
ecbd4aea-612d-533f-9da5-629e3a770594 | With an interscalene brachial plexus block | more local anesthetic drug is required than for axillary block | the biceps and brachialis muscles are blocked last | the intercostobrachial nerve is usually blocked | the lateral antebrachial cutaneous nerve is usually spared | 5 | E | 1 | the ulnar nerve is most likely to be spared | null | null | null | null |
066b3a6b-9ccd-5ad3-bcf6-2fb2ea4402fe | Compared with healthy nonhypertensive patients, in patients with untreated hypertension undergoing anesthesia and operation, | cerebral ischemia may occur at higher blood pressures | intravenous fluid should be restricted before induction | left ventricular hypertrophy enhances compensation for intraoperative fluid loss | responses to sympathetic stimulation are decreased | 5 | A | 1 | the incidence of intraoperative hypotension is lower | null | null | null | null |
e6b597e1-ce43-541e-8d58-5d9a8447347d | At a body temperature of 30°C, resistance to blood flow increases because of | increased hematocrit | increased plasma fibrinogen concentration | increased viscosity of blood | rouleaux formation of red blood cells | 5 | C | 1 | sequestration of platelets in portal circulation | null | null | null | null |
3b2201eb-2e5c-59a4-ba03-967a5e36c1b0 | Which of the following spirometric tests is most likely to be accurate in a patient with severe pain? | Forced expiratory volume in one second | Peak expiratory flow rate | Maximum midexpiratory flow | Maximum breathing capacity | 5 | C | 2 | Negative inspiratory pressure | null | null | null | null |
be134997-1ac1-54df-b393-84fc2816fd65 | Each of the following is an effect of intravascular radiographic contrast media EXCEPT | altered protein binding of anesthetic drugs | bronchospasm | increased systemic vascular resistance | pulmonary edema | 5 | C | 1 | seizures | null | null | null | null |
2bafaffb-a671-59fd-bf1f-1e5a2a073a65 | 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? | Administration of a fluid bolus | Administration of a vasopressor | Application of positive end-expiratory pressure | Discontinuation of nitrous oxide | 5 | C | 3 | Flooding the surgical wound with saline solution | null | null | null | null |
7df9bd30-4840-5392-9439-ad6f547fd5fe | 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 | acidosis at the site of the injection | epinephrine-induced limitation of drug diffusion | insufficient dose | low ionization of lidocaine | 5 | A | 1 | protein binding of lidocaine | null | null | null | null |
614b6b9f-a6ba-58d7-9bef-457510ea0c3d | Which of the following is associated with the application of a transdermal fentanyl patch? | Achievement of a peak plasma level within one hour | Continued uptake after patch removal | Dose-independent plasma clearance | Tachyphylaxis when used for cancer pain | 5 | B | 1 | Naloxone-resistant toxicity | null | null | null | null |
93385df8-b92c-58db-81c9-bc158f46da6f | 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? | Positive-pressure relief mechanism | Negative-pressure relief mechanism | Low-volume scavenging reservoir | High-volume scavenging reservoir | 5 | B | 1 | Maximum vacuum flow rate of 5 L/min | null | null | null | null |
26669121-c424-5f14-a258-45e21ac44e6d | The metabolism of which of the following hypotensive agents is most likely to be affected in patients with severe renal disease? | Esmolol | Hydralazine | Nitroglycerin | Nitroprusside | 5 | D | 2 | Trimethaphan | null | null | null | null |
a857537d-608e-5699-9b35-e60d5757965d | 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 app... | glipizide 5 mg orally | NPH insulin 10 units subcutaneously | regular insulin 10 units intravenously | dextrose and regular insulin by infusion | 5 | E | 2 | no additional diabetic medication | null | null | null | null |
90e14375-13d6-5bed-a8ff-4dd8adcd381d | 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... | increase FiO2 | administer additional atropine | infuse crystalloid | infuse prostaglandin E1 | 5 | E | 3 | administer phenylephrine | null | null | null | null |
c578a956-74bf-52f0-8371-5791e0c5dbf1 | Left ventricular end-diastolic volume is most likely to be underestimated by pulmonary artery occlusion pressure in patients with | acute myocardial ischemia | aortic insufficiency | mitral stenosis | primary pulmonary hypertension | 5 | B | 2 | tricuspid stenosis | null | null | null | null |
863a041c-6272-51ee-805d-e3f851cc4cda | 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... | Bilateral vocal cord paralysis | Cerebral infarction | Congestive heart failure | Denervation of the carotid bodies | 5 | D | 3 | Phrenic nerve injury | null | null | null | null |
306fd87e-e12a-501d-9b62-807df55e6354 | 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? | Herniation of the endobronchial cuff over the carina | Occlusion of the right upper lobe bronchus | Placement of the endobronchial lumen in the left mainstem bronchus | Placement of the endobronchial lumen in the right mainstem bronchus | 5 | D | 2 | Placement of the endobronchial lumen in the trachea | null | null | null | null |
4f07ab91-5daa-5fdf-a401-6c4642ebe2c2 | Which of the following interventions is most effective in preventing neurologic injury resulting from global cerebral ischemia? | Induction of barbiturate coma prior to ischemia | Maintenance of serum glucose concentration greater than 200 mg/dl prior to ischemia | Induction of hypothermia to a core temperature of 15 degrees C prior to ischemia | Maintenance of PaCO2 less than 25 mmHg following ischemia | 5 | C | 1 | Prevention of systemic hypertension following ischemia | null | null | null | null |
be9347f8-202e-51d3-a2bb-6293d40b35ab | Which of the following statements concerning the effects of glycopyrrolate is true? | It decreases gastric pH | It causes bronchoconstriction | It decreases lower esophageal sphincter tone | It does not prevent succinylcholine-induced bradycardia | 5 | A | 1 | It causes a central anticholinergic syndrome | null | null | null | null |
affe9bb4-5a0f-544b-9ae0-8207eb586ecd | 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... | endobronchial intubation | overinflation of the endotracheal tube cuff | pneumothorax | pulmonary edema | 5 | C | 3 | pulmonary embolism | null | null | null | null |
e524a28a-3be3-5bbe-88d0-1d9154a08f53 | Myofascial pain is an example of | a central pain state | neuropathic pain | psychogenic pain | somatic pain | 5 | D | 1 | visceral pain | null | null | null | null |
09dd628d-4798-5fb5-9130-018ce9725e32 | 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 | oxygen 40%, nitrous oxide 60% | oxygen 25%, nitrous oxide 75% | oxygen 30%, nitrogen 70% | oxygen 30%, helium 70% | 5 | D | 2 | oxygen 30%, air 70% | null | null | null | null |
784eb082-eeaa-53f8-8b96-af87b2458846 | 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? | Administration of a phenylephrine bolus when the cross clamp is removed | Correction of any base deficit with sodium bicarbonate during clamping | Decrease of anesthetic to allow blood pressure to increase to 20% above preclamp levels | Volume loading to increase pulmonary artery occlusion pressure prior to removal | 5 | D | 3 | Infusion of dopamine 10 minutes prior to removal | null | null | null | null |
856677c6-eb03-5f1a-845d-87925e574aab | 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? | Axillary | Intercostobrachial | Musculocutaneous | Radial | 5 | C | 2 | Ulnar | null | null | null | null |
83187d89-4726-5b20-ab4c-5fcf2f5e7009 | Which of the following is the most likely effect of infrarenal cross clamping of the aorta without pharmacologic manipulation? | Decreased cardiac output | Decreased pulmonary artery occlusion pressure | Increased left ventricular stroke volume | Increased renal blood flow | 5 | A | 1 | Improved myocardial oxygen supply-demand ratio | null | null | null | null |
eb06bdee-2744-5fb5-86c7-be9d816d2a81 | 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 | droperidol | cimetidine | atropine | meperidine | 5 | A | 2 | midazolam | null | null | null | null |
2b4c2697-0458-58aa-8d31-9a0394f80031 | 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? | Intercostal muscle function is normal | SpO, will be 80% or less while breathing room air | Total lung capacity is normal | The patient has chronic obstructive pulmonary disease | 5 | D | 3 | These findings are expected in this patient | null | null | null | null |
35518728-a7ef-5a98-9650-597dc86700d8 | The plasma concentration of equal doses of a local anesthetic is highest when the site of administration is | axillary brachial plexus | caudal | intercostal | lumbar epidural | 5 | C | 1 | subcutaneous | null | null | null | null |
bace3a70-14a5-5bfd-b914-802a8c8d4ba9 | 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, Opening to Air) | Head Wrist | Head Head | Head Heart | Heart Heart | 5 | B | 2 | Heart Wrist | null | null | null | null |
c9833352-1d14-5523-9e1d-e78bf3ca4ca3 | 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 | isoflurane | nitroprusside | digoxin | nitroglycerin | 5 | D | 2 | furosemide | null | null | null | null |
122d8809-5832-5dc8-a918-68b38030333b | 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? | Anemia | Decreased cardiac output | Increased dead space | Intrahepatic arteriovenous shunts | 5 | E | 3 | Intrapulmonary arteriovenous shunts | null | null | null | null |
36a2e91b-349f-5d4a-8eee-4706e846fb52 | 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 c... | compare mixed venous oxygen saturation in the right atrium and pulmonary artery | draw blood for culture and start antibiotic therapy | start dopamine infusion in low dose | administer a fluid challenge | 5 | A | 3 | monitor peripheral capillary oxygenation by transcutaneous oximetry | null | null | null | null |
1f09cef3-d7cf-5cd7-8185-5d336874ae18 | Recognized side effects of magnesium sulfate used for the treatment of preeclampsia that would be of anesthetic concern include each of the following EXCEPT | maternal pulmonary edema | neonatal hypotonia | increased maternal sensitivity to succinylcholine | increased maternal sensitivity to vecuronium | 5 | E | 1 | maternal hypokalemia | null | null | null | null |
9160aa8d-9fd3-5d75-8b6e-755eb62eef60 | A complication of terbutaline therapy to terminate premature labor is | bronchoconstriction | hypoglycemia | fetal bradycardia | closure of the fetal ductus arteriosus | 5 | E | 1 | pulmonary edema | null | null | null | null |
a64a3e12-3ecf-534f-acf2-680398bcc0ec | 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 | cardiac disease | the need for spinal anesthesia | an electrolyte disturbance | the need for insertion of a temporary pacemaker | 5 | A | 1 | a normal finding in a patient of this age | null | null | null | null |
80ccb14c-9f2f-5eec-826c-c5a7fda4f68a | Which of the following is a sign of cyanide toxicity during nitroprusside therapy? | Decreased SpO2 | Increased PaCO2 | Increased arteriovenous oxygen tension difference | Increased mixed venous pH | 5 | E | 1 | Increased mixed venous PO2 | null | null | null | null |
c1d76d17-5522-5658-a051-bb4f514d0abb | 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? | Administration of sodium bicarbonate | Intravenous administration of hypertonic glucose solution | Decrease in cardiac output | Decrease in fresh gas flow in a Bain circuit | 5 | C | 2 | Malfunction of the inspiratory valve in a circle system | null | null | null | null |
8bcd7d88-fb4b-503d-9b51-c7e303819c6f | The most likely cause of bilateral fixed and dilated pupils after clipping of a basilar artery aneurysm is | preoperative administration of atropine | intraoperative infusion of trimethaphan | naloxone antagonism of opioid | persistent hypothermia | 5 | B | 2 | brain stem ischemia | null | null | null | null |
b732f380-2781-5741-8810-859edbe6f373 | 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 thera... | cryoprecipitate | desmopressin | fresh frozen plasma | lyophilized factor VII concentrate | 5 | B | 2 | platelets | null | null | null | null |
28c4f771-a8df-5972-9b56-3b5b66c49921 | 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 | administer atropine | administer epinephrine | administer lidocaine | apply a transthoracic pacemaker | 5 | E | 2 | start cardiopulmonary resuscitation | null | null | null | null |
226d428b-8d01-5e4a-bb21-3a97b369227a | Compared with adult hemoglobin, which of the following is a characteristic of fetal hemoglobin? | It has a greater oxygen-carrying capacity | It has a lower P50 | It is more likely to cause an artifactual increase in Sp02 | It is more likely to sickle | 5 | B | 1 | It unloads oxygen more readily at the tissues | null | null | null | null |
4d3b81af-d9c1-5c93-8bad-6416c624926c | Transcutaneous electrical nerve stimulation is LEAST likely to be effective in which of the following pain syndromes? | Acute postoperative pain | Chronic pancreatitis | Myofascial syndrome | Phantom limb pain | 5 | B | 1 | Reflex sympathetic dystrophy | null | null | null | null |
e94c1776-f186-5501-af51-826e1b776b4c | Which of the following statements concerning monitoring of neuromuscular function during general anesthesia is true? | Facial nerve electrodes underestimate recovery from block, compared with ulnar nerve electrodes | More current is required to depolarize a nerve beneath the negative electrode than beneath the positive electrode | Needle electrodes should be electrically grounded | Supramaximal voltage is 10% higher than the voltage required to elicit pain in the awake patient | 5 | E | 1 | The amount of neuromuscular block is underestimated if electrodes are placed on a paretic limb | null | null | null | null |
c965b996-1be6-5606-85ab-16bf1c952aec | During one-lung ventilation, each of the following affects hypoxic pulmonary vasoconstriction in the nonventilated lung EXCEPT | application of continuous positive airway pressure to the nonventilated lung | high alveolar pO2 in the ventilated lung | infusion of isoproterenol | low mixed venous pO2 | 5 | B | 2 | pulmonary hypertension | null | null | null | null |
9799f25d-5aed-50cd-9920-b315b3c6a4e6 | 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... | Atrial flutter | Cardiac tamponade | Hypovolemia | Junctional tachycardia | 5 | D | 3 | Tension pneumothorax | null | null | null | null |
84d73816-e1f9-593b-a37d-5e49d9332b00 | 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 | 50 ml | 125 ml | 175 ml | 225 ml | 5 | C | 2 | 300 ml | null | null | null | null |
9338c146-8bb1-565c-acd7-40662aebcb1a | 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? | Atropine | Calcium chloride | Ephedrine | Magnesium sulfate | 5 | B | 2 | Phenylephrine | null | null | null | null |
4ebe5bec-4e87-5afd-8525-dbc4789e961e | 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 | normal saline solution were mistakenly used | the patient's hematocrit were still 25% | only 9.0 ml of injectate were used | atrial fibrillation were present | 5 | C | 2 | the room were excessively cold | null | null | null | null |
299118c7-b87b-564f-af9f-79cb223da300 | 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 line-isolation monitor fault | Current leak from the EKG module | Defective grounding of the electrocautery unit | Dried gel on the electrocautery pad | 5 | D | 2 | Excessive current setting for cutting mode | null | null | null | null |
5babc330-75c9-5045-bfd2-7fe485ede39d | 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 | cardioversion | digoxin | esmolol | ouabain | 5 | A | 2 | verapamil | null | null | null | null |
2ead731d-e1c3-524a-83fa-405ae3e3a637 | Which of the following is most likely to decrease uterine tone? | Administration of isoflurane 1% | Administration of nitrous oxide 50% | Intravascular injection of 5 ml of 0.5% bupivacaine | Intravenous administration of ketamine 2 mg/kg | 5 | A | 1 | Paracervical block with 20 ml of 1% lidocaine | null | null | null | null |
58b9ecca-1414-5fad-874c-24468d17f4ab | 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? | Increase FiO2 to 1.0 | Instill saline into the endotracheal tube | Perform cricothyroidotomy | Remove the endotracheal tube | 5 | D | 2 | Ventilate with air | null | null | null | null |
dd0771dd-aca2-50db-b7d4-9f72da99f1b7 | Each of the following conditions causes resistance to nondepolarizing neuromuscular blockade EXCEPT | chronic severe infections | major burns | myotonia congenita | prolonged immobilization | 5 | C | 1 | upper motor neuron injury | null | null | null | null |
306f498c-c187-5733-a89a-3b94a30438a4 | The highest serum fluoride levels are seen following the administration of which of the following volatile anesthetics? | Desflurane | Enflurane | Halothane | Isoflurane | 5 | E | 1 | Sevoflurane | null | null | null | null |
11ff2f22-517f-562f-8ccb-c42a3ac18700 | 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? | High fetal hemoglobin concentration | High ratio of oxygen consumption to functional residual capacity | Low functional residual capacity in milliliters per kilogram | Poor thoracic compliance | 5 | B | 2 | Patent ductus arteriosus | null | null | null | null |
b6a4e8cf-75b0-5cd3-866b-bf72ee21f53f | 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 | low airway pressure alarm | "fail-safe" system | oxygen analyzer on the expiratory limb | oxygen flowmeter reading | 5 | E | 1 | mass spectrometric analysis of gases | null | null | null | null |
9ccf16e6-14ec-58a1-ae44-b6bc8d0f5edb | 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? | Gasserian ganglion | Glossopharyngeal nerve | Hypoglossal nerve | Mandibular nerve | 5 | B | 1 | Vagus nerve | null | null | null | null |
cfb63860-dbda-5d91-b204-035798bca476 | 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 | insensible water loss | lean body mass | metabolic rate | sodium loss | 5 | C | 1 | third space losses | null | null | null | null |
ead7d0df-5317-5c1f-8f6c-0c916a390f62 | 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 f... | decrease of oxygen pipeline pressure to 20 psi | increase in the concentration of nitrous oxide in the circuit | inaccuracy of flowmeters at low flow rates | malfunction of the oxygen monitor | 5 | B | 3 | progressive hypothermia | null | null | null | null |
56f994b0-ab40-5453-ab51-06470eaaeb36 | 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 | physical therapy, employing stress loading | oral prazosin | intravenous regional sympathetic block with guanethidine | stellate ganglion block with 6% phenol | 5 | D | 2 | transcutaneous electrical nerve stimulation | null | null | null | null |
06e2c149-2ec5-5f4b-a781-3ce2bb54367e | 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 | chronic respiratory alkalosis | decreased ventilatory response to hypoxemia | increased ventilatory response to hypercarbia | labile hypertension | 5 | B | 1 | resting bradycardia | null | null | null | null |
ea47549d-603a-5969-97b8-b1ab37603c2c | Which of the following drugs best facilitates management of cerebral vasospasm after subarachnoid hemorrhage? | Nifedipine | Nimodipine | Nitroglycerin | Nitroprusside | 5 | B | 1 | Thiopental | null | null | null | null |
4259c820-0f35-56b4-9fc6-dd8599030846 | 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 | abnormal liver function | bone marrow depression | heart failure | chronic renal failure | 5 | C | 1 | pulmonary fibrosis | null | null | null | null |
26e67943-a475-544d-a990-0cd492674bef | 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 | moderate-sized aneurysm of the left ventricle | acute myocardial ischemia | recent myocardial infarction | old myocardial infarction | 5 | B | 2 | Prinzmetal's variant angina | null | null | null | null |
49a52c51-922c-5dc3-ab23-e5c7ef2d8636 | Normal pregnancy is associated with a decrease in each of the following EXCEPT | expiratory reserve volume | FEV1/FVC ratio | functional residual capacity | thoracic compliance | 5 | B | 1 | vital capacity | null | null | null | null |
208d138b-ea73-5793-bffe-e9bf066fd298 | 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? | Infusion of dopamine at 2 mcg/kg/min | Infusion of sodium nitroprusside | Intravenous administration of furosemide | Intravenous administration of mannitol | 5 | E | 2 | Volume loading with crystalloid | null | null | null | null |
fe351ae6-3d45-56ce-8348-7194207f8907 | 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 | dose-dependent elimination half-life | genetically slow biotransformation | large volume of distribution | presence of an active metabolite in high concentration | 5 | E | 3 | time required for hepatic elimination | null | null | null | null |
90d84fbb-0a41-5664-8c4b-0892bfbd03ab | Optimal ventilation of a newborn with congenital diaphragmatic hernia should consist of | PaCO2 30 mmHg, low tidal volumes | PaCO2 30 mmHg, high tidal volumes | PaCO2 40 mmHg, low tidal volumes | PaCO2 40 mmHg, high tidal volumes | 5 | E | 2 | PaCO2 45 mmHg, low tidal volumes | null | null | null | null |
f5900b86-e669-5cd0-8024-11f07fcd1aa2 | At equipotent doses, which of the following opioids is most likely to migrate cephalad in cerebrospinal fluid after epidural administration? | Fentanyl | Hydromorphone | Meperidine | Morphine | 5 | D | 1 | Sufentanil | null | null | null | null |
ce677fa1-df7d-5a25-9e5d-92abae9beb83 | Which of the following is a cardiorespiratory effect of epidural block to a T4 sensory level? | Decreased expiratory reserve volume | Decreased tidal volume | Increased circulating catecholamine concentrations | Increased heart rate | 5 | A | 1 | Unchanged vital capacity | null | null | null | null |
a48ef704-9fdf-5a0e-ba66-9af7db53f3f4 | The effect of neomycin at the neuromuscular junction is | decreased by depolarizing relaxants | partially reversed by calcium | potentiated by anticholinesterases | prevented by pretreatment with magnesium | 5 | B | 1 | primarily prejunctional | null | null | null | null |
4bffa74d-0e81-571a-9f5e-d2386ed24d50 | 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 vent... | Decreasing positive end-expiratory pressure | Decreasing respiratory rate | Increasing fresh gas flow rate | Increasing FiO2 | 5 | E | 3 | Increasing tidal volume | null | null | null | null |
7685d363-cd18-52b7-9079-3aaff51dd0c3 | 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 | decreased euglobulin lysis time | decreased platelet count | prolonged activated partial thromboplastin time | prolonged bleeding time | 5 | D | 2 | prolonged prothrombin time | null | null | null | null |
36806a70-ec74-5190-98d6-9aa69ebab2d7 | 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? | Fail-safe system | Infrared capnograph | Nitrogen analyzer | Oxygen analyzer | 5 | B | 2 | Pulse oximeter | null | null | null | null |
8e205603-fcbb-5f16-bfc6-e61040730299 | 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? | Confirm position of the tube with bronchoscopy | Apply 5 cmH20 continuous positive airway pressure to the nondependent lung | Apply 5 cmH20 positive end-expiratory pressure to the dependent lung | Resume two-lung ventilation | 5 | D | 3 | Clamp the pulmonary artery of the nondependent lung | null | null | null | null |
3a4034dc-5ff2-50f3-a508-259ce6ddd166 | Which of the following statements concerning the management of diabetes mellitus during pregnancy is true? | Insulin requirements remain essentially unchanged during pregnancy | Maternal blood glucose concentration of 200 mg/dL is optimal | Maternal hyperglycemia may cause neonatal acidosis | Neonatal hyperglycemia is common | 5 | C | 1 | Infants delivered under general anesthesia have lower Apgar scores than those delivered under spinal anesthesia | null | null | null | null |
10a8b7f1-8f23-5e5b-b89a-de287fcaebcc | Normal pseudocholinesterase | is highly concentrated at the motor end-plate | hydrolyzes succinylcholine by Hofmann elimination | is produced primarily at nerve terminals | is antagonized by acetylcholinesterase inhibitors | 5 | D | 1 | resists dibucaine inhibition more than its atypical variant | null | null | null | null |
c6cd4b3d-edcc-5ecd-8738-0b0406621c6a | Which of the following effects of catecholamine results in the greatest increase in preload? | Augmented contractility | Decreased afterload | Decreased venous capacitance | Improved chronotropism | 5 | E | 2 | Increased cardiac output | null | null | null | null |
2902bf20-7d64-585e-8900-912e316454f7 | 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 | intubate and assist spontaneous ventilation | intubate and control ventilation | insert an orogastric tube | allow the patient to breathe spontaneously by mask until gastrostomy | 5 | A | 3 | control ventilation by mask until gastrostomy | null | null | null | null |
0f3f0c2e-3d64-5f38-bb3a-fbd60224d2c8 | 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... | administer calcium gluconate 250 mg intravenously | augment ventilation with bag and mask | administer lidocaine 100 mg intravenously | administer NaHC03 50 mEq intravenously | 5 | B | 3 | observe only | null | null | null | null |
237aa3b6-6a6f-5f04-a2e0-d81122596e06 | 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? | Dextrose 5% in water for maintenance and lactated Ringer's solution for replacement of third space losses | Dextrose 10% in water for maintenance and lactated Ringer's solution for replacement of third space losses | Lactated Ringer's solution for maintenance and replacement of third space losses | Lactated Ringer's solution for maintenance and albumin 5% for replacement of third space losses | 5 | B | 2 | Normal saline solution for maintenance and lactated Ringer's solution for replacement of third space losses | null | null | null | null |
9ee47c6d-7e02-5a61-910f-65f6a1ddd137 | Metoclopramide acts to | block dopamine receptors | decrease gastric acid production | decrease lower esophageal sphincter tone | delay gastric emptying | 5 | A | 1 | facilitate central cholinergic stimulation | null | null | null | null |
39fdb736-6ad2-509d-ba46-28fdbd08ce20 | When using a Venturi face mask with a reservoir bag | a known constant FiO2 is delivered | the reservoir bag ensures predictable FiO2 while conserving fresh gas flow | low fresh gas flows will not decrease FiO2 | the system prevents hypocarbia during tachypnea | 5 | B | 1 | the system increases anatomic dead space | null | null | null | null |
33ae59a7-8ab1-57a5-8769-4f6f4a74ae21 | Pseudocholinesterase | is increased in patients with myasthenia gravis | is inhibited by glycopyrrolate | is inhibited by pilocarpine | is synthesized by the liver | 5 | D | 1 | reverses atracurium blockade | null | null | null | null |
4767b71d-dc7b-5f8a-a827-f78b91df9448 | Deliberate hypothermia and circulatory arrest is planned for clipping of a giant basilar artery aneurysm. Which of the following statements is true? | Administration of a muscle relaxant slows the cooling process | Anesthesia is not required if body temperature is below 31°C | Decreasing body temperature below the level at which the EEG is isoelectric further decreases cerebral metabolic rate for oxygen | Sinus bradycardia during cooling results from increased intracranial pressure | 5 | C | 1 | T-wave inversion during cooling indicates myocardial ischemia | null | null | null | null |
c6745193-0970-5464-ad5f-1a11448139d0 | 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 ... | intubate the trachea and control ventilation | perform bronchoscopy to treat foreign body aspiration | obtain a pulmonary ventilation-perfusion scan | administer methylene blue intravenously | 5 | D | 2 | administer thiosulfate in normal saline solution intravenously | null | null | null | null |
8157bcf7-c71e-585b-8813-ad2bdec78d33 | 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? | Absence of coronary atherosclerosis | Biventricular hypokinesis on echocardiography | Down-regulation of cardiac beta-adrenergic receptors | Increased heart rate at rest | 5 | D | 2 | Right ventricular hypertrophy | null | null | null | null |
02e12756-39d6-5eb3-b484-0a3cc52632b9 | Desflurane at a stable alveolar concentration of 7% | causes bradycardia | decreases cerebrovascular resistance | degrades in soda lime | increases systemic vascular resistance | 5 | B | 1 | stimulates the respiratory centers | null | null | null | null |
d52fbf45-69aa-5e45-966d-1ecc560d49e0 | 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 | droperidol | nifedipine | normal saline solution | propranolol | 5 | D | 3 | verapamil | null | null | null | null |
269c2643-9b56-5523-b839-5b4e4b4b4623 | 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 | cryoprecipitate | desmopressin (DDAVP) | fresh frozen plasma | platelets | 5 | B | 2 | vitamin K | null | null | null | null |
5ac44ecb-f0c4-55ce-b1d3-161bca562923 | 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 | diphenhydramine | epinephrine | furosemide | hydrocortisone | 5 | A | 2 | mannitol | null | null | null | null |
9423f6d4-eca4-543a-bc42-f3937a32913f | Monitoring sensory evoked potentials may be useful in detecting functional derangement of each of the following EXCEPT | cranial nerve pathways during posterior fossa operations | motor pathways during anterior cervical discectomy | dorsal column pathways during operations for spinal tumors | visual pathways during operations on the sphenoid wing | 5 | B | 2 | cortical pathways during carotid artery operations | null | null | null | null |
992bf8e4-8350-5b1f-81d6-cb969327c0e1 | Which of the following statements concerning the innervation of the larynx is true? | The glossopharyngeal nerve provides motor innervation to the vocal cords | The recurrent laryngeal nerve provides sensory innervation to the mucosa of the larynx above the vocal cords | The hypoglossal nerve provides sensory innervation to the aryepiglottic folds | Unilateral recurrent laryngeal nerve injury results in an abducted vocal cord on the injured side | 5 | E | 1 | The vagus nerve provides innervation to all structures below the vocal cords | null | null | null | null |
a61568d4-0916-5ba9-935f-e440f41aaf15 | 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 o... | 3% Saline solution | 5% Dextrose solution | Glucagon | Hydrocortisone | 5 | E | 2 | Vasopressin | null | null | null | null |
464a0c4c-30d8-598d-bb86-546f6102828a | 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 | increases during spontaneous breathing | indicates increased dead space ventilation | is caused by increased intrapulmonary shunt | reflects inhibition of hypoxic pulmonary vasoconstriction | 5 | B | 1 | results from increased cardiac output | null | null | null | null |
d71fa3ce-e9fa-50e3-b044-a0fc5aba73d2 | A successful celiac plexus block can be expected to | block parasympathetic fibers to the adrenal medulla | block sympathetic fibers to the sigmoid colon | block somatic fibers to the pancreas | enhance peristalsis | 5 | D | 1 | inhibit ejaculation | null | null | null | null |
f3462ac2-3332-5ec3-9f32-d878e8aa93a4 | 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? | Decreased serum osmolality | Serum sodium concentration 132 mEq/L | Increased serum ammonia concentration | Bibasilar rales | 5 | B | 3 | Jugular venous distention | null | null | null | null |
ed901543-93f6-5e8b-b4b7-12e8918643c6 | Left ventricular subendocardial perfusion pressure is best estimated by the difference between | mean arterial and central venous pressures | diastolic arterial and pulmonary artery occlusion pressures | mean arterial and pulmonary artery occlusion pressures | systolic arterial and pulmonary artery occlusion pressures | 5 | B | 2 | diastolic arterial and central venous pressures | null | null | null | null |
e9aa3e89-1765-5a25-8b38-40e32c03ec33 | Which of the following is most effective in decontaminating an anesthesia machine that was splattered with HIV-contaminated blood? | Bleach | Deionized water | Ethylene oxide | Hydrogen peroxide | 5 | A | 1 | Isopropyl alcohol | null | null | null | null |
ac9c559b-3a71-5d43-82f8-adfa9ac351eb | 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 | administer furosemide 40 mg intravenously | infuse normal saline solution until urine output reaches 35 mL/hr | administer dopamine at 3 mcg/kg/min | expect normal urine flow with restoration of normal blood pressure | 5 | D | 2 | discontinue nitroprusside administration | null | null | null | null |
2e99c94b-5be1-52a1-a38c-a8a70c7dd134 | Numbness and tingling on the lateral aspect of the thigh 24 hours after uneventful vaginal delivery is most likely a complication of | forceps delivery | lithotomy position | pudendal nerve block | lumbar epidural anesthesia | 5 | B | 1 | spinal anesthesia | null | null | null | null |
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