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f50bc887-76b2-5851-9e66-9232eec518d6 | A 50-year-old man is scheduled to undergo emergency craniotomy for evacuation of an epidural hematoma. His Glasgow Coma Scale score is 6; heart rate is 54 bpm, and blood pressure is 190/110 mmHg. The most appropriate initial management is administration of which of the following agents? | Atropine | Mannitol | Nimodipine | Sodium nitroprusside | 5 | E | 3 | Thiopental | null | null | null | null |
cea8ed7e-0fd8-51b2-8ad8-b4a4c65fb232 | Each of the following conditions is associated with autonomic hyperreflexia in patients with spinal cord injury EXCEPT | bradycardia | flushing below the level of injury | headache | sweating above the level of injury | 5 | B | 1 | systolic hypertension | null | null | null | null |
b88a9f03-3fc1-572f-934d-84cf70aa45ba | Neurolytic block is most appropriate for | abdominal pain secondary to hepatic carcinoma | abdominal pain secondary to chronic pancreatitis | persistent chest wall pain secondary to intercostal neuralgia following a thoracotomy for trauma | reflex sympathetic dystrophy of the upper extremity with an excellent but transient response to a series of stellate ganglion blocks with local anesthetic | 5 | A | 1 | a diabetic patient scheduled for surgical sympathectomy to relieve unilateral lower extremity pain secondary | null | null | null | null |
dc12b3d2-d4ec-5f9c-a160-9716ec57492b | Which of the following statements concerning the superior laryngeal nerve is true? | It provides sensory innervation to the subglottic surface of the vocal cord | It provides sensory innervation to the inferior surface of the epiglottis | It is a branch of the glossopharyngeal nerve | It is blocked by injection of anesthetic near the lateral portion of the cricothyroid membrane | 5 | B | 1 | It is the most commonly injured nerve during thyroid surgery | null | null | null | null |
accd37cf-0b3d-5db1-9f10-ea467dc836a6 | A 2-year-old child is hospitalized for exposure. Rectal temperature is 30°C. The most appropriate method of warming is to | apply radiant heat | increase ambient temperature to 28°C | use a heating blanket set at 39°C | warm and humidify inspired gases | 5 | D | 2 | warm intravenous fluids to 37°C | null | null | null | null |
77e52a88-ad4a-5fbc-a68f-47ec327b6fa1 | Which of the following is most likely to result in oxygen desaturation in a patient with Eisenmenger's syndrome who is scheduled for cesarean delivery? | Breathing room air | Epidural administration of lidocaine | Intravenous administration of ketamine | Intravenous administration of ephedrine | 5 | B | 3 | Mild hypocarbia | null | null | null | null |
de1dcd11-31a4-5bbb-90bb-37f0bbde92ba | Which of the following findings best indicates complete resolution of spinal anesthesia? | Ability to ambulate | Ability to urinate | Perianal pinprick sensation | Pain at the surgical site | 5 | B | 1 | Proprioception of the big toe | null | null | null | null |
c858d270-1e19-588c-ab14-9a790bbbcd95 | In patients with reflex sympathetic dystrophy affecting the arm, which of the following findings indicates a therapeutic block? | Bradycardia | Contralateral nasal congestion | Hoarseness | Increased skin temperature | 5 | D | 2 | Ipsilateral Horner's syndrome | null | null | null | null |
e4c4d706-d4ad-5b91-8682-464b3c423ec1 | Following maternal epidural injection, fetal exposure to chloroprocaine is lower than fetal exposure to bupivacaine for which of the following reasons? | Chloroprocaine is metabolized by plasma cholinesterase | Chloroprocaine is more protein bound | Chloroprocaine is not readily absorbed from the epidural space | The ionized fraction of chloroprocaine in the fetal circulation is smaller | 5 | A | 1 | The pKa of chloroprocaine is less than that of bupivacaine | null | null | null | null |
b29096c5-7341-51f8-b49e-82a46c35bdbb | The acute onset of hypotension without a decrease in mixed venous oxygen saturation is most likely associated with the onset of | hemorrhage | myocardial infarction | pulmonary edema | pulmonary embolus | 5 | E | 2 | sepsis | null | null | null | null |
4f0eaeb4-e9c1-5d07-8d2d-7c9206f1f44b | Compared with thiopental, etomidate causes | greater histamine release | greater myocardial depression | greater myoclonic activity | increased seizure threshold | 5 | C | 1 | less nausea | null | null | null | null |
6599e7a8-5804-5817-b8da-c1f276b24036 | Postdural puncture headache occurs most commonly in which of the following patients? | Children | Elderly persons | Misn | Parturients | 5 | D | 1 | Persons with obesity | null | null | null | null |
21830f18-8943-5e5d-b69d-a051f4ae0873 | Delirium produced by high doses of atropine can be reversed by intravenous injection of | diphenhydramine | flumazenil | naloxone | neostigmine | 5 | E | 1 | physostigmine | null | null | null | null |
b8c7f0c3-7df7-5ee3-9cb7-d8ce5975be96 | A 40-year-old woman has continuous nondermatomal burning pain of the distal foot four weeks after sustaining a metatarsal fracture. On examination, the foot is mildly swollen, tender, and cool. Which of the following statements concerning this condition is true? | A radiograph of the distal bones of the painful foot will show severe osteoporosis | A technetium scan of the distal joints of the painful foot will show decreased uptake | Early use of opioid analgesia will prevent progression of the symptoms | Intravenous phentolamine will relieve the pain | 5 | D | 3 | The chance of spontaneous recovery within eight weeks is greater than 80% | null | null | null | null |
51087395-6136-53a6-9f8c-bd5b2d6d325b | Intraoperative heat loss in an unclothed, undraped patient is caused primarily by | conduction to colder objects | convective heat loss | insensible perspiration | radiant heat loss to the environment | 5 | D | 1 | respiratory tract water loss | null | null | null | null |
dce2735e-09ef-5a32-b08d-d06be7ca941e | A 40-year-old man requires brief surgical relaxation after administration of neostigmine and glycopyrrolate for reversal of vecuronium-induced neuromuscular blockade. Succinylcholine 1 mg/kg is administered intravenously. Compared with a patient who has not had prior reversal of neuromuscular blockade, which of the fol... | Greater antagonism with calcium chloride | Slower onset | Less profound | Less likelihood of phase II neuromuscular blockade | 5 | E | 3 | Prolonged duration | null | null | null | null |
a4b75875-647c-5d89-8e43-589952c98f3d | Coughing that occurs during awake intubation is prevented by local anesthetic block of which of the following nerves? | Glossopharyngeal | Hypoglossal | Recurrent laryngeal and glossopharyngeal | Recurrent laryngeal and superior laryngeal | 5 | D | 1 | Superior laryngeal and glossopharyngeal | null | null | null | null |
8cc4dbe9-c43e-5f47-b540-e9967e7c4f82 | The need for increased doses of nondepolarizing muscle relaxants in patients with extensive burns is best explained by | increased protein binding | hypermetabolism | increased glomerular filtration rate | proliferation of receptors on burned muscle | 5 | D | 1 | decreased volume of distribution | null | null | null | null |
5586050a-2252-5bc6-aac3-ba529f143b93 | On routine inspection of an anesthesia machine, the nitrous oxide E cylinder pressure is 360 psi. This indicates that the | pressure in the cylinder is 16 atm | cylinder contains no liquid nitrous oxide | cylinder is half full | cylinder contains enough nitrous oxide for one hour of anesthesia at a flow rate of 3 L/min | 5 | B | 2 | reducing valve is malfunctioning | null | null | null | null |
a6fb5288-c2ef-5eab-9ebf-b1ee8f28843e | Static lung compliance is decreased by each of the following EXCEPT | pulmonary emphysema | congestive heart failure | adult respiratory distress syndrome | pulmonary fibrosis | 5 | A | 1 | inhalational anesthesia | null | null | null | null |
66eab134-f019-53e0-b649-accd88bf7828 | A healthy, spontaneously breathing, supine, anesthetized patient has an arterial to end-tidal carbon dioxide tension difference of 3 mmHg. Following institution of mechanical ventilation the value increases to 12 mmHg. The most likely cause of this change is | 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 |
af2a0f94-b8b8-5926-9c02-8913c72a13a2 | Which of the following findings is most likely in an 85-kg 30-year-old man who is breathing spontaneously through 6-mm endotracheal tube? | Decreased PetCO2 | Decreased SpO2 | Increased minute ventilation | Increased respiratory rate | 5 | D | 2 | Increased tidal volume | null | null | null | null |
76328efa-f6f8-51fd-8859-bf8cffe4a94f | During induction of anesthesia in a 70-year-old man with aortic stenosis, the blood pressure decreases from 140/ 80 to 70/45 mmHg as the cardiac rhythm changes from normal sinus at 70 bpm to junctional at 120 bpm. The most appropriate initial therapy would be | cardioversion | esmolol | fluid bolus | phenylephrine | 5 | D | 3 | verapamil | null | null | null | null |
17e340e9-5e09-5aeb-937b-60178de9ff13 | Which of the following correctly describes the anatomical location of the brachial plexus? | Adjacent to the subclavian vein as it passes between the scalene muscles | Between the middle and posterior scalene muscles | Posterior to the first rib | Posterior to the subclavian artery | 5 | B | 1 | Posterior to the vertebral artery | null | null | null | null |
ff6e9d76-e725-5ae4-ad55-8f8cc3865fd7 | Halothane | has no effect on reflex hypoxic pulmonary vasoconstriction | protects the myocardium from beta-adrenergic stimulation | has a direct, negative chronotropic effect on the sinoatrial node | metabolites decrease renal concentrating ability | 5 | C | 1 | is unsafe for use with epinephrine-containing local anesthetics | null | null | null | null |
96068ad8-7754-5c21-9855-1cf7e3ebf1f7 | Mepivacaine 40 ml of a 1% solution with epinephrine 1:200,000 is injected into the brachial plexus sheath at the axilla after eliciting a paresthesia in the ulnar nerve distribution. Which of the following is most likely to remain intact? | Adduction of the thumb | Flexion at the wrist | Sensation of the lateral forearm | Sensation on the palmar surface of the lateral three and one half fingers | 5 | C | 2 | Sensation on the palmar surface of the medial one and one half fingers | null | null | null | null |
3c3f9026-09f6-593f-92d2-7e5d89d7059e | Which of the following is a known effect of propofol? | Decreased amplitude of somatosensory evoked potentials | Induction of malignant hyperthermia | Inhibition of cytochrome P450 | Initiation of porphyria | 5 | A | 1 | Suppression of adrenocortical function | null | null | null | null |
f438bc24-092e-50ac-8e39-249d5710a071 | Following protamine administration, profound pulmonary hypertension is most likely initiated by release of | epinephrine | histamine | leukotriene | norepinephrine | 5 | E | 1 | thromboxane | null | null | null | null |
732721bd-b224-5c81-ae57-627056898dd4 | If minute ventilation remains constant, a decrease in end-expiratory carbon dioxide concentration will occur with | a decrease in physiologic dead space | a decrease in cardiac output | a decrease in physiologic shunt fraction | the development of metabolic alkalosis | 5 | B | 3 | an increase in body temperature | null | null | null | null |
1b9d9fd3-57e6-5096-be1f-c67ef43923b5 | Following delivery with pudendal block, a patient requires anesthesia for removal of a retained placenta. The most appropriate anesthetic is | epidural block | ketamine analgesia with midazolam for amnesia | opioid-based general endotracheal anesthetic | potent inhaled general endotracheal anesthetic | 5 | D | 2 | subarachnoid block | null | null | null | null |
91225942-b178-555c-b557-90ff822b9afc | A 32-year-old man who is addicted to opioids complains of pain in the PACU one hour after fixation of a mandibular fracture. He has received intravenous morphine 30 mg during the past hour. The most appropriate management is | continued intravenous administration of morphine until the pain resolves | intravenous administration of nalbuphine in 5-mg increments until the pain resolves | intramuscular administration of hydroxyzine 75 mg | evaluation for entrapment of the mandibular nerve | 5 | A | 3 | evaluation for drug-seeking behavior | null | null | null | null |
d61dc8fd-22c7-5deb-9dbc-d88012c7a341 | Which of the following is a respiratory effect of 1 MAC halothane? | Decreased contribution of abdominal muscles to exhalation | Decreased contribution of the chest wall to ventilation | Decreased respiratory rate | Decreased ratio of dead space to tidal volume | 5 | B | 1 | Increased tidal volume | null | null | null | null |
59856714-d51e-5aae-ab99-1646ae1fb338 | A computer program for hemodynamic calculations has the following input values: body surface area, arterial blood pressure, heart rate, pulmonary artery occlusion pressure, pulmonary artery pressure, and cardiac output. Each of the following values can be derived with this program EXCEPT | cardiac index | stroke volume index | systemic vascular resistance | pulmonary vascular resistance | 5 | C | 2 | left ventricular stroke work index | null | null | null | null |
6c95ef48-0ffb-56e0-8057-30f630934397 | After an uncomplicated cesarean delivery, a full-term neonate has intermittent cyanosis. Diaphragmatic effort is vigorous and respiratory distress is relieved while crying. The most likely diagnosis is | amniotic fluid aspiration | choanal atresia | diaphragmatic hernia | tetralogy of Fallot | 5 | B | 2 | tracheoesophageal fistula | null | null | null | null |
a8db24a2-7cc9-59e8-be12-ee0de253a638 | During surgery with a carbon dioxide laser, which inhaled gas mixture is LEAST likely to promote combustion of the endotracheal tube? | Oxygen 25%-helium 75% | Oxygen 25%-nitrogen 75% | Oxygen 25%-nitrous oxide 75% | Oxygen 50%-nitrogen 50% | 5 | A | 2 | Oxygen 50%-nitrous oxide 50% | null | null | null | null |
3ce8e87d-44e6-53b2-a3e6-e94eca849316 | An adult patient with atrial fibrillation develops pulseless ventricular tachycardia wfiile undergoing synchronized electirical cardioversion. Which of the following is the most appropriate management? | Intravenous administration of adenosine | Intravenous administration of a bolus of lidocaine followed by electrical cardioversion | Immediate repeat synchronized cardioversion at the same energy level | Immediate repeat synchronized cardioversion at twice the previous energy level | 5 | E | 2 | Unsynchronized electrical cardioversion | null | null | null | null |
3758ee72-0b59-54b0-b4cd-665b32cc90d3 | Which of the following statements best describes testing for susceptibility to malignant hyperthermia (MH)? | Live skeletal muscle cells are required for testing | The MH gene is located on the X chromosome | Muscle biopsy is appropriate in children younger than 1 year | A normal serum creatine phosphokinase concentration eliminates the need for muscle biopsy | 5 | A | 1 | Succinylcholine is used to stimulate muscle obtained on biopsy for MH | null | null | null | null |
c0f4c1ef-7887-51e8-8d97-00167b649434 | Hypomagnesemia is associated with | decreased risk for digitalis toxicity | dysrhythmias sensitive to bretylium | hypercalcemia | prolonged succinylcholine blockade | 5 | E | 1 | surgery requiring cardiopulmonary bypass | null | null | null | null |
94420d76-eca8-5d99-bc02-1254a1b4a0f9 | Following completion of an ankle block, the patient reports intact sensation on the tips of the toes. Which of the following nerves was blocked inadequately? | Deep peroneal | Posterior tibial | Saphenous | Superficial peroneal | 5 | B | 2 | Sural | null | null | null | null |
fa75d957-72bd-5f47-9b42-cc8670f83d4f | Gravid uterine blood flow is | autoregulated | decreased by normotensive epidural analgesia | decreased by uterine contractions | increased with an increase in maternal Pa02 | 5 | C | 1 | unaffected by alpha-adrenergic agonists | null | null | null | null |
89949087-7dce-59aa-9ee9-7d5bf7ece6a7 | Arterial pressure in the radial artery is 155/70 mmHg measured by a correctly calibrated catheter-transducer system. At the same time, aortic pressure is 140/75 mmHg using a high-fidelity catheter tip transducer. The most likely cause of this discrepancy is | a large amount of air in the dome of the radial artery transducer | coarctation of the aorta | peripheral vascular constriction produced by sympathetic stimulation | physiologic amplification of the waveform from the aorta to the radial artery | 5 | D | 2 | too high a frequency response in the catheter-transducer system | null | null | null | null |
9244818e-94b5-527d-98d1-b9f39b4cc3ce | Which of the following results in the greatest increase in right-to-left shunting in an infant with cyanotic heart disease? | Decreased pulmonary vascular resistance | Decreased systemic vascular resistance | Hemodilution | Increased heart rate | 5 | B | 2 | Myocardial depression | null | null | null | null |
24c9a0cc-79bd-59f8-92c1-f7f04d3634a9 | A 55-kg, 70-year-old woman with mild chronic renal failure is unresponsive 20 hours after an uneventful coronary artery bypass grafting procedure. Anesthetic drugs included fentanyl 3000 mcg, diazepam 35 mg, and pancuronium 20 mg. Which of the following is the most appropriate next step in management? | Administration of edrophonium | Administration of flumazenil | Administration of naloxone | CT scan of the head | 5 | B | 2 | Measurement of core body temperature | null | null | null | null |
143f4560-6f36-52ca-8c1c-baf3ad7a8488 | Five minutes after initiating one-lung ventilation using a double-lumen endobronchial tube, a 70-year-old patient has a decrease in Sp02 from 99% to 90%. Tidal volume and respiratory rate are unchanged. Fiberoptic bronchoscopy verifies appropriate positioning of the tube. Which of the following is the most likely cause... | Blood flow to the nondependent lung | Failure of hypoxic pulmonary vasoconstriction in the dependent lung | Inadequate filling of the bronchial cuff | Inadequate minute ventilation | 5 | A | 3 | Surgical manipulation of the nondependent lung | null | null | null | null |
ec0d9d06-1a4d-5cee-bd1e-f21d0c002c3e | A 10-week-old infant born at 28 weeks gestation is scheduled for elective repair of bilateral inguinal hernias. It is most appropriate to | delay the operation until the infant is 6 months old | transfuse blood preoperatively if hemoglobin concentration is 9 g/dl | avoid tracheal intubation | limit inspired oxygen concentration to less than 50% | 5 | E | 2 | monitor for apnea for 24 hours postoperatively | null | null | null | null |
e416d2ae-3277-5b27-892a-dc65053b37dd | A 46-year-old man is scheduled for repair of an inguinal hernia. Six years ago, he had an episode of malignant hyperthermia during cholecystectomy. Which of the following is the most appropriate perioperative management? | Administration of a regional anesthetic | Administration of dantrolene orally for two days prior to surgery | Avoidance of all inhalational anesthetics except isoflurane | Avoidance of ester local anesthetics | 5 | A | 2 | Flushing the anesthesia machine with oxygen 10 L/min for a minimum of 12 hours | null | null | null | null |
badadf25-c3ee-5aab-9a9a-bc2f1d94f2d6 | In a patient with surgically significant aortic insufficiency, cardiac output measured by thermodilution will | be greater than right ventricular output | be less than left ventricular output | be less than cardiac output measured by the Fick method | be inaccurate because of decreased signal-to-noise ratio | 5 | B | 2 | underestimate net systemic arterial blood flow | null | null | null | null |
48e59230-dced-50a8-8886-1e29d48b6642 | To predict the requirement for isoflurane in milliliters of vapor per minute during closed circuit anesthesia, each of the following is necessary EXCEPT | cardiac output | oxygen consumption | MAC of isoflurane | duration of administration | 5 | B | 1 | blood-gas partition coefficient | null | null | null | null |
0ad3c8f2-900f-59cb-a6e0-a385a5fe1cb1 | Local anesthetics block nerve conduction by | closing calcium channels | decreasing intracellular calcium concentration | decreasing potassium conductance | causing extrusion of intracellular potassium | 5 | E | 1 | inhibiting cellular influx of sodium | null | null | null | null |
c156823e-4876-5b12-b4ab-21153bd9efda | Which of the following is the most appropriate drug to treat hypotension in patients with asymmetric septal hypertrophy (IHSS)? | Amrinone | Calcium chloride | Dopamine | Ephedrine | 5 | E | 2 | Phenylephrine | null | null | null | null |
0b55601f-085b-5fa5-855b-a423413b2734 | Oxygen 100 ml/min is bubbled through a vaporizer containing an anesthetic with a vapor pressure of 150 mmHg, and this mixture is added to a fresh gas flow of 5 L/min. The delivered anesthetic concentration is | 0.25% | 0.5% | 1% | 2.5% | 5 | B | 2 | 5% | null | null | null | null |
50a7a08e-6801-53fe-b756-c62528a1ae2e | In patients with head trauma, which of the following factors results in a return of arterial pH toward normal levels after two days of mechanical hyperventilation? | Decreased renal absorption of hydrogen ions | Decreased renal blood flow | Increased PaCO2 with constant minute ventilation | Increased renal excretion of bicarbonate ions | 5 | D | 1 | Normalized cerebrospinal fluid pH | null | null | null | null |
6dc0267b-d5db-556a-a4d8-ea7913c35b85 | Anesthesia is induced with halothane in a 3-year-old girl. Sixty seconds after administration of succinylcholine 1 mg/kg intravenously, heart rate decreases rapidly from 120 to 60 bpm. The most likely cause is | acute hyperkalemia | failure to pretreat with a nondepolarizing relaxant | halothane overdose | muscarinic activity | 5 | D | 2 | sympathetic ganglionic blockade | null | null | null | null |
9cc4849a-1094-5813-ad17-058fe40b0014 | Compared with dopamine, dobutamine | is more useful in patients taking monoamine oxidase inhibitors because it depends on the release of norepinephrine for its effect | is more useful in patients in right heart failure because it does not increase pulmonary vascular resistance | has no positive chronotropic response | induces diuresis without increasing cardiac output | 5 | B | 2 | in doses greater than 10 mcg/kg/min increases systemic vascular resistance more than similar doses of dopamine | null | null | null | null |
43915708-ffe7-53a2-a3b9-c08075e43aa7 | Which of the following premedicant drug combinations is most effective in preventing passive regurgitation during anesthesia? | Cimetidine and glycopyrrolate | Metoclopramide and atropine | Metoclopramide and ranitidine | Metoclopramide, atropine, and ranitidine | 5 | C | 1 | Metoclopramide and sodium bicitrate | null | null | null | null |
ac60fb02-45a0-58b7-966a-d41e1662ec63 | Brain stem auditory evoked potentials are most likely to be absent during which of the following? | Anesthesia with 1.5 MAC isoflurane | Barbiturate coma | Hypotension to a mean arterial pressure of 50 mmHg | Surgical retraction of the temporal lobe | 5 | E | 1 | Surgical traction on the pons | null | null | null | null |
eff7c0fb-ccc7-5d44-97ab-c0cff2f04be3 | The most likely effect of a celiac plexus block for an abdominal operation is | bowel distention | hypotension | incisional analgesia | muscle relaxation | 5 | B | 1 | urinary retention | null | null | null | null |
2c4e238b-52be-59ae-80f7-292a24298d00 | Which of the following statements concerning absorption of carbon dioxide by soda lime in an anesthetic circuit is correct? | A warm canister indicates reserve absorption capability | Fresh soda lime includes calcium carbonate | Intergranular volume of the canister should exceed the patient's tidal volume | The color indicator is methylene blue | 5 | C | 1 | The reaction removes water | null | null | null | null |
6533bcf8-6fb6-5e25-a777-e531c4c3e741 | A patient with moderate hypothyroidism and unstable angina requires urgent coronary artery bypass grafting. Which of the following is most appropriate before proceeding with the operation? | Initiation of epinephrine infusion | Intramuscular administration of a barbiturate | Intravenous administration of triiodothyronine (T3) | Intravenous administration of thyroxine (T4) | 5 | E | 3 | Treatment of myocardial ischemia | null | null | null | null |
bb2aaaa4-72ca-5f38-8bf6-26a7bd9f5b29 | A patient undergoes axillary block for placement of an arteriovenous shunt in the forearm. Blockade of the musculocutaneous nerve is not achieved. Injection of a local anesthetic at which of the following sites will provide the required sensory block? | Between the tendon of the palmaris longus and flexor carpi radialis | Body of coracpbrachialis muscle | Medial to the brachial artery at the elbow | Proximal to the medial epicondyle against the medial surface of the humerus | 5 | B | 2 | Superficial to the pulse of the axillary artery | null | null | null | null |
95264c01-0c83-5071-b657-0f79eb5171c9 | An 8-kg, 1-year-old boy is scheduled for a bilateral inguinal hernia repair. If regional anesthesia is to be used for post-operative analgesia, which of the following statements is true? | Caudal administration of 0.25% bupivacaine will provide analgesia without evidence of motor block | Caudal administration of 0.125% bupivacaine is as effective as caudal administration of 0.25% bupivacaine | Caudal analgesia is more difficult to achieve in young children than in adults | The recommended volume of local anesthetic used for caudal analgesia in children is 3 ml per year of age | 5 | B | 2 | The volume of 0.25% bupivacaine required for bilateral ilioinguinal and iliohypogastric nerve blocks would be too large | null | null | null | null |
984e5856-0f39-5bc7-947e-fa0274a834fa | The pin index system | is not used in central pipeline connections | requires aligning four pins with four holes | is used on all sizes of medical gas cylinders | has been replaced by color coding of gas cylinders | 5 | A | 1 | prevents overfilling of gas cylinders | null | null | null | null |
dec89ce1-29d4-5604-9b94-c5fedd5b9821 | A patient with metastatic carcinoma and chronic renal failure has tremors, fasciculations, mydriasis, and hyperreflexia after several days of therapy with high doses of meperidine for analgesia. Which of the following is most likely to occur if the meperidine is continued? | Disappearance of the symptoms as tolerance to meperidine develops | Pinpoint constriction of pupils | Progressive hypothermia | Progressive sedation from meperidine toxicity | 5 | E | 3 | Seizures from normeperidine toxicity | null | null | null | null |
b4176173-2984-5d25-abe1-771452323ae4 | A 22-year-old woman with severe preeclampsia vaginally delivers a 3-kg infant after 12 hours of treatment with magnesium sulfate and continuous epidural infusion of bupivacaine 0.0625% and fentanyl 1 mcg/ml at 10 ml/hr. The infant is pink and hypotonic; heart rate is 110 bpm and blood pressure is 35/25 mmHg. Which of t... | 10% Dextrose in water | Calcium gluconate | Epinephrine | Naloxone | 5 | B | 2 | Intubation and ventilation | null | null | null | null |
a74b93b9-825b-5534-97f9-571f82a787a4 | At the end of an anesthetic in which a nondepolarizing muscle relaxant was administered, the least number of receptors are blocked | after administration of neostigmine 5 mg and glycopyrrolate 1 mg | if the tetanus is sustained at 30 Hz | if the patient can sustain head lift for 5 sec | when the ratio of twitch height T1:T4 is 0.8 | 5 | C | 2 | when tidal volume is normal | null | null | null | null |
60721e9f-c669-5d49-b2dd-bcf16189a944 | A 70-year-old patient is shivering and has chest pain in the PACU following a cholecystectomy. Heart rate is 120 bpm, and blood pressure is 220/120 mmHg. SpO2 is 97% at an FiO2 of 0.4. An ECG shows ST-T wave changes, which are not affected by intravenous administration of nitroglycerin. Which of the following is the mo... | Administration of esmolol | Administration of hydralazine | Administration of nitroprusside | Application of a warming blanket | 5 | A | 3 | Increasing FiO2 | null | null | null | null |
c60f8bd0-820a-59ef-9474-bf3d8b6f871b | During nitrous oxide anesthesia, which of the following expands most rapidly? | Air bubble in the blood | Air in the intestine | Endotracheal tube cuff | Pneumothorax | 5 | A | 1 | Sulfahexafluoride bubble in the vitreal cavity | null | null | null | null |
6c133abd-2086-5e60-a1cb-09c7e18a4e92 | Bupivacaine 30 ml injected into the inguinal perivascular space will usually block the | femoral, lateral femoral cutaneous, and obturator nerves | ilioinguinal, femoral, and sciatic nerves | femoral, sciatic, and obturator nerves | ilioinguinal, iliohypogastric, and pudendal nerves | 5 | A | 1 | sciatic, femoral, and posterior femoral cutaneous nerves | null | null | null | null |
c488e143-26a7-537e-9f01-15e07580c251 | A 2.8-kg 8-hour-old infant undergoes laparotomy for a ruptured omphalocele. Following primary closure of the abdominal wall, arterial blood gases are PaO2 40 mmHg (FiO2 0.6), PaCO2 55 mmHg, and pH 7.1. Blood pressure is 30/20 mmHg. After increasing the FiO2, the most appropriate action would be to | obtain a radiograph of the chest immediately | withdraw the endotracheal tube 1 cm | assess the patient for coexisting congenital heart disease | administer lactated Ringer's solution 15 ml/kg | 5 | E | 3 | ask the surgeon to reopen the wound | null | null | null | null |
17c215bb-4566-5ebc-8d36-e36cdaa5d6fe | In normal tissue, which property of drugs has the greatest effect on the speed of onset of a local anesthetic? | Amide structure | Degree of protein binding | Intrinsic vasoconstrictor activity | pKa | 5 | D | 1 | Potency | null | null | null | null |
e07d0793-9bcf-5467-a13a-5379325ccf15 | A 30-year-old woman is undergoing laparoscopic tubal ligation. Thirty minutes after induction of general anesthesia, arterial oxygen saturation has decreased to 89%. Arterial blood gases at an FiO2 of 1.0 are PaO2 63 mmHg and PaCO2 40 mmHg; PetCO2 is 32 mmHg. Which of the following is the most likely cause? | Carbon dioxide embolus | Endobronchial intubation | Hypoventilation | Inadvertent application of high levels of positive end-expiratory pressure | 5 | B | 3 | Leak in the capnography sampling catheter | null | null | null | null |
917c40e3-c1a3-5a12-aa0b-a87c38191d89 | Which of the following drugs has the shortest elimination half-life? | Diazepam | Flumazenil | Flumazepam | Lorazepam | 5 | B | 1 | Midazolam | null | null | null | null |
373a5c3d-f9b5-5f87-853c-0b5f13d560e5 | An infant becomes cyanotic and hypotensive after ventilatory pressures increase to 45 cm H2O during closure of the abdominal wall at the end of a gastroschisis repair. The most appropriate next step is to | administer a muscle relaxant | administer 5% dextrose in lactated Ringer's solution 10 ml/kg | change the endotracheal tube | ask the surgeon to insert a chest tube | 5 | E | 3 | ask the surgeon to reopen the abdomen | null | null | null | null |
30f78f62-8dc8-564a-ab61-c1a8e11249bb | Which of the following is the most sensitive indicator of impending renal failure following trauma? | Central venous pressure | Creatinine clearance | Fractional excretion of sodium | Hourly urine output | 5 | B | 1 | Urine osmolality | null | null | null | null |
57f30e65-87f1-5802-a836-013ef7a95df1 | A 30-year-old man who is breathing spontaneously has a ventilatory pattern of sustained deep inspiration and occasional expiratory gasps during emergence from general anesthesia after posterior fossa craniotomy. Which of the following is the most likely cause? | Air in the cerebral ventricles | Expiratory obstruction from subglottic edema | Injury to the C3-5 nerve roots | Injury to the pons | 5 | D | 3 | Residual neuromuscular paralysis | null | null | null | null |
c60a432b-7824-5c41-ace6-4a3c984a1844 | Which of the following conditions decreases right-to-left shunt through a patent ductus arteriosus in a neonate? | Arterial hypotension | Arterial hypoxemia | Metabolic acidemia | Positive end-expiratory pressure | 5 | E | 2 | Respiratory alkalemia | null | null | null | null |
289f4748-37e5-50e3-ab30-440633c389e4 | A patient is undergoing thoracotomy in the lateral position. Five minutes after initiation of one-lung ventilation using a double-lumen tube and 100% oxygen, SpO2 decreases from 100% to 65%. Which of the following is the most appropriate initial step in management? | Adding continuous positive airway pressure to the nondependent lung | Adding positive end-expiratory pressure to the dependent lung | Increasing the tidal volume to the dependent lung | Resuming two-lung ventilation | 5 | D | 3 | Verifying the position of the double-lumen tube | null | null | null | null |
b3e56d57-dc2f-5bb6-8984-c12316bc0d7c | Syringe A contains 100 ml of normal blood with a PO2 of 2 mmHg, and syringe B contains 100 ml of normal blood with a PO2 of 98 mmHg. The contents of the two syringes are mixed anaerobicaily to equilibrium. The PO2 of the resultant mixture Is | 27 mmHg | 50 mmHg | 63 mmHg | 96 mmHg | 5 | A | 3 | 100 mmHg | null | null | null | null |
b34c5b40-bd0e-50dd-9aad-acd1ae78f403 | A burn is found at the site of the electrocautery pad. Which of the following is most likely? | The electrosurgical unit was in the bipolar mode | The electrocautery pad became partially detached | The electrosurgical unit ground wire was severed | The line-isolation monitor alarmed | 5 | B | 2 | The patient became grounded | null | null | null | null |
024f8a71-2f95-568b-9672-56af49a028ca | The two E oxygen cylinders on an anesthesia machine have pressure readings of 1100 psi each. At an oxygen flow of 3 L/min, there will be sufficient oxygen for approximately | 2.5 hours | 3.5 hours | 5.5 hours | 7 hours | 5 | B | 2 | 8 hours | null | null | null | null |
aea3d5da-06d3-5b7a-a91b-1127d535c14d | A healthy 10-kg child is flushed and restless after premedication with meperidine 15 mg and scopolamine 0.2 mg intramuscularly. His skin is warm and dry; temperature is 38°C, pulse is 130 bpm, and blood pressure is 90/60 mmHg. The most likely cause is | dehydration | idiosyncratic reaction to meperidine | malignant hyperthermia | neuroleptic malignant syndrome | 5 | E | 2 | scopolamine | null | null | null | null |
b88990d7-f424-58ec-92c1-46df419816a9 | The most beneficial effect of continuous positive airway pressure in a newborn with respiratory distress syndrome is | increased functional residual capacity | decreased airway resistance | promotion of surfactant formation | increased alveolar PO2 | 5 | A | 1 | maintenance of functional closure of the foramen ovale | null | null | null | null |
76e7148c-e567-5f82-98df-e5876f574dcf | Which of the following statements concerning barbiturate protection from cerebral ischemia is true? | It may be achieved with dosages low enough to avoid cardiovascular effects | It is linearly dose-related | It improves neurologic outcome following cardiac arrest | It is most useful in patients with focal ischemia | 5 | D | 1 | It is unrelated to EEG activity | null | null | null | null |
82865d4f-c826-5cf0-b983-63a5238681de | An otherwise healthy 16-year-old girl is undergoing posterior spinal fusion for thoracolumbar scoliosis. During the procedure, the most likely cause of a marked decrease in the amplitude of the somatosensory evoked potentials after stimulation of the posterior tibial nerve is | administration of fentanyl 30 jag /kg for induction | administration of isoflurane 1.3 MAC for maintenance | administration of vecuronium 0.15 mg/kg | a decrease in body temperature from 37 to 35°C | 5 | B | 2 | a decrease in cerebrospinal fluid pressure | null | null | null | null |
9b3404ea-b131-507b-8569-ba746e38848f | Which of the following must be considered during perioperative management of a patient on long-term lithium therapy? | Intravenous fluids should include sodium | Therapy should be discontinued for 14 days prior to anesthesia | The requirement for succinylcholine is increased | The requirement for volatile anesthetics is increased | 5 | A | 1 | Urine output should be maintained with furosemide | null | null | null | null |
676fcb8a-6dc0-5819-9489-14a94d8715a6 | A 27-month-old, 14-kg infant with intestinal obstruction is anesthetized with nitrous oxide at 1 L/min, oxygen at 0.4 L/min, and halothane at 0.8% using a Bain circuit. Ventilation is controlled at a rate of 30/min. The child's temperature is 39°C, and the PaCO2 is 65 mmHg. Which of the following is most likely? | Malignant hyperthermia | Low gas inflow rate | Low respiratory rate | Pulmonary aspiration of gastric contents | 5 | B | 2 | Inaccurate flowmeters | null | null | null | null |
e752e720-a406-5d2f-9d82-d70dadb0ae2f | After termination of an inhalation anesthetic, patient-controlled analgesia will | be effective without a loading dose of opioid if started in the immediate postanesthetic period | be associated with greater analgesic requirements than conventional intramuscular opioid techniques | cause addiction or dependence to opioids if continued for more than 72 hours | produce less patient satisfaction than intermittent intravenous administration of opioids | 5 | E | 1 | show a diurnal variation in analgesic requirement | null | null | null | null |
e125d01d-6b3f-5294-9484-af44fc8a9705 | During attempted cannulation of the right internal jugular vein, the exploring needle goes lateral to the vein. Which of the following structures is most likely to be encountered? | Carotid artery | Vagus nerve | Thoracic duct | Phrenic nerve | 5 | D | 1 | Long thoracic nerve | null | null | null | null |
0e8b0b5c-8616-58b7-88b0-89046bdd67b4 | Which of the following statements concerning pulmonary function in patients with pulmonary fibrosis is true? | Diffusion capacity is decreased | Pulmonary artery diastolic-to-occlusion pressure gradients are normal | Ventilation-perfusion relationships are normal | Static pulmonary compliance is unchanged | 5 | A | 1 | Mechanical ventilation with slow rate and large tidal volume is optimal | null | null | null | null |
d94a1e45-ab12-5101-8414-2d744eccea80 | At extubation performed one week after nasotracheal intubation, each of the following is likely to occur EXCEPT | upper airway obstruction | aspiration after extubation | ulceration of vocal cords | tracheal stenosis | 5 | D | 1 | sinusitis | null | null | null | null |
013d3195-6cd1-59a8-b008-aed2e2f5533b | During cardiopulmonary resuscitation (CPR) in an adult, external chest compression is being performed at the rate of 90/min with 2 inches of sternal depression and a compression-relaxation ratio of 20:80. The most appropriate action is to | decrease the rate of compression | increase the duration of compression | increase the duration of relaxation | increase the depth of sternal depression | 5 | B | 2 | continue the original pattern of CPR | null | null | null | null |
9d9c2253-222c-5f34-90b4-5ae35fb6dc02 | Which the following findings is most hazardous in premature infants? | Hematocrit of 55% | Rectal temperature of 35 degrees C | Umbilical arterial blood PO2 of 50 mmHg | Umbilical arterial blood PCO2 of 45 mmHg | 5 | B | 2 | Umbilical arterial systolic pressure of 60 mmHg | null | null | null | null |
6a802889-8fb2-5a39-86c6-eafe6ed1aa8b | During application of continuous positive airway pressure, lung compliance increases because of | decreased airway resistance | decreased lung water | decreased venous return | increased intercostal muscle tone | 5 | E | 1 | increased resting lung volume | null | null | null | null |
31f1df6b-15c1-51ef-91c0-2fd36923adf7 | Intraoperatively, the occurrence of prominent "a" waves on the central venous pressure waveform can be explained by each of the following EXCEPT | acute right ventricular failure | atrial flutter | complete heart block | onset of junctional tachycardia | 5 | B | 2 | ventricular pacing | null | null | null | null |
facaaaf8-48b9-56c6-8f98-0e28842ce8ff | Which of the following drugs is LEAST likely to cross the placenta? | Lidocaine | Meperidine | Midazolam | Thiopental | 5 | E | 1 | Vecuronium | null | null | null | null |
379d4c8e-08ba-5a90-b60b-1970531db996 | Which of the following statements concerning ketorolac is true? | It binds to opioid receptors | It causes dose-related thrombocytopenia | It decreases heart rate during isoflurane anesthesia | It is eliminated unchanged in urine | 5 | E | 1 | It reversibly inhibits cyclooxygenase | null | null | null | null |
920258b5-664c-5130-a083-eb5e2c71a9a3 | Which of the following muscle relaxants in an ED95 dose would have the longest duration of action in a patient with renal failure? | Atracurium | Metocurine | Pancuronium | d-Tubocurarine | 5 | B | 2 | Vecuronium | null | null | null | null |
48083a60-fb9d-5aea-af90-4be46454db8b | Compared with a semiclosed circle system, a closed system | decreases the risk for anesthetic overdose | decreases the risk for rebreathing carbon dioxide | has lower resistance to gas flow | permits calculation of oxygen consumption | 5 | D | 1 | permits more rapid changes in anesthetic depth | null | null | null | null |
cd59ffdd-e87a-5925-8120-1bf9172f3b35 | A patient whose trachea is intubated develops partial airway obstruction two hours after induction of fentanyl, nitrous oxide, oxygen anesthesia. The anesthesiologist discontinues the nitrous oxide and controls ventilation, and there is gradual improvement during the next hour. No evidence of a respiratory disorder is ... | The endotracheal tube was in the right mainstem bronchus | The patient had an unrecognized air embolism | The patient had a nitrous oxide pneumothorax | The endotracheal tube cuff narrowed the airway | 5 | D | 2 | The fentanyl induced chest rigidity | null | null | null | null |
5b381199-93ca-5a78-8bef-b985c2225bd0 | 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 |
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