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84c9db7c-2c1f-5c00-adbf-0cbf18be6701 | Each of the following may increase MAC for volatile anesthetics EXCEPT | Cocaine | Hyperthyroidism | Hypernatremia | Tricyclic antidepressants | 4 | B | 1 | null | null | null | null | null |
9cc01dd8-bafe-5c08-a375-f2d6824b0735 | A 37-year-old patient with a history of manic-depressive illness is scheduled to undergo surgery for removal of an intramedullary rod in the left tibia. Which of the following statements regarding potential untoward effects of lithium therapy is NOT true? | Long-term administration may be associated with nephrogenic diabetes insipidus | Administration of succinylcholine to patients treated with lithium may result in hyperkalemia | Long-term therapy may be associated with hypothyroidism | Duration of action of vecuronium may be prolonged | 4 | B | 1 | null | null | null | null | null |
e65f974d-fbac-563b-913e-8311c533581d | Treatment of hypotension in a patient anesthetized for resection of metastatic carcinoid would be best accomplished with | Epinephrine | Ephedrine | Vasopressin (DDAVP) | Octreotide | 4 | D | 2 | null | null | null | null | null |
76720ba3-c139-55c8-904f-774af1aad8bc | You are asked to evaluate a patient in the recovery room after having undergone an exploratory laparotomy for a colonic perforation. Which of the following factors in the quick Sequential Organ Failure Assessment (qSOFA) would be associated with an in-hospital mortality of 10%? | Respiratory rate of 24/min; confusion; blood pressure of 110/60 | Lactate of 3.0 mmol/L; confusion; blood pressure of 110/60 | Lactate of 5.0 mmol/L; confusion; blood pressure of 110/60 | Respiratory rate of 24/min; awake, in pain; blood pressure of 110/60 | 4 | A | 2 | null | null | null | null | null |
e0249eb6-7fe5-557d-98bc-abc2c59c4a5c | A 31-year-old patient has been in the ICU on a ventilator for 24 hours after an MVA. The patient does not open his eyes to any stimulus and has no verbal or motor response. The Glasgow Coma Scale corresponding to this patient would be | 0 | 1 | 2 | 3 | 4 | D | 1 | null | null | null | null | null |
e7e86113-0760-5027-907f-0f9eef66866f | Hypoglycemia is more likely to occur in the diabetic surgical patient with which of the following diseases? | Renal disease | Rheumatoid arthritis requiring high-dosage prednisone | Chronic obstructive lung disease treated with a terbutaline inhaler and aminophylline | Manic-depressive disorder treated with lithium | 4 | A | 1 | null | null | null | null | null |
1d67a492-ba68-51d0-85fd-50207f589fc6 | Which of the following is most likely to be associated with a falsely elevated SaO2 as measured by pulse oximetry (dual wave)? | Hemoglobin F | Carboxyhemoglobin | Methylene blue dye | Fluorescein dye | 4 | B | 1 | null | null | null | null | null |
a37eb58b-4a81-5c05-8772-66cd93e79931 | Select the FALSE statement regarding clinical performance and sleep deprivation | A period of vulnerability has been identified between 2 AM and 7 AM | There is an increased incidence of MVAs in post-call house staff | When patient simulation was used to study sleep deprivation in anesthesia residents, no reduction in clinical performance was demonstrable | After inception of restriction of resident work hours in July 2003, a reduction in patient death rates was shown to be less in hospitals with large numbers of resident physicians versus those with fewer | 4 | D | 1 | null | null | null | null | null |
c0f4976e-1eea-5d12-813b-91fa7fc261fe | Gabapentin (Neurontin) as used in the treatment of chronic pain belongs to the same broad class of drugs as | Carbamazepine | Imipramine | Clonidine | Fluoxetine (Prozac) | 4 | A | 1 | null | null | null | null | null |
47cba30e-1fb9-5a78-ace3-b8b292c71baf | A 47-year-old morbidly obese patient develops bilateral blindness (only able to perceive light) after a 6-hour, three-segment laminectomy and fusion. The patient received 6 units of blood and 5 L of lactated Ringer solution. A mean arterial blood pressure was maintained at 50 to 60 mm Hg. The MOST likely structure invo... | Central retinal artery | Optic nerve | Retina | Cerebral cortex | 4 | B | 2 | null | null | null | null | null |
5f88629c-3ef1-560a-9220-149490ff85fc | Each of the following statements regarding postoperative shivering is true EXCEPT | It may increase metabolism and oxygen consumption significantly | It may be treated with meperidine | It may be treated with droperidol | It does not occur in the absence of hypothermia | 4 | D | 1 | null | null | null | null | null |
674dbe3b-1c49-5b52-abcf-0e9c77d3dece | ECG changes associated with hyperkalemia include | Increased P-wave amplitude | Shortened PR interval | Narrowed and peaked T waves | Increase in U-wave amplitude | 4 | C | 1 | null | null | null | null | null |
7d439f87-6fa6-5faa-9075-f4d7928a966c | A 53-year-old woman presents to the preoperative evaluation clinic before a scheduled pancreaticoduodenectomy. She complains of a 6 month history of dyspnea on exertion, fatigue, palpitations, chest discomfort, and occasionally feeling "like she is about to faint." She has a 40-pack-year history of smoking and a long h... | Absence of P2 heart sounds during auscultation of chest | Left axis deviation in 12-lead ECG tracing | Enlarged aorta in chest x-ray | Partial systolic closure of the pulmonary valve during transesophageal echocardiograph (TEE) evaluation | 4 | D | 2 | null | null | null | null | null |
d0939fe9-6a9b-5ad2-9132-be73cfffb0ac | Each of the following is associated with acromegalic patients undergoing transsphenoidal hypophysectomy EXCEPT | Enlargement of the tongue and epiglottis | Narrowing of the glottic opening | Nasal turbinate enlargement | Continuous positive airway pressure (CPAP) should be used postoperatively because obstructive sleep apnea (OSA) is common | 4 | D | 1 | null | null | null | null | null |
f814ff52-68b8-54a8-9b61-fd0ffe823551 | Evidence of an anaphylactic reaction to atracurium 1 to 2 hours after the episode could be best established by measuring blood levels of | Tryptase | Laudanosine | Histamine | Bradykinin | 4 | A | 1 | null | null | null | null | null |
078082d7-edf7-5211-814a-407cede1b5df | Which of the following findings is NOT consistent with a diagnosis of MH? | PaCO2 150 mm Hg | MVO2 50 mm Hg | pH 6.9 | Onset of symptoms an hour after end of operation | 4 | B | 3 | null | null | null | null | null |
fcf5e84a-3eef-5e22-87b1-c98350ca161a | A 52-year-old business executive undergoes a radical retropubic prostatectomy uneventfully under general isoflurane anesthesia. He takes fluoxetine (Prozac) for depression. Upon discharge, which of the following analgesics would be the best choice for postoperative pain management in this patient? | Oxycodone plus aspirin (Percodan) | Hydrocodone with acetaminophen (Vicodin) | Codeine with acetaminophen (Tylenol No. 3) | Hydromorphone (Dilaudid) | 4 | D | 2 | null | null | null | null | null |
7bd4b9f2-6cd0-52cb-8acc-244c14c6ce63 | The phase of liver transplantation where the greatest degree of hemodynamic instability is expected is | Induction | Dissection phase | Anhepatic phase | Reperfusion phase | 4 | D | 1 | null | null | null | null | null |
06e4e53c-943e-59e4-84b8-7abf128f8868 | After closure of the incision for an open hemicolectomy, an abdominal x-ray is performed in the OR that shows a piece of gauze remaining in the abdomen. The surgeon requests neuromuscular blockade to facilitate retrieval of the retained surgical object. You used rocuronium for the case, which you subsequently reversed ... | Administering cisatracurium would result in a faster-thannormal onset and more potent blockade | No neuromuscular blocking agent other than succinylcholine will be effective at this time | Administering rocuronium or vecuronium would result in the most potent neuromuscular blockade | Sugammadex forms inclusion complexes with benzylisoquinolinium neuromuscular blockers | 4 | A | 2 | null | null | null | null | null |
29358418-b03c-59b8-aea9-f6ae3cd2d017 | Which of the factors in adults listed below is the strongest independent predictor of PONV in most studies? | Female gender | History of PONV | History of migraines | History of cigarette smoking | 4 | A | 1 | null | null | null | null | null |
0717e525-f892-5eeb-8e50-e8aef14f6404 | Near the end of a 3-hour colectomy, the surgeon complains that the patient is not relaxed. Two twitch monitors placed at different locations show only one twitch of a train-of-four. Blood gases are reported to be pH 6.9, CO2 82, K 4.6. The most appropriate action would be | Administer more vecuronium | Administer bicarbonate | Increase minute ventilation | Administer dantrolene | 4 | D | 3 | null | null | null | null | null |
0b4e6262-2c23-51d3-872e-8100ee5d856e | A 22-year-old parturient is anesthetized for an emergency laparoscopic cholecystectomy. She is in the twenty-fourth week of gestation and receives general sevoflurane anesthesia and has received rocuronium for muscle relaxation. Just before emergence, muscle relaxation is reversed with glycopyrrolate and neostigmine. T... | Fetal head compression | Uteroplacental insufficiency | Fetal hypoxia | Reversal agents | 4 | D | 2 | null | null | null | null | null |
d5c57e2f-cee3-5062-9311-4fde8c200410 | A 43-year-old woman with end-stage liver disease is admitted to the ICU. Which therapy is LEAST likely to improve symptoms associated with hepatic encephalopathy (HE)? | Amino acid–rich total parenteral nutrition (TPN) | Neomycin | Lactulose | Flumazenil | 4 | A | 1 | null | null | null | null | null |
97478064-97f3-5aaf-8dad-d78bc0005f66 | Ketorolac is contraindicated in patients undergoing scoliosis surgery because of | Renal effects | Risk of postoperative hemorrhage | Effects on bone healing | Effects on pulmonary function | 4 | C | 1 | null | null | null | null | null |
6a8c63f4-50a3-5a99-9aaf-8de119abc492 | Genetic records show a patient has glucose-6-phosphate deficiency.Which of the drugs below should be avoided during cholecystectomy? | Propofol | Fentanyl | Benzocaine | Bupivacaine | 4 | C | 2 | null | null | null | null | null |
2809d232-6053-579f-befb-c88f2e2b41a1 | Which of the following factors is the greatest predictor of sleep apneas in an adult? | Neck circumference | Micrognathia | Weight | BMI | 4 | A | 1 | null | null | null | null | null |
7da8c8a7-7bb2-53fb-9854-4c8a858f0574 | The greatest number of malpractice claims made against | Eye injury | Brain damage | Nerve damage | Death | 4 | D | 1 | null | null | null | null | null |
b65e86dc-c4ca-5841-a2f0-b54de9da6107 | Resynchronization therapy | Is indicated for short QRS complexes | Is contraindicated in patients with CAD | Requires pacemaker implantation | Is usually accomplished with biphasic defibrillator | 4 | C | 1 | null | null | null | null | null |
3da29b1e-cd5d-5563-8b7e-73e077a0404b | The underlying feature in patients with syndrome X is | Hypertension | Morbid obesity | Hypoglycemia | Insulin resistance | 4 | D | 1 | null | null | null | null | null |
6251573a-e115-516b-ab93-567be07fb404 | A 65-year-old hospitalized patient is being treated for pain from pancreatic cancer and is well controlled on 30 mg IV morphine per day. What is the equivalent total oral daily dosage of morphine in this patient for discharge planning? | 10 mg | 30 mg | 90 mg | 120 mg | 4 | C | 2 | null | null | null | null | null |
ba285f60-9a0e-5891-98b6-3fa001576773 | A 64-year-old patient is brought to the PACU after a 7-hour cosmetic surgery operation under 1.7% sevoflurane anesthesia for the entire case. Which of the following describes the sevoflurane concentration in the | VRG: falling, MG: falling, VPG: rising | VRG: falling, MG: rising, VPG: rising | VRG: rising, MG: falling, VPG: falling | All three compartments (VRG, MG, and VPG) falling | 4 | A | 3 | null | null | null | null | null |
167c6138-34ee-599e-b376-d27941ceb2c4 | You have been asked to see a 13-year-old boy in the preoperative area scheduled for tooth extraction under general anesthesia. The nurse caring for him in the preoperative area has noted that the boy is arguing with his parents and repeatedly stating that he does not want to have surgery. Upon your arrival, the parents... | Informed consent | Distraction | Coercion | Informed assent | 4 | D | 1 | null | null | null | null | null |
ff166983-f386-5a86-a1f6-9cb0cd6d17f7 | Which of the following nerves is NOT derived from a cranial nerve? | Great auricular | Infraorbital | Supratrochlear | Supraorbital | 4 | A | 1 | null | null | null | null | null |
05a768bd-e3f2-58f4-8fc5-06f8487c4abe | A 45-year-old woman is experiencing progressive mental deterioration over a 6-hour period, 5 days after emergency evacuation of a large subarachnoid hemorrhage and clipping of a middle cerebral artery aneurysm. The MOST likely cause for deterioration is | Cerebral edema | Improper placement of the aneurysm clip | Recurrent cerebral hemorrhage | Vasospasm | 4 | D | 2 | null | null | null | null | null |
2fc3a7fa-5547-5420-a7a3-32d9df2702fd | The most common adverse cardiac event in the pediatric population is | Hypotension | Bradycardia | Tachycardia | Bigeminy | 4 | B | 1 | null | null | null | null | null |
117fc0bb-9b73-5020-bb18-39cf3c90eaa7 | Each of the following is a predictor of difficulty with mask ventilation EXCEPT | Presence of beard | BMI greater than 26 | Presence of teeth | Age greater than 55 | 4 | C | 1 | null | null | null | null | null |
4e171f2f-1c20-5322-91ce-9a9bd119ad38 | In a patient with compartment syndrome, which of the following signs would be the last to appear? | Pulselessness | Pain | Paresthesia | Paralysis | 4 | A | 1 | null | null | null | null | null |
88626bab-b686-56bf-b58d-45a100090b0a | Select the TRUE statement regarding the dose per kilogram of body weight and duration, respectively, of local anesthetics for spinals in infants compared with adults. | Greater dose and longer duration | Greater dose and shorter duration | Greater dose and duration is the same | Smaller dose and longer duration | 4 | B | 1 | null | null | null | null | null |
e10402fa-f11d-5ea0-a898-7eeb6ecc655a | A number 6 endotracheal tube indicates which size? | 6-mm internal diameter (ID) | 6-mm external diameter | 6-mm external circumference | 6-mm internal circumference | 4 | A | 1 | null | null | null | null | null |
b3e6ed6f-83c6-5b79-ac76-427e91ac657d | If a patient were to become trapped in the magnetic resonance imaging (MRI) scanner by a metal object and the engineers decided to quench the magnet, the greatest hazard to the patient would be | Heat | Cold | Fire | Noise | 4 | B | 1 | null | null | null | null | null |
356b9967-6e30-54ae-b52f-7bd7315e7000 | During surgery for correction of scoliosis, somatosensory evoked potential (SSEP) monitoring is employed. An increase in SSEP latency and a decrease in amplitude could be explained by each of the following EXCEPT | Anterior spinal artery syndrome | Propofol infusion (200 μg/kg/min) | Hypotension | 2 MAC isoflurane anesthesia | 4 | A | 3 | null | null | null | null | null |
9451f516-0ecb-59af-8ae3-4adc407a8745 | In which of the following conditions would the response to atropine be MOST pronounced? | Diabetic autonomic neuropathy | Brain death | Status post heart transplant | High (C8) spinal anesthesia# General Anesthesia# | 4 | D | 3 | null | null | null | null | null |
9d450e55-d0b9-5ec1-822a-f75948b15d44 | A previously healthy 3.5-kg, 1-month-old infant with a strong family history of sickle cell anemia is brought to the emergency room with an incarcerated inguinal hernia. Which of the following should be carried out before surgery? | Hemoglobin electrophoresis | Peripheral smear | Hematology consultation | None of the above | 4 | D | 2 | null | null | null | null | null |
b3007e00-0d8f-5c1f-badb-c2f1e27eea91 | In the premature newborn, the glottis is at which level relative to the cervical spine? | C3 | C4 | C5 | C6 | 4 | A | 1 | null | null | null | null | null |
c66fcfd3-206e-5603-9464-09d68ea78b10 | A 5-month-old infant is scheduled for an elective operative reduction of a right inguinal hernia. Spinal anesthesia is performed. The first sign of a high spinal block in this patient would be | Decrease in blood pressure | Increase in heart rate | Decrease in oxygen saturation | Asystole | 4 | C | 1 | null | null | null | null | null |
4ea7e7b4-97cc-51cf-8c04-0d035d05fe02 | What percentage of a term newborn's total body weight consists of water? | 45% | 60% | 75% | 90% | 4 | C | 1 | null | null | null | null | null |
65ab321f-c22d-5376-bcfa-6eddba056930 | Which of the following patients is LEAST likely to develop retinopathy of prematurity (ROP)? | A term infant, 46 weeks' postmenstrual age (PMA), exposed to 100% oxygen for 6 hours | A premature infant, 29 weeks' PMA, exposed to a Pao2 of 150 mm Hg for 1 hour | A premature infant, 28 weeks' PMA, never exposed to supplemental oxygen | A cyanotic infant with tetralogy of Fallot, 34 weeks' PMA, receiving supplemental oxygen | 4 | A | 2 | null | null | null | null | null |
d18af32c-dc1d-550b-af16-c764fa73e408 | A 4-week-old male infant is brought to the emergency room with projectile vomiting. At the time of admission, the patient is lethargic, with a respiratory rate of 16 breaths/min and has had no urine output in the preceding 3 hours. A diagnosis of pyloric stenosis is made, and the infant is brought emergently to the ope... | Awake intubation after placing an oral gastric tube | Inhalation induction with sevoflurane with cricoid pressure after placing an oral gastric tube | Awake saphenous IV catheter or an intraosseous needle placement followed by a rapid-sequence induction with ketamine, atropine, and rocuronium after placing an oral gastric tube | Postpone surgery | 4 | D | 2 | null | null | null | null | null |
4c274cbc-2b39-5379-b332-5f6f61bfa639 | The predicted blood volume in a 3-kg term newborn is | 100 mL | 150 mL | 250 mL | 300 mL | 4 | C | 1 | null | null | null | null | null |
832ba56f-c14d-5d7b-9f4d-d245f8d1e0c9 | An 11-month-old infant is to undergo a craniosynostosis repair. The surgeon and anesthesiologist agreed to start transfusing blood when the hemoglobin fell to 8 g/dL (hematocrit [Hct] of 24%). Using the transfusion threshold of a hemoglobin of 8, what is the maximum allowable blood loss (MABL) for this 10-kg infant who... | 180 mL | 200 mL | 320 mL | Cannot be calculated without additional information | 4 | B | 2 | null | null | null | null | null |
7b5d7709-9c43-5ca0-afd4-7ffaa5bd37c8 | What volume of packed red blood cells (PRBCs) with an Hct of 60 is needed to raise the Hct from 18 to 24 in a 10-kg 11-month-old? | 40 mL | 80 mL | 120 mL | Cannot be calculated without additional information | 4 | B | 2 | null | null | null | null | null |
f78a9811-1cab-5d32-bc1f-beabd8f640ea | Reasons for selecting a cuffed endotracheal tube (ETT) over an uncuffed ETT include all of the following EXCEPT | Fewer intubations and ETTs are needed | Less chance for airway fires | Spontaneous breathing is easier | Aspiration of gastric contents is less likely | 4 | C | 1 | null | null | null | null | null |
b263caf5-d040-50fc-8653-ed3c10da2a24 | An otherwise healthy 4-year-old male patient is undergoing elective tonsillectomy. Before induction of general anesthesia, the patient is breathing at a rate of 20 breaths/min. An inhalation induction is begun with 8% sevoflurane, 50% nitrous oxide, and oxygen. Sixty seconds later, the patient is noted to breathe at a ... | Severe hypoxia | Hypercarbia and early development of malignant hyperthermia (MH) | The excitement stage of anesthesia | Aspiration of gastric contents | 4 | C | 2 | null | null | null | null | null |
5e85f827-e7ac-5911-96cb-49ae50308a4c | A healthy 3-kg, 1-month-old neonate is anesthetized for an inguinal hernia repair. An inhalation induction with sevoflurane is carried out, and the patient is intubated. Before the surgical incision, the systolic blood pressure is noted to be 65 mm Hg and the heart rate is 150 beats/min. The most appropriate interventi... | Administration of ephedrine | Administration of phenylephrine | 50-mL fluid bolus | None of the above | 4 | D | 2 | null | null | null | null | null |
75403904-e21a-5ee0-9131-48b92a6674b5 | A 5-year-old boy is anesthetized for elective repair of an umbilical hernia. General anesthesia is induced and maintained with sevoflurane, nitrous oxide, and oxygen via an anesthesia mask. At the conclusion of the operation, the patient is taken to the recovery room and subsequently discharged to the outpatient ward. ... | Discharge the patient with instructions to return if urine color does not normalize | Discharge the patient in 3 hours if no other signs or symptoms are manifested | Obtain serum creatinine and blood urea nitrogen (BUN) levels and discharge the patient if they are normal | Evaluate the patient for MH | 4 | D | 2 | null | null | null | null | null |
bca31b17-24f8-522e-bf58-40e4620dd30d | At what maximum inspiratory pressure should a cuffed ETT leak in a child (leak test)? | 5 to 15 cm H2O | 15 to 25 cm H2O | 25 to 35 cm H2O | None of the above | 4 | B | 1 | null | null | null | null | null |
55dcb91f-43e4-5b1a-a86d-4d625a4dca5e | A premature newborn delivered at 32 weeks of gestation is brought to the OR 5 days after delivery for repair of a left-sided congenital diaphragmatic hernia (CDH). The newborn has a nasogastric tube in place, is intubated, and is stable with mechanical ventilation at peak airway pressures < 25 cm H2O. 30 minutes after ... | Pull the ETT from the right mainstem bronchus | Ventilate with positive end-expiratory pressure (PEEP) and administer furosemide | Place a chest tube on the right side after confirming a tension pneumothorax | Pull out the ETT, mask ventilate, and reintubate the patient | 4 | C | 3 | null | null | null | null | null |
1266d46f-6e41-58f8-86d5-d0012ce757a6 | An 8-year-old boy, who weighs 30 kg, was found at the site of a motor vehicle accident (MVA). He has arrived in the OR for exploratory laparotomy. He has not received any sedation or pain medication because he appeared "confused and lethargic." He has a normal blood pressure, is tachycardic with thready distal pulses, ... | < 20% | 25% | 40% | Cannot determine | 4 | B | 2 | null | null | null | null | null |
c761b507-3fea-563a-8ee7-b56288c3f07c | In a 6-year-old child, the distance an oral ETT should be placed (from the gums to the midtrachea) most often is | 10 cm | 13 cm | 15 cm | 20 cm | 4 | C | 2 | null | null | null | null | null |
17bd8bf3-e7ee-5cb2-a145-d4caaeddde9f | Which of the following is the most suitable intraoperative replacement fluid for a 3-year-old, 14-kg child who has been NPO for 10 hours and will be undergoing repair of clubfeet? | D5W | D5 in 0.2 NaCl | D5 in 0.45 NaCl | Lactated Ringer solution | 4 | D | 2 | null | null | null | null | null |
b5031483-3ce4-53b0-854c-f20e54e6d0be | An otherwise healthy 14-day-old neonate is transported to the OR well hydrated for surgery for a bowel obstruction. A rapid-sequence induction is planned. Compared with the adult dose, the intravenous (IV) dose of succinylcholine administered to this patient should be | Diminished because of the immature nervous system | The same as the adult dose | Decreased because of decreased acetylcholine receptors | Increased because of a greater volume of distribution | 4 | D | 2 | null | null | null | null | null |
d332f457-7d20-55cb-926a-94a1ae97448c | You receive a call from the preoperative nurse stating that the child you will be caring for with type 1 diabetes mellitus has a preoperative blood glucose value of 300 mg/dL. He has been NPO for the morning and has not had any rapid-onset or short-acting insulin. The child typically uses a total of 30 units of insulin... | 1 unit | 3 units | 5 units | 10 units | 4 | B | 2 | null | null | null | null | null |
86f0980b-936d-5532-bf58-479a3432d7e2 | A 10-week-old infant born at 31 weeks' gestation is anesthetized for repair of an inguinal hernia. General anesthesia is induced by mask with sevoflurane, an ETT is placed, and anesthesia is maintained with | Caudal block with 0.25% bupivacaine, 1 mL/kg, and admitted to a pediatric ward for overnight observation | Caudal block with 0.25% bupivacaine, 2 mL/kg, and admitted to a pediatric ward for overnight observation | Oral pain medication (acetaminophen) and discharged home | Fentanyl (1 mL = 50 μg IV), and admitted to a pediatric ward for overnight observation | 4 | A | 2 | null | null | null | null | null |
686a76ae-8ec7-58f6-a89e-018d081cdf0b | A 6-year-old, 20-kg girl develops pulseless ventricular tachycardia (pVT) after induction of general anesthesia for a tonsillectomy. The anesthesiologist intubates the child, administers 100% oxygen, and starts chest compressions. When the biphasic defibrillator quickly arrives in the OR and is attached to the child, t... | 10-20 joules (J) | 20-30 joules (J) | 40-80 joules (J) | 120-200 joules (J) | 4 | C | 2 | null | null | null | null | null |
abb0cb36-9cd1-5852-8c3b-ec1f17c9296a | The spinal cord of newborns extends to the | L1 vertebra | L2-L3 vertebrae | L4-L5 vertebrae | S1 vertebra | 4 | B | 1 | null | null | null | null | null |
33029417-0bbc-509f-b498-96fdb6b92656 | The most common initial symptom of esophageal atresia (EA) or tracheoesophageal fistula (TEF) is | Respiratory distress at delivery (e.g., retractions, tachypnea) | Projectile vomiting | Hypoxia | Coughing and regurgitation during first feeding | 4 | D | 1 | null | null | null | null | null |
97eb5cfe-9365-592d-8857-655796d671dd | A 4.5-kg, 3-hour-old newborn with Beckwith-Wiedemann syndrome is scheduled for surgical repair of an omphalocele. Which of the following is NOT part of this syndrome? | Large fontanelles | Macroglossia | Polycythemia | Hyperglycemia | 4 | D | 1 | null | null | null | null | null |
6fa25e99-2438-5aca-a0d6-0302eee1901e | Which of the following is the LEAST appropriate technique for induction of general anesthesia in a newborn for surgical repair of a TEF? | Awake tracheal intubation | Sedated tracheal intubation (e.g., fentanyl) | Inhalation induction with spontaneous ventilation and tracheal intubation | Inhalation induction with cisatracurium as a muscle relaxant and positive-pressure bag and mask ventilation and tracheal intubation | 4 | D | 2 | null | null | null | null | null |
f496c477-21a1-55f4-b0eb-f24b6282a8e1 | A 3-year-old with cough, sore throat, and temperature of 102° F, is scheduled for hydrocele repair. Physical examination reveals wheezing and rhonchi. Chest x-ray reveals small left lower lobe (LLL) infiltrate. The best course of action would be | Administer IV steroids and proceed | Administer acetaminophen and if the temperature goes below 100° F, proceed | Postpone surgery for at least 4 weeks | Proceed, because the temperature will return to normal during anesthesia | 4 | C | 2 | null | null | null | null | null |
4e40da06-1bf8-5bc3-839f-75b6eb69dba3 | Which of the following statements regarding teeth is INCORRECT? | Primary teeth start to erupt around 6 to 9 months of age | There are 20 primary teeth, and all are usually present by 3 years of age | Permanent teeth start to erupt at 4 years of age | There are 32 permanent teeth, and most are present by 12 years of age, except for the third molars, which erupt at 15 to 25 years of age | 4 | C | 1 | null | null | null | null | null |
1f85caf1-18c4-5c21-af99-cbe85c001c14 | The pulmonary vascular resistance (PVR) in newborns decreases to that of adults by age | 1 to 2 days | 1 to 2 weeks | 1 to 2 months | 1 year | 4 | C | 1 | null | null | null | null | null |
1c7b04fa-580c-5ccb-b545-1e6cc6646ebb | A 10-month-old infant is undergoing elective repair of a left testicular hydrocele under general anesthesia with isoflurane, nitrous oxide, oxygen, and fentanyl. All of the following are effective and reasonable | Placement of an infrared heater over the operating table and prewarming the OR | Covering the OR table with a heating blanket | Wrapping the extremities with sheet wadding and covering the head with a cloth cap | Ventilating the patient with a Mapleson D circuit at low gas flows (e.g., 50 mL/kg/min) | 4 | D | 2 | null | null | null | null | null |
8adcbff8-67b8-5fef-a916-d35eb83d1944 | Postoperative mechanical ventilation is common after repair of the following lesions. Which of the following is MOST likely to result in central postoperative depression of spontaneous ventilation in a term newborn? | Gastroschisis | Omphalocele | TEF | Pyloric stenosis | 4 | D | 2 | null | null | null | null | null |
27f9facf-ae5a-5e92-9d6b-5baaa60dcf45 | A premature male neonate born at 36 weeks of gestation is scheduled to undergo repair of a left-sided diaphragmatic hernia. Which of the following vessels could be cannulated for preductal arterial blood sampling? | Femoral artery | Umbilical artery | Right radial artery | Left radial artery | 4 | C | 1 | null | null | null | null | null |
b40a9b40-d082-5d33-adde-0f9b61125d90 | In which of the following patients would the minimum alveolar concentration (MAC) for isoflurane be the greatest? | A premature infant 30 weeks' postconceptual age (PCA) | Full-term neonate | 3-month-old infant | 13-year-old adolescent | 4 | C | 2 | null | null | null | null | null |
79d484b5-2685-566b-87f2-6c8a7aee2dd2 | A 40-kg, 10-year-old child sustains a thermal injury to his legs, buttocks, and back. The estimated area involved is 50%. Using only crystalloid fluids, how much fluid should be administered during the first 24 hours after the burn? | 2.5 L | 5.5 L | 8.0 L | 10.0 L | 4 | C | 2 | null | null | null | null | null |
535705b6-967c-5f92-984e-cc642f2b1f25 | An otherwise healthy 3-month-old black female infant who had a hemoglobin value of 19 mg/dL at birth presents for elective repair of an inguinal hernia. Her preoperative hemoglobin is 10 mg/dL. Her father has a history of polycystic kidney disease. The most likely explanation for this patient's anemia is | Sickle cell anemia | Iron deficiency | Undiagnosed polycystic kidney disease | It is a normal finding | 4 | D | 1 | null | null | null | null | null |
db869d42-6880-5280-aa80-0e66f02ffdb1 | The anesthesiologist is called to the emergency room by the pediatrician to help manage a 3-year-old boy with a high fever and upper airway obstruction. His mother stated that earlier that afternoon, he complained of a sore throat and hoarseness. The patient is sitting erect and leaning forward; has inspiratory stridor... | Aerosolized racemic epinephrine | Awake tracheal intubation in the emergency room or the OR if time permits | Transfer to the OR, inhalation induction, and tracheal intubation | Transfer to the OR, IV induction, paralysis with succinylcholine, and tracheal intubation | 4 | C | 3 | null | null | null | null | null |
6702886c-829f-55f2-9105-46b74514bd5c | A 2-year-old child with cerebral palsy (CP) and known severe gastroesophageal reflux (with frequent nightly aspiration) and a seizure disorder is scheduled to undergo iliopsoas release under general anesthesia. Which of the following would be the preferred technique for inducing general anesthesia in this patient? | Inhalation induction with sevoflurane followed by tracheal intubation | IV induction with propofol followed by laryngeal mask airway | IV induction with etomidate and vecuronium followed by tracheal intubation | Rapid-sequence induction with propofol and succinylcholine followed by tracheal intubation | 4 | D | 2 | null | null | null | null | null |
d9af4bf7-a207-500b-bf58-e155d1377ffa | A 7-week-old male infant is admitted to the pediatric intensive care unit (ICU) with a bowel obstruction. His laboratory values are sodium 120 mEq/L, chloride 85 mEq/L, glucose 85 mg/dL, and potassium 2.0 mEq/L. Respiratory rate is 40 breaths/min, heart rate is 220 beats/minute, and blood pressure is 50/32. According t... | D2.5W with 0.45 sodium chloride and 20 mEq/L potassium chloride | 0.45% sodium chloride | 0.9% sodium chloride with 30 mEq/L potassium chloride | 0.9% sodium chloride | 4 | D | 3 | null | null | null | null | null |
b36f268e-b0d4-5a11-8f11-732db3697b9d | A 24-hour-old, 1200-g neonate, 30 weeks' estimated gestational age (EGA), is noted in the ICU to begin making twitching movements. Blood pressure is 45/30, heart rate is 160, oxygen saturation is 88%, blood glucose is 50 mg/dL, total calcium level is 4 mg/dL, and urine output is 5 mL/hr. The MOST appropriate course of ... | Administer calcium gluconate (1 mL of 10% solution) over 5 to 10 minutes | Administer glucose 200 mg/kg (D10W) IV over 5 minutes | Hyperventilate with 100% O2 | Administer a 10-mL/kg bolus of 5% albumin | 4 | D | 3 | null | null | null | null | null |
ea1a5c4b-0160-597c-8df8-b3e37266142c | A Eutectic Mixture of Local Anesthetics (EMLA) cream is a mixture of which local anesthetics? | Lidocaine 2.5% and prilocaine 2.5% | Lidocaine 2.5% and benzocaine 2.5% | Prilocaine 2% and benzocaine 2% | Lidocaine 4% | 4 | A | 1 | null | null | null | null | null |
f930c2dd-6002-5c7e-9960-fd7bf3273cd0 | Advantages of catheterization of the umbilical artery versus the umbilical vein in a newborn include all of the following EXCEPT | It allows assessment of oxygenation | Hepatic damage from hypertonic infusion is avoided | It permits assessment of systemic blood pressure | It is easier to cannulate | 4 | D | 1 | null | null | null | null | null |
9f7112d0-cbea-538c-9f32-aa37d434d168 | The TRUE statement concerning thermoregulation in neonates is which of the following? | A significant proportion of their heat loss can be accounted for by their small surface area*–*to-weight ratio | They compensate for hypothermia by shivering | The principal method of heat production is metabolism of brown fat | Heat loss through conduction can be reduced by humidification of inspired gases | 4 | C | 1 | null | null | null | null | null |
b39dfec7-4a51-5ed6-9586-d6040148dfe2 | A 10-year-old child was climbing a tree and fell, sustaining a lower cervical neck injury. He is unable to move his legs but can move his arms somewhat and is scheduled for an MRI scan. All of the following are signs of neurogenic shock EXCEPT | Hypotension | Narrow pulse pressure | Hypothermia | Normal heart rate | 4 | B | 1 | null | null | null | null | null |
2db56e0f-839e-577c-8aae-4e3e77151123 | A 5-year-old child undergoing strabismus surgery under general anesthesia suddenly develops sinus bradycardia and intermittent ventricular escape beats but is hemodynamically stable. Which initial therapy is appropriate for treating this arrhythmia? | Tell the surgeon to stop pulling on the eye muscle | Tell the surgeon to do a retrobulbar block | Decrease the depth of the volatile anesthetic | Administer atropine | 4 | A | 2 | null | null | null | null | null |
79e34989-875f-5c67-a61e-21ad32f47604 | Which of the following respiratory indices is increased in healthy neonates compared with healthy adults? | Tidal volume (mL/kg) | Minute ventilation (mL/kg/min) | Functional residual capacity (mL/kg) | Paco2 | 4 | B | 1 | null | null | null | null | null |
28603776-6631-5e75-ad5c-e77371329bd4 | A 16-year-old girl with neurofibromatosis is anesthetized for resection of an acoustic neuroma. Each of the following may potentially complicate the anesthetic management of this patient EXCEPT | Presence of a pheochromocytoma | Upper airway obstruction from a laryngeal neurofibroma | Intracranial hypertension | Increased risk for MH | 4 | D | 1 | null | null | null | null | null |
88cd853b-9818-5fee-82ef-373746357966 | Which of the following is NOT CONSISTENT with an infant who suffers from severe dehydration? | 15% weight loss | Normal respirations | Urine output < 0.5 mL/kg/hr | Tachycardia | 4 | B | 2 | null | null | null | null | null |
e479f76c-bdbc-5ada-b02b-673e99087040 | Postoperative bleeding following tonsillectomy occurs most commonly | By the first 6 hours | 6 to 24 hours after surgery | On the third postoperative day | On the seventh postoperative day | 4 | A | 1 | null | null | null | null | null |
79c07847-2b69-5050-85be-a20e83862372 | A 9-year-old undergoing sinus surgery is treated with an unmeasured amount of 0.5% phenylephrine by the surgeon, and the patient develops a blood pressure of 250/150. The most appropriate treatment for this would be | Administer verapamil | Administer esmolol | Administer labetalol | Administer phentolamine | 4 | D | 2 | null | null | null | null | null |
99e080db-59ee-53d4-8a73-c8abc378e05a | A 5-kg, 3-month-old male infant undergoes a left inguinal herniorrhaphy with a spinal anesthetic. Typically, how long would 1 mL of a 0.5% bupivacaine (5 mg) isobaric solution last? | Less than 30 minutes | 30 to 60 minutes | 60 to 80 minutes | 90 to 100 minutes | 4 | C | 1 | null | null | null | null | null |
da15a022-c3b2-5f9f-a0d2-01b1902cdb9b | Which of the following combination of drug and dose used alone is INCORRECT for preoperative sedation for an anxious child? | Midazolam 0.1 mg/kg orally | Clonidine 2 to 5 μg/kg orally | Dexmedetomidine 1 to 2 μg/kg nasally | Ketamine 3 to 7 mg/kg intramuscular (IM) | 4 | A | 1 | null | null | null | null | null |
83ade90d-118d-5533-8495-4d2f13ee016e | Which of the following statements regarding resuscitation of the infant by health care providers is NOT correct? | Mouth-to-mouth or mouth-to-nose ventilation at a rate of 12 to 20 breaths/min is performed when breathing is inadequate but an adequate pulse is present | Start chest compressions when the pulse is less than 60 beats/min and there are signs of poor tissue perfusion | Chest compression depth is 1/5 the anteroposterior diameter of the chest (about 1 cm) | Compression-to-ventilation ratio is 30:2 for one-person and 15:2 for two-person cardiopulmonary resuscitation (CPR) | 4 | C | 1 | null | null | null | null | null |
66a33122-b0e9-55c7-a9e3-92cd56a037ca | All of the following are true statements concerning the physiology of newborns compared with that of adults EXCEPT | Newborns have a greater percentage of total body water compared with adults | Newborns have a higher glomerular filtration rate (GFR) than adults | Newborns' hearts are relatively noncompliant compared with adults' hearts | Newborns' diaphragms have a lower proportion of type I muscle fibers (i.e., fatigue-resistant, highly oxidative fibers) | 4 | B | 1 | null | null | null | null | null |
a423568c-9eb3-5a80-818b-e7aa82c334f0 | Which of the following statements concerning the anatomy of the infant and the adult airway is INCORRECT? | The larynx is in a more cephalic position in infants than in adults | The infant's epiglottis is narrower and "omega" shaped, whereas the adult epiglottis is flat and broad | The vocal cords are in a more perpendicular position to the trachea in infants and in a more diagonal position to the larynx and trachea in adults | The narrowest part of the infant and adult larynx is at the level of the cricoid cartilage | 4 | C | 1 | null | null | null | null | null |
7991b6ec-7ff8-542c-8d21-7c0ff1e6f723 | Which of the following operations would be associated with the LEAST incidence of postoperative nausea and vomiting (PONV) in a 5-year-old boy? | Tonsillectomy | Strabismus surgery | Myringotomy tube placement | Orchiopexy | 4 | C | 1 | null | null | null | null | null |
45326e95-95d7-5503-96c6-9a5a2f4aea63 | Anomalies and features associated with Down syndrome include | Smaller tracheas | Atlanto-occipital instability | Thyroid hypofunction | All of the above | 4 | D | 1 | null | null | null | null | null |
809d9bf2-053b-5685-a49d-60968eb19754 | Congenital syndromes frequently associated with cardiac abnormalities include all of the following EXCEPT | Tracheoesophageal fistula (TEF) | Meningomyelocele | Omphalocele | Gastroschisis | 4 | D | 1 | null | null | null | null | null |
218c1573-49b1-5abe-8517-b024c486294d | Appropriate management of a neonate born with congenital diaphragmatic hernia (CDH) should include | Insertion of an orogastric or nasogastric tube | Expansion of the hypoplastic lung with positive-pressure ventilation | Hyperventilation to keep the PaCO2 below 40 and the pH greater than 7.40 | Rapid transport to the OR for surgical correction | 4 | A | 2 | null | null | null | null | null |
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