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73c1a04b-8b0a-5467-a7c7-fee46402fc91
A 17-year-old type 1 diabetic with history of renal failure is in the preoperative holding area awaiting an operation for acute appendicitis.
Renal tubular acidosis
Lactic acidosis
Diabetic ketoacidosis
Aspirin overdose
4
A
2
null
null
null
null
null
087b9e50-1b86-5144-96b5-165b3552fac4
Methods to decrease the incidence of central venous catheter infections include all of the following EXCEPT
Changing the central catheter every 3 to 4 days over a guidewire
Using minocycline/rifampin impregnated catheters over chlorhexidine/silver sulfadiazine impregnated catheters for suspected long-term use
Using the subclavian over the internal jugular route for access
Using a single lumen over a multilumen catheter
4
A
1
null
null
null
null
null
7f582ea5-1c74-5ece-9e30-ee9bda21dad2
Signs of Sarin nerve gas poisoning include all of the following EXCEPT
Diarrhea
Urination
Mydriasis
Lacrimation
4
C
1
null
null
null
null
null
cf20ecb9-622c-5916-97aa-15c18aba13c1
Which of the following conditions would be associated with the LEAST risk of venous air embolism during removal of a central line?
Spontaneous breathing, head up
Spontaneous breathing, flat
Spontaneous breathing, Trendelenburg
Mechanical ventilation, Trendelenburg
4
D
3
null
null
null
null
null
e6752ed6-4511-5d32-a8f5-4e6a9191ed7f
Which of the following adverse effects is NOT attributable to
Increased intracranial pressure
Peripheral vasoconstriction
Increased pulmonary vascular resistance
Increased serum potassium concentration
4
B
1
null
null
null
null
null
77404f82-a065-5b63-ba7c-63d51e173c8f
Which of the following maneuvers is LEAST likely to raise arterial
Inflating the pulmonary artery catheter balloon (in the left pulmonary artery)
Raising hemoglobin from 8 to 12 mg/dL
Raising Fio2 from 0.8 to 1.0
Increasing cardiac output from 2 to 5 L/min
4
C
2
null
null
null
null
null
ca9de464-9ab3-5915-8d55-8cf3ab823b32
A 100-kg man is 24 hours status post four-vessel coronary artery bypass graft. Which of the following pulmonary parameters would be compatible with successful extubation in this patient?
Vital capacity 2.5 L
Paco2 44 mm Hg
Maximum inspiratory pressure −38 cm H2O
All of the above
4
D
2
null
null
null
null
null
d393608a-a667-5bd0-b2e0-ae915bf34091
Which of the following can cause a rightward shift of the oxyhemoglobin dissociation curve?
Methemoglobinemia
Carboxyhemoglobinemia
Hypothermia
Pregnancy
4
D
1
null
null
null
null
null
8b6346a8-c6b1-56a1-8ebd-675e4c97bad3
A 24-year-old man is brought to the operating room 1 hour after a motor vehicle accident. He has C7 spinal cord transection and ruptured spleen. Regarding his neurologic injury, anesthetic concerns include
Risk of hyperkalemia with succinylcholine administration
Risk of autonomic hyper-reflexia with urinary catheter insertion
Increased risk of hypothermia
All of the above
4
C
2
null
null
null
null
null
550f13a0-1b53-5b70-a5d5-b5b648a8a985
After sustaining traumatic brain injury, a 37-year-old patient in the ICU develops polyuria and a plasma sodium concentration of 159 mEq/L. What pathologic condition is associated with these clinical findings?
Syndrome of inappropriate antidiuretic hormone (SIADH)
Diabetes mellitus
Diabetes insipidus
Cerebral salt wasting syndrome
4
C
1
null
null
null
null
null
d391c658-2f6e-568e-9ac5-4a3ca8fa3bfe
Which of the following drugs is the best choice for treating hypotension in the setting of severe acidemia?
Norepinephrine
Epinephrine
Phenylephrine
Vasopressin
4
D
3
null
null
null
null
null
2021ac00-6e64-50ed-bbb9-d81626a4c24b
The end-tidal CO2 measured by an infrared spectrometer is 35 mm Hg.
Morbid obesity
Pulmonary embolism
Intrapulmonary shunt
Chronic obstructive pulmonary disease (COPD)
4
C
2
null
null
null
null
null
20fb5600-daf4-5ef6-a23e-69dc7ee1781f
A transfusion-related, acute lung injury (TRALI) reaction is suspected in a 48-year-old man in the ICU after a 10-hour operation for scoliosis during which multiple units of blood and factors were administered. Which of the following items is inconsistent with the diagnosis of a TRALI reaction?
Fever
Alveolar-to-arterial (A–a) oxygen gradient of 25 mm Hg
Acute rise in neutrophil count after onset of symptoms
Bilateral pulmonary infiltrates
4
C
1
null
null
null
null
null
501f9e11-a187-5dd4-bf96-8c8bf332a60e
If a central line located in the superior vena cava (SVC) is withdrawn such that the tip of the catheter is just proximal to the SVC, it would be located in which vessel?
Subclavian vein
Brachiocephalic vein
Cephalic vein
Internal jugular vein
4
B
1
null
null
null
null
null
e7aeff23-c401-524f-8059-000e8d985efe
The time course of anticoagulation therapy is variable after different percutaneous coronary interventions (PCIs). Arrange the interventions in order, starting with the one requiring the shortest course of aspirin and clopidogrel (Plavix) therapy to the one requiring the longest course.
Bare-metal stent, percutaneous transluminal coronaryangioplasty (PTCA), drug-eluting stent
Drug-eluting stent, bare-metal stent, PTCA
PTCA, drug-eluting stent, bare-metal stent
PTCA, bare-metal stent, drug-eluting stent
4
D
1
null
null
null
null
null
9d79f4d1-5769-54e8-87b8-3d42615c34fa
A 75-year-old patient in the ICU is intubated and ventilated on AC 12, Vt 500, and "some" PEEP. In a 60-second period, he initiates two spontaneous breaths. The peak airway pressure alarm has not sounded. His minute ventilation would be
Incalculable without knowledge of PEEP value
Incalculable without knowing dead space
Incalculable without knowing magnitude of the two spontaneous breaths
Seven liters
4
D
2
null
null
null
null
null
62284627-0f88-570e-8961-1a7bc51b3003
Which of the features below is suggestive of weaponized anthrax exposure as opposed to a common flu-like viral illness?
Widened mediastinum
Fever, chills, myalgia
Severe cough
Pharyngitis
4
A
1
null
null
null
null
null
a9509a79-a0fd-541f-8fdc-31771f4fac22
Which of the following factors could not explain a Pao2 of 48 mm Hg in a patient breathing a mixture of nitrous oxide and oxygen?
Hypoxic gas mixture
Eisenmenger syndrome
Profound anemia
Hypercarbia
4
C
2
null
null
null
null
null
ba9aa064-d0e4-54e4-a3e9-414300df8fba
During a left hepatectomy under general isoflurane anesthesia, arterial blood gases are: O2 138, CO2 39, pH 7.38, saturation 99%. At the same time, CO2 on infrared spectrometer is 26 mm Hg. The most plausible explanation for the difference between CO2 measured with infrared spectrometer versus arterial blood gas gradie...
Mainstem intubation
Atelectasis
Shunting through thebesian veins
Hypovolemia
4
D
3
null
null
null
null
null
89d1ed5e-e976-5688-87c3-75606aaa37e1
Under which set of circumstances would energy expenditure per day be the greatest?
Sepsis with fever
60% burn
Multiple fractures
1 hour status post liver transplantation
4
B
1
null
null
null
null
null
e79bf1e3-3bfa-59f4-a4ff-5ac07e7ebf76
Select the FALSE statement regarding amiodarone (Cordarone).
It is shown to decrease mortality after myocardial infarction
It is indicated for ventricular tachycardia and fibrillation refractory to electrical defibrillation
Adverse effects include pulmonary fibrosis and thyroid dysfunction
It is useful in treatment of torsades de pointes
4
D
1
null
null
null
null
null
692ba259-61a8-51ac-adb2-d2177b502d46
A 58-year-old woman is awaiting orthotopic liver transplantation for primary biliary cirrhosis in the ICU. An oximetric pulmonary artery catheter is placed, and an Svo2 of 90% is measured. Which of the following blood pressure interventions is the LEAST appropriate for treatment of hypotension in this patient?
Milrinone
Norepinephrine
Vasopressin
Phenylephrine
4
A
3
null
null
null
null
null
ce5d4ef9-0c46-58a4-ac27-a72eafc08af7
A 73-year-old patient is on a ventilator after an MVA. Rate is set at AC 16, Vt 450 with 5 cm H2O PEEP. The respiratory therapist notes that the measured PEEP is greater than 15 cm H2O and that the patient is not breathing above the set rate. Which option below is most reasonable for reducing the measured PEEP?
Increase the respiratory rate
Increase inspiratory flow rate
Reverse the I to E ratio
Paralyze the patient
4
B
2
null
null
null
null
null
3f0c9a86-c6ae-50e4-895b-4deff1fcc7d0
A 68-year-old asthmatic drunk driver comes into the ER after being in a motor vehicle accident. After a difficult intubation, you fail to observe end-tidal CO2 on the monitor. Reasons for this include all of the following EXCEPT
You intubated the esophagus by mistake
You forgot to ventilate the patient
The connection between the circuit and monitor has become disconnected
The patient also has a pneumothorax, and high airway pressures are needed to adequately ventilate the patient
4
D
2
null
null
null
null
null
04b35252-b08d-5b8a-a43e-046379ff94b9
A 30-year-old woman has undergone a 2-hour abdominal surgical procedure and is sent to the ICU intubated for postoperative monitoring, due to suspected sepsis. Three hours later, the ventilator malfunctions and the resident disconnects the patient from the ventilator and hand ventilates the patient with 100% oxygen. Th...
Administer atropine
Start epinephrine
Confirm ETT position
Apply external pacemaker# Respiratory Physiology and Critical Care Medicine###
4
C
3
null
null
null
null
null
6c4e621f-82dc-593c-8c6c-c99b355622bf
Which of the following muscle relaxants is eliminated the most by renal excretion?
Pancuronium
Vecuronium
Atracurium
Rocuronium
4
A
1
null
null
null
null
null
d4ae8963-a913-5603-977f-b4f05ddc2b58
All of the following conditions may develop when using propofol for prolonged sedation in the intensive care unit (ICU) EXCEPT
Pancreatitis
Hyperlipidemia
Metabolic acidosis
Adrenal suppression
4
D
1
null
null
null
null
null
74e3e7cb-465b-5488-b8f0-6b0c743e38e6
Under which scenario should dantrolene be withheld in a patient in whom malignant hyperthermia (MH) is suspected?
Concomitant treatment with a calcium channel blocker
History of previous uneventful anesthetic with volatileanesthetic
History of negative genetic test for ryanodine mutation
Never
4
D
1
null
null
null
null
null
95b71f1f-7e7d-564c-8856-9eb248e42002
A 78-year-old patient with Parkinson disease undergoes a cataract operation under general anesthesia. In the recovery room, the patient has two episodes of emesis and complains of severe nausea. Which of the following antiemetics would be the best choice for treatment of nausea in this patient?
Droperidol
Promethazine
Ondansetron
Metoclopramide
4
C
2
null
null
null
null
null
50de533f-3f14-5ad5-9d33-134e822cc026
Which of the following diseases is associated with increased resistance to neuromuscular blockade with succinylcholine?
Myasthenia gravis
Myasthenic syndrome
Huntington chorea
Polymyositis
4
A
1
null
null
null
null
null
ec7fa703-42e1-5de4-aae8-7efdd09de397
Sedation with which of the following drugs is most likely to resemble normal sleep?
Propofol
Midazolam
Dexmedetomidine
Ketamine
4
C
1
null
null
null
null
null
615ba2d4-d0d4-50fc-bacd-b59c385265d3
Which of the following intravenous anesthetics is converted from a water-soluble to a lipid-soluble drug after exposure to the bloodstream?
Propofol
Midazolam
Ketamine
None of the above
4
B
1
null
null
null
null
null
7b833594-7b9e-554b-bdb9-ec96ed91e78a
A 33-year-old, 70-kg patient is brought to the operating room for resection of an anterior pituitary prolactin-secreting tumor. Anesthesia is induced with sevoflurane, nitrous oxide, and oxygen. The patient is intubated, and nitrous oxide is discontinued. Anesthesia is maintained with 1.2 minimum alveolar concentration...
55 mL
45 mL
35 mL
25 mL
4
C
2
null
null
null
null
null
b22e75d9-98d5-59d4-a9e1-d405cfe79171
Patients receiving antihypertensive therapy with propranolol are at increased risk for each of the following EXCEPT
Blunted response to hypoglycemia
Bronchoconstriction
Rebound tachycardia after discontinuation
Orthostatic hypotension
4
D
1
null
null
null
null
null
bb150dbf-29ec-59b8-ae4f-38a486bd7578
Atropine causes each of the following EXCEPT
Decreased gastric acid secretion
Inhibition of salivary secretion
Increased lower esophageal sphincter tone
Mydriasis
4
C
1
null
null
null
null
null
10019042-8561-5c8a-b190-84e981e29c53
Which of the following drugs is capable of crossing the blood-brain barrier?
Neostigmine
Pyridostigmine
Edrophonium
Physostigmine
4
D
1
null
null
null
null
null
9fae8d6c-f8dc-5287-9b0a-42d29763c776
Which drug exerts its main central nervous system (CNS) action by inhibiting the *N*-methyl-D-aspartate (NMDA) receptors?
Propofol
Midazolam
Etomidate
Ketamine
4
D
1
null
null
null
null
null
497e4587-715d-5418-bc22-5b1218ca95d8
Which of the following opioid-receptor agonists has anticholinergic properties?
Morphine
Hydromorphone
Sufentanil
Meperidine
4
D
1
null
null
null
null
null
2c0c2f5e-a98c-5ab6-acc6-3626519ed8b5
Which of the following statements about ketamine is FALSE?
In the United States it is a racemic mixture of two isomers
It is a potent cerebral vasodilator and can increase intracranial pressure (ICP)
Respiratory depression rarely occurs with induction doses
Its metabolite norketamine is more potent than the parent compound
4
D
1
null
null
null
null
null
9fdb04fa-04b2-574e-9a37-94decd901864
Which of the following vasopressor agents increases systemic blood pressure (BP) indirectly by stimulating the release of norepinephrine from sympathetic nerve fibers and directly by binding to adrenergic receptors?
Vasopressin
Ephedrine
Epinephrine
Phenylephrine
4
D
1
null
null
null
null
null
05f06f3d-45bf-5288-aba5-82521d2e929f
Methadone-induced constipation could be reversed without loss of analgesic effect with which of the following opioid antagonists?
Naloxone
Nalmefene
Naltrexone
Methylnaltrexone
4
D
1
null
null
null
null
null
112a57cf-a362-5be1-bb58-286cb688f15e
The treatment of patients with human immunodeficiency virus (HIV) may include indinavir, nelfinavir, or ritonavir. What anesthetic consideration is significant with these drugs?
Decreased platelet function
Increased sensitivity to midazolam
Hypoglycemia
Hyperkalemia
4
B
1
null
null
null
null
null
66c00097-a0a8-5d74-b140-e264e33eb7d2
Neurokinin-1 (NK1) antagonists such as aprepitant have all the following properties EXCEPT
Anxiolytic
Antidepressant
Analgesic
Antiemetic
4
C
1
null
null
null
null
null
e6ffbad5-149d-539b-a07e-87b063af615a
Which of the following drugs should be administered with caution to patients receiving echothiophate for the treatment of glaucoma?
Atropine
Succinylcholine
Ketamine
Remifentanil
4
B
1
null
null
null
null
null
a35b6496-30a3-5e00-9aef-4e803e267fa1
When one of four thumb twitches in the train-of-four (TOF) stimulation of the ulnar nerve can be elicited, how much suppression would there be if you were measuring a single twitch?
20 to 25
45 to 55
75 to 80
90 to 95
4
D
1
null
null
null
null
null
859eabbc-9cc4-52e5-b690-2b8815bf2a1f
Which of the following muscle relaxants causes slight histamine release at two to three times the ED95 (effective dose in 95% of subjects) dose?
Rocuronium
Pancuronium
Atracurium
Cisatracurium
4
C
1
null
null
null
null
null
76c904ff-8732-55d3-9bb4-978e5b778147
Termination of action of the neurotransmitter norepinephrine is achieved predominately by which mechanism?
Reuptake into postganglionic sympathetic nerve endings (uptake 1)
Dilution by diffusion away from receptors
Metabolism by catechol-*O*-methyltransferase (COMT)
Metabolism by monoamine oxidase (MAO)
4
A
1
null
null
null
null
null
73fa0cb5-b65c-5787-8e69-958d26fd65f1
The incidence of unpleasant dreams associated with emergence from ketamine anesthesia can be reduced by the administration of
Caffeine
Droperidol
Physostigmine
Midazolam
4
D
1
null
null
null
null
null
9d2cdd27-6ce9-57fc-9198-f470ecbe4693
The principal advantage of Ryanodex over conventional formulations of dantrolene is
Cost
Speed of reconstitution and administration
Absence of large amounts of mannitol
Need for lower dose
4
B
1
null
null
null
null
null
c178cf61-3d2b-5ab4-8035-ac409042b23a
Eplerenone (Inspra) inhibits the renin-angiotensin-aldosterone system by which mechanism?
Blocks aldosterone receptor
Blocks conversion angiotensinogen to angiotensin I
Blocks angiotensin receptor
Prevents formation of renin
4
A
1
null
null
null
null
null
8e6516f7-0882-528f-9468-2ef5b863e27a
Each of the following drugs can enhance the neuromuscular blockade produced by nondepolarizing muscle relaxants EXCEPT
Calcium
Aminoglycoside antibiotics
Magnesium
Intravenous lidocaine
4
A
1
null
null
null
null
null
33e7181e-c1a6-54e5-a290-35ba510dfd83
The primary site of action of lisinopril is
Heart
Lungs
Kidney
Metarterioles
4
B
1
null
null
null
null
null
0f9c3b89-63da-5eaa-9733-137a4b245d1b
Circulating BNP (B-type natriuretic peptide) is a powerful biomarker predicting outcomes of which of the following?
Heart
CNS
Kidneys
Organ rejection
4
A
1
null
null
null
null
null
e80a19b6-4103-57ae-a455-17103da77f92
Hyperkalemia is NOT a risk for patients receiving succinylcholine with which of the following?
Multiple sclerosis (MS)
Myasthenia gravis
Guillain-Barré syndrome
Becker muscular dystrophy
4
B
1
null
null
null
null
null
69b9b3ae-0113-5e16-8112-f83731559203
Which of the antibiotics below does NOT augment neuromuscular blockade?
Clindamycin
Neomycin
Streptomycin
Erythromycin
4
D
1
null
null
null
null
null
0879d068-d07c-57c9-bf79-450fe869013d
A 43-year-old woman with ascites, hepatopulmonary syndrome, and bleeding esophageal varices is admitted to the ICU. Which of the therapies below is LEAST likely to improve symptoms associated with hepatic encephalopathy (HE)?
Amino acid–rich total parenteral nutrition (TPN)
Neomycin
Lactulose
Flumazenil
4
D
2
null
null
null
null
null
971362e3-a68a-510c-85db-8671b9fb3f93
100 mg succinylcholine is administered to a 70-kg anesthetized man before intubation. The patient remains paralyzed for 20 minutes. Which of the parameters below is NOT consistent with this finding?
Dibucaine number 70
Heterozygous for atypical cholinesterase
Incidence of 1/480
Presence of fasciculations with this dose
4
A
2
null
null
null
null
null
94436d1f-8b2d-51b2-ad2f-1ce4d0d88348
In which of the following situations is succinylcholine most likely to cause severe hyperkalemia?
24 hours after a right hemisphere stroke
14 days after a severe burn injury
24 hours after a midthoracic spinal cord transection
2 days with a severe abdominal infection
4
B
2
null
null
null
null
null
19aa9aa2-6af7-5bee-bf24-b76fa7c9810a
The most common minor side effect reported after flumazenil administration in anesthesia is
Nausea and/or vomiting
Dizziness
Tremors
Hypertension
4
A
1
null
null
null
null
null
6efbd3bc-516e-5fb6-839f-8655b304a202
Ketorolac
Is a selective cyclooxygenase-2 (COX-2) inhibitor
Does not inhibit thromboxane A2 (TXA2 )
Does not inhibit prostaglandin I2
Exhibits a dose ceiling effect with regard to analgesia
4
D
1
null
null
null
null
null
fbb91c41-cbbe-5e77-9dff-a69197f9ae03
A 37-year-old patient with a history of acute intermittent porphyria is scheduled for knee arthroscopy under general anesthesia. Which of the following drugs is contraindicated in this patient?
Fentanyl
Isoflurane
Propofol
Etomidate
4
D
1
null
null
null
null
null
0115eb0e-592f-5337-b3f4-04a0836cb003
A 57-year-old male is discharged after tooth extraction of two molars. His only medication is paroxetine (Paxil), which he takes for depression. Codeine is a poor analgesic choice for this patient because
It is likely to be ineffective
It is likely to cause extreme sedation
He is at increased risk for nausea
He is at increased risk for serotonin syndrome
4
A
2
null
null
null
null
null
217201f7-64a7-5aaa-8a6f-946f9aa446b5
If etomidate were accidentally injected into a left-sided radial arterial line, the most appropriate step to take would be
Left stellate ganglion block
Administer intra-arterial clonidine
Slowly inject dilute (0.1 mEq/L) [HCO3 - ]
Observe
4
D
1
null
null
null
null
null
a218bac5-0c9d-5332-80a6-35ee35b27324
The most important reason for the more rapid onset and shorter duration of action of fentanyl with single dose compared with morphine is the difference in
Volume of distribution
Hepatic clearance
Protein binding
Lipid solubility
4
D
1
null
null
null
null
null
64a6182c-aa00-59a5-b7e5-089e82dda9a5
A narcotic infusion is initiated in a patient without a bolus (loading dose). Of the following drugs, which would reach steady state after 2 hours or less of continuous infusion (fentanyl, remifentanil, alfentanil, and morphine)?
All of these
Remifentanil and alfentanil
Alfentanil only
Remifentanil only
4
D
1
null
null
null
null
null
ce5ffd84-46f6-52d6-85b2-633eced6c614
The period of vulnerability after three courses of bleomycin for testicular cancer is
1 month
1 year
Lifelong
No vulnerability with just three courses
4
C
1
null
null
null
null
null
b661d165-28dc-52e9-9e3e-aa2c0725647d
The unique advantage of rocuronium over other muscle relaxants is its
Short duration of action
Metabolism by pseudocholinesterase
Onset of action
Lack of need for reversal
4
C
1
null
null
null
null
null
becd7d2b-3c36-56ac-b8b4-3b86691d7bf2
Which of the following statements regarding the efficacy of neuromuscular blockade in the setting of acute hypokalemia is correct?
There is no effect with depolarizing or nondepolarizing muscle relaxants
There is resistance to effects of both depolarizing and nondepolarizing muscle relaxants
There is increased sensitivity to effects of both depolarizing and nondepolarizing muscle relaxants
There is resistance to depolarizing muscle relaxants and increased sensitivity to nondepolarizing muscle relaxants
4
D
1
null
null
null
null
null
caecd4ea-ec00-5375-a734-41c5bc268d45
A patient undergoing which of the following operations would be at highest risk for operative recall?
Laparoscopic cholecystectomy with total intravenous anesthesia (TIVA) (no volatile)
Cervical spine fusion with MEP (motor evoked potentials) monitoring
Pneumonectomy with one-lung ventilation
Emergency splenectomy after falling from a ladder
4
D
2
null
null
null
null
null
5fe175ed-ab96-5ecf-838c-28951575d779
A 58-year-old patient is brought to the emergency room with the following symptoms: miosis, abdominal cramping, salivation, loss of bowel and bladder control, bradycardia, ataxia, and skeletal muscle weakness. The most likely diagnosis is
Central anticholinergic syndrome
Malignant neuroleptic syndrome
Anticholinesterase poisoning
Serotonin syndrome
4
C
1
null
null
null
null
null
6a83906d-dbc4-52d4-b36d-a705e6ea1941
Flumazenil
Is contraindicated in narcotic addicts
Can be given orally as well as intravenously
Can produce seizures in chronic benzodiazepine users
Has a longer elimination half-life compared with midazolam
4
C
1
null
null
null
null
null
46c08be3-a92b-5145-97e8-cef5c1c6de59
What percentage of neuromuscular receptors could be blocked and still allow patients to carry out a 5-second head lift?
5%
15%
25%
50%
4
D
1
null
null
null
null
null
eb0bd4e6-e6c4-515f-a955-8ebbbeb30f36
Which of the following drugs can prevent tachyarrhythmias in patients with Wolff-Parkinson-White (WPW) syndrome?
Droperidol
Pancuronium
Ketamine
Verapamil
4
A
1
null
null
null
null
null
12a413a9-3fdb-55ae-86a8-d62f2c5e64b2
The half-life of pseudocholinesterase is
1 hour
12 hours
1 week
2 weeks
4
B
1
null
null
null
null
null
da36f61e-d120-5c31-9515-1a682da1aa0a
A patient with CYP2D6 polymorphism is tested and shown to be an ultrarapid metabolizer. Which of the following statements regarding PONV prophylaxis with serotonin receptor antagonists is true?
Neither granisetron nor ondansetron would likely be efficacious
Granisetron would likely be more efficacious than ondansetron
Ondansetron would likely be more efficacious than granisetron
Both would likely be efficacious
4
B
2
null
null
null
null
null
5b4f646f-c7ae-5652-9cc4-547e9d23349d
Which of the following equals the anti-inflammatory activity of 50 mg of prednisone (Deltasone)?
100 mg cortisol (Solu-Cortef)
80 mg methylprednisolone (Solu-Medrol)
7.5 mg dexamethasone (Decadron)
4 mg betamethasone (Celestone)
4
C
1
null
null
null
null
null
df7fbfd0-516b-5731-9eb7-47c90ee7a558
The recovery index (RI) of which of the following nondepolarizing muscle relaxants is NOT altered by aging?
Atracurium
Vecuronium
Rocuronium
Pancuronium
4
A
1
null
null
null
null
null
c8aa8a13-3e8f-59bc-948e-fbe93f320059
Side effects associated with cyclosporine therapy include each of the following EXCEPT
Nephrotoxicity
Pulmonary toxicity
Seizures
Limb paresthesias
4
B
1
null
null
null
null
null
2c8970a5-cfd9-5002-a0f7-be8225644bf1
What is the predominant mechanism for succinylcholine-induced tachycardia in adults?
Direct sympathomimetic effect at postjunctional muscarinic receptors
Stimulation of nicotinic receptors at autonomic ganglia
Blockade of nicotinic receptors at autonomic ganglia
Direct vagolytic effect at postjunctional muscarinic receptors
4
B
1
null
null
null
null
null
beb7c198-cc50-5a7a-afb5-6129c259644d
A 72-year-old patient with a history of type 2 diabetes and hypertension is brought to the ICU after aortobifemoral bypass grafting. The patient is up 3 kilograms since surgery, and diuretic therapy is initiated to enhance urine output. Which of the choices below is LEAST likely to cause hypokalemic, hypochloremic meta...
Triamterene
Furosemide
Bumetanide
Oral thiazide
4
A
2
null
null
null
null
null
19b2095d-ade9-541e-a2ff-58a04a50156f
Which of the commonly used drugs below is NOT metabolized by nonspecific esterases?
Propofol
Esmolol
Atracurium
Remifentanil
4
A
1
null
null
null
null
null
4cfd675e-3bf2-5407-962d-3fbd71a32d97
Succinylcholine is contraindicated for routine tracheal intubation in children because of an increased incidence of which of the following side effects?
Hyperkalemia
Malignant hyperthermia
Masseter spasm
Sinus bradycardia
4
A
1
null
null
null
null
null
7404ccdc-ed86-5bb3-9c62-1f7df96bba98
From MOST to LEAST rapid, select the correct temporal sequence of neuromuscular blockade in the adductor of the thumb, the orbicularis oculi, and the diaphragm after administration of an intubating dose of vecuronium to an otherwise healthy patient.
Diaphragm, orbicularis oculi, thumb
Orbicularis oculi, diaphragm, thumb
Orbicularis oculi, thumb, diaphragm
Orbicularis oculi same as diaphragm, thumb
4
D
1
null
null
null
null
null
299c3162-be5a-51fd-94a2-375818d63da6
Select the TRUE statement regarding interaction of nondepolarizing neuromuscular blocking drugs when durations of action are dissimilar.
If a long-acting drug is administered after an intermediateacting drug, the duration of the long-acting drug will be longer than normal
If a long-acting drug is administered after an intermediateacting drug, the duration of the long-acting drug will be about the same as expected
If an intermediate-acting drug is administered after a longacting drug, the duration of the intermediate-acting drug will be about the same as expected
If an intermediate-acting drug is administered after a longacting drug, the duration of action of the intermediate-acting drug will be longer than expected
4
D
2
null
null
null
null
null
fc834ce0-8bd7-5f81-a7fb-295e986bedf5
Select the correct statement regarding the effects of volatile anesthetics on nondepolarizing neuromuscular blocking drugs and the reversal agents.
Volatile anesthetics potentiate neuromuscular blockade but retard reversal agents
Volatile anesthetics potentiate both neuromuscular blocking drugs and reversal agents
Volatile anesthetics retard both neuromuscular blocking drugs and reversal agents
Volatile anesthetics retard neuromuscular blocking drugs but potentiate reversal agents
4
A
1
null
null
null
null
null
08ac173d-edfb-5be6-8653-0d797b485fa1
Meperidine is contraindicated in patients taking which of the following
Bromocriptine
Trihexyphenidyl (Artane)
Selegiline (Eldepryl)
Amantadine (Symmetrel)
4
C
1
null
null
null
null
null
df8a5bdf-ed37-5955-a7f5-23c27d51e20b
Emergence delirium (ED) occurs most often with
Sevoflurane
Desflurane
Ketamine
Propofol
4
A
1
null
null
null
null
null
115a3920-a623-5c7e-a4c2-628fb234db4b
The most common reason for patients to rate anesthesia with etomidate as unsatisfactory is
PONV
Pain on injection
Recall of intubation
Postoperative hiccups
4
A
1
null
null
null
null
null
66c7489f-ffd7-544f-b207-6a593f36948c
Which of the following muscle relaxants inhibits the reuptake of norepinephrine by the adrenergic nerves?
Pancuronium
Vecuronium
Rocuronium
Atracurium
4
A
1
null
null
null
null
null
5aacfb19-00cd-5619-82d0-78013109c6b8
The most common side effect of oral dantrolene used to prevent MH is
Nausea and vomiting
Muscle weakness
Blurred vision
Tachycardia
4
B
1
null
null
null
null
null
decd7aba-a383-5f43-8d86-c82f16473fc7
A 65-year-old patient is admitted for right upper quadrant pain. Acute cholecystitis is diagnosed, and laparoscopic cholecystectomy planned. The patient has no major medical problems other than type 2 diabetes, for which she takes metformin, and depression, for which she takes paroxetine (selective serotonin reuptake i...
Risk of metabolic acidosis
Risk of hypoglycemia
Risk of serotonin syndrome
None of the above
4
D
2
null
null
null
null
null
422a6fd0-7ff0-5d88-ad8a-798b7c6bedb0
A 37-year-old man is brought to the operating room for repair of a broken mandible sustained in a motor vehicle accident. No other injuries are significant. The patient has been in treatment for alcohol abuse and takes disulfiram and naltrexone. Which of the following would be the best technique for management of this ...
Continue naltrexone with round-the-clock low-dose methadone
Continue naltrexone with small doses of morphine every 4 hours as needed
Continue naltrexone with small doses of nalbuphine every 4 hours as needed
Discontinue naltrexone and treat pain with morphine as needed
4
D
3
null
null
null
null
null
3d7627cc-edab-54be-8ee4-86e11b6e4cd4
Context sensitive half-time for a pharmacologic agent is most closely related its
Lipid solubility
Duration of administration
Concentration
Route of administration
4
A
1
null
null
null
null
null
3d51b85b-2759-54fe-8449-e8dfe048447e
The neuromuscular effects of an intubation dose of vecuronium are terminated by
Diffusion from the neuromuscular junction back into the plasma
Nonspecific plasma cholinesterases
The kidneys
The liver
4
A
1
null
null
null
null
null
e351ad31-8204-58fd-aa93-da6874fcce8d
Respiratory depression produced by which of the following analgesics is not readily reversed by administration of naloxone?
Meperidine
Methadone
Hydromorphone
Buprenorphine
4
D
1
null
null
null
null
null
91e7ccb2-efc1-50d1-9705-140c258e3dc1
Which of the following intravenous anesthetic agents is associated with the highest incidence of nausea and vomiting?
Midazolam
Etomidate
Ketamine
Propofol
4
B
1
null
null
null
null
null
ec1c6c8e-fde9-5509-99b4-7484ba989e37
If naloxone were administered to a patient who is receiving ketorolac for postoperative pain, the most likely result would be
Bradycardia
Hypotension
Pain
None of the above
4
D
2
null
null
null
null
null
df2d4e7a-fe8b-527c-a69d-7a9fdd10772f
Which drug produces strong pulmonary arterial dilation with the least amount of systemic artery dilation?
Nitroprusside
Prostaglandin E1
Phentolamine
Nitric oxide
4
D
1
null
null
null
null
null
88184fc0-b7a4-5779-a813-ba93247be320
The action of succinylcholine at the neuromuscular junction is terminated by which mechanism?
Hydrolysis by pseudocholinesterase
Diffusion into extracellular fluid
Reuptake into nerve tissue
Reuptake into muscle tissue
4
B
1
null
null
null
null
null
a42d7642-c060-5c96-bd35-f55fdf4d808d
The LEAST likely side effect of dexmedetomidine in a healthy patient
Respiratory arrest
Bradycardia
Sinus arrest
Hypotension
4
A
1
null
null
null
null
null