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d3765b54-a3a9-5237-b049-bfb3b81ede96 | During pulmonary artery catheterization, a 65-year-old man receives morphine 6 mg and scopolamine 0.4 mg intravenously. The pulse oximeter indicates desaturation, which quickly resolves with stimulation. When the drapes are removed, he has unilateral eye pain, decreased visual acuity, and dilated and irregular pupils. ... | retinal hemorrhage | morphine-induced oculogyric crisis | corneal abrasion | carotid artery embolization | 5 | E | 2 | angle-closure glaucoma | null | null | null | null |
f6666614-1846-593c-a9dc-c08175d24b52 | A 90-kg, 59-year-old man with chronic obstructive pulmonary disease is undergoing laparotomy. Mechanical ventilation is being carried out with a fresh gas flow of 2 L/min at a rate of 16/min and tidal volume of 900 ml; I:E ratio is 1:2.5. PaCO2 remains greater than 50 mmHg. Preoperative PaCO2, was normal. Which of the ... | Adding 10 cmH20 of positive end-expiratory pressure | Converting to spontaneous ventilation | Decreasing inspiratory flow rate | Increasing exhalation time | 5 | D | 3 | Increasing fresh gas flow | null | null | null | null |
cac6d9d5-4d64-5680-91bf-0590524bd6ec | Which of the following statements concerning isolated mitral stenosis is true? | Afterload reduction increases cardiac output | Pulmonary artery occlusion pressure overestimates left ventricular filling pressure | Pulmonary hypertension is irreversible | Tachycardia decreases the mitral transvalvular gradient | 5 | B | 1 | Thermodilution cardiac output measurements are unreliable | null | null | null | null |
3d58a62c-197a-5003-a69c-29b80ac0627d | Preoperative evaluation of a patient who has marked malnutrition will demonstrate each of the following EXCEPT | decreased respiratory muscle function | decreased serum albumin concentration | decreased metabolic rate | suppressed immune function | 5 | E | 1 | decreased extracellular fluid volume | null | null | null | null |
6d44a69f-f83f-56a6-bce5-a1504395737b | Which of the following statements concerning banked blood is true? | Red blood cells preserved with CPDA-1 have a shelf life of approximately 21 days | Packed red blood cells deliver oxygen normally immediately after administration | Packed red blood cells contain most of the leukocytes present in the donated unit | Citrate is used as a source of energy for whole blood | 5 | C | 1 | Stored whole blood contains all coagulation factors except II and VIII | null | null | null | null |
e0dffc5f-4e49-52c0-a31b-6e2a281bcb8f | Statistical analysis of 20 patients shows a mean cardiac output (CO) of 5 L/min with a standard deviation of 1 L/min. The distribution pattern in the sample population is normal. Which of the following is the most appropriate conclusion? | Approximately 33% of the sample population would be expected to have a CO between 4 and 6 L/min | Approximately 95% of the sample population would be expected to have a CO between 3 and 7 L/min | Ten of the sample patients have a cardiac output greater than 5 L/min | The mean and the median are both at the 50th percentile | 5 | B | 2 | The median and the mode are the same in the sample population | null | null | null | null |
5dcc5eb6-ecbe-50e6-9ca5-2df0e6d21380 | The drug that causes dose-dependent EEG evidence of both central nervous system excitation and depression is | lidocaine | halothane | thiopental | nitrous oxide | 5 | A | 1 | midazolam | null | null | null | null |
fc0937b6-f131-568b-886b-5ecdea6ac251 | Each of the following would be expected after preoperative oral administration of clonidine EXCEPT | bradycardia in the absence of surgical stimulation | decreased requirement for inhalational anesthetics | decreased requirement for opioid anesthetics | decreased response to exogenous epinephrine | 5 | D | 1 | sedation | null | null | null | null |
03f90816-c37f-5b7f-91f9-1c3c5eda074d | Epidural administration of corticosteroids is most effective in relieving pain in patients with which of the following conditions? | Back pain caused by metastatic cancer | Postherpetic neuralgia | Postlaminectomy syndrome | Postural low back pain | 5 | E | 1 | Radiculopathy following disk herniation | null | null | null | null |
a87281be-752d-5747-aeba-182a6c63978d | Which of the following statements concerning use of amitriptyline to treat chronic pain is true? | It acts primarily via opioid receptors | It increases serotonin levels in the brain | It is rarely effective for postherpetic neuralgia | Onset of action occurs after four to six weeks of treatment | 5 | B | 1 | Response depends on reversal of depression | null | null | null | null |
b2d716f7-1f9f-5694-856a-e210c8b6fcb5 | Which of the following statements concerning neuroleptic malignant syndrome is true? | It does not respond to dantrolene therapy | It is inherited as an autosomal trait | It is not triggered by succinylcholine | It occurs after long-term use of L-dopa | 5 | C | 1 | The halothane-caffeine contracture test is negative in susceptible patients | null | null | null | null |
373aefc5-4b65-548f-b3c5-945eac8b3a1e | Compared with epidural morphine, intrathecal morphine produces | better relief of visceral pain | greater loss of analgesia after administration of naloxone | less pruritus | less urinary retention | 5 | E | 1 | more respiratory depression | null | null | null | null |
943765eb-5621-5673-88af-6085b0cf7ac5 | A newborn infant is undergoing repair of gastroschisis. During closure of the abdominal wall, ventilatory pressures and central venous pressure increase markedly. The most appropriate management is to | administer a bronchodilator | decrease tidal volume and increase ventilatory rate | increase the neuromuscular block | increase the depth of anesthesia | 5 | E | 3 | ask the surgeon to reopen the abdomen | null | null | null | null |
8fbe76aa-d2d7-53fd-8187-37bc1eb4ddcf | Which of the following additives accelerates the onset of lidocaine axillary block without shortening duration? | Carbon dioxide | Dextran | Dextrose | Epinephrine | 5 | A | 1 | Hyaluronidase | null | null | null | null |
3a47daac-d0d8-5b09-b9d5-3dfc318b2541 | A 25-year-old woman undergoes a difficult open cholecystectomy during anesthesia with isoflurane, nitrous oxide, fentanyl, and vecuronium. Five units of blood are administered intraoperatively. Two days later, the patient has mildly increased serum transaminase concentrations and markedly increased alkaline phosphatase... | Acute viral hepatitis | Hemolysis | Isoflurane-induced liver dysfunction | Retained common duct stone | 5 | D | 3 | Sepsis | null | null | null | null |
ab4a8c4c-e0f1-5310-ab21-454d3a53f31b | An otherwise healthy 20-year-old man undergoes laser surgery for vocal cord polyp removal. During jet ventilation with 100% oxygen, arterial blood gas analysis shows PaO2 90 mmHg, PaCO2 40 mmHg, and pH 7.40. Which of the following is the most likely explanation? | Aspiration of gastric contents | Atelectasis | Pneumothorax | Pulmonary embolism | 5 | E | 2 | Room air entrainment | null | null | null | null |
059db4a2-a003-5c9b-b762-b8b2a65e57a5 | Which of the following would be most likely to result in neonatal depression when administered to a healthy parturient during an uncomplicated labor and vaginal delivery? | Nitrous oxide 60% in oxygen supplemented with halothane 0.5% for 10 minutes before delivery | Ketamine 20 mg intravenously 30 minutes before delivery | Meperidine 100 mg intramuscularly 2 hours before delivery | Thiopental 100 mg intravenously 30 minutes before delivery | 5 | C | 2 | Nitrous oxide 60% in oxygen supplemented with enflurane 0.7% for 10 minutes before delivery | null | null | null | null |
e6563715-811d-5780-8b85-b34c7d2ced98 | Which of the following perioperative interventions decreases the risk for renal insufficiency in patients undergoing aortic aneurysm repair? | Administration of furosemide | Administration of mannitol | Administration of renal-dose dopamine | Epidural anesthesia | 5 | E | 1 | Preoperative volume expansion | null | null | null | null |
e59c1191-5329-5ccd-b4b0-3a95d9f686cf | Which of the following is the most likely sequela of interscalene brachial plexus block? | Cervical epidural block | Hemidiaphragmatic paralysis | Pneumothorax | Seizure | 5 | B | 1 | Vocal cord paralysis | null | null | null | null |
d560c58a-1e63-5c8e-a410-2440f88531dc | Prompt control of seizures induced by bupivacaine is necessary because | cerebral metabolic rate for oxygen increases more than cerebral blood flow | cerebral blood flow is increased | bupivacaine decreases aerobic cerebral metabolism | cardiac failure may occur | 5 | E | 1 | ventilation may be impaired | null | null | null | null |
67fc6502-ece5-5a71-952c-537e17317181 | A patient receives remifentanil 25 mcg just before retrobulbar block with 0.25% bupivacaine 4 mL. Over the next 10 minutes, he develops apnea and loses consciousness. Which of the following is the most likely explanation? | Effects of remifentanil | Injection of local anesthetic into cerebrospinal fluid | Intravascular injection of local anesthetic | Oculocardiac reflex | 5 | B | 2 | Systemic absorption of local anesthetic | null | null | null | null |
e22fc47c-a60f-53aa-9606-fca3da49cf05 | A patient has severe hypotension, bronchospasm, and edema of the upper airway after injection of radiocontrast medium during cerebral angiography. The most appropriate immediate treatment is administration of | diphenhydramine | epinephrine | methylprednisolone | phenylephrine | 5 | B | 2 | ranitidine | null | null | null | null |
f87a3a90-bf14-53b6-abeb-0b8b2386ce42 | During craniotomy in the sitting position, end-tidal carbon dioxide tension suddenly decreases. Ventilatory excursion of the chest is normal. Further evaluation is most likely to show a decrease in | alveolar-to-arterial oxygen tension difference | alveolar-to-arterial carbon dioxide tension difference | dead space ventilation | pulmonary artery pressure | 5 | E | 3 | pulmonary artery occlusion pressure | null | null | null | null |
9a7a27b2-dcf2-56ed-851c-669bdc8d92ca | Preoperative administration of an alpha-adrenergic blocker for 10 days to patients with pheochromocytoma will decrease | episodic tachycardia | hyperglycemia | hypovolemia | nasal stuffiness | 5 | C | 1 | postural hypotension | null | null | null | null |
12810c49-7d9f-510b-9e3a-affb192e3cdf | An 80-kg, 70-year-old woman is scheduled for a mastectomy. She has a history of congestive heart failure treated with digoxin 0.25 mg daily. Preoperative examination shows a sinus rhythm at 80 bpm and blood pressure of 110/70 mmHg. Laboratory studies show a serum potassium concentration of 4.2 mEq/L and a serum digoxin... | Administration of calcium chloride | Administration of ephedrine | Administration of lidocaine | Administration of potassium chloride | 5 | E | 3 | Decrease in ventilation | null | null | null | null |
7eb20ffe-385b-57e0-b487-ab02d20bd7ab | Block of the superficial cervical plexus is performed at which location? | At the midposterior border of the sternocleidomastoid muscle | In the interscalene groove | Over the mastoid process | Over the transverse process of C4 | 5 | A | 1 | Over Chassaignac's tubercle | null | null | null | null |
da91c774-d3c6-5201-89f3-b81d4e65d26c | A 5-year-old child is brought to the emergency department in considerable respiratory distress. He is sitting leaning forward and drooling. He was well until four hours ago, when temperature increased to 38.9°C and he complained of a sore throat. The most appropriate initial management is to | administer nebulized racemic epinephrine | gently examine the airway with a tongue blade | obtain a lateral radiograph of the neck | perform a rapid induction-intubation sequence | 5 | E | 3 | perform inhalation induction without cricoid pressure | null | null | null | null |
1d2eb070-b756-50e5-899c-a73d99ef5852 | A 65-kg 70-year-old man in the PACU is breathing spontaneously at 20/min through an endotracheal tube connected to a T-piece with a fresh gas flow of 5 L/min. He has a tidal volume of 350 mL and an FiO2 of 0.5. SpO2 decreases from 98% to 84% over one hour, then improves to 92% with an FiO2 of 1.0. Which of the followin... | Decreased functional residual capacity | Increased dead space ventilation | Inhibition of hypoxic pulmonary vasoconstriction | Room air admixture during inspiration | 5 | A | 2 | Shivering | null | null | null | null |
36b8597d-607c-5a21-b055-276c6e830ccc | Each of the following landmarks is used in performing wrist block to remove a cystic mass on the fourth digit EXCEPT the | extensor pollicis longus tendon | ulnar artery | palmaris longus tendon | flexor carpi radialis tendon | 5 | A | 1 | flexor carpi ulnaris tendon | null | null | null | null |
86cf338a-5493-532c-9139-e22c175b12f0 | Which of the following statements about pulmonary function testing is true? | Forced expiratory volume in one second (FEV1) is directly related to maximum voluntary ventilation | FEV, is the most reliable indicator of small airways resistance | Forced vital capacity is markedly decreased in obstructive lung disease with air-trapping | Maximum mid-expiratory flow is less effort dependent than FEV1 | 5 | D | 1 | Three-second forced expiratory volume is the amount of air exhaled during the third second of exhalation | null | null | null | null |
22a9b632-542b-5870-a77e-9e82173efddb | A 70-kg patient with no acute bleeding has a preoperative platelet count of 40,000/mm3. Following preoperative transfusion of platelets 10 units, the predicted platelet count would be | 50,000/mm3 | 80,000/mm3 | 90,000/mm3 | 140,000/mm3 | 5 | D | 2 | 190,000/mm3 | null | null | null | null |
5315dcf1-3f88-5761-ad08-0da3f19d756c | A morbidly obese patient is to undergo gastric stapling during general anesthesia. Following preoxygenation and induction, the oxygen saturation decreases after 40 seconds of laryngoscopy and attempted intubation. The rapid onset of arterial desaturation is most likely due to | aspiration during induction | decreased functional residual capacity | increased cardiac output | increased oxygen consumption | 5 | B | 2 | increased ventilatory dead space | null | null | null | null |
0dbeb745-2173-5175-83c5-c4f0f51e6eb0 | During insufflation of the peritoneal cavity with carbon dioxide at the start of laparoscopy, heart rate increases to 140 bpm, blood pressure decreases to 70/40 mmHg, and a loud murmur is heard through the esophageal stethoscope. The most appropriate immediate step is to | administer a vasoconstrictor | infuse crystalloid solution rapidly | discontinue the inhaled anesthetic | insert a central venous catheter | 5 | E | 2 | deflate the abdomen | null | null | null | null |
446f276b-cccb-511f-a686-81394b0b51c8 | Which of the following best describes the relationship between cerebral perfusion pressure and cerebral blood flow in a patient with untreated chronic hypertension? | It is constant at mean blood pressures between 50 and 150 mmHg | It is linear for all blood pressures | Flow versus pressure curve is hyperbolic | Flow versus pressure curve is shifted to the right | 5 | D | 1 | Flow versus pressure curve is shifted to the left | null | null | null | null |
ef5a9160-856b-5622-8002-38c3178cc25b | Which of the following findings is most likely in patients receiving intravenous milrinone? | Decreased left ventricular afterload | Decreased myocardial oxygen consumption | Increased atrioventricular conduction | Increased right ventricular preload | 5 | A | 1 | Stimulation of beta-adrenergic receptors | null | null | null | null |
23bb1578-78e6-50d0-b57d-0c85210cb980 | The mortality rate of patients given drug A is 12% (8 of 66) and the mortality rate of patients given drug B is 15% (10 of 66). Which of the following tests is most appropriate to compare these mortality rates? | t-Test for paired data | t-Test for unpaired data | Wilcoxon rank test | Chi-square test | 5 | D | 2 | Analysis of covariance | null | null | null | null |
d58d235d-a69f-59b0-8be5-fb23092772e2 | The portion of the infant airway with the smallest cross-sectional area occurs at the level of the | cricoid cartilage | false vocal cords | thoracic inlet | tonsillar pillars | 5 | A | 1 | true vocal cords | null | null | null | null |
6ac13eee-af4a-5e26-8cfa-bd8501f5b95d | Which of the following should be included in the preoperative management of a 12-year-old patient with Duchenne muscular dystrophy who is unable to ambulate? | Determination of serum creatine kinase concentration | Determination of serum potassium concentration | Liver function profile | Echocardiography | 5 | D | 2 | Dantrolene prophylaxis | null | null | null | null |
eb07a873-10af-5b7b-8f7b-9c53e7271441 | A 16-year-old child has an arterial catheter inserted prior to a potentially difficult intubation for a craniofacial operation. While awake and breathing room air, arterial blood gas values are: PaO2 134 mm Hg, PaCO2 28 mm Hg, and pH 7.45. These values can be explained by | excess heparin mixed with the arterial sample | a patient core temperature of 38°C | excess air entrained in the syringe during sampling | storing the sample at room temperature for 15 minutes before processing | 5 | C | 2 | anxiety and hyperventilation | null | null | null | null |
b9f2a844-39ef-56cc-b261-7f9145e54ba7 | A 63-year-old man with a history of congestive heart failure and left ventricular dilation is scheduled for carotid endarterectomy. During carotid cross-clamping, the surgeon requests that systolic blood pressure be increased from 100 to 160 mmHg. Compared with an identical patient with normal left ventricular size, wh... | Equal decrease | Greater decrease | Lesser increase | Equal increase | 5 | E | 3 | Greater increase | null | null | null | null |
b3097374-c707-5469-a7e8-6cf79c96b7b8 | Acute epiglottitis usually | requires a lateral radiograph of the neck for diagnosis | occurs in children 2 to 4 years of age | is treated effectively with racemic epinephrine | has a viral etiology | 5 | B | 1 | requires immediate awake intubation by direct laryngoscopy in the emergency department | null | null | null | null |
4c5ac962-4596-5ce6-9be4-e5911f0e5de4 | A 57-year-old man with hepatocellular disease is scheduled to undergo a colectomy for colon cancer. Preoperative laboratory studies show a plasma albumin concentration of 2.4 g/dl (normal = 3.5 to 5.5 g/dl); prothrombin time is 16 sec (control 12 sec). Which of the following statements concerning the anesthetic managem... | Atracurium will have a prolonged duration of action | The risk for perioperative hyperglycemia is increased | Mivacurium will have a shortened duration of action | The unbound fraction of thiopental will be increased | 5 | D | 2 | Vitamin K injection will normalize the prothrombin time | null | null | null | null |
a08f3318-d632-533d-bd39-e2613b7081f9 | A 65-kg man is scheduled for wrist surgery with intravenous regional anesthesia with 0.5% lidocaine 50 ml. Which of the following statements is true? | This anesthetic is contraindicated if the patient has sickle cell disease | Mottling of the skin after injection dictates abandonment of the technique | Tourniquet discomfort is an indication to inject more local anesthetic | Bupivacaine 0.5% could be substituted to prolong anesthesia | 5 | A | 1 | Epinephrine (1:400,000) should be added to prolong anesthesia | null | null | null | null |
c9c84e2c-2382-5870-962b-58d06ac5782c | A 65-year-old patient receiving long-term clonidine therapy fails to take it one day before surgery. This would most likely | be beneficial, since clonidine decreases cardiac output | be of no consequence due to the long half-life of clonidine | produce a lower anesthetic requirement than if the drug had been continued | produce rebound hypertension | 5 | D | 1 | result in seizure activity | null | null | null | null |
fdc10946-d57a-53d2-9af5-2553d96d12de | One hundred children who are to have strabismus surgery are enrolled in a research protocol. Fifty receive a new antiemetic and 50 receive a placebo preoperatively. Fifteen children in the treatment group and 37 children in the control group have nausea and vomiting postoperatively. Which of the following analyses is m... | Analysis of variance | Chi-square analysis | Linear regression and correlation coefficient | Student's t-test | 5 | B | 2 | Wilcoxon's rank sum test | null | null | null | null |
e7936885-da11-5f76-929d-2207e0853645 | Compared with lidocaine, bupivacaine is more likely to cause dysrhythmias because it | enhances potassium-hydrogen ion exchange | is less soluble in lipids | produces more prolonged block of sodium channels | sensitizes the myocardium to catecholamines | 5 | C | 1 | sustains calcium channels open | null | null | null | null |
fa205502-0fb3-535d-9737-6a773ec0d5b8 | Administration of magnesium sulfate for treatment of preeclampsia results in a decreased dose requirement for each of the following drugs EXCEPT | bupivacaine | halothane | midazolam | succinylcholine | 5 | A | 1 | vecuronium | null | null | null | null |
c152a66b-11a7-5af1-88ac-0eafe479d150 | A woman is undergoing a repeat cesarean delivery at term following a normal pregnancy. Anesthesia consists of thiopental 250 mg, succinylcholine infusion (180 mg in 20 minutes), nitrous oxide and oxygen (7:3 L/min) until delivery. Twenty minutes after the incision a floppy newborn with a 1-minute Apgar score of 5 is de... | high serum thiopental concentration | high serum succinylcholine concentration | high serum nitrous oxide concentration | high serum glucose concentration | 5 | C | 2 | uterine hypoperfusion | null | null | null | null |
ba653fda-714c-5b25-8e76-993d02328f9e | Which of the following statements concerning the retinopathy of prematurity is true? | The initial lesion is dilation of retinal capillaries | It can be prevented by maintaining FiO2 below 0.4 | It is less likely to develop if PaO2 is maintained below 70 mmHg | The incidence is unrelated to birth weight | 5 | A | 1 | Infants whose postconceptual age has reached 40 weeks are no longer at risk | null | null | null | null |
3373745c-5245-5764-98a4-d8783d76ac35 | During induction of anesthesia for cesarean delivery, pancuronium is inadvertently substituted for succinylcholine. The neonate shows no clinical signs of muscle relaxation because pancuronium is | highly ionized | highly protein bound | a large molecule | lipid soluble | 5 | A | 1 | unaffected by "ion trapping" | null | null | null | null |
3278c03e-c769-51ca-bcea-78eed129e0b7 | Each of the following is a complication or side effect of neurolytic celiac plexus blockade EXCEPT | constipation | hematuria | orthostatic hypotension | paraplegia | 5 | A | 1 | pneumothorax | null | null | null | null |
6be14859-8a32-58ff-a643-1f8946224e87 | Which of the following is indicated by an alarm condition in the line-isolation monitor? | An electrical shock to the patient | A power surge in the main hospital power supply | Disconnection of the patient from an electrocautery grounding pad | Overload of the operating room circuits | 5 | E | 1 | The presence of a current leak between an operating room electrical device and ground | null | null | null | null |
4927425d-1590-544f-b255-ba70d22a7cc4 | Compared with midazolam, diazepam has which of the following characteristics? | Greater solubility in water | Shorter beta half-life | More potent ventilatory depressant effect | Lower risk for thrombophlebitis | 5 | E | 1 | A pharmacologically active metabolite | null | null | null | null |
b2892b79-1586-5668-b61c-24098c907923 | The gauge pressure on a cylinder of nitrous oxide | varies with the size of the cylinder | is the same for full and half-full cylinders | is the same as that of a full cylinder of oxygen if both are full | is independent of the temperature of the cylinder | 5 | B | 1 | reliably indicates the amount of nitrous oxide in the cylinder | null | null | null | null |
3a49c608-6791-5b80-8184-b3cf895d1476 | A 24-year-old woman requires anesthesia for emergency repair of open fractures of the tibia and fibula. She used cocaine two hours ago. Blood pressure is 170/110 mmHg. Each of the following is useful in managing the hypertension EXCEPT | hydralazine | labetalol | nitroprusside | phentolamine | 5 | E | 2 | propranolol | null | null | null | null |
fdd11fc2-afcb-579d-a460-77eaf6084243 | A 35-kg child requires mechanical ventilation with pure oxygen at a tidal volume of 350 ml and a rate of 20/min during a severe asthma attack. The most likely cause of severe hypotension after initiating mechanical ventilation is | hypoxic circulatory depression | inadequate expiratory time | increased pulmonary vascular resistance | respiratory alkalosis | 5 | B | 2 | tension pneumothorax | null | null | null | null |
cb7d8983-a40d-5a12-b9d0-2ab2ea0d1171 | Which of the following is an effect of acetazolamide? | Glucose intolerance | Increased minute ventilation | Metabolic alkalosis | Sinus bradycardia | 5 | B | 1 | Slowed intravenous anesthetic induction | null | null | null | null |
242651d8-8475-5670-9190-2b0441d6cf91 | During recovery from halothane anesthesia, an alveolar concentration of 0.1% will have the greatest effect on | myocardial contractility | ventilatory response to hypercarbia | atrioventricular conduction | ventilatory response to hypoxia | 5 | D | 1 | neuromuscular transmission | null | null | null | null |
3dbc016d-d8c1-58f7-a9d7-86d41600c1e8 | During anesthesia with nitrous oxide, oxygen, and a relaxant, the patient's lungs are being mechanically ventilated and there is a heated humidifier in the circuit. The most likely cause of an apparent increase in inspired oxygen concentration is | a hole in the ventilator bellows | backflow of fresh gas because of resistance in the humidifier | decreased oxygen utilization by the patient | heat damage to the oxygen sensor | 5 | A | 2 | water condensation on the oxygen sensor | null | null | null | null |
22cd971d-1868-5eb6-a749-8dbcc842413b | A 19-year-old woman receives a spinal anesthetic for a repeat cesarean delivery. Two days later she is afebrile but has severe occipital pain that is aggravated by sitting or standing and relieved by lying flat. Associated findings would likely include | bradycardia | difficulty swallowing | diplopia | facial pain | 5 | C | 1 | Horner's syndrome | null | null | null | null |
9ae5f882-5788-520a-a650-cb19609eca43 | An elderly man has an acute dissection of the descending thoracic aorta. Which of the following antihypertensive therapies is most likely to extend the dissection? | Esmolol infusion | Nitroglycerin infusion | Nitroprusside infusion | Nitroprusside infusion combined with a beta-adrenergic blocker | 5 | C | 2 | Trimethaphan infusion | null | null | null | null |
6bc10c3e-cee0-5884-9f26-04d5a8674899 | A 68-year-old patient is undergoing total hip replacement during general anesthesia using positive pressure ventilation and neuromuscular blockade. Intraoperative monitoring shows a gradual decrease in end-tidal CO2, an increase in exhaled tidal volume, and an increase in measured FiO2. Which of the following is the mo... | Air entrainment around a deflated endotracheal tube cuff | Channeling of the exhaled air through the carbon dioxide canister | Fat embolism | Inadequate muscle relaxation with spontaneous patient ventilation | 5 | E | 3 | A small hole in the ventilator bellows | null | null | null | null |
85961afe-5d97-5193-ba18-9da764e60a81 | A 30-year-old, 70-kg woman with mitral stenosis is scheduled for elective laparoscopic sterilization. Preoperatively she is taking digoxin and an unknown medication for chronic mental depression. The EKG demonstrates atrial fibrillation. Heart rate is 68 bpm. Anesthesia is induced with thiopental followed by nitrous ox... | increase the halothane concentration to 1.25% | discontinue the succinylcholine infusion | increase minute ventilation to 7.5 L/min | administer potassium 5 mEq intravenously over one minute followed by propranolol 0.25 mg | 5 | C | 2 | measure arterial blood gas and serum electrolyte values | null | null | null | null |
eb5b258b-46c9-59a3-85c4-5e5d3d1a1d44 | Which of the following statements concerning relationships among alveolar pressure, volume, and surface tension is true? | Surface tension of surfactant decreases as alveolar volume decreases | Surface tensions of water and of surfactant behave similarly as volume decreases | Changes in alveolar surface tension with volume are the same during expansion as during contraction | Pressure in the alveolus is inversely related to surface tension | 5 | A | 1 | Pressure in the alveolus is directly related to alveolar radius | null | null | null | null |
97e56d5e-c127-512e-aa66-929ae30d58ed | Physiologically, coronary blood flow relates most directly to | cardiac work | systolic blood pressure | myocardial oxygen consumption | heart rate | 5 | C | 1 | mean arterial pressure | null | null | null | null |
842bb137-f38b-593c-878b-abbf17de65c8 | A patient who is paraplegic secondary to spinal cord transection at T3 develops bradycardia and facial flushing during a nephrectomy under general anesthesia with nitrous oxide, fentanyl, and atracurium. The most likely cause of this response is | release of histamine | stimulation of the carotid sinus | release of prostaglandins | vagal response to peritoneal traction | 5 | B | 3 | release of epinephrine | null | null | null | null |
ee55104d-6895-51ca-b3f8-923df62dd68e | Which of the following is the most appropriate management of decreased cardiac output in patients with isolated aortic insufficiency? | Dobutamine | Esmolol | Intra-aortic balloon counterpulsation | Norepinephrine | 5 | A | 3 | Positive pressure ventilation | null | null | null | null |
6c9aeb12-7a8f-51ab-81ff-8d9461237731 | A 45-kg, 80-year-old woman undergoes pin fixation of the right hip in the lateral decubitus position under spinal anesthesia. One day after the operation, she cannot move her left ankle or foot actively. The most likely cause is | compression of the sciatic nerve | compression of the common peroneal nerve | injury of the nerve root at L4-5 | stretching of the femoral nerve | 5 | A | 2 | stretching of the tibial nerve | null | null | null | null |
531acb06-8fc0-5f4d-b675-1f4d8eca1a62 | Which of the following remains normal in an otherwise healthy patient with obesity? | Alveolar PO2 | Expiratory reserve volume | Functional residual capacity | Lung compliance | 5 | D | 1 | Static lung volumes | null | null | null | null |
acc23414-12f4-58a9-b885-6a82d881441c | In the majority of cases, fetal heart rate decelerations in a variable pattern are associated with | decreased uteroplacental perfusion | fetal head compression during contractions | umbilical cord compression | low Apgar scores at birth | 5 | C | 1 | low neurobehavioral scores eight hours post partum | null | null | null | null |
6af88dc5-f009-5017-af7c-cd5517a0c73f | A 60-year-old obese man who has an antithrombin III deficiency is scheduled for radical prostatectomy. Prior to the operation this patient should receive | fresh frozen plasma | vitamin K | epsilon-aminocaproic acid | heparin | 5 | E | 2 | none of the above | null | null | null | null |
b95c1610-932a-5cfb-810e-3bdba7826a73 | Which of the following findings necessitates the preoperative insertion of a ventricular pacemaker in a 48-year-old man scheduled to undergo cholecystectomy? | Atrial flutter with 3:1 atrioventricular block | Bifascicular (right bundle branch block and left anterior hemiblock) block | Left bundle branch block with first-degree atrioventricular block | Second-degree (Mobitz I) atrioventricular block | 5 | E | 3 | Second-degree (Mobitz II) atrioventricular block | null | null | null | null |
6c20b434-9678-5387-8725-4cb14202f0f6 | Compared with halothane, desflurane has which of the following characteristics? | Greater potency | A higher boiling point | Increased blood solubility | Less airway irritability | 5 | E | 1 | Less biodegradation | null | null | null | null |
1c26e9fb-aebe-525d-b350-01cfc3e8dbac | A 29-year-old man who has been nasotracheally intubated for two weeks following a motor vehicle accident has a fever (39C) and a constant headache. Leukocyte count is 18,000/mm3. The most likely cause is | fractured nasal septum | retropharyngeal abscess | maxillary sinusitis | meningitis | 5 | C | 2 | rhinovirus infection | null | null | null | null |
18fe9ba9-f815-5c32-9a81-92776b16e077 | When evaluating a screening test, which of the following is the most appropriate term for the proportion of patients with a disease who have a positive test result? | Accuracy | Incidence | Selectivity | Sensitivity | 5 | D | 1 | Specificity | null | null | null | null |
599cf8cd-1168-5bfd-a616-9bed2d289506 | A multiparous 24-year-old woman sustains an amniotic fluid embolism during general anesthesia. The LEAST likely clinical finding is | increased end-tidal carbon dioxide tension | increased uterine bleeding | jugular venous distention | ST and T wave abnormalities on ECG | 5 | A | 1 | wheezing | null | null | null | null |
3020cafd-2efe-533f-809e-f4229935b935 | During general anesthesia administered through a circle system, the soda lime absorbant is exhausted. No fresh soda lime is available for use. Which of the following is the most appropriate next step to prevent hypercapnia in this patient? | Decreasing the dead space of the circle system | Discontinuing nitrous oxide | Increasing the fresh gas flow | Increasing tidal volume | 5 | C | 2 | Switching to spontaneous ventilation | null | null | null | null |
6cdfd240-0512-5aa9-86bf-f9957f640e05 | The low fetal/maternal plasma ratio of bupivacaine compared with lidocaine is due to | fetal tissue binding | fetal plasma protein binding | maternal plasma protein binding | ionization in maternal blood | 5 | C | 1 | ionization in fetal blood | null | null | null | null |
8688ce56-09ef-5e96-a618-7d153aaf8604 | You are called to a witnessed cardiac arrest where cardiopulmonary resuscitation is being performed. After successful intubation, arterial blood gas values are PaO2 86 mmHg, PaCO2 63 mmHg, and pH 7.25 at an FiO2 of 1.0. The most appropriate management at this time is to | repeat arterial blood gas analysis using a new specimen | administer sodium bicarbonate | administer fluid challenge with 500 ml of normal saline solution | hyperventilate the patient | 5 | D | 3 | add positive end-expiratory pressure | null | null | null | null |
51786f19-75f4-58fe-858f-f65eed5ddcc3 | A 6-year-old child with severe cerebral palsy is scheduled for general anesthesia. He is at increased risk for each of the following EXCEPT | gastroesophageal reflux | hypersensitivity to central nervous system depressants | poor function of laryngeal reflexes | postoperative pulmonary complications | 5 | E | 1 | succinylcholine-induced hyperkalemia | null | null | null | null |
7441b671-a3dd-5602-bce5-77bbe18a797d | Which of the following best explains the decreased effect of hyperventilation on cerebral blood flow when PaCO2 decreases below 20 mmHg? | Maximal constriction of cerebral vessels | Decreased cerebral perfusion pressure | Decreased cerebral metabolic rate for oxygen | Increased cardiac output | 5 | A | 1 | Increased cerebrospinal fluid pressure | null | null | null | null |
586bfa0f-2a4c-5d45-bd04-e7864992338c | Proper handling of oxygen cylinders includes | maintenance of storage room temperature above 60°F | separate storage rooms for nitrous oxide and oxygen | opening the cylinder valve just sufficiently to register tank pressure accurately | storage in a room with conductive flooring | 5 | E | 1 | opening the cylinder valve briefly before attachment to the anesthesia machine | null | null | null | null |
f680a758-a2bf-5f1c-8520-01a66cf85e74 | A 70-kg 58-year-old man with unstable angina is scheduled to undergo coronary artery bypass grafting. Intravenous heparin and nitroglycerin are administered for four days before surgery. Before initiating cardiopulmonary bypass, 21,000 units of heparin are administered through the central venous catheter; five minutes ... | Discontinue nitroglycerin | Administer additional heparin | Administer cryoprecipitate | Administer fresh frozen plasma | 5 | B | 2 | Initiate cardiopulmonary bypass | null | null | null | null |
9e022a24-5519-596d-ba55-be8510c1cc6b | Of the following, the most reliable criterion for adequate clinical reversal of neuromuscular blockade is | return of twitch height to 90% of normal | peak inspiratory force of -20 cmH20 | T4:T1 ratio of 0.75 for train of four | normal tidal volume | 5 | C | 1 | disappearance of post-tetanic facilitation | null | null | null | null |
31f0b8aa-99ad-503c-a89b-7b03d6f353a0 | Prior to occlusion of any major pulmonary blood vessels during a thoracotomy, applying positive end-expiratory pressure to ventilation through the dependent lumen of a double-lumen tube and occluding the upper lumen of the tube will | increase blood flow to the dependent lung | increase the alveolar-arterial oxygen tension difference | override hypercarbic pulmonary vasoconstriction | improve the patient's oxygenation | 5 | B | 3 | increase the right ventricular dP/dt | null | null | null | null |
868512b5-20e6-5721-8f3c-91bdd23604ed | Which of the following would be most likely to increase the duration of seizures during electroconvulsive therapy using a barbiturate and succinyleholine for general anesthesia? | Administration of atropine prior to therapy | Changing to a benzodiazepine for induction | Changing to etomidate for induction | Adding phenytoin to preoperative medications | 5 | E | 2 | Decreasing the dose of barbiturate used for induction | null | null | null | null |
af831b32-2e3e-553e-936e-e45665d02497 | When succinylcholine is administered intravenously to infants, intragastric pressure | is usually unchanged | increases to a peak of 30 cmH20 within two minutes | increases because of abdominal muscle fasciculations | increases because of an acetylcholine-like effect on the vagus nerve | 5 | A | 1 | peaks and subsides within five minutes | null | null | null | null |
26bfb7d0-cd27-5510-b737-055c9174ed68 | A patient receiving monoamine oxidase inhibitor therapy for depression undergoes an emergency cholecystectomy. Which of the following is the best means of providing postoperative analgesia in this patient? | Epidural analgesia using 0.25% bupivacaine | Intravenous meperidine | Epidural analgesia using meperidine | Epidural analgesia using 1% lidocaine with epinephrine | 5 | A | 2 | Intercostal analgesia using 1% lidocaine with epinephrine | null | null | null | null |
20afcc97-361d-573d-82d1-45cf406e2494 | Alveolar and inspired anesthetic concentrations equilibrate more rapidly with nitrous oxide than with desflurane because nitrous oxide | has a higher vapor pressure | has a lower blood gas solubility | has a lower MAC | is delivered at a higher inspired concentration | 5 | D | 1 | produces a second gas effect | null | null | null | null |
cb2834ae-76fd-5591-b395-10f1d6fc1665 | A 26-year-old man who sustained multiple trauma undergoes open reduction and internal fixation of bilateral tibial-fibular fractures during anesthesia with isoflurane. nitrous oxide, and oxygen with positive pressure ventilation. During the procedure, the patient has sudden onset of hypotension, jugular venous distenti... | Chest x-ray | Blood tranfusion | Subxiphoid pericardiocentesis | Fiberoptic bronchoscopy | 5 | E | 2 | Left chest needle thoracostomy | null | null | null | null |
5567c533-51e2-5c22-9745-be16566d38ad | Which of the following is the most likely effect of intramuscular ketamine used for induction of anesthesia in a 2-year-old child undergoing elective surgery? | Bronchoconstriction | Decreased heart rate | Decreased intracranial pressure | Increased salivation | 5 | D | 1 | Respiratory depression | null | null | null | null |
eb06e4fe-56d9-56ce-bbc2-9f30f560e4c7 | A single dose of etomidate for induction of anesthesia will cause | adrenal cortical suppression | decreased skeletal muscle tone | hypotension | increased airway reactivity | 5 | A | 1 | tachycardia | null | null | null | null |
1a54bc3f-19bd-5a38-a376-a8375e52b5a7 | A patient with a fasting blood glucose concentration of 100 mg/dl undergoes a four-hour operation under general anesthesia without intraoperative administration of glucose. On emergence the most likely finding will be | marked hypoglycemia | mild hypoglycemia | normoglycemia | mild hyperglycemia | 5 | D | 2 | marked hyperglycemia | null | null | null | null |
2e700142-9ceb-5138-913a-20e61a718880 | During laparotomy for a ruptured spleen, unexplained oozing occurs after infusion of 2 liters of crystalloid and 3 units of blood. The most likely cause is | citrate toxicity | dilutional thrombocytopenia | hemolytic transfusion reaction | labile clotting factor deficiency | 5 | C | 2 | leukoagglutinin reaction | null | null | null | null |
5e2f3981-0f2d-5f1f-a22e-2bb373dff4b0 | During a craniotomy for a supratentorial tumor, a 28-year-old man receives isoflurane 0.75% in nitrous oxide 70% and oxygen. Ventilation is controlled to maintain PaCO2 at 25 mmHg. Nasopharyngeal temperature is 35.8°C. While the dura mater is open, the surgeon complains that the brain is bulging. The most appropriate m... | decrease the inspired isoflurane concentration to 0.5% | hyperventilate further to decrease PaCO2 to 20 mmHg | discontinue nitrous oxide | administer thiopental | 5 | D | 3 | administer additional muscle relaxants | null | null | null | null |
423ff0de-2e16-5669-ad46-57da59a01440 | A 157 cm (5 ft 2 in), 180-kg, 40-year-old woman has a PaO2 of 65 mmHg, a PaCO2 of 38 mmHg, and a pH of 7.43 while breathing room air preoperatively. The most likely cause of these values is | decreased hypoxic ventilatory drive | higher than normal oxygen extraction from blood | lower than normal cardiac output | lower than normal functional residual capacity | 5 | D | 2 | polycythemia | null | null | null | null |
c79b542e-a755-51c1-bb31-68ddd5fc549f | In treating arterial hypertension in a patient with a head injury, the agent LEAST likely to increase intracranial pressure is | hydralazine | nitroprusside | nitroglycerin | trimethaphan | 5 | D | 2 | halothane | null | null | null | null |
abae331a-50a1-5455-83c8-e8858aa7df13 | Cerebral blood flow is decreased by each of the following EXCEPT | etomidate | midazolam | nitrous oxide | increased minute ventilation | 5 | C | 1 | positive end-expiratory pressure | null | null | null | null |
9b51b072-d881-546e-8aed-458683b03402 | Which of the following drugs exerts a vasoconstrictor effect by blocking the reuptake of norepinephrine at the neuronal synapse? | Cocaine | Dopamine | Ephedrine | Metaraminol | 5 | A | 1 | Phenylephrine | null | null | null | null |
a72050c3-32d6-5574-a895-56e5137fd846 | A 7-year-old, obese, 30-kg boy was anesthetized using an adult circle system containing a 3-liter bag and mask. Induction with nitrous oxide (2 liters), oxygen (1 liter), and enflurane 3% was characterized by three minutes of hyperventilation followed by apnea. Forty-five seconds later, the child moved and became diffi... | decreased alveolar concentration of enflurane during the period of apnea | excessive uptake of enflurane by the child's fat | higher fresh gas flows required with use of an adult circle system in a child | convulsions induced by enflurane | 5 | A | 2 | hypoxia developing during the period of apnea | null | null | null | null |
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