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888e6d05-a51c-59b9-8401-be89c8ce8c25 | A 30-kg patient with asthma is receiving general anesthesia and being mechanically ventilated with a measured tidal volume of 300 mL. Increasing the fresh gas flow from 3 L/min to 9 L/min without changing the ventilatory rate or I:E ratio will result in | decreased physiologic dead space | increased delivered tidal volume | increased end-expired carbon dioxide | unchanged delivered minute volume | 5 | B | 2 | unchanged peak inspiratory pressure | null | null | null | null |
12d57f5d-950d-516b-a981-aa03fd696019 | Which of the following is a characteristic of the Bain breathing circuit? | Condensation of moisture in inspired gases is facilitated by the circuit design | Fresh gas flows coaxially around the exhalation limb | Fresh gas flows need not exceed minute ventilation | The circuit eliminates the possibility of rebreathing | 5 | E | 1 | The circuit is functionally similar to the Jackson-Rees system | null | null | null | null |
2f578f15-06cf-539e-bf46-f9efcb2d5142 | A 20-year-old man with a history of substance abuse is undergoing preoperative evaluation. Which of the following findings suggests current use of cocaine? | Absence of deep tendon reflexes | Bradycardia | Hypertension | Hypothermia | 5 | C | 1 | Pinpoint pupils | null | null | null | null |
4c24e05c-3248-5176-8115-6021e9036cd3 | A 2.8-kg newborn undergoes repair of a moderate-sized omphalocele. Intravenous fluid is administered at 14 mL/hr. Forty-five minutes after beginning surgery and before reduction of the omphalocele, arterial blood pressure decreases from 80/40 to 55/30 mmHg. SaO2 is 98% at an FiO2 of 0.5. Breath sounds are equal bilater... | Associated congenital cardiac defect | Compression of the lungs by the abdominal contents | Inadequate fluid administration | Pneumothorax | 5 | C | 2 | Sepsis | null | null | null | null |
c9f59ef5-0dcc-52cf-9b56-694851b9ecd9 | During apneic oxygenation (FiO2 1.0) through a rigid bronchoscope | duration of the procedure is limited by the increase in PaCO2 | functional residual capacity decreases 5%/min | PaO2 remains unchanged for the first 5 minutes | PaCO2 increases 2 to 6 mmHg/min for 15 minutes and then reaches a plateau | 5 | A | 1 | PaO2 and PaCO2 equilibrate with mixed venous gases at the same rate | null | null | null | null |
a2fcf654-7fcc-5185-a65d-acef5169e0fc | During prolonged labor, a fetal scalp blood sample shows a PO2 of 21 mmHg, a PCO2 of 46 mmHg, and a pH of 7.35. These findings suggest | fetal hypoxemia | maternal hypoventilation | sampling of venous blood | miscalibration of the oxygen electrode | 5 | E | 2 | no abnormality | null | null | null | null |
c8cee1be-e8a7-5712-a672-1e92c609f2e3 | In a patient receiving an epidural analgesic infusion postoperatively, clear fluid is noted to drip back freely from the epidural catheter. Each of the following findings correctly identifies the associated fluid EXCEPT | precipitation when mixed with an equal volume of thiopental — local anesthetic | pH 7.1— saline solution | glucose 55 mg/dl - CSF | sodium 150 mEq/L - CSF | 5 | B | 1 | PCO2 51 mmHg - CSF | null | null | null | null |
fad06e2a-bc86-5039-bf88-6f4b4ac10103 | Each of the following statements concerning the activated clotting time (ACT) is true EXCEPT: | The ACT is more sensitive than the activated partial thromboplastin time (APTT) to blood heparin concentration | The ACT is prolonged if the specimen is not warmed during the assay | The ACT should be greater than 300 sec before initiating cardiopulmonary bypass | Hypofibrinogenemia may prolong the ACT after cardiopulmonary bypass | 5 | A | 1 | Whole blood is used for measurement of the ACT | null | null | null | null |
bdfe993d-e17c-5b3f-aab5-53dd32fe0f00 | The following hemodynamic values are obtained two hours after coronary artery bypass surgery: Cardiac index 1.7 L/min/m2; Pulm Art. Occ. Pressure 22 mmHg; MAP 60 mmHg; Urine volume 0.2 ml/kg/hr. The most appropriate management is | dopamine infusion | nitroprusside infusion | norepinephrine infusion | volume expansion | 5 | A | 3 | observation without intervention | null | null | null | null |
23c472cb-74b6-5a7f-bbde-e69520364b1c | Which of the following is the most likely effect of administration of magnesium sulfate in a patient with preeclampsia? | Decreased motor end-plate sensitivity to acetylcholine | Decreased uteroplacental blood flow | Increased platelet aggregation | Increased systemic vascular resistance | 5 | A | 1 | Inhibited acetylcholinesterase | null | null | null | null |
b3fa3e2d-042f-5cfb-a7cd-ea3f284c409c | A neurologically intact 48-year-old woman is scheduled for removal of a parietal lobe arteriovenous malformation. The relative risk for complete resection is to be determined by a test occlusion of the feeding artery. Which of the following intraoperative monitoring techniques is most appropriate for this test? | Brain stem auditory evoked potentials | Cerebral blood flow using radioactive xenon | EEG | Evoked potentials elicited by stimulating the posterior tibial nerve | 5 | D | 2 | Transcranial Doppler | null | null | null | null |
0c470dbc-1352-5727-89f5-747e81149f96 | The second gas effect refers to | acceleration of rise in alveolar concentration of a gas caused by concomitantly administered nitrous oxide | change in volatile anesthetic vaporizer output with the addition of nitrous oxide to the carrier gas mixture | decrease in MAC of a volatile anesthetic by addition of nitrous oxide | expansion of gas-containing spaces by addition of nitrous oxide | 5 | A | 1 | rapid diffusion of nitrous oxide from pulmonary capillary blood into alveolar gas at the termination of anesthesia | null | null | null | null |
5f2db97c-02d6-5a45-ac5a-393fa80ed446 | Which of the following will result in the largest change in oxygen content? | Increased hemoglobin (Hgb) concentration from 10 to 15 g/dl | Increased PaO2 from 40 to 50 mmHg (Hgb 15 g/dl) | Increased PaO2 from 60 to 70 mmHg (Hgb 15 g/dl) | Increased P50 of Hgb from 27 to 37 mmHg (Hgb 15 g/dl) | 5 | A | 2 | Increased pH from 7.20 to 7.40 | null | null | null | null |
17b6d7c7-78c1-5d91-aff6-988de761b017 | Each of the following increases arterial to end-tidal carbon dioxide tension difference EXCEPT | addition of positive-end expiratory pressure | deliberate hypotension | endobronchial intubation | hypovolemia | 5 | C | 2 | pulmonary embolism | null | null | null | null |
46aa1b60-f82e-533e-8ef2-59b5e5a3d33f | Each of the following is an effect of acute preoperative oral administration of clonidine EXCEPT | sedation | respiratory depression | decreased intraoperative plasma catecholamine concentrations | decreased MAC of inhalational anesthetics | 5 | B | 1 | decreased perioperative opioid requirement | null | null | null | null |
7482c999-510b-5b78-ac3c-ca395bff9a84 | Two hours after sustaining extensive burns of the head, neck and chest in a house fire, a patient has stridor and difficulty breathing. The most appropriate management is | administration of aerosolized epinephrine | administration of helium and oxygen | endotracheal intubation | intravenous injection of dexamethasone | 5 | C | 2 | tracheostomy | null | null | null | null |
93598bf9-e3cb-530c-95f7-94088188adc4 | Addition of 20 cm H2O positive end-expiratory pressure to a patient receiving controlled mechanical ventilation decreases cardiac output and left ventricular function by | increasing right ventricular preload | increasing right ventricular afterload | increasing left ventricular preload | increasing left ventricular afterload | 5 | B | 2 | producing myocardial ischemia | null | null | null | null |
d75ae1a2-8a7a-5723-823a-5a678039f4f0 | When PaO2 is increased to 300 mmHg in a healthy parturient at term, the umbilical vein PCs will | not change | increase slightly | decrease slightly | nearly triple | 5 | B | 2 | approach maternal PaO, | null | null | null | null |
9adefc24-fac3-505b-8a6c-77e468c79f29 | During liver transplantation, venovenous bypass from the femoral and portal veins to the axillary vein during cross-clamping of the inferior vena cava | decreases urine output | prevents hypothermia | prevents metabolic acidosis | requires heparinization | 5 | E | 1 | supports cardiac output | null | null | null | null |
d6530e54-8a74-505a-9dbb-1b491a6d6747 | Twenty minutes after an axillary block, the patient reports feeling over the "back of the hand." Examination shows normal sensation over the lateral aspect of the dorsum of the hand and the dorsal base of the thumb and index finger. Supplementary anesthesia of this area can be provided by blocking which of the followin... | Ulnar | Musculocutaneous | Median | Radial | 5 | D | 2 | Intercostobrachial | null | null | null | null |
c1461b01-5544-5881-be4e-17a71472a949 | Which of the following neural functions demonstrates the highest segmental block after spinal anesthesia? | Afferent sympathetic activity | Proprioception | Sharp pain perception | Temperature sensation | 5 | A | 1 | Touch sensation | null | null | null | null |
3816b57d-08f8-5637-9e96-fbd64936a589 | A 30-year-old woman undergoes thyroidectomy under general endotracheal anesthesia. Immediately after extubation while breathing spontaneously, she has laryngospasm that resolves after 60 seconds of continuous positive airway pressure applied by face mask. In the PACU, she develops shortness of breath, tachypnea, hypoxe... | Gastric acid aspiration | Myocardial infarction | Pulmonary edema | Pulmonary embolism | 5 | C | 2 | Vocal cord paralysis | null | null | null | null |
77b6060a-2d5d-5919-98ab-8c1595c7b1fa | Which of the following statements concerning the use of epidural anesthesia for extracorporeal shock wave lithotripsy is true? | Adequate anesthesia can be obtained with fentanyl alone | Anesthesia decreases the incidence of hypothermia | Anesthesia decreases the incidence of ventricular dysrhythmias | Anesthesia is unnecessary in paraplegics with absence of sensation below T4 | 5 | E | 1 | "Loss of resistance" should be performed with fluids rather than air | null | null | null | null |
396244c3-d9bf-5f74-8e64-ab05a37b76c6 | Which of the following statements concerning absorption of irrigation fluid during transurethral resection of the prostate is true? | Hydrostatic pressure has minimal effect on the amount of fluid absorbed | Typically 10 to 30 ml of fluid per minute are absorbed | Use of iso-osmotic solutions decreases the risk of hyponatremia | CNS complications are independent of the type of fluid used | 5 | B | 1 | Spinal anesthesia to T6 will mask the symptoms of overhydration | null | null | null | null |
b8d4e189-50d0-5b41-936f-2dda70a77060 | An sevoflurane vaporizer is filled with isoflurane and the vaporizer dial is set at 1%. Which of the following will occur? | Less than 1% isoflurane will be delivered | More than 1% isoflurane will be delivered | Thymol precipitation will prevent vaporization | The vaporizer bypass will not open | 5 | B | 2 | The vaporizer will be damaged | null | null | null | null |
a5c382ba-585a-5a6b-8607-eeaac2e41a65 | A 67-year-old man undergoes spinal anesthesia with hyperbaric tetracaine 10 mg for transurethral resection of the prostate. At the end of the 50-minute procedure, the level of anesthesia is T6 and blood pressure is 120/70 mmHg. Within two minutes after transfer to a stretcher, the patient has nausea and blood pressure ... | Acute congestive heart failure | Decreased venous return | Dilutional hyponatremia | Progression of sympathetic block | 5 | B | 2 | Unrecognized bladder perforation | null | null | null | null |
9aa1b123-a847-55a0-b92a-b8b264ba0471 | Which of the following is most indicative of reflex sympathetic dystrophy? | Dry skin | Dull pain that improves with movement | Fasciculations | Motor weakness | 5 | E | 1 | Pallor and cyanosis | null | null | null | null |
2271c56d-5a1f-54a6-a313-131cbf573f1c | Prilocaine is NOT recommended for obstetric regional anesthesia because it | causes fetal methemoglobinemia | has a very short duration of action | is not metabolized by the newborn | is the most toxic of the amide local anesthetics | 5 | A | 1 | produces a longer motor block than sensory block | null | null | null | null |
3b28f7c9-9f98-538b-a1b6-dd20169ae179 | Which of the following treatments is LEAST effective in patients with acute herpes zoster? | Acyclovir | Antidepressants | Epidural block | Opioids | 5 | B | 2 | Sympathetic nerve block | null | null | null | null |
d4348e00-fabc-5b6a-a944-ed5351ef3d8f | Five minutes after intrathecal administration of tetracaine 12 mg in hyperbaric solution, a 60-year-old man has a weak hand grasp. Respirations are normal, heart rate has decreased from 80 to 45 bpm, and blood pressure has decreased from 150/80 to 90/50 mmHg. The most appropriate management at this time is | administration of atropine | administration of ephedrine | administration of phenylephrine | placement of the patient in the head-down position | 5 | A | 2 | observation | null | null | null | null |
029be89f-ed0f-5be0-b879-e0b3fc7182ef | Compared with a person of normal weight, which of the following findings are most likely on pulmonary function testing of a patient with morbid obesity? (FVC, FEV/FVC, FRC, A-a DO2)? | Decreased, Normal, Decreased, Normal | Decreased, Normal, Decreased , Increased | Decreased, Normal, Normal, Increased, | Increased, Decreased, Normal, Increased | 5 | B | 1 | Increased, Decreased, Decreased, Increased | null | null | null | null |
415b6798-47c0-599a-9afb-0db9cd704bb0 | A 77-year-old woman is still intubated and breathing spontaneously following a total hip replacement. The muscle relaxant has been reversed. Tidal volume is 400 ml, end-tidal carbon dioxide tension is 45 mmHg, and SpO2 is 98% at an FiO2 of 1.0. On transfer from the operating table to the gurney, heart rate increases fr... | anaphylactic reaction | bronchospasm | myocardial infarction | pulmonary embolism | 5 | E | 3 | unreplaced blood loss | null | null | null | null |
f12cf1b5-ed2f-58d0-8d27-6258c1973655 | A patient with alcoholic cirrhosis, ascites, and gastrointestinal bleeding receives 4 units of red blood cells prior to anesthesia with isoflurane in oxygen for emergency exploratory laparotomy. After the peritoneum is opened and the fluid is drained, blood pressure decreases to 60/40 mmHg and SpO2 decreases to 90%. Th... | acute myocardial ischemia | decreased 2,3-diphosphoglycerate in transfused blood | increased intrapulmonary shunting | relative hypovolemia | 5 | D | 3 | venous air embolism | null | null | null | null |
fae32b8e-d731-5292-818b-3ff4a09734a5 | A newborn is in respiratory distress. Examination shows a scaphoid abdomen, cyanosis while breathing oxygen by mask, and heart sounds in the right hemithorax. Which of the following is the most appropriate next step? | Assisted ventilation with a bag and face mask | Insertion of a chest tube on the left side | Insertion of a nasogastric tube | Tracheal intubation and assisted ventilation | 5 | D | 3 | Tracheal intubation and expansion of the left lung | null | null | null | null |
04fa51f5-fa90-5d35-b2db-f14c2331be80 | A celiac plexus block provides effective relief of pain associated with primary cancers at each of the following locations EXCEPT the | adrenal gland | liver | pancreas | sigmoid colon | 5 | D | 1 | stomach | null | null | null | null |
62227d78-2098-56b9-914a-4aaf24be8a4a | A 68-year-old man has signs of a coagulopathy after receiving 10 units of packed erythrocytes during emergency repair of a leaking abdominal aortic aneurysm. The most likely cause is | depletion of factor V | disseminated intravascular coagulation | hypothermia | platelet dysfunction | 5 | E | 2 | thrombocytopenia | null | null | null | null |
216c8c38-1101-5636-a319-0719fc5a195d | A patient with uremia is scheduled for emergency surgery. Bleeding time is 18 minutes. The most appropriate initial treatment is | cryoprecipitate | desmopressin | fresh frozen plasma | platelets | 5 | B | 2 | vitamin K | null | null | null | null |
8f3f193a-261e-5501-8889-7175cda87f6d | Which of the following is characteristic of the airway in a 2-month-oId infant when compared with an adult airway? | Airway is narrowest at the cricoid cartilage | Epiglottis is broader | Laryngeal mucosa is more tightly adherent | Larynx is positioned lower in the neck | 5 | A | 1 | Vocal cords have a more cephalad anterior attachment | null | null | null | null |
b9909fd7-9399-5a97-afb7-3f05d85ec515 | The use of glycine as irrigating solution during transurethral resection of the prostate could be associated with each of the following EXCEPT | ammonia toxicity | coma | hemolysis | hyponatremia | 5 | C | 1 | transient blindness | null | null | null | null |
6a2f12df-2e97-5ef6-959f-28000d61252e | After inflation of both the tracheal and endobronchial cuffs of a left-sided double-lumen tube, the following are noted on auscultation of the chest: Left lumen clamped --> Breath sounds absent bilaterally; Right lumen clamped --> Breath sounds present on left only; Both lumens open --> Breath sounds present on left on... | decrease the endobronchial cuff volume | decrease the tracheal cuff volume | reinsert the tube, rotating it 180 degrees to the right | suction both lumens | 5 | E | 3 | withdraw the tube slightly and repeat the auscultory maneuvers | null | null | null | null |
d171c8a5-7df1-528e-86be-04ffdc917509 | Which of the following best explains why neonates are at greater risk than adults for hypothermia during surgical procedures? | Greater body surface area relative to body mass | Greater cutaneous vasodilation at equal MAC concentrations of volatile anesthetics | Greater dependence on shivering to produce heat | Inability to increase metabolic rate | 5 | A | 1 | Less insulation by adipose tissue | null | null | null | null |
6337c6b4-2953-556f-ab45-8f7259040e10 | Which of the following is a side effect of beta-adrenergic blockade? | Cerebral vasodilation | Decreased left ventricular filling pressures | Hypokalemia | Increased airway resistance | 5 | D | 1 | Uterine relaxation | null | null | null | null |
394b7e3a-375a-58ec-8235-53c45bd1a400 | Preoperative evaluation shows a serum sodium concentration of 140 mEq/L, serum chloride concentration of 90 mEq/L, PaCO2 of 46 mmHg, and arterial pH of 7.50. These findings are most indicative of prior treatment with | acetazolamide | enalapril | furosemide | mannitol | 5 | C | 2 | spironolactone | null | null | null | null |
93d2c5c6-df82-5ab3-8cc3-0cbbdd04f441 | Which of the following is the most likely cause of dyspnea during spinal anesthesia to a T3 sensory level? | Decreased abdominal muscle tone | Decreased afferent input from the thoracic wall | Increased dead space ventilation | Increased intrapulmonary shunting | 5 | B | 2 | Partial diaphragmatic paralysis | null | null | null | null |
c4513815-336a-5a5d-b47e-a55cc72ad143 | An 8-kg, 1-year-old child has a measured blood loss of 50 ml during the first two hours of a rectal pull-through operation. Preoperative hematocrit was 31%. Balanced saline solution 150 ml has been administered for replacement. Urine output has been 2 ml for the last hour, heart rate is 160 bpm, and blood pressure is 4... | 25% albumin | balanced salt solution | balanced salt solution and mannitol | 5% dextrose in 0.45% saline solution | 5 | B | 2 | packed red blood cells | null | null | null | null |
e7164a39-82a1-5e95-b8ed-ae1b28fbdc74 | The Bain circuit | provides nearly identical delivered and inspired anesthetic concentrations | has the fresh gas flow inlet near the reservoir bag | is a nonrebreathing circuit at any fresh gas flow rate | is most efficient during spontaneous ventilation | 5 | A | 1 | has a time constant greater than 1 minute for change in inspired anesthetic concentrations | null | null | null | null |
6a499a51-b2bf-598c-ba0f-501aed9f9cef | A 75-year-old man with aortic stenosis and coronary artery disease has a preinduction heart rate of 68 bpm and blood pressure of 125/70 mmHg. After induction of anesthesia with fentanyl, midazolam, and pancuronium, heart rate is 90 bpm and blood pressure is 85/45 mmHg. ECG shows a new ST-segment elevation in lead II. W... | Ephedrine | Epinephrine | Esmolol | Nitroglycerin | 5 | E | 3 | Phenylephrine | null | null | null | null |
96b35be0-166c-58b0-9e65-0812e133cc57 | Which of the following is decreased by alkalinization of a 1.5% lidocaine solution? | Concentration of free base | Dose required for anesthesia | Duration of anesthesia | Intracellular concentration of ionized lidocaine | 5 | E | 2 | Time to onset of anesthesia | null | null | null | null |
35fcba72-ae2a-5947-808b-d5cc92ff4ff6 | Which of the following is the most important function of temperature compensation in anesthetic vaporizers? | Compensation for changes in the specific heat of the anesthetic during vaporization | Delivery of diluent gas at a constant temperature regardless of flow rate | Increase of bypass flow when the vaporizer is cooled by high fresh gas flow | Maintenance of constant anesthetic vapor output over a range of vaporizer temperatures | 5 | D | 1 | Maintenance of constant vapor concentrations at low flow rates | null | null | null | null |
e4ed6053-900a-5a75-bc2d-68ef39e43c42 | The test dose of local anesthetic administered through an epidural needle or catheter should be sufficient to produce | bradycardia | seizure activity | hypotension | segmental analgesia | 5 | E | 1 | spinal anesthesia | null | null | null | null |
54a8a13f-6a68-5b81-bb41-870b8f88dccf | During anesthesia, the ventilation/perfusion ratios change | to preferential ventilation of the dependent portion | due to cephalad shift of the diaphragm | by insignificant amounts from that in the awake state | to preferential perfusion of the superior portion | 5 | B | 1 | from changes in pulmonary compliance | null | null | null | null |
fd37e468-c1df-590b-a574-1b8f0a5e91fd | In clinical anesthesia practice, the term "informed consent" is best described as a legal concept in which patients | agree to anesthesia care based on full disclosure of facts needed to make the decision intelligently | are told of all possible risks of anesthesia and anesthetic procedures | delegate all decisions regarding anesthesia care to the anesthesiologist | release the physicians from liability | 5 | A | 1 | sign global consent forms for surgical procedures that cover the administration of anesthesia care | null | null | null | null |
0b128936-d741-5dee-85c0-6d09ac043e3e | A 14-year-old girl with status asthmaticus is receiving oxygen 3 L/min through nasal prongs. Heart rate is 110 bpm. Arterial blood gas values are PaO2 90 mmHg, PaCO2 32 mmHg, and pH 7.46. If ventilation appears unchanged, which of the following is the most reliable sign of impending respiratory failure? | PaO2 of 80 mmHg | PaCO2 of 39 mmHg | Heart rate of 140 bpm | Increased wheezing | 5 | B | 2 | Deterioration of mental status | null | null | null | null |
6f7890a7-f9b3-5222-9b49-3719ee0e25ef | Which of the following is characteristic of soda lime and Baralyme carbon dioxide absorption canisters used in circle systems? | Calcium carbonate is a major end product | Carbon dioxide absorption cools the anesthetic gases | Flushing the canister with oxygen for six hours will regenerate 50% of the spent Baralyme | Gases lose water vapor as they pass through the canisters | 5 | A | 1 | Soda lime and Baralyme depend on silica as a binding agent | null | null | null | null |
c461e63f-85bc-5eb6-948d-f047c7f0a579 | Which of the following statements concerning the use of epidural opioids during labor is true? | Fentanyl decreases the concentration of epidural bupivacaine required for satisfactory analgesia | Fentanyl is an effective analgesic for the second stage of labor | Sufentanil is an unsatisfactory analgesic for labor | The addition of epinephrine to morphine prolongs the duration of analgesia | 5 | A | 1 | The duration of analgesia with fentanyl is six to ten hours | null | null | null | null |
c82f4713-f1e4-5deb-9d09-3fac4e9b1a5d | Following transfusion of packed red blood cells during general anesthesia, the patient's blood pressure decreases, heart rate and temperature increase, and hemoglobinuria and diffuse oozing are observed. Which of the following is the most appropriate first step in management? | Administration of hydrocortisone | Administration of fresh frozen plasma | Administration of epsilon-aminocaproic acid | Rapid infusion of crystalloid | 5 | D | 2 | Transfusion of platelet concentrates | null | null | null | null |
e6614686-4c80-5bb5-bd5f-af5cab9f3c0f | Which of the following is increased in patients with chronic anemia? | Mixed venous oxygen content | P50 | Pulmonary vascular resistance | Systemic vascular resistance | 5 | B | 1 | Blood viscosity | null | null | null | null |
aa6979ef-f897-5e12-9395-9be05e14d1c9 | Which of the following statements concerning brain stem auditory evoked responses is true? | They monitor cortical function | They are not affected by changes in carbon dioxide tension | They are not affected by mild hypothermia (34°C) | They are more resistant to anesthetic effects than somatosensory evoked responses | 5 | D | 1 | They are abolished coincident with flattening of the EEG | null | null | null | null |
33cffad4-f2f9-5fea-a6a7-554722003f95 | You are called to anesthetize a patient for an emergency pericardial window for a large pericardial effusion. Which of the following drugs is most appropriate for initiation of anesthesia? | Alfentanil | Ketamine | Midazolam | Propofol | 5 | B | 2 | Thiopental | null | null | null | null |
2f249c15-a71b-52e8-b8ce-0c3b9544bca8 | The most sensitive means of detecting venous air embolism is | precordial Doppler stethoscope | transesophageal echocardiography | end-tidal carbon dioxide measurement | pulmonary artery pressure measurement | 5 | B | 1 | central venous pressure measurement | null | null | null | null |
ee55db4c-cbae-521c-ad67-a4efc406cba4 | A 40-year-old patient has pain following injection of 8 ml of thiopental 2.5% through a right radial artery catheter. His hand remains pink. Which of the following is the most appropriate next step? | Injection of lidocaine through the catheter | Injection of nitroglycerin through the catheter | Injection of papaverine through the catheter | Right stellate ganglion block | 5 | E | 2 | No intervention | null | null | null | null |
79f1d264-f243-5ea1-993f-42f9a5f7bc2c | Five minutes after a stellate ganglion block is performed, a patient becomes restless, then apneic. The most likely cause is | paratracheal hematoma | phrenic nerve block | recurrent laryngeal nerve block | subarachnoid injection | 5 | D | 2 | vertebral artery injection | null | null | null | null |
4e60871e-8d1c-573e-9538-a754727dd87c | During controlled ventilation, which of the following will cause an increase in end-tidal carbon dioxide tension with a normal waveform on the capnograph? | Bronchospasm | Rapid blood loss | Ventricular fibrillation | Endobronchial migration of the endotracheal tube | 5 | E | 2 | Release of a thigh tourniquet | null | null | null | null |
7520d17a-6870-540c-94d7-bd41f9b27cbf | Nonsteroidal analgesics such as aspirin decrease pain by | decreasing axonal transmission of pain stimuli through a local anesthetic mechanism | directly competing with substance P for receptor occupancy | inhibiting enzymatic breakdown of met-enkephalin | inhibiting production of prostaglandin E2 | 5 | D | 1 | potentiating the action of endorphin in the substantia gelantinosa of the spinal cord | null | null | null | null |
5e6c083f-0f3d-596c-821e-70d17466e4e7 | Which of the following should be included in the preoperative management of a 12-year-old patient with Duchenne's 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 |
ac301552-26b1-5d70-b04d-58fbc713b197 | Which of the following is the LEAST likely cause of a prolonged prothrombin time? | Chronic warfarin therapy | Disseminated intravascular coagulation | Hemophilia A | Systemic heparinization | 5 | C | 1 | Vitamin K deficiency | null | null | null | null |
a644849d-33da-56b6-a7bb-12c7051f49fd | In a patient with 20% pulmonary shunt and a PaO2 of 60 mmHg, cardiac output suddenly decreases from 5 L/min to 3 L/min. Oxygen consumption is unchanged. As a result, the PaO2 will | increase slightly because of decreased shunt blood flow | decrease slightly because of decreased mixed venous PO2 | increase because of decreased affinity of hemoglobin for oxygen | decrease because of an increased dead space to tidal volume ratio | 5 | B | 3 | increase because of increased pulmonary oxygen uptake per milliliter of blood | null | null | null | null |
a8c7f798-0653-563e-9ece-cedd1f593f8e | Tingling in the fifth finger during spinal anesthesia is associated with anesthesia at which of the following dermatomes? | C4 | C6 | C8 | T2 | 5 | C | 1 | T4 | null | null | null | null |
6a47397e-4506-54d8-9207-c5c1c377f620 | The short clinical duration of action of a single dose of fentanyl is a result of its | small volume of distribution | large volume of distribution | low lipid solubility | rapid redistribution | 5 | D | 1 | short elimination half-life | null | null | null | null |
4c29d7b1-9307-53e5-8be8-88658cf26ca7 | Fresh frozen plasma is indicated in each of the following situations EXCEPT | after rapid transfusion of 1.5 L CPD-stored red blood cells | antithrombin III deficiency | replacement of factor VIII | reversal of warfarin effect | 5 | A | 1 | thrombotic thrombocytopenic purpura | null | null | null | null |
3ff9959b-90fb-578f-a404-2db6e29ec602 | Nausea and vomiting in pediatric outpatients are | directly related to postoperative pain | unrelated to the length of the procedure | eliminated by preoperative administration of droperidol | eliminated by intraoperative nasogastric drainage | 5 | A | 1 | more frequent than in adults | null | null | null | null |
42886f8e-420a-577c-86a6-14888d903c38 | A healthy 24-year-old woman is undergoing knee arthroscopy with spinal anesthesia to a level of T4. Which of the following findings is LEAST likely? | Decreased heart rate | Decreased hepatic blood flow | Decreased mean arterial pressure | Decreased tidal volume | 5 | D | 2 | Hyperperistalsis | null | null | null | null |
ed37e08d-9d14-58d8-bc5d-0407efa5e865 | Which of the following laboratory studies is the best indicator of reversal of the effects of warfarin? | Activated clotting time | Activated partial thromboplastin time | Bleeding time | Plasma fibrinogen concentration | 5 | E | 1 | Prothrombin time | null | null | null | null |
309e10c8-4417-5ed7-bcec-7c830fcfbe6e | Which of the following physiologic changes occurs with immersion in water during extracorporeal shock wave lithotripsy? | Decreased cardiac output | Decreased central venous pressure | Increased expiratory reserve volume | Increased functional residual capacity | 5 | E | 1 | Increased stroke volume | null | null | null | null |
43013bc8-b090-5c51-b4e8-68661d6065b0 | The use of droperidol as a preanesthetic medication has been associated with each of the following EXCEPT | acute anxiety | anterograde amnesia | hypotension | extrapyramidal signs | 5 | B | 1 | catalepsy | null | null | null | null |
a0d06f9f-c8a9-5d06-98cf-51d3804b1f97 | Which of the following will most closely mimic the effects of stellate ganglion block? | Axillary perivascular block with 25 mL of 1.5% lidocaine | Cervical nerve block at C2-5 with 2 mL of 1.5% lidocaine | Supraclavicular block at the level of the first rib with 25 mL of 1.5% lidocaine | Block of the median, radial, ulnar, musculocutaneous, and intercostobrachial nerves | 5 | E | 2 | Excision of thoracic sympathetic ganglia Tl-4 | null | null | null | null |
f8216d21-5c5a-5573-857b-1c0eb260bd40 | Initiation of positive pressure mechanical ventilation is LEAST likely to decrease cardiac output in patients with which of the following conditions? | Abdominal distention with decreased lung volume | Acute cardiogenic pulmonary edema | Chronic obstructive pulmonary disease | Flail chest following an automobile accident | 5 | B | 2 | 20% Right pneumothorax | null | null | null | null |
d6fa787e-46b8-5c7d-b6e7-cead45150461 | The MAC of a volatile anesthetic agent is greatest when administered to which of the following groups of healthy patients? | Neonates | Infants | Adolescents | Men 30 years of age | 5 | B | 1 | Parturients | null | null | null | null |
5beb24df-229d-5fad-9b21-1c790a27173c | The carbon dioxide/ventilation response curve | is primarily a measure of the integrity of the peripheral chemoreceptors | shows parallel displacement to the left in the presence of opioids | is linear between a PaCO2 of 20 and 120 mmHg | shows progressive changes in slope with increased doses of halogenated anesthetics | 5 | D | 1 | is unaffected by a decrease in PaO2 to 60 mmHg | null | null | null | null |
e8f364b0-c701-54c9-9f19-ab9b9e3c5414 | Which of the following best describes cardiomyopathy following therapy with doxorubicin (Adriamycin)? | The initial presentation is concentric hypertrophy | The diagnosis is confirmed by a shortened QT interval | It is exacerbated by hyperoxia | It is resistant to inotropic agents | 5 | E | 1 | It: may persist for years after therapy is discontinued | null | null | null | null |
dd4aeb25-7b00-53a5-8ccd-11b8dfe7c948 | Which of the following neurophysiologic monitoring modalities is LEAST affected by administration of volatile anesthetic agents? | Brain stem auditory evoked potentials | Electroencephalogram | Motor evoked potentials | Somatosensory evoked potentials | 5 | A | 1 | Visual evoked potentials | null | null | null | null |
8e823120-ffd6-5291-bcb3-2a313db1b2fc | A 75-year-old patient in the intensive care unit (ICU) is extubated after recovering from acute respiratory distress syndrome (ARDS). He has a history of previous myocardial infarction, congestive heart failure, and pneumonia. He has an A-line, pulmonary artery (PA) catheter and is receiving oxygen by nasal cannula. Wh... | Central venous pressure (CVP) | PA occlusion pressure | Transesophageal echocardiography (TEE) | Measurement of pulse pressure variation (PPV) | 4 | D | 3 | null | null | null | null | null |
c8609977-7852-5e4f-a18f-b8a07ac955fa | Select the correct statement regarding color Doppler imaging. | It is a form of M-mode echocardiography | The technology is based on continuous wave Doppler | By convention, motion toward the ultrasound probe is red and motion away from the probe is blue | Two ultrasound crystals are used: one for transmission of the ultrasound signal and one for reception of the returning wave | 4 | C | 1 | null | null | null | null | null |
7dbf6288-9108-5b99-bbb9-ac26965a3157 | When the pressure gauge on a size "E" compressed-gas cylinder containing N2O begins to fall from its previous constant pressure of 750 psi, approximately how many liters of gas will remain in the cylinder? | 200 L | 400 L | 600 L | Cannot be calculated | 4 | B | 1 | null | null | null | null | null |
a67d8ba0-8edf-5d09-91ef-b3a2c67a2aef | What percent desflurane is present in the *vaporizing chamber* of a desflurane vaporizer (pressurized to 1500 mm Hg and heated to 23° C)? | Nearly 100% | 85% | 65% | 45% | 4 | D | 2 | null | null | null | null | null |
02b9c310-fdcb-5008-bf69-13c3d10efb40 | If the internal diameter of an intravenous catheter were doubled, flow through the catheter would be | Decreased by a factor of 2 | Decreased by a factor of 4 | Increased by a factor of 8 | Increased by a factor of 16 | 4 | D | 2 | null | null | null | null | null |
d427561b-acbf-599e-b760-42161652ab06 | A size "E" compressed-gas cylinder completely filled with N2O contains how many liters? | 1160 L | 1470 L | 1590 L | 1640 L | 4 | C | 1 | null | null | null | null | null |
76ef8163-4e48-5faa-8949-113878acee0c | Which of the following methods can be used to detect all leaks in the low-pressure circuit of all contemporary anesthesia machines? | Negative-pressure leak test | Common gas outlet occlusion test | Traditional positive-pressure leak test | None of the above | 4 | D | 1 | null | null | null | null | null |
89010f19-ab84-513f-9f1f-5ecfd4300c47 | Which of the following valves prevents transfilling between compressedgas cylinders? | Fail-safe valve | Check valve | Pressure-sensor shutoff valve | Adjustable pressure-limiting valve | 4 | B | 1 | null | null | null | null | null |
b912c3cb-dc02-5551-87c6-76d9eb402b6e | The driving force of the ventilator (Datex-Ohmeda 7000, 7810, 7100, and 7900) on the anesthesia workstation is accomplished with | Compressed oxygen | Compressed air | Electricity alone | Electricity and compressed oxygen | 4 | A | 1 | null | null | null | null | null |
50ecb5fc-5a59-5bfa-ac2b-15551ebfe750 | The pressure gauge on a size "E" compressed-gas cylinder containing O2 reads 1600 psi. How long could O2 be delivered from this cylinder at a rate of 2 L/min? | 90 minutes | 140 minutes | 250 minutes | 320 minutes | 4 | C | 2 | null | null | null | null | null |
1125d0b6-7e5e-5d61-a8ec-cceb5052a439 | A 25-year-old healthy patient is anesthetized for a femoral hernia repair. Anesthesia is maintained with isoflurane and N2O 50% in O2 , and the patient's lungs are mechanically ventilated. Suddenly, the "low-arterial saturation" warning signal on the pulse oximeter gives an alarm. After the patient is disconnected from... | Flow of O2 through the O2 rotameter | No flow of O2 through the O2 rotameter | A leak in the O2 rotameter below the bobbin | A leak in the O2 rotameter above the bobbin | 4 | B | 1 | null | null | null | null | null |
eee07c2a-30d9-579c-8cbd-377d66f00d20 | The O2 pressure-sensor shutoff valve requires what O2 pressure to remain open and allow N2O to flow into the N2O rotameter? | 10 psi | 30 psi | 50 psi | 100 psi | 4 | B | 1 | null | null | null | null | null |
3354f0ce-d1b6-5041-b48f-69ed8bc05f80 | A 78-year-old patient is anesthetized for resection of a liver tumor. After induction and tracheal intubation, a 20-gauge arterial line is placed and connected to a transducer that is located 20 cm below the level of the heart. The system is zeroed at the stopcock located at the wrist while the patient's arm is stretch... | It will be 20 mm Hg higher | It will be 15 mm Hg higher | It will be the same | It will be 15 mm Hg lower | 4 | C | 2 | null | null | null | null | null |
3c9ebb57-6330-5e65-8da1-c11a187ccbd7 | The second-stage O2 pressure regulator delivers a constant O2 pressure to the rotameters of | 4 psi | 8 psi | 16 psi | 32 psi | 4 | C | 1 | null | null | null | null | null |
56cf37eb-7ffe-5365-acda-3b8c87756f24 | You are called to assist a colleague who notes a large gas leak in the anesthesia circuit. Very high oxygen flows (15 L/minute) are being used, but the ventilator bellows do not fill during the ventilator cycle. You then attempt to manually ventilate the patient, but the reservoir bag does not fill. You then disconnect... | Deflate cuff and reinflate until there is a good seal | Pull out nasogastric tube | Reintubate the patient | Reconnect the endotracheal tube to the anesthesia machine circuit with 15 L/minute flow O2 plus 15 L/flow air | 4 | B | 3 | null | null | null | null | null |
85228fe1-95f5-5e15-966b-c125a3798d62 | A sevoflurane vaporizer will deliver an accurate concentration of an unknown volatile anesthetic if the latter shares which property with sevoflurane? | Molecular weight | Oil/gas partition coefficient | Vapor pressure | Blood/gas partition coefficient | 4 | C | 1 | null | null | null | null | null |
681163c7-cfe0-5c49-a828-0cc23ef9e433 | A 58-year-old patient has severe shortness of breath and "wheezing." On examination, the patient is found to have inspiratory and expiratory stridor. Further evaluation reveals marked extrinsic compression of the midtrachea by a tumor. The type of airflow at the point of obstruction within the trachea is | Laminar flow | Turbulent flow | Undulant flow | Stenotic flow | 4 | B | 1 | null | null | null | null | null |
c8e7ba93-adeb-572b-ba00-da5706b7c3e5 | Concerning the patient in Question 17, administration of 70% helium in O2 instead of 100% O2 will decrease the resistance to airflow through the stenotic region within the trachea because | Helium decreases the viscosity of the gas mixture | Helium decreases the friction coefficient of the gas mixture | Helium decreases the density of the gas mixture | Helium increases the Reynolds number of the gas mixture | 4 | C | 2 | null | null | null | null | null |
83fb213d-34e3-50a9-95da-9fdf468bfc37 | A 56-year-old patient is brought to the operating room (OR) for elective replacement of a stenotic aortic valve. An awake 20-gauge arterial catheter is placed into the right radial artery and is then connected to a transducer located at the same level as the patient's left ventricle. The entire system is zeroed at the ... | 140/100 mm Hg | 135/95 mm Hg | 120/80 mm Hg | 105/65 mm Hg | 4 | C | 2 | null | null | null | null | null |
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