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dcf37b7c-c174-5d72-ab55-e17cb7677b27 | Miosis, incontinence, excess salivation, and convulsions are toxic effects of | amphetamines | phenothiazines | cocaine | tricyclic antidepressants | 5 | E | 1 | organophosphate insecticides | null | null | null | null |
c48c7153-6a46-59ad-bf26-1f755b18d01f | An otherwise healthy 42-year-old woman is referred for management of pain associated with adenocarcinoma of the breast and metastasis to the anterior body of L3. She perceives the pain as moderate and currently takes no pain medication. Her oncologist estimates her life expectancy to be 18 months. The most appropriate ... | a benzodiazepine as needed and at bedtime | an oxycodone preparation as needed and a tricyclic antidepressant at bedtime | intravenous patient-controlled analgesia | morphine infusion via an implanted epidural catheter | 5 | B | 2 | parenteral meperidine | null | null | null | null |
175175d9-fcd1-50d5-9d9e-4bab1ad42767 | A 70-kg, 50-year-old man is scheduled for muscle flap closure of a decubitus ulcer over the sacrum. He has been quadriplegic at the level of C6-7 for six years. Which of the following is most likely to result from subarachnoid anesthesia with tetracaine 10 mg for this procedure? | Atrioventricular block | Decreased risk for autonomic dysreflexia | Impaired expiratory muscle function | Impaired inspiratory muscle function | 5 | B | 2 | Inadequate block of spastic movements | null | null | null | null |
b42f3efc-c6b4-5036-892c-c261d559fe44 | Which of the following is the most likely cause of the increased incidence of right ventricular failure in patients with morbid obesity? | Chronic hypoxia | Chronic silent pulmonary aspiration | Chronic silent subendocardial ischemia | Decreased vital capacity | 5 | A | 1 | Increased pulmonary blood flow | null | null | null | null |
202cabad-b37a-5712-83d4-7fbb303046ba | Succinylcholine can be administered safely to a patient with | amyotrophic lateral sclerosis | cerebral palsy | a pelvic crush injury sustained two weeks ago | a 20% body surface area burn sustained 10 days ago | 5 | B | 1 | hemiparesis one month after a cerebrovascular accident | null | null | null | null |
3454a868-7fb8-507d-880a-240b122e6a6f | The supine hypotensive syndrome of pregnancy | begins at 32 weeks' gestation | causes fetal distress by aortocaval compression | is corrected by Trendelenburg's position | is less likely following subarachnoid block than epidural block | 5 | B | 1 | occurs in 90% of supine women at 38 to 40 weeks' gestation | null | null | null | null |
133d4077-1973-50f9-ab7a-64272e70f1b6 | Ketamine decreases | bronchomotor tone | intracranial pressure | intraocular pressure | salivation | 5 | A | 1 | seizure threshold | null | null | null | null |
c0c1b975-aaf2-5f04-a067-b5ad84ad8e5d | Each of the following statements about the anatomy of the autonomic nervous system is true EXCEPT: | Preganglionic cell bodies are located in the central nervous system | Postganglionic neurons are located in outlying ganglia | The parasympathetic ganglia are located near their target organs | The adrenal gland is innervated only by the sympathetic nervous system | 5 | E | 1 | The parasympathetic nervous system has thoracic and sacral segments | null | null | null | null |
8570f8b7-bcc4-519e-9fa6-7de62b6e00eb | Cyanide toxicity from nitroprusside is unlikely in patients with renal dysfunction because | renal excretion of thiosulfate is decreased | metabolic acidosis inactivates cyanide | anemia inhibits breakdown of nitroprusside by oxyhemoglobin | thiocyanate is formed in the liver | 5 | A | 1 | the dose of nitroprusside necessary to lower blood pressure is greatly decreased | null | null | null | null |
f7a11762-a57d-5668-941a-b7fd0a1ce48b | Each of the following is consistent with exposure to organophosphates EXCEPT | bronchodilation | muscle weakness | salivation | sweating | 5 | A | 1 | urinary retention | null | null | null | null |
ef477dcd-d967-5b52-83ed-57bf7baee78e | Which of the following findings differentiates the pickwickian syndrome from morbid obesity? | Carbon dioxide retention | Upper airway obstruction | Decreased forced expiratory volume | Increased shunt fraction | 5 | A | 1 | Increased functional residual capacity | null | null | null | null |
9d489c07-1fc1-5150-85b6-725860b0ce49 | Compared with morphine 5 mg administered epidurally at T12, morphine 5 mg administered intravenously is associated with | greater incidence of urinary retention | less intense analgesia | less nausea and vomiting | longer duration of analgesia | 5 | B | 1 | longer time to maximum analgesia | null | null | null | null |
26a06716-8f19-5cbd-a065-becd7822c665 | During induction of anesthesia, a 56-year-old man with small bowel obstruction vomits a large quantity of undigested food particles and presumably aspirates. After instituting ventilation with pure oxygen, the most appropriate management is to | administer dexamethasone | administer penicillin G | perform bronchoscopy | ventilate with positive end-expiratory pressure 15 cmH2O | 5 | C | 2 | proceed with the anesthesia plan if the tracheal pH is greater than 2.5 | null | null | null | null |
7c650baa-9298-5c07-9049-43f5ca120d11 | Which of the following statements concerning anesthesia machine flowmeters is true? | At high gas flows, viscosity is the predominant determinant of flow rate | At low flow rates, gas density is the predominant determinant of flow rate | Flowmeters should be upstream from the oxygen fail-safe device | The oxygen flowmeter should be upstream from other flowmeters | 5 | E | 1 | Tapered flow tubes allow a constant decrease in pressure across the float | null | null | null | null |
e5577db0-aae1-51f2-87cf-e911ca264686 | The condition LEAST likely to be associated with sustained pain relief following a nerve block is | causalgia | myofascial pain | diabetic neuropathy | acute herpes zoster | 5 | C | 1 | reflex sympathetic dystrophy | null | null | null | null |
1758dd6f-57df-5969-9d08-6e33c842aeef | A 70-kg, 22-year-old man who is unconscious after a closed head injury is to undergo emergency splenectomy. He is anesthetized with thiopental, given pancuronium for paralysis, and started on nitrous oxide and oxygen 50% each with controlled ventilation (tidal volume 700 ml, rate 10/min). Pulse is 70 bpm, blood pressur... | Add 10 cmH2O positive end-expiratory pressure (PEEP), increase respiratory rate to 14/min | Add sufficient PEEP to increase PaO2 to 80 mmHg | Add 10 cmH2O PEEP, increase FlO2 to 1.0 | Increase tidal volume to 1000 ml, increase FiO2 to 1.0 | 5 | D | 3 | Increase tidal volume to 1200 ml, decrease respiratory rate to 8/min | null | null | null | null |
e07766d2-168c-50c6-ad54-20290b4668e8 | A woman is in labor at 40 weeks' gestation and the fetus is in breech presentation. Which of the following will provide adequate uterine relaxation for vaginal delivery? | Spinal anesthesia | Epidural anesthesia | Halothane anesthesia | Pudendal nerve block | 5 | C | 2 | Magnesium sulfate | null | null | null | null |
88532865-cafd-525d-a1b8-b358870e9849 | Which of the following can be used as a sole criterion for brain death? | Absence of cerebral blood flow | Absence of doll's eye movements | Fixed, dilated pupils | Isoelectric EEG | 5 | A | 1 | Unresponsiveness to all externally applied stimuli | null | null | null | null |
7dc34298-265c-5aad-b9c6-091781f29982 | Severe nausea and vomiting in the PACU is most effectively treated with a drug that acts as an antagonist at which of the following receptors? | Alpha-adrenergic | Beta-adrenergic | Dopamine | GABA | 5 | C | 1 | Glutamate | null | null | null | null |
5f142ec6-7795-541f-b392-9e39770116ae | During postoperative indirect laryngoscopy, the vocal cords appear symmetric during quiet breathing and approximate to the left of midline during phonation. The most likely cause is | pure abductor paralysis of the left cord | pure abductor paralysis of the right cord | abductor and adductor paralysis of the left cord | abductor and adductor paralysis of the right cord | 5 | C | 3 | adductor paralysis of both cords | null | null | null | null |
a941e31b-a74b-5e07-a9e6-7530f12933a3 | In patients who have undergone cardiopulmonary bypass, administration of milrinone is most likely to result in an increase in which of the following? | Arterial blood pressure | Heart rate | Pulmonary capillary wedge pressure | Stroke volume | 5 | D | 1 | Systemic vascular resistance | null | null | null | null |
d1fa6b3c-3573-50ac-8f10-dc1936c8ce52 | DC shocks of 200 joules applied directly to the heart are likely to | worsen coronary perfusion | prevent postshock arrhythmias | produce myocardial contractile abnormalities | increase myocardial impedance | 5 | C | 1 | decrease myocardial temperature | null | null | null | null |
344bb25a-ca09-5547-9c1b-194718c1d978 | Which of the following statements concerning use of temperature-corrected blood gas measurement (pH-stat) during hypothermic cardiopulmonary bypass is true? | Blood gas analysis is performed at the patient's temperature | Carbon dioxide should not be added to the bypass circuit | The carbon dioxide content of the patient's blood is greater than it would be without temperature correction | The incidence of postoperative neurologic deficits is increased compared with the alpha-stat method | 5 | C | 1 | The patient's temperature should be maintained above 25°C | null | null | null | null |
f31902ac-b364-5dc3-846e-b17000f06da3 | A 14-month-old child has tetralogy of Fallot with dynamic obstruction to right ventricular outflow. Which of the following is most likely to decrease cyanosis in this child? | Calcium | Epinephrine | Nitroglycerin | Nitroprusside | 5 | E | 2 | Propranolol | null | null | null | null |
510369ab-777b-571e-a5ec-1141c87f4240 | During direct intra-arterial measurement of blood pressure | the mean arterial pressure will be unaffected by small air bubbles in the system | an underdamped system will overestimate the mean arterial pressure | an underdamped system will overestimate the diastolic pressure | long tubing from the catheter to the transducer will tend to decrease resonance in the system | 5 | A | 1 | calibration of the transducer by opening a stopcock to air at the sternal angle will overestimate the mean | null | null | null | null |
9ed89293-0e46-5087-afbb-985f7547cf0e | A patient has a seizure within seconds after receiving a retrobulbar injection of 0.5% bupivacaine with epinephrine 1:200,000. Which of the following is the most likely cause? | Air embolism | Oculocardiac reflex | Ophthalmic artery injection | Retrobulbar hemorrhage | 5 | C | 1 | Subdural injection | null | null | null | null |
d7a310cd-38fd-541d-9575-12e46381e371 | After the bronchial and tracheal cuffs of a right endobronchial tube are inflated, ventilation through the tracheal lumen is not possible. This finding is most consistent with | cuff occlusion of the right upper lobe bronchus | intubation of the left bronchus | left-sided tension pneumothorax | overinflation of the bronchial cuff | 5 | E | 2 | positioning of both cuffs in the trachea | null | null | null | null |
78d29de8-91d7-5793-aaf0-313c198e1872 | Which of the following cardiovascular abnormalities is LEAST likely to be present in a patient with end-stage alcoholic cirrhosis? | Decreased myocardial contractility | High cardiac index | High mixed venous oxygen saturation | Increased peripheral vascular resistance | 5 | D | 2 | Low blood viscosity | null | null | null | null |
ac8b7075-fae1-5e4b-b384-7d98b51809d5 | Which of the following statements concerning pipecuronium is true? | It has a faster onset than pancuronium | It increases systemic vascular resistance | It induces tachycardia | It is eliminated by the kidney | 5 | D | 1 | It induces histamine release | null | null | null | null |
eb36991e-54bf-5bc4-b20b-e6936b424f9c | When compared with a healthy 30-year-old man, which of the following respiratory parameters is decreased in an otherwise healthy 80-year-old man? | Alveolar to arterial oxygen gradient | Lung compliance | Ratio of functional residual capacity to total lung capacity | Resting tidal volume | 5 | E | 1 | Ventilatory response to carbon dioxide | null | null | null | null |
d792ca45-231d-51b2-b528-bd27cc28790a | In a patient who is receiving nitroglycerin intravenously after a coronary artery operation, peripheral oxygen saturation is 85% and PaO2 is 200 mmHg. The most appropriate management is administration of | exchange transfusion | hydroxocobalamin | methylene blue | pure oxygen at 3 atmospheres | 5 | C | 2 | thiocyanate | null | null | null | null |
57790b70-7d7e-5891-abb0-44ba3a6b2aee | A 50-year-old man with alcoholism and jaundice is scheduled to undergo umbilical herniorrhaphy. An increase in which of the following best indicates impaired synthetic hepatic function? | Prothrombin time | Serum alanine aminotransferase concentration | Serum albumin/globulin ratio | Serum alkaline phosphatase concentration | 5 | A | 1 | Serum bilirubin concentration | null | null | null | null |
6a1f3918-f4d1-5a9e-a1f3-d0c8ed8d6a72 | A 19-year-old man is undergoing inguinal herniorrhaphy. He is anesthetized with a spinal block supplemented with midazolam and fentanyl. During the procedure, he has sudden loss of consciousness, profound hypotension, and bradycardia; systolic pressure is 40 mmHg and heart rate is 30 bpm. Cardiopulmonary resuscitation ... | atropine | ephedrine | epinephrine | flumazenil | 5 | C | 2 | naloxone | null | null | null | null |
e283a818-9f4f-510f-ba19-1a286885de26 | In a patient with peripheral vascular disease, the most likely result of lumbar sympathetic block is | increased blood flow to skin and decreased blood flow to muscle | increased blood flow to skin and unchanged blood flow to muscle | increased blood flow to skin and muscle | decreased blood flow to skin and muscle | 5 | B | 2 | decreased blood flow to skin and unchanged blood flow to muscle | null | null | null | null |
206743b7-512b-5054-947f-9fdd2058f604 | Which of the following statements concerning carbon monoxide poisoning is true? A 38-year-old woman with a large goiter has undergone subtotal thyroidectomy. Airway obstruction is noted immediately after extubation despite normal vocal cord function on laryngoscopy. Which of the following is the most likely explanation... | Arytenoid dislocation | Hematoma | Hypocalcemia | Recurrent laryngeal nerve injury | 5 | E | 3 | Tracheomalacia | null | null | null | null |
d123c244-7d86-5d32-a09b-b25718b5fc26 | A 75-year-old woman with significant carotid artery stenosis is scheduled for general anesthesia for repair of a fractured hip. Which of the following is the greatest disadvantage of using propofol as an induction agent in this patient? | Decreased arterial blood pressure | Pain during intravenous injection | Prolonged apnea after induction | Prolonged awakening | 5 | A | 2 | Prolonged elimination half-life | null | null | null | null |
6fe0c725-9910-5a6c-ad66-df7df1444e7b | Two opened oxygen cylinders, one full and one empty, are attached to an anesthesia machine. The check valve to the empty cylinder fails. This is expected to result in | activation of the fail-safe device | cessation of oxygen flow to the anesthesia circuit | filling of the empty cylinder with a mixture of all gases supplied to the anesthesia machine | increase in the temperature of the empty cylinder | 5 | D | 3 | interruption of gas delivery from the central oxygen source | null | null | null | null |
45ccc5f1-e5e5-5b72-86d3-1a9c17bd33c2 | A 25-year-old woman is undergoing emergency appendectomy at 36 weeks' gestation. Following subarachnoid injection of hyperbaric bupivacaine and placement in the supine position, the patient has nausea; heart rate is 105 bpm and blood pressure is 90/60 mmHg. Which of the following is the most appropriate management? | Displacement of the uterus to the left | Immediate tracheal intubation | Intramuscular administration of ephedrine | Placement of the operating table in the reverse Trendelenburg position | 5 | A | 2 | Ventilation by mask with 100% oxygen | null | null | null | null |
ddff903e-6424-5247-9e2a-356c4f97ca2a | A 64-year-old patient with chronic obstructive pulmonary disease sustained fractures of ribs 4 through 8 on the left one hour ago. Examination shows agitation, heart rate of 120 bpm, respiratory rate of 30/min, and blood pressure of 180/100 mmHg. PaO2 is 70 mmHg and PaCO2 is 35 mmHg on room air. Radiographs of the ches... | Continuous epidural analgesia using local anesthetics | Mechanical ventilation | Infusion of midazolam | Patient-controlled analgesia with morphine sulfate | 5 | A | 3 | Surgical stabilization of rib fractures | null | null | null | null |
609085f4-7735-587f-b198-ced12118e868 | Metoclopramide | decreases gastric acid secretion | decreases gastroesophageal sphincter tone | is contraindicated in patients with Parkinson's disease | is most effective when administered in combination with atropine | 5 | C | 1 | requires an intact vagus nerve for gastrointestinal effects | null | null | null | null |
8934fe9a-b332-5887-8f8d-08a6c76dbf4f | Which of the following is an effect of ritodrine? | Anisocoria | Hypocalcemia | Hypoglycemia | Hypokalemia | 5 | D | 1 | Urinary retention | null | null | null | null |
7702e931-6003-512f-b906-066496c51b23 | An obese patient and a lean patient receive halothane for the same duration and at the same inspired tension. Postoperatively, the obese patient would demonstrate | higher serum creatinine concentration | higher serum fluoride concentration | lower eosinophil count | lower serum alkaline phosphate activity | 5 | B | 2 | lower serum bromide concentration | null | null | null | null |
e081ac0a-fed9-5162-8c70-97a7f524d709 | Which of the following statements concerning interscalene brachial plexus block is true? | The three trunks of the plexus are in the same fascial plane as the internal jugular vein | Distal spread of anesthetic past the humeral head is accelerated by adduction of the arm | Anesthetic solution can spread up the fascial sheaths to involve the stellate ganglion | Ipsilateral diaphragmatic paralysis results from epidural spread | 5 | C | 1 | Rich vascularity in the sheaths promotes rapid vascular uptake of anesthetic | null | null | null | null |
b30de8f6-9bba-523b-a943-28df897efea2 | High positive end-expiratory pressure can result in each of the following EXCEPT | decreased venous return | increased functional residual capacity | a left-to-right shift of the ventricular septum | decreased PaO2 | 5 | C | 1 | pulmonary barotrauma | null | null | null | null |
616b6554-275d-5f0f-9dc6-d5ffccf25d8d | A 95-kg, 65-year-old woman receives sevoflurane and pancuronium during a laparoscopic cholecystectomy. Three minutes after administration of neostigmine 5 mg and atropine 1.2 mg, the twitch height returns to normal. Spontaneous tidal volume is 500 ml when the endotracheal tube is removed. In the PACU she reports dyspne... | Atelectasis | Cholinergic crisis | Pain | Residual enflurane | 5 | E | 3 | Residual muscle paralysis | null | null | null | null |
ec14ad80-f634-5a88-99a0-53a645672268 | An advantage of CPDA-1 over CPD for storage of packed red blood cells is | greater enhancement of red cell survival | lesser increase in plasma hemoglobin concentration | lesser increase in PC02 of stored blood | better maintenance of blood pH | 5 | A | 1 | better maintenance of 2,3-diphosphoglycerate concentration | null | null | null | null |
b3431a29-a421-5803-b06d-07961351e2f1 | Compared with isoflurane, desflurane | causes higher plasma norepinephrine levels | has greater biodegradability | has a higher blood/gas partition coefficient | has a lower MAC value | 5 | A | 1 | has a lower vapor pressure | null | null | null | null |
97722ab4-0c11-516b-b938-45f03cd6597e | Epinephrine is less effective in prolonging epidural anesthesia with bupivacaine than epidural anesthesia with lidocaine because | peak bupivacaine concentrations are decreased less than peak lidocaine concentrations | the acidic pH of epinephrine decreases the concentration of the nonionized bupivacaine | bupivacaine produces more vasoconstriction than lidocaine | the duration of action of bupivacaine is independent of local blood flow | 5 | D | 3 | bupivacaine antagonizes the vasoconstrictor activity of epinephrine | null | null | null | null |
738ae9be-3e26-59c1-9849-b9e358a6d33f | Which of the following results in decreased mixed venous oxygen saturation? | Cardiogenic shock | Decreased metabolic rate | Increased cardiac output | Left-to-right intracardiac shunt | 5 | A | 2 | Pulmonary vasodilation | null | null | null | null |
f17893e5-7f04-5c7e-872c-43f6f49a781f | Compared with other volatile inhalation anesthetics, desflurane has which of the following characteristics? | Equipotency to isoflurane | Greater extent of biotransformation than enflurane | Less airway irritation than halothane | Lower blood gas solubility coefficient than enflurane | 5 | D | 1 | Lower vapor pressure than isoflurane | null | null | null | null |
502f29cb-4b9d-5df0-aa3e-270ed4a0b945 | An anesthesia machine is set to deliver oxygen 2 L/min, nitrous oxide 2 L/min, and sevoflurane. After 30 minutes of stable anesthesia, which of the following, is the most likely cause of a decrease in the oxygen analyzer reading from 50% to 30%? | A leak in the ventilator bellows | Accumulation of water on the oxygen sensor membrane | Calibration at 100% oxygen using less than 100% oxygen | Disconnection of the wall oxygen hose | 5 | B | 2 | Presence of the oxygen analyzer in the expiratory limb | null | null | null | null |
49d0498c-e598-5900-a6fd-10ed38c37d0f | Diplopia following lumbar puncture with a 25-gauge, 3 1/2-inch needle is the result of | stretching the abducens nerve | pressure on the optic nerve | distortion of the oculomotor nucleus from collapse of the wall of the third ventricle | the severity of the accompanying headache | 5 | A | 1 | compensatory cerebral swelling | null | null | null | null |
e42c3b0b-0c0b-55d0-9312-069206750e92 | A child undergoing general anesthesia is breathing spontaneously using the Jackson-Rees modification of the Ayres T-piece. Respiratory rate is 20/min and tidal volume is 75 ml. What is the minimum fresh gas flow required to prevent rebreathing? | 750 ml/min | 1500 ml/min | 2250 ml/min | 4500 ml/min | 5 | D | 2 | 6000 ml/min | null | null | null | null |
4f050889-e0dc-5e03-a0c2-3c7c0eb40c79 | Immediately after a retrobulbar block for cataract surgery, the eye grossly protrudes and the patient has the sensation of pressure in the eye. The most appropriate initial intervention is | hyperventilation | surgical drainage of a hematoma | manual compression of the globe | administration of atropine intravenously | 5 | B | 2 | administration of mannitol intravenously | null | null | null | null |
19318858-a355-5bfa-ab22-bb1e5105dcd8 | A 75-year-old man in the PACU complains of severe pain following thoracotomy. Respiratory rate is 30/min; arterial blood gas values are PaO2 70 mmHg, PaCO2 56 mmHg, and pH 7.28 at an FiO2 of 0.6. The patient has a thoracic epidural catheter and received epidural morphine 2 mg 45 minutes earlier. Which of the following ... | Intravenous administration of naloxone | Epidural administration of additional morphine | Epidural administration of 0.125% bupivacaine | Epidural administration of fentanyl | 5 | C | 3 | Intubation of the trachea | null | null | null | null |
0c6dbb4b-2790-51f8-9d45-5b02afe161a2 | Intractable pain due to unresectable pancreatic carcinoma is most effectively treated with | bilateral neurolytic intercostal blocks at T10-12 | bilateral sympathetic blocks with phenol | celiac plexus block with alcohol | epidural block with phenol | 5 | C | 1 | subarachnoid block with alcohol | null | null | null | null |
f26edd7d-4f49-58d6-b285-678e55ed727b | Each of the following is an effect of electroconvulsive therapy EXCEPT | increased intracranial blood volume | increased oxygen consumption | inhibition of parasympathetic activity | retrograde amnesia | 5 | C | 1 | stimulation of the sympathetic nervous system | null | null | null | null |
4c3e5a69-5176-5049-84c3-7727b7b3ca31 | When methylmethacrylate is inserted into the femur, each of the following may occur EXCEPT | monomer metabolic breakdown | vasodilation | hypercarbia | hypoxia | 5 | C | 1 | increased intramedullary pressure | null | null | null | null |
4f0a0cfa-8489-544e-9fd2-c575345007a6 | Each of the following statements about muscle rigidity induced by opioids is true EXCEPT: | The degree of rigidity is related to the rate of opioid administration | It is more apparent during the administration of nitrous oxide | Muscles of the trunk are affected more than muscles of the extremities | It results from a direct effect of the opioid on skeletal muscles | 5 | D | 1 | It can be produced by large doses of morphine | null | null | null | null |
77d678bb-d549-5745-acac-c4a6d99a8cae | Following a vaginal hysterectomy in the lithotomy position under general anesthesia, a patient has numbness of the lateral aspect of the left calf and medial half of the dorsum of the left foot. On physical examination she has footdrop and the toes cannot be extended. Which nerve is most likely to be involved? | Common peroneal nerve | Deep peroneal nerve | Posterior tibial nerve | Saphenous nerve | 5 | A | 1 | Sciatic nerve | null | null | null | null |
888c55c7-366a-5050-86ae-847f378b713c | Each of the following indicates a hemolytic transfusion reaction in an anesthetized patient EXCEPT | bleeding diathesis | wheezing | hypotension | hemoglobinuria | 5 | B | 1 | decreased serum haptoglobin concentration | null | null | null | null |
89e618cc-1480-5ff2-a4a9-b3e09e008ebd | A patient is anesthetized using an inhaled anesthetic with a blood/gas partition coefficient of 13.0. Recovery time depends primarily on | oil/gas solubility of the drug | cardiac output | tidal volume | duration of administration | 5 | D | 2 | MAC of the drug | null | null | null | null |
77b08b6f-e1ca-573d-b89d-74758c9065df | Inhibition of labor by terbutaline causes each of the following maternal side effects EXCEPT | hyperkalemia | hypotension | ventricular dysrhythmias | hyperglycemia | 5 | A | 1 | pulmonary edema | null | null | null | null |
d7088c9b-9be2-5a79-b091-66ffedde865b | The primary determinant of the duration of an intravenous regional block sufficient to provide surgical anesthesia of an upper extremity is | duration of tourniquet inflation | capacitance of the venous system of the extremity | local anesthetic agent injected | volume of anesthetic solution injected | 5 | A | 1 | method of exsanguinating the arm | null | null | null | null |
e38d89d6-ecf7-5496-8e41-fca72e187341 | Thirty-six hours after primary repair of meningomyelocele, a term newborn has frequent periods of apnea lasting 25 seconds and associated with oxygen desaturation to 80%. The most likely explanation is | hyperglycemia | loss of cerebrospinal fluid | obstructive hydrocephalus | residual anesthetic effect | 5 | C | 3 | normal postoperative events | null | null | null | null |
b403c0b9-e5d4-5426-9287-a21ae2d13589 | Administration of succinylcholine 1 mg/kg to a pregnant woman rarely causes fetal neuromuscular blockade. Which characteristic of succinylcholine best explains this phenomenon? | High protein binding | Ionization | Lack of passive placental diffusion | Lipid solubility | 5 | B | 1 | Metabolism in the fetal liver | null | null | null | null |
f2956634-111e-5504-abab-d2bd0f0c7343 | A patient has pain in the left thoracic wall associated with metastatic rib lesions. An intrathecal neurolytic block with 6% phenol in glycerin is planned for pain relief. Prior to performing the block, the patient should be placed in which of the following positions? | Left lateral semisupine | Right lateral semisupine | Left lateral semiprone | Right lateral semiprone | 5 | A | 1 | Prone | null | null | null | null |
40a6a0a7-728e-50a2-84aa-2313f48baa11 | Which of the following is the primary factor regulating normal coronary blood flow? | Aortic diastolic pressure | Coronary perfusion pressure | Heart rate | Myocardial oxygen consumption | 5 | D | 1 | Systolic wall tension | null | null | null | null |
4825872b-5979-5db0-b7d6-a956f63767a3 | A 1150-g, 10-day-old infant is undergoing a bowel resection for necrotizing enterocolitis. Heart rate is 200 bpm and blood pressure measured through a femoral artery catheter is 45/24 mmHg. The most appropriate next step is administration of | calcium gluconate | epinephrine | esmolol | fentanyl | 5 | E | 2 | normal saline solution | null | null | null | null |
58f76473-a262-57c4-a32d-e2e50cc747bf | An obese, 35-year-old man had an episode of coughing followed by vomiting during induction of anesthesia for arthroscopy of the left knee. Intense wheezing developed bilaterally over five minutes. PaO2 is 60 mmHg, PaCO2 is 42 mmHg, and pH is 7.35. Optimal management following intubation of the trachea includes | mechanical ventilation with positive end-expiratory pressure (PEEP), cancellation of surgery, and transfer to the intensive care unit | saline lavage and continuation of surgery using halothane anesthesia | cancellation of surgery and administration of corticosteroids and antibiotics | thorough suctioning and proceeding with halothane anesthesia | 5 | A | 3 | cancellation of surgery, vigorous mechanical ventilation, thorough suctioning, and administration of aminophylline | null | null | null | null |
97932750-4e38-5baf-a0b6-3d732ece0b2d | A 69-year-old man is confused and agitated one hour after preoperative intramuscular administration of scopolamine for awake fiberoptic laryngoscopy. SpO2 measured by pulse oximetry is 97%. Which of the following drugs is most appropriate for treatment of the change in mental status? | Fentanyl | Flumazenil | Midazolam | Neostigmine | 5 | E | 2 | Physostigmine | null | null | null | null |
dc4516ea-41df-5d81-9bb6-5f657c8bddad | Which of the following muscle relaxants has a prolonged duration of action in a patient who is homozygous for atypical plasma cholinesterase? | Atracurium | Doxacurium | Mivacurium | Pipecuronium | 5 | C | 1 | Vecuronium | null | null | null | null |
daac56f4-ea7f-5d7b-8d19-4700ed3bd2f4 | Intravenous administration of mannitol during a craniotomy | decreases intracranial pressure relative to dosage | hastens excretion of pancuronium | induces metabolic alkalosis | produces a sustained increase in intravascular volume | 5 | E | 1 | requires an intact blood-brain barrier to decrease brain water | null | null | null | null |
2dff275d-35f2-522e-aef4-3636be6a7e25 | An 8-year-old child with chronic renal failure is scheduled for an operation to create an arteriovenous fistula. Laboratory studies include: Hemoglobin 6.5 g/dl, Blood gases (breathing air) : PaO2 97 mmHg, PaCO2 29 mmHg, pH 7.30 Sodium 129 mEq/L Potassium 5.5 mEq/L Chloride 101 mEq/L Bicarbonate 15 mEq/L. Before induci... | Anemia | Metabolic acidosis | Potassium concentration | Anemia, metabolic acidosis, and potassium concentration | 5 | E | 3 | None of the above | null | null | null | null |
eb108ebf-8d26-5334-9007-7128cce5b9e1 | Each of the following conditions is associated with upregulation of the acetylcholine receptor at the neuromuscular junction EXCEPT | burn injuries | myasthenia gravis | prolonged bed rest | prolonged use of neuromuscular relaxants | 5 | B | 1 | upper motor neuron injury | null | null | null | null |
2b992da9-c919-5c15-970b-acc4700a5b2a | Which of the following statements concerning the cardiovascular effects of intravenous bupivacaine is true? | Intralipid is effective in treating bupivacaine-induced ventricular arrhythmias | Cardiovascular toxicity is decreased during pregnancy | Cardiovascular toxicity occurs at lower blood levels than central nervous system toxicity | Systemic vascular resistance is unchanged | 5 | A | 1 | The rate of impulse conduction through the heart is increased | null | null | null | null |
4c4399fe-bcff-5c48-97b9-ddad63bfb01d | A patient who had liver transplantation two years ago now requires general anesthesia for ENT surgery. Minimal rejection has occurred on a regimen of cyclosporine and prednisone. Which of the following is most likely? | Hypoalbuminemia | Hypocalcemia | Episodic hypoglycemia | Increased serum creatinine concentration | 5 | D | 2 | Prolonged prothrombin time | null | null | null | null |
7864fcdc-e27a-51cc-8aef-18d6f4c7f4f0 | Each of the following is a recognized complication during a transurethral resection for which glycine is used as an irrigant EXCEPT | disseminated intravascular coagulopathy | hemolysis | hyperammonemia | shoulder pain | 5 | B | 1 | transient blindness | null | null | null | null |
ac0a9fe2-c160-5ffc-9b73-ca16d4b993ac | The fail-safe mechanism on an anesthesia machine is activated by | a wall-oxygen pressure of less than 25 psi | a disconnection between the endotracheal tube and the machine | a nitrous oxide concentration in excess of 85% | an incompetent expiratory valve | 5 | A | 1 | no oxygen flow | null | null | null | null |
0fe60c64-de4b-5d1b-9f1c-00a890290f63 | Intraocular pressure is | decreased by glycopyrrolate | increased by hyperventilation | decreased by halothane | increased by nondepolarizing muscle relaxants | 5 | C | 1 | increased by phenylephrine eye drops | null | null | null | null |
51c96382-fc02-569b-a127-7b8c4e21dd16 | Which of the following vaporizer filling errors is most likely to result in inadvertent anesthetic overdose? | Sevoflurane in a halothane vaporizer | Sevoflurane in an isoflurane vaporizer | Halothane in an sevoflurane vaporizer | Halothane in an isoflurane vaporizer | 5 | C | 2 | Isoflurane in an sevoflurane vaporizer | null | null | null | null |
eb0fc0ae-0dca-5329-8014-87d29afe7d62 | During an otherwise uneventful nitrous oxide-sevoflurane anesthetic in a spontaneously breathing patient, 85% nitrous oxide is accidently administered, resulting in a PO2 of 48 mmHg. Which of the following would be expected? | Tachycardia | Sweating | Tachypnea | Hyperactive EEG | 5 | E | 2 | None of the above | null | null | null | null |
b33c2a5e-1329-5070-8333-cc3aa9a41d88 | Proper zeroing of an arterial pressure transducer attached to a supine anesthetized patient is best accomplished by | continuous flow of fluid through the intravascular catheter | opening the system to air at heart level | placement of the transducer diaphragm at heart level | proper damping of the transducer system | 5 | B | 1 | zeroing the transducer during the expiration phase of mechanical ventilation | null | null | null | null |
a92b8231-4484-5a37-bd1c-64799ddf78ac | Carbon monoxide poisoning with a carboxyhemoglobin concentration of 20% is characterized by each of the following EXCEPT | decreased oxygen-carrying capacity of hemoglobin | decreased PaO2 | shift of the oxyhemoglobin dissociation curve to the left | normal minute volume of ventilation | 5 | B | 1 | headache and nausea | null | null | null | null |
df989236-b8d7-5b77-87f1-afd6803df9aa | The flow proportioning system on an anesthesia machine | is regulated primarily by changes in oxygen input pressure | limits nitrous oxide flow when oxygen pressure falls below a preset value | maintains a minimum ratio of oxygen to nitrous oxide in fresh gas flow | precludes the use of a closed system | 5 | C | 1 | regulates flows of oxygen and nitrous oxide to maintain a fixed FlO: | null | null | null | null |
9c8d70f7-c793-52e6-a8bb-cfe339ce7cbc | Systemic hypothermia to 30°C is accompanied by | a shift to the right of the oxyhemoglobin dissociation curve | a decrease in carbon dioxide dissolved in plasma | a decrease in the glomerular filtration rate | an increase in MAC of volatile inhalation agents | 5 | C | 1 | low-voltage, high-frequency EEG pattern | null | null | null | null |
066d216f-db12-5bce-86c4-8de5944d0da6 | In a patient with chronic renal failure, which of the following statements concerning muscle relaxants is true? | Duration of action of vecuronium is prolonged | The elimination half-life of atracurium is tripled | Reversal with neostigmine is con train dicated | The onset of action of mivacurium is delayed | 5 | A | 1 | Succinylcholine is contraindicated | null | null | null | null |
ac8a193d-dd15-55d0-9b2a-0126d2909fa1 | During the first stage of labor, the pain of uterine contractions and cervical dilatation is transmitted via the spinal cord segments | T6 to L1 | T6 to S5 | T10 to L1 | T10 to S1 | 5 | C | 1 | T10 to S5 | null | null | null | null |
d5438ac2-48a9-57a3-b796-ad62c73f7a64 | A 30-year-old man who is undergoing laparotomy and resection of a large kidney tumor has a decrease in SpO2 from 100% to 92% and an increase in peak airway pressure from 20 to 35 cm H2O. Plateau pressure is unchanged at 18 cm H2O. Which of the following is the most likely cause? | Abdominal packing | Inadequate anesthesia | Inadequate muscle relaxation | Obstruction of the endotracheal tube | 5 | D | 2 | Pneumothorax | null | null | null | null |
c80f13b2-dcec-584e-bf72-589d9b78de9f | An air/oxygen blender with E-size cylinders is supplying gas to a Mapleson D circuit being used to ventilate a neonate during transport. The air tank is full (psi= 1900/625 L) and flow is 4 L/min. The oxygen tank flow is 5 L/min and the pressure gauge indicates 500 psi. If the flow rates remain unchanged, which of the ... | The air tank will be empty in 90 minutes | The oxygen tank will be empty in 30 minutes | The concentration of oxygen in the circuit is 60% | The oxygen tank will fill with air when the pressure gauge falls below 50 psi | 5 | B | 2 | The volume of oxygen remaining can be determined only by weighing the tank | null | null | null | null |
f894a097-3efe-5e25-9b76-779b01b707fb | Which of the following is most likely to be effective in the treatment of clinically evident cerebral vasospasm occurring after subarachnoid hemorrhage? | Administration of nimodipine | Administration of thiopental | Decreasing cerebral perfusion pressure | Hypercarbia | 5 | A | 1 | Hypocarbia | null | null | null | null |
42797ce5-b9cd-5e16-8c6e-d43bd1ccf7b2 | Which of the following statements regarding latex allergy is true? | Diphenhydramine is the treatment of choice for latex-induced anaphylactic reaction | Hospital workers are at equal risk as the general population | It is more common in patients with frequent urethral catheterizations | Latex gloves can be rinsed free of antigens | 5 | C | 1 | Skin testing should be performed immediately after an acute reaction in the operating room | null | null | null | null |
e90fd454-49d5-5026-8791-2684a45dbc9b | Which of the following drugs administered to a parturient eliminates fetal heart rate variability? | Atropine | Ephedrine | Hydralazine | Magnesium sulfate | 5 | A | 1 | Terbutaline | null | null | null | null |
4f35548f-5add-5d89-8a49-81024b1451fe | Each of the following factors decreases uterine blood flow EXCEPT | aortocaval compression | hypocarbia | hypoxia | sympathetic block | 5 | C | 1 | uterine contractions | null | null | null | null |
9e17d60a-1f6e-5aba-8b23-2e8f44d79cef | The best premedication regimen for a known active narcotic addict would include | secobarbital | diazepam | nalbuphine | morphine | 5 | D | 2 | droperidol | null | null | null | null |
97ea27bf-240d-5f5c-b760-57726d534f60 | A patient who is scheduled for emergency laparotomy for bowel obstruction has had oliguria for three hours. She has had hypertension for 10 years. Which of the following laboratory findings would indicate preoperative fluid challenge? | Urine osmolality: 300 mOsm/L | Urine specific gravity: 1.015 | Urine sodium concentration: 35 mmol/L | Fractional excretion of sodium: 0.5 | 5 | D | 2 | Ratio of urine-to-plasma creatinine concentrations: 8 | null | null | null | null |
945028b7-3ccc-5365-9358-36a328aa49ca | Two months ago a 68-year-old man with insulin-dependent diabetes mellitus had a transurethral resection of the prostate under spinal anesthesia with tetracaine plus epinephrine. He now has numbness and tingling in both feet and disturbance of gait. Physical examination demonstrates stocking-type hypesthesia of both fee... | anterior spinal artery syndrome | diabetic neuropathy | adhesive arachnoiditis | cauda equina syndrome | 5 | B | 2 | peripheral nerve injury from the lithotomy position | null | null | null | null |
e22f57aa-1e29-5eef-b657-577ba33e4aeb | An acutely ill 65-year-old man with sepsis has severe hypophosphatemia. Which of the following is most likely to result from this electrolyte disorder? | Bronchospasm | Diarrhea | Muscle weakness | Seizures | 5 | C | 1 | Ventricular ectopy | null | null | null | null |
194ffbe2-2824-566c-a466-d7823168b667 | A 5-month-old infant with tetralogy of Fallot is scheduled for elective inguinal herniorrhaphy. Which of the following would require the operation to be postponed? | Current propranolol therapy | Hematocrit of 65% | History of "tet spells" | Patent ductus arteriosus | 5 | B | 3 | Room air oxygen saturation of 82% | null | null | null | null |
de9129cc-d77e-5233-896e-d3a9230806e3 | While delivering nitrous oxide 1.5 L/min, oxygen 1.5 L/min, and sevoflurane 2%, a leak in the oxygen flowmeter would most likely be detected by the | low airway pressure alarm | "fail-safe" system | oxygen analyzer on the expiratory limb | oxygen flowmeter reading | 5 | E | 1 | mass spectrometric analysis of gases | null | null | null | null |
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