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41c1e6d4-a690-5ce1-b719-2d66559e0b7d | A 58-year-old woman with rheumatoid arthritis and hyperactive gag reflex requires awake intubation prior to cervical spine stabilization. Which of the following regional nerve blocks is most appropriate? | Deep cervical plexus | Glossopharyngeal nerve | Hypoglossal nerve | Superior laryngeal nerve | 5 | B | 2 | Trigeminal nerve | null | null | null | null |
5218c63b-2be9-58fa-ae62-cdb9542bf25f | Maternal hyperventilation to a PaCO2 of 20 mmHg during labor can result in | decreased fetal trapping of local anesthetics | fetal metabolic acidosis | fetal respiratory acidosis | increased oxygen release at the placenta | 5 | B | 2 | uterine vasodilation | null | null | null | null |
5f63a9f2-84c9-53c8-9650-2a00cacc4c41 | Ninety minutes after administration of succinylcholine 1 mg/kg to a 28-year-old woman, the train-of-four shows a T4:T1 ratio of 25%. This is most consistent with | dibucaine number of 30 | hypersensitivity to succinylmonocholine | pregnancy | pretreatment with pancuronium 2 mg | 5 | A | 2 | severe cirrhosis | null | null | null | null |
a3540407-3f0a-5ce5-9601-0e23af75aab9 | A patient receives an emergency transfusion of three units of O, Rh-negative blood for profuse hemorrhaging. If his blood type is AB, Rh-negative, which of the following is most appropriate for continuing transfusion? | AB, Rh-negative whole blood | B, Rh-negative whole blood | O, Rh-negative whole blood | A, Rh-negative erythrocytes | 5 | E | 2 | O, Rh-negative erythrocytes | null | null | null | null |
ae3b51f8-1a90-5d15-b9f3-a05b7c85f515 | Which of the following is a manifestation of preeclampsia? | Hypovolemia | Increased colloid osmotic pressure | Natriuresis | Resistance to catecholamines | 5 | A | 1 | Thrombocytosis | null | null | null | null |
0ee9e40f-484f-5776-b0fe-49578642b371 | The action of dantrolene on skeletal muscle | occurs within the neuromuscular junction | alters electrical properties of the muscle membrane | does not result in muscle relaxation | decreases myoplasmic calcium concentration | 5 | D | 1 | results from competitive inhibition of caffeine | null | null | null | null |
d8980a74-164a-5361-a46e-8a385158b0f4 | To eliminate involuntary expulsive effort with contraction in the second stage of labor, a nerve block must include at least | T6-T12 | T4-S5 | T8-L2 | L1-S2 | 5 | E | 1 | S2-S4 | null | null | null | null |
9b780910-c8a1-541a-88d2-b74807dfbc54 | One hour after an open cholecystectomy, a 42-year-old patient is hemodynamically stable and breathing spontaneously (rate 10/min and regular) at an FiO2 of 0.4. Fentanyl, isoflurane, nitrous oxide, and pancuronium were used during the procedure. Analysis of arterial blood gases (pH, pCO2, pO2) is most likely to show: | 7.18 40 100 | 7.18 60 140 | 7.28 50 85 | 7.40 26 220 | 5 | C | 3 | 7.40 40 40 | null | null | null | null |
1ed73bee-216a-572a-9221-7ea122f0fa8a | The patient at LEAST risk of pulmonary aspiration of gastric contents during induction of anesthesia is | markedly obese and NPO for eight hours | fed black coffee four hours before elective surgery | scheduled for elective cesarean delivery and NPO for 20 hours | NPO for four hours after a full meal | 5 | B | 2 | scheduled for elective repair of a hiatus hernia | null | null | null | null |
4da0a395-e6eb-5e9d-bf44-c1d50d4818c3 | Forty-eight hours after thoracotomy, a patient's T6-7 epidural catheter is removed and the distal 2 cm is noted to be missing. The patient felt no pain during removal and neurologic examination shows no abnormalities. After informing the patient, which of the following is the most appropriate next step in management? | Observation | Culture of cerebrospinal fluid | MRI of the thoracic spine | Myelography | 5 | A | 2 | Surgical removal of the catheter | null | null | null | null |
d8dc508f-662a-5348-8c11-9f684b35ccb5 | Which of the following changes in pulmonary function best explains the more rapid rate of rise of alveolar concentration of volatile anesthetics in pregnant women than in nonpregnant women? | Decreased functional residual capacity | Decreased dead space ventilation | Increased cardiac output | Increased oxygen consumption | 5 | A | 1 | Increased pulmonary venous admixture | null | null | null | null |
a56ebece-063f-5404-8808-3051c1e9899d | A 56-year-old woman with pulmonary fibrosis is scheduled for pneumonectomy. Which of the following parameters best predicts potential postoperative functional impairment? | Exercise tolerance | Flow-volume loop | Resting arterial blood gas values | Unilateral pulmonary artery occlusion pressure | 5 | D | 3 | Vital capacity and FEV, | null | null | null | null |
d7d5c819-b56d-5207-9835-46e8754f4027 | A 72-year-old man has massive venous hemorrhage during a radical prostatectomy. Blood pressure decreases from 110/60 to 75/30 mmHg and central venous pressure decreases from 12 to 4 mmHg. End-expiratory carbon dioxide tension decreases from 34 to 24 mmHg during constant minute ventilation. The most appropriate next ste... | apply positive end-expiratory pressure to the breathing circuit | attempt to aspirate air from the central venous catheter | expand intravascular volume | place the patient in the Trendelenburg position | 5 | C | 2 | turn the patient to the left lateral decubitus position | null | null | null | null |
e55453bb-cb87-54f5-88c1-eeecd5b010cd | With direct arterial blood pressure monitoring | systolic pressure in the aortic root exceeds that in the radial artery | mean and diastolic pressures are lower in the dorsalis pedis artery than in the aortic root | the dicrotic notch is not clearly found on femoral arterial waveforms | an underdamped waveform is characteristic of bubbles in the system | 5 | E | 1 | longer tubing between artery and transducer artifactually augments systolic pressure | null | null | null | null |
231cf06d-3b3a-520a-99ed-d59b725b0f50 | A patient has severe pain after total knee arthroplasty. Systemic opioids are most likely to modify the pain through action at which of the following sites? | Corpus callosum | Hippocampus | Substantia gelatinosa | Substantia nigra | 5 | C | 1 | Ventral horn of the spinal cord | null | null | null | null |
d98c8753-7b2b-5362-b300-77944eb69bd5 | Which of the following findings is most likely in a 3-year-old child who has a secundum-type atrial septal defect with a 2:1 left-to-right shunt? | Pulmonary blood flow twice that of systemic blood flow | Pulmonary vascular resistance twice normal | Mean pulmonary artery pressure twice normal | Right atrial pressure twice normal | 5 | A | 2 | Hypoxemia while breathing room air | null | null | null | null |
288eefbf-1757-579f-8199-1d39b7e1f675 | Six hours after coronary artery bypass grafting, a pulmonary artery catheter oximeter shows a mixed venous hemoglobin oxygen saturation of 50%. This value may result from each of the following EXCEPT | anemia | fever | hypovolemia | respiratory alkalosis | 5 | D | 2 | shivering | null | null | null | null |
7b13cc86-edaf-54cd-b193-4459de5b31ce | Each of the following would be expected in an otherwise healthy 165-kg woman undergoing cholecystectomy EXCEPT | decreased functional residual capacity | decreased ventilatory response to carbon dioxide | increased cardiac output | increased gastric fluid volume | 5 | B | 3 | increased metabolism of volatile anesthetics | null | null | null | null |
da2c8e47-9bd3-5473-a2b3-479193729725 | Which of the following is the correct sequence of anatomic structures encountered when using a paramedian approach for lumbar spinal anesthesia? | Ligamentum flavum — dura mater — arachnoid mater | Interspinous ligament — ligamentum flavum — dura mater — arachnoid mater | Posterior longitudinal ligament — ligamentum flavum — dura mater — arachnoid mater | Anterior longitudinal ligament — ligamentum flavum — dura mater — arachnoid mater | 5 | A | 1 | Ligamentum flavum — dura mater — pia mater — arachnoid mater | null | null | null | null |
807c0be7-3e74-53e5-9c39-ffcbfa97a887 | Which of the following abnormalities in serum is most likely to result from intraoperative discontinuation of parenteral hyperalimentation? | Hypocalcemia | Hypocarbia | Hypoglycemia | Hypokalemia | 5 | C | 1 | Hyponatremia | null | null | null | null |
e0101d8b-b29c-558a-a034-9bc1472e58ce | During a right lower lobe resection, SpO2 decreases from 99% to 70% after institution of one-lung ventilation. FiO2 is 1.0. The most appropriate management is to | administer an inhaled bronchodilator | apply continuous positive airway pressure to the right lung | apply positive end-expiratory pressure to the left lung | increase tidal volume | 5 | E | 2 | reinflate the right lung | null | null | null | null |
9f9cb729-056b-59ca-a8bd-74d23d940d0a | Which of the following factors causes a decrease in mixed venous oxygen saturation? | Arteriovenous fistula | Decreased hemoglobin concentration | Decreased oxygen consumption | Increased cardiac output | 5 | B | 1 | Nitroprusside toxicity | null | null | null | null |
248f7dbb-c86d-5b60-8c43-800176ce7059 | The effect of succinylcholine is terminated at postsynaptic effector cells by | binding and uptake by effector cells | diffusion into capillaries | hydrolysis by junctional cholinesterase | hydrolysis by pseudocholinesterase | 5 | B | 1 | spontaneous degradation to succinylmonocholine | null | null | null | null |
ce8b424a-6415-5470-8021-68dd9817be93 | Which of the following factors is LEAST predictive of postoperative cardiac complications? | Congestive heart failure | Major vascular surgery | Premature ventricular contractions | Preoperative hypertension | 5 | D | 1 | Recent myocardial infarction | null | null | null | null |
96fad996-5fcd-5ebe-b060-f6df026f02e4 | A healthy, but obese, 110-kg woman is scheduled for gastric stapling. Compared with that required at her ideal weight, the dose of thiopental required for anesthetic induction would likely be increased because of changes in | blood volume | muscle mass | circulation time | body fat | 5 | A | 2 | metabolic rate | null | null | null | null |
e1c45ba1-1677-5e0c-9439-f51dff6d555a | A 32-year-old woman is anesthetized for suboccipital craniotomy. During positioning, the capnograph shows an abrupt decrease in the slope of the expiratory upstroke. Which of the following is the most likely cause? | Air embolism | Incompetent expiratory valve | Incomplete neuromuscular block | Kinked endotracheal tube | 5 | D | 2 | Tracheal extubation | null | null | null | null |
d94073ca-e13c-5911-9a43-4afcc1bcfd82 | The jet ventilation technique using an injector during laryngobronchoscopy relies on | air entrainment | relative density of inhaled gases | presence of an endotracheal tube | presence of spontaneous ventilation | 5 | A | 1 | use of helium-oxygen mixtures | null | null | null | null |
d470bb2c-eec6-506d-a793-0ede301b88ad | A 72-year-old woman with stable angina is undergoing bowel resection. Anesthesia is induced with etomidate. Five minutes after starting isoflurane 1% in nitrous oxide 50%, her blood pressure decreases from 110/84 to 70/40 mmHg. The most likely cause is | coronary steal produced by isoflurane | direct myocardial depression produced by isoflurane | vasodilation produced by isoflurane | adrenocortical suppression produced by etomidate | 5 | C | 2 | myocardial depression produced by etomidate | null | null | null | null |
7689bc52-e354-532d-8b95-92c94de2ee81 | An increased initial dose and a decreased maintenance dose of pancuronium are required in patients with | advanced age | burns | cirrhosis | chronic renal failure | 5 | C | 1 | fever | null | null | null | null |
34090ffa-112f-5bb1-8f67-54857e52eeb7 | If minute ventilation remains constant, which of the following changes in PetCO2 and PaCO2 will result from a decrease in cardiac output? (PetCO2, PaCO2) | Decreased, Decreased | Increased, Increased | Unchanged, Unchanged | Decreased, Increased | 5 | D | 3 | Increased, Decreased | null | null | null | null |
f5cadce5-6c45-5680-b8e1-5033925e4173 | A patient has decreased lung compliance and hypoxemia after a 30-minute episode of laryngospasm following extubation. The most likely cause is | allergic reaction to the anesthetic | altered alveolar-capillary membrane permeability | anesthetic-induced lymphatic dysfunction | increased pulmonary capillary pressure | 5 | E | 3 | negative pulmonary interstitial hydrostatic pressure | null | null | null | null |
ab366874-fc0a-5394-bdd4-20d3a06149a2 | A 26-year-old woman comes to a pain clinic because of pain, swelling and limitation of motion in the right knee for six months following a blow to the knee. Findings on knee arthroscopy and leg roentgenograms are normal. The best trial of therapy is | right paravertebral lumbar sympathetic nerve block | epidural administration of a steroid | intrathecal administration of an opioid | tricyclic antidepressants for one month | 5 | A | 2 | a nonsteroidal anti-inflammatory drug for five days | null | null | null | null |
23d0e63e-f76d-5b5a-977c-4b0acb626cdf | Which of the following provides the most definitive diagnosis in a patient with suspected brain death? | Absent bilateral somatosensory evoked potentials | Absent cerebral blood flow during four-vessel contrast cerebral arteriography | Intracranial pressure greater than mean arterial pressure | Score of zero on Glasgow Coma Scale | 5 | B | 1 | Two isoelectric electroencephalograms | null | null | null | null |
8ea95d4b-08f3-50ab-9f32-dc1459be5df3 | After an axillary brachial plexus block, the patient feels pain when the surgeon clips the skin over the thenar eminence. The most likely cause is inadequate anesthesia in the distribution of the | intercostobrachial nerve | median nerve | musculocutaneous nerve | radial nerve | 5 | B | 2 | ulnar nerve | null | null | null | null |
4ba66aac-1b4a-5f5f-ba94-7c455a2538bb | Compared with similar use in adults, routine use of succinylcholine in children is hazardous because of the increased risk for which of the following? | Anaphylactoid reaction | Phase II blockade | Pseudocholinesterase deficiency | Pulmonary aspiration | 5 | E | 1 | Undiagnosed myopathy | null | null | null | null |
b005876d-bfce-5ca8-9c66-0a35f1a62a23 | Which of the following drugs increases cerebral blood flow while decreasing cerebral metabolic rate? | Etomidate | Fentanyl | Isoflurane | Lidocaine | 5 | C | 1 | Midazolam | null | null | null | null |
e3a7ff9e-bda5-5dea-afac-64a8c9f57af3 | A 35-year-old woman undergoes a one-hour abdominal liposuction procedure under general anesthesia. During the procedure, 2000 ml of crystalloid is administered and 800 ml of fatty tissue is extracted. Thirty minutes postoperatively, blood pressure is 75/40 mmHg and heart rate is 100 bpm; SpO2 is 94% on room air. Which ... | Acute systemic vasodilation | Circulating free fatty acids | Hypocalcemia | Inadequate intravascular volume replacement | 5 | D | 2 | Venous fat embolism | null | null | null | null |
0abae771-3763-53e0-818c-90470b836e3d | A 23-year-old man who is receiving his first anesthetic has not resumed spontaneous ventilation two hours after receiving succinylcholine. The train-of-four monitor shows no twitch response. Which of the following is the most likely cholinesterase genotype in this patient? | Atypical : atypical | Fluoride-resistant : fluoride-resistant | Fluoride-resistant : silent | Normal : normal | 5 | A | 1 | Normal : silent | null | null | null | null |
d9041861-672c-5775-98aa-1fd3193faab4 | Maximum current is delivered to the myocardium by a countershock for defibrillation when | paddle contact pressure is minimal | petroleum jelly is used under the paddles | previous countershocks of the same power have been attempted | the patient is grounded securely | 5 | C | 1 | the shock is applied at the end of inspiration | null | null | null | null |
d6a2066d-1ff0-54a0-8991-577261bd19f2 | A 4-year-old child with myelomeningocele and a ventriculoperitoneal shunt is scheduled for bladder augmentation. One year ago, hypotension and bronchospasm occurred during laparotomy for placement of a feeding gastrostomy and responded to fluids and epinephrine. At that time, anesthesia was induced with thiopental, the... | Latex gloves | Polyvinyl tracheal tubes | Halothane | Succinylcholine | 5 | A | 2 | Thiopental | null | null | null | null |
c2ee9c24-8a20-5728-9a3f-5f18371c7eb3 | Electrocautery units operate at frequencies between 300 kHz and 2 mHz to | avoid pacemaker interference | minimize ECG tracing interference | minimize the likelihood of ventricular fibrillation | optimize hemostasis | 5 | C | 1 | provide the best "cutting" current | null | null | null | null |
5610df6b-4f68-5605-818c-a770e3b48cf0 | A 20-year-old woman with poorly controlled diabetes mellitus is scheduled for urgent drainage of an abdominal abscess. She received an initial dose of regular insulin 10 units followed by regular insulin 5 units/hr for the past five hours. Laboratory studies show serum sodium concentration 128 mEq/L, potassium 5.4 mEq/... | addition of subcutaneous NPH insulin | administration of sodium bicarbonate to correct metabolic acidosis | administration of normal saline solution to correct the presumed hypovolemia | administration of furosemide to correct hyponatremia | 5 | C | 3 | infusion of 5% dextrose in 0.2% saline solution to prevent hypoglycemia | null | null | null | null |
b494d48e-8e5a-5b40-ad81-cd6dc1d82691 | Which of the following is the most reliable indicator of antagonism of nondepolarizing neuromuscular block sufficient for airway protection? | Clinically assessed ulnar nerve train-of-four ratio of 0.75 | Peak negative pressure of 25 cmH2O | End-tidal PC02 of 40 mmHg during spontaneous ventilation | Sustained head lift for 5 seconds | 5 | D | 2 | Vital capacity of 15 ml/kg | null | null | null | null |
accc3a65-56e2-5094-940e-467015ddd509 | A patient becomes flushed, dyspneic, and hypotensive during transfusion of 1 unit of packed red blood cells in the PACU. After discontinuing the transfusion, the most appropriate next step is administration of | aminophylline | cimetidine | diphenhydramine | epinephrine | 5 | D | 2 | hydrocortisone | null | null | null | null |
751bbbec-a975-5d44-94b3-f986d6dde98c | Positive end-expiratory pressure is effective for treatment of hypoxia resulting from each of the following EXCEPT | cardiogenic pulmonary edema | intraoperative Trendelenburg position | lateral position during total hip replacement | lung contusion | 5 | E | 2 | status asthmaticus | null | null | null | null |
70fbad04-cea6-5db0-9787-d761e59ed058 | A 70-kg 78-year-old man undergoing small-bowel resection during anesthesia with isoflurane in oxygen becomes hypotensive and develops frothy pink sputum in the endotracheal tube. Heart rate is 50 bpm, blood pressure is 75/60 mmHg, pulmonary artery occlusion pressure is 22 mmHg, and cardiac output is 1.7 L/min. The most... | Albumin | Digoxin | Dopamine | Esmolol | 5 | C | 2 | Nitroglycerin | null | null | null | null |
ce967aec-b965-542f-aedd-1772d8c5049f | A 40-year-old woman with Graves' disease is undergoing thyroidectomy with 1% isoflurane, 60% nitrous oxide, and oxygen. During surgical manipulation of the thyroid, temperature increases to 38.5°C, heart rate to 160 bpm, and blood pressure to 150/100 mmHg. The most appropriate initial treatment is to | administer dantrolene sodium | administer potassium iodide | administer propranolol | administer propylthiouracil | 5 | C | 3 | increase the concentration of isoflurane | null | null | null | null |
5f9f29aa-51db-57f8-b14e-9fbb99e8930d | The adult oxyhemoglobin dissociation curve will resemble that of the fetus in the presence of | increased 2,3-diphosphoglycerate concentration | chronic anemia | hyperthermia | metabolic alkalemia | 5 | D | 2 | hyperkalemia | null | null | null | null |
42bb1246-83cc-5345-81f0-85253cd8fed5 | A 26-year-old woman has headache, nausea, and photophobia 36 hours after cesarean delivery for chorioamnionitis using subarachnoid block. Temperature is 38.8°C and leukocyte count is 14,200/mm3. Which of the following is the most appropriate next step in management? | Oral ibuprofen | Intravenous caffeine sodium benzoate | Intravenous hydration | Epidural blood patch | 5 | E | 3 | Diagnostic lumbar puncture | null | null | null | null |
84379cdd-aec3-53d5-9c2f-e807df32309d | Which of the following pulmonary components is altered the most in a morbidly obese patient? | Total lung volume | Tidal volume | Inspiratory reserve volume | Expiratory reserve volume | 5 | D | 1 | Ratio of dead space to tidal volume | null | null | null | null |
f14a7820-0f99-5120-97de-c6cc7fd17988 | Arterial oxyhemoglobin desaturation develops more rapidly following apnea in a pregnant patient at term than in a nonpregnant patient with a large intra-abdominal tumor. Which of the following findings in pregnancy is the most likely cause? | Higher cardiac output | Higher oxygen consumption | Larger anatomic dead space | Smaller blood volume | 5 | B | 2 | Smaller functional residual capacity | null | null | null | null |
afc4d1b2-70ff-5384-b367-904528c73913 | A healthy, 18-year-old, 65-kg woman undergoing diagnostic laparoscopy is being monitored with a properly functioning and calibrated capnograph. The end-tidal carbon dioxide concentration is 6%, and the inspired carbon dioxide concentration is 1%. This may be caused by each of the following EXCEPT | malfunction of the expiratory valve in a circle system | low gas inflow with a Bain circuit | exhausted soda lime within a circle system | absorption of carbon dioxide from carbon dioxide laparoscopy | 5 | D | 2 | carbon dioxide in the fresh gas flow | null | null | null | null |
3ab3aa21-f107-508a-bd6d-25e2d7eefc46 | A 67-year-old man is undergoing total hip replacement under general anesthesia. He had a permanent endocardial VVI pacemaker placed two years ago for complete heart block, and since arrival in the operating room has been paced continuously. Use of the electrocautery causes the pacemaker to malfunction intermittently. T... | tape a magnet over the pacemaker generator and convert to asynchronous mode | do nothing since the pacemaker is programmed to deal with this circumstance | stop the surgeon from using the electrocautery | limit the surgeon to 10 sec/min electrocautery bursts | 5 | A | 2 | place the electrocautery indifferent lead as close as possible to the pacemaker | null | null | null | null |
c2578935-8174-585a-9de7-4472a7502b93 | Which of the following is the most frequent cause of hemorrhagic diathesis after administration of 20 units of CPD-stored blood over six hours? | Disseminated intravascular coagulation | Hypofibrinogenemia | Low plasma concentrations of factors V and VIII | Primary fibrinolysis | 5 | E | 1 | Thrombocytopenia | null | null | null | null |
4df7169c-fdbe-548a-bbed-e5fc5095b279 | Postoperatively, a patient is being mechanically ventilated by a constant-flow, pressure-cycled ventilator with the following initial settings: inspiratory/expiratory (I/E) ratio of 1:2, peak inspiratory pressure (PIP) of 25 cmH2O, and rate of 10/min. One hour later, the I/E ratio is 1:4. Which of the following would e... | Inflate the endotracheal tube cuff to prevent leakage | Double the respiratory rate | Decrease the expiratory pause until the I/E ratio is 1.0 | Increase the PIP until the I/E ratio is 1:2 | 5 | D | 3 | Increase the PIP to 50 cmH20 | null | null | null | null |
eeb43311-52f9-52fe-9692-cb4fdac8710d | Retrobulbar block for ophthalmologic surgery can be administered safely to patients with which of the following conditions? | Agitation | Bleeding disorder | Frequent coughing spasms | Increased intraocular pressure | 5 | A | 2 | Perforated globe | null | null | null | null |
caaf7563-0cf5-5647-bd16-3d7af8b5eb20 | During cardiopulmonary bypass, the perfusionist notes that the mixed venous oxygen saturation has decreased from to 55%. Which of the following is the most likely cause? | Administration of a nitroprusside bolus | Administration of a thiopental bolus | Decrease in rectal temperature from 34°C to 28°C | Inadequate muscle relaxation | 5 | D | 2 | Increase in pump flow | null | null | null | null |
76d641c2-3e6c-5f44-8902-70b2d8b5aeb3 | In a patient who has undergone cholecystectomy, which of the following is the most likely pulmonary effect of systemically administered opioids? | Decreased Qs/Qt | Decreased dead space | Restored vital capacity | Restored functional residual capacity | 5 | E | 1 | Shift of the carbon dioxide response curve to the right | null | null | null | null |
4fba2294-39d1-54c2-893e-f991772e607d | A 28-year-old woman undergoes total thyroidectomy. The left recurrent laryngeal nerve is transected during the procedure. Which of the following findings is most likely postoperatively? | Normal voice | Aphonia | Hoarseness | Expiratory stridor | 5 | C | 2 | Inspiratory stridor | null | null | null | null |
09f5b0c2-d423-5401-abd8-3d299e4de07b | Each of the following conditions can be accurately evaluated with transesophageal echocardiography EXCEPT | intimal tear at the aortic arch | intracardiac air | left atrial thrombus | patent foramen ovale | 5 | A | 1 | right atrial myxoma | null | null | null | null |
7dc46002-743b-575c-85d3-e3047fbc2051 | The most common clinical viral infection following homologous blood transfusion is caused by | cytomegalovirus | Epstein-Barr virus | hepatitis B virus | human immunodeficiency virus | 5 | E | 1 | non-A, non-B hepatitis virus | null | null | null | null |
e736024e-2845-52f3-bdbf-851602bc87b7 | Which of the following statements concerning postherpetic neuralgia is true? | It is effectively treated with neurolytic surgery | It is effectively treated with sympathetic nerve blocks | Duration is three to four weeks | Hyperesthesia occurs in the affected area | 5 | D | 1 | It occurs predominantly in adolescents | null | null | null | null |
3664c9be-011d-5520-b3ee-4f0ad0ef142c | A 60-kg 25-year-old woman is undergoing laparoscopy in the Trendelenburg position during general anesthesia. Five minutes after peritoneal inflation, the peak airway pressure required to deliver a tidal volume of 800 ml increases from 25 cmH2O to 60 cmH2O. SpO2 decreases from 100% to 80% and systolic blood pressure inc... | Acute tension pneumothorax | Excessively steep Trendelenburg position | Excessive ventilator tidal volume setting | Kink in the endotracheal tube | 5 | D | 3 | Massive carbon dioxide embolism | null | null | null | null |
5d0b109a-be53-51a1-98de-b5f367cc5628 | A 6-year-old child with asthma begins wheezing during anesthesia with halothane and nitrous oxide in oxygen. A loading dose of aminophylline is administered followed by continuous infusion. Premature ventricular contractions appear on the ECG. The most appropriate management is to | administer fentanyl | discontinue aminophylline | increase exhalation time | increase the inspired concentration of halothane | 5 | E | 3 | switch the inhalational agent to isoflurane | null | null | null | null |
f0f68536-0bb1-5e04-bc5a-48d4cc43b183 | During uncomplicated mask induction with halothane and 50% nitrous oxide in oxygen in a 6-month-old infant with a large ventricular septal defect and valvular pulmonic stenosis, SpO2 decreases from 85% (room air) to 60%; heart rate is 100 bpm and blood pressure is 62/40 mmHg. The most appropriate management is to | administer atropine | administer phenylephrine | administer propranolol | increase anesthetic depth | 5 | B | 3 | intubate the trachea | null | null | null | null |
b8f00c66-471a-59cf-909d-701852054160 | A newly developed volatile anesthetic has a MAC of 10% in oxygen for adults. Which of the following statements concerning this anesthetic is true? | The expected MAC of this drug in combination with 60% nitrous oxide is 7.5% | The dose of this drug required to anesthetize a patient with acute amphetamine intoxication is less than the dose required for a normal patient | The potency of this drug is 25% of a drug with a MAC of 2.5% | The dose of this drug required to suppress the hormonal response to surgical incision is less than the MAC value | 5 | C | 2 | The MAC of this drug is decreased by metabolic alkalosis | null | null | null | null |
d1c7860e-501c-57cf-a3d0-ab1754f9e744 | Which of the following is the best method of pacing to improve cardiac output in a patient with third-degree heart block? | VOO | AOO | VVI | DVI | 5 | D | 1 | Transcutaneous | null | null | null | null |
c667ac71-e567-5548-9528-add36833dd60 | Which of the following best reflects findings of inadequate cerebral perfusion during carotid cross clamping? | Decreased frequency on EEG | Increased latency of brain stem auditory evoked potentials | Increased spectral edge frequency | Jugular bulb oxygen tension of 27 mmHg | 5 | A | 1 | Stump pressure of 50 mmHg | null | null | null | null |
068c5561-6e41-5ceb-bd37-0e8b4ccefa03 | A 54-year-old man receives 25 ml of a 50% alcohol and 0.25% bupivacaine solution for celiac plexus block. During the next 20 minutes, blood pressure decreases from 130/75 mmHg to 85/55 mmHg. Which of the following is the most likely cause? | Intravascular injection | Retroperitoneal hemorrhage | Splanchnic vasodilation | Subarachnoid blockade | 5 | C | 3 | Tension pneumothorax | null | null | null | null |
44bb0e21-754f-50a1-9216-c5b4f135ad7f | The physiologic function most likely to be spared when a local anesthetic differential nerve block is administered is | sweating | temperature sensation | proprioception | touch sensation | 5 | C | 1 | pain sensation | null | null | null | null |
9c390154-71b6-52c2-bf50-6f8e9df8a0d5 | Block of each of the following nerves is required for inguinal herniorrhaphy EXCEPT the | genitofemoral | iliohypogastric | ilioinguinal | obturator | 5 | D | 1 | twelfth thoracic | null | null | null | null |
73f61b47-4454-510a-b495-b9caa7faab7f | Hemodilution is used during profound hypothermic cardiopulmonary bypass primarily because it | decreases cold-induced coagulopathy | decreases edema formation | increases oxygen-carrying capacity of plasma | increases oxygen dissociation from hemoglobin | 5 | E | 1 | limits the cold-induced increase in blood viscosity | null | null | null | null |
2a76c4f1-f571-57a2-ba57-3fd72ce4d4e9 | Each of the following structures may participate in causing acute bradycardia during strabismus surgery EXCEPT the | globe | rectus muscles | optic nerve | trigeminal nerve | 5 | C | 1 | vagus nerve | null | null | null | null |
e3fd137b-fe4d-5ff1-b4f2-566657551cb2 | Intrabiliary pressure will be increased to the greatest extent by intravenous administration of | atropine | glucagon | naloxone | fentanyl | 5 | D | 1 | butorphanol | null | null | null | null |
1d052d02-6bf1-5503-a495-f9aea7a5282f | During axillary brachial plexus anesthesia, motor block frequently precedes sensory block because of | conduction velocity of motor fibers | myelination of motor fibers | size of motor fibers | presence of septa between motor fibers | 5 | E | 1 | peripheral location of motor fibers in the nerve bundle | null | null | null | null |
c2dc95cd-ef41-5250-bebf-1e9a89f4a18d | Which of the following is the most common initial manifestation of malignant hyperthermia? | Hyperkalemia | Increased distal esophageal temperature | Increased PETCO2 | Red discoloration of urine | 5 | C | 1 | Ventricular irritability | null | null | null | null |
81bcf691-b51d-5ce4-a5dc-465145d9c94e | Following pneumonectomy, a paralyzed patient being mechanically ventilated has the following arterial blood gas values: PaO2 71 mmHg, PaCO2 55 mmHg, pH 7.29. SvO2 is 45%. The most likely explanation for this SvO2 is | decreased red cell mass | high cardiac output | hypothermia | peripheral left-to-right arteriovenous shunt | 5 | A | 3 | ventilation / perfusion mismatch | null | null | null | null |
602b0320-db22-56d1-a324-7d6025215ca0 | Intrathecally administered opioids exert their analgesic effects primarily in the | brain stem | fourth ventricle | spinal nerve roots | spinothalamic tracts | 5 | E | 1 | substantia gelatinosa | null | null | null | null |
8a0658b2-33fe-5e67-898b-a33208b4186f | Compared with the adult airway, the airway of an infant is characterized by | greater narrowing at the cricoid ring | a less rigid epiglottis | a more caudad laryngeal opening | a relatively smaller tongue | 5 | A | 1 | relatively larger tonsils | null | null | null | null |
df35df73-aaab-5c81-bbde-dfafe18f0019 | Which of the following statements concerning the check valve of the common gas outlet on an anesthesia gas machine is true? | It prevents backflow into vaporizers | It prevents delivery of a hypoxic mixture | It prevents rebreathing | It is located downstream from the oxygen flush valve | 5 | A | 1 | It is required for proper functioning of the proportioning system | null | null | null | null |
39c7c4e3-6cbf-5461-97e1-0224f3921e8f | Which of the following combinations of hemoglobin, blood gases, and cardiac output provides the greatest delivery of oxygen to tissue? (Hb, PaO2, SaO2, CO) | 7.0 85 95 7.0 | 8.0 290 100 8.0 | 9.9 61 90 9.8 | 12.0 140 100 4.5 | 5 | C | 2 | 16.0 40 75 5.8 | null | null | null | null |
4091878d-3d58-5090-a26a-15d06c7e8dc2 | Which of the following parts of the infant's airway determines the appropriate diameter of a nasotracheal tube? | Nares | Glottis | Vocal cords | Cricoid cartilage | 5 | D | 1 | Third tracheal ring | null | null | null | null |
d83b3871-09d9-59dc-ab8d-80bc01076eaf | Massive venous air embolism occurs in a patient who is undergoing craniotomy in the sitting position with nitrous oxide, oxygen, fentanyl anesthesia. Which of the following changes in end-tidal (ET) concentrations of carbon dioxide, nitrogen, and nitrous oxide are most likely in this patient? (ETCO2, ETN2, ETN2O) | Increased, increased, decreased | Decreased, decreased, increased | Decreased, decreased, decreased | Decreased, increased, decreased | 5 | D | 3 | Increased, decreased, decreased | null | null | null | null |
03f1d2ff-714f-5b5c-a01a-558db29b873c | Compared with a patient without liver disease, a patient with cirrhosis will have | greater accumulation of vecuronium with infusion | increased unbound plasma vecuronium concentration | more frequent occurrence of phase II block after succinylcholine administration | prolonged elimination half-life of atracurium | 5 | A | 1 | unchanged volume of distribution for pancuronium | null | null | null | null |
e51ff39a-f2f4-5d60-ac3c-e7a8f931ad49 | A delay in surgery for 24 to 48 hours for preoperative stabilization and preparation is acceptable in each of the following neonatal conditions EXCEPT | biliary atresia | diaphragmatic hernia | meningomyelocele | pyloric stenosis | 5 | C | 1 | tracheoesophageal fistula | null | null | null | null |
c871b4ce-da4f-5fcb-a5a2-a8b269f83f89 | During acute normovolemic hemodilution in an adult, which of the following compensatory mechanisms is most important in maintaining tissue oxygenation? | Increased cardiac output | Increased oxygen extraction | Increased synthesis of erythropoietin | Redistribution of regional blood flow | 5 | A | 2 | Shift of the oxyhemoglobin dissociation curve | null | null | null | null |
2fb08a3c-ed2c-5d97-bc6f-caa3f5b14bd5 | Each of the following improves coagulation in patients with uremia EXCEPT | conjugated estrogens | desmopressin | dialysis | epsilon-aminocaproic acid | 5 | D | 1 | platelet transfusion | null | null | null | null |
cb4fe7d8-ce40-5865-9021-fd3e7714da7b | The most likely cause of a fetal heart rate pattern of variable decelerations to 90 bpm is | aortocaval compression | compression of the fetal head | fetal acidosis | maternal hypotension | 5 | E | 1 | umbilical cord compression | null | null | null | null |
edb05c0a-e0e7-55a6-8052-1e87d9415fe4 | Which of the following is the most likely cause of apnea occurring after a retrobulbar block? | Epidural injection | Increased intracranial pressure | Oculopontine reflex | Ophthalmic artery injection | 5 | E | 1 | Subarachnoid injection | null | null | null | null |
93ec0d02-c927-539d-9057-b566b75b713c | A middle-aged, 70-kg man with a brain tumor is scheduled for an elective craniotomy. Preoperatively, he is alert but papilledema is present. Anesthesia is induced with thiopental 300 mg and succinylcholine 100 mg, followed by tracheal intubation. Immediately following intubation vigorous bucking occurs. The best immedi... | administer succinylcholine 100 mg intravenously | administer fentanyl 500 jug intravenously | hyperventilate with isoflurane 2% | administer thiopental 400 mg intravenously | 5 | D | 3 | hyperventilate and administer lidocaine 1 mg/kg intravenously | null | null | null | null |
f2fc429e-4edd-5b59-898a-936dc53d7a2e | A 3-day-old infant is comatose 18 hours after surgical correction of transposition of the great vessels. Tracheal suctioning produces only a tachycardic response. Anesthesia included midazolam 0.5 mg/kg, fentanyl 60 mcg/kg, and pancuronium 0.3 mg/kg. Which of the following is the most appropriate first step in evaluati... | Administration of flumazenil | Administration of naloxone | Train-of-four assessment | CT scan of the head | 5 | C | 3 | EEG | null | null | null | null |
62cbed71-f125-560d-ba07-153583d1565b | A 62-year-old man, who had a myocardial infarction three years ago, complicated by congestive heart failure and renal failure, is undergoing a colectomy. A pulmonary artery catheter demonstrates a cardiac output higher than measurements recorded during a cardiac catheterization two months after the infarction. Which of... | Creation of an arteriovenous fistula | Increased hemoglobin concentration from 10 to 12 g/dl | Stimulation of carotid body receptors | Transcutaneous nitroglycerin | 5 | A | 2 | Use of a beta-adrenergic blocker to prevent myocardial reinfarction | null | null | null | null |
acf0b573-0623-5ab8-b9a9-29c0ff5ba8bd | During a reoperative total hip arthroplasty requiring transfusion of 8 units of packed red blood cells, blood begins to ooze from the operative field and intravenous catheter sites. Urine is pink. The most likely cause is | citrate intoxication | factor V and VIII deficiencies | rhabdomyolysis | thrombocytopenia | 5 | E | 2 | transfusion reaction | null | null | null | null |
01f815d6-ac94-5f45-a8ca-0d605c253c16 | A patient is scheduled for amputation of the third metatarsal. A tourniquet will not be used during the procedure. The most effective anesthesia will be provided by block of which of the following nerves? | Femoral | Common peroneal and tibial | Sural and deep peroneal | Sural and tibial | 5 | B | 2 | Tibial, saphenous, and deep peroneal | null | null | null | null |
e29eeab1-aabf-5009-99d7-be232acabe01 | A patient has palpitations, flushing, and light-headedness after gingival injection of a local anesthetic. This reaction is most likely caused by | epinephrine in the local anesthetic | local anesthetic allergy | para-aminobenzoic acid allergy | methylparaben reaction | 5 | A | 1 | vasovagal reaction | null | null | null | null |
9d1f0e27-3872-5bd8-929b-346dbb8a85cc | Which of the following is an effect of nitrous oxide? | Decreased pulmonary vascular resistance | Depression of uterine contractility | Inhibition of methionine synthetase | Stimulation of lymphocyte chemotaxis | 5 | C | 1 | Stimulation of myocardial contractility | null | null | null | null |
cb810603-dc25-5a68-b311-576668664473 | One week after sustaining third-degree burns over 40% of his body surface area, a patient requires general anesthesia for debridement and skin grafting. Which of the following responses to neuromuscular blockers is most likely? | Clinically insignificant increases in serum potassium concentration after administration of succinylcholine 1 mg/kg | Increased risk of hyperkalemia after administration of succinylcholine 1 mg/kg | Increased sensitivity to vecuronium | Laudanosine toxicity after administration of atracurium 0.4 mg/kg | 5 | B | 2 | Normal serum potassium concentration if administration of succinylcholine is preceded by d-tubocurarine 3 mg | null | null | null | null |
e50542e8-2880-5adf-999d-e1b2bbdbdf07 | Blind nasotracheal intubation is contraindicated in the presence of | a basilar skull fracture | a comminuted mandibular fracture | an orbital blow-out fracture | an unstable cervical spine fracture | 5 | A | 1 | a zygomatic arch fracture | null | null | null | null |
e100fedf-86d3-5d11-a979-6fc0da88c9f8 | Four hours after open cholecystectomy, a patient who is breathing spontaneously has an SpO2 of 93% in the supine position and an SpO2 of 98% when placed in the head-up position. The most likely cause of this change is an increase in which of the following? | Functional residual capacity | Minute ventilation | Pulmonary blood flow | Residual volume | 5 | D | 2 | Vital capacity | null | null | null | null |
46830d20-4e95-5864-b1dc-76167947a502 | Which of the following statements regarding carbon monoxide poisoning is true? | Breathing 100% oxygen at 1 atmosphere reduces the carboxyhemoglobin half-life | Effective treatment includes administration of methylene blue | It is commonly associated with respiratory acidosis | It is incompatible with a normal Sp02 while breathing room air | 5 | A | 1 | The oxyhemoglobin dissociation curve is shifted to the right | null | null | null | null |
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