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b3c2b78f-27e0-549f-aab5-700d595a52a3 | Which of the following statements about the differences between a partial rebreather and a nonrebreather oxygen delivery mask is most correct? | A nonrebreather can theoretically reach an Fio2 of 1.0, whereas a partial rebreather can reach an FiO2 of 0.7-0.8. | A nonrebreather utilizes a large reservoir bag of 600-1000 mL, whereas a partial rebreather utilizes a smaller reservoir bag. | A nonrebreather allows expired gases to enter the reservoir bag, whereas a partial rebreather has a 1-way valve that inhibits expired gases from entering the reservoir bag. | A nonrebreather allows inhaled nebulized bronchodilator therapy to bedelivered, whereas a partial rebreather does not. | 4 | A | 1 | null | null | null | null | null |
23e4eda4-8077-5840-ac46-55fcac2c360e | Which of the following statements is most correct regarding oxygen delivery to a patient wearing a Venturi mask? | A variable FiO2 is delivered depending on the patient's minute ventilation. | A fixed FiO2 is delivered based on the entrainment port size on the mask, independent of the patient's minute ventilation. | A fixed FiO2 is delivered to the patient based on the oxygen flow rate to the mask, independent of the patient's minute ventilation. | A variable FiO2 is delivered to the patient depending on the oxygen flow rate to the mask. | 4 | B | 1 | null | null | null | null | null |
2f805ed4-432d-55c0-9c29-68adfb4eec36 | Which of the following statements regarding the benefit of high-flow nasal cannula (HFNC) is/are most correct? | HFNC can provide PEEP. | HFNC can improve CO2 exchange. | HFNC can achieve an FiO2 between 0.21 and 1.0 that is independent of patient respiratory effort. | All of the above. | 4 | D | 1 | null | null | null | null | null |
1f398851-394c-5ba1-876b-3a132c6e65a6 | A delivery system that allows for nitric oxide (NO) to have a long residence time in the ventilator circuit can lead to high concentrations of which of the following toxic metabolites? | NO2 | NO | N2O | N2O2 | 4 | A | 1 | null | null | null | null | null |
396f454e-998b-5be9-8b47-d29badfa466c | Which of the following best describes the method for calculating of mean arterial pressure (MAP) using a noninvasive blood pressure monitor? | Calculated from a proprietary algorithm based on systolic and diastolic blood pressure | Inflation pressure at which maximum oscillometric pulse amplitude is detected | Noninvasive blood pressure monitors do not give MAP | Calculated using the equation, MAP = diastolic blood pressure + 1/3 (systolicdiastolic blood pressure) | 4 | B | 1 | null | null | null | null | null |
cee831b2-724d-5fdc-8bd1-57d28cee546e | A "square wave" test is performed to measure the dynamic response of a radial arterial line. Two oscillations are seen before the tracing returns to baseline. Which of the following best describes the state of the arterial pressure | Underdamped | Adequately damped | Overdamped | Cannot be determined | 4 | B | 2 | null | null | null | null | null |
7630e341-f885-5437-9b8a-76fee6e2fe4b | 33. You are called to evaluate a patient in the ICU who has an indwelling pulmonary artery catheter. The nurse states that the waveform (below) appears markedly changed from 30 minutes ago. Which of the following best explains the portion of the waveform indicated by the arrow? | Pulmonary regurgitation | Right ventricular diastole | Right ventricular systole | Intermittent wedging of the pulmonary artery catheter | 4 | B | 1 | null | null | null | null | null |
fc17c02b-a78a-5abe-bac4-ca098cd019c5 | Which of the following conditions have the most insignificant effect on left ventricular end-diastolic pressure (LVEDP) estimation using a pulmonary artery catheter? | Severe mitral regurgitation | Tip of pulmonary artery catheter in West Zone I | Severe tricuspid regurgitation | Peak end-expiratory pressure at 15 cm H2O. | 5 | C | 2 | Left atrial myxoma | null | null | null | null |
dba08939-7f44-57e7-b847-b1034c180b6a | Using the following measurements obtained from a patient with a pulmonary artery catheter that are listed below, what is the systemic vascular resistance (SVR) (in dynes/cm5 )? | 1003 | 851 | 673 | Cannot be calculated with the given information | 4 | D | 2 | null | null | null | null | null |
87068bb2-34d3-5c75-978d-ec50fe32c0ea | A patient is being monitored in the ICU using a noninvasive cardiac output monitoring device attached to radial arterial line. It uses arterial pressure contour for estimating stroke volume and cardiac output. In which of the following clinical scenarios would stroke volume estimated by this cardiac output monitor be most accurate? | Rapid atrial fibrillation | Acute aortic regurgitation | During fluid resuscitation | End-stage liver disease | 4 | C | 2 | null | null | null | null | null |
9d7e0ca7-cec5-5c8a-afc1-7abea44b8d07 | Based on the Stewart-Hamilton equation, the relationship between thermodilution-based cardiac output and area under the temperature curve is best characterized by which of the following? | Directly proportional | Inversely proportional | Varies based on body surface area | Not related | 4 | B | 1 | null | null | null | null | null |
1f51d995-5367-5e13-a279-a4976ecb1a70 | Which of the following statements regarding the Bispectral index (BIS) for monitoring depth of anesthesia is most correct? | BIS is superior to end-tidal anesthetic gas monitoring in preventing awareness. | BIS correlates with probability of patient movement to noxious stimuli. | BIS is an American Society of Anesthesiology standard monitor. | BIS is unreliable during total intravenous anesthesia. | 4 | B | 1 | null | null | null | null | null |
dc1d4d32-5993-5189-8ffc-5b97d75a3b1c | An EEG monitor is being used to measure the depth of anesthesia for a patient receiving total intravenous anesthesia with propofol. Which of the following best describes the characteristics of an EEG in an awake patient and in a patient under general anesthesia? | Awake: high frequency and high amplitude; general anesthesia: low frequency and low amplitude | Awake: low frequency and low amplitude; general anesthesia: high frequency and high amplitude | Awake: high frequency and low amplitude; general anesthesia: low frequency and high amplitude | Awake: low frequency and high amplitude; general anesthesia: high frequency and low amplitude | 4 | C | 1 | null | null | null | null | null |
aa5eb5df-b929-5bb7-a9eb-f55496b0c312 | The velocity of blood through the middle cerebral artery, measured using transcranial Doppler (TCD), is likely to be elevated in all the following scenarios, EXCEPT which one? | Increased cerebral perfusion pressure (CPP) | Increased intracranial pressure | Cerebral vasospasm | Carotid artery stenosis | 4 | B | 3 | null | null | null | null | null |
faa9eb64-1dec-5a3d-84cd-0b01917fe83e | Which of the following BEST represents the degree of influence of anesthetic agents on somatosensory evoked potential (SSEP) monitoring? (Arranged from most deleterious to the least deleterious agents.) | Etomidate > isoflurane > propofol > opioids | Isoflurane > propofol > opioids > etomidate | Isoflurane > opioids > etomidate > propofol | Propofol > isoflurane > opioids > etomidate | 4 | B | 1 | null | null | null | null | null |
07cc97b0-102a-59df-afac-85d79f47361e | Which of the following modalities for monitoring evoked potentials (EPs) is least affected by inhalational anesthetics? | Visual EP | Somatosensory EP | Motor EP | Brainstem auditory EP | 4 | D | 1 | null | null | null | null | null |
7d198112-7f21-519a-9857-ae939c257f5c | A 67-year-old man is scheduled for a Whipple procedure and is offered an epidural for postoperative pain control. Which of the following is an absolute contraindication to placement of an epidural? | Aortic stenosis with a valve area of 1.2 cm2 | Recent upper respiratory tract infection | Patient refusal | Scoliosis | 4 | C | 1 | null | null | null | null | null |
456258fb-2196-53d0-bea2-3fa5480c3501 | You are called to the postanesthesia care unit because a patient with an epidural placed at T12-L1 is complaining of pain at the site of his lower abdominal incision but cannot move his legs. He was initially very comfortable. His motor examination has not changed since arrival in the postanesthesia care unit. Which of the following local anesthetics is most likely to have been used? | Etidocaine 1.5% | Lidocaine 2% | Bupivacaine 0.5% | Chloroprocaine 3% | 4 | A | 2 | null | null | null | null | null |
c1ea6d13-a4da-5366-aa5a-6ae430d5cc62 | A 67-year-old woman is on the first postoperative day following a Whipple procedure. She has a thoracic epidural in place and is receiving a mix of bupivacaine and dilaudid. She reports good pain relief but states that she is incredibly itchy, especially in her face and on her nose. Which of the following is | Naloxone | Propofol | Diphenhydramine | Elimination of opioids from epidural mix | 4 | C | 2 | null | null | null | null | null |
28e40994-7e57-5f91-bbe6-3080b23448bb | A 100-kg, 71-year-old man with a history of asthma, snoring, and emphysema undergoes thoracotomy and wedge resection for removal of a lung tumor. Which of the following treatments would be most effective to control his pain postoperatively while also maintaining adequate ventilation? | Thoracic epidural with a continuous infusion of bupivacaine and hydromorphone | As-needed doses of hydromorphone administered by the nurse | Patient-controlled analgesia (PCA) with hydromorphone | Lumbar epidural with a continuous infusion of bupivacaine and hydromorphone | 4 | A | 3 | null | null | null | null | null |
a1d1d855-79b4-5ee2-8928-9ad4240eb1c8 | 5. A 67-year-old woman who is 9 hours status post gastrectomy is noted to have a respiratory rate of 6 and is also somewhat somnolent. Which of the following neuraxial medications or combinations of medications would be predicted to cause respiratory depression within 6-12 hours of exposure? | Morphine | Fentanyl | Bupivacaine | Bupivacaine plus sufentanil | 4 | A | 1 | null | null | null | null | null |
2d48433e-3ccf-5f6b-808f-e59d1657edda | Compared with a single epidural dose of morphine, a single epidural dose of fentanyl has a longer half-time in the epidural space secondary to which of the following properties? | Lipid solubility | Ionization state | Molecular size | Molecular weight | 4 | A | 1 | null | null | null | null | null |
ebfa64d4-525a-5671-9c0e-b3bbb2cd446b | A 42-year-old woman undergoes total colectomy under general anesthesia with a thoracic epidural (T10-T11) in place. At the conclusion of the procedure, she receives an infusion of bupivacaine 0.1% and hydromorphone 20 μg/mL at 6 mL/h through her epidural catheter. You are called to see her 8 hours postoperatively and find that she is complaining of pain at the site of her incision. Her heart rate is 100 beats per minute and her blood pressure is 160/92 mm Hg. What is the most appropriate next step to manage this patient's pain? | Administer a bolus of 5 cc of 1.5% lidocaine with epinephrine 1:200 000 through her epidural catheter. | Add PCA with hydromorphone to her current regimen. | Add Toradol to her current regimen. | Check a serum bupivacaine level. | 4 | A | 2 | null | null | null | null | null |
6d35883d-ce9f-5fc3-8bf3-8d3eb44abc69 | You are caring for a 77-year-old man with no significant medical history who underwent an L5-S1 fusion yesterday for spinal stenosis. He was taking oxycodone at home for his chronic back pain, and you decide to write him for a PCA. Which of the following medications should be avoided? | Hydromorphone | Morphine | Meperidine | Fentanyl | 4 | C | 1 | null | null | null | null | null |
bd4d3267-d8af-5e47-b848-171d39c32f42 | Which of the following settings is not recommended for a PCA pump using hydromorphone for an opioid-naive patient in the postoperative period? | Continuous background infusion | Initial lockout interval of 10 minutes | Initial hourly dose limit of 1-2 mg | Addition of opioid-sparing medications to the analgesic regimen | 4 | A | 1 | null | null | null | null | null |
66dc6c0a-cb3b-589f-ab33-392d32a67739 | A 65-year-old woman with Parkinson disease and esophageal cancer is receiving an intravenous PCA with hydromorphone after undergoing Ivor Lewis esophagectomy. She reports excellent pain control but is experiencing nausea. Which of the following antiemetics is the most appropriate selection for this patient? | Ondansetron | Haldol | Promethazine | Droperidol | 4 | A | 2 | null | null | null | null | null |
3be699df-499d-5bda-9411-a2a846c15c91 | 11. Which of the following best describes the mechanism of acetaminophen? | Central inhibition of cyclooxygenase (COX) activation | Inhibition of lipoxygenase activation | Activation of lipoxygenase central a2 receptors | Activation of GABA receptors | 4 | A | 1 | null | null | null | null | null |
ca047e42-8f34-58b8-8f0d-33865c012b3b | You are consulted on a patient with a history of chronic back pain who is now on the first postoperative day from a L4-L5 fusion surgery. He tells you that he | Ketamine | Hydromorphone | Tizanidine | Tylenol | 4 | C | 2 | null | null | null | null | null |
9bd0b727-6186-5853-bfda-11551de0c271 | Which of the following agents or drugs is most likely to have a similar mechanism of action to ketamine? | Sevoflurane | Nitrous oxide | Midazolam | Clonidine | 4 | B | 1 | null | null | null | null | null |
d535a56b-3d41-5b90-9b6a-769430a16d53 | A 60-year-old man with bilateral radicular pain in his legs presents 4 weeks after implantation of a spinal cord stimulator (SCS) with dual percutaneous leads. He had reported greater than 50% pain relief with his SCS trial and also reports feeling well after implantation of his SCS. He has therefore greatly increased his daily activity. He now complains of paresthesias in his lower abdominal region and worsening pain in his legs. His neurologic exam is unremarkable. There is no pain on palpation of his lower back. His incision site is clean, dry, and intact and he is afebrile. Which of the following most likely explains this presentation? | Epidural abscess | Migration of leads | Disc herniation | Infection of the SCS leads | 4 | B | 2 | null | null | null | null | null |
b28ca67d-279b-5348-b23d-3bf82681febf | Which of the following areas is targeted by SCSs? | Dorsal columns | Lateral corticospinal tract | Botzinger complex | Peripheral nerves | 4 | A | 1 | null | null | null | null | null |
e5a9b617-9172-5863-a319-fa4a9b457973 | 17. A patient with a history of prostate cancer with metastases to his spine causing back pain presents to your office. You have been managing his opioid prescriptions for over a year, and during that time he has required increasing doses of hydromorphone to treat his back pain. He currently takes 8-10 mg of dilaudid every 3 hours. When questioned about his pain, he describes a diffuse pain that affects his arms and legs. His back pain is also present. Which of the following receptors or family of receptors is thought to be involved in this phenomenon? | GABA-A | NMDA | GABA-B | Dopamine-2 | 4 | B | 2 | null | null | null | null | null |
79575af3-9282-5407-803f-38efd5384065 | In the perioperative period, patients maintained on Suboxone will most likely experience which of the following? | Increased postoperative opioid requirements | Increased sensitivity to opioids | Withdrawal symptoms within 24 hours of discontinuing Suboxone | Increased risk of postoperative delirium | 4 | A | 1 | null | null | null | null | null |
dc4195a9-9b9c-56dc-bf01-cd684b66df31 | Which of the following effects would be likely to occur after parenteral injection of Suboxone in a patient actively taking heroin? | Respiratory depression | Withdrawal | Euphoria | Miosis | 4 | B | 2 | null | null | null | null | null |
f0845d9b-300d-5502-9249-c79d2e76f557 | A 76-year-old man with pancreatic cancer and chronic abdominal pain admits to his pain specialist that he has been giving his son, who has chronic back pain, some of his oxycodone pills. Which of the following terms best characterizes | Abuse | Misuse | Pseudoaddiction | Addiction | 4 | B | 2 | null | null | null | null | null |
6f3ba33d-56eb-53e3-8e46-e28d6fef4bae | A patient with metastatic prostate cancer complains of back pain. He is found to have metastases to his vertebral bodies. He has no neurologic deficits. Which of the following is the first-line definitive treatment for this pain? | Physical therapy | Glucocorticoids | Radiation therapy | Surgical decompression | 4 | C | 2 | null | null | null | null | null |
59d5f9af-f03c-5751-a624-22acfcc80c2d | Which of the following would you expect to see in a patient receiving continuous thoracic epidural analgesia as compared with one receiving PCA with morphine after undergoing open nephrectomy? | Faster return of bowel function | Comparable requirements for antiemetic medications | Inferior pain control at the surgical site | Similar patient satisfaction | 4 | A | 2 | null | null | null | null | null |
1821b106-2db3-53f1-80c8-3ae17810686d | 23. An immunocompromised patient undergoing treatment for lymphoma presents to the emergency department with altered mental status. He has recently tested positive for coccidiomycosis, and there is a concern that he has a disseminated infection. He undergoes a lumbar puncture, which is negative. His mental status clears later that night, but 2 days later he returns to the emergency department with a positional headache, consistent with a postdural puncture headache (PDPH). Every time he sits up, he reports severe pain and nausea. He fails treatment with rest, intravenous fluids, and medications. Which of the following epidural injections is most appropriate? | Normal saline | Autologous blood | Allogeneic blood | Autologous blood with fibrin glue | 4 | C | 3 | null | null | null | null | null |
13b35c56-d551-56b7-8df4-3162aa1c6562 | A patient with unresectable pancreatic cancer presents for a celiac plexus block. Which of the following organs or structures does not receive innervation from the celiac plexus? | Biliary tract | Mesentery | Descending colon | Adrenal glands | 4 | C | 1 | null | null | null | null | null |
8ffcf6d7-8375-5e6d-a59c-1864ea4b81d7 | A patient with unresectable pancreatic cancer presents for celiac plexus neurolysis via a posterior approach. He asks what the risks of the procedure are. Which of the following is the most common complications? | Constipation | Lower-extremity paralysis | Anterior abdominal pain | Orthostatic hypotension | 4 | D | 1 | null | null | null | null | null |
cf79ad7e-e318-51d8-8a7e-42b58cbbd8e2 | When used for neurolytic blocks, compared with ethanol, which of the following is true about phenol? | Painless on injection | More effective | Provides a longer duration of block | More likely to cause hypotension | 4 | A | 1 | null | null | null | null | null |
3d0fe68e-b6d2-5e57-994b-b8f60b7ce900 | According to the World Health Organization (WHO) pain ladder, what is the next treatment step for a patient who has inadequate pain control for back pain secondary to metastatic prostate cancer after trying Tylenol, ibuprofen, aspirin as well as multiple nonnarcotic adjuvant pain medications such as gabapentin, tizanidine, and lidocaine patches? | Paracetamol | Fentanyl patch | Tramadol | Morphine | 4 | C | 2 | null | null | null | null | null |
3d317223-0b00-59dc-81a7-72d0e1de4267 | Which of the following statements is most consistent with the WHO pain ladder? | The oral form of analgesics should be used over other forms whenever possible. | Analgesics should be given only as needed. | Standardized dosing of opioids should be used for adult patients. | Treatment of cancer pain should begin with an opioid medication. | 4 | A | 1 | null | null | null | null | null |
094663f7-8328-53ee-b206-413d78293c2f | 29. All of the following are part of the diagnostic criteria for fibromyalgia EXCEPT which one? | Allodynia to digital pressure at 11 or more of 18 anatomically defined tender points | A history of widespread pain for at least 3 months | A history of sleep disturbance | A history of radicular pain in both arms and legs | 4 | D | 1 | null | null | null | null | null |
b5adba46-2e7d-5265-85c4-bc935af52943 | Which of the following medications has been shown to be efficacious in the treatment of fibromyalgia? | Duloxetine | Amitriptyline | Pregabalin | Hydrocodone | 4 | A | 1 | null | null | null | null | null |
ec4db7a2-6149-5db7-9ee5-c0555176302f | Which of the following scenarios is suggestive of complex regional pain syndrome (CRPS) type II? | A patient burns his right foot and develops pain, hyperalgesia, and allodynia in his right lower leg that continues more than 6 months after his burn. His right foot is noted to be shiny and without hair. | A patient's right forearm is crushed by a falling object. She reports pain, hyperalgesia, and allodynia of the forearm more than a year later. Her forearm is noted to be shiny and without hair. | A patient's left forearm is crushed by a falling object. She reports pain, hyperalgesia, and allodynia of the forearm more than a year later. Atrophy of the muscles of the forearm is noted. | After surgery, a patient develops numbness over his right lateral thigh. He reports pain, hyperalgesia, and allodynia of the lateral thigh more than a year later. The area is noted to be shiny and without hair. | 4 | D | 2 | null | null | null | null | null |
f2144623-db6d-5262-8a59-56fd9842f1ae | What is the greatest risk factor for the development of postherpetic neuralgia (PHN)? | Increasing age | Male sex | Lack of a prodrome | Use of antiviral agents during acute herpes zoster infection | 4 | A | 1 | null | null | null | null | null |
5b1207ed-673c-5753-bd89-239ab967a3a9 | All of the following are risk factors for the development of phantom limb pain EXCEPT which one? | Preamputation pain | Depression | Distal amputation | Proximal amputation | 4 | C | 1 | null | null | null | null | null |
7b49ee47-4064-5909-b992-b3588e8521ff | Which of the following is most characteristic with facetogenic back pain? | Pain in the low back that radiates to the ipsilateral posterior thigh | Nonradiating pain in the low back | Pain in the ipsilateral buttocks | Numbness over the lower back | 4 | A | 1 | null | null | null | null | null |
6d569186-da48-5cda-8c82-c646487f6d0f | A patient with a history of pain in the lower back that radiates to his ipsilateral thigh presents to a pain clinic for a facet joint injection. Which nerve fibers innervate the facet joints? | Medial branch of the dorsal ramus of spinal nerve | Lateral branch of the dorsal ramus of spinal nerve | Lateral branch of the posterior cutaneous branch of the dorsal ramus | Medial branch of the posterior cutaneous branch of the dorsal ramus | 4 | A | 1 | null | null | null | null | null |
0f4f642e-de0f-5fa9-aee3-a54447857675 | 36. Which of the following would you expect to find in a patient who presents with pain originating from the sacroiliac joint? | Back pain that radiates to the ipsilateral buttocks | Back pain accompanied by pain extending down the ipsilateral leg when the ipsilateral leg is passively raised straight in the air up to 60° | Numbness of the anterolateral thigh | Back pain accompanied by a leg length discrepancy | 4 | A | 1 | null | null | null | null | null |
9f883f21-29c0-588d-96cd-c12594340b28 | A patient presents with pain in the left buttock. He reports that he frequently carries his wallet in the left pocket and that his wallet is quite large. Furthermore, he sits on the wallet throughout most of the day at a desk job. You suspect piriformis syndrome and plan to inject a combination of local anesthetic and steroid. Which anatomic relationship between the piriformis muscle and the sciatic nerve is most common? | The undivided sciatic nerve passes below the piriformis muscle. | The divided sciatic nerve passes through and below the piriformis muscle. | The divided sciatic nerve passes through and above the piriformis muscle. | The undivided nerve passes through the piriformis muscle. | 4 | A | 1 | null | null | null | null | null |
af21ea2e-c242-5b01-8790-e3fcc1417539 | A 56-year-old man with a history of hypertension, chronic obstructive pulmonary disease, and diabetes presents for a lumbar epidural steroid injection (ESI) for lower-back pain that radiates into his right leg. He receives an injection of methylprednisone and lidocaine. Which of the following is most likely to occur after he receives this injection? | Arachnoiditis | Headache | Infection | Hyperglycemia | 4 | D | 1 | null | null | null | null | null |
0ea3218a-2cd3-5223-b99b-28bcf73cf77d | Which of the following statements about new, acute onset low-back pain is most accurate? | Bed rest is recommended for up to 1 week. | In the absence of "red flag" symptoms, imaging is not indicated in the acute setting. | Opioids are the first-line therapy for this type of pain. | A short course of oral steroids may be helpful in treating this pain. | 4 | B | 1 | null | null | null | null | null |
15705985-4e9b-5052-83ad-4226def8b51d | A patient presents to you with pain on the left side of her face. She states that the pain began a month ago and that chewing food is excruciating. She also notes the sensation of "shooting" pain on the left side of her face. Which of the following statements about this condition is most likely true? | Pain on the left side of the face is more common than the right side. | Involvement of the V1 distribution is uncommon. | Autonomic symptoms such as tearing or nasal discharge are common. | The most common first-line drug is oxycodone. | 4 | B | 1 | null | null | null | null | null |
57420f6d-1618-5dd8-8d2c-fa431ca5a1cc | A 38-year-old man with a history of HIV well managed on antiretroviral agents presents with painful neuropathy in both feet. He describes the pain as burning and constant. It gets worse when he does his job as a postal carrier. Initially he responded to tramadol but no longer finds it helpful. Which of the following is the next most appropriate step to manage this patient's foot pain? | Further evaluate the patient's antiviral regimen. | Initiate antiepileptic therapy. | Perform an ESI. | Initiate oxycontin. | 4 | A | 2 | null | null | null | null | null |
f64f766d-abaf-5ac7-b306-cf6f0c39e490 | 42. In a patient taking methadone, which of the following is most likely to contribute to development of torsades de pointes? | Methadone dose of 10 mg a day | HIV | Male sex | Obesity | 4 | B | 2 | null | null | null | null | null |
549f1e72-f698-5e64-b18b-ad6f96ab6053 | A lumbar sympathetic block is appropriate for diagnosis and/or treatment of all the following conditions EXCEPT which one? | CRPS type I of the right calf | Phantom limb pain of the left lower extremity | PHN of the right thigh | Coccydynia | 4 | D | 1 | null | null | null | null | null |
4626a62e-c709-588f-ac8f-35c085126cd6 | Which of the following is the most likely cause of a "failed" spinal? | Resistance to local anesthetics | Displacement of the tip of a pencil-point needle | Dural ectasia | Use of lidocaine instead of bupivacaine | 4 | B | 1 | null | null | null | null | null |
702bbfa5-8a77-585e-bbc2-604af4c81492 | An otherwise healthy 42-year-old patient who has received a spinal anesthetic for outpatient total knee arthroplasty reports severe pain in his legs and buttocks. The pain began a few hours after surgery and has persisted on the first postoperative day. Which medication was most likely used for the spinal anesthetic? | Bupivacaine | Lidocaine | Bupivacaine and fentanyl | 2-Chloroprocaine | 4 | B | 2 | null | null | null | null | null |
69732d9c-fea6-5958-8ecc-7b326d8fd40d | Six months after undergoing a right inguinal hernia repair, a 27-year-old man presents to your office with continuing pain in the groin. He describes the pain as a constant burning sensation that is also occasionally sharp. He has seen his surgeon and does not have a recurrence of his hernia. Which of the following nerve blocks might be helpful in diagnosing this condition? | Genitofemoral nerve block | Pudendal nerve block | Transversus abdominus plane (TAP) block | Lateral femoral cutaneous nerve (LFCN) block | 4 | A | 1 | null | null | null | null | null |
ea295afb-f89c-5889-9e3a-dd7498446130 | The pudendal nerve can become entrapped at all the following locations EXCEPT which one? | Inside the Alcock canal | Between the sacrospinous and sacrotuberous ligaments | Across the inner margin of the falciform process of the sacrotuberous ligament | Inside the deep inguinal ring | 4 | D | 1 | null | null | null | null | null |
e7200a91-dcae-555a-b288-d3c14a0edd8e | Which of the following nerve blocks is associated with a nearly 100% chance of ipsilateral diaphragmatic palsy? | Superficial cervical plexus block | Infraclavicular block | Greater auricular nerve block | Axillary nerve block | 4 | A | 1 | null | null | null | null | null |
44c53a0b-b837-5e63-afa7-a9aaa745f040 | 49. Which one of the following is the benefit of transcutaneous electrical stimulation (TENS)? | It can be applied by the patient at home. | It has shown to be effective for chronic pain management. | It is cost-effective. | It improves the level of disability due to back pain. | 4 | A | 1 | null | null | null | null | null |
cc880b64-ca00-5e77-ad82-bd6d7611b8ba | A 56-year-old type 1 diabetic man comes to your office to complaining of bilateral "stocking distribution" neuropathy. When questioned about his glucose control, the patient states that he normally maintains tight glucose control and he follows a strict low-carbohydrate diet. Which of the following is not a risk factor for development of peripheral neuropathy? | Poorly controlled blood glucose | Duration of diabetes | Gender | Patient age | 4 | C | 1 | null | null | null | null | null |
2a963f14-08c2-57f0-a04a-394fa0e4583c | A 42-day-old infant is brought to the operating room (OR) for repair of hypertrophic pyloric stenosis. After appropriate rapid sequence induction and intubation of the trachea, the surgeons begin the procedure. One hour into the procedure you notice that the infant's body temperature has dropped from 37°C to 35.5°C. Which of the following is the LEAST effective method of maintaining thermal homeostasis in an infant? | Raising the room temperature from 24°C to 29°C | Running maintenance IV fluids through a fluid warmer | Wrapping the infant's head in plastic | Applying a forced-air warming device to exposed body areas | 5 | B | 2 | Using a circulating warm-water mattress | null | null | null | null |
671ebcfb-737e-5c8c-913d-0a801b24b412 | When considering premedication with midazolam in the pediatric patient, all of the following are true EXCEPT which one? | Midazolam's fast onset of action is due to its water insolubility. | Midazolam can be administered via the oral, nasal, intramuscular (IM), buccal, intravenous (IV), and rectal routes. | As age decreases, required midazolam dose in mg/kg for effective anxiolysis increases. | Oral midazolam has a bioavailability of 30% compared with IV administration. | 5 | A | 1 | Time to peak plasma concentration of rectally administered midazolam is 15-20 minutes. | null | null | null | null |
e381e427-f640-59b2-b905-b9ababa26d5b | Of the various types of Mapleson circuits, which one has the fresh gas inflow furthest from the patient/T-piece? | Mapleson A | Mapleson B | Mapleson C | Mapleson D | 5 | A | 1 | Mapleson E | null | null | null | null |
3e5f393d-c1e2-5e90-951b-3b50eceaac8b | Of the various types of Mapleson circuits, which has a spring-loaded pop-off valve located at the distal end of the circuit (furthest from the patient/Tpiece?) | Mapleson A | Mapleson B | Mapleson C | Mapleson D | 5 | D | 1 | Mapleson E | null | null | null | null |
e53f568e-d77c-5d97-b666-be967cf74f30 | 5. The Bain modification is a coaxial circuit where fresh gas flows through an inner tube through the corrugated reservoir tubing of which Mapleson circuit? | Mapleson A | Mapleson B | Mapleson C | Mapleson D | 5 | D | 1 | Mapleson E | null | null | null | null |
a0f4806b-c919-584b-834e-71bacdfcdde6 | All of the following are acceptable agents for induction of anesthesia in children EXCEPT which one? | Sevoflurane | Ketamine | Halothane | Desflurane | 5 | D | 1 | Methohexital | null | null | null | null |
e71f8351-55a7-5521-8f3f-dd4a859784e1 | When evaluating a 4-month-old for elective circumcision revision in the preoperative area, the patient's mother tells you that she fed the child expressed breastmilk fortified with formula powder 3.5 hours ago. According to the ASA NPO status guidelines, how many hours must pass between this feeding and the induction of general anesthesia? | 2 hours | 4 hours | 6 hours | 8 hours | 5 | C | 2 | 12 hours# The following vignette applies to questions 8, 9, and 10.A 2-year-old, 12.5-kg girl with history of a ventriculoperitoneal shunt that was placed in infancy for congenital aqueductal stenosis presents to your OR for emergent shunt revision in the setting of lethargy, vomiting, and irritability. Her parents tell you she "ate some crackers" 2 hours ago. The patient is otherwise healthy with no known drug allergies. | null | null | null | null |
664227d1-ec09-5093-bb43-b1f461b45da8 | The MOST appropriate blade and endotracheal tube for this patient would be which of the following? | Miller 1 blade, size 4.0 uncuffed endotracheal tube | Miller 1 blade, size 4.0 cuffed endotracheal tube | Miller 1 blade, size 4.5 cuffed endotracheal tube | Wis-Hipple 1.5 blade, size 4.0 cuffed endotracheal tube | 5 | D | 2 | Wis-Hipple 1.5 blade, size 5.0 uncuffed endotracheal tube | null | null | null | null |
de9b812a-8b70-51d9-aaa1-dcd49045d801 | After successful intubation and initiation of general anesthesia, you decide you would like to attempt to decrease the patient's chance of emergence excitation. With that in mind, which of the following would be the least appropriate choice for maintenance anesthesia? | Desflurane at 0.5 minimum alveolar concentration (MAC), dexmedetomidine infusion at 0.5 μg/kg/h | Propofol and fentanyl total IV anesthesia | Sevoflurane at 1.0 MAC, oxygen, and air | Isoflurane at 1.0 MAC, oxygen, and air | 5 | C | 2 | Ketamine infusion, 50% nitrous oxide/50% oxygen | null | null | null | null |
76ad2271-407e-530e-94ae-6137ab60861d | At what age is MAC of isoflurane the highest? | Newborn | 6 months of age | 12 months of age | 2 years of age | 5 | B | 1 | 5 years of age | null | null | null | null |
1ad7d2a8-7aa5-521b-bbfe-cc1df4271fab | One MAC of isoflurane in a neonate equates to what percentage of end-tidal isoflurane concentration? | 0.9 | 1.1 | 1.3 | 1.6 | 5 | D | 1 | 2.2 | null | null | null | null |
23fcaf3d-b966-55b2-b14b-7d667b8e784e | When considering the relative ED95 in μg/kg of nondepolarizing neuromuscular blocking drugs (NMBDs), the impact of age on relative pharmacodynamics is which of the following? | Neonates require less than children who require less than adults. | Neonates require more than children who require more than adults. | Neonates require more than children, but children require less than adults. | Neonates require less than children, but children require more than adults. | 4 | D | 1 | null | null | null | null | null |
53dd6d04-80a2-5a8a-8fa0-10063b96f01d | The estimated circulating blood volume of a 4-kg, full-term neonate is which of the following? | 200 mL | 240 mL | 340 mL | 420 mL | 5 | C | 2 | 480 mL | null | null | null | null |
6a087fa5-28a3-5012-ab0b-4351f9baecf3 | The benefits of leukoreduction of donor blood products include all of the following EXCEPT which one? | Prevention of cytomegalovirus transmission | Prevention of nonhemolytic febrile transfusion reactions | Prevention of graft-versus-host disease | Prevention of human leukocyte antigen alloimmunization | 4 | C | 1 | null | null | null | null | null |
72155fef-1b52-58cf-95a0-24003eb9027d | 17. Which of the following is the most likely cause of the emesis? | Pyloric stenosis | Duodenal atresia | Choanal atresia | Necrotizing enterocolitis | 5 | B | 1 | Intussusception | null | null | null | null |
5bd10b71-3dda-5346-8225-e8121694f394 | Which of the following is the most common radiologic finding that would be seen in this infant during workup for bilious emesis? | Gastric bubble above the diaphragm | Multiple dilated loops of bowel | Pneumatosis | "Double-bubble" sign on X-ray | 5 | D | 1 | Target sign on abdominal ultrasonography | null | null | null | null |
8bc9fcb7-9320-5516-95d1-aa254d4f7541 | The patient undergoes successful surgical repair in the neonatal period. At 6 months of age he returns for an esophagogastroduodenoscopy. He has appropriately fasted, and an inhalational induction is planned. While your resident is managing the airway, you attempt to place an IV. The patient slightly withdraws to the needle, so your resident increases the inhaled sevoflurane concentration from 4% to 8% to aid with depth of anesthesia. The | Hypotension | Tachycardia | Bradycardia | Decreased respiratory rate | 5 | C | 2 | Increased tidal volume | null | null | null | null |
36d3e605-7377-5e69-a804-6134489c7316 | Compared with adults, infants desaturate more quickly during induction of anesthesia because of which of the following? | Increased respiratory rate | Increased cardiac output in mL/kg/min | Decreased O2 consumption in mL/kg/min compared with adults | Decreased closing capacity | 5 | E | 1 | Decreased functional residual capacity (FRC) in mL/kg | null | null | null | null |
295c1a77-a534-5cbe-bfc9-e2eddad416e5 | A 14-week-old infant, who was born at 36 weeks' gestational age, presents for elective repair of a right-sided inguinal hernia. He is otherwise healthy and does not have any known allergies, and his parents have not noted any symptoms that would indicate a recent upper respiratory tract infection. The infant did not spend any time in the NICU and has never had an apneic or bradycardic spell. The surgeon asks you about the patient's disposition after surgery. Which of the following is true? | Preterm infants who are less than 60 weeks' postconceptual age (PCA) need to undergo extended apnea monitoring after general anesthesia but not after light sedation with a natural airway. | This patient does not have a history of apnea or bradycardia and therefore does not meet criteria for postanesthetic admission for apnea monitoring. | This patient will need to be admitted for apnea monitoring after general anesthesia with the requirement that 24 hours of apnea-free time elapse before discharge. | Spinal and regional anesthesia without supplemental sedation does not abolish the need for postoperative apnea monitoring in former preterm infants less than 60 weeks' PCA. | 5 | D | 2 | Prophylactic administration of caffeine is recommended for this patient after general anesthesia to prevent apnea. | null | null | null | null |
c846e5f9-1434-57c2-ad29-7e10184e012c | Of the following pediatric surgical patients, which one would have the lowest risk of postoperative nausea and vomiting (PONV)? | A 3-year-old undergoing open reduction of a radial fracture | A 16-year-old undergoing hernia repair | A 5-year-old undergoing strabismus repair | An 8-year-old undergoing tonsillectomy | 5 | A | 2 | A 12-year-old undergoing orchiopexy | null | null | null | null |
a8a5b497-2309-51f3-8cc7-00efad9cc289 | All of the following are efficacious in preventing and managing PONV in children EXCEPT which one? | Intraoperative fluid restriction | Ondansetron | Dexamethasone | Total IV anesthesia with propofol | 5 | A | 1 | Postoperative oral fluid restriction | null | null | null | null |
1bc479c5-c92b-5020-86a8-0362582e7607 | Considerations in anesthetizing a neonate with meningomyelocele include which of the following? | It is necessary to avoid succinylcholine because these patients are at higher risk for hyperkalemia. | There is high likelihood of a difficult airway. | Evaporative heat and fluid loss through the defect results in hypothermia and hypovolemia. | Defect should be repaired within 12 hours of birth to avoid infection and worsening neurologic damage. | 5 | C | 1 | Cardiac anomalies are commonly present. | null | null | null | null |
d5b1846d-23a7-528a-9e20-3ac4fdbb5101 | A 12-day-old, 875-g infant born at 25 weeks' gestational age is brought to the OR for exploratory laparotomy for concern for necrotizing enterocolitis. The patient's vital signs on entry to the OR are notable for HR 160, RR 40, SPO2 of 98%, and BP 70/40. The patient has appropriate IV access, and the decision is made to do an awake intubation after administration of 1 µg/kg of fentanyl. The laryngoscopy is more difficult than anticipated, but successful tracheal intubation occurs within 60 seconds. Despite this, the infant desaturates during laryngoscopy from 98% to 65%. The SpO2 recovers with gentle positive pressure ventilation. With regard to the respiratory mechanics and anatomy of the newborn as compared with adults, which of the following is false? | Tidal volumes in mL/kg are decreased compared with adults. | FRC is equal in neonates and adults. | Neonates have a higher rate of O2 consumption in mL/kg/min. | Neonates have a higher closing capacity than adults. | 5 | A | 1 | Neonates have a decreased total lung capacity (TLC) in mL/kg compared withadults.# The following vignette pertains to questions 26 and 27.A 3-year-old, 16-kg unvaccinated child presents to the emergency department with fever, dysphagia, and drooling. His parents attempted herbal remedies for his fever and sought medical evaluation once he started drooling out of fear that he had been accidentally poisoned by the herbs. Vital signs include HR 120, BP 90/50, RR 40, SpO2 98%, and T 39.8°C. On examination the patient is in visible respiratory distress, drooling, and sitting leaning forward on one arm. | null | null | null | null |
159c9ce3-8c5c-59b2-b780-02aeac60a4fa | 27. The emergency department physicians decide that the child needs a secure airway, given that he is rapidly decompensating from a respiratory standpoint. The best strategy for airway management in this patient would be which of the following? | Immediate placement of an IV in the emergency department followed by rapid sequence intubation with pediatric anesthesia on standby | IM ketamine and glycopyrrolate, followed by IV placement and intubation in the emergency department with pediatric anesthesiology on standby | Expedited transfer to the OR with pediatric anesthesiologists followed by rapid sequence intubation with succinylcholine, propofol, and fentanyl | Expedited transfer to the OR, inhalational induction, and direct laryngoscopy with rigid bronchoscope and surgical personnel present on standby | 4 | D | 3 | null | null | null | null | null |
7868657c-40bc-5013-8e72-c3969930699a | A 7-day-old, 3.5-kg neonate with severe coarctation of the aorta has failed percutaneously repair in the catheterization laboratory and comes to the OR for an open repair. In addition to placing noninvasive blood pressure cuffs on both upper and lower extremities to monitor precoarctation and postcoarctation blood pressures, where should the pulse oximeter probe be placed in this patient? | Right upper extremity | Right lower extremity | Left upper extremity | Left lower extremity | 4 | A | 2 | null | null | null | null | null |
3f6aceb3-ea06-5a68-bd20-03f33122f62c | An 18-month-old, 12-kg child with hypoplastic left heart syndrome is following a | 10 mL/kg crystalloid bolus | Hypoventilation, 100% oxygen | Transfusion of whole blood to achieve hematocrit of 39% from 33% | Hyperventilation with 100% oxygen | 4 | D | 3 | null | null | null | null | null |
2ce7f3dd-d4a3-58b3-a8cc-8b4bebd5dcbe | A 3-year-old, 16-kg boy with unrepaired tetralogy of Fallot is presenting to the OR for repair. Preinduction vitals are BP 88/52, HR 100, and SpO2 90%. He receives sevoflurane and nitrous oxide for induction of anesthesia, followed by IV placement and rocuronium. Airway placement is unexpectedly difficult, and the patient's vitals after successful intubation are BP 69/40, HR 135, and SpO2 60% and falling, despite confirmation of ETCO2 and bilateral breath sounds. Which of the following would be an appropriate pharmacologic intervention? | Phenylephrine | Ephedrine | Lasix | Epinephrine | 4 | A | 3 | null | null | null | null | null |
15369de9-60dd-5319-8e04-9626c96b93eb | Which of the following conditions seen in pediatric patients confers the lowest risk for development of hyperkalemia after succinylcholine administration? | Central core disease | Duchenne muscular dystrophy | Spastic paraplegia | 10% total-body surface area burns | 5 | A | 1 | Werdnig-Hoffman syndrome (spinal muscular atrophy type 1) | null | null | null | null |
c0f185cf-860a-5d65-bf4d-5585546333c6 | 32. A 5-year-old, 20-kg boy comes to the OR for laparoscopic appendectomy in the setting of acute appendicitis. He is otherwise healthy with no known allergies, and he takes no medications. Surgery is uneventful, and before emergence you administer 10 mg of ketorolac and 2 mg of morphine IV for analgesia. Compared with an adult, the clearance of morphine in this patient is which of the following? | Less | Equal | Greater | Cannot be determined | 4 | B | 1 | null | null | null | null | null |
dc00b397-1639-5976-93ba-efaedfcbecd2 | A 6-month-old male infant, who was born healthy at full term, is presenting for bilateral herniorrhaphy. His parents have read recent warnings about exposure to general anesthesia in infants and inquire about other anesthetic techniques available for this procedure. You decide to administer a spinal anesthetic. In infants, the spinal cord terminates at which of the following? | T12 | L1 | L3 | L4 | 4 | C | 1 | null | null | null | null | null |
a7b67b6f-d3d0-524b-8fbe-61c219e5c731 | You are administering anesthesia to a healthy 14-month-old girl for an inguinal herniorrhaphy. You decide to perform a caudal epidural block for postoperative analgesia. The proper level of needle entry for a caudal block is which of the following? | At the center of a line drawn connecting the posterior-superior iliac spines | At the cornua of the sacral hiatus | Between the sacrum and coccyx, piercing the sacrococcygeal ligament | 1 cm above the crease of the buttocks | 4 | B | 1 | null | null | null | null | null |
9990ebbb-bb9e-5882-9168-510d40602fa7 | According to ASA practice guidelines, all of the following are required before discharge to home from the postanesthesia care unit (PACU) EXCEPT which one? | Return to baseline level of consciousness | Nausea/vomiting adequately controlled | Pain adequately controlled with oral analgesics | Patient's ability to void | 5 | D | 1 | Stable blood pressure and heart rate | null | null | null | null |
1e8b7948-c561-5c77-a883-8177ab1088b0 | You are caring for an ex-25-week, 1-kg premature infant at 6 days of life who has necrotizing enterocolitis. You are concerned about the risk for retinopathy of prematurity in this very premature infant. To reduce his risk of developing this complication, your goals for management of his vital signs include which of the following? | SpO2 > 94% with no greater than 50% FiO2 | SpO2 90%-94% with the minimum FiO2 necessary to achieve stable SpO2 | Permissive hypercapnia with ETCO2 goals of 42-47 mm Hg | Normotension, mean arterial pressure > 60 mm Hg | 5 | B | 2 | Normotension, mean arterial pressure > 50 mm Hg | null | null | null | null |
17c9fb48-688e-5fea-aeb2-66f762b1f655 | An infant is born at 38 weeks with omphalocele and macroglossia. Birth weight is 4500 g. Which of the following is the most likely diagnosis? | Beckwith-Wiedemann syndrome | Angelman syndrome | Treacher-Collins syndrome | Hurler syndrome | 5 | A | 1 | Trisomy 21 | null | null | null | null |
ceca468b-7685-5366-85be-948934e975bc | A 1-year-old child has mandibular hypoplasia, macrostomia, and cleft palate. His airway is expected to become more difficult with age. Which of the following is the most likely diagnosis? | Beckwith-Wiedemann syndrome | Angelman syndrome | Treacher-Collins syndrome | Hurler syndrome | 5 | C | 1 | Trisomy 21 | null | null | null | null |
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