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ce7f9af0-8176-5077-877c-db388587ecb4 | During Harrington rod instrumentation for scoliosis, monitoring somatosensory evoked potentials | is unreliable if halothane is used | eliminates the need for a wake-up test | accurately assesses proprioceptive integrity | accurately assesses motor function integrity | 5 | C | 1 | is unreliable if nondepolarizing muscle relaxants are used | null | null | null | null |
187eb2af-2cfa-58f3-8ef0-04bf7679f6ca | During rapid-sequence induction prior to an emergency surgical procedure, a 20-year-old patient vomits gastric contents containing particulate matter. An endotracheal tube is easily inserted and ventilation with pure oxygen is initiated. Despite the presence of bilateral breath sounds, SpO2 is 90%. Which of the followi... | Administration of broad-spectrum antibiotics | Intravenous administration of high-dose methylprednisolone | Bronchial lavage with normal saline solution | Bronchoscopy to remove particulate matter | 5 | D | 2 | Cancellation of the surgical procedure | null | null | null | null |
5feafc1a-1017-5722-8cde-80c02053fca0 | Fetal distress is noted after administration of an epidural local anesthetic during labor. Fetal scalp pH is 7.0. Compared with a fetus with a scalp pH of 7.3, in this fetus the local anesthetic is present in | a higher concentration, with a larger fraction in the ionized form | a higher concentration, with a larger fraction in the unionized form | the same concentration, with a larger fraction in the ionized form | the same concentration, with a larger fraction in the unionized form | 5 | A | 2 | a lower concentration, with a larger fraction in the ionized form | null | null | null | null |
6c9fd6a4-b486-5d40-b659-cc7609aae5ef | A 1-month-old infant becomes hypoxemic faster during apnea than an adult. Which of the following is the primary cause of this difference? | Functional residual capacity in an infant is half that of an adult | Metabolic rate in an infant is twice that of an adult | Resting PaO2 in an infant is lower than that in an adult | The number of alveoli in an infant is 12% the number in an adult | 5 | B | 1 | The hemoglobin dissociation curve in an infant is shifted to the right | null | null | null | null |
34e7cc10-8c1a-588a-bc21-9b42f94369a4 | Which of the following is an effect of ketorolac administered after vaginal hysterectomy? | Euphoria | Prolonged prothrombin time | Respiratory depression | Suppression of inflammation | 5 | C | 1 | Thrombocytopenia | null | null | null | null |
2ed343d9-c73b-52fd-b4e3-9c0e36fed93c | Which of the following statements concerning the pharmacokinetics of local anesthetics is true? | Decreased molecular weight is associated with decreased incidence of allergic reactions | Decreased protein binding is associated with decreased systemic toxicity | Increased ionization is associated with increased placental transfer | Increased lipid solubility is associated with faster onset | 5 | D | 1 | Presence of an ester linkage is associated with increased duration of action | null | null | null | null |
631f275e-8c52-5d93-abc1-fbb8600b4862 | A Fluotec vaporizer is set to administer halothane 4% using a fresh gas flow of 4 L/min. If the diluent gas flow is increased to 8 L/min, and at the same time the room temperature increases from 20 to 25°C, the approximate concentration of halothane delivered to the patient would be | 2% | 2.5% | 3% | 4% | 5 | D | 2 | 5% | null | null | null | null |
66019076-2749-5e7e-bb38-13f70b98d37c | Which of the following is an indication for administration of fresh frozen plasma? | Antithrombin III deficiency | Emergency antagonism of heparin effect | Hemophilia A | Transfusion of 5 units of homologous erythrocytes | 5 | A | 1 | Uremic coagulopathy | null | null | null | null |
b679852d-96b2-5916-b415-9e226d076fa0 | Which of the following is the most likely cause of the coronary steal phenomenon? | Idiopathic hypertrophic subaortic stenosis (IHSS) | Decreased cardiac contractility | Dilation of coronary arterioles | Dilation of epicardial coronary arteries | 5 | C | 1 | Increased systemic vascular resistance | null | null | null | null |
ef775182-6f66-5dd7-8417-fcaa4cae295b | Which of the following is most responsible for the duration of action of local anesthetics? | Concentration | Metabolism | Molecular weight | Tissue protein binding | 5 | D | 1 | Volume injected | null | null | null | null |
61a4d172-f5e0-5bd6-b5f6-3317e255ecae | A 75-year-old man received an uneventful epidural anesthetic for total knee arthroplasty. Twenty-four hours later he has a painless flaccid paralysis in both legs. This clinical presentation is most consistent with | adhesive arachnoiditis | anterior spinal artery thrombosis | epidural abscess | epidural hematoma | 5 | D | 2 | transverse myelitis | null | null | null | null |
701c0f54-77ee-5b2f-b18d-4e7f10762725 | The induction dose of thiopental should be decreased in each of the following situations EXCEPT | age greater than 70 years | cardiogenic shock | decreased hepatic blood flow | hypoalbuminemia | 5 | C | 1 | hypothyroidism | null | null | null | null |
9efb917b-7db5-534c-9e7f-28a34a4bdbd4 | A 31-year-old man received an uneventful epidural anesthetic for arthroscopy of the knee and meniscectomy. Twenty-four hours later he still has painless flaccid paralysis in both legs. This clinical presentation is most consistent with | adhesive arachnoiditis | anterior spinal artery thrombosis | epidural abscess | epidural hematoma | 5 | D | 1 | transverse myelitis | null | null | null | null |
6c1ad5b0-cc98-5984-b93e-852e2910a633 | Hypothermia to 29°C will decrease | hematocrit | plasma fibrinogen concentration | plasma pH | plasma protein concentration | 5 | E | 1 | platelet function | null | null | null | null |
143b754c-ba86-52e9-a126-84e97951ba3d | Which of the following is the primary physiologic response in a neonate exposed to a hypothermic environment? | Hyperventilation | Increased 2,3-DPG concentration in erythrocytes | Metabolism of brown fat | Shivering | 5 | C | 1 | Vasoconstriction | null | null | null | null |
9f6cf7ec-aa88-5060-843b-f9419b328702 | A full-term newborn has marked respiratory distress in the delivery room. Breath sounds are asymmetric and the abdomen is scaphoid. Which of the following maneuvers is most appropriate? | Hyperventilation with bag and mask | Intubation and ventilation with positive end-expiratory pressure | Intubation and ventilation with zero end-expiratory pressure | Bronchoscopy | 5 | C | 2 | Insertion of a chest tube | null | null | null | null |
a946de80-4197-5017-910b-13900717c771 | Which of the following opioids is vagolytic? | Morphine | Meperidine | Sufentanil | Nalbuphine | 5 | B | 1 | Alfentanil | null | null | null | null |
75f54eeb-4676-5f90-97d0-fb3a1a128bf7 | Which of the following statements concerning use of a Bain circuit is true? | Fresh gas flow can be as low as the patient's minute ventilation | Heat conservation is better than with a circle system | Lower flows can be used with controlled ventilation than with spontaneous ventilation | Lower fresh gas flows can be used than with a Jackson-Rees system | 5 | E | 1 | The concentration of inspired vapors can be changed rapidly | null | null | null | null |
f4f8bdad-c88c-54b7-b134-4ef8bd5b067e | Which of the following situations is most likely related to paraplegia following repair of a descending thoracic aortic aneurysm? | Decreased cerebrospinal fluid pressure | Epidural hematoma | Hypertension proximal to the aortic cross clamp | Improper placement of surgical retractors | 5 | E | 1 | Prolonged aortic cross-clamp time | null | null | null | null |
ba29b31d-cf5e-5fe3-8fd5-f933546e992a | Which of the following is the most appropriate initial therapy for acute pulmonary hypertension with right ventricular dysfunction and severe systemic hypotension that occurs during anesthesia? | Amrinone | Epinephrine | Isoflurane | Isoproterenol | 5 | B | 3 | Nitroglycerin | null | null | null | null |
d1c8e776-fd17-5549-8d5b-7dc06b0bc9d1 | Which of the following processes is primarily responsible for the decrease in core body temperature that occurs during the first hour of general anesthesia? | Decreased production of heat | Convective heat loss caused by cutaneous vasodilation | Evaporative heat loss during skin preparation | Heat loss from the respiratory tract | 5 | D | 1 | Redistribution of core body heat to the periphery | null | null | null | null |
46559e7a-8ef6-542e-bb18-308c874cd157 | During general anesthesia using a modern anesthesia machine, a patient's spontaneous ventilation is manually assisted with a fresh gas flow of 5 L/min. A sudden malfunction of the pressure-relief (pop-off) valve of the circle absorption system occurs, and the valve cannot be opened. The most appropriate next step is to | change to a smaller reservoir bag | increase total fresh gas flow | open the scavenger valve | control ventilation manually | 5 | E | 3 | switch to mechanical ventilatory mode | null | null | null | null |
00ca4cd7-4b15-5ba4-b489-fed4c4a95b3e | Microatelectasis 48 hours after abdominal surgery is most consistently manifested by | decreased PaO2 | ground glass infiltrate on a roentgenogram of the chest | scattered fine inspiratory rales | increased PaCO2 | 5 | A | 1 | scattered areas of dullness to chest percussion | null | null | null | null |
e7ad4398-a7ff-5199-b6f8-c1dc16050dcb | Which of the effects of epidural morphine is most resistant to intravenous naloxone? | Analgesia | Nausea | Pruritus | Respiratory depression | 5 | A | 1 | Urinary retention | null | null | null | null |
3a2ca792-7dcf-5de2-9c79-e10235b08fb6 | A patient suddenly makes a respiratory effort during craniotomy for clipping of a cerebral aneurysm in a 15-degree head-up position with controlled ventilation. The most likely cause is | air embolism | cerebral hypoxia | direct stimulation of the respiratory center | intraventricular hemorrhage | 5 | A | 1 | stimulation of the motor cortex | null | null | null | null |
2ecca373-41bc-507f-a9a9-2ee0b800ebaf | A woman at 39 weeks' gestation has been in labor for 12 hours. She has had nausea and vomiting for the past eight hours. Maternal arterial blood gas values are PaO1 85 mmHg, PaCO2 31 mmHg, and pH 7.50. Which of the following is the most likely cause of fetal distress occurring at this time? | Hypocarbia-induced placental ischemia | Impaired fetal oxyhemoglobin dissociation | Shift to the left of the maternal oxyhemoglobin dissociation curve | Maternal hypovolemia | 5 | D | 3 | Maternal hypoxemia | null | null | null | null |
cc907cb4-8689-5efb-ac5d-dc40d7919569 | Which of the following is characteristic of low back pain associated with myofascial pain syndrome but not of pain associated with a herniated lumbar disk? | Loss of reflexes in the lower extremities | Pain along the distribution of nerve roots | Responsiveness to epidural corticosteroids | Sensitivity to injection at trigger points | 5 | D | 1 | Trophic alteration in the sympathetic nervous system | null | null | null | null |
0abbcc4a-bd2f-5795-9d4c-77daceaddd96 | Compared with the adult airway, the neonatal airway has which of the following characteristics? | More cephalad larynx | Narrowest diameter at the vocal cords | Relatively smaller epiglottis | Smaller tongue relative to the size of the oral cavity | 5 | A | 1 | Vocal cords perpendicular to the trachea | null | null | null | null |
538fea75-6307-5d5d-bc5a-b617e78453dc | Which of the following factors is LEAST likely to affect serum ionized calcium concentration following blood transfusion? | Age of blood transfused | Amount of blood transfused | Body temperature | Serum pH | 5 | A | 2 | Rate of transfusion | null | null | null | null |
2da091ec-8531-5b32-a0e4-16e0bcbfb3ec | A 26-year-old patient with multiple trauma is admitted to the intensive care unit postoperatively. The early development of polyuria, hypotension, low urine sodium excretion, high serum osmolality, and normal serum creatinine concentration is best explained by | adrenal insufficiency | fluoride-induced high-output renal failure | inappropriate ADH secretion | intraoperative fluid overload | 5 | E | 3 | posterior pituitary insufficiency | null | null | null | null |
f4e966cb-737c-5100-8ca9-d2db26245e5a | A 70-kg man has stable 80% neuromuscular block induced with d-tubocurarine. Compared with neostigmine 3 mg, antagonism with edrophonium 70 mg will | be of shorter duration | be of slower onset | be less reliable | produce less change in heart rate | 5 | D | 2 | require more anticholinergic | null | null | null | null |
b1edc76b-57d9-51b5-8196-bd92a957dbe2 | Which of the following statements concerning intercostal nerve block for postoperative pain is true? | Block at the midaxillary line provides analgesia for the anterior and lateral abdominal walls | Blood levels of local anesthetic are higher than after an axillary block | Intravascular injection is unlikely | Loss of resistance assures proper needle placement | 5 | B | 1 | Paravertebral spread is prevented by adding epinephrine to the local anesthetic solution | null | null | null | null |
128156ff-ffde-5ab1-92c3-9c775ec62b9d | A 50-year-old man who takes aspirin and nifedipine is scheduled for thoracotomy with one-lung ventilation. Which of the following is associated with the greatest risk for intraoperative hypoxemia? | Preoperative withdrawal of nifedipine therapy | Intraoperative mild respiratory acidosis | Intraoperative administration of isoflurane | Intraoperative administration of nitroglycerin | 5 | D | 3 | Intraoperative thoracic epidural morphine | null | null | null | null |
50c3e7b8-9821-561a-a4ea-588f2bddb472 | In an Infant, spinal anesthesia to a sensory level of T8 is achieved with tetracaine administered at the L2-3 interspace. Compared with spinal anesthesia to the same sensory level in an adult, this anesthetic is associated with a | higher risk for neurotoxicity | higher risk for systemic toxicity | lower risk for spinal cord injury | more significant decrease in blood pressure | 5 | E | 2 | shorter duration of action | null | null | null | null |
89e03fa1-52b8-5a82-bb38-4d949fd35c91 | A 32-year-old patient with end-stage renal failure has irreversible neuromuscular blockade two hours after tracheal intubation with a muscle relaxant. Which of the following is the most likely cause? | Atracurium | Doxacurium | Mivacurium | Pancuronium | 5 | B | 2 | Vecuronium | null | null | null | null |
8c153a1a-03ab-5ba2-80f1-7e0c349ae3fc | In patients with renal failure, which of the following muscle relaxants has the most prolonged elimination half-life? | Atracurium | Pancuronium | Succinylcholine | d-Tubocurarine | 5 | B | 1 | Vecuronium | null | null | null | null |
0dee476c-4e7f-5133-9f1c-26140de77160 | During cardiopulmonary bypass at a nasopharyngeal temperature of 28°C and a hematocrit of 20%, temperature-corrected PaCO2 is 50 mmHg and uncorrected PaCO2 is 60 mmHg. The most appropriate management is to | administer additional opioid | administer packed red blood cells to increase hematocrit to 25% | further decrease the patient's temperature | increase fresh gas flow to the oxygenator | 5 | D | 3 | institute mechanical ventilation | null | null | null | null |
1d084ae9-ca24-5fea-91a8-4c78ce3962ca | Depression of cerebral oxygen requirements below the level required to create an isoelectric EEG can be achieved by | administration of isoflurane | administration of nimodipine | barbiturate coma | hyperventilation | 5 | E | 1 | hypothermia | null | null | null | null |
5d50e4de-402a-5742-8f48-f888fd3c0dc3 | Pulse oximetry accurately reflects SaO2 in which of the following situations? | Administration of indocyanine green | Administration of methylene blue | Carboxyhemoglobinemia | 40% fetal hemoglobin concentration | 5 | D | 1 | Methemoglobinemia | null | null | null | null |
4ad50329-8def-5383-aa2b-6c94da71e752 | Each of the following affects the induction dose of thiopental EXCEPT | acute ethanol intoxication | chronic use of barbiturates | intravascular volume | rate of hepatic extraction of thiopental | 5 | D | 3 | serum albumin concentration | null | null | null | null |
334460e2-ce87-5355-820b-aa7faf9865c4 | A 25-year-old woman is admitted to the hospital in the early stages of labor at term. Initial hematocrit is 33%. Which of the following is the most likely cause of the hematocrit value? | Decreased erythropoietin activity | Destruction of erythrocytes by the placenta | Early placental abruption | Increased plasma volume | 5 | D | 1 | Iron deficiency | null | null | null | null |
1e1c8c0f-9b53-5f71-803f-a56f6571ace1 | A 72-year-old patient who takes levodopa and carbidopa is undergoing colon resection. Metoclopramide is administered preoperatively and anesthesia is maintained with proposal, fentanyl, and nitrous oxide, with vecuronium for muscle relaxation. Fifteen minutes after reversal of muscle relaxation with neostigmine and atr... | Central anticholinergic syndrome | Fentanyl-induced rigidity | Inhibition of methionine synthetase by nitrous oxide | Metoclopramide-induced dopamine antagonism | 5 | D | 3 | Peripheral conversion of levodopa to dopamine | null | null | null | null |
75d77436-a667-5c03-bb42-abea2be017c9 | A 28-year-old patient has severe laryngospasm after extubation of the trachea following general anesthesia. Administration of 100% oxygen using continuous positive airway pressure does not improve symptoms. SpO2 is 75%. Which of the following is the most appropriate immediate management? | Laryngeal mask airway | Lidocaine | Racemic epinephrine | Succinylcholine | 5 | D | 3 | Cricothyroidotomy | null | null | null | null |
2649aaa6-706f-5e8b-bc9f-9e21772f9035 | During use of the ventilator on an anesthesia machine, positive pressure is noted on the airway pressure gauge during exhalation. Positive end-expiratory pressure has not been purposefully added to the breathing circuit. Which of the following is the most likely cause? | Closure of the pop-off valve in the circle system | Excessive tidal volume settings on the ventilator | Obstruction of the pressure relief valve on the scavenging system | Overinflation of the endotracheal tube balloon | 5 | C | 2 | Tension pneumothorax | null | null | null | null |
f0d0ebbb-9053-5545-8fd9-0f9ff39f73b8 | Each of the following parameters of cerebral perfusion and metabolism is approximately equal to 50 EXCEPT | cerebral oxygen consumption in ml O2/min for a normal adult | lower limit of mean arterial pressure for cerebral autoregulation in mmHg | normal cerebral blood flow in ml /100 g tissue/min | PaO2 at which cerebral blood flow increases | 5 | E | 1 | PaCO2 at which cerebral blood flow doubles | null | null | null | null |
2c12a2d2-7d1a-51cf-8457-a1667fe77e3a | A 64-year-old man with diabetes mellitus well controlled with NPH insulin undergoes lower extremity revascularization. Following administration of protamine 10 mg, the patient has facial flushing and blood pressure of 60/30 mmHg. The most appropriate initial step in management is administration of which of the followin... | Diphenhydramine | Epinephrine | Hydrocortisone | Norepinephrine | 5 | B | 2 | Phenylephrine | null | null | null | null |
f4691f0b-5389-50cd-a31b-897b4dddf873 | Unilateral or bilateral diaphragmatic paralysis is a complication of each of the following EXCEPT | surgical ligation of a patent ductus arteriosus | use of pericardial ice-slush for topical cardiac hypothermia | stellate ganglion block | interscalene brachial plexus block | 5 | E | 2 | C6 cervical fracture-dislocation | null | null | null | null |
1a8d30af-3d10-5907-b968-1ca7e3bf4800 | An 18-month-old child with tetralogy of Fallot is anesthetized with halothane and nitrous oxide. Following intubation, oxygen saturation decreases abruptly from 85% to 45%. The most effective treatment is | discontinuation of halothane | hyperventilation | intravenous epinephrine | intravenous phenylephrine | 5 | D | 3 | positive end-expiratory pressure | null | null | null | null |
9c3e929e-d782-5cea-8296-00c548ed7075 | A 20-kg, 6-year-old boy is undergoing strabismus surgery under anesthesia with sevoflurane, nitrous oxide, and oxygen. The heart rate suddenly decreases from 85 to 40 bpm. Which of the following is the most appropriate first step in management? | Decrease the depth of anesthesia | Increase the depth of anesthesia | Hyperventilate the patient | Administer atropine | 5 | E | 2 | Stop the surgical procedure | null | null | null | null |
c6f5aa3a-1f53-5a99-87d5-d84ce4d7b467 | Which of the following features is characteristic of the airway in a neonate? | Glottis that is located at the level of the C6 vertebral body | Larger tongue relative to the head than in an adult | Laryngeal mucosa that is densely adherent to the cartilages | More posterior glottis than that of an adult | 5 | B | 1 | Narrowest portion of the airway that is located at the arytenoid cartilages | null | null | null | null |
91c5d077-b577-5aa1-864e-91c94af4c4ae | Which of the following statements is true concerning administration of 70% nitrous oxide to a patient with an unrecognized pneumothorax? | Expansion of the pneumothorax by nitrous oxide occurs at a greater rate than expansion of bowel gas | Expansion of the pneumothorax by nitrous oxide occurs at a linear rate | The maximum expansion of a closed space occurs within 15 minutes | The maximum concentration of nitrous oxide achievable within the pneumothorax is 35% | 5 | A | 1 | The maximum increase in a closed gas-containing space is 100% | null | null | null | null |
1438a9f6-763c-5837-8695-4300d75ec8ef | A patient receiving propranolol and nifedipine is scheduled for elective coronary artery bypass surgery. During induction with fentanyl and oxygen, heart rate decreases from 52 to 36 bpm and blood pressure decreases from 130/85 to 80/50 mmHg. Administration of atropine 2 mg intravenously has no effect. The most appropr... | epinephrine | pancuronium | naloxone | phenylephrine | 5 | A | 3 | calcium chloride | null | null | null | null |
66e769ec-c961-5959-a2eb-c8a24e8e5539 | A 46-year-old patient who abuses intravenous drugs develops acute aortic valvular insufficiency from bacterial endocarditis. Which of the following statements concerning pressures measured through a pulmonary artery catheter is true? | Pulmonary artery occlusion pressure will underestimate left ventricular end-diastolic pressure | Pulmonary artery oxygen saturation will overestimate mixed venous oxygen saturation | Thermodilution cardiac output determination will overestimate cardiac output | Right ventricular end-diastolic pressure will equal left ventricular end-diastolic pressure | 5 | A | 2 | The pulmonary artery occlusion pressure trace will most likely have large V waves | null | null | null | null |
f696ded0-31eb-5508-8b40-5154c628b445 | Which of the following muscle relaxants is most likely to result in histamine release following administration of a bolus dose sufficient to facilitate rapid endotracheal intubation? | Atracurium | Pancuronium | Succinylcholine | Rocuronium | 5 | A | 1 | Vecuronium | null | null | null | null |
41181de5-8ee3-5ab6-af70-974a7bc5980f | A 68-year-old man has a permanent DVI pacemaker that has been functioning appropriately. Which of the following is most likely to cause conversion to VOO pacing? | Electroconvulsive therapy | Insertion of a pulmonary artery catheter | Placement of a magnet over the pulse generator | Use of electrocautery near the pacemaker | 5 | C | 1 | Shivering | null | null | null | null |
b67bed51-ea4f-54bd-9357-f09f96f6e46b | A 52-year-old woman undergoes facial surgery during general endotracheal anesthesia. The ventilator is set to deliver a tidal volume of 600 ml and a respiratory rate of 10/min at an FiO2 of 1.0. SpO2 is 100%, peak inspiratory pressure is 18 cmH2O, and PetCO2 is 40 mmHg. The surgeon flexes the patient's head so the chin... | Fluctuating capnographic waveform | Greater expiratory volume than inspiratory volume | Unchanged SpO2 | Unchanged PetCO2 | 5 | E | 2 | Unchanged peak inspiratory pressure | null | null | null | null |
a124498f-026b-5bd0-908b-403ea6f4952b | Which of the following chemotherapeutic drugs is a cause of pulmonary fibrosis? | Bleomycin | Cisplatin | Cyclosporine | Daunorubicin | 5 | A | 1 | Vincristine | null | null | null | null |
01047263-4f76-5da3-b3ed-487c6be03089 | A patient has a decrease in heart rate from 80 to 50 bpm and a decrease in blood pressure from 140/90 to 60/40 mmHg while in the recovery room after adrenalectomy for pheochromocytoma. The most appropriate treatment is administration of | atropine | calcium | hydrocortisone | isoproterenol | 5 | E | 2 | norepinephrine | null | null | null | null |
75a2f877-c0c8-513e-80ed-3e173e8e43e1 | A 65-year-old man has a history of alcohol abuse. Which of the following preoperative serum concentrations would provide the best assessment of synthetic hepatic function? | Albumin | Alkaline phosphatase | Bilirubin | Globulin | 5 | A | 1 | Transaminases | null | null | null | null |
e73d1b73-9917-55e2-9b70-4395eafee63e | Which of the following statements concerning air embolism during intracranial operations is true? | It does not occur in supine patients | It is prevented by positive end-expiratory pressure | It is confined to the right side of the heart and the pulmonary vasculature | It is detectable by measurement of end-tidal nitrogen | 5 | D | 1 | It is most efficiently treated by aspiration from a pulmonary artery catheter | null | null | null | null |
7e9965f6-730f-55dd-ac20-c2721b6bb907 | Which of the following is described by the standard deviation during analysis of the results of a clinical study? | Central tendency of the study results | Distribution of the results of the study group | Range of the results of the study group | Regression analysis of the study group | 5 | D | 1 | Statistical significance of the difference between the study groups | null | null | null | null |
e19ebbd3-ea7c-5e4a-819a-c51795a462bf | Each of the following is a characteristic of prostaglandin E1 (alprostadil) pharmacology in an infant EXCEPT: | It is effective in the treatment of large left-to-right shunts | It is a cause of apnea | It is a potent vasodilator | It prevents closure of the ductus arteriosus | 5 | A | 1 | It is metabolized rapidly | null | null | null | null |
8cb15969-811c-5114-be09-6d22db608517 | A 5-year-old child undergoes strabismus correction during spontaneous ventilation with halothane 1.5%, nitrous oxide and oxygen 50%. Intravenous atropine 0.2 mg is administered after inhalation induction. Ten minutes after incision, heart rate decreases from 110 bpm to 40 bpm. Which of the following is the most likely ... | Administration of phenylephrine eyedrops | Inadvertent external pressure on the carotid sinus | Paradoxical response to a small dose of atropine | Sinoatrial nodal depression by halothane | 5 | E | 2 | Traction on an extraocular muscle | null | null | null | null |
d900a12d-4196-58bb-be96-9ad2dd1a3397 | An atrioventricular sequential demand pacemaker is placed in a patient who has abnormal atrioventricular conduction. Each of the following statements about this situation is true EXCEPT: | Electrocautery could lead to long pauses in the paced rhythm | Placing a magnet over the generator will convert it to an asynchronous (fixed rate) unit | If complete heart block develops, the paced ventricular rate will be the same as the sinus node rate | An atropine-induced increase in the sinus rate will increase the ventricular rate | 5 | E | 3 | During symptomatic tachyarrhythmia, cardioversion would be contraindicated because it would alter the pacemaker's function | null | null | null | null |
8ad9ac35-1f37-537d-8113-2bcd964b6e7d | Compared with adults, neonates are more likely to become hypoxemic following anesthesia and extubation because of a relatively | higher rate of oxygen consumption | greater sensitivity to neuromuscular blockade | larger Vd/Vt ratio | lower blood pressure | 5 | A | 1 | smaller functional residual capacity | null | null | null | null |
3338a552-19e8-589b-8412-7621ceb800f8 | A 64-year-old, 70-kg woman treated with lithium for manic-depressive psychosis is given methohexital 90 mg and succinylcholine 35 mg intravenously for electroconvulsive therapy. Ten minutes later she remains sedated and the peripheral nerve stimulator shows a decreased twitch response. The most likely explanation is | cerebral hypoxia | postictal depression | relative overdose of methohexital | unrecognized atypical pseudocholinesterase | 5 | E | 3 | residual lithium effects | null | null | null | null |
ad0d0432-3408-5746-be68-5fbd23633908 | A patient is bleeding excessively after routine transurethral resection of the prostate. Re-exploration discloses diffuse oozing. The most appropriate management is administration of | platelets | fresh frozen plasma | desmopressin | epsilon-aminocaproic acid | 5 | D | 2 | cryoprecipitate | null | null | null | null |
b729489e-b3c6-5721-93fa-bcf502861ef3 | A 70-kg, 47-year-old man is undergoing a repeat coronary artery bypass graft. Following sternotomy, administration of heparin 300 units/kg for anticoagulation increases the activated coagulation time from a baseline of 135 sec to 210 sec. This finding is compatible with | antithrombin III deficiency | heparin-induced thrombocytopenia | normal response to this dose of heparin | increased sensitivity to heparin | 5 | A | 2 | von Willebrand's disease | null | null | null | null |
4f264bf2-6d86-5f60-9ff7-24cf8625aa69 | Prolonged respiratory depression following administration of morphine is more likely in patients with chronic renal faillure than in patients with normal kidney function because of | decreased biotransformation | decreased protein binding | decreased volume of distribution | delayed excretion of morphine metabolites | 5 | D | 1 | the effect of acidosis on morphine ionization | null | null | null | null |
c1d5b354-8f41-57bb-a232-592eca2fcfb3 | While checking an anesthesia machine, opening the oxygen flow-control valve yields no oxygen flow, although the wall-mounted oxygen pipeline supply gauge reads 50 psig. Opening the backup oxygen cylinder results in normal oxygen flow. The most likely cause is | failure of the oxygen pipeline supply | failure of the second-stage oxygen pressure regulator | a malfunctioning check valve in the oxygen pipeline supply inlet | a malfunctioning fail-safe valve | 5 | C | 3 | a malfunctioning oxygen flow-control valve | null | null | null | null |
27644be8-bff7-5440-a298-54fb566d2040 | A 2500-g, 12-hour-old infant is tracheally intubated and mechanically ventilated at a rate of 20/min with an FiO2 of 0.4 and peak inspiratory pressure of 25 cmH2O. At birth, amniotic fluid was meconium stained and Apgar scores were 2 and 7. The most recent arterial blood gas levels are PaO2, 50 mmHg, PaCO2, 55 mmHg, an... | administer sodium bicarbonate | begin intravenous infusion of prostaglandin E, | increase FiO2 | increase ventilation | 5 | D | 2 | perform bronchial lavage | null | null | null | null |
ff41f680-bdf3-5065-b2b5-fb5580090d06 | Each of the following changes is expected with deliberate hypothermia EXCEPT | decreased unloading of oxygen from hemoglobin | a 5% decrease in MAC for each 1°C decrease in temperature | increased arterial oxygen and carbon dioxide contents | a 50% decrease in cerebral metabolic rate at 28°C | 5 | E | 1 | spike and dome EEG activity at temperatures below 30°C | null | null | null | null |
b12a7ff1-5782-5aaf-a7f1-cc9895663678 | A 30-year-old man is brought to the emergency department after being rescued from a house fire. With the trachea intubated and FiO2 at 1.0, arterial blood gas values are PaO2 495 mmHg, PaCO2 28 mmHg, and pH 7.28. Hemoglobin saturation measured by co-oximeter is 50%. The most appropriate next step is to | add positive end-expiratory pressure | add n-acetylcysteine to the inhaled gases | administer sodium bicarbonate intravenously | transfuse 2 units of packed red blood cells | 5 | E | 3 | transfer to a hyperbaric chamber | null | null | null | null |
67b1305f-4a62-5a6a-9cd9-507287f4c728 | Each of the following decreases hepatic blood flow EXCEPT | isoflurane anesthesia | spinal anesthesia | hypercarbia | mechanical ventilation | 5 | C | 1 | positive end-expiratory pressure | null | null | null | null |
b9fa1ed5-693d-5a30-a4f0-42dc8b1f087e | In a normally functioning circle anesthesia system, if the length of the inspiratory and expiratory hose is doubled, the mechanical dead space will be | halved | unchanged | doubled | quadrupled | 5 | A | 2 | dependent on compression volume | null | null | null | null |
fe55b255-2859-5c4d-b956-bff0f480a3fd | The most common early indication of drug dependence in an anesthesiologist is | a positive finding on random screening of urine | inconsistency between anesthetic and drug control records | change in behavior | incapacitation due to overdose | 5 | C | 1 | the presence of needle tracks on the extremities | null | null | null | null |
f08628b8-075a-5ce0-8343-1170a67dc12a | During axillary block of the brachial plexus, which nerve is most likely to be encountered if the needle is inserted through the posterior wall of the artery? | Intercostobrachial | Median | Musculocutaneous | Radial | 5 | D | 1 | Ulnar | null | null | null | null |
5a6cf74e-a193-577d-a59f-b43924509b83 | Which of the following is a sign of cyclosporine toxicity? | Abnormal hepatic enzyme activity | Decreased hemoglobin concentration | Increased serum creatinine concentration | Nodular density on radiograph of the chest | 5 | C | 1 | ST-T wave changes on ECG | null | null | null | null |
5f8669cc-582a-59ae-90d7-d2c7aeb1ae79 | Carbon dioxide retention first occurs when the ratio of forced expiratory volume in 1 second to vital capacity (FEV1/VC) decreases below | 15% | 35% | 50% | 65% | 5 | B | 1 | 75% | null | null | null | null |
6fe15712-358c-5cc8-a034-599e39597d36 | The EEG begins to flatten during carotid endarterectomy when regional cerebral blood flow (in ml/min/100 g brain) decreases to | 55 | 45 | 30 | 20 | 5 | D | 1 | 10 | null | null | null | null |
e19a6a6f-4b00-5917-a9b2-cfa2a0ecc063 | During steady-state intraoperative controlled mechanical ventilation, exhaled tidal volume will be increased by | changing to more compliant tubing in the ventilatory circuit | increasing fresh gas flow in the anesthesia machine | increasing nitrous oxide concentration in the inspired mixture | increasing ventilatory rate | 5 | B | 2 | moving the volume sensor as far as possible from the patient | null | null | null | null |
88053240-7a4b-5b30-ba87-06ef842c11e0 | When used with morphine for premedication, which of the following drugs is most likely to cause sedation? | Atropine | Cephalothin | Clonidine | Metoclopramide | 5 | C | 1 | Ranitidine | null | null | null | null |
7246704f-57b6-5c73-8074-0763306f30b3 | A 39-year-old patient with insulin-dependent diabetes mellitus receives thiopental 250 mg and succinylcholine 80 mg and is ventilated with 0.75% isoflurane in oxygen. Arterial pressure decreases abruptly from 140/100 to 80/50 mmHg while heart rate remains unchanged at 70 bpm. Failure of heart rate to increase most like... | acute hypoglycemia | autonomic neuropathy | depression of sinus node function by thiopental | depression of the baroreflex response by isoflurane | 5 | B | 2 | ganglionic stimulation by succinylcholine | null | null | null | null |
51cdf2dd-e943-5d23-960c-9bb2720e0ac5 | Diffuse microvascular bleeding is noted in a patient who has received 25 units of whole blood for a liver resection. Platelet count is 40,000/mm3, prothrombin time is 18 sec, activated partial thromboplastin time is 54 sec, and serum fibrinogen concentration is 60 mg/dl. The most likely cause of the bleeding is | abnormal platelet function | citrate toxicity | depressed levels of factors V and VIII | dilutional thrombocytopenia | 5 | E | 3 | disseminated intravascular coagulation | null | null | null | null |
d30122ff-e6c0-5e4e-b587-1bc35daf1124 | A 66-year-old man with chronic obstructive pulmonary disease who underwent colectomy 12 hours ago has been receiving an epidural infusion of fentanyl at a rate of 100 mcg/hr. Which of the following is LEAST likely to develop? | Hypotension | Nausea | Pruritus | Respiratory depression | 5 | A | 2 | Urinary retention | null | null | null | null |
3d64bf4f-e878-5d5d-ba07-07ce00104e00 | In a patient with hypovolemic shock, which of the following factors is the best measure of the overall balance between oxygen supply and demand? | Arterial oxygen content | PetO2 | Mixed venous oxygen saturation | PaO2 | 5 | C | 2 | Transcutaneous oxygen tension | null | null | null | null |
09a943f8-35e2-5fda-8003-e372dd7586e9 | Which of the following is the most likely adverse effect of prolonged intravenous administration of nitroglycerin? | Cyanmethemoglobinemia | Hemolysis | Methemoglobinemia | Neutropenia | 5 | C | 1 | Thrombocytopenia | null | null | null | null |
8ea796e4-cee2-5c12-84c2-4bf85ef1cfad | Trimethaphan causes each of the following EXCEPT | cerebral vasodilation | urinary retention | pupillary cycloplegia | histamine release | 5 | A | 1 | potentiation of succinylcholine block | null | null | null | null |
22389f0d-0e6e-57e6-bfa9-67962e9c2538 | An apneic adult is receiving an oxygen flow of 4 L/min through a rigid bronchoscope. After five minutes of apnea, which of the following findings is most likely? | A decrease in cardiac output | A decrease in pulmonary vascular resistance | A decrease in SpO2 from 99% to 89% | An increase in PaCO2 of 18 mmHg | 5 | D | 3 | Serum bicarbonate concentration of 30 mEq/L | null | null | null | null |
e967a494-e94c-5f59-83ee-6d7b42ff1bd8 | During anesthesia with nitrous oxide 65% in oxygen, fentanyl, and pancuronium, nitroprusside is administered to decrease arterial pressure to 85/50 mmHg. A decrease in PaO2 from 120 to 65 mmHg is most likely caused by | cyanide toxicity | depressed cardiac output | mild hypercarbia | metabolic acidosis | 5 | E | 3 | pulmonary vasodilation | null | null | null | null |
649899f2-3521-5c3e-8950-22b0996377b3 | A 69-year-old woman with mitral stenosis and atrial fibrillation is scheduled for mitral valve replacement and removal of a left atrial thrombus. After administration of pancuronium, heart rate increases to 140 bpm and blood pressure decreases to 70/40 mmHg. Which of the following is the LEAST appropriate treatment? | Cardioversion | Edrophonium | Esmolol | Phenylephrine | 5 | A | 3 | Verapamil | null | null | null | null |
1342ae35-6eee-50d2-afda-f3327b49fd22 | Which of the following statements concerning fetal hemoglobin is true? | It makes up less than 50% of the total hemoglobin in the neonate | It has less affinity for oxygen than adult hemoglobin | It binds with greater affinity to 2,3-DPG than adult hemoglobin | It shifts the oxyhemoglobin dissociation curve to the left | 5 | C | 1 | It has a P50 of 27 mmHg | null | null | null | null |
f655a128-2ef8-5ea4-bb07-2e230c7e2685 | An 8-kg, 5-month-old infant undergoes craniotomy for an arteriovenous malformation. During the procedure, severe hemorrhaging occurs and packed red blood cells 3 units are transfused rapidly. During infusion of the third unit, hypotension, nodal bigeminy, and prolongation of the QT interval are noted. The most appropri... | bicarbonate | calcium | ephedrine | lidocaine | 5 | B | 2 | potassium | null | null | null | null |
8f4bd4ad-07b7-5343-af86-5d80c3db566c | A 68-year-old woman who is receiving urokinase for deep venous thrombosis and pulmonary emboli requires emergency laparotomy for a bleeding gastric ulcer. Which of the following agents is most appropriate to reverse the effects of urokinase? | Cryoprecipitate | Factor VIII concentrate | Fresh frozen plasma | Platelets | 5 | A | 2 | Vitamin K | null | null | null | null |
37d3819e-8460-53ed-b62d-5c79f784bc7f | A bilateral superior laryngeal nerve block performed to facilitate fiberoptic intubation will provide anesthesia of the | base of the tongue | larynx above the vocal cords | superior surface of the epiglottis | tonsillar pillars | 5 | B | 1 | upper trachea | null | null | null | null |
e1f78927-de11-5d51-a80b-244021438c5c | A patient who is scheduled for a gastrectomy had abnormal liver function tests for four days following a prior cholecystectomy. In your consultation note, you should | recommend sevoflurane anesthesia since abnormal postoperative liver function tests are unlikely with this drug | recommend subarachnoid anesthesia since changes in hepatic blood flow would be less than with general anesthesia | indicate that abnormal liver function tests are likely to follow this operation regardless of the anesthetic drugs used | require preoperative screening for hepatitis B antigen and antibodies | 5 | C | 2 | recommend avoiding halothane since it is more likely to produce hepatitis in patients who had previous upper abdominal surgery | null | null | null | null |
fa26e5a8-e008-581c-9835-deb7f4b3701c | A 76-year-old man has a leaking abdominal aortic aneurysm. His blood pressure and pulse have remained stable for 15 minutes at 90/60 mmHg and 130 bpm, respectively. His hemoglobin concentration is 11 g/dl, and the EKG shows a left bundle branch block. Induction of anesthesia should proceed | after a pulmonary artery catheter has been inserted and the pulmonary artery occlusion pressure is greater than 7 mmHg | when the pulse has decreased below 130 bpm from the rapid transfusion of blood | when systolic blood pressure has increased to more than 120 mmHg from the rapid infusion of lactated Ringer's solution | immediately on arrival in the operating room | 5 | D | 3 | when circulatory signs deteriorate or cease to improve with rapid volume expansion | null | null | null | null |
5dfab547-9fb3-5a9a-90d2-fd55b4d9e98f | Which of the following is the most common initial sign of hemolytic transfusion reaction during general anesthesia? | Bronchospasm | Diffuse bleeding | Fever | Hemoglobinuria | 5 | D | 1 | Hypotension | null | null | null | null |
78450fd5-6a78-5b64-a20b-5f04ef1a0eca | Which of the following is the most appropriate treatment of methemoglobinemia prior to emergency surgery? | Hydroxocobalamin | Methylene blue | Oxygen by face mask | Packed red blood cells | 5 | B | 1 | Thiosulfate | null | null | null | null |
87068a2b-7ae0-5932-8e4e-61c8144f9eea | The risk for airway fire during laser resection of a tracheal tumor is decreased by use of | a CO2 laser rather than a YAG laser | an inspired helium concentration greater than 60% | an inspired nitrous oxide concentration greater than 60% | a polyvinylchloride endotracheal tube | 5 | B | 1 | halothane in the inspired mixture | null | null | null | null |
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