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5c22413b-0b8d-5825-b20f-8987f0f7be7b | A liver failure patient may show all of the following clinical signs EXCEPT which one? | Jaundice | Easy bruising | Confusion | Hyperglycemia | 4 | D | 1 | null | null | null | null | null |
21ad81ec-c414-5ff7-9084-7dcc69eca92c | The level of which coagulation factor may not be affected by advanced liver disease? | II | V | VII | VIII | 4 | D | 1 | null | null | null | null | null |
9cdc906d-1a75-5039-b7a9-cbb45dad5430 | 14. A patient with an elevated total serum bilirubin and an elevated indirect serum bilirubin may have which of the following conditions? | Gilbert syndrome | Primary biliary cirrhosis | Primary sclerosing cholangitis | Wilson disease | 4 | A | 1 | null | null | null | null | null |
d8931793-2391-54a9-a3ee-c57dac39cd10 | Which of the following is the mechanism by which lactulose relieves symptoms of hepatic encephalopathy? | Inhibition of hepatic ammonia production | Increasing the conversion of ammonia to urea | Acidification of the colon | Diuresis to decrease intracranial pressure | 4 | C | 1 | null | null | null | null | null |
6765f344-32cf-5234-b788-62793909b5a1 | Metabolism and clearance of morphine may be increased in which of the following situations? | Congestive heart failure | Inhaled anesthetics | Intra-abdominal surgery | Sepsis | 4 | D | 1 | null | null | null | null | null |
048cc8b5-4f65-5659-b039-b8efec3bd577 | The clearance of which of the following drugs through the liver is NOT dependent on liver blood flow? | Propofol | Morphine | Fentanyl | Midazolam | 4 | D | 1 | null | null | null | null | null |
e0408564-e497-5016-838a-d90a978ac5dd | Inducers of cytochrome P450 system include all of the following EXCEPT which one? | Ethanol | Phenytoin | Isoniazid | Rifampin | 4 | C | 1 | null | null | null | null | null |
dfb63db2-dbd4-5129-8517-e2d714ad84e4 | A 60-year-old man who has just been listed for a liver transplant remains overly sedated for 24 hours after being administered midazolam 4 mg IV. What other medication might he be taking at the same time? | Erythromycin | Penicillin | Gentamicin | Vancomycin | 4 | A | 2 | null | null | null | null | null |
28d37126-1d53-5a7b-8126-26acd2d5cf8d | A patient with deactivating mutation in the cytochrome P450 2D6 gene may have ineffective analgesia from which of the following opioids? | Morphine | Codeine | Fentanyl | Methadone | 4 | B | 1 | null | null | null | null | null |
67e06cd2-9541-5061-b81c-b7930cae2788 | What is the approximate glomerular filtration rate (GFR) in a patient with normal renal function? | 10 mL/min | 125 mL/min | 500 mL/min | 1000 mL/min | 4 | B | 1 | null | null | null | null | null |
d47389af-bcc1-548b-af1b-3126a6317b01 | Which of the following tissues has the highest oxygen extraction ratio in the body? | Renal medulla | Cardiac myocytes | Neurons | Hepatocytes | 4 | A | 1 | null | null | null | null | null |
f1bb30d5-4b0c-51e5-bbf2-a33baf2be790 | Which of the following factors will increase sodium resorption in the proximal tubule? | Increased blood pressure | Increased extracellular volume | High salt intake | Angiotensin II | 4 | D | 1 | null | null | null | null | null |
f5c09835-f5b9-56f4-a0f9-1d4660c60744 | Sodium reabsorption in the distal nephron (connecting the segment and | Aldosterone | Angiotensin II | Vasopressin | Renin | 4 | A | 1 | null | null | null | null | null |
24df18b2-9733-5c85-8ae1-056b22d12d42 | An increase in which of the following will decrease the GFR? | Renal blood flow (RBF) | Afferent arteriolar pressure | Efferent arteriolar pressure | Plasma osmotic pressure | 4 | C | 2 | null | null | null | null | null |
bba94c6b-8526-5739-9abe-9d3bf315d15b | 6. Sympathetic stimulation increases sodium and water retention through which of the following mechanisms? | Increased Na + /H2O reabsorption in the nephron | Vasoconstriction leading to decreased net filtration | Activation of the renin-angiotensin-aldosterone system (RAAS) | All of the above | 4 | D | 1 | null | null | null | null | null |
e74d08cf-6cf0-5ece-b604-c443c92e2534 | Which of the following statements is true of renal function and aging? | Production of vitamin D is preserved in the aging kidney. | Progressive decline in renal function begins to occur at 30-40 years of age. | Serum creatinine tends to rise with age. | GFR is preserved in healthy adults at the age of 80 years. | 4 | B | 1 | null | null | null | null | null |
8d7ac41c-9c1b-57b1-a67f-2f2114d45c0f | Which of the following situations meets criteria for stage 3 acute kidney injury (AKI) according to the Acute Kidney Injury Network (AKIN) classifications? | Creatinine rise from 0.8 to 1.5 | Creatinine rise from 4.1 to 4.3 | Commencement of renal replacement therapy | Urine output of 40 mL/h for a 70-kg man | 4 | C | 1 | null | null | null | null | null |
c13f75bb-cdca-5dce-80c5-9a886a338793 | RBF represents what fraction of cardiac output? | 10% | 25% | 40% | 50% | 4 | B | 1 | null | null | null | null | null |
06348ebd-b381-5269-ad6c-a303ab46ae53 | Which of the following classes of drugs is known to raise serum creatinine by decreasing tubular secretion? | Cimetidine | Cephalosporins | Vitamin D | Aminoglycosides | 4 | A | 1 | null | null | null | null | null |
7a3ce04e-5cb3-56f1-99ce-fc6acfcfc248 | A patient is admitted to the surgical ICU following a motor vehicle accident and is now status post an open splenectomy with massive hemorrhage. Which of the following sets of laboratory indices is most consistent with a diagnosis of prerenal AKI, assuming a serum sodium of 140 mEq/L and a urine creatinine of 50 mg/dL? | | Cr 2.1(mg/dL) | BLOOD UREA NITROGEN 30(mg/dL) | Urine 40 + Na (mEq/L) | URINE OSMOLALITY 300(mOsm/L) | | | Cr 2.1(mg/dL) | BLOOD UREA NITROGEN 45(mg/dL) | Urine 40 + Na (mEq/L) | URINE OSMOLALITY 200(mOsm/L) | | | Cr 2.1(mg/dL) | BLOOD UREA NITROGEN 30(mg/dL) | Urine 14 + Na (mEq/L) | URINE OSMOLALITY 400(mOsm/L) | | | Cr 2.1(mg/dL) | BLOOD UREA NITROGEN 45(mg/dL) | Urine 14 + Na (mEq/L) | URINE OSMOLALITY 800(mOsm/L) | | 4 | D | 2 | null | null | null | null | null |
8abf576f-873b-521b-8856-e78d29494f8d | 12. What percentage of the kidney's nephrons must be affected to see a rise in serum creatinine? | 25% | 50% | 75% | 90% | 4 | B | 1 | null | null | null | null | null |
092ffc73-3572-5ef0-acc6-386caf36723f | Where is angiotensinogen produced? | Kidney | Lung | Liver | Muscle | 4 | C | 1 | null | null | null | null | null |
993619b7-a947-58ae-b287-3bcf58f5be87 | Which of the following substances is principally responsible for renal vasodilation in the face of surgical stress? | Nitric oxide | Prostaglandins | Endothelial-derived hyperpolarizing factor | Atrial natriuretic peptide (ANP) | 4 | A | 1 | null | null | null | null | null |
66490fcf-08ee-530c-989b-8ce53e15868b | Release of which of the following substances is most likely to lead to postoperative hyponatremia? | Angiotensin II | Aldosterone | Renin | Vasopressin | 4 | D | 1 | null | null | null | null | null |
f8f9d032-eba2-5279-b717-0eb7b4612bf9 | What is the net effect of angiotensin II on the glomerular arterioles and RBF? | | AFFERENT ARTERIOLE Vasodilation | EFFERENT ARTERIOLE Vasodilation | RENAL BLOOD FLOW Increased | | | AFFERENT ARTERIOLE Vasodilation | EFFERENT ARTERIOLE Vasoconstriction | RENAL BLOOD FLOW Increased | | | AFFERENT ARTERIOLE Vasoconstriction | EFFERENT ARTERIOLE Vasodilation | RENAL BLOOD FLOW Decreased | | | AFFERENT ARTERIOLE Vasoconstriction | EFFERENT ARTERIOLE Vasoconstriction | RENAL BLOOD FLOW Decreased | | 4 | D | 1 | null | null | null | null | null |
52cf6ead-ad84-52ff-92aa-8d3642654b71 | What is the net effect of ANP on the glomerular arterioles, RBF, and GFR? | | AFFERENT ARTERIOLE Vasodilation | EFFERENT ARTERIOLE Vasodilation | RENAL BLOOD FLOW Increased | RENAL BLOOD FLOW Unchanged | | | AFFERENT ARTERIOLE Vasodilation | EFFERENT ARTERIOLE Vasoconstriction | RENAL BLOOD FLOW Increased | RENAL BLOOD FLOW Increased | | | AFFERENT ARTERIOLE Vasoconstriction | EFFERENT ARTERIOLE Vasodilation | RENAL BLOOD FLOW Decreased | RENAL BLOOD FLOW Decreased | | | AFFERENT ARTERIOLE Vasoconstriction | EFFERENT ARTERIOLE Vasoconstriction | RENAL BLOOD FLOW Decreased | RENAL BLOOD FLOW Unchanged | | 4 | B | 1 | null | null | null | null | null |
906e8f64-8d29-5046-98a2-f70a540129da | 18. Which of the following is the treatment of choice for a patient who has acutely developed hypernatremia with a urine output of 600 cc/h in the postanesthesia care unit following transphenoidal resection of a pituitary adenoma? | Normal saline | Desmopressin | Spironolactone | Hydrocortisone | 4 | B | 2 | null | null | null | null | null |
003114ff-e336-514e-8621-519789052303 | Which of the following mechanisms primarily accounts for the normalization of arterial pH after prolonged hyperventilation in a patient with head injury? | Increased renal excretion of bicarbonate ions | Decreased RBF | Decreased renal absorption of hydrogen ions | Increased renal resorption of bicarbonate ions | 4 | A | 1 | null | null | null | null | null |
c0cc840f-8707-53b4-af5d-1fbe9e3b2c57 | The following laboratory values are most consistent with which of the following acid-base disturbances? | Anion gap acidosis | Respiratory alkalosis with metabolic compensation | Mixed anion gap and nonanion gap metabolic acidosis | Combined metabolic and respiratory acidosis | 4 | C | 3 | null | null | null | null | null |
2587235c-01d8-5930-b44a-aedab20adb63 | Which of the following is a cause of metabolic alkalosis? | Prolonged suction on nasogastric tube | Administration of acetazolamide | Diarrhea | Ethylene glycol administration | 4 | A | 1 | null | null | null | null | null |
aac0a4b5-8981-590a-83dc-1b04474788a6 | An increase in which of the following ions will decrease the strong ion difference (SID)? | Calcium | Sodium | Chloride | Magnesium | 4 | C | 1 | null | null | null | null | null |
caae5666-0a8b-5eaf-8220-988c64cef317 | An anion gap metabolic acidosis with a normal osmolar gap is seen with ingestion of which of the following substances? | Methanol | Ethanol | Ethylene glycol | Aspirin | 4 | D | 1 | null | null | null | null | null |
0abac0e5-de25-588d-b9a6-e551373ad5a5 | 24. Which of the following best describes the acid-base disturbances seen with salicylate overdose? | Anion gap metabolic acidosis with respiratory compensation | Respiratory alkalosis with renal compensation | Combined metabolic acidosis and respiratory alkalosis | Combined metabolic and respiratory acidosis | 4 | C | 1 | null | null | null | null | null |
046f7b6d-20a3-58ee-8866-a7cb88dad61d | Excretion of which of the following intravenous anesthetics is unaffected in patients with end-stage renal disease (ESRD)? | Propofol | Ketamine | Etomidate | Thiopental | 4 | A | 1 | null | null | null | null | null |
718153ee-4dc4-53f5-b895-618674ee3671 | Increased levels of normeperidine, seen in patients with renal failure, are associated with what symptoms? | Emesis | Seizures | Bradycardia | Hypotension | 4 | B | 1 | null | null | null | null | null |
b854966a-ce0a-5777-95b0-df69a347ddc9 | Which of the following classes of drugs must be dosage-adjusted in patients with renal impairment? | Phenothiazines (eg, promethazine) | Antidopaminergics (eg, droperidol) | H2 -receptor antagonists | 5-HT3 antagonists | 4 | C | 1 | null | null | null | null | null |
936ad7b7-7147-5fb8-a247-5e4da776ccca | Which inhalation agent can react with barium hydroxide lime or soda lime to form compound A? | Isoflurane | Desflurane | Sevoflurane | Nitrous oxide | 4 | C | 1 | null | null | null | null | null |
6ffbe3f9-0aea-53c2-95ef-4abfa8af5dc5 | Approximately how much is potassium concentration elevated following administration of succinylcholine in patients with ESRD? | 0-0.2 mEq/L | 0.5-1 mEq/L | 1.0-1.5 mEq/L | 1.5-2 mEq/L | 4 | B | 1 | null | null | null | null | null |
e51a49f7-7756-54aa-bc8a-5386182071fc | What is the primary form of elimination of vecuronium? | Renal excretion | Biliary excretion | Degradation by nonspecific esterases | Hoffman elimination | 4 | B | 1 | null | null | null | null | null |
9e589a44-7b04-5a41-99d3-0f409a4414a4 | Cisatracurium is often used in patients with renal impairment. What is the primary mode of metabolism of cisatracurium? | Renal excretion | Biliary excretion | Degradation by nonspecific esterases | Hoffman elimination | 4 | D | 1 | null | null | null | null | null |
d1754447-b9cb-52d8-b352-33e492f72de6 | 32. Which of the following morphine metabolites can be responsible for delayed respiratory depression in patients with renal impairment? | Morphine-3-glucuronide | Morphine-6-glucuronide | Normorphine | Codeine | 4 | B | 1 | null | null | null | null | null |
901ebed5-ce68-5896-8197-f0c5adba1122 | In what population has mannitol been shown to be protective against AKI? | Patients undergoing laparoscopic partial nephrectomies | Patients undergoing infrarenal abdominal aortic aneurysm repair | Cadaveric kidney transplant recipients | Patients with traumatic rhabdomyolysis | 4 | C | 1 | null | null | null | null | null |
c8eddb3f-8985-56b6-9aa6-ebd833a568c4 | Which of the following statements is true of eplerenone? | It may cause gynecomastia in males. | Hypokalemia is a common side effect. | It acts in the distal convoluted tubule. | It is indicated in patients with ascites due to end-stage liver disease. | 4 | D | 1 | null | null | null | null | null |
3e6005a3-ca56-5777-81bb-2f72ef0b9217 | Nonsteroidal anti-inflammatory drugs (NSAIDs) most commonly contribute to what type of kidney injury? | Prerenal | Acute tubular necrosis | Glomerulonephritis | Postrenal obstruction | 4 | A | 1 | null | null | null | null | null |
848960df-c5f6-55c6-8e08-d8666d6cd558 | Which of the following is true of fenoldopam? | Rebound hypertension may occur when an infusion is discontinued. | It is a nonselective α- and β-agonist. | It is equipotent with dopamine. | It is a selective DA1 receptor agonist. | 4 | D | 1 | null | null | null | null | null |
f052ddd8-27e9-5960-b507-478325ca4194 | On which part of the nephron do loop diuretics work? | Proximal tubule | Thick ascending limb | Distal convoluted tubule | Collecting duct | 4 | B | 1 | null | null | null | null | null |
0274741f-1505-5c71-a324-848eaa93b643 | Which of the following is the mechanism of action of acetazolamide? | Inhibition of carbonic anhydrase | Blockade of NaCl cotransporter in the distal convoluted tubule | Increasing the oncotic pressure in tubular filtrate | Inhibition of the Na-K-2Cl cotransporter in the thick ascending loop | 4 | A | 1 | null | null | null | null | null |
9aae22b9-e40f-50da-89f6-372c346dcb54 | Which of the following electrolyte abnormalities is most likely to be seen with uremia? | Hypokalemia | Hypernatremia | Hyperphosphatemia | Hypomagnesemia | 4 | C | 1 | null | null | null | null | null |
a6d3842a-3d61-59c6-ba58-d10fbf0cb63c | 40. In a patient with a blood urea nitrogen (BUN) of 80 mg/dL, which of the following elements meets criteria for a diagnosis of uremia? | Potassium of 6.1 mEq/L | Serum creatinine of 4.5 mg/dL | Urine output of 100 cc over a 24-hour period | Asterixis and hiccups | 4 | D | 1 | null | null | null | null | null |
b19acb01-ab45-5e7d-8000-f087e7d36bc4 | Clinical effects of unfractionated heparin (UFH) are best monitored by which of the following? | Partial thromboplastin time (PTT) | Prothrombin time (PT) | International normalized ratio (INR) | Antithrombin III (ATIII) | 4 | A | 1 | null | null | null | null | null |
7e3edd74-e1e5-5675-becf-598db4257243 | With respect to reversal with protamine, which of the following statements is true when comparing UFH and low-molecular-weight heparin (LMWH)? | UFH results in less predictable reversibility. | UFH results in more predictable reversibility. | Hypotension is less likely with UFH. | Hypotension is more likely with UFH. | 4 | B | 1 | null | null | null | null | null |
6538fe22-08cf-5fd7-8c2a-c0615ad1b2e5 | Heparin-induced thrombocytopenia type 2 (HIT2) is mediated by which of the following? | IgG antibodies binding to heparin-PF-4 complexes on the surface of red blood cells (RBCs) | IgG antibodies binding to ATIII on the surface of RBCs | IgG antibodies binding to heparin-PF-4 complexes on the surface of platelets | IgG antibodies binding to ATIII on the surface of platelets | 4 | C | 1 | null | null | null | null | null |
8b4f9e88-6250-57f2-b156-bd50447b26fe | HIT typically presents in what period after the initiation of therapy? | 1-3 days | 3-5 days | 5-10 days | 10-15 days | 4 | C | 1 | null | null | null | null | null |
d23382d1-754b-5157-8f69-a7b9cca49431 | The mechanism of action of hirudin-derived compounds involves which of the following? | Inhibition of vitamin K–derived clotting factors | Inhibition of thrombin in its free and fibrin-bound states | Potentiation of vitamin K–derived clotting factors | Potentiation of thrombin in its free and fibrin-bound states | 4 | B | 1 | null | null | null | null | null |
f2e07e57-8540-5e1d-871a-22892b5a63ef | 6. Warfarin's primary mechanism of action is inhibition of the synthesis of vitamin K–dependent clotting factors. These factors include which of the following? | Factors II, VII, VIII, and X and protein C | Factors II, VII, VIII, and XII and proteins C and S | Factors VII, IX, X, and XII and protein S | Factors II, VII, IX, and X and proteins C and S | 4 | D | 1 | null | null | null | null | null |
adbd859b-66df-5dd1-8aba-f1117e5d422e | Before undergoing a trigger finger release under local anesthesia at an orthopedic surgeon's office, a patient's dabigatran should be discontinued for what length of time? | 12 hours | 24 hours | 36 hours | 48 hours | 4 | B | 1 | null | null | null | null | null |
e2a2c722-d6b8-5089-b729-3a85d379aac8 | Tranexamic acid, a lysine analogue, acts by which of the following mechanisms? | Reversibly binds to plasminogen, thereby preventing the degradation of fibrin | Inhibition of COX-1 and COX-2 | Inhibition of vitamin K–dependent clotting factors | Inhibition of glycoprotein (GP) IIb/IIIa expression on the surface of activated platelets | 4 | A | 1 | null | null | null | null | null |
0f4c02bf-29de-51f6-ac3b-45525895f2f3 | When comparing prothrombin complex concentrates (PCCs) with fresh frozen plasma (FFP), which of the following is true? | PCCs have a faster correction of coagulopathy. | PCCs have a higher risk of infection. | PCCs require a larger volume for administration. | PCCs require a type and cross before administration. | 4 | A | 1 | null | null | null | null | null |
56f4a95c-4b5f-5f67-9601-6d1d675c355e | Fondaparinux exerts its effects by which of the following? | Acting as an antagonist to free factor VII | Acting as an antagonist to free factor IX | Acting as an antagonist to free factor Xa | Acting as an antagonist to the expression of GP IIb/IIIa | 4 | C | 1 | null | null | null | null | null |
639ab579-0252-5ff6-bcce-f12c40842480 | The effects of aspirin therapy can be reversed by infusing which of the following products? | Vitamin K | Platelets | Protamine | von Willebrand factor | 4 | B | 1 | null | null | null | null | null |
957b2369-ceb5-5fe0-856d-4fa34cc182f6 | The effects of aspirin therapy rely primarily on the direct inhibition of which of the following? | COX-1, TxA2 | COX-2, TxA1 | COX-1, COX-2 | COX-1 only | 4 | C | 1 | null | null | null | null | null |
deb6367a-356d-58c4-9574-4a9a08f8cf22 | For patients on aspirin therapy at a high risk of cardiac events in the perioperative period, which of the following should be performed? | Aspirin should be discontinued 24 hours before surgery and resumed after 6 weeks. | Aspirin should be continued throughout the perioperative period. | Aspirin should be discontinued at least 5 days (preferably 10 days) before surgery and resumed after 24 hours. | Aspirin should be continued until surgery and discontinued for 6 weeks postoperatively. | 4 | B | 2 | null | null | null | null | null |
ffa59f8e-77ab-5413-860b-fbe1428b7802 | 14. Which of the following is the mechanism of action of ADP receptor antagonists such as clopidogrel? | Inhibition of GP IIb/IIIa expression on the surface of activated platelets | Inhibition of the action of GP Ib | Promotion of GP IIb/IIIa expression on the surface of activated platelets | Promotion of the action of GP Ib | 4 | A | 1 | null | null | null | null | null |
2576f3bb-d3cd-5e8c-b74b-a77fddf5bf60 | Eptifibatide (integrellin) is an inhibitor of which of the following? | Cyclooxygenase | Phosphodiesterase | ADP receptors | GP IIb/IIIa receptors | 4 | D | 1 | null | null | null | null | null |
240c6416-ab19-562e-936d-d06f583ef0f4 | Autologous blood transfusion involves which 3 methods? | Preoperative autologous blood donation, acute normovolemic hemodilution, and perioperative blood cell salvage | Preoperative allogenic blood donation, acute normovolemic hemodilution, and perioperative blood cell salvage | Preoperative autologous blood donation, acute hypervolemic hemodilution, and perioperative blood cell salvage | Preoperative allogenic blood donation, acute hypovolemic hemodilution, and perioperative blood cell salvage | 4 | A | 1 | null | null | null | null | null |
50568e83-8765-5e0e-affa-79c43ef8714f | To increase the amount of times one may safely donate his/her own blood (autologous blood donation) for a future surgical procedure, which of the following may be administered to the patient before donation? | Intravenous iron | Oral iron | Factor VIII concentrate | Erythropoietin | 4 | D | 1 | null | null | null | null | null |
279e7f30-b00b-5658-8c94-b3f871ceecfe | Which of the following examples could be an indication for using the process known as "acute normovolemic hemodilution"? | Congenital heart disease | Refusal of allogenic blood products | Anticipated blood loss of one-third of the patient's volume | Preoperative anemia | 4 | B | 1 | null | null | null | null | null |
c1de9c0b-efd2-51a8-b1dc-c9984fd79081 | A primary concern with intraoperative blood cell salvage includes which of the following? | Lack of validated evidence | Increased rates of infection compared with allogenic blood products | Dilutional coagulopathy | Decreased stimulation of erythropoiesis | 4 | C | 1 | null | null | null | null | null |
a96f2832-8f0e-5717-bcb7-8b458abbfd31 | Perioperative blood salvage can be considered if the estimated blood loss will likely exceed which of the following? | 500 mL | 1000 mL | 1500 mL | 2000 mL | 4 | B | 1 | null | null | null | null | null |
b95ce0f1-be9e-5b6a-b793-a44fa8085017 | 21. Jehovah's Witnesses are a population whose beliefs lead to a refusal to accept blood products. Which of the following represents the best management of a conscious Jehovah's Witness patient who presents for emergency surgery with a high likelihood of significant blood loss? | Transfuse blood products as clinically indicated. | Refuse to transfuse blood products. | Have a discussion with patients about their beliefs about blood products. | Meet with hospital ethics team and legal counsel before surgery. | 4 | C | 3 | null | null | null | null | null |
03e59db0-b606-5279-adb7-b1b3ed0047a6 | When an individual's hematocrit falls below a certain value, erythropoietin is released. Which of the following %is the "critical" value for its release? | 25% | 30% | 35% | 40% | 4 | B | 1 | null | null | null | null | null |
ea6db718-69b2-542e-92f1-ca30a63a41d5 | A 66-year-old man is scheduled to undergo a right total hip replacement and prefers a neuraxial technique. You note that he has a history of thrombocytopenia. Which of the following is the platelet transfusion threshold for patients undergoing neuraxial anesthesia? | 10 000 | 50 000 | 75 000 | 100 000 | 4 | B | 1 | null | null | null | null | null |
9efd5ff2-da5f-57e2-857d-2769053f2c7b | Routine transfusion of packed red cells in a (stable) critically ill patient is NOT necessary unless the hemoglobin concentration is below which of the following? | 5.8 g/dL | 6.5 g/dL | 7 g/dL | 8.6 g/dL | 4 | C | 1 | null | null | null | null | null |
5d0671ee-499b-5ca9-ae9c-50b957b6f06d | What is the most appropriate storage parameters for packed RBCs that LACK an additive solution? | 1°C-6°C for 21-35 days | <−65°C for 10 years | 20°C-24°C for 5 days | <−18°C for 1 year | 4 | A | 1 | null | null | null | null | null |
7e2dcd0a-5198-5d1e-b9d1-0878bb8e5697 | Blood donors in the United States are required to have a minimum hemoglobin level of which of the following? | 7 | 9.5 | 11 | 12.5 | 4 | D | 1 | null | null | null | null | null |
fa13d773-3458-54a6-8cd6-7f60acfd0e38 | Which of the following statements is true with regard to transfusing FFP? | It contains all factors involved in hemostasis. | It does not need to be ABO-compatible. | It must be used within 1 year of collection. | It carries no risk of transfusion-related acute lung injury (TRALI). | 4 | A | 1 | null | null | null | null | null |
546b6255-752b-5e6f-ac19-c2cad07129d6 | 28. Cryoprecipitate contains all of the following factors EXCEPT which one? | von Willebrand factor | Factor VIII | Factor IX | Factor XIII | 4 | C | 1 | null | null | null | null | null |
c478f37e-b16d-5a26-ad9c-bae749d58211 | The most common reaction observed during transfusions of blood products is which of the following? | An anaphylactoid reaction | Febrile nonhemolytic transfusion reaction (FNHTR) | Acute hemolytic transfusion reaction (AHTR) | Delayed hemolytic transfusion reaction (DHTR) | 4 | B | 1 | null | null | null | null | null |
bfabd796-9dfc-57b1-b9c0-a1b01d379c27 | Immediately following a blood transfusion in the PACU, a patient becomes tachycardic, hypotensive, and febrile, and his nurse notes that he appears to have blood leaking from his incision. After stopping the transfusion and administering IV fluids, which of the following is the most appropriate test to conduct? | Tryptase | Direct Coombs test | Indirect Coombs test | Caffeine-halothane contracture test | 4 | B | 2 | null | null | null | null | null |
7071feb3-e583-5691-8595-f354e286cd52 | Allergic reactions to blood products in patients with a known IgA deficiency can be avoided by which of the following? | Leukoreduction | Washing | Irradiation | Premedication with acetaminophen | 4 | B | 2 | null | null | null | null | null |
66ebc394-a304-5837-a8bd-70f5d8b1262c | Which of the following is true about anaphylactoid responses to blood product tranfusions? | They show evidence of anti-IgA antibodies. | They are type I hypersensitivity IgE-mediated reactions. | The majority occur secondary to IgM-mediated antibody-antigen complexes. | They show evidence of IgG alloantibodies to Rh. | 4 | A | 1 | null | null | null | null | null |
c57e3e9c-5801-5243-baac-0621b1540c13 | To decrease the risk of transfusion-related graft-versus-host disease (GVHD), cellular components of blood should undergo which of the following? | Leukoreduction | Washing | Irradiation | Preservation using citrate phosphate dextrose adenine (CDPA) solution | 4 | C | 1 | null | null | null | null | null |
b6e46dce-35fc-5290-9daa-e8e2a2245079 | 35. Following exploratory laparotomy for trauma in which a patient underwent a massive transfusion, the patient is noted to have twitching of the ipsilateral facial muscles when tapping on the face just below the zygomatic bone, as well as wrist flexion and hyperextension of the fingers when a blood pressure cuff is inflated above systolic blood pressure. Which of the following is the most likely cause for these symptoms? | Hyperkalemia | Hypokalemia | Citrate toxicity | Hypothermia | 4 | C | 2 | null | null | null | null | null |
7ec7bae3-4d5f-5b55-9dbb-beeb0e0ec35a | A patient received several units of blood products because of a massive GI hemorrhage. Which of the following sets of parameters is most concerning for | Onset of shortness of breath 3 days after transfusion with chest X-ray (CXR) showing focal infiltrates in the right lower lobe | Decreased lung compliance after induction of anesthesia with CXR showing no acute changes | CXR showing pulmonary edema, elevated B-type natriuretic peptide, and transthoracic echocardiogram showing left atrial enlargement | CXR showing pulmonary edema with acute bilateral infiltrates, PaO2 /FiO2 <300, SaO2 , 90% on room air, no evidence of left atrial hypertension | 4 | D | 3 | null | null | null | null | null |
7082c677-c0d4-51cd-ad11-c5a46849cf50 | A patient received several units of blood products because of a massive GI hemorrhage. Which of the following sets of parameters is most concerning for transfusion-related acute cardiovascular overload (TACO)? | Onset of shortness of breath 3 days after transfusion with CXR showing focal infiltrates in the right lower lobe | Decreased lung compliance after induction of anesthesia with CXR showing no acute changes | CXR showing bilateral pulmonary edema, elevated B-type natriuretic peptide, and transthoracic echocardiogram showing left atrial hypertension | CXR showing pulmonary edema with acute bilateral infiltrates, PaO2 /FiO2 <300, SaO2 , 90% on room air, no evidence of left atrial hypertension | 4 | C | 2 | null | null | null | null | null |
b145e766-ab15-5f31-91ba-ed52b52faf9d | Which of the following infections carries the highest residual risk post blood product transfusion in the United States? | Human immunodeficiency virus (HIV) | Hepatitis C virus | Hepatitis B virus | Cytomegalovirus (CMV) | 4 | D | 1 | null | null | null | null | null |
eaf149d2-70ae-5bdf-8e5f-2aa9522fa5c8 | Transfusion of which of the following blood products has the highest rate of infection? | Red blood cells | Platelets | Fresh frozen plasma | Cryoprecipitate | 4 | B | 1 | null | null | null | null | null |
a1efff1d-18e9-555f-8271-fdcbce172d42 | Transfusion of blood products has been associated with which of the following? | Increased flares in patients afflicted with Crohn disease | Decreased rate of miscarriages in women with history of recurrent spontaneousabortion | Decreased reactivation of latent tuberculosis | Decreased rates of recurrent malignancies | 4 | B | 1 | null | null | null | null | null |
4d5f199d-9df8-51bf-9549-fc6e855f2d16 | While performing a preoperative assessment on a patient with acromegaly, you note that his home medication list includes octreotide. Which of the following is the mechanism of action of octreotide? | Competitive inhibition at the growth hormone (GH) receptor | Inhibition of GH and IGF-1 secretion | Stimulation of insulin secretion | Agonism at the dopamine receptor | 4 | B | 1 | null | null | null | null | null |
ff91e6d8-656c-580c-bcdb-8bafec24ae8e | Which of the following hormones is released from the posterior pituitary gland? | Thyroid-stimulating hormone (TSH) | Vasopressin (antidiuretic hormone [ADH]) | Corticotropin (adrenocorticotropic hormone [ACTH]) | Growth hormone | 4 | B | 1 | null | null | null | null | null |
561314d4-fc38-5ef2-9a25-6980b1dcfe87 | Which of the following statements is true of the syndrome of inappropriate antidiuretic hormone (SIADH)? | Chronic hyponatremia from SIADH should be corrected with hypertonic saline. | Peripheral edema is a common physical exam finding. | Most cases of SIADH are due to an intrinsic pituitary disorder. | Demeclocycline may be used to treat SIADH. | 4 | D | 1 | null | null | null | null | null |
e073e9bf-176e-57c3-bf43-c3c81e6afcac | Which of the following statements is true with regard to diabetes insipidus (DI)? | Desmopressin administration can distinguish central versus nephrogenic DI. | Patients with nephrogenic DI will increase urine osmolality in response to desmopressin. | Thiazide diuretics may be used to treat central DI. | Patients with central DI will fail to respond to exogenous desmopressin administration. | 4 | A | 1 | null | null | null | null | null |
ce35483c-34ec-5993-aef6-6501116c139d | Which of the following features is more consistent with a diagnosis of a pituitary macroadenoma than that of a pituitary microadenoma? | Galactorrhea | Visual field deficit | Thyrotoxicosis | Cushing disease | 4 | B | 1 | null | null | null | null | null |
44e5e751-4398-5ecd-85f2-499868b933d0 | Which of the following statements pertaining to thyroid storm is true? | Atrial fibrillation is required for diagnosis. | Mortality rate may exceed 20%. | TSH levels are elevated. | Hyperthermia is rare. | 4 | B | 1 | null | null | null | null | null |
b271a8c1-eeed-51b0-a2c9-1554f7a2a9a4 | Which of the following is likely to be seen when a patient with hypothyroidism is under general anesthesia? | Hypotension | Prolongation of nondepolarizing neuromuscular blockers | Bradycardia | Hyperglycemia | 4 | C | 1 | null | null | null | null | null |
5bf0bd53-fa49-53f4-bf80-7e469a3b923f | Which of the following statements is true with regard to potential complications associated with thyroid surgery? | Unilateral recurrent laryngeal nerve damage will cause aphonia. | Unanticipated difficult airway is present in 5%-8% of thyroid cases. | Retrosternal thyroid may cause airway obstruction with prone positioning. | Postoperative hypocalcemia typically manifests immediately in the postanesthesia care unit. | 4 | B | 1 | null | null | null | null | null |
1f68d89a-1547-55d0-83a9-b413f23f8821 | Which of the following diagnostic results is consistent with a diagnosis of Grave disease? | Elevated TSH | Normal free T4 | Diffusely increased radioactive iodine uptake | Decreased free T3 | 4 | C | 1 | null | null | null | null | null |
09c55fbf-4272-5c1e-b52c-740fc738058e | Which statement correctly describes one of the actions of parathyroid hormone (PTH)? | PTH increases Ca 2+ resorption in the ascending loop of Henle, distal tubule, and collecting tubule of the kidney. | PTH inhibits 1α-hydroxylase gene in renal cells. | PTH promotes uptake of calcium by osteocytes. | PTH increases the reabsorption of phosphate and bicarbonate in the nephron. | 4 | A | 1 | null | null | null | null | null |
c710469b-0b0c-5c2e-8df4-390943710671 | Which of the following is the primary mechanism by which calcitonin reduces serum Ca 2+ levels? | Increasing the renal excretion of phosphate | Decreasing the intestinal absorption of calcium | Promotion of osteoblastic activity to increase bone formation | Inhibition of osteoclast activity to decrease bone resorption | 4 | D | 1 | null | null | null | null | null |
1afd7adb-f5e3-51d1-8266-1ea89cfd9c6e | 13. What is the initial step in the management of a patient with symptomatic hypercalcemia? | Calcitonin | Furosemide | Normal saline | Pamidronate | 4 | C | 1 | null | null | null | null | null |
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