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c2e26d9e-4cf7-53f4-8831-9ac9841a6f73 | In a patient with ventricular fibrillation refractory to repeated attempts at defibrillation and epinephrine administration, the most appropriate management is administration of | amiodarone | procainamide | propranolol | quinidine | 5 | A | 1 | verapamil | null | null | null | null |
edaa657a-4f17-5ab9-b10f-bc35075b1504 | During anesthesia with nitrous oxide and isoflurane in a 70-kg, 25-year-old patient, airway resistance would be decreased by | a decrease in lung volume | insertion of a 9-mm endotracheal tube | administration of atropine | neuromuscular block with d-tubocurarine | 5 | C | 2 | movement of the patient from the supine to the sitting position | null | null | null | null |
7c114911-e34c-52c3-9287-cabe3e8b283c | A 67-kg, 52-year-old man is undergoing heart transplantation. After implantation of the donor heart and discontinuation of cardiopulmonary bypass, isoproterenol is administered intravenously to maintain heart rate greater than 100 bpm. During the next 10 minutes, blood pressure decreases from 105/55 mmHg to 75/40 mmHg.... | amrinone | digoxin | dopamine | epinephrine | 5 | E | 3 | norepinephrine | null | null | null | null |
bc932819-16c6-5fd1-a8ef-7cbfeace8f73 | A patient with chronic obstructive pulmonary disease is undergoing spinal anesthesia to a T6 sensory level. The most pronounced effect on pulmonary function will be a decrease in | minute ventilation | peak expiratory flow | physiologic dead space | tidal volume | 5 | B | 2 | vital capacity | null | null | null | null |
2a49a59a-0f45-56ef-aad4-b4806b90b0bb | Following induction of general anesthesia, mask ventilation and the initial attempt at intubation is unsuccessful. Which of the following procedures is most appropriate? | Administration of additional muscle relaxant | Repeat attempt at intubation | Fiberoptic intubation | Retrograde intubation | 5 | B | 2 | Cricothyroidotomy | null | null | null | null |
53b3155a-ce48-5d78-9c9a-d4e80c803eb7 | Pancuronium blocks the bradycardic effect of fentanyl by a direct effect on | beta-adrenergic receptors | cardiac muscarinic receptors | carotid baroreceptors | central vagal nuclei | 5 | B | 1 | sympathetic ganglia | null | null | null | null |
b033171f-9bbd-50aa-bab1-31de5c554039 | In a spontaneously breathing patient, each of the following increases the work of breathing EXCEPT | an increase in respiratory rate by 10/min | a decrease in lung-thorax compliance by 10 cmH2O | an increase in carbon dioxide production by 1 ml/kg/min | a decrease in PaO2 from 80 to 65 mmHg | 5 | D | 2 | a 0.1 increase in the ratio of dead space to tidal volume | null | null | null | null |
00a32823-2137-5ec2-930d-1e02402823a0 | In pregnant patients, which of the following is an effect of the long-term use of cocaine? | Decreased uterine tone | Decreased thiopental requirement | Increased isoflurane MAC | Increased sensitivity to ephedrine | 5 | C | 1 | Lower than expected level of block with tetracaine spinal analgesia | null | null | null | null |
550ffc41-46e2-5df2-8f58-dc62f6504565 | Which of the following statements concerning functional residual capacity is true? | It decreases linearly during a three-hour anesthetic | It decreases in pregnancy primarily because of a decrease in the expiratory reserve volume | It increases in patients with a history of heavy smoking | It increases with pulmonary contusions | 5 | B | 1 | It is smaller (ml/kg) in children than in adults | null | null | null | null |
c69098ab-dd8b-5c97-a2f6-4feb611a5de9 | Which of the following correctly describes the anatomic location of the stellate ganglion? | Anterior to the transverse process of C5 | Anterior to the transverse process of C7 | Posterior to the prevertebral fascia | Posterior to the vertebral artery | 5 | B | 1 | Lateral to the carotid artery | null | null | null | null |
9d2efce2-94e4-50d8-bca4-fe87895c623c | Equipment that is attached to a patient should have leakage current no greater than | 10 microamps | 100 microamps | 1 milliamp | 10 milliamps | 5 | A | 1 | 100 milliamps | null | null | null | null |
36fd71e5-f4d9-5e05-aa5b-edc14301308f | Inhalation induction of anesthesia is more rapid in a 6-month-old infant than in an adult because infants have | greater ratio of alveolar ventilation to functional residual capacity | greater ratio of blood volume to body weight | greater solubility of anesthetic in blood | lower anesthetic requirement | 5 | A | 1 | lower distribution of cardiac output to vessel-rich organs | null | null | null | null |
ad5c2ab6-44db-583b-a21f-04ed2ab62f07 | In children with preoperative upper respiratory tract infection, which of the following is associated with the greatest risk for postoperative airway obstruction? | Age less than 1 year | Endotracheal intubation | Head and neck surgery | Inadequate airway humidification | 5 | A | 1 | Surgery for more than two hours | null | null | null | null |
4ed70d9c-f88e-5796-88da-409c3e104e30 | Perception of pain from cutaneous sources involves each of the following EXCEPT | frontal lobe gyri | lateral spinothalamic tracts | periaqueductal gray matter | spinal dorsal horn lamina V | 5 | A | 1 | unmyelinated C fibers | null | null | null | null |
0ccea366-62fd-5a9a-93e6-4605e8c64373 | In patients with pregnancy-induced hypertension, magnesium sulfate is most likely to | decrease maternal heart rate | decrease sensitivity to relaxants | decrease succinylcholine-induced fasciculations | prevent hypokalemia | 5 | C | 1 | produce fetal bradycardia | null | null | null | null |
26cdbc4b-308a-5543-9549-600616978f5d | Which of the following statements best describes the decrease in functional residual capacity that accompanies the induction of general anesthesia? | It does not change compliance | It is greater with spontaneous ventilation than with controlled ventilation | It is independent of body position | It is not corrected by application of positive end-expiratory pressure | 5 | E | 1 | It occurs within the first 10 minutes of anesthesia | null | null | null | null |
772672de-001f-5755-9dc0-e8002587d8a5 | Which of the following statements concerning carbon monoxide poisoning is true? | Diagnosis is excluded if the PaO2 is greater than 300 mmHg while breathing 100% oxygen | Increased inspired oxygen concentration accelerates displacement of carbon monoxide from hemoglobin | Methylene blue decreases binding of carbon monoxide to hemoglobin | Pulse oximetry accurately reflects hemoglobin oxygen saturation | 5 | B | 1 | Tissue oxygen delivery is normal | null | null | null | null |
be0c5c88-52e6-5d6b-9809-d3b29014842c | Which surface area of the upper extremity is most likely to be unanesthetized by an interscalene brachial plexus block? | Hypothenar eminence | Thenar eminence | Dorsolateral surface of the hand | Lateral aspect of the forearm | 5 | A | 1 | Lateral surface of the upper arm | null | null | null | null |
2b36d2e4-98d6-5589-bf83-e6cae8aaf0d4 | Which of the following statements concerning cardiovascular physiology in a healthy term neonate is true? | Heart rate is increased in response to hypoxemia | Heart rate increases reflexly in response to hypotension | Stroke volume increases in response to decreased systemic vascular resistance | Stroke volume increases in response to bradycardia | 5 | E | 1 | Stroke volume is near-maximal under resting conditions | null | null | null | null |
44d5cf3e-1017-50b9-b6c3-a68e2420336e | Cessation of smoking on the day prior to an operation is associated with a perioperative | decrease in carbon monoxide in blood | improvement in ciliary beating in the airways | decrease in sputum volume | decrease in the need for postoperative ventilatory support | 5 | A | 1 | decrease in the risk of deep vein thrombosis | null | null | null | null |
415b1443-d724-5ac0-a2e0-040e70caf520 | Which of the following is an effect of clonidine? | Agitation | Salivation | Tachycardia | Tachypnea | 5 | E | 1 | Vasodilation | null | null | null | null |
b7f466c8-8831-517a-ada5-3581c54c440a | Each of the following findings is characteristic of restrictive lung disease EXCEPT | decreased elasticity of the lungs | decreased FEV1/FVC ratio | decreased inspiratory reserve volume | increased work of breathing | 5 | B | 1 | normal anatomic dead space | null | null | null | null |
4bc1e110-915a-553b-819b-262288ce47c3 | When used for irrigation during transurethral resection of the prostate, glycine 1.5% is associated with each of the following EXCEPT | hemolysis | hyperammonemia | cerebral edema | hypofibrinogencmia | 5 | A | 1 | visual disturbances | null | null | null | null |
40dd240f-e79b-5416-afd0-b19b87df80e3 | A 35-year-old woman with severe myasthenia gravis is scheduled for thymectomy. Which of the following preoperative pulmonary function tests is most likely to be normal? | Forced expiratory volume in 1 second (FEV1) | Forced vital capacity (FVC) | FEV1/FVC | Maximum voluntary ventilation | 5 | C | 2 | Peak inspiratory force | null | null | null | null |
32601239-99e5-5b73-8355-b4c0e46ad8a4 | The concentration of bupivacaine is higher in maternal blood than in fetal blood because | bupivacaine is metabolized in the placenta | maternal blood has a higher pH | maternal blood has greater plasma protein binding | maternal hemoglobin has a higher affinity for bupivacaine | 5 | C | 2 | placental transfer of bupivacaine is limited | null | null | null | null |
0ebc85e7-1d1a-5ac3-b3d3-e42be69a18c2 | A 19-year-old woman has severe nausea and vomiting following laparoscopy. After intramuscular administration of prochlorperazine 10 mg, she has muscle spasms in the face, neck, and tongue. Which of the following is the most appropriate management? | Baclofen | Diphenhydramine | Epinephrine | Hydrocortisone | 5 | B | 2 | Naloxone | null | null | null | null |
e0895cc8-1ddb-5837-9027-e72af0f5e551 | The newborn infant of an 18-year-old heroin addict has an initial Apgar score of 1. After intubation of the trachea and ventilation with pure oxygen, the Apgar score is 3 at five minutes. Appropriate management at this time would include administration of each of the following EXCEPT | dextrose 10% | epinephrine | naloxone | normal saline solution | 5 | C | 2 | sodium bicarbonate | null | null | null | null |
d56aacf2-8df9-5d29-bb4b-78ae39bec466 | A 25-year-old man requires exploratory laparotomy following a motor vehicle accident. He is acutely intoxicated with alcohol. Which of the following is the most likely result of the alcohol ingestion? | Hyperdynamic circulation | Hyperglycemia | Hyperthermia | Increased respiratory depression from opioids | 5 | D | 2 | Increased sensitivity to neuromuscular blocking drugs | null | null | null | null |
5e7fb80d-e525-571d-9453-5e81b1b44913 | During isoflurane anesthesia, a 45-year-old patient with chronic asthma has wheezing, prolonged expiration, sinus tachycardia of 120 bpm, and premature ventricular contractions. Preoperative medication included cromolyn and theophylline. The most appropriate treatment is to administer | albuterol aerosol | aminophylline by intravenous infusion | cromolyn aerosol | halothane | 5 | A | 2 | hydrocortisone by intravenous bolus | null | null | null | null |
72ebb2fd-ba4c-5b63-9c87-a31d7088cc77 | 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 wave form from the aorta to the radial artery | 5 | D | 3 | too high a frequency response in the catheter-transducer system | null | null | null | null |
15cc18bd-f60d-5d92-a199-67d0463cd687 | Compared with an induction dose of thiopental (4 mg/kg), an induction dose of propofol (2.5 mg/kg) produces | better maintenance of cerebral perfusion pressure | greater inhibition of glucocorticoid production | higher incidence of myoclonus | less severe hypotension | 5 | C | 1 | less severe respiratory depression | null | null | null | null |
c842c84d-c586-524a-a485-fcf9c46891cf | Which property of oxygen is detected by the fail-safe device on the anesthesia machine? | Concentration | Flow | Pressure | Partial pressure | 5 | C | 1 | Reserve volume | null | null | null | null |
04576a53-0b6b-5211-830b-4f566ffebce8 | During general anesthesia with spontaneous ventilation, a patient has a VD/VT of 0.5. Which of the following is most likely to decrease the ratio? | Acute bronchospasm | Continuous positive airway pressure | Decreased tidal volume | Increased cardiac output | 5 | D | 2 | Pulmonary embolism | null | null | null | null |
f0fbd88b-0a97-5291-9c87-0854a1b0c756 | Nitroprusside therapy for hypertension should be discontinued in the presence of | acute myocardial infarction | increasing metabolic acidosis | methemoglobinemia | mitral regurgitation | 5 | B | 1 | renal failure | null | null | null | null |
65212e9a-d8bd-5d68-9116-f045d9ead43d | An 18-year-old woman has knee pain during arthroscopy performed with femoral and sciatic nerve blocks for repair of a torn medial meniscus. The most appropriate management is addition of which of the following nerve blocks? | Deep peroneal | Obturator | Popliteal | Saphenous | 5 | B | 2 | Superficial peroneal | null | null | null | null |
ec5d86bd-1fb2-5f0a-9207-2f94078c9b3b | A child has tachypnea immediately after reintubation for intractable laryngospasm. Oxygen saturation is 78% at an FiO2 of 1.0. A radiograph of the chest taken 15 minutes later is most likely to show | bilateral pleural effusions | diffuse homogenous pulmonary infiltrates | patchy central infiltrates of the right upper lobe | pneumothorax | 5 | B | 2 | segmental atelectasis at both lung bases | null | null | null | null |
566e8c43-bbe8-5012-b4b7-5b4c5a8d40ce | Which of the following statements concerning the risk of acquiring hepatitis from a blood transfusion is true? | Most patients with post-transfusion hepatitis become clinically jaundiced | Most cases of post-transfusion hepatitis are caused by the hepatitis B virus | The risk for hepatitis is less than the risk for AIDS | The risk for post-transfusion hepatitis is less than 1% per unit transfused | 5 | D | 1 | The incidence of post-transfusion hepatitis has remained unchanged over the past decade | null | null | null | null |
d9e7ffb9-1252-548c-98f7-3b356b60a2c9 | One full E-cylinder of oxygen at 20°C can deliver 2 L/min of oxygen for at most | 30 minutes | 90 minutes | 3 hours | 5 hours | 5 | D | 2 | 12 hours | null | null | null | null |
9a4c48d8-ec2f-5e9e-887e-6aee1454e82b | A patient has tonic movements of the head and neck, nystagmus, and slurred speech after receiving metoclopramide for nausea after nitrous oxide-opioid anesthesia. The most appropriate pharmacologic treatment is | diphenhydramine | midazolam | naloxone | phenytoin | 5 | A | 2 | physostigmine | null | null | null | null |
a3510232-bd8d-5cd9-b94e-0c55644996bf | Two days after total abdominal hysterectomy, a 54-year-old woman develops lethargy followed by seizures and coma. Laboratory studies show a serum sodium concentration of 108 mEq/L and serum osmolality of 225 mOsm/kg. The most appropriate next step in management is administration of which of the following? | Desmopressin | Furosemide only | Saline solution 0.9% only | Furosemide and saline solution 0.9% | 5 | E | 3 | Furosemide and saline solution 3% | null | null | null | null |
d5b2eaa2-cf01-56ec-8451-898367408e2d | During repair for coarctation of the aorta in a healthy 13-year-old patient, right radial artery pressure increases from 100/60 to 105/70 mmHg after the aorta is cross clamped. This most likely indicates that | collateral blood flow has decreased the hemodynamic consequences of cross-clamping | left ventricular hypertrophy has decreased left ventricular compliance | spinal cord blood flow is impaired | the coarctation has decreased aortic diameter less than 50% | 5 | A | 3 | the coarctation involves the origin of the right subclavian artery | null | null | null | null |
36f2de2b-3a01-5ac5-8232-41bbdeeef18c | Which of the following statements concerning hyperkalemia after succinylcholine administration to a patient with a spinal cord injury is true? | It is unlikely to occur if the lesion is located below T6 | It is unlikely to occur within 24 hours of the injury | It is unlikely to occur more than 60 days after the initial injury | It is prevented by pretreatment with small doses of a nondepolarizing agent | 5 | B | 1 | It is decreased in magnitude by pretreatment with calcium chloride | null | null | null | null |
8620804b-f952-542c-90d8-991d44c19d4e | An obese, 70-year-old woman with a long history of tobacco abuse is awake and semirecumbent after uneventful anesthesia with isoflurane for a ventral hernia repair. During the first hour in the recovery room while breathing 50% oxygen by face mask, her arterial oxygen saturation decreases to 90% while other vital signs... | Intravenous doxapram | Racemic epinephrine by inhalation | Continuous positive airway pressure by mask | Reintubation of the trachea | 5 | E | 3 | Coughing | null | null | null | null |
1d09e3ab-3295-5a33-a703-1d957915ec84 | During anesthesia using the Bain circuit | PaCO2 is independent of minute volume if fresh gas flow is greater than 17 ml/kg | PaCO2 is independent of fresh gas flow if minute volume is greater than 100 ml/kg | PaCO2 may be normal in the presence of rebreathing | carbon dioxide removal is more efficient during spontaneous ventilation than during controlled ventilation | 5 | C | 1 | less body heat is lost than with a circle system | null | null | null | null |
09bd2d11-52c0-56dc-9f4a-709d29b5428f | Epidural block is safer at the L3-L4 interspace than at the T12-L1 interspace because of the location of the | anterolateral epidural veins | inferior border of the cauda equina | inferior border of the conus medullaris | inferior border of the subarachnoid space | 5 | C | 1 | blood supply to the anterior spinal cord | null | null | null | null |
63a489b6-1cef-507e-b638-3a440ac8415f | Which of the following is most effective in preventing intraoperative hypothermia in adults? | Heating and humidifying inspired gases | Maintaining a warm operating room | Using a circulating warm-water mattress | Using reflective coverings | 5 | B | 1 | Warming intravenous fluids | null | null | null | null |
ad00a493-c90a-5709-829a-069d0d4012c1 | Administration of 200 mEq of sodium bicarbonate during cardiopulmonary resuscitation is associated with | CSF alkalosis | hypercalcemia | hypercarbia | hyperkalemia | 5 | C | 1 | shift of the oxyhemoglobin dissociation curve to the right | null | null | null | null |
d96afc15-b61e-5e96-aba0-28795b1e499c | The correlation between anesthetic potency and lipid solubility | suggests that the number of molecules dissolved at the site of action causes anesthesia | applies to anesthetic agents dissolved in olive oil | suggests that the type of molecule causes anesthesia | is consistent with the synergistic effect of anesthetics | 5 | A | 1 | is not consistent with a unitary molecular site of action of anesthetics | null | null | null | null |
b8675162-e303-5745-8a2b-804d1cb4bde6 | Which of the following is a potentially beneficial effect of ketamine used for induction of anesthesia? | Analgesia | Attenuation of respiratory response to carbon dioxide | Decreased cerebral metabolic rate | Increased stroke volume in patients with hemorrhagic shock | 5 | A | 1 | Preservation of laryngeal reflexes | null | null | null | null |
ae11274e-d617-5db8-a50b-8b986914d5cb | The last muscle to be affected by an interscalene brachial plexus block is the | brachialis | brachioradialis | biceps | flexor carpi radialis | 5 | E | 1 | interosseous | null | null | null | null |
5f72ab75-0763-50fc-b9bf-f423ed6c9f8e | During protamine administration following separation from cardiopulmonary bypass, blood pressure decreases from 100/70 to 60/30 mmHg and peak inspiratory pressure increases from 26 to 60 cm H2O. The most appropriate next step in management is administration of | diphenhydramine | dopamine | epinephrine | methylprednisolone | 5 | C | 2 | terbutaline | null | null | null | null |
95f4f40d-4741-5b8f-bdd2-44cd1c3ba7e3 | During induction of general anesthesia in a patient with a supraglottic tumor, both intubation and subsequent ventilation via a face mask are impossible. A cricothyroidotomy is performed with a 16-gauge intravenous catheter. Which of the following statements is true? | Application of pressures greater than 35 cmH2O to the catheter will increase the risk for pulmonary barotrauma | PaC02 can be maintained at a normal level using a standard circle system attached to the catheter | PaO2 greater than 100 mmHg can be maintained indefinitely using transtracheal jet ventilation with pure oxygen through the catheter | Emergency surgical tracheostomy would have improved the likelihood of survival | 5 | C | 2 | The presence of this tumor contraindicates jet ventilation via cricothyroidotomy | null | null | null | null |
6d578b09-9e4e-527a-a53f-ec362ec59af0 | A 50-year-old man with an 80 pack-year history of cigarette smoking has a forced expiratory volume in one second of 1.5 L and a forced vital capacity of 3.5 L. Which of the following statements concerning intraoperative anesthetic management is true? | An I:E ratio of 1:1 will improve carbon dioxide removal more than an I:E ratio of 1:2.5 | Antagonism of neuromuscular block will most likely trigger acute bronchospasm | Functional residual capacity will increase during an acute exacerbation of bronchospasm | Induction with ketamine will increase airway resistance | 5 | C | 2 | Nitrous oxide is contraindicated | null | null | null | null |
6be7f60a-40da-5666-ad8a-335d19cbbf34 | A newly developed inhalational anesthetic has a blood-gas partition coefficient of 0.2. Which of the following statements best describes this drug compared with isoflurane? | MAC is lower | The difference between Fa and Fl during maintenance of anesthesia is greater | Time to emergence is shorter | Rapid induction requires greater overpressure | 5 | C | 2 | Equilibrium in a circle system with the same flow of fresh gas is slower | null | null | null | null |
4b10457d-315c-512e-a6f5-949312c55e1b | A 70-kg man with ischemic heart disease is undergoing abdominal aortic aneurysm resection. At the time of infrarenal cross-clamping, 0.2-mV ST-segment depression appears on lead V5 of the ECG. Hemodynamic changes occurring at the same time are shown below. Systemic blood pressure 90/50 --> 150/90; Heart rate 80 --> 95;... | blood pressure | heart rate | pulmonary artery pressure | pulmonary artery occlusion pressure | 5 | E | 3 | cardiac output | null | null | null | null |
c75e376a-4915-58b0-ae5f-8d57c5c91ac7 | A 65-year-old woman has respiratory distress and loss of consciousness immediately following superficial and deep cervical plexus block for right carotid endarterectomy. Which of the following is the most likely cause? | Phrenic nerve paralysis | Pneumothorax | Recurrent laryngeal nerve block | Subarachnoid injection | 5 | D | 2 | Vertebral artery injection | null | null | null | null |
3cc8d0a3-45c4-5373-b5d3-3cb629943d6c | Which of the following findings on the left is most likely to be associated with an increased risk of complications with cannulation of the left internal jugular vein compared with cannulation of the right internal jugular vein? | Longer recurrent laryngeal nerve | Lower location of the cupola of the pleura | More acute angle between the internal jugular and innominate veins | More anterior location of the phrenic nerve | 5 | E | 1 | Presence of the thoracic duct | null | null | null | null |
3c1ff444-82a3-53f6-a211-91114ecac7e1 | Which of the following characteristics of local anesthetics is associated with long duration of action? | High degree of lipid solubility | High degree of protein binding | High molecular weight | High pKa | 5 | B | 1 | Presence of ester linkage | null | null | null | null |
7dc735f1-68dc-5863-b225-7d6cb58e8c37 | An otherwise healthy 70-year-old man receives 12 units of packed red blood cells for persistent diffuse bleeding during suprapubic prostatectomy. Hemoglobin concentration is 11 g/dL, platelet count is 55,000/mm3, plasma fibrinogen concentration is 180 mg/dL, protime is 14 sec, and partial thromboplastin time is 35 sec.... | cryoprecipitate | desmopressin (DDAVP) | epsilon-aminocaproic acid | fresh frozen plasma | 5 | E | 3 | platelets | null | null | null | null |
6bd3aaea-3d5c-5584-b76b-b260009135a2 | The vapor pressure of a volatile anesthetic depends on | temperature only | ambient pressure only | temperature and ambient pressure | pressure and volume of the system | 5 | A | 1 | none of the above | null | null | null | null |
c26402f0-fe44-50c6-8867-788c9ef9abc6 | Surgery is cancelled 10 minutes after initiation of intravenous regional anesthesia with 50 ml of lidocaine 0.5%. To terminate anesthesia safely, what is the most appropriate timing for deflating the tourniquet? | Immediately if benzodiazepines have been administered | Immediately after intravenous administration of ephedrine 10 mg | Immediately, followed by repeated reinflation and deflation | In no less than 20 minutes after initial injection | 5 | D | 1 | In no less than 45 minutes after initial injection | null | null | null | null |
7b539ff4-7251-5aa0-a055-b809d65c187d | Bupivacaine is more likely than lidocaine to cause refractory cardiac arrest because bupivacaine | has a lower rate of plasma clearance | has a secondary blocking effect on cardiac beta,-adrenergic receptors | dissociates more slowly from sodium channels in cardiac muscle | inhibits spontaneous phase 4 depolarization in pacemaker cells | 5 | C | 1 | preferentially blocks calcium channels in Purkinje fibers | null | null | null | null |
ed015b48-f69e-5b00-ace5-27a5a7a5cc20 | After brachial plexus block, a patient has sensation over the inner aspect of the upper arm. Block of which of the following nerves would obtund this sensation? | Intercostobrachial | Median | Musculocutaneous | Radial | 5 | A | 1 | Ulnar | null | null | null | null |
4b468083-05e1-5f87-a120-4e4827c2645b | Reduction of fire hazards during laser surgery of the airway is best accomplished by use of | continuous mode laser emissions | a nitrous oxide/opioid/relaxant anesthetic technique | a polyvinylchloride endotracheal tube and cuff | topical lidocaine | 5 | E | 1 | saline-filled sponges over exposed tissues | null | null | null | null |
b86347ae-5789-5263-9d52-1cfd3b5b0a32 | A 20-year-old man involved in a motor vehicle accident is brought to the operating room for irrigation and debridement of open fractures of the femur and humerus. Cyanosis, decreased breath sounds on the left, increased peak airway pressure, and hypotension are noted after intubation of the trachea. The most likely cau... | aspiration | fat embolus | intubation of the right mainstem bronchus | tension pneumothorax | 5 | D | 3 | unilateral bronchospasm | null | null | null | null |
f1b7dcfb-4a4e-54c3-b7a9-65c835295e3b | Mivacurium-induced neuromuscular blockade is prolonged for the greatest period of time in patients who have which of the following conditions? | Ethanol-induced hepatitis | Hemiplegia | Pseudocholinesterase deficiency | Renal insufficiency | 5 | C | 1 | Thermal burns | null | null | null | null |
1da73490-b326-56fb-8ddf-74fd007248d3 | An endobronchial Robertshaw tube is inserted for resection of a midesophageal tumor under isoflurane, oxygen, pancuronium anesthesia. Forty minutes into a planned two-hour resection, arterial blood gas values are reported as PO2 45 mmHg, PCO2 45 mmHg, and pH 7.33. Ten minutes earlier, the values were PO2 210 mmHg, PCO2... | reposition the Robertshaw tube | apply positive end-expiratory pressure to the ventilated lung | reinflate and ventilate the non ventilated lung | increase minute ventilation | 5 | C | 3 | repeat the arterial blood gas analysis | null | null | null | null |
7dd206f2-3b8c-5427-ad50-5af74c3d4f97 | Awakening after a single dose of thiopental is caused by redistribution from the brain primarily to which of the following sites? | Fat | Heart | Liver | Lung | 5 | E | 1 | Skeletal muscle | null | null | null | null |
befd2eb8-5cf6-5bb4-85d5-b2b6daa91f0b | Which of the following statements concerning the volume of distribution of a drug is true? | It is equal to the sum of the volumes of the tissue spaces into which it diffuses | It is equal to the volume to which it is distributed outside the plasma volume | It is unaltered by the amount bound to red blood cells and plasma proteins | It depends on elimination from plasma | 5 | E | 1 | It relates the total amount of the drug in the body to the plasma concentration | null | null | null | null |
984cc5c2-16ea-5552-a869-c181db49e454 | After administration of a single dose of vecuronium, function returns last to which of the following muscles? | Adductor pollicis | Diaphragm | Laryngeal muscles | Orbicularis oculi | 5 | A | 1 | Rectus abdominis | null | null | null | null |
6562a982-a37d-56b6-9121-7661f48e3950 | A patient who is receiving ventilatory support after coronary artery bypass grafting has a PaO2 of 132 mmHg, a PaCO2 of 19 mmHg, and a pH of 7.57. Which of the following is most likely to result from this level of hypocarbia? | Decreased airway resistance | Increased myocardial contractility | Hyperkalemia | Shortened QT interval | 5 | E | 1 | Cerebral ischemia | null | null | null | null |
76f33fe5-eee6-54aa-a62d-d322af085d27 | A patient is in sinus rhythm but has no pulse during cardiopulmonary resuscitation. There is marked resistance to positive pressure ventilation and breath sounds are difficult to hear bilaterally. The endotracheal tube is clearly in the trachea. The most appropriate next step in management is to | administer isoetharine by inhalation | apply electrical countershock | insert needles in the left and right chest | order a roentgenogram of the chest | 5 | C | 3 | start an infusion of aminophylline | null | null | null | null |
705561fa-3304-527a-8471-5196aa8cfe37 | A combined epidural and general anesthetic is used for aortofemoral bypass surgery. Just prior to extubation, the patient received morphine 5 mg through the epidural catheter. Eleven hours later, he is unresponsive while breathing 40% oxygen from a face mask. Respiratory rate is 6/min and SpO2 is 92%. Arterial blood ga... | Hypercarbia is contributing to the decreased level of consciousness | Naloxone is ineffective for reversing the respiratory depression | The oxygen saturation is higher than expected because of the pH | The risk for respiratory depression would have been lower with subarachnoid administration of 0.5 mg morphine | 5 | A | 3 | Residual local anesthetic is contributing to the respiratory depression | null | null | null | null |
91270ad7-bfe9-556e-a2bc-ad51aaf54482 | A 65-year-old patient with hypertrophic cardiomyopathy has chest pain prior to induction of anesthesia. Pulse is 80 bpm and blood pressure is 130/80 mmHg. The ECG (V5) shows sinus rhythm and new ST-segment depression. The most appropriate management is administration of | furosemide | metoprolol | morphine | nifedipine | 5 | B | 2 | nitroglycerin | null | null | null | null |
cfda1815-ab18-5539-8860-0e664d86a4de | Compared with intermittent positive pressure ventilation (IPPV), intermittent mandatory ventilation (IMV) | better maintains cardiac output | provides less than full mechanical ventilatory support | requires a greater level of sedation | requires a higher FlO2 | 5 | A | 1 | requires a lower inspiratory flow rate | null | null | null | null |
5c1948fb-87dc-5332-b459-0fa73cc2fad1 | A 30-year-old woman has difficulty talking 15 minutes after initiation of interscalene block for closed reduction of a dislocated shoulder. The most likely cause is | cervical sympathetic block | delayed systemic toxic reaction | phrenic nerve paralysis | pneumothorax | 5 | E | 2 | recurrent laryngeal nerve block | null | null | null | null |
4d7579c9-c9df-5672-af5b-12efffb499f4 | If a patient with excessive bleeding during exploratory laparotomy has a normal activated clotting time, the LEAST likely cause of the bleeding is | antithrombin III deficiency | dilutional thrombocytopenia | fibrinolysis | administration of heparin 5000 units | 5 | D | 2 | preoperative ingestion of aspirin | null | null | null | null |
10ba8720-7398-5af2-9cdc-b9c2aedbac2e | An arterial blood sample is obtained from a patient undergoing hypothermic cardiopulmonary bypass at 28 C. Analysis at 37 C shows a pH of 7.40 and PaCO2 of 40 mmHg. Which of the following values are most likely if the analysis is corrected to 28 C? | pH = 7.40; PaCO2 = 40 | pH > 7.40; PaCO2 < 40 | pH > 7.40; PaCO2 > 40 | pH < 7.40; PaCO2 < 40 | 5 | B | 2 | pH < 7.40; PaCO2 > 40 | null | null | null | null |
d7d37ff3-b78a-53b9-b1cd-e8a97781bbc7 | Spinal anesthesia at a T6 sensory level is most likely to improve cardiac output in patients with | aortic stenosis | asymmetric septal hypertrophy (IHSS) | chronic constrictive pericarditis | cor pulmonale | 5 | E | 3 | mitral regurgitation | null | null | null | null |
6c2caf14-132d-52bd-9dee-6636effe248e | Immediately after sustaining severe head injury, a 20-year-old man has a blood pressure of 150/90 mmHg and an intracranial pressure of 35 mmHg. After one hour of thiopental infusion, blood pressure is 105/60 mmHg, intracranial pres sure is 20 mmHg, central venous pressure is 5 mmHg, and temperature is 36°C. The EEG sho... | additional thiopental | a corticosteroid | furosemide | nimodipine | 5 | A | 3 | phenylephrine | null | null | null | null |
9d6468ec-d188-5833-a4df-4f90181c30a4 | An axillary block is administered to a 60-kg patient using 40 ml of 0.5% bupivacaine. Ten minutes after placement of the block, the patient has a seizure. Which of the following statements is true? | A low serum albumin concentration could have contributed to the occurrence of the seizure | CNS hypoperfusion is the most likely cause of the seizure | The seizure was probably secondary to an allergic reaction to the local anesthetic | The use of an equipotent dose of lidocaine rather than bupivacaine would have decreased the likelihood of the seizure | 4 | A | 2 | null | null | null | null | null |
4b129b0f-7233-5ca8-9ead-0ace13feb5d9 | Following blunt trauma to the chest, a patient has tachycardia, hypotension, and markedly distended neck veins. Each of the following is expected EXCEPT | cardiac output of 2.1 L/min | mixed venous oxygen saturation of 75% | pulmonary artery occlusion pressure of 25 mmHg | pulmonary artery diastolic pressure of 25 mmHg | 5 | B | 2 | right atrial pressure of 25 mmHg | null | null | null | null |
83ce3281-e51e-5ef7-a5c8-5dc90cc84cb3 | A previously healthy 46-year-old woman has severe substernal chest pain one hour after receiving morphine sulfate 10 mg intramuscularly for an elective cholecystectomy. Vital signs, SpO2, and findings on a five-lead ECG on the operating room monitor are within normal limits. Which of the following is the most appropria... | Sublingual administration of nitroglycerin | Intravenous administration of butorphanol | Intravenous administration of naloxone | Cardiology consultation | 5 | C | 2 | Cancellation of surgery | null | null | null | null |
73496b04-d38a-5ee7-a1aa-ebd3c7f47bfe | During transurethral resection of the prostate under spinal anesthesia with a sensory level to T10, a patient has sudden onset of sharp upper abdominal pain and nausea. Arterial blood pressure increases from 120/80 to 150/90 mmHg; the patient becomes diaphoretic. Which of the following is the most likely diagnosis? | Bladder perforation | Hemolysis | Hypervolemia | Hyponatremia | 5 | A | 2 | Myocardial ischemia | null | null | null | null |
c4bf123c-3a51-53a0-b99c-9c166eff4dc1 | A normotensive 66-year-old man undergoes total hip arthroplasty. Mean arterial pressure is maintained at 60 mmHg with isoflurane and labetalol; intraoperative FiO2 is 1.0. Eight units of red blood cells are administered intraoperatively because of an injury to the femoral artery. Five days later, the patient develops j... | Delayed hemolysis from transfusion | Heart failure with hepatic congestion | Hepatocellular injury from labetalol | Intraoperative hypotension | 5 | A | 2 | Isoflurane-associated hepatitis | null | null | null | null |
4fb8e16f-f333-5ac6-91ac-73db0e95fbbd | After tracheal extubation, a healthy 21-year-old man has a 30-second episode of laryngospasm with marked intercostal and sternal retractions, which are corrected with continuous positive airway pressure administered by mask. He now has dyspnea and tachypnea, and a roentgenogram of the chest shows diffuse bilateral inte... | airway reactivity | intrapleural pressure | left ventricular afterload | right ventricular preload | 5 | E | 3 | transpulmonary vascular pressure | null | null | null | null |
8c565987-95f4-55d7-96eb-8f19a3b5626e | Each of the following is a complication of stellate ganglion block EXCEPT | brachial plexus block | diplopia | local anesthetic-induced seizure | recurrent laryngeal nerve palsy | 5 | B | 1 | subarachnoid block | null | null | null | null |
ce51c478-54a0-5d51-8ef6-e549d19cc85a | During open reduction of a tibial fracture, a tourniquet cuff is applied around the proximal thigh and inflated to 300 mmHg. Which of the following is most likely to prevent pain and hypertension caused by the tourniquet? | Intravenous administration of fentanyl during subarachnoid block | Lumbar sympathetic block | Spinal anesthesia to a T6 sensory level | Obturator nerve block | 5 | C | 3 | General anesthesia | null | null | null | null |
753528e6-2af8-5da4-845b-28c7d68c6cad | Pulsus paradoxus is commonly seen during anesthesia in patients with each of the following conditions EXCEPT | severe asthma | right-sided heart failure | hypovolemia | atrial septal defect | 5 | D | 1 | obesity | null | null | null | null |
381ff37c-b62c-5f15-a29e-1368313eae80 | Pulmonary artery diastolic pressure increases acutely from 10 to 20 mmHg in a 28-year-old man undergoing cervical laminectomy in the sitting position. The most appropriate first step in the management of this patient is to | administer furosemide | aspirate from the proximal port of the pulmonary artery catheter | inflate the balloon on the pulmonary artery catheter | place the patient in the left lateral decubitus position | 5 | B | 2 | start an infusion of nitroglycerin | null | null | null | null |
107a1394-aa9d-5954-aa53-6823d92f3d5e | A patient with jaundice who has a minimally elevated SGOT (AST), markedly elevated alkaline phosphatase, and normal prothrombin time is to receive a muscle relaxant. Which of the following is most likely in this patient? | Decreased intubating dose of pancuronium | Increased intubating dose of atracurium | Prolonged duration of succinylcholine effect | Prolonged duration of vecuronium effect | 5 | D | 2 | Shortened duration of d-tubocurarine effect | null | null | null | null |
06aaa910-f601-5281-9107-c006be8284fc | Following enflurane anesthesia, serum free fluoride concentration is most likely to be increased in association with long-term use of | diazepam | ethanol | isoniazid | phenobarbital | 5 | C | 1 | phenytoin | null | null | null | null |
4a7c08ae-5cf5-58b0-8fc5-2257cd4cc51e | In a patient undergoing liver transplantation, sodium bicarbonate and calcium chloride are administered immediately before reperfusion of the transplanted liver to counteract | coagulopathy | decreased cardiac output | hyperkalemia | hypermagnesemia | 5 | C | 1 | hypotension | null | null | null | null |
9ed616ce-bd86-5b5a-ad2e-2a7c0207dd61 | In a 65-year-old man, which of the following findings on preoperative pulmonary function testing is associated with the highest risk for respiratory insufficiency following pneumonectomy? | Maximum voluntary ventilation at 65% of predicted | Mean pulmonary artery pressure of 28 mmHg | Predicted postoperative forced expiratory volume in one second (FEV1) of 800 ml | Residual volume to total lung capacity (RV/TLC) ratio of 0.35 | 5 | C | 2 | Vital capacity of 3 liters | null | null | null | null |
663277e8-855f-5e2c-a5d2-08c8ac4f0b41 | A 73-year-old woman with a preoperative serum creatinine concentration of 2.1 mg/dl develops oliguria during enflurane anesthesia. Urine sodium concentration is 10 mEq/L and urine osmolality is 450 mOsm/L. The most likely cause of these findings is | acute renal failure | chronic renal insufficiency | decreased renal perfusion | fluoride nephrotoxicity | 5 | C | 2 | intraoperative administration of furosemide | null | null | null | null |
d7c25220-b758-5e03-bf8e-2c614b99064f | Measurement of blood pressure with a Doppler device involves | reflection of ultrasound waves off blood elements | detection of oscillations in cuff pressure | amplification of Korotkoff sounds with a miniature microphone | transillumination with a near infrared light | 5 | A | 1 | detection of variations in blood vessel diameter | null | null | null | null |
98329421-86f7-5ab3-af12-9eb295e42371 | After a gastric stapling procedure, a 150-kg woman is extubated and breathing spontaneously in the recovery room at a rate of 26/min and an FiO2 of 0.5. Arterial blood gas analysis shows PaO2 96 mmHg, PaCO2 44 mmHg, and pH 7.37. The parameter most closely related to her increased alveolar-arterial oxygen tension gradie... | decreased expiratory reserve volume | decreased minute volume | decreased residual volume | decreased total lung capacity | 5 | A | 2 | rapid respiratory rate | null | null | null | null |
3fe439c5-808d-554f-b45f-bb774b1334be | A 40-year-old woman receives alfentanil 75 mcg/kg followed by an infusion of 1.5 mcg/kg/min for a one-hour cholecystectomy and cholangiogram. This regimen could be associated with each of the following EXCEPT | muscle rigidity | increased biliary tract pressure | inadequate anesthesia | postoperative respiratory depression | 5 | E | 1 | two to four hours of postoperative analgesia | null | null | null | null |
19b2cf50-4ad5-57c6-a4b6-00dccbe2ffa9 | During total cardiopulmonary bypass, metabolic acidosis and decreasing mixed venous oxygen saturation are noted. The most likely cause is | hypothermia | hypoperfusion | hypocarbia | rewarming | 5 | B | 2 | light anesthesia | null | null | null | null |
c7870298-a4ad-59be-ab44-baffb01a6a2d | A 66-year-old man with aortic regurgitation is brought to the operating room for aortic valve replacement after having received morphine, scopolamine premedication. PO2 is 40 mmHg in a sample of pulmonary artery blood drawn 10 minutes after the patient started breathing pure oxygen. This finding is compatible with | wedging of the catheter tip | left-to-right intracardiac shunt | increased intrapulmonary shunting | excessively depressed ventilation | 5 | E | 2 | normal cardiac output | null | null | null | null |
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