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11e4ddc1-0a65-5c77-a058-9f3d75cd10ce | What is the CORRECT order of structures (from cephalad to caudad) in the intercostal space? | Nerve, artery, vein | Vein, nerve, artery | Vein, artery, nerve | Artery, nerve, vein | 4 | C | 1 | null | null | null | null | null |
07dff91f-68fe-5dc1-9fb8-21a2d01c79d1 | Which of the following types of regional anesthesia is associated with the GREATEST serum concentration of lidocaine? | Intercostal | Epidural | Brachial plexus | Femoral nerve block | 4 | A | 1 | null | null | null | null | null |
58b8dc3a-83ea-5c3d-848b-6331385419dd | Differences in which of the following local anesthetic properties account for the fact that the onset of an epidural block with 3% 2-chloroprocaine is more rapid than 2% lidocaine? | Protein binding | pKa | Lipid solubility | Concentration | 4 | D | 1 | null | null | null | null | null |
ed27c84f-51c9-5fbe-bf50-62e53084579e | A 69-year-old man with a history of diabetes mellitus and chronic renal failure is to undergo placement of a dialysis fistula under regional anesthesia. During needle manipulation for a supraclavicular brachial plexus block, the patient begins to cough and complain of chest pain and shortness of breath. The MOST likely... | Angina | Pneumothorax | Phrenic nerve irritation | Intravascular injection of local anesthetic | 4 | B | 2 | null | null | null | null | null |
91cdfa22-3e6e-5339-a5e7-c6b3e1861b2d | Each of the following statements is true concerning a femoral nerve block EXCEPT | The femoral nerve primarily arises from the second to the fourth lumbar nerve roots | The femoral nerve provides sensation to the anterior and medial aspect of the thigh | The femoral nerve lies lateral to the femoral artery and femoral vein | Proper needle placement produces sartorius musclecontraction without patellar movement when electrically stimulated | 4 | D | 1 | null | null | null | null | null |
ff8b7284-bb33-5287-928f-1e3ebea144f8 | If a needle is introduced 1.5 cm inferior and 1.5 cm lateral to the pubic tubercle, to which nerve will it lie in close proximity? | Obturator nerve | Femoral nerve | Lateral femoral cutaneous nerve | Ilioinguinal nerve | 4 | A | 1 | null | null | null | null | null |
9fa172f1-278f-5136-9022-6bd25659e784 | The MOST common complication associated with a supraclavicular brachial plexus block is | Blockade of the phrenic nerve | Intravascular injection into the vertebral artery | Blockade of the recurrent laryngeal nerve | Pneumothorax | 4 | A | 1 | null | null | null | null | null |
0093335f-1d6b-5ba6-81e1-68cc2b63fcac | Which portion of the upper extremity is NOT innervated by the brachial plexus? | Posterior medial portion of the arm | Elbow | Lateral portion of the forearm | Medial portion of the forearm | 4 | A | 1 | null | null | null | null | null |
b8e49093-72fa-5f92-b6f5-cbb02e47ffdb | Which section of the brachial plexus is blocked with a supraclavicular block? | Roots/trunks | Trunks/divisions | Cords | Branches | 4 | B | 1 | null | null | null | null | null |
9ab34869-997b-5804-8435-217abc31d79e | A celiac plexus block would NOT effectively treat pain resulting from a malignancy involving which of the following organs? | Uterus | Stomach | Pancreas | Gallbladder | 4 | A | 1 | null | null | null | null | null |
b82286e1-7146-51ea-ad63-65927013b19c | A healthy 27-year-old woman stepped on a nail and is to undergo débridement of a wound on her right great toe. She is anxious about general anesthesia but agrees to an ankle block with mild sedation. Which nerves must be adequately blocked in order to perform the surgery? | Deep peroneal, posterior tibial, saphenous, sural | Deep peroneal, saphenous, superficial peroneal, sural | Deep peroneal, posterior tibial, superficial peroneal, sural | Deep peroneal, superficial peroneal, posterior tibial, saphenous | 4 | D | 2 | null | null | null | null | null |
cebf278b-9146-5136-8475-766f5f88860d | A 54-year-old man is administered morphine via patient-controlled analgesia (PCA) pump after a left total hip arthroplasty. The pump is programmed to deliver a maximum dose of 2 mg every 15 minutes (lockout time) as needed for patient comfort. The total maximum dose that can be delivered in 4 hours is 30 mg. On the fir... | Discontinue the PCA pump and administer intramuscular morphine | Increase the lockout time from 15 to 25 minutes | Change the analgesic from morphine to meperidine | Increase the dose to 3 mg every 15 minutes as needed up to a total maximum dose of 40 mg every 4 hours | 4 | D | 2 | null | null | null | null | null |
a0d93a6a-4d69-51b5-af6a-ff32eedcccb6 | The mechanism of low-frequency transcutaneous electrical nerve stimulation (TENS) units in relieving pain is | Direct electrical inhibition of type A-δ and C fibers | Depletion of neurotransmitter in nociceptors | Hyperpolarization of spinothalamic tract neurons | Activation of inhibitory neurons | 4 | D | 1 | null | null | null | null | null |
ac7c59b3-02cb-5cba-b70b-17cc768ab419 | Epidural use of which of the following opioids would result in the GREATEST incidence of delayed respiratory depression? | Sufentanil | Fentanyl | Morphine sulfate | Hydromorphone | 4 | C | 1 | null | null | null | null | null |
d1e22ead-c03e-53b4-813b-6eb0509e7bff | A 21-year-old patient reports tingling in her thumb during her cesarean section under epidural anesthesia. To which dermatomal level would this correspond? | C5 | C6 | C7 | C8 | 4 | B | 1 | null | null | null | null | null |
79b7d5cd-da8d-5711-85a1-b0e93c03c99c | Which of the following would hasten the onset and increase the clinical duration of action of a local anesthetic, and provide the GREATEST depth of motor and sensory blockade when used for epidural anesthesia? | Increasing the volume of local anesthetic | Increasing the concentration of local anesthetic | Increasing the dose | Placing the patient in the head-down position | 4 | C | 3 | null | null | null | null | null |
54b9cb73-c5fd-5022-8b47-0ca69f4a406c | Select the FALSE statement concerning neurolytic nerve blocks. | Destruction of peripheral nerves can be followed by a denervation hypersensitivity that is worse than the original pain | Neurolytic blocks should be reserved for patients with short life expectancies | Neurolytic blockade with phenol is permanent | Intrathecal neurolysis may be an effective management for certain pain conditions | 4 | C | 1 | null | null | null | null | null |
e64d5879-46c0-5f0d-a011-c28a5158661f | Transient neurologic symptoms (TNS) after spinal anesthesia are associated with each of the following EXCEPT | Lidocaine | Lithotomy position | Ambulatory anesthesia | Concentration of local anesthetic injected | 4 | D | 1 | null | null | null | null | null |
83735247-6432-598a-a324-7abbc562e420 | After you select the appropriate ultrasound transducer, you can adjust several factors to optimize the image for regional anesthesia. Which of the following descriptions is FALSE? | Frequency—higher-frequency ultrasound use is better for viewing deep structures | Depth—adjusted to limit the centimeters of viewing area on the monitor | Gain—increased gain produces increased brightness | Frequency—higher-frequency ultrasound use produces better image resolution | 4 | A | 1 | null | null | null | null | null |
2cdd217b-d692-5327-ad8b-4bf733eb365a | Each of the following is associated with an increased incidence of PDPHs EXCEPT | Younger adults | Early ambulation | Pregnancy | Large needle size | 4 | B | 1 | null | null | null | null | null |
cca9e816-74b4-590f-8e67-f76bf311c053 | Each of the following items describes pain in the abdominal viscera EXCEPT | Pain is transmitted via the vagus nerve | The nerve fibers are type C | Pain is characterized by a dull aching or burning sensation | Distention of the transverse colon causes more pain than surgical transection | 4 | A | 1 | null | null | null | null | null |
b3cb1e5e-b9c4-5089-89d2-9e9ae09875bb | Which of the following blocks has the LONGEST duration of action when bupivacaine with epinephrine is administered? | Axillary | Epidural | Infiltration | Spinal | 4 | A | 1 | null | null | null | null | null |
1ebc8389-aa7c-54cf-a79e-502131771b37 | All of the following statements concerning a psoas compartment block are true EXCEPT | Compartment block is used to provide unilateral anesthesia to the proximal aspect of the thigh and hip | Stimulation of the quadriceps muscle demonstrates good needle placement | Complete leg anesthesia can be obtained when combined with a sciatic nerve block | Continuous catheters are not used because the amount of drug infused would lead to toxicity | 4 | D | 1 | null | null | null | null | null |
3da23039-ea9f-5ed3-9ba9-65e9fd6b638b | A 35-year-old woman receives a popliteal block for ankle and foot surgery. Which other nerve must be blocked in order to have complete anesthesia of the foot? | Superficial peroneal nerve | Sural nerve | Saphenous nerve | Posterior tibial nerve | 4 | C | 2 | null | null | null | null | null |
11787521-a3cb-5720-8c69-b90f17195eeb | The most common complication of a celiac plexus block is | Hypotension | Seizure | Retroperitoneal hematoma | Constipation | 4 | A | 1 | null | null | null | null | null |
9ee2e1e9-ba28-51f8-a675-4af849bcd65b | The occipital portion of the skull receives sensory innervation from | Spinal accessory nerve (nerve XI) | Facial nerve (nerve VII) | Ophthalmic branch of trigeminal nerve (nerve V) | Cervical plexus | 4 | D | 1 | null | null | null | null | null |
f4cdb28a-c288-5c0b-bb13-a792a3cc5cd4 | Each of the following is a potential complication of thoracic paravertebral blocks EXCEPT | Pneumothorax | Epidural spread of local anesthetic | Hypertension | Total spinal | 4 | C | 1 | null | null | null | null | null |
7ee1b9a2-a6b2-5618-853b-b1cc8a2d60ed | After placement of an epidural catheter in a 55-year-old patient for total hip arthroplasty, an entire epidural dose is administered into the subarachnoid space. Physiologic effects consistent with subarachnoid injection of large volumes of local anesthetic include all of the following EXCEPT | Hypotension and bradycardia | Respiratory depression | Constricted pupils | Possible cauda equina syndrome | 4 | C | 1 | null | null | null | null | null |
ca300b9f-c9f6-560c-badd-bedc9f7f72bd | A 49-year-old type 1 diabetic patient with a long history of burning pain in the right lower extremity receives a spinal anesthetic with 100 mg of procaine with 5% dextrose. The patient reports no relief in symptoms but has complete bilateral motor blockade. What diagnosis is consistent with this differential blockade ... | Diabetic neuropathy | Central pain | Myofascial pain | Complex regional pain syndrome (CRPS) I (RSD) | 4 | B | 3 | null | null | null | null | null |
5d8cc638-1cb2-512d-8c61-65b7f00e3a87 | An 18-year-old man has a seizure during placement of an interscalene brachial plexus block with 0.5% bupivacaine. The anesthesiologist begins to hyperventilate the patient's lungs with 100% O2 using an anesthesia bag and mask. The rationale for this therapy includes all of the following EXCEPT | The therapy helps to prevent and treat hypoxia | Hyperventilation decreases blood flow and delivery of local anesthetic to the brain | Hyperventilation elevates the seizure threshold | Hyperventilation induces alkalosis and converts local anesthetics to the protonated (ionized) form, which is less likely to cross the cell membranes | 4 | D | 3 | null | null | null | null | null |
18cde671-87f5-5c02-951e-a5dc689dc2c0 | Para-aminobenzoic acid is a metabolite of | Mepivacaine | Ropivacaine | Bupivacaine | Procaine | 4 | D | 1 | null | null | null | null | null |
7d8444f6-5b88-5201-8c86-f531b2a89230 | Which statement concerning peripheral nerve structure and function is FALSE? | Both nonmyelinated and myelinated nerves are surrounded by Schwann cells | The speed of propagation of an action potential along a nerve axon is greatly enhanced by myelin | Generation of an action potential is an "all-or-nothing" phenomenon | Myelination renders nerves less sensitive to local anesthetic blockade | 4 | D | 1 | null | null | null | null | null |
ba9d60fb-0551-5050-88d9-e52bb27f826c | A 42-year-old woman with a morbid fear of general anesthesia receives an interscalene block for shoulder arthroscopy consisting of 20 mL 0.5% ropivacaine. Much of her arm, shoulder, and hand are numb, but the patient complains of pain as the incision is made at the upper portion of the shoulder. The most appropriate ne... | Repeat block | Perform intercostobrachial block | Perform superficial cervical plexus block | Perform a deep cervical plexus block | 4 | C | 2 | null | null | null | null | null |
ea33e006-9658-52d6-bcb4-d1a3f7147ac9 | According to the 2016 American Society of Regional Anesthesia and Pain Medicine (ASRA) practice advisory on infectious complications of regional anesthesia and pain medicine, the MOST important action to maintain aseptic technique and prevent cross-contamination during regional anesthesia techniques is | Wearing a surgical gown | Hand washing | Using soap and water instead of alcohol-based antiseptics | Using povidone-iodine (e.g., Betadine) instead of alcoholbased chlorhexidine to scrub | 4 | B | 1 | null | null | null | null | null |
f76625c2-918d-588c-bec2-826dcc4c1ffa | A 75-year-old woman with a history of pulmonary embolism is scheduled for a right lower lobectomy for lung cancer. She is receiving dalteparin (Fragmin) for deep vein thrombosis (DVT) prophylaxis. How long after her last dose should one wait before placement of a thoracic epidural? | 12 hours | 24 hours | 72 hours | No waiting is necessary since the dose for prophylaxis is low | 4 | A | 1 | null | null | null | null | null |
6e852d7c-3502-50d8-82d9-f01433be1a5c | How long should a patient be off clopidogrel (Plavix) before a central neuraxial block is performed? | 24 hours | 7 days | 14 days | No waiting necessary | 4 | B | 1 | null | null | null | null | null |
262cce88-50e0-542b-ac0e-fa14bfbcf0ed | Addition of bicarbonate to local anesthetics results in | Delayed onset of action | Reduced toxicity | Increased duration of action | Reduced pain with skin infiltration | 4 | D | 1 | null | null | null | null | null |
34f41584-c7ec-532c-af7f-da6976f8ded5 | Through which of the following would a spinal needle NOT pass during a midline placement of a subarachnoid block in the L3-L4 lumbar space? | Supraspinous ligament | Interspinous ligament | Posterior longitudinal ligament | Dura mater | 4 | C | 1 | null | null | null | null | null |
b7041366-e924-5e8d-8e3c-00507c876eea | What epidural dose of bupivacaine will give sensory analgesia similar to 10 mL of 2% lidocaine? | 5 mL of 0.25% | 10 mL of 0.25% | 5 mL of 0.5% | 10 mL of 0.5% | 4 | D | 2 | null | null | null | null | null |
297aace8-fa27-5d6a-a3ec-f4ba84d72886 | Each of the following additives to a spinal anesthetic possesses | Clonidine | Hydromorphone | Epinephrine | All of the above have analgesic properties | 4 | D | 1 | null | null | null | null | null |
80b3b6a0-1eea-5663-9699-3b2cbacbe300 | Which of the following local anesthetics is inappropriately paired with a clinical application because of its properties or toxicity? | Tetracaine, topical anesthesia | Bupivacaine, IV anesthesia | Prilocaine, infiltrative anesthesia | Chloroprocaine, epidural anesthesia | 4 | B | 2 | null | null | null | null | null |
a332c376-74b8-5b69-b86f-bc9962569258 | Discharge criteria from the PACU would be reached FASTEST after a 20- to 30-mL volume of which of the following epidurally administered local anesthetics? | 3% 2-Chloroprocaine | 2% Lidocaine | 0.75% Ropivacaine | 0.5% Levobupivacaine | 4 | A | 1 | null | null | null | null | null |
7ce6f370-b201-599c-92b7-5970d5e3ee33 | A caudal block (performed under sevoflurane general anesthesia) with 0.25% bupivacaine and 1:200,000 epinephrine is planned for postoperative analgesia after bilateral inguinal hernia repair in a 5 month-old patient. Each of the following would be consistent with an intravascular injection EXCEPT | Systolic blood pressure increase by greater than 15 mm Hg | Heart rate decrease by greater than 10 beats/min | Ventricular extrasystoles | Increase in T-wave amplitude > 25% over baseline | 4 | B | 2 | null | null | null | null | null |
fae67c31-9027-52c5-a4b8-15b30c353867 | Which is NOT a potential complication of a stellate ganglion block? | Recurrent laryngeal nerve paralysis | Subarachnoid block | Brachial plexus block | Increased heart rate | 4 | D | 1 | null | null | null | null | null |
16d2cf77-986b-5759-8603-96fa5aede5e9 | Discontinuation of which of the following antiplatelet medications, for 14 days, would be necessary before a spinal could be safely administered? | Aspirin | Clopidogrel | Ticlopidine | Abciximab (GPIIb/IIIa) | 4 | C | 1 | null | null | null | null | null |
3ad2f94d-f230-5ae9-8733-0ea6563317dc | Three days after knee arthroscopy under spinal anesthesia, a 55-year-old patient complains of double vision and difficulty hearing. The other likely finding would be | Headache | Fever | Weakness in legs | Mental status changes | 4 | A | 1 | null | null | null | null | null |
20027f43-4b3d-586f-942f-cde048395e9e | Which of the following statements is TRUE concerning transversus abdominis plane (TAP) block? | Ultrasound is useful in finding the intercostal nerves | The local anesthetic is injected directly into the transversus abdominis muscle | The subcostal, ilioinguinal, and iliohypogastric nerves are blocked | 10 mL of local anesthetic is all that is needed for good spread | 4 | C | 1 | null | null | null | null | null |
0565684c-40df-5f41-a151-81e3741f6dcd | Which of the following nerves can be electrically stimulated at the ankle to produce flexion of the toes? | Posterior tibial nerve | Saphenous nerve | Deep peroneal nerve | Superficial peroneal nerve | 4 | A | 1 | null | null | null | null | null |
9a98d381-84fb-5b8e-be46-a0fd8847585b | Which motor response from peripheral nerve stimulation is | Musculocutaneous nerve—flexion of the forearm at the elbow | Radial nerve—extension of all digits as well as the wrist and forearm | Ulnar nerve—abduction of the thumb | Median nerve—flexion of the wrist, pronation of the forearm | 4 | C | 1 | null | null | null | null | null |
b6d114ae-5480-5151-9083-a1e1d908dd6f | During an airway examination, a 53-year-old patient mentions that his right thumb tingles and then becomes numb if he extends his head for more than a few seconds. This symptom MOST likely represents a(n) | Unstable C-spine | Lhermitte's phenomenon | C6 nerve root irritation | C8 radiculopathy | 4 | C | 1 | null | null | null | null | null |
782b5422-a832-58dd-b443-4b346b40670c | When performing an interscalene block with a peripheral nerve stimulator, you note diaphragmatic movement. You should now | Inject the local anesthetic, as the needle is in an appropriate location | Redirect the needle in an anterior direction | Redirect the needle in a posterior direction | Advance the needle about 0.5 cm more and inject | 4 | C | 2 | null | null | null | null | null |
9672624b-f8c4-5cde-8421-d3e11d1062fa | During placement of an interscalene block, the patient becomes hypotensive, bradycardic, apneic, and cyanotic. The MOST likely cause is | Vertebral artery injection | Phrenic nerve blockade | Total spinal | Stellate ganglion block | 4 | C | 2 | null | null | null | null | null |
6ac14128-d988-5a03-a590-6f744c0bd41f | The reason that ropivacaine is marketed as pure S enantiomers is because the S form is associated with | Increased potency | Longer duration | Reduced cardiac toxicity | Reduced incidence of anaphylaxis | 4 | C | 1 | null | null | null | null | null |
f3fe3219-8873-5ea9-a65f-906bd5c12373 | Nerves that originate from the sacral plexus include each of the following EXCEPT | Femoral nerve | Tibial nerve | Sciatic nerve | Common peroneal nerve | 4 | A | 1 | null | null | null | null | null |
bdcbd666-0cf9-5a3e-a103-d57e204874f6 | The only technique shown to prevent anesthetic-related nerve injury during placement of peripheral nerve blocks is | Ultrasound-guided regional technique | Transarterial technique | Nerve stimulator | None of the above | 4 | D | 1 | null | null | null | null | null |
4d55519c-50e2-5672-83ad-eaf6a66a12aa | An axillary block is performed on a healthy 19-year-old athlete. A 30 mL quantity of 0.75% bupivacaine is injected incrementally. Five minutes after the bupivacaine injection, the patient has a seizure and experiences CV collapse. Which of the measures below is NOT | Begin chest compressions at 100 per minute | Ventilate with 100% oxygen | Bolus propofol to bind local anesthetic | Infuse 20% lipid emulsion | 4 | C | 2 | null | null | null | null | null |
5c50641d-900e-5f8f-b514-1c181694031e | The structure MOST likely to be blocked during placement of an interscalene block in addition to the brachial plexus is the | Phrenic nerve | Vertebral artery | Recurrent laryngeal nerve | Vagus nerve | 4 | A | 1 | null | null | null | null | null |
806b3086-0666-5bc6-a11c-e468d762058e | All of the following are symptoms of a developing epidural hematoma EXCEPT | Radicular back pain | Bowel and bladder dysfunction | Motor deficits | Fever | 4 | D | 1 | null | null | null | null | null |
b8be242c-6807-5962-82d3-9156c07f419e | In addition to C nerve fibers, which nerve fibers carry pain impulses? | A-alpha (Aα) | A-beta (Aβ) | A-delta (Aδ) | B | 4 | C | 1 | null | null | null | null | null |
39200c0a-e743-5601-97c3-7c27c7e97b08 | An intradural mass lesion at the tip of a drug infusion catheter is LEAST likely to present as | Increasing pain | Development of numbness in T8 dermatomal pattern | Hypopnea | Perianal numbness | 4 | C | 3 | null | null | null | null | null |
02276081-79ed-5dc0-be1a-61fcd840cc97 | Which statement concerning local anesthetics is CORRECT? | The un-ionized form of a local anesthetic binds to the nerve membrane to actually block conduction | If one node of Ranvier is blocked, conduction will be reliably interrupted | The presence of myelin enhances the ability of a local anesthetic to block nerve conduction | Local anesthetics block transmission by inhibiting the voltage-gated potassium ion channels | 4 | C | 1 | null | null | null | null | null |
2646a111-995f-5250-8ebe-c67b3920e743 | Postdural puncture headaches (PDPHs) | Usually occur immediately following dural puncture | Are relieved 8 to 12 hours after an epidural blood patch is performed | Occur more frequently in nonpregnant patients compared with pregnant patients | Can be associated with neurologic deficits | 4 | D | 1 | null | null | null | null | null |
5864dc25-a579-509e-acc4-c171dfde8f1c | Which of the following procedures for treatment of chronic pain requires localization of the epidural space with an epidural needle as part of technique? | Radio-frequency ablation of a lumbar facet joint | Spinal cord stimulation | Percutaneous disk decompression | Vertebroplasty | 4 | B | 1 | null | null | null | null | null |
1154f109-f750-564a-bbff-ff68c9d85834 | Each of the following drugs has been used to treat neuropathic pain. Selective inhibition of serotonin and norepinephrine reuptake is the mechanism of which drug? | Duloxetine | Mexiletine | Gabapentin | Carbamazepine# Anatomy, Regional Anesthesia, and Pain Management# | 4 | A | 1 | null | null | null | null | null |
014573aa-00c5-5303-9843-e25417e6a7b4 | An oximetric pulmonary artery (PA) catheter is placed in a 69-year-old man who is undergoing surgical repair of an abdominal aortic aneurysm under general anesthesia. Before the aortic cross-clamp is placed, the mixed venous O2 saturation decreases from 75% to 60%. Each of the following could account for the decrease i... | Hypovolemia | Bleeding | Congestive heart failure (CHF) | Sepsis | 4 | D | 3 | null | null | null | null | null |
b4dc711b-eab4-57b0-af28-641340f6a4c7 | Postoperatively a 64-year-old man develops heparin-induced thrombocytopenia (HIT), type II (antibody proven), after anticoagulation for aortic valve replacement with 25,000 units of heparin. The same patient requires an elective tricuspid valve replacement soon thereafter because of trauma from a transvenous pacemaker.... | Defer until disappearance of antibodies; use heparin | Cardiopulmonary bypass with lepirudin in place of heparin | Cardiopulmonary bypass with tirofiban in place of heparin | Anticoagulation with fondaparinux | 4 | A | 2 | null | null | null | null | null |
8c33b732-514b-5fb4-8e00-7167707cadc4 | Oxygen consumption (Vo2 ) is measured in a 70-kg subject on a | 1 metabolic equivalent (MET) | 5 METs | 10 METs | 15 METs | 4 | C | 2 | null | null | null | null | null |
82bcbca5-b628-5cb0-9022-38a242b15d4e | Accidental injection of air into a peripheral vein would be LEAST likely to result in arterial air embolism in a patient with which of the following anatomic cardiac defects? | Patent ductus arteriosus | Eisenmenger syndrome | Tetralogy of Fallot | Tricuspid atresia | 4 | A | 2 | null | null | null | null | null |
0c863a33-6719-5413-921c-d950b9a44e9b | A 71-year-old man is undergoing revascularization of three coronary vessels on cardiopulmonary bypass at 28° C. After the last graft is sewn into the aorta, the arterial pressure measured from a left radial artery is 47 mm Hg and the PA pressure is 6 mm Hg. Thirty minutes later, the arterial pressure is 52 mm Hg and PA... | Malposition of the aortic cannula | Malposition of the venous cannula | Faulty ventricular venting | PA catheter migration | 4 | D | 3 | null | null | null | null | null |
71e358ac-66da-56ce-80cc-dc5a32d20d6c | While on cardiopulmonary bypass during elective coronary artery revascularization, the patient is noted to have bulging sclerae. Mean arterial pressure (MAP) is 50 mm Hg, temperature is 28° C, and there is no ECG activity. The MOST appropriate action to take at this time is to | Administer mannitol, 50 g IV | Decrease the cardiac index | Check the position of the aortic cannula | Check the position of the venous return cannula | 4 | D | 3 | null | null | null | null | null |
2283e4d1-c169-58da-a872-b9450690f1f0 | Anastomosis of the right atrium to the PA (Fontan procedure) is a useful surgical treatment for each of the following congenital cardiac defects EXCEPT | Tricuspid atresia | Hypoplastic left heart syndrome | Pulmonary valve stenosis | Truncus arteriosus | 4 | D | 1 | null | null | null | null | null |
473f09f8-aed1-52d5-81b0-c05f72be97de | By what percentage is tissue metabolic rate reduced during cardiopulmonary bypass at 30° C? | 10% | 25% | 50% | 75% | 4 | C | 1 | null | null | null | null | null |
e4424267-31d2-5b45-8f66-5a64423b477c | Effective inflation of an intra-aortic balloon catheter should occur at which of the following times? | Immediately after P wave on ECG | Immediately after closure of aortic valve | During opening of the aortic valve | During systolic upstroke on arterial tracing | 4 | B | 1 | null | null | null | null | null |
b812b8df-6ef8-5f6f-bf16-169b399184eb | Afterload reduction is beneficial during anesthesia for noncardiac surgery in patients with each of the following conditions EXCEPT | Aortic insufficiency | Patent ductus arteriosus | Tetralogy of Fallot | CHF | 4 | C | 3 | null | null | null | null | null |
c56d4a29-9e38-5302-860d-15a0135f9f00 | Administration of protamine to a patient who has not received heparin can result in | Anticoagulation | Hypercoagulation | Profound bradycardia | Hypertension | 4 | A | 1 | null | null | null | null | null |
08fdcdfb-212e-5b5f-ae2a-0efd3c5af379 | The primary determinants of myocardial O2 consumption, from most to | Preload > afterload > heart rate | Heart rate > preload > afterload | Afterload > preload > heart rate | Heart rate > afterload > preload | 4 | D | 1 | null | null | null | null | null |
66cfe50a-da68-5b78-aa68-5fe5a53481e0 | Cardiac tamponade is associated with | Pulsus alternans | Pulsus tardus | Pulsus parvus | Pulsus paradoxus | 4 | D | 1 | null | null | null | null | null |
5552d041-85d5-5c13-a4a4-fd99a00b153e | Which of the following drugs should NOT be administered via an endotracheal tube? | Lidocaine | NaHCO3 | Atropine | Naloxone | 4 | B | 1 | null | null | null | null | null |
bec76444-d72c-5214-8c79-9a105a42f709 | The MAP in a patient with a blood pressure of 180/60 mm Hg is | 90 mm Hg | 100 mm Hg | 110 mm Hg | 120 mm Hg | 4 | B | 2 | null | null | null | null | null |
f66b8323-3b03-5019-8d20-8523c7b256d5 | Hypothyroidism and hyperthyroidism could develop in patients receiving which of the following antidysrhythmic drugs? | Amiodarone | Verapamil | Procainamide | Lidocaine | 4 | A | 1 | null | null | null | null | null |
9479d7ae-4419-505b-8554-1e14a494b692 | Calculate the systemic vascular resistance (SVR; in dyne-sec/cm5 ) from the following data: cardiac output 5.0 L/min, central venous pressure (CVP) 8 mm Hg, mean arterial blood pressure 86 mm Hg, mean pulmonary arterial blood pressure 20 mm Hg, pulmonary capillary wedge pressure 9 mm Hg, heart rate 85 beats/min, patien... | 750 | 1000 | 1250 | 1500 | 4 | C | 2 | null | null | null | null | null |
aa5baf8d-d1bb-5944-b611-491c9b5b12d9 | A 57-year-old man with a history of Brugada syndrome is scheduled for appendectomy. The greatest anesthetic concern for this patient would be | Airway | Response to nondepolarizing muscle relaxants | Risk of malignant hyperthermia | Dysrhythmias | 4 | D | 1 | null | null | null | null | null |
7bda800f-22ea-5d02-a902-2f446d0a4ee8 | The MOST important pathophysiologic difference between pericardial effusion and cardiac tamponade is | Type of fluid (e.g., transudate, exudate, blood) | Quantity of fluid | Pressure | Inflammation | 4 | C | 1 | null | null | null | null | null |
ad7b2ccc-5817-5cd3-8538-c89904cd1508 | A healthy 59-year-old, 60-kg woman with a normal preoperative ECG develops wide complex tachycardia under general anesthesia for breast biopsy. Blood pressure is 81/47 mm Hg, and heart rate is 220 beats/min and regular. The MOST appropriate therapy would be | Electrical cardioversion | Administration of lidocaine, 60 mg IV | Administration of procainamide, 20 mg/min IV | Administration of amiodarone, 300 mg IV | 4 | A | 2 | null | null | null | null | null |
4e737ec6-703e-53b5-9188-52293fe74e39 | A 64-year-old patient with an axial flow left ventricular assist device (VAD; e.g., HeartWare) is scheduled for laparoscopic cholecystectomy under general anesthesia. Monitoring which of the following parameters is likely to be difficult in this patient? | Blood pressure with blood pressure cuff | Blood pressure with arterial line | PA pressure with PA catheter | Temperature with esophageal temperature probe | 4 | A | 2 | null | null | null | null | null |
e3de9d51-4267-596c-b7c2-facb5cd09f5e | In a normal person, what percentage of the cardiac output is dependent on the "atrial kick"? | 25% | 35% | 45% | 55% | 4 | A | 1 | null | null | null | null | null |
72cd138a-6db3-59e3-a3c4-1be446162073 | Using transesophageal echocardiography (TEE), the midesophageal short axis view at 45 degrees shows a valve shaped like the "Mercedes Benz" sign. Which valve is examined in this view? | Tricuspid valve | Pulmonic valve | Mitral valve | Aortic valve | 4 | D | 1 | null | null | null | null | null |
3d4e0d28-11b4-56be-8250-a1322ba3feb5 | A 62-year-old patient scheduled for elective repair of an abdominal aortic aneurysm develops a wide complex regular tachycardia (heart rate 150 beats/min) during induction of anesthesia. Blood pressure is 110/78 mm Hg. Which of the following drugs would be MOST useful in the management of this dysrhythmia? | Esmolol, 35 mg IV | Amiodarone, 150 mg IV over 10 minutes | Adenosine, 6 mg rapidly over 3 seconds | Verapamil, 5 to 10 mg IV | 4 | B | 3 | null | null | null | null | null |
293083cf-28c1-552d-9ed1-46a853f3b4d7 | A 47-year-old patient with known hypertrophic obstructive cardiomyopathy (HOCM) is anesthetized with propofol and nasally intubated. After induction, his blood pressure rises to 180/120 mm Hg and heart rate rises to 110. One millimeter ST depression is noted on leads I, II, and AVF. Which of the following interventions... | Esmolol 30 mg IV | Start sodium nitroprusside infusion | Start nitroglycerin infusion | Deepen the volatile anesthetic with desflurane | 4 | A | 3 | null | null | null | null | null |
a9844ec7-08cb-5ed8-a068-d5abe12476d8 | With pacemakers, the concept of upper tracking rate (UTR) is relevant with which type(s) of device? | VDD | DDI | AAI | All of the above | 4 | A | 1 | null | null | null | null | null |
79812b0b-cddc-560e-9534-655352a162c3 | Calculate the cardiac output from the following data: patient weight 70 kg, hemoglobin concentration 10 mg/dL, arterial blood gases on 100% O2 : Pao2 450 mm Hg, Paco2 32 mm Hg, pH 7.46, Sao2 99%. Mixed venous blood gases are: Pvo2 30 mm Hg, Paco2 45 mm Hg, pH 7.32, Svo2 60%. | 1.5 L/min | 2.5 L/min | 3.5 L/min | 4.5 L/min | 4 | D | 2 | null | null | null | null | null |
352e00f0-58fb-5bea-bce1-2e2d804c06d9 | Normal resting myocardial O2 consumption is | 2.0 mL/100 g/min | 3.5 mL/100 g/min | 8 mL/100 g/min | 15 mL/100 g/min | 4 | C | 1 | null | null | null | null | null |
3dc8aa0b-80e9-544a-8c33-4d904fb86ec2 | A 65-year-old patient with moderate aortic stenosis develops a sudden increase in heart rate during an appendectomy under general anesthesia. The ventricular rate is 190 beats/min and is irregularly irregular, arterial blood pressure is 70/45 mm Hg, and there is 2-mm ST segment depression in lead V5 of the ECG. Which o... | Electrical cardioversion | Esmolol | Phenylephrine | Verapamil | 4 | A | 3 | null | null | null | null | null |
d4e734d9-7b5b-5064-9357-0e5df17c21a7 | All of the following are TRUE concerning purely vasospastic angina EXCEPT | Chest discomfort occurs most often at rest | Pain may awaken the patient in the morning | β-blockers suppress episodes | Transient ST segment elevation occurs with the discomfort | 4 | C | 1 | null | null | null | null | null |
d086452b-8b25-532c-814f-a5510a33b853 | Normal resting coronary artery blood flow is | 10 mL/100 g/min | 40 mL/100 g/min | 75 mL/100 g/min | 120 mL/100 g/min | 4 | C | 1 | null | null | null | null | null |
f4dcf969-daac-5bf9-b002-792fe28060fa | Each of the following is associated with an increased incidence of PA rupture in patients with PA catheters EXCEPT | Pulmonary hypertension | Presence of PA atheromas | Old age | Anticoagulation | 4 | B | 1 | null | null | null | null | null |
c97c43b4-3451-5a0f-9577-995fd4ee60c9 | Allergic reactions to protamine can occur with each of the following EXCEPT | Diabetes treated with NPH insulin | Diabetes treated with regular insulin | Diabetes treated with PZI insulin | Previous vasectomy | 4 | B | 1 | null | null | null | null | null |
e93c35c6-bb50-50c2-a14f-8d0d28531ef3 | A 66-year-old patient is undergoing a three-vessel coronary artery bypass operation. Anticoagulation is achieved with 20,000 units of heparin. How much protamine should be administered to this patient to completely reverse the heparin after cardiopulmonary bypass? | 100 mg | 200 mg | 300 mg | 400 mg | 4 | B | 2 | null | null | null | null | null |
358a528d-920e-5baa-a34c-898ac4e494eb | A 69-year-old man with an axial flow left VAD is anesthetized for kidney stone removal from the left ureter. The patient is "dry," and blood pressure falls precipitously to a mean pressure of 51 mm Hg with no pulsatility on the arterial tracing. In addition to a fluid bolus, each of the other interventions would be use... | Increase pump speed from 7800 to 8500 rpm | Ephedrine | Phenylephrine | Trendelenburg position | 4 | A | 3 | null | null | null | null | null |
69976497-cfd3-5dfc-99e1-911527c2dc83 | The dose of adenosine necessary to convert paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm should be initially reduced | In patients receiving theophylline for chronic asthma | In patients with a history of arterial thrombotic disease taking dipyridamole | In patients with a history of chronic renal failure | In chronic alcoholics | 4 | B | 1 | null | null | null | null | null |
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