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18a85d3d-bf42-593f-8fee-ebd10593f1f2 | By what percentage does cerebral blood flow (CBF) change for each mm Hg *decrease* in Paco2 in a previously normotensive patient with a severe brain injury? | 2% to 4% increase | 2% to 4% decrease | 7% to 10% decrease | 7% to 10% increase | 4 | B | 1 | null | null | null | null | null |
5a2409aa-f8ad-5215-98b7-98603ba9eb7c | Which of the following intravenous (IV) anesthetic induction agents is relatively contraindicated in patients with intracranial hypertension? | Propofol | Etomidate | Ketamine | Thiopental | 4 | C | 1 | null | null | null | null | null |
1e7a67ad-3c42-5f4f-ad44-ca38026f8b1c | The term *cerebral steal* refers to a situation that occurs in the brain when | Blood flow has resumed after a period of ischemia | Blood flow is directed from a normal region of the brain to an ischemic region | Vasoparalysis exists with hypercarbia | The Robin Hood phenomenon exists | 4 | C | 1 | null | null | null | null | null |
345f3cbe-f838-5b98-89a9-c3dd4687c59d | A 62-year-old patient is scheduled to undergo resection of a large frontal lobe intracranial tumor under general anesthesia. Preoperatively, the patient is alert and oriented, and has no focal neurologic deficits. Within what range should Paco2 be maintained during surgery? | 15 and 20 mm Hg | 30 and 35 mm Hg | 40 and 45 mm Hg | 45 and 50 mm Hg | 4 | B | 2 | null | null | null | null | null |
5af58de4-9645-5900-bfec-d20db20ab8ae | A 32-year-old patient is anesthetized for resection of a supratentorial tumor. Preoperatively, the patient is lethargic and disoriented. Which of the following is MOST likely to adversely alter ICP? | 5% Dextrose in water | Normal saline | Lactated Ringer solution | 5% Albumin | 4 | A | 2 | null | null | null | null | null |
c4229b2d-14ea-5cad-81fa-af0ba5de0a0c | A 22-year-old patient is anesthetized for resection of a temporal lobe tumor. Preoperatively, he is lethargic and confused. After induction of general anesthesia, which of the following would be the MOST appropriate drug to control systemic arterial BP (160/100) during direct laryngoscopy and tracheal intubation? | Esmolol | Nitroprusside | Hydralazine | Isoflurane | 4 | A | 2 | null | null | null | null | null |
522cde54-ff82-58f0-8279-59ba7e9c14be | Normal global cerebral blood flow (CBF) is | 25 mL/100 g brain tissue/min | 50 mL/100 g brain tissue/min | 75 mL/100 g brain tissue/min | 100 mL/100 g brain tissue/min | 4 | B | 1 | null | null | null | null | null |
560649bf-b954-5ac4-b6a9-a156af007871 | CBF remains constant between cerebral perfusion pressure (CPP)s of | 25 and 125 mm Hg | 25 and 200 mm Hg | 40 and 250 mm Hg | 50 and 150 mm Hg | 4 | D | 1 | null | null | null | null | null |
bcd14584-6c0e-5bd4-b0e1-4a42bcd3caa5 | All of the following are true concerning vagal nerve stimulator (VNS) placement for the treatment of medically refractory seizures EXCEPT | Patients should not take their anticonvulsant medications before the surgery | Placement is usually performed under general anesthesia | The electrode array is placed around the left vagus nerve | Hoarseness occurs about 50% of the time | 4 | A | 1 | null | null | null | null | null |
c66528b5-086b-5d77-9d4e-d42a92162f06 | Select the FALSE statement concerning autonomic hyperreflexia. | Distention of a hollow viscus below the level of the spinal cord transection can elicit autonomic hyperreflexia | Up to 85% of patients with a spinal cord transection above the T5 dermatome will exhibit autonomic hyperreflexia | Propranolol alone is especially effective in treating hypertension associated with autonomic hyperreflexia | Spinal anesthesia can be effective in preventing autonomic hyperreflexia | 4 | C | 1 | null | null | null | null | null |
e734e378-4194-554a-ac19-0f33d92b4758 | What is the normal cerebral metabolic rate for oxygen (CMRO2 ) per minute? | 0.5 mL of oxygen/100 g brain tissue/min | 2.0 mL of oxygen/100 g brain tissue/min | 3.5 mL of oxygen/100 g brain tissue/min | 7.5 mL of oxygen/100 g brain tissue/min | 4 | C | 1 | null | null | null | null | null |
bf7297ba-3544-5c5e-b16d-d76542df198c | A 14-year-old girl with severe scoliosis is to undergo spine surgery. Anesthesia is maintained with propofol, remifentanil, and N2O 50% in | Increased amplitude and increased latency | Decreased amplitude and increased latency | Decreased amplitude and decreased latency | Increased amplitude and decreased latency | 4 | B | 1 | null | null | null | null | null |
d3121a9a-773a-5efc-9f9c-a7355d150662 | For each 1° C decrease in body temperature, how much will cerebral metabolic rate (CMRO2 ) be diminished? | 2% | 4% | 6% | 10% | 4 | C | 1 | null | null | null | null | null |
b7a17dcb-613c-58c9-99c9-7355f8230a79 | A 24-year-old carpenter is treated for a closed head injury sustained 3 days earlier after falling from a roof. He has been hemodynamically stable. Despite aggressive efforts to pharmacologically reduce ICP, he is now unconscious and unresponsive to painful stimuli. All of the following are clinical criteria consistent... | Persistent apnea for 10 minutes | Absence of pupillary light reflex | Persistent spinal reflexes | Decorticate posturing | 4 | D | 1 | null | null | null | null | null |
7388c7ce-3b45-5a51-8f1e-d61c6aaa9dc3 | A 60-year-old man is to undergo posterior fossa surgery in the sitting position. Which of the following is the MOST sensitive means of detecting venous air embolism (VAE)? | Esophageal stethoscope | End-tidal CO2 | Transesophageal echocardiography (TEE) | Precordial Doppler | 4 | C | 1 | null | null | null | null | null |
0a4102cb-09f9-58ec-aa71-d327ae99598b | When intracranial hypertension exists, the main initial compensatory mechanism from the body is | Decreased production of CSF | Increased absorption of CSF in the spinal arachnoid villi | Shifting of CSF from intracranial to spinal subarachnoid space | Reduction of cerebral blood volume (CBV) due to compression of intracranial arteries | 4 | C | 1 | null | null | null | null | null |
84d0af63-0be8-5503-90c5-3e98d59a0084 | Administration of vecuronium during spinal surgery may interfere with monitoring of | Dorsal columns | Corticospinal tract | ECoG (Electrocorticography) | Bispectral index | 4 | B | 2 | null | null | null | null | null |
2c1d51ab-03d4-50b6-a5fa-2a3ff246a3c9 | Patients can be safely imaged in the magnetic resonance imaging (MRI) scanner with conventional versions of which of the following monitors? | Pulmonary artery catheter with cardiac output probe | Foley catheter with temperature probe | Electrocardiography (ECG) electrodes | Arterial line | 4 | D | 1 | null | null | null | null | null |
357078ae-0831-556f-81f9-f7072193facf | What is the minimum quantity of intracardiac air that can be detected by a precordial Doppler? | 0.25 mL | 5.0 mL | 10 mL | 25 mL | 4 | A | 1 | null | null | null | null | null |
a636dbaf-4855-56cc-ac8e-c0ecc30ace76 | Which of the following drugs at high doses CANNOT produce an isoelectric electroencephalogram (EEG)? | Etomidate | Isoflurane | Midazolam | Propofol | 4 | C | 1 | null | null | null | null | null |
c8881f15-0856-5dbf-b84d-44621e582677 | Which of the following statements is FALSE concerning cerebral blood flow (CBF)? | CBF is coupled with metabolic demand | CBF is 10% to 20% of the cardiac output during the first 6 months of life | CBF peaks at 55% of the cardiac output between 2 and 4 years of age | CBF decreases to 35% of the cardiac output at 10 years of age | 4 | D | 1 | null | null | null | null | null |
1e0c2835-f7ed-51a8-86dc-efc7274c47db | At what level of cerebral blood flow (CBF) does the EEG start to show signs of cerebral ischemia? | 5 mL/100 g brain tissue/min | 10 mL/100 g brain tissue/min | 20 mL/100 g brain tissue/min | 25 mL/100 g brain tissue/min | 4 | C | 1 | null | null | null | null | null |
a99210c2-02c1-560a-8e38-30045eb1fdf9 | What effect does cerebral ischemia have on CBF autoregulation? | CBF autoregulation is abolished and becomes passively dependent on CPP | CBF autoregulation is ablated at low CPPs but remains intact at high CPPs | CBF autoregulation is ablated at high CPPs but remains intact at low CPPs | The CBF autoregulatory curve is shifted to the right | 4 | A | 1 | null | null | null | null | null |
33ab8c64-c22f-5a15-a908-b5d6316bc625 | Which of the following is the MOST rapid maneuver available for lowering ICP in a patient with a large intracranial mass? | Mannitol, 1 g/kg IV | Methylprednisolone, 30 mg/kg IV | Hyperventilation to 25 mm Hg Paco2 | Furosemide, 1 mg/kg IV | 4 | C | 1 | null | null | null | null | null |
ee3e8c13-3f49-569b-8004-31022c35b976 | What effect does propofol have on the CO2 responsiveness of the cerebral vasculature? | Propofol attenuates the effect of hypocarbia on CBF | Propofol attenuates the effect of hypercarbia on CBF | Propofol augments the effect of hypocarbia on CBF | Propofol does not affect CO2 reactivity at a dose used clinically | 4 | D | 1 | null | null | null | null | null |
0757a989-358a-5448-9c04-115925710c19 | Cerebral autoregulation is MOST likely to remain intact | Immediately after cerebral aneurysm rupture | In a patient with traumatic brain injury (TBI) and a- Glasgow Coma Scale (GCS) score of 3 | With total IV anesthesia (TIVA) anesthetic using propofol | With 2.5% end-tidal sevoflurane anesthesia | 4 | C | 1 | null | null | null | null | null |
8c566ad9-ff5e-5e3d-a93e-caa5410f7118 | A 72-year-old patient undergoing resection of an astrocytoma in the sitting position suddenly develops hypotension. Air is heard on the precordial Doppler ultrasound. Each of the following therapeutic maneuvers to treat VAE is appropriate EXCEPT | Discontinue N2O | Apply jugular venous pressure | Implement positive end-expiratory pressure (PEEP) | Administer epinephrine to treat hypotension | 4 | C | 2 | null | null | null | null | null |
f429c75d-0599-564d-9837-156d6763fa82 | Which of the following is the LEAST likely sequela of venous air embolism (VAE) during posterior fossa surgery in the upright position? | Increase in pulmonary dead space | Bronchoconstriction | Stroke | Pulmonary hypotension | 4 | D | 2 | null | null | null | null | null |
0e5c50c0-edaa-5d16-80d6-904500e3aa38 | A 30-year-old anxious patient is to undergo Electrocorticography (ECoGH) monitoring to identify epileptogenic foci during seizure surgery. All of the following drugs may make it easier to identify the epileptogenic foci EXCEPT? | Alfentanil (20 mcg/kg) | Dexmedetomidine (1 mcg/kg over 10 minutes) | Etomidate (0.2 mg/kg) | Methohexital (20-50 mg) | 4 | B | 1 | null | null | null | null | null |
01cd32d0-d4a1-5e58-8682-551e89b217d4 | How long after a stroke should surgery be deferred for an elective surgical procedure? | 1 week | 6 weeks | 6 months | 1 year | 4 | B | 1 | null | null | null | null | null |
56884fce-6d2d-5c5d-887c-605bd128a4ab | A 13-year-old boy is anesthetized with a propofol infusion and remifentanil infusion for scoliosis repair. SSEP monitoring is conducted during the procedure. Which of the following structures is NOT | Corticospinal tract | Medial lemniscus | Ipsilateral dorsal column of the spinal cord | Thalamus | 4 | A | 1 | null | null | null | null | null |
b1eb7973-ccc2-5ad0-9e38-9223f88eda7c | A 19-year-old woman with scoliosis is undergoing surgery with Harrington rod placement under general anesthesia with SSEP monitoring. General anesthesia is administered with desflurane, nitrous oxide, and fentanyl. After completion of spinal instrumentation, the SSEP monitoring is equivocal and a wake-up test is undert... | 3 mg neostigmine plus 0.6 mg glycopyrrolate IV | 0.04 mg naloxone IV | 0.1 mg flumazenil IV | Reduce the distraction on the rods | 4 | B | 3 | null | null | null | null | null |
22d2ff40-3320-5bea-aeb0-bea35b79e10f | A 75-year-old patient is undergoing craniotomy for resection of a large astrocytoma. During administration of isoflurane anesthesia, the BP is 110/80 and the arterial blood gas sampling reveals a Paco2 of 30 mm Hg. | 15 mL/100 g brain tissue/min | 25 mL/100 g brain tissue/min | 35 mL/100 g brain tissue/min | 45 mL/100 g brain tissue/min | 4 | C | 3 | null | null | null | null | null |
e08b0c19-3a90-5dd7-8806-028e6dac5b27 | A 24-year-old patient is brought to the ICU after sustaining a closed head injury in a motor vehicle accident. Each of the following would be useful in managing intracranial hypertension in this patient EXCEPT | Corticosteroids | Propofol | Hyperventilation to a Paco2 of 35 mm Hg | Osmotic diuretics | 4 | A | 1 | null | null | null | null | null |
9ee244e3-4066-599f-a98a-4e137756f14b | Which of the following frequency ranges is seen on the EEG in the normal awake patient? | Delta (< 4 Hz) | Theta (4-7 Hz) | Alpha (8-13 Hz) | Beta (> 13 Hz) | 4 | D | 1 | null | null | null | null | null |
17e0839a-991f-5e99-89f7-32f60f068415 | A 75-year-old patient with signs and symptoms of an SAH is brought to the emergency room for evaluation. T-wave inversion, a prolongation of the QT interval, and U waves are noted on the preoperative ECG. Appropriate action at this point would be to | Begin infusion of nitroglycerin | Check serum calcium and potassium | Administer esmolol | Place a pulmonary artery catheter | 4 | B | 2 | null | null | null | null | null |
39d91b14-c0e2-511c-94af-b706df26fe25 | Which of the following pharmacologic agents would have the LEAST effect on transcranial motor evoked potentials (MEPs)? | Isoflurane | Nitrous oxide | Etomidate | Fentanyl | 4 | D | 1 | null | null | null | null | null |
70728108-dffb-5aef-ba40-8e4c7d56aa11 | A 75-year-old man with medically refractory Parkinson disease is to undergo deep brain stimulation (DBS). Each of the following statements about DBS is true EXCEPT | DBS device can be placed with patients awake, slightly sedated, or with general anesthesia | Dexmedetomidine is most often used for sedation and analgesia | Midazolam is contraindicated for sedation | Patients will need anticonvulsants for the associated seizures in over 50% of patients | 4 | D | 1 | null | null | null | null | null |
014aee6c-5a25-56a8-94f5-a92fc61e0959 | CMR and CBF are decreased by | Dexmedetomidine | Seizure | Hyperthermia | Ketamine | 4 | A | 1 | null | null | null | null | null |
8e042ad3-72c7-5e72-b1b5-0e739f916dae | Which of the following statements is FALSE concerning the blood supply to the central nervous system? | 70% of the brain's blood supply comes from the right and left internal carotid arteries; the remaining 30% comes from the two vertebral arteries | Each internal carotid artery divides into three branches: the anterior cerebral artery, the posterior communicating artery, and the middle cerebral artery | The vertebral arteries connect directly to the posterior communicating arteries, forming the circle of Willis | The spinal cord gets its blood supply from one anterior spinal artery and two posterior spinal arteries | 4 | C | 1 | null | null | null | null | null |
b63fa2fb-e045-5d35-9214-ff1ee0da2546 | A 65-year-old patient is brought to the ICU after sustaining a cervical spine injury with quadriplegia during a motor vehicle accident. In the first 24 hours after the injury, the patient is at risk for | Hypothermia, hypotension | Tachycardia | Stress response with hypertension and hyperventilation | Autonomic hyperreflexia | 4 | A | 1 | null | null | null | null | null |
c9e565e5-83dd-546c-b446-818236276289 | Signs and symptoms of intracranial hypertension include | Papilledema | Headache | Nausea and vomiting | All of the above | 4 | D | 1 | null | null | null | null | null |
dc32c71f-71d9-5f4f-aad7-a593e27db47e | A 79-year-old man with a history of transient ischemic attacks is scheduled to undergo a carotid endarterectomy under general anesthesia with EEG monitoring. Which of the following would be appropriate in the anesthetic management of this patient? | Initiation of deliberate hypotension (after induction of anesthesia) to reduce bleeding | Hyperventilation of the lungs to a Paco2 of 30 mm Hg to reduce ICP | Injection of local anesthetic around the carotid body to prevent bradycardia | Induction of anesthesia with propofol | 4 | D | 3 | null | null | null | null | null |
8e84558d-6b5c-59ba-98ae-ac21268d4832 | Anesthetics that decrease ICP include | Fentanyl | Nitrous oxide | Propofol | All of the above | 4 | C | 1 | null | null | null | null | null |
727f6763-69bc-5787-a971-e6ffb998788d | Therapy that is useful in the treatment of cerebral vasospasm after an SAH includes all of the following EXCEPT | BP elevation | Hemodilution | Diuretics (e.g., furosemide) | Calcium channel blockers (e.g., nimodipine) | 4 | C | 1 | null | null | null | null | null |
c3b7b4ff-f274-5b5f-8e65-1185b43bbd88 | All of the following are associated with acromegalic patients undergoing transsphenoidal hypophysectomy EXCEPT | Enlargement of the tongue and epiglottis | Narrowing of the glottic opening | Difficulty in placing nasal airways | Increased postoperative use of continuous positive airway pressure (CPAP) because obstructive sleep apnea (OSA) is more common | 4 | D | 1 | null | null | null | null | null |
e7a8a902-e6a2-5782-af98-b0e820e7a17f | The CBF autoregulatory curve is shifted to the right by | Hypoxia (Pao2 < 50 mm Hg) | Volatile anesthetics | Hypercarbia | Chronic hypertension | 4 | D | 1 | null | null | null | null | null |
c9ab9a97-41ca-57e6-b316-446c178daabc | Cerebral autoregulation is abolished by | Hyperbaric pressure of 4 atmospheres (breathing room air) | Cardiopulmonary bypass with a core temperature of 27° C | Chronic hypertension | 3% Isoflurane | 4 | D | 1 | null | null | null | null | null |
7610e32a-dc1a-5468-9066-02cfb4e6aee0 | Etomidate does all of the following EXCEPT | Abolishes CO2 reactivity of cerebral blood vessel tone | Reduces CMR | Increases both SSEP amplitude and latency | Reduces CBF | 4 | A | 1 | null | null | null | null | null |
e9491f1e-56a4-5e0a-b31d-38ddba49e86a | Following a motor vehicle accident, a 25-year-old man with head trauma is brought to the operating room for repair of facial lacerations and fractures. The patient is cooperative but extremely micrognathic and weighs 150 kg (330 lb). Acceptable techniques for securing the airway include | Blind nasal intubation | Direct laryngoscopy after rapid-sequence induction | Awake fiberoptic intubation | Laryngeal mask airway | 4 | C | 3 | null | null | null | null | null |
6e4562e1-75e9-5047-971f-d2baef262042 | After resection of a grade II astrocytoma in a 60-year-old patient, the serum sodium is 127 mEq/L, urine sodium is 25 mEq/L, and the BP is 120/80. Therapy could include which of the following? | Intranasal or IV vasopressin (DDAVP) | 500 mL 3% saline over 30 minutes | Chlorpropamide | Demeclocycline | 4 | D | 3 | null | null | null | null | null |
f6773a59-36aa-5a15-9233-0a99cfbbefcd | A 48-year-old, 110-kg man with a supratentorial astrocytoma is scheduled for a craniotomy for tumor debulking. His wife states he has been somnolent and confused. On examination he is noted to be hyperventilating and sleepy, but arousable, and hypertensive. Useful measures for his anesthetic include | Morphine to decrease his tachypnea | Esmolol to reduce a hypertensive response to intubation | Hyperventilation to 20 mm Hg | 10 cm H2O PEEP to reduce atelectasis | 4 | B | 2 | null | null | null | null | null |
5ba0cb41-c234-5845-8b6e-6c319ba5ec89 | If, during an MRI scan, a patient were to become trapped in the scanner by a large (50 kg) metallic object, the appropriate course of action would be to | Stop the scan immediately to release the magnet | Summon enough people to pull the object away | Interrupt electrical power for 60 seconds to release the magnetic force | Quench the magnet | 4 | D | 2 | null | null | null | null | null |
73baa536-953a-5594-841c-82b4b70b5f3c | A 45-year-old man is undergoing a posterior cervical decompression in the sitting position. Induction of anesthesia and tracheal intubation are uneventful. Anesthesia is maintained with N2O 50% in O2 , and sevoflurane. Suddenly, air is heard on the precordial Doppler ultrasound. | Decreased Paco2 | Decreased CVP | Decreased pulmonary arterial pressure (PAP) | Decreased end-tidal CO2 | 4 | D | 2 | null | null | null | null | null |
040010c9-c20c-53ce-a2dc-c32be92f1b21 | In patients with head injuries and increased ICP, hyperventilation is typically limited to a Paco2 of 25 to 30 mm Hg because additional hyperventilation | Is virtually impossible | Causes brain ischemia due to a rightward shifting of the oxyhemoglobin dissociation curve | May be associated with a worsening of neurologic outcome | Could result in paradoxical cerebral vasodilation | 4 | C | 1 | null | null | null | null | null |
6ab47fca-fa6c-5721-b764-eac5315e6b52 | A 28-year-old man arrives in the emergency department by ambulance after being hit by a car while riding his motorcycle. He was not wearing a helmet and sustained a head injury. His oxygen saturation is 99% breathing spontaneously, with a nasal airway in his right nostril and a face mask applied and 5 liters/min of oxy... | 11 | 9 | 7 | 5# Neurologic Physiology and Anesthesia | 4 | C | 2 | null | null | null | null | null |
a33a2218-b6ca-5023-9d3a-8b7ae1079696 | Which of the following is the best example of neuropathic pain? | Postherpetic neuralgia (PHN) | Fibromyalgia | Chronic hip pain | Lumbar facet joint pain | 4 | A | 1 | null | null | null | null | null |
50f6f4f7-5095-5084-a1bb-6efc4599ad61 | Which of the following techniques is LEAST effective in the treatment of pruritus from administration of neuraxial opiates? | Nalbuphine 5 mg intravenous (IV) | Dexmedetomidine 30 μg IV | Diphenhydramine 50 mg IV | Propofol 10 mg IV | 4 | B | 2 | null | null | null | null | null |
0ad47d38-92c5-575c-8e1e-af29b7c796b6 | The MAXIMUM dose of lidocaine containing 1:200,000 epinephrine that can be administered to a 70-kg patient for most major regional anesthetic techniques (and excluding spinal and IV regional) is | 100 mg | 200 mg | 500 mg | 1000 mg | 4 | C | 1 | null | null | null | null | null |
5f9b9412-a260-5ace-8e7d-bdc1313fcb76 | Which of the following concentrations of epinephrine corresponds to a 1:200,000 mixture? | 0.5 μg/mL | 5 μg/mL | 50 μg/mL | 0.5 mg/mL | 4 | B | 1 | null | null | null | null | null |
42654d1b-0de9-5566-86cb-6a6d92d576c9 | A 62-year-old fit patient with no comorbidities other than osteoarthrosis receives a spinal anesthetic for hip replacement. He takes nonsteroidal anti-inflammatory drugs (NSAIDs) and consumes coffee daily. The operation takes less than 1 hour and is uneventful. In the postanesthesia care unit (PACU) the patient complai... | Blood sugar greater than 200 mg/dL | Nausea and vomiting | Severe headache | Urinary retention | 4 | D | 1 | null | null | null | null | null |
d90430db-4c1d-55c8-9d66-194857d89b9c | Which of the following is the EARLIEST sign of lidocaine toxicity from a high blood level? | Shivering | Nystagmus | Light-headedness and dizziness | Tonic-clonic seizures | 4 | C | 1 | null | null | null | null | null |
1eaa9c87-fef7-5879-b567-22bdbca4188b | An analgesic effect similar to the epidural administration of 2.5 mg of morphine could be achieved by which dose of intrathecal morphine? | 0.05 mg | 0.1 mg | 1 mg | Morphine should not be injected into the intrathecal space | 4 | B | 1 | null | null | null | null | null |
21dfaa91-a032-5790-8c55-2c93f9f7da2c | Which of the following peripheral nerves is MOST likely to become injured in patients who are under general anesthesia? | Ulnar nerve | Median nerve | Radial nerve | Common peroneal nerve | 4 | A | 1 | null | null | null | null | null |
8a645b2d-ea83-5f52-ad8c-910041b5b246 | Which of the following is the MOST important disadvantage of interscalene brachial plexus block compared with other approaches? | Large volumes of local anesthetics required | Frequent sparing of the ulnar nerve | Frequent sparing of the musculocutaneous nerve | High incidence of pneumothorax | 4 | B | 1 | null | null | null | null | null |
cb2e5c23-596f-54a9-8119-04f1925b949d | A 68-year-old woman is to undergo lower-extremity surgery under spinal anesthesia. Which of the following statements concerning the immediate physiologic response to the surgical incision is TRUE? | The cardiovascular (CV) response to stress will be blocked, but the adrenergic response will not | The adrenergic response to stress will be blocked, but the CV response will not | Both the adrenergic and CV responses will be blocked | Neither the adrenergic nor the CV response will be blocked | 4 | C | 3 | null | null | null | null | null |
1330bac7-3ac9-5387-b694-5ae511c55511 | The "snap" felt just before entering the epidural space represents passage through which ligament? | Posterior longitudinal ligament | Ligamentum flavum | Supraspinous ligament | Interspinous ligament | 4 | B | 1 | null | null | null | null | null |
91361c28-6002-535f-93af-1a0ff574dc0f | The common element thought to be present in cases of cauda equina syndrome after continuous spinal anesthesia is | Use of microcatheter | Maldistribution of local anesthetic | Administration of lidocaine | Addition of epinephrine | 4 | B | 2 | null | null | null | null | null |
ceba8cf4-8715-5c52-9ecb-e53ef7e02cb9 | When performing a single-shot spinal anesthetic, the level of block for motor, sensory, and sympathetic blocks differs often by at least two dermatomes. Which of the following sequences is correct from the highest to the lowest level of block? | Sensory, sympathetic, motor | Sympathetic, sensory, motor | Sympathetic, motor, sensory | Sensory, motor, sympathetic | 4 | B | 1 | null | null | null | null | null |
78d1dfe6-6549-52d7-8c49-31ea52d118e8 | A 95-year-old woman has persistent and prolonged thoracic pain after a herpes zoster infection. Which of the treatments below would be the LEAST efficacious in the treatment of her pain? | Oral amitriptyline | Oral clonidine | Topical capsaicin ointment | Topical lidocaine patch | 4 | B | 1 | null | null | null | null | null |
e06d8cd2-39a7-53b0-9c65-063deb476ac8 | The deep peroneal nerve innervates the | Lateral aspect of the dorsum of the foot | Entire dorsum of the foot | Web space between the great toe and the second toe | Medial aspect of the dorsum of the foot | 4 | C | 1 | null | null | null | null | null |
a19be952-1df6-58f7-b11e-ef0c3e2272be | The correct arrangement of local anesthetics in order of their ability to produce cardiotoxicity from most to least is | Bupivacaine, lidocaine, ropivacaine | Bupivacaine, ropivacaine, lidocaine | Ropivacaine, bupivacaine, lidocaine | Lidocaine, ropivacaine, bupivacaine | 4 | B | 1 | null | null | null | null | null |
e5c54631-e4e9-5d04-afa5-12c20d6584d0 | Allodynia is defined as | Spontaneous pain in an area or region that is anesthetic | Pain initiated or caused by a primary lesion or dysfunction in the nervous system | An increased response to a stimulus that is normally painful | Pain caused by a stimulus that does not normally provoke pain | 4 | D | 1 | null | null | null | null | null |
948fbb6f-5e33-5e65-aa92-df138715f239 | The primary mechanism by which the action of tetracaine is terminated when used for spinal anesthesia is | Systemic absorption | Uptake into neurons | Hydrolysis by pseudocholinesterase | Hydrolysis by nonspecific esterases | 4 | A | 1 | null | null | null | null | null |
07d30928-7a87-5d5d-8132-f219027fd5ed | Complex regional pain syndrome (CRPS) type I (reflex sympathetic dystrophy [RSD]) is differentiated from CRPS type II (causalgia) by knowledge of its | Etiology | Chronicity | Type of symptoms | Rapidity of onset | 4 | A | 1 | null | null | null | null | null |
1ca32a72-b9dc-56a3-b362-0b030892344d | The primary determinant of local anesthetic potency is | pKa | Molecular weight | Lipid solubility | Protein binding | 4 | C | 1 | null | null | null | null | null |
4a9471ee-fb51-55dd-afaa-7d9744f7b5b7 | Which of the following would have the GREATEST effect on the level of sensory blockade after a subarachnoid injection of hyperbaric 0.75% bupivacaine? | Patient age | Addition of epinephrine to the local anesthetic solution | Patient weight | Patient position | 4 | D | 3 | null | null | null | null | null |
690433ef-34f5-5ac4-a3a0-de7569886f6e | Which of the following local anesthetics would produce the LOWEST concentration in the fetus relative to the maternal serum concentration during a continuous lumbar epidural? | Ropivacaine | Bupivacaine | Lidocaine | Chloroprocaine | 4 | D | 2 | null | null | null | null | null |
81b2a96f-158a-57b7-8fee-114b9031c9c8 | Severe hypotension associated with high spinal anesthesia is caused primarily by | Decreased cardiac output secondary to decreased preload | Decreased systemic vascular resistance | Decreased cardiac output secondary to bradycardia | Decreased cardiac output secondary to decreased myocardial contractility | 4 | A | 1 | null | null | null | null | null |
cdae2fcd-cd95-561b-916f-b1f9e9eb8c54 | Select the one TRUE statement concerning phantom limb pain. | The incidence of phantom limb pain increases with more distal amputations | Most amputees do not experience phantom limb pain | Nerve blocks may be used to decrease the incidence of phantom limb pain | Traumatic amputees have a much higher incidence of phantom limb pain than nontraumatic amputees | 4 | C | 1 | null | null | null | null | null |
09e741d8-0144-547c-82ab-381a47d0ab28 | Which of the following is TRUE regarding IV regional anesthesia (Bier block)? | Useful for postoperative pain in extremity surgery | Can be used for extremity surgeries lasting 2 to 3 hours | Bupivacaine is the drug of choice for prolonged blocks | Lidocaine is most commonly used | 4 | D | 1 | null | null | null | null | null |
86df54bb-2883-56a5-ba89-e242bfce0164 | Select the FALSE statement regarding spinal anatomy and spinal anesthesia. | The addition of phenylephrine to lidocaine will prolong spinal anesthesia | A high thoracic sensory block will result in total sympathetic blockade | The largest vertebral interspace is L5-S1 | The dural sac extends to the S4-S5 interspace | 4 | D | 1 | null | null | null | null | null |
12a66e40-f503-5f32-bc04-fc879cb5d57c | Four days after a left total hip arthroplasty, an obese 62-year-old woman complains of severe back pain in the region where the epidural was placed. Over the ensuing 72 hours, the back pain gradually worsens and a severe aching pain that radiates down the left leg to the knee develops. The MOST likely diagnosis is | Epidural abscess | Epidural hematoma | Anterior spinal artery syndrome | Meralgia paresthetica | 4 | A | 2 | null | null | null | null | null |
4b236f6d-5c44-584b-a22c-533f2fae2b4e | Which of the following choices is NOT consistent with a limb affected by complex regional pain syndrome (CRPS) | Allodynia | Dermatomal distribution of pain | Atrophy of the involved extremity | Hyperesthesia | 4 | B | 1 | null | null | null | null | null |
29097120-8805-5a92-980e-e70f2b591871 | The MAIN advantage of neurolytic nerve blockade with phenol versus alcohol is | Denser blockade | Blockade is permanent | The effects of the block can be evaluated immediately | The block is less painful | 4 | D | 1 | null | null | null | null | null |
450c87c1-e266-560b-9782-e63c7b1035b6 | A 75-year-old man is scheduled to undergo elective orchiectomy for prostate cancer. The patient has selected spinal anesthesia. What is the minimum dermatomal level that must be achieved to carry out this operation? | T4 | T10 | L3 | S1 | 4 | B | 1 | null | null | null | null | null |
9227f771-556d-517e-9fe9-3a8341b511eb | The artery of Adamkiewicz MOST frequently arises from the aorta at which spinal level? | T1-T4 | T5-T8 | T9-T12 | L1-L4 | 4 | C | 1 | null | null | null | null | null |
01753f53-f3cb-5732-a738-63961c3862dc | Which local anesthetic has the longest elimination half-time (T½)? | Bupivacaine | Lidocaine | Mepivacaine | Ropivacaine | 4 | A | 1 | null | null | null | null | null |
b386d201-d819-5355-851c-8207f5d0d1c9 | Important landmarks for performing a sciatic nerve block (classic approach of Labat) include | Iliac crest, sacral hiatus, and greater trochanter | Iliac crest, coccyx, and greater trochanter | Posterior superior iliac spine, coccyx, and greater trochanter | Posterior superior iliac spine, greater trochanter, and sacral hiatus | 4 | D | 1 | null | null | null | null | null |
ec0a2475-bb0f-5ae4-897e-febe21a8cc54 | A 76-year-old female patient is undergoing a carotid endarterectomy under a deep cervical plexus nerve block. Which of the following complications would be LEAST likely with this unilateral block? | Unilateral phrenic nerve paralysis | Subarachnoid injection | Blockade of the spinal accessory nerve | Vertebral artery injection | 4 | C | 2 | null | null | null | null | null |
cad261c1-0278-59b2-abe9-09257dd3e2f6 | A retrobulbar block anesthetizes each of the following nerves EXCEPT | Ciliary nerves | Cranial nerve III (oculomotor nerve) | Cranial nerve VII (facial nerve) | Cranial nerve VI (abducens nerve) | 4 | C | 1 | null | null | null | null | null |
0a4b1b04-1811-5bd2-8f02-4245ca238810 | Which of the following muscles of the larynx is innervated by the external branch of the superior laryngeal nerve? | Vocalis muscle | Thyroarytenoid muscles | Posterior cricoarytenoid muscle | Cricothyroid muscle | 4 | D | 1 | null | null | null | null | null |
d3cb77cb-94e3-5f66-87f7-3ef83c2421b3 | All of the following agents are acceptable for use in a Bier block EXCEPT | 0.5% Lidocaine | 0.5% Mepivacaine | 0.25% Bupivacaine | 0.5% Prilocaine | 4 | C | 1 | null | null | null | null | null |
30e5eb55-a46e-5133-8a7d-c45741c48530 | The stellate ganglion lies in closest proximity to which of the following vascular structures? | Common carotid artery | Internal carotid artery | Vertebral artery | Aorta | 4 | C | 1 | null | null | null | null | null |
65c35646-40f0-59a8-8af3-9d8ff8ad3a9b | Which of the following structures in the antecubital fossa is the MOST medial? | Brachial artery | Radial nerve | Tendon of the biceps | Median nerve | 4 | D | 1 | null | null | null | null | null |
7a31da43-6229-545f-a669-65cf8235d07e | During placement of an epidural in a 78-year-old patient scheduled for a total knee arthroplasty, the patient complains of a sharp, sustained pain radiating down his left leg as the catheter is inserted to 2 cm. The MOST appropriate action at this time would be to | Leave the catheter at 2 cm, and give a test dose | Give a small dose to relieve pain, then advance 1 cm | Withdraw the catheter 1 cm, then give a test dose | Withdraw the needle and catheter, then reinsert in a new position | 4 | D | 2 | null | null | null | null | null |
09f83da6-af03-5437-97a2-ea39d76db88d | Cutaneous innervation of the plantar surface of the foot is provided by the | Sural nerve | Posterior tibial nerve | Saphenous nerve | Deep peroneal nerve | 4 | B | 1 | null | null | null | null | null |
c3551e59-462b-5ebb-99d3-a9ca150d715c | A 57-year-old patient is scheduled for hemorrhoidectomy. The patient has a history of mild chronic obstructive pulmonary disease, hypertension, and traumatic foot amputation from a tractor accident. His only hospitalizations were for two suicide attempts related to phantom limb sensations 10 years ago. He takes phenelz... | Spinal anesthetic with 0.5% hyperbaric bupivacaine | Epidural anesthetic with 0.5% bupivacaine | Local infiltration with lidocaine and epinephrine, sedation with propofol and meperidine | General anesthesia with propofol, succinylcholine, nitrous oxide, and fentanyl | 4 | D | 3 | null | null | null | null | null |
77c58700-3d3b-50e5-8442-35a510357ebd | If the recurrent laryngeal nerve were transected bilaterally, the vocal cords would | Be in the open position | Be in the closed position | Be in the intermediate position (i.e., 2-3 mm apart) | Not be affected unless the superior laryngeal nerve were also injured | 4 | C | 2 | null | null | null | null | null |
bc4fae47-f0a4-526b-b180-7eb48cda57e9 | A 63-year-old woman undergoes total knee arthroplasty under spinal anesthesia. Two days later she complains of a severe headache. Pain intensity is not related to posture. The LEAST likely cause of this headache is | Caffeine withdrawal | Viral illness | Migraine | Postdural puncture headache (PDPH) | 4 | D | 2 | null | null | null | null | null |
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